New Publication on LISA-TRACKER

Crohn’s disease is a serious chronic inflammatory condition of the digestive tract. It currently affects about 115,000 patients in the UK. Severely ill patients can be treated with drugs called infliximab and adalimumab.

These are expensive drugs for the NHS. Some patients improve on them, whereas others improve initially but then lose response. One cause of lost response is that the patient develops antibodies against the drug which cancel out the effect of treatment.

Tests have been developed to measure both the level of drug and the level of antibodies against these drugs in the patient’s blood. The idea is that treatment can be adapted in response to the test outcomes to ensure that the patient is on the best treatment for them.

In this assessment we systematically reviewed the literature for three of these new tests and combined the results to obtain our own estimates of clinical effectiveness and cost-effectiveness.

We found that no test accurately measures levels of drugs or antibodies to drugs and that tests disagree, which means that it is difficult to assess the effectiveness of new tests. The model drew mainly on evidence from two randomised controlled trials using infliximab and showed that, compared with standard care, testing appeared to be more costly and less effective.

We conclude that more evidence is required to tell us how the tests and the treatment options prescribed by the test results can benefit the management of patients with severe Crohn’s disease.

This week Warwick Evidence is welcoming their latest addition to the team, Theo Mantopoulos. We are excited about working together and getting to know each other!

A new publication has been published:

Pulikottil-Jacob R, Connock M, Kandala N-B, Mistry H, Grove A, Freeman K, et al. Has Metal-On-Metal Resurfacing Been a Cost-Effective Intervention for Health Care Providers?—A Registry Based Study. PLoS ONE 2016;11:e0165021. http://dx.doi.org/10.1371/journal.pone.0165021

Abstract

Background: Total hip replacement for end stage arthritis of the hip is currently the most common elective surgical procedure. In 2007 about 7.5% of UK implants were metal-on-metal joint resurfacing (MoM RS) procedures. Due to poor revision performance and concerns about metal debris, the use of RS had declined by 2012 to about a 1% share of UK hip procedures. This study estimated the lifetime cost-effectiveness of metal-on-metal resurfacing (RS) procedures versus commonly employed total hip replacement (THR) methods.

Methodology/Principal Findings: We performed a cost-utility analysis using a well-established multi-state semi-Markov model from an NHS and personal and social services perspective. We used individual patient data (IPD) from the National Joint Registry (NJR) for England and Wales on RS and THR surgery for osteoarthritis recorded from April 2003 to December 2012. We used flexible parametric modelling of NJR RS data to guide identification of patient subgroups and RS devices which delivered revision rates within the NICE 5% revision rate benchmark at 10 years. RS procedures overall have an estimated revision rate of 13% at 10 years, compared to <4% for most THR devices. New NICE guidance now recommends a revision rate benchmark of <5% at 10 years. 60% of RS implants in men and 2% in women were predicted to be within the revision benchmark. RS devices satisfying the 5% benchmark were unlikely to be cost-effective compared to THR at a standard UK willingness to pay of £20,000 per quality-adjusted life-year. However, the probability of cost effectiveness was sensitive to small changes in the costs of devices or in quality of life or revision rate estimates.

Conclusion/Significance: Our results imply that in most cases RS has not been a cost-effective resource and should probably not be adopted by decision makers concerned with the cost effectiveness of hip replacement, or by patients concerned about the likelihood of revision, regardless of patient age or gender.

Clinical Research Network West Midlands Conference on 07/09/2016

Mark Thomas, himself nominated for "Investigator of the Year" by Sarah Pountain, nominated the AKORDD team for the ‘Team of the Year’ award. Both Mark and the team received a commendation certificate.

The Project: Acute Kidney Outreach to Reduce Deterioration and Death (AKORDD)

AKORDD is a pilot study looking at enhancing patient care, improving patient outcomes and reducing NHS costs. It aims to reduce the high mortality and morbidity due to acute kidney injury (AKI) in the NHS. AKI patients are elderly and comorbid, often requiring complex care in areas with a high workload. The project looks at whether an AKI Outreach team, delivering a standardised package of early advice and support to the clinical team looking after a patient, will reduce the mortality, morbidity and costs due to AKI.

The team involves members from Heart of England NHS Foundation Trust, University of Birmingham and University of Warwick (Professor Gavin Perkins and Dr Hema Mistry)