“UroLift is an important addition to our current treatment options. It offers a minimally invasive treatment for men who have failed or had side effects from medical treatment or don’t want the more invasive surgical options. The majority of my patients have been very happy with the outcome, and we have been helping to reduce the trust waiting list because the procedure is quick and does not require a bed.”
Mr Mark Harris, Consultant Urologist, Southampton General Hospital

Overview

Wessex AHSN - Urolift implant and delivery deviceUroLift® is an innovative, cost-effective, short and non-invasive treatment for the common condition of Benign Prostatic Hyperplasia (BPH) – where an enlarged prostate can affect men aged 50+. The treatment is completed in less than 30 minutes, can prevent lengthy unnecessary stays in hospital, and targets the problem area for patients with increased accuracy and better outcomes and healing.

Experiences from NHS trusts that have adopted UroLift (published as part of a series of NICE Shared Learning case studies) have demonstrated that each procedure has taken 25 minutes; meaning seven or eight could potentially be completed in one afternoon’s case list, compared to (up to) 72 minutes using current treatment. Each patient has been treated as a day case, with no need for a hospital stay, and only one patient has required a follow-up appointment. The potential for savings to the NHS is therefore potentially enormous.

Wessex AHSN recognised the huge potential of UroLift to improve patient outcomes and reduce NHS costs, and has worked with UroLift to help broker a relationship with the local NHS system. For example, the AHSN has helped to develop a health economic infographic which demonstrates benefits to each specific CCG, rather than relying on clinical trial data extrapolated to a national view.

The AHSN has also introduced the team to local hospital trusts, and has showcased UroLift at important stakeholder events, both locally and nationally. This has helped to raise awareness and stimulate discussion with key NHS organisations – a key role in enabling this innovative treatment into widespread use.

Furthermore, UroLift is recommended by NICE (MTG26), and more recently, by the Accelerated Access Review as an innovative medical technology with cost-saving potential. Patients achieve relief from symptoms which helps them quickly return to normal daily activity. Urolift is eligible for the Innovation and Technology Tariff, effective from 1 April 2017.

Challenges/ problems identified

Benign Prostatic Hyperplasia (BPH) is a common, yet chronic, condition where an enlarged prostate can make it difficult for a man to pass urine. This leads to urinary tract infections, urinary retention, and in some cases, renal failure. Prevalence increases with advancing age, affecting more than one in three men in their 50s, and 80% of men over 70. Drugs for BPH are poorly tolerated and cause undesirable side effects.

Men with moderate or severe symptoms are commonly offered a surgical procedure (TURP or laser), which involves cutting away or removing existing tissue. This can lead to permanent side effects affecting sexual function, and persistent complications, placing further demand on the patient and NHS.

There are 20,000 TURP procedures each year (average inpatient stay of three days) costing the NHS £54M. A further £109M is spent on complications that require more episodes of hospital care.*

*HES Data provided under a data sharing agreement from the Health and Social Care Information Centre via Harvey Walsh Ltd 2015. National Schedule of Reference Costs.

Actions taken

UroLift was designed to provide a minimally-invasive and durable solution for men with symptoms of BPH. By delivering the following, UroLift provides solutions to several key challenges of managing BPH:

• Short (<30 mins) ambulatory procedure, performed under local anaesthetic or light sedation (TURP requires 60-90 mins and general anaesthetic)
• No overnight stay requirement
• Minimally invasive – no cutting or removing of tissue. Minimal side effects and post-operative complications
• No requirement for catheterisation – reduced risk of CAUTI
• Reduced requirement for outpatient follow-up
• Easy and rapidly deployable technology – no capital outlay or specialist equipment apart from the implants
• Minimal training requirements.

UroLift is proven in multiple peer review clinical studies, with durability demonstrated in published follow-up out to four years. It is recommended by NICE (MTG26) and is eligible for an Innovation and Technology Tariff.

Wessex AHSN has worked with UroLift to develop a health economic infographic that demonstrates benefits to each specific CCG, rather than relying on clinical trial data extrapolated to a national view.

The AHSN has also introduced the team to local hospital trusts, and has showcased UroLift at important stakeholder events, both locally and nationally. This has helped to raise awareness and stimulate discussion with key NHS organisations – a key role in brokering this innovative treatment into widespread use.

