Cost-effectiveness of a rapid point-of-care test for diagnosing patients with suspected bloodstream infection in Ireland

Speed is of the essence for sepsis management and faster diagnosis of specific pathogens may help ensure that patients receive the most appropriate treatments as soon as possible. In addition, reducing the use of broad-spectrum antibiotics is an essential part of antibiotic stewardship to prevent the emergence of antibiotic resistance. This work explored the potential use of a novel diagnostic test to detect Gram-negative or Gram-positive bacterial or fungal infections rapidly to aid in the diagnosis of sepsis in severely ill, hospitalised adult patients.  

A rapid point-of-care (PoC) test as an adjunct to blood culture to aid the diagnosis of sepsis patients with bloodstream infections may decrease the use of broad-spectrum antibiotics and reduce rates of inappropriate antimicrobial therapy (IAAT) use. Through a decision tree model, taking the perspective of the Irish healthcare provider, the cost-effectiveness of such an intervention was evaluated against the current standard of care (SoC) in hospitalized adults in Ireland. The base-case scenario showed that using a rapid PoC test was cost-saving and lifesaving, with €8188 saved per death averted. The results were sensitive to the length of hospital stay for patients with true-positive and true-negative results and to the length of stay (LOS) in the intensive care unit. The threshold analysis showed that even at lower sensitivities, the rapid PoC test could be cost-effective due to the substantial impact of starting earlier targeted and appropriate treatment in patients with bloodstream infection (BSI) and sepsis. Clinical studies are ongoing to determine the clinical impact in practice.

The results of this work are published in Informatics in Medicine Unlocked and the full text can be accessed here.

This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No. 967968. Novus Diagnostics (SepTec) funded Aquarius Population Health to conduct the study.

Vankelegom M, Burke D, Mohammed AMF, et al. Cost-effectiveness of a rapid point-of-care test for diagnosing patients with suspected bloodstream infection in Ireland. Informatics in Medicine Unlocked [Internet]. 2022 Jan 1;32:101056. Available from: https://www.sciencedirect.com/science/article/pii/S2352914822001952

© Aquarius Population Health 2022. For commercial use or distribution, please contact info@aquariusph.com.

Health economic evaluation of an mRNA HR-HPV assay versus a DNA HR-HPV assay for the proposed French cervical screening programme

Persistent infection with high-risk human papillomavirus (HR-HPV) has been linked to precancerous lesions which may progress to cervical cancer. Guidance was issued in 2020 in France to include the use of assays to detect HR-HPV infections in a national cervical screening programme.

A decision tree model simulating the French cervical screening algorithms was developed to evaluate the effect of using a similarly sensitive, but more specific, mRNA HR-HPV assay (Aptima HR-HPV assay) compared to a DNA HR-HPV test (cobas 4800 HPV assay) in the proposed cervical screening algorithm for a hypothetical cohort of women aged 25 to 65 years in France.

Results showed using an mRNA assay could yield an estimated annual cost saving of €6.5 million and reduces the total number of colposcopies, HPV and cytology tests. As mRNA and DNA assays have similar test sensitivity, true positives will not be missed, and total costs are reduced by eliminating unnecessary colposcopy referrals, HR-HPV and cytology tests.

The choice of high-risk human papillomavirus assay makes a significant difference in resource use and costs and is important to consider when implementing cervical screening in France. Using an mRNA versus DNA assay can result in cost savings and reductions in unnecessary testing and procedures, which in turn benefits women and the health care system.

The results of this work are published in Medicine and the full text can be accessed here.

Dombrowski CA, Weston GM, Descamps PP, et al. Health economic evaluation of an mRNA high-risk human papillomavirus (HR-HPV) assay versus a DNA HR-HPV assay for the proposed French cervical screening programme. Medicine (Baltimore). 2022 Jul 22;101(29):e29530.

© Aquarius Population Health 2022. For commercial use or distribution, please contact info@aquariusph.com.

Identifying the common barriers to optimal COPD care in Japan, Canada, England, and Germany through Evidenced Care Pathways

COPD was the third leading cause of mortality worldwide in 2019 (1), responsible for 3.23 million deaths (2). Improved understanding of the common barriers to care delivery could inform international approaches to improving care standards and patient outcomes.

