Novel Technology Improves Outcome for Patients with Complex Polyps

The number of NHS patients diagnosed with polyps in the colon across England in 2022 was approximately 177,000. Polyps can be benign, but over time certain types can develop into more complex lesions which can be cancerous or pre-cancerous.

Many patients with complex polyps are directed to surgery to remove the lesions, the outcome often resulting in long hospital stays, stoma bags, repeat hospital visits and the risk of infection.

In 2019 Creo Medical developed the first Advanced Energy multi-modal instrument, Speedboat Inject, designed for flexible endoscopy. It allows for the curative resection of complex legions in the colon to be performed in a day case endoscopy setting, compared to widely used surgical alternatives.

In 2022, Creo Medical approached NHS Supply Chain for support in demonstrating, and sharing, the value-added benefits of this minimally invasive device. East Kent Hospitals University NHS Foundation Trust (EKHUFT) were quickly identified as a key exemplar, having been the earliest adopter of the device and completing over two hundred Speedboat Submucosal Dissections (SSD) cases in quick succession.

Speedboat Submucosal Dissection (SSD), the procedure facilitated by Speedboat Inject, has allowed EKHUFT to establish the UK’s first Complex Polyp Service. Treating patients endoscopically using SSD drives efficiencies across the full patient pathway. Not only does it reduce procedure time, but it also saves on bed days required pre/post operation, follow up appointments and further treatment due to complications. At a time when waiting lists have lengthened, following the COVID-19 pandemic, EKHUFT feel that having the ability to treat patients in a timelier fashion has been crucial.

In delivering these efficiencies, EKUHFT’s financial modelling has identified net benefits of £687,000, for the 130 SSD procedures on the 12-month patient pathway, which equates to £5,300 per patient.

The aim of this Value Based Procurement pilot was to identify if the use of this novel technology could safely and effectively remove pre-cancerous and certain cancerous complex lesions in the colon, whilst delivering the following:

• Improved patient experience and outcomes.
• Reduction in procedure times.
• Reduction in the number of in-patients and their length of stay.
• Reduction in the need for follow-up hospital appointments.
• Reduction in overall costs.
• Increase in clinical capacity.

The introduction of this service at East Kent, and the pathway it facilitates, has immediately had a positive impact in terms of patient outcomes and overall value. With over 200 Speedboat Submucosal Dissection cases now completed, our in-depth costing work shows tangible and consistent financial benefits largely stemming from a reduction in the time patients are spending in hospital. This is due to our ability to re-direct patients from surgical waiting lists to our excellent endoscopy unit.

Elisa Llewellyn – Director of Commissioning, Contracting and Costing.

During the piloting of SSD, and the use of Speedboat Inject, EKHUFT have been able to identify the budgetary impact of performing SSD compared with surgical alternatives.

Over 1,000 patients had been analysed (130 of those being Speedboat patients) from April 2018 to March 2022. Multiple trust-specific datasets, including those from PAS (a), Theatreman (theatre system), Unisoft (endoscopy system), imaging and pathology, had been joined together using the trust’s Patient-Level Information and Costing System (PLICS).

This approach enabled all activities associated with each patient to be identified and costed based on the trust’s 2019 / 2020 direct costs* (uplifted by the National Tariff Payment System’s Inflation figure) using the NHS England Approved Costing Guidance (ACG). The ACG explains how NHS trusts should cost at patient-level, using the costing standards to ensure consistency is maintained across the sector.

The patient administration system (PAS) performs the basic but crucial function of recording non-clinical patient details including age, sex, and date of birth. The system also has all admissions clinically coded by the trust’s clinical coding team.

In collating and analysing the above data sets, EKHUFT have been able to evidence that the adoption of Speedboat Inject, and its implementation as part of the new service, has resulted in significant savings (outlined below). In addition, the level of detail provided will enable statistical analysis and health economics evaluations to be successfully undertaken with confidence.

*Only direct costs have been considered, any costs relating to trust overheads have been excluded.

* Clinical training with Creo Medical is required for this technology so please contact us to facilitate this with the supplier prior to ordering.

By working with NHS Supply Chain, EKHUFT demonstrated that the use of SSD, when compared with surgical alternatives, results in a less invasive procedure for patients, whilst maintaining an en-bloc resection with clear margins.

The endoscopic nature of the procedure, and the device’’’s advanced energy modalities, makes this procedure safe, efficient and more cost effective. A breakdown of the findings are as follows:

• £687,000 saving for the 130 SSD procedures on the one year patient pathway, which equates to £5,300 per patient.
• Theatre time reduced from average of 198 minutes to 149 minutes (25% reduction).
• Length of stay reduced from average of 8.39 days (of which 0.72 ITU days) to 1.07 days (of which 0.01 ITU days) (87% reduction).
• Theatre procedure cost reduction from £4,500 to £2,800 (38% reduction).
• Accommodation cost reduction from £4,000 to £300 (91% reduction).
• Admission cost reduction from £8,200 to £3,100 (62% reduction).
• Over a one year period a cost reduction from £8,800 to £3,600 (59% reduction).

Since the pilot concluded, Speedboat continues to delivery net benefits of £671,000, for the 130 SSD procedures, per annum.

*The direct cost differential between the two procedures is evidential, however, there needs to be considerations around the current tariff received for the Speedboat procedure, which does not fully reimburse the admission. For the Trust this means any cost savings are currently offset by the tariff loss.

See our Downloads ▼ section for Appendix A – full details of the financial modelling from the surgical approach versus using Speedboat.

The National Institute for Health and Care Excellence (NICE) has selected Speedboat Inject to be scoped and routed for guidance in respect of the endoscopic submucosal dissection of lower gastrointestinal (GI) lesions.

See our Useful Links section for further information.

Speedboat Inject represents an alternative method of removing cancerous and pre-cancerous lesions from the colon within a day case setting, improving patient outcomes, reducing surgical operating lists, and releasing financial savings into the healthcare system.

The recent launch of slimmer Speedboat devices enables compatibility with a wider range of commonly used flexible endoscopes within the NHS; further expanding the opportunity for wider adoption. Following the recent CE approval for procedures in the stomach and oesophagus, further opportunities now present themselves for Speedboat to be used in the upper GI tract.

*This case study was carried out at East Kent Hospitals University NHS Foundation Trust in conjunction with Creo. Savings are related to a product chosen and created by the trust. This may not be suitable for all organisations and, in these situations, we have other alternatives available depending on clinical need.

For further information or support in facilitating clinical training on this technology (required prior to ordering), please contact us.