Three simple tests could save the NHS nearly £6.9 billion

This year marks the 70th birthday of the NHS – a time to celebrate its achievements and the dedicated staff who keep its wheels turning. Yet, there is increasing concern about the future of the NHS, and particularly its funding. In this article, jointly commissioned by the British In Vitro Diagnostics Association (BIVDA) and Innovate UK, we showcase three tried and tested in vitro diagnostics, which, if more widely adopted, could save the NHS an estimated £6.9 billion over the next five years.

 

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Test n Treat – rapid STI testing and treatment in colleges: study protocol

Sexually active young people attending London further education (FE) colleges have high rates of chlamydia, but screening rates are low. We describe the study protocol for “Test and Treat” (TnT), an NIHR-funded research study. This is a cluster randomised feasibility trial of frequent, rapid, on-site chlamydia testing using the Cepheid GeneXpert system and same-day treatment in six FE colleges. As part of the study we also conducted qualitative and economic assessments to assess the feasibility of conducting a future large-scale trial to investigate if TnT reduces chlamydia rates. The methods for recruitment, participant data collection, sample collection and testing are described, for baseline and follow-up in the control and intervention groups. The statistical analysis plan for TnT has been published separately.

 

PublicationKerry-Barnard S, Fleming C, Reid F, et al. ‘Test n Treat (TnT)’- Rapid testing and same-day, on-site treatment to reduce rates of chlamydia in sexually active further education college students: study protocol for a cluster randomised feasibility trial. Trials. 2018 Jun 5;19(1):311. doi: 10.1186/s13063-018-2674-8.

To request a copy of the published article, please email caroline.dombrowski@aquariusph.com.

Enabling more efficient patient management of blood stream infections

The Guardian supplement ‘Acting on AMR’, was published in March 2018, and focused on a number of ways to improve antimicrobial stewardship. This supplement included an article by Momentum Bioscience, which highlighted the importance of using technology to enable earlier rule-out of blood stream infections.

In addition to the benefits to patients, Aquarius conducted an economic analysis for Momentum Bioscience to estimate the impact if the test is used on neonates with suspected sepsis. Our estimates showed that if the test is used on all babies born in England, an estimated £6 million could be saved, with a significant reduction in the antibiotics used and length of stay of babies who were free from infection.

Publication Bennett, H  ‘How do we enable more efficient patient management and antibiotic stewardship?’ MediaPlanet (an independent supplement distributed in The Guardian) March 2018 p5.

 

 

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Assessing the impact of point-of-care testing for influenza and respiratory syncytial virus in children admitted to hospital

We assessed the impact and economic benefits of using a point-of-care (POC) assay instead of standard laboratory testing to detect influenza and respiratory syncytial virus (RSV) in children and infants admitted to hospital . This real-world evaluation was conducted in two subsequent ‘flu seasons at the Evelina Children’s Hospital in London. Results showed that following the introduction of the POC testing, children with influenza were more likely to receive oseltamivir treatment, the antiviral recommended for influenza. Although there was no statistically significant reduction in the average length of hospital admission or in the number of antibiotics prescribed, there was a reduction in laboratory costs and in reimbursement charges for hospital admissions suggesting that use of the POC assay resulted in fewer procedures and interventions performed during admissions.

Publication Vecino-Ortiz AI, Goldenberg SD, Douthwaite ST, et alImpact of a multiplex PCR point-of-care test for influenza A/B and respiratory syncytial virus on an acute pediatric hospital ward. Diagnostic Microbiology and Infectious Disease, March 2018. In Press. http://www.dmidjournal.com/article/S0732-8893(18)30103-2/abstract

 

To request a copy of the published article, please email caroline.dombrowski@aquariusph.com.

 

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Exploring HCV eradication through diagnosis and treatment strategies

The World Health Organization aims to eradicate hepatitis C virus (HCV) by 2030. To achieve this, improved HCV diagnosis and treatment coverage are required. We explored the relationship between diagnosis and treatment in the next 5 years in Italy, France, and the UK to understand how to achieve the most benefit.

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Harvey MJ, Cheng C-Y, Leone E, et al. Exploring HCV eradication through diagnosis and treatment strategies. EASL Monothematic Conference, Striving Towards the Elimination of HCV Infection. 2-3 February 2018, Berlin, Germany.

