Provision of the NHS 111/Urgent Care Patient Relationship Manager Evaluation

Improving the delivery of urgent and emergency care (UEC) services in London is a main priority of NHS England London. To this aim, NHS England London has implemented the Patient Relationship Manager (PRM) system, a Cloud-based clinical record system, designed to improve patient care by information sharing. It works by assisting in directing NHS 111 calls to the most appropriate health care professional depending on the nature of the call. The economic analysis of the PRM aims to estimate the incremental cost of the service and the potential benefit in economic terms. The expected benefits of the PRM from an economic perspective are the operational efficiencies for both integrated Urgent Care Services, and the wider urgent and emergency care networks. These may translate in changes in the use of Urgent Care Services and the potential saving for the NHS

Obstetric training to reduce OBPI: costs and outcomes (PhD supervision)

Obstetric brachial plexus injuries (OBPIs) are rare but can have significant implications for those affected, their caregivers and the health system. Symptoms can range from restricted movement to complete paralysis of the arm. We investigated health-related quality of life in adults with OBPIs and parents of children with permanent OBPIs, compared these with population norms, and investigated whether certain socio-demographic or clinical factors were associated with the quality of life in these cohorts.

OBPI Quality of Life

The cost of obstetric training

Effectiveness and acceptability of metformin in preventing onset of type 2 diabetes after gestational diabetes in postnatal women - OMAHA

Up to half of all women diagnosed with gestational diabetes mellitus develop type 2 diabetes within 5 years after delivery. Metformin is effective in preventing type 2 diabetes in high-risk non-pregnant individuals, but its effect when commenced in the postnatal period is not known. We plan to assess the feasibility of evaluating metformin versus placebo in minimising the risk of dysglycaemia including type 2 diabetes after delivery in postnatal women with a history of gestational diabetes through a randomised trial.


Effectiveness and acceptability of myo-inositol nutritional supplement in the prevention of gestational diabetes - EmMY

Gestational diabetes increases maternal and offspring complications in pregnancy and cardiovascular complications in the long term. The nutritional supplement myo-inositol may prevent gestational diabetes; however, further evaluation is required, especially in multiethnic high-risk mothers. Our pilot trial on myo-inositol to prevent gestational diabetes will evaluate trial processes, assess acceptability to mothers and obtain preliminary estimates of effect and cost data prior to a large full-scale trial.


Endovascular Thrombectomy in Patients with Large Core Ischemic Strokes: a Cost-Utility Analysis from the SELECT Study

Every year, 15 million people worldwide suffer a stroke. Nearly 6 million die and another 5 million are left permanently disabled. For acute ischemic stroke, intravenous recombinant plasminogen activator (IV-tPA) has demonstrated efficacy and cost-effectiveness when administer to eligible patients. However, the prognosis for patients remains disappointing in part because IV-tPA alone is often unable to achieve recanalization, especially when there is a major vessel occlusion. In this case, there is increasing evidence that mechanical thrombectomy has the potential to improve recanalization rates and outcomes for patients with ischemic stroke. We use a Markov model to model the lifetime cost-utility of mechanical thrombectomy compared to IV-tPA alone in the USA.


Cost-utility analysis of mechanical thrombectomy between 6 and 24 hours in acute ischemic stroke

We compared the cost-utility of mechanical thrombectomy in addition to medical treatment versus medical treatment alone performed beyond 6 h from stroke onset in the UK National Health Service (NHS).


Cost-effectiveness of a melanoma screening programme using whole disease modelling

A Markov simulation model estimates the cost-effectiveness of a one-time, general practitioner-based melanoma screening strategy in the population aged over 20, compared with no screening. The study considered the most up-to-date drug therapy and was conducted from the perspective of the Veneto regional healthcare system within the Italian National Health Service. Over a 25-year time horizon, the screening intervention dominated usual care. The key drivers of the model were the proportion of melanomas detected by the screening procedure and the adherence of the target population to the screening programme.