Due to Wessex AHSN’s support and assistance, one trust has recently approved use of UroLift for its patients, and several others are processing applications.

Impacts/ outcomes

Clinical opinion suggests that at least 40% of patients requiring surgery for BPH would be clinically eligible for UroLift. There is a particular need in Wessex, due to the aging populations in areas such as Dorset and the Isle of Wight. Offering UroLift as an alternative to TURP or laser realises the following benefits:

Benefits for patients
• Rapid and sustained improvement in symptoms and flow
• Improved safety and side effect profile compared with current surgical treatments
• Preservation of sexual function
• Significantly reduced post-operative complications – more rapid return to daily living compared with TURP.

Benefits to the NHS
Wide-ranging benefits to the NHS, particularly around efficiency savings. Adoption in 40% of surgical patients could realise:
• Improved bed capacity – Estimated to save over 1,500 bed days per year in Wessex. If scaled nationally, adoption would save 24,000 bed days per year.
• Improved theatre capacity – Estimated to save over 500 hours of theatre time in Wessex. If scaled nationally, adoption would save over 8,000 hours of theatre time.
• Reduced requirement for outpatient follow-up – save at least 1 follow-up appointment per patient, which would save over 500 O/P appointments in Wessex and over 8,000 nationally.
• Reduced risk of complications. It has been estimated that adoption of Urolift in Wessex would save over £1.3M in post-surgery complication costs. Scaled nationally, these savings are expected to exceed £22M as a conservative calculation.
• Help reduce waiting times.

With Wessex AHSN’s support and assistance, one trust has recently approved use of Urolift for its patients, and several others are processing applications.

NICE Shared Learning Case Studies – Insights from the NHS
• Adoption of UroLift for treating lower urinary tract symptoms of BPH at St Helens and Knowsley NHS Trust.
• Adoption of UroLift for treating LUTS of BPH at Frimley Park Hospital.
• UroLift using local anaesthesia in the Ambulatory and one-stop Urology service at Norfolk and Norwich.1500beddays

UroLift is “an innovative medical technology with cost saving potential” Accelerated Access Review final report

UroLift is eligible for the Innovation and Technology Tariff.

Three trusts have published their experience so far in NICE’s Shared Learning Programme. Two of these trusts describe the impact here.

“It really has been great and I’d have no hesitation in recommending men have UroLift.” Chris, Bedfordshire

Plans for the future

UroLift is eligible for an Innovation and Technology Tariff. This is help to incentivise hospitals to adopt UroLift and ensure they are properly reimbursed. This tariff will come into effect on 1 April 2017, from which point we expect uptake to increase and spread at pace and scale.

Wessex AHSN will work with UroLift to understand the implications of the new ITT for CCGs and providers and ensure that the ITT does drive uptake of this innovation.

Which national clinical or policy priorities does this example address?

UroLift addresses the NHSE priority of funding and efficiency. The recently published final report of the Accelerated Access Review (AAR) highlighted UroLift as “an innovative medical technology with cost saving potential”. The Accelerated Access Partnership aims to build on the Five Year Forward View infrastructure and collaborate with AHSNs; aligning to existing programmes such as the New Models of Care, RightCare, the NHS Test Beds and the Carter implementation programme.

In its Medical Technologies Guidance (MTG26), NICE stated that UroLift “may result in productivity savings for the NHS trusts from reduced length of stay in hospital and the associated inpatient resource use (such as theatre operating time and associated staffing costs and consumables). It also helps improve productivity (saving physician and other healthcare professionals’ time) within outpatient settings due to reduced post-discharge follow-ups both in primary care settings and in an outpatient setting.”

Find out more

 

Find out more about how UroLift helps the NHS here.

Start and end dates

2016 – ongoing

Contact for help and advice

Justin Hall, VP and General Manager EMEA, Neotract Inc
T: 07702 208 053
E: jhall@neotract.com

Frank Ratcliff, Senior Programme Manager
E: Frank.Ratcliff@wessexahsn.net

Michael Goodeve, Head of Communications
E: Michael.Goodeve@wessexahsn.net