 

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Mapping the treatment pathway for metastatic uveal melanoma patients in England: A qualitative pilot study

Metastatic uveal melanoma (mUM) is a rare disease, and with few effective therapeutic options it is unclear what patients receive as standard of care. Based on national guidelines, we mapped out real-world patient pathways with clinical experts across regional and supra-regional centres across England, to inform a consensus pathway of care following mUM diagnosis.

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Adams E, Cheng CY, Sacco J, et. al.  Mapping the treatment pathway for metastatic uveal melanoma (mUM) patients in England: A qualitative pilot study. Society for Immunotherapy of Cancer’s 32nd Annual Meeting. 8-10 November 2017, National Harbour, Maryland, USA.

 

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Using real world evidence to characterise a cohort of metastatic uveal melanoma patients in England

We identified a cohort of uveal melanoma (UM) and metastatic uveal melanoma (mUM) patients within England using the Hospital Episodes Statistics database, which had similar characteristics to other cohorts identified in the clinical literature.

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Schwenkglenks M, Alamgir G, Cheng CY, et al. A real world evidence (RWE) approach to characterising an ultra-rare disease (URD) cohort of metastatic uveal melanoma (mUM) patients within National Health Service England (NHSE). International Society for Pharmacoeconomics and Outcomes Annual European Congress. 4-8 November 2017. Glasgow, Scotland, UK.

 

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Quantifying standard of care hospital-related resource utilisation for metastatic uveal melanoma patients in England

We assessed the hospital resource use of a cohort of patient with uveal melanoma and metastatic uveal melanoma identified in the Hospital Episode Statistics in England. This showed differences in where patients receive care before and after they develop metastatic disease, indicated a high burden on health care services, and significant travel distances for patients receiving care.

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Cheng CY, Alamgir G, Adams EJ, et al. Quantifying standard of care (SoC) hospital-related resource utilisation for metastatic  uveal melanoma (mUM) patients in NHS England (NHSE) using the Hospital Episodes Statistics (HES) dataset. International Society for Pharmacoeconomics and Outcomes Annual European Congress. 4-8 November 2017. Glasgow, Scotland, UK.

 

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Rapid testing and treatment for sexually transmitted infections improve patient care and yield public health benefits

With collaborators at Chelsea and Westminster NHS Foundation Trust, we estimated the impact of a rapid testing and result notification service for patients testing for sexually transmitted infections at the Dean Street Express clinic. We found that a rapid testing service for asymptomatic infections resulted in 8 days’ faster time to result notification for CT and/or NG which enables faster treatment, thus reducing infectious periods and leading to fewer transmissions, unnecessary partner attendances and clinic costs, compared with those attending an existing ‘standard’ sexual health clinic.

PublicationWhitlock GG, Gibbons DC, Longford N, et al. Rapid testing and treatment for sexually transmitted infections improve patient care and yield public health benefits
International Journal of STD & AIDS. First Published October 23, 2017
https://doi.org/10.1177/0956462417736431

 

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Cost-effectiveness of antimicrobial resistance point-of-care testing for optimising gonorrhoea treatment

In July, Emma Harding-Esch spoke at the STI and HIV World Congress in Rio on how to best manage the increasing challenge of anti-microbial resistance (AMR). The research she presented was a collaboration between Aquarius Population Health and ADREU St. Georges.  In recent years, there has been an increase in resistance to first-line therapies used to treat STIs such as gonorrhoea. The Aquarius team built a decision tree model to assess the cost-effectiveness of standard care compared to several hypothetical rapid point-of-care tests (POCT) for antibiotic susceptibility. The model simulated a cohort of sexual health clinic attendees. The results showed that while standard care is the cheapest option, AMR POCTs may be cost-effective and maximise the number of effective agents in treatment regimens, providing long-term benefits in some scenarios.

Harding-Esch EM, Huntington SE, Harvey MJ, et al. Cost-effectiveness of antimicrobial resistance point-of-care testing for optimising the treatment of gonorrhoea STI & HIV World Congress. 9-12 July 2017. Rio de Janiero, Brazil.

 

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