Cost-comparison analysis of FIB-4, ELF and fibroscan in community pathways for non-alcoholic fatty liver disease

The identification of patients with advanced liver fibrosis secondary to non-alcoholic fatty liver disease (NAFLD) remains challenging. Using non-invasive liver fibrosis tests (NILT) in primary care may permit earlier detection of patients with clinically significant disease for specialist review, and reduce unnecessary referral of patients with mild disease. We constructed an analytical model to assess the clinical and cost differentials of such strategies.

Our analyses suggest that the use of NILT in primary care can increases early detection of advanced liver fibrosis and reduce unnecessary referral of patients with mild disease and is cost efficient. Adopting a two-tier approach improves resource utilization.


NIHR CLAHRC North Thames – STAR and diabetes prevention

There are currently 2.6 million people with Type 2 diabetes in England, accounting for just under nine per cent of the annual NHS budget (£8.8 billion a year). There are currently 5 million people in England at high risk of developing Type 2 diabetes and, if current trends persist, one in ten will develop Type 2 diabetes. At this rate, diabetes, pre diabetes and the complications of these conditions would result in a massive increase in the burden of disease and costs of treatment. Evidence shows that prevention is cost-effective for many cases of Type 2 diabetes. But these interventions do not save costs to the NHS. This is because interventions to prevent diabetes can be expensive if sustained for a long period of time, but also because the benefits are relatively short and they translate into savings only in the long term. NIHR CLAHRC North Thames is currently working on a project which aims to review local economies’ plans to prevent diabetes in terms of their scale against the population estimated to be at risk and estimate the cost and impact of those plans.

Valuing Active Life in Dementia

Valuing Active Life in Dementia (VALID) aims to promote independence, meaningful activity and quality of life for people with dementia and their family carers living in the community. We are conducting the economic evaluation of a new form of community occupational therapy for people with dementia and their family carers.


Impact and experiences of delayed discharge: A mixed‐studies systematic review

We review the current evidence on the impact of delayed discharge on patients, health‐care staff and hospital costs.  Delayed discharge was associated with mortality, infections, depression, reductions in patients’ mobility and their daily activities. The adverse effects of delayed discharge are both direct (through increased opportunities for patients to acquire avoidable ill health) and indirect, secondary to the pressures placed on staff.

NHS Litigation Authority - Economic Evaluation of the Incentivisation Scheme in support of Sign up to Safety

The NHS Litigation Authority (NHS LA) is supporting Sign up to Safety (SuTS), a campaign launched in June 2014 aiming to improve and strengthen the safety of patients in the NHS. As part of the scheme financial incentives have been given to Trusts to reduce harm leading to clinical claims. UCL is conducting the economic evaluation of the scheme to assess the impact of the incentives in reducing errors, incidents and claims in the NHS.


Does use of point of care testing improve cost effectiveness of the NHS Health Checks programme in the primary care setting? A cost minimisation analysis.

To determine if use of Point of Care Testing (POCT) is less costly than laboratory testing to the NHS in delivering the NHS Heath Check (NHSHC) programme in the primary care setting


ABLE - Age of Transfused Blood in Critically Ill Adults

At present red blood cells (RBCs) are stored for up to 42 days prior to transfusion. There is currently insufficient evidence concerning the relative safety of different RBC storage times prior to transfusion in critically ill patients. In this project we assess the clinical and cost-effectiveness of transfusing fresher RBCs (stored for ≤7 days) compared with current standard aged RBCs in critically ill patients requiring blood transfusions.


Cost-Utility Analysis of Mechanical Thrombectomy Using Stent Retrievers in Acute Ischemic Stroke

Every year, 15 million people worldwide suffer a stroke. Nearly 6 million die and another 5 million are left permanently disabled. For acute ischemic stroke, intravenous recombinant plasminogen activator (IV-tPA) has demonstrated efficacy and cost-effectiveness when administer to eligible patients. However, the prognosis for patients remains disappointing in part because IV-tPA alone is often unable to achieve recanalization, especially when there is a major vessel occlusion. In this case, there is increasing evidence that mechanical thrombectomy has the potential to improve recanalization rates and outcomes for patients with ischemic stroke. We use a Markov model to model the lifetime cost-utility of mechanical thrombectomy compared to IV-tPA alone in the UK.