Evidence Care Pathways (ECPs) were created to bring to life the story of how COPD care is currently delivered in Japan, Canada, England and Germany. Published epidemiological, clinical, and economic data was used to populate the ECPs. Thematic content analysis was performed on the clinician interviews (twenty-four respiratory healthcare professionals in primary and secondary care) to inform and validate the ECPs.

The results of this work published in the International Journal of Chronic Obstructive Pulmonary Disease identified three key themes relating to barriers to optimal COPD management across the countries: journey to diagnosis, treatment and management, and the impact of COVID-19. Presentation to healthcare with advanced COPD, low consideration of COPD by patients and healthcare professionals, and sub-optimal acute and chronic disease management were common across all countries. COVID-19 has negatively impacted disease management across the pathway – but has also opened opportunities for virtual consultations.

COPD is a significant public health issue that needs urgent prioritisation. The common barriers to optimal COPD care identified across the four studied countries highlight the continued need for strategies to optimise COPD care, particularly as the burden of COPD continues to grow.

The Evidenced Care Pathways for the four countries can be downloaded here. Please download this document and open it in a PDF reader such as Adobe for full functionality.

This study was funded and commissioned by AstraZeneca.

Meiwald A, Gara-Adams R, Rowlandson A, et al. Qualitative Validation of COPD Evidenced Care Pathways in Japan, Canada, England, and Germany: Common Barriers to Optimal COPD Care. Int J Chron Obstruct Pulmon Dis. 2022;17:1507-1521 https://doi.org/10.2147/COPD.S360983

References

1. WHO. The top 10 causes of death. Accessed October 22, 2021. https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death

2. WHO. Chronic obstructive pulmonary disease (COPD) fact sheet. Published 2021. Accessed August 18, 2021. https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)

© Aquarius Population Health 2021. For commercial use or distribution, please contact info@aquariusph.com.

Further evidence that rapid near-patient testing for chlamydia and gonorrhoea in sexual health clinics benefits patient care

Chlamydia and gonorrhoea are among the most common sexually transmitted infections (STIs) and around 2 million people are tested for chlamydia and gonorrhoea in sexual health services (SHSs) each year in England [1].

The turnaround time for test results can vary from 1-2 days in many urban clinics to more than 8 days in some areas [2-4]. This means that instead of waiting for the result before treating people, many clinics choose to treat patients when they first attend if they have symptoms, or their partner has a confirmed infection. Inevitably, this means that some people without an infection receive antibiotics whilst people with an infection, but no symptoms must return to receive treatment on a subsequent day, risking onward transmission in the meantime.

In an Innovate UK grant-funded project, Aquarius Population Health collaborated with three sexual health clinics in England to develop evidence around the impact of using a new highly accurate 30-minute point-of-care test for chlamydia and gonorrhoea developed by binx Health.

The results of this work indicate that compared to using standard laboratory tests, using a 30-minute point-of-care test reduces waiting times for test results and time to chlamydia treatment. The paper reporting this work is published in Therapeutic Advances in Infectious Disease and the full text can be accessed here.

Huntington S, Weston G, Adams E. Assessing the clinical impact and resource use of a 30-minute chlamydia and gonorrhoea point-of-care test at three sexual health services. Therapeutic Advances in Infectious Disease. January 2021. doi:10.1177/20499361211061645

References

  1. Public Health England. Sexually transmitted infections and screening for chlamydia in England, 2020. Available online.
  2. Public Health England. Audit report on turnaround times National Chlamydia Screening Programme. [Internet]. 2014 Nov. Available online.
  3. Harding-Esch E, Sherrard-Smith E, Fuller SS, et al. P65 Sexual behaviour in the time period between being tested for chlamydia and receiving test result and treatment. Sex Transm Infect [Internet]. 2015 Jun 1 [cited 2019 Feb 27];91(Suppl 1):A37–A37. Available online.
  4. British Association for Sexual Health and HIV (BASHH). Standards for the management of sexually transmitted infections (STIs) (Draft for public consultation) [Internet]. 2019 Jan. Available online.

