Innovative Technology Reduces Operating And Recovery Time in Value Based Procurement Pilot

With ever increasing demand for healthcare different approaches are needed to ensure the NHS remains sustainable. The pilot demonstrates the benefit of working in partnership with industry to look beyond unit cost and adopt new systems able to both improve patient outcomes and free up capacity.

David Lawson, Procurement Director, Guy’s and St Thomas’ NHS Foundation Trust

Guy’s and St Thomas’ NHS Foundation Trust is a large provider of acute and specialist services for residents of Lambeth and Southwark, across London, the South East and further afield. The trust has 26,000 staff and an annual turnover of £2.2 billion.

The current treatment for lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia is by Trans Urethral Resection of Prostate (TURP), which involves resecting tissue away from the prostate using a diathermy loop. Prior to the pandemic in 2018/19 the trust performed 350 number of cases per annum.

The procedure takes between 1-1.5 hours and requires 2-4 days in hospital due to the requirement to irrigate afterwards. At Guy’s and St Thomas this requires theatre time of circa 70 minutes per procedure and an average length of stay for patients of 2.8 days.

The aim of this Value Based Procurement (VBP) pilot was to identify if the use of new technology could:

• Improve patient experience.
• Reduce theatre operating time.
• Reduce length of stay.
• Improve patient flow and release capacity.

Working with the clinical and procurement teams at Guys and St Thomas, Boston Scientific successfully piloted Rezūm, a novel minimally invasive surgical option for men with lower urinary tract symptoms, as a means of reducing length of stay, theatre time and improving patient experience.

Rezūm is a minimally invasive device that uses radio frequency to heat water to 103 degrees. The water is then injected into the transition zone of the prostatic, heating the tissue to around 70 degrees. This causes coagulative necrosis and over the weeks that follow the tissue is absorbed, thus reducing the size of the prostate.

It is a quick and simple procedure usually offered as a day case using different anaesthetic approaches: local anaesthetic including a peri-prostatic block, general anaesthetic and sometimes sedation.

The proof of concept pilot had originally intended to include 50 procedures (equating to circa 25% of the annual potential volume), however due to the impact of COVID-19, 16 cases have been performed with Rezūm and used to demonstrate the benefits of the solution.

The procedure options of TURP versus Rezūm were discussed with the patients. The patients consented based on anatomical suitability, with a prostate size of less than 80g.

• Theatre time reduced from average of 75 to 20 minutes.
• Length of stay reduced from average of 2.8 days to 4 hours.

Before

After

We believe the benefits have been delivered as expected however further follow up would be required at a later date in line with product mechanism. I can confirm in general no patients had any long-term issues and had overall good outcomes, no worse than to be expected from the TURP offering clinically. We are satisfied with the procedure and the benefits it has brought to the trust.

Mr Oussama El Hage , Consultant Urologist, Guy’s and St Thomas’ NHS Foundation Trust

The pilot project aimed to generate financial benefits for the trust through reduced length of stay and relocating recovering patient from a ward to the day case unit, thereby giving the trust the opportunity to improve patient flow and increase activity.

Efficiency benefits through reduced length of stay and improved theatre efficiency have released net benefits of £15,370 for the 16 procedures undertaken as part of this pilot. This equates to a £961 per patient net efficiency saving through the adoption of the Rezum device.

In forecasting a potential annual saving by using 2018 / 2019 data, the trust reported 350 TURP procedures, of which the supplier predicts that the product can treat around 60% of those patients, which is equal to 210 patients.

NICE have provided guidance and an economic assessment in relation to this product. However, it should be noted that the benefits demonstrated in the evaluation by NICE are based on the assessment undertaken by the Economic Assessment Centre. Providers would need to undertake their own assessment based on their own costs and the capacity benefits that would be achieved by implementing these technologies. In 2020 Nice guidance estimated an average saving of £550 per patient as a mean value across the NHS through use of Rezum.

See our Useful Links section for more details on the NICE guidance.

There is the potential for wider adoption and contribution across Integrated Care Systems. It is suggested that if the introduction of the product was aligned to a process of service redesign with the trust and potentially across an ICS footprint, this could optimise productivity opportunities.

Undertaking the pilot has contributed to the wider learning in relation to Value Based Procurement adoption in healthcare. Specifically, in relation to the need to have greater visibility of pathway costs versus income. In this case, by conducting a financial analysis of the TURP pathway, it was possible to identify and that the trust was running a deficit for each procedure undertaken which highlighted that corrective action was required. In this instance, the adoption of technology provided a solution for patients that met the Rezūm eligibility requirements.

A comprehensive review of pathway expenditure and income could potentially be a rich source of opportunity to identify area for enhanced efficiency, improved patient outcomes and reduced cost delivered through the adoption of Value Based Procurement practices.

Please note

This case study was carried out at Guys and St Thomas NHS Trust in conjunction with Boston Scientific. Savings are relating to a product chosen by the trust from a range of products available through NHS SC Frameworks and this may not be suitable for all organisations, and in these situations we have other alternatives available dependant on clinical need.

See our Useful Links section for VBP Contacts, who will be available to discuss this case study and opportunities for your trust to explore using this technology.

For support regarding the implementation of the MedTech Funding Mandate, please contact your local Health Innovation Network (HIN) or NHS England and NHS Improvement’s Innovation Team via nhsinnovationservice@innovation.nhs.uk

See our Useful Links section to find the contact details for your regional HIN.