NSPCC – The cost of child maltreatment in the UK

According to NSPCC (2011) child abuse includes “all forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child’s health, survival, development or dignity in the context of a relationship of responsibility, trust or power”. This project has developed the first comprehensive estimates of the costs of child maltreatment in the UK across different short- and long-term outcomes. We used an incidence-based approach to calculate the lifetime costs of child maltreatment.


London Speech and Language TherapyWorkforce Scoping Project

University College London (UCL), in partnership with the Royal College of Speech and Language Therapists (RCSLT), was commissioned by Health Education North Central and East London (HENCEL) to undertake a scoping project of the speech and language therapy (SLT) workforce in London. The project investigated the whole London workforce, including those working outside the NHS to: a) provide a snapshot of the current London SLT workforce; b) estimate the levels of current unmet client need for SLT services in London; and c) predict future unmet need for SLT services in London up to 2025, taking account of a range of variables that might impact future need.

Phase 2: modelling workforce transformation example

We model the impact of a specific technology-based workforce transformation project on the SLT workforce in London. We focus on a novel teleswallowing model for the assessment of swallowing problems in residents of nursing or residential homes, which make up a significant proportion of all referrals to community-based SLT settings.

One size fits all? Mixed methods evaluation of the impact of 100% single-room accommodation on staff and patient experience, safety and costs

There is little strong evidence relating to the impact of single-room accommodation on healthcare quality and safety. We explore the impact of all single rooms on staff and patient experience; safety outcomes; and costs.

Patient and public involvement: how much do we spend and what are the benefits?

Patient and public involvement (PPI) is seen as a way of helping to shape health policy and ensure a patient-focused health-care system. While evidence indicates that PPI can improve health-care decision making, it also consumes monetary and non-monetary resources. Given the financial climate, it is important to start thinking about the costs and benefits of PPI and how to evaluate it in economic terms.


A retrospective analysis of the cost of hospitalizations for sickle cell disease with crisis in England, 2010/11

Sickle cell disease (SCD) is an inherited blood disorder which may result in a broad range of complications including recurring and severe episodes of pain - sickle “crises” - which require frequent hospitalisations. We assessed the cost of hospitalisations associated with SCD with crisis in England. Methods Hospital Episodes Statistics data for all hospital episodes in England between 2010-2011, recording Sickle Cell Anaemia with Crisis as primary diagnosis were used. The total cost of admissions and exceeded length of stay due to SCD were assessed using the Healthcare Resource Groups ( HRGs) tariffs. The impact of patients’ characteristics on SCD admissions costs and the likelihood of incurring extra bed days were also examined. Results In 2010-2011, England had 6,077 admissions associated with SCD with crisis as primary diagnosis. The total cost for these admissions for commissioners was £18,798,255. The cost of admissions increases with age (children admissions costs 50% less than adults). Patients between 10-19 years old are more likely to stay longer in hospital compare to others. Conclusion SCD represents a significant cost for commissioners and the NHS. Further work is required to assess how best to manage patients in the community, which could potentially lead to a reduction in hospital admissions and length of stay, and their associated costs.


Screenee perception and health-related quality of life in colorectal cancer screening: A review

Screening for colorectal cancer (CRC) has become established to varying degrees in several Western countries for the past 30 years. Because of its effectiveness, screening has been adopted or is planned in a number of other countries. In most countries, the screening method (e.g., fecal occult blood test [FOBT], sigmoidoscopy) is followed by colonoscopy, for verification. In other countries (e.g., United States, Germany), colonoscopy is the preferred first-line investigation method. However, because colonoscopy is considered to be invasive, might be poorly tolerated, and can be associated with complications, the idea of adopting colonoscopy as the primary screening method suffers. Negative effects of screening methods can reduce participation in programs and thereby negate the desired effect on individual and societal health. At present, there is no generally accepted method either to assess the perception and satisfaction of patients screened or the outcome of the screening procedures in CRC. In this review, we discuss the past development and present availability of instruments to measure health-related quality of life (HRQoL), the scarce studies in which such instruments have been used in screening campaigns, and the findings. We suggest the creation of a specific instrument for the assessment of HRQoL in CRC screening.