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.

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.

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.

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.

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.
Publications

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

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

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

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

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

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

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

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

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

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

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