Improving clinical decision making and patient management

The Aquarius team has a breadth of experience in sexual health research and our work in this area has informed international policy and patient care.

Projects within this field include health economic evaluations, assessing the impact of new innovations such as rapid diagnostics, measuring the burden of disease, evaluating alternative screening strategies and creating interactive tools to inform decisions making around adoption of new technologies.

Case Studies

Cervical screening and HPV testing: Opportunities for rapid tests

We explored the use of a rapid, on-demand human papillomavirus (HPV) test. Interviews with UK experts revealed that a co-located, on-demand HPV test following cytology could reduce the time to cervical screening results by up to a week, with a near-patient primary HPV test followed by cytology triage could radically change the testing paradigm. A follow-up tool we built in Excel was used to understand cervical screening burden and HPV testing across Europe.

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The cost of pelvic inflammatory disease and potential cost-savings of chlamydia screening

We worked with clinicians from St Georges University who had published a trial estimating the incidence of pelvic inflammatory disease (PID) among women screened and unscreened for chlamydia. Patient data was analysed, and the average cost of managing PID was estimated to be £163 in community and hospital settings, and that over £60,000 could be saved in London alone from screening for chlamydia. This paper has been cited widely and results have informed policy and further modelling studies.

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Estimating the true costs of splitting HIV antiretroviral drugs

There is a temptation to switch to cheaper generic antiretroviral drugs compared to fixed-dose combination therapy for HIV patients in the interests of cost savings. However, in our analysis we found that there were no costs saved when including all patient care including drugs, additional clinic visits and monitoring. We also found that switching may cause confusion for some patients, risking loss of adherence. This evidence can help commissioners make better policy decisions about drug provision.

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Increased efficiency and improved treatment for stable HIV patients in England

Collaborators at St Georges Hospital wanted to understand the impact of changing service provision for stable HIV patients, as no evidence existed on what was best for clinics. We built a tool in Excel, and results indicated that 6-monthly appointments and 3-monthly home delivery of drugs is the cheapest option and could yield £2000 savings per patient, translating to an annual cost reduction of ~£8 million for the estimated 4000 eligible patients not currently on home delivery in England in 2012.

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The benefits and cost-savings of a new point-of-care test for chlamydia and gonorrhoea

We developed an understanding of how sexual health clinics in England could use a rapid point of care test for two common sexually transmitted infections. We defined the current patient care pathways and found that the pathways could be streamlined and costs of care reduced by using point-of-care tests. The economic model developed by Aquarius Population Health showed that the test could deliver £10 million in cost savings, and give far more effective management of chlamydia and gonorrhoea at a population level.

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Publications

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

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


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Examining the acceptability of offering STI screening in higher educational settings

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Modelling the choice of high-risk human papillomavirus (HR-HPV) assay in the English cervical screening programme

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Cost analysis of near patient chlamydia and gonorrhoea screening and treatment in further education/technical colleges

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

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Modelling cost-effectiveness of multipathogen POC tests for sexually transmitted infections

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

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

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

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Evaluating multi-bug point-of-care tests for sexually transmitted infections

Evaluating the costs, benefits and cost-effectiveness of multi-pathogen point-of-care tests for sexually transmitted infections

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Modelling how point-of-care tests can enable personalised treatment for resistant gonorrhoea infections

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How can European countries improve cervical cancer prevention for women?

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Exploring the value of a rapid, on-demand test for the detection of human papillomavirus

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Benefits of a point of care test for sexual health testing

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Managing Mycoplasma genitalium as an STI

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The financial and service implications of splitting fixed-dose antiretroviral drugs – a case study

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Point-of-care testing leads the way: article in the Parliamentary Review 2014

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Mapping patient pathways and cost of point of care versus standard testing and treatment for chlamydia and gonorrhoea in sexual health clinics

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Treatment for stable HIV patients in England: can we save costs and improve patient care?

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The cost-effectiveness of point of care tests for chlamydia and gonorrhoeae in sexual health clinics

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Cost effectiveness of screening for Chlamydia trachomatis in Ireland

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Costs and cost-effectiveness of different strategies for chlamydia screening and partner notification

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What is the cost of pelvic inflammatory disease and how much could be prevented by screening for chlamydia?

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News

How much would community-based screening for chlamydia and gonorrhoea cost? - We collaborated with St George’s, University of London, on a NIHR-funded study ‘Test n Treat’ (TnT). This study assessed the cost of providing same-day chlamydia and gonorrhoea testing and treatment service at higher education colleges. The paper presenting this work was published in BMC Health Services Research and is now available online.
Using an mRNA versus DNA test in the English cervical screening programme can save £15m annually and reduce unnecessary testing - The results of our economic evaluation comparing the use of mRNA and DNA assays in screening for cervical cancer in England were published in BMJ Open and are now available online. Results show large cost savings from avoiding unnecessary testing and follow-up, which can benefit women and healthcare services.
Could a same day test and treatment service in further education colleges improve uptake of chlamydia testing among young people? - Aquarius were part of a recent feasibility trial looking at whether provision of a same day test and treatment service for chlamydia in further education colleges increased uptake of chlamydia testing and treatment. The results of the trial were published this week in Clinical Microbiology and Infection and are available online.
Evaluating multi-bug point-of-care tests for diagnosing STIs - New point-of-care (POC) tests are currently being developed which can be used in clinic to simultaneously test for multiple sexually transmitted infections (STIs). In work now published online in BMJ Open, we developed a model to compare three possible strategies for POC STI testing with the current practice of microscopy and lab-based testing. The three… Read More
A rapid testing service for chlamydia and gonorrhoea yields significant patient and public health benefits - Aquarius Population Health, a leading independent health economics consultancy, worked with Chelsea and Westminster NHS Foundation Trust to assess the impact of Dean Street Express, their award winning sexual health clinic in Soho, London. This service tests symptom-free people wanting a routine sexual health check-up using an on-site 90-minute chlamydia and gonorrhoea rapid test. They… Read More
SBRI2 Grant Press Release PRESS RELEASE: Aquarius Population Health wins a prestigious SBRI grant from Innovate UK - Work has begun to develop a digital value proposition tool for a novel rapid sexually transmitted infection (STI) test London, UK, 14 August 2017 Aquarius Population Health, a leading independent health economics consultancy, has recently been awarded an 18-month Innovate UK grant in collaboration with Atlas Genetics Ltd and the Applied Diagnostic Research and Evaluation… Read More
Point-of-care tests for STI Evaluating the use AMR POCT in treatment of gonorrhoea - Aquarius Population Health recently worked with the Applied Diagnostic Research & Evaluation Unit (ADREU) at St. Georges, University of London, to assess the cost-effectiveness of six hypothetical strategies for using antimicrobial resistance point-of-care testing to guide the treatment of gonorrhoea.  Our findings were presented at the STI & HIV World Congress in Rio de Janeiro,… Read More
Evaluating multi-bug point-of-care tests for sexually transmitted infections Evaluating multi-bug point-of-care tests for sexually transmitted infections - We were a collaborator on a recent Innovate UK-funded SBRI project with Atlas Genetics and the Applied Diagnostic Research and Evaluation Unit at St George’s University of London. In this project, our team compared the overall costs, patient benefits and cost-effectiveness of three different multi-pathogen point-of-care testing strategies with the current strategy of microscopy and… Read More
Antimicrobial resistance point-of-care test for gonorrhoea - In a study commissioned by the Review on Antimicrobial Resistance, Aquarius Population Health worked with modellers at the University of Bristol to create a mathematical model. The model was used to assess the economic implications and treatment impact of introducing a hypothetical antimicrobial resistance (AMR) point-of-care test (POCT) for gonorrhoea. Results of the study were… Read More
Antimicrobial Resistance: Rapid Diagnostics Antimicrobial Resistance: Innovation in rapid diagnostics - Part 3: What role does innovation such as rapid diagnostics have in preventing AMR? Just as new technology has helped us in the fight against global warming (fuel efficiency, clean energy etc.), technology can also help us in the fight against antimicrobial resistance (AMR). One such area is rapid diagnostics – identified as a key… Read More