© Aquarius Population Health 2022. For commercial use or distribution, please contact info@aquariusph.com.

Care Pathway Mapping for Dravet Syndrome (DS) Patients in England

Dravet syndrome (DS) is a rare, early onset, lifelong, epileptic encephalopathy characterised by frequent and severe convulsive seizures. Finding effective treatments is imperative to reducing seizures and improving patient outcomes: DS is highly burdensome for both the patient and their family as well as the healthcare system.

It is important to understand how care is currently delivered to children and adults to improve care to meet the needs of DS patients. Aquarius Population Health presented the results of our pilot study at this year’s ILAE British Branch Virtual Annual Scientific Conference. We describe how care for people with DS is delivered across England and determine the utilisation of healthcare resources for the treatment of patients with DS, and the effects of seizure burden and age group.

Gara-Adams R, Mowlem F, Thomas RH, et al. Care Pathway Mapping for Dravet Syndrome (DS) Patients in England – interim results from a pilot study. Presented at: ILAE British Branch Virtual Annual Scientific Conference, September 23 – 24, 2021; Virtual

Analysing the COPD care pathway in Japan, Canada, England, and Germany: a global view

Chronic obstructive pulmonary disease (COPD) is a preventable, progressive respiratory disease that causes airflow blockage and breathing problems. COPD caused 3.23 million deaths in 2019 (1), affecting approximately 384 million people globally (2); and is associated with significant resource burden with global costs estimated to be US$2.1 trillion in 2010, rising to US$4.8 trillion by 2030 (3).

Despite the availability of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations for COPD management, there remains uncertainty around how care is currently delivered within individual countries and what barriers exist to optimal COPD care delivery.

Aquarius Population Health collaborated with AstraZeneca to present our research at a poster session at this year’s European Respiratory Society International Congress. Based on clinician interviews and local data reviews, our research advances our understanding of COPD care pathways in Japan, Canada, England, and Germany and identifies cross-cutting barriers to optimal COPD care. Opportunities for policy change were highlighted – to improve disease awareness, care management and patient outcomes while reducing resource use and costs.

Meiwald A, Gara-Adams R, Ma Y, et al. Analysing the COPD care pathway in Japan, Canada, England and Germany: a global view. Presented at: European Respiratory Society International Congress 2021, September 5 – 8, 2021; Virtual

1.  WHO. Chronic obstructive pulmonary disease (COPD) fact sheet. 2021

2. Adeloye D, Chua S, Lee C, et al. Global and regional estimates of COPD prevalence: Systematic review and meta–analysis. J Glob Health. 2015 ;5(2):020415.

3.  Bloom DE, Cafiero ET, Jané-Llopis E, et al. The Global Economic Burden of Noncommunicable Diseases. Geneva; 2011

Read Publication

A health economic model to estimate the costs and benefits of an mRNA vs DNA high-risk HPV assay in a hypothetical HPV primary screening algorithm in Ontario, Canada

While cervical cancer cases in Canada have decreased recently due to cytology primary screening, cervical cancer remains a relatively common and preventable cause of cancer in women. Cervical cancer is primarily caused by persistent genital infection with high-risk human papillomaviruses (HR-HPV). Ontario Health has been evaluating implementing HPV-based testing in cervical screening.

A decision tree model was developed to evaluate the impact of using a similarly sensitive, but more specific, mRNA HR-HPV assay (Aptima HR-HPV assay) compared to a DNA HR-HPV assay (Hybrid Capture 2 HPV assay) in a hypothetical cervical screening algorithm in Ontario, Canada. Results indicated that screening using an mRNA assay could yield cost savings of $4M CAD and a reduction in unnecessary colposcopies, HPV, and cytology tests. These results indicate that the choice of HR-HPV test is important when implementing a primary HPV screening program to avoid unnecessary resource use and cost, which will benefit both women and healthcare providers.

