Mapping and comparing COPD Care Pathways across 10 countries to understand barriers to optimal care: clinicians’ perspectives

Although predominantly preventable and treatable, chronic obstructive pulmonary disease (COPD) is a leading cause of death globally (1). Guidelines for managing the condition are widely available (2), yet, COPD care remains suboptimal in many settings, including high and middle-income countries (3).

Concerted regional or global efforts in COPD care may lead to important synergies in improving outcomes for patients across many healthcare settings. To achieve this, researchers and policymakers must gain a better understanding of the extent to which countries share common barriers.

Aquarius Population Health led a multifaceted project that used published literature and clinical guidelines to map the COPD care pathways in 10 countries: Argentina, Australia, Canada, England, Germany, Japan, Mexico, Russia, Spain, and Taiwan. To validate the pathways and understand how clinicians perceive barriers to optimal COPD care, we spoke to 41 healthcare professionals across all these countries. Finally, we combined all the data and compared the pathways, to see how different or similar are barriers to COPD among the studied countries.

The results of this work indicate that regardless of differences in economic development or healthcare systems among countries, many issues in COPD care are quite similar. Further efforts are needed to address these issues at a global level. The poster reporting this work is published at the 11th IPCRG World Conference and can be accessed here.

Shahaj O, Meiwald A, Gara-Adams R et al. Mapping and comparing COPD Care Pathways across 10 countries to understand barriers to optimal care: clinicians’ perspectives.” Presented at: 11th IPCRG World Conference, May 5-7 2022; Virtual

1.           Vos T, Lim SS, Abbafati C, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet. 2020 Oct;396(10258):1204–22.

2.           Singh D, Agusti A, Anzueto A, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease: the GOLD science committee report 2019. Eur Respir J [Internet]. 2019 May 1 [cited 2022 Jan 19];53(5). Available from: https://erj.ersjournals.com/content/53/5/1900164

3.           Young M, Villgran V, Ledgerwood C, et al. Developing a Multidisciplinary Approach to the COPD Care Pathway. Crit Care Nurs Q. 2021 Mar;44(1):121–7.

© Aquarius Population Health 2022. 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.

Evidenced Care Pathways (ECPs) for chronic obstructive pulmonary disease in Japan, Canada, England, and Germany

Chronic obstructive pulmonary disease (COPD) is a preventable, progressive respiratory disease that causes considerable morbidity and mortality worldwide (1).

Despite the availability of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations for COPD management (2), there remains uncertainty around how care is currently delivered within individual countries and what barriers exist to the optimal delivery of COPD care.

Aquarius Population Health collaborated with AstraZeneca to create Evidenced Care Pathways (ECPs) to bring to life the story of how COPD care is currently delivered. Local data reviews and clinician interviews (twenty-four respiratory healthcare professionals in primary and secondary care) were used to inform and validate the ECPs.

The ECPs are a valuable tool in healthcare evaluation and were used to help identify the key barriers for optimal COPD care, and therefore opportunities for policy change – to improve disease awareness, care management and patient outcomes while reducing resource use and costs. The results of our research are published in the International Journal of Chronic Obstructive Pulmonary Disease] found here. These ECPs for COPD care in Japan, Canada, England, and Germany accompany the published paper.

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

VIEW ECP

1. 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.

2. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease: 2021 Report. 2021.

© Aquarius Population Health 2021. 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

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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

A Cost-Effectiveness Analysis of Fenfluramine for the Treatment of Seizures for Patients with Dravet Syndrome (DS) in the UK Setting

Dravet syndrome (DS) is a rare epileptic encephalopathy that is diagnosed in early infancy and extends through adulthood.   Fenfluramine (FFA) is a recently licensed add-on therapy for the treatment of seizures in patients with DS aged 2 years and older.

This work presents a novel individual-level simulation modelling approach to calculate the cost-effectiveness of FFA compared with cannabidiol plus clobazam as an add-on therapy for DS patients in England. Results indicate that FFA is a cost-effective intervention.

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Weston G, Pinsent A, Adams EJ, Linley W, Hawkins N, Schwenkglenks M, Hamlyn Williams C, Toward T. A Cost-Effectiveness Analysis of Fenfluramine for the Treatment of Seizures for Patients with Dravet Syndrome (DS) in the UK Setting. Presented at: International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 2021 Congress, May 17 – 20, 2021; Virtual

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Determining the Relationship of Seizures, Seizure Free Days and Other Predictors of Health Related Quality of Life in Patients with Dravet Syndrome (DS) and Their Carers

Dravet syndrome (DS) is a rare, early onset, lifelong, epileptic encephalopathy characterised by frequent and severe convulsive seizures. The often-daily seizure episodes are associated with cognitive, motor, behavioural, and sleep impairments with substantial impairment and burden to the health-related quality of life (HRQoL) of patients, primary caregivers and family members.

This study explored the impact of increasing seizure free days (SFDs) on patients’ and carers’ HRQoL and examined and quantified the impact of clinical and epidemiological covariates to understand which factors may predict DS patient and carer HRQoL. The results showed that SFDs have a significant impact on QoL for both patients and carers; this suggests that treatment options that increase SFD can substantially impact both DS patients’ and carers’ QoL.

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Pinsent A, Weston G, Adams EJ, Linley W, Hawkins N, Schwenkglenks M, Hamlyn Williams C, Toward T. Determining the Relationship of Seizures, Seizure Free Days and Other Predictors of Health Related Quality of Life in Patients with Dravet Syndrome (DS) and Their Carers. Presented at: International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 2021 Congress, May 17 – 20, 2021; Virtual

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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.

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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

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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.

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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

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