Photodynamic Diagnosis of Bladder Cancer Technology Implementation Project

1
Photodynamic Diagnosis of Bladder
CancerTechnology Implementation Project

• Khurram Akhtar,
• Project Manager, NHS Technology Adoption Centre
• Malcolm Crundwell,
• Consultant Urologist, Royal Devon and Exeter
  Hospital

2
Delivery

• Introduction to the project- Khurram Akhtar
• The project at Royal Devon Exeter- Malcolm
  Crundwell

3
Why PDD

• Evidence indicates benefit- increased detection
  rate of tumours- reduced need for subsequent
  resections
• Step change to current, long-standing procedures
• Not widely adopted in the NHS

4
Sites Selected

• Brighton and Sussex University Hospitals NHS
  Trust
• Northern Lincolnshire and Goole Hospitals NHS
  Foundation Trust
• Royal Devon and Exeter NHS Foundation Trust
• Aim in selection
• to explore the widest possible set of adoption
  issues,
• in a variety of environments,
• over a broad geographical area.

5
Current Situation

• Initial post-selection meetings held
• Determining optimal pathways, follow-up regimes
• Defining data sets for implementation evaluation
• Procurement and implementation to follow

6
What is PDD?

• Supplement to standard white light cystoscopy
• Instill Hexvix 1 hour prior
• Illuminate with blue light
• Bladder tumours fluoresce

cis
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Advantages of PDD

• Quality improvement
• Improved diagnosis
• More accurate and complete treatment
• Less recurrence
• Less need for additional procedures
• Recommended in EAU and SIGN guidelines

TCC
8
Why is PDD not standard in NHS?

• Additional cost of procedure and equipment
• Long-term cost saving to NHS difficult to prove
• Long-term improvements in
  survival unproven
• Not yet assessed by NICE

9
Why RDE Applied

• Previous attempts to
  introduce PDD failed
• NTAC offered
  opportunities to
• Re-apply for PDD
• Review management of bladder cancer
• Interest in wider involvement in NHS

10
Why implement PDD

• Urology cancer centre
• Part of comprehensive bladder cancer service
• Benefit to
• Patients
• Staff
• Status of department

TCC
11
Implementation 1

• Drug and Therapeutics approval
• Previously done
• Business case for equipment and drug
• Approved by NHS Trust
• PCT to be approached re. tariff
• Procurement
• Standard NHS process underway

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Implementation 2

• Design protocols for use
• Audit of last 1 years workload
• Patient pathways
• Data collection and re-audit
• Staff training
• Go live

TCC
TCC
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Partnership with NTAC

• NTAC partnership allows
• Audit of implementation process
• Advice on implementation
• Opportunity to liaise with
  other urology departments
• Benefit to wider UK population

Exeter
14
Adoption barriers

• Difficult to measure quality improvement
• May provide cost benefit to NHS overall
• More effective treatment
• Increased cost for Hospital Trust
• Capital outlay
• Ongoing cost
• Decreased revenue

15
Conclusion

• Advantages of PDD
• PDD offers quality improvement in diagnosis and
  treatment of bladder cancer
• May provide cost saving to NHS
• Disincentives to implementation
• Increased cost for individual Trusts
• Lack of long term survival data