Weston G, Dombrowski C, Steben M, et al.A health economic model to estimate the costs and benefits of an mRNA vs DNA high-risk HPV assay in a hypothetical HPV primary screening algorithm in Ontario, Canada. Preventive Medicine Reports [Internet]. 2021 Sep 1 [cited 2021 Jul 29];23:101448. Available from: https://www.sciencedirect.com/science/article/pii/S2211335521001388

Evaluating the benefits and costs of using an mRNA versus DNA HR-HPV assay in the National Cervical Screening Programme in the Netherlands

Persistent infection with high-risk human papillomavirus (HR-HPV) is a leading cause of cervical cancer. The National Cervical Screening Programme (NCSP) implemented HR-HPV primary screening to detect HR-HPV infections in the Netherlands in 2017. The choice of HR-HPV test (mRNA or DNA) used in screening programmes can impact resource use and costs, follow-up testing and referral for colposcopy.

A decision tree model was adapted from a previously published model in England to represent the current cervical screening flowchart in the Netherlands. The model estimates the impact on costs, the number of colposcopies, HR-HPV and cytology tests of using an mRNA assay compared to a DNA assay for a cohort aged 30 to 65 years. Results found adopting an mRNA HR-HPV test instead of a DNA test as part of the NCSP in the Netherlands, gave an estimated €1.8M in total cost savings annually. The results from the model are comparable to results for other countries including England, Sweden, Denmark, Canada, and France.

presentation_icon


Dombrowski C, Weston G, Adams E. Evaluating the benefits and costs of using an mRNA versus DNA HR-HPV assay in the National Cervical Screening Programme in the Netherlands. Poster presented at: EUROGIN International Multidisciplinary HPV Congress; 2021 May 30 – June 1; Virtual

Read Publication

Modelling the impact of using a DNA compared to mRNA HPV assay as part of the cervical screening programmes in Sweden and Denmark

Nearly all cases of cervical cancer are caused by 14 high-risk human papillomavirus (HR-HPV) genotypes. Denmark and Sweden are assessing the structure of their cervical cancer screening programmes and implementing HR-HPV screening in certain populations. While both DNA and mRNA assays have similar sensitivity, mRNA assays have been shown to have higher specificity resulting in fewer false-positive results.

We adapted a decision tree model from a previously published study in England to explore how the type of assay used to detect HR HPV infections in a screening programme may impact costs, patient follow-up, and resource use. The results showed the use of mRNA tests in cervical screening for women in Sweden or Denmark instead of DNA testing would result in cost savings and a decrease in the number of unnecessary cytology tests, unnecessary recall HR-HPV tests and unnecessary colposcopies compared to HR-HPV DNA testing and can be used to inform the implementation of screening programmes with benefits for health services and women.

presentation_icon


Dombrowski C, Weston G, Adams E. Modelling the impact of using a DNA compared to mRNA HPV assay as part of the cervical screening programmes in Sweden and Denmark. Poster presented at: EUROGIN International Multidisciplinary HPV Congress; 2021 May 30 – June 1; Virtual

Read Publication

Estimating the costs and benefits of HR-HPV assay choice in a theoretical HPV primary cervical screening algorithm in Ontario, Canada

Current cervical screening program guidelines for Ontario recommend cytology testing every 3 years for ages 25-70. Primary HR-HPV screening has been found to be more sensitive than primary cytology in detecting high-grade disease of the cervix. As Canadian provinces and territories move towards implementing primary HR-HPV screening in their cervical screening programs, how cervical screening is organized and implemented will need to be considered, including the choice of HR-HPV assay as the type of test influences costs and resource use.

A published decision tree model based on the Cervical Screening Programme (CSP) in England was adapted to simulate the primary HPV algorithm proposed by the Cervical Screening Guideline Working Group in Ontario. Results showed using mRNA tests instead of DNA tests could save over CAD $4 million annually, and avoid approximately 11,000 unnecessary colposcopies, 15,000 HPV tests and 40,000 cytology tests. Whilst the Ontario algorithm has not yet been agreed upon, this study shows that the choice of HPV assay is an important consideration within an HPV primary cervical screening program.

presentation_icon


Weston G, Steben M, Popadiuk C, Bentley J, Dombrowski C, Adams E. Estimating the costs and benefits of HR-HPV assay choice in a theoretical HPV primary cervical screening algorithm in Ontario, Canada. Poster presented at: EUROGIN International Multidisciplinary HPV Congress; 2021 May 30 – June 1; Virtual

Read Publication