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.
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.
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.
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.
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.
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.