COPD Exacerbation Alert for patient stratification

COPD is the second most common cause of emergency admissions in the UK, responsible for one in eight (130,000) acute adult medical admissions. It is a global problem, with 210 million sufferers and 3 million deaths annually (WHO, 2009). There are 1.2M COPD patients in the UK. Patients with COPD have daily symptoms, a poorer health status, reduced exercise capacity, and impairment in lung function. The symptoms can deteriorate rapidly in response to infection or pollution. The acute and sustained worsening of the symptoms is termed an acute exacerbation of COPD. In the UK COPD exacerbations account for 15% of all medical admissions, 1 million bed days and an annual NHS expenditure of £500M [NICE 2010]. Mologic has developed two products for patient stratification. These are simple urine based tests similar to the familiar home pregnancy test kits. The first test Headstart