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:

© Aquarius Population Health 2022. For commercial use or distribution, please contact

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

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


1. WHO. The top 10 causes of death. Accessed October 22, 2021.

2. WHO. Chronic obstructive pulmonary disease (COPD) fact sheet. Published 2021. Accessed August 18, 2021.

© Aquarius Population Health 2021. For commercial use or distribution, please contact

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:

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

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


  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

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 cost effectiveness analysis of repeat screening for syphilis in pregnancy as an alternative screening strategy in the UK

Syphilis is a treatable sexually transmitted infection (STI) which can be passed from mother to foetus during pregnancy resulting in congenital syphilis. Syphilis infection also increases the risk of adverse pregnancy outcomes such as stillbirth and pre-term delivery. Most cases of congenital syphilis and adverse pregnancy outcomes can be avoided if the infection is diagnosed and correctly treated during pregnancy.

In the UK, pregnant women are offered screening for syphilis, HIV and hepatitis at their first antenatal appointment, typically at or before 12 weeks gestation. Despite the very high coverage of these routine screens plus repeat screening in some higher risk women, a handful of congenital syphilis cases still occur each year, either in women who miss screening or in women who become infected with syphilis after their antenatal screen. For this reason, the UK National Screening Committee (UK NSC) commissioned Aquarius to assess the cost effectiveness of offering a repeat screen to all pregnant women later in pregnancy.

We worked closely with a small group of experts to compare the current strategy – screening in the first trimester only – with an alternative strategy – screening in the first trimester and a repeat screen later in pregnancy.  We developed a decision tree and model inputs which accounted for the sensitivity and specificity of the syphilis assay, the small number of women who do not attend antenatal care until their third trimester (thereby missing the opportunity for repeat screening) and the costs associated with screening, delivery and antenatal care for all women delivering in the UK in one year.

The model revealed that repeat screening would prevent 5.5 cases of congenital syphilis each year but at cost of £1.8 million per case avoided. When a lifetime horizon was considered, the incremental cost-effectiveness ratio (ICER) for the repeat screening strategy was £120,494 per QALY gained – well above the £20k-30k cost per QALY threshold that NICE uses to assess interventions.

The paper concludes that in the UK setting, where prevalence of syphilis is very low, repeat screening for syphilis in pregnancy would not be a cost-effective strategy and alternative strategies should be sought to prevent congenital syphilis.

This is the first published study from outside the US to compare these two screening strategies. The results will be used to inform national screening policy and are relevant countries with similar syphilis prevalence and healthcare costs. 

Huntington S, Weston G, Seedat F, et al Repeat screening for syphilis in pregnancy as an alternative screening strategy in the UK: a cost-effectiveness analysis BMJ Open 2020;10:e038505. doi: 10.1136/bmjopen-2020-038505

Cost-effectiveness and impact of five different point of care strategies to preserve last line treatment for gonorrhoea

Antimicrobial resistance (AMR) has developed to every class of antibiotic used for the treatment of gonorrhoea – and in recent years several multi-drug resistant strains of gonorrhoea have been reported in the UK and elsewhere. Once the prevalence of resistance to a first-line treatment reaches 5%, an alternative drug is selected as first-line treatment. In the UK, as with many other countries, ceftriaxone is the current first-line treatment for gonorrhoea. There are few alternative treatments available should ceftriaxone resistance become widespread and therefore steps are being taken to preserve the effectiveness of ceftriaxone by avoiding its use for infections that could be treated using other antibiotics.

Aquarius was commissioned by the Applied Diagnostic Research and Evaluation Unit (ADREU) at St. Georges London to compare the cost and effectiveness of five different strategies to test for antibiotic susceptibility in NG infections. We developed a decision tree model to assess how point-of-care (POC) testing could be used to diagnose gonorrhoea and at the same time test for antibody susceptibility, allowing the use of previously abandoned antibiotics for the majority of patients, thereby sparing ceftriaxone use.

The results of the model showed that all five strategies cost more than the current strategy of not testing for AMR. The paper concludes that AMR POC testing may enable improved antibiotic stewardship but would require investment into the health system.

The article was published in October in Eurosurveillance and is available free online [link].

Harding-Esch EM, Huntington SE, Harvey MJ, Weston G, Broad CE, Adams EJ, et al. Antimicrobial resistance point-of-care testing for gonorrhoea treatment regimens: cost-effectiveness and impact on ceftriaxone use of five hypothetical strategies compared with standard care in England sexual health clinics. Eurosurveillance [Internet]. 2020;25(43). Available from:

Cluster-randomised feasibility trial of a chlamydia test and treat (TnT) service in further education colleges

Aquarius were involved in a recent cluster-randomised feasibility trial looking at whether provision of a same day test and treatment (TnT) service for chlamydia in further education colleges could be used to improve uptake of chlamydia testing in sexually active 16-24 year olds. The trial found that despite a high prevalence of chlamydia among sexually active students at the colleges, uptake of the free confidential TnT service was low. At the three colleges, 13% of students were tested when the service was first offered and 10% when it was offered again three months later. Interviews with students revealed that low uptake was associated with not feeling at risk of a sexually transmitted infection, perceptions of stigma, and lack of knowledge about sexually transmitted infections, while all students interviewed were positive about the TnT service itself.

PublicationOakeshott P, Kerry-Barnard S, Fleming C, et al. “Test n Treat” (TnT): a cluster randomised feasibility trial of on-site rapid Chlamydia trachomatis tests and treatment in ethnically diverse, sexually active teenagers attending technical colleges. Clinical Microbiology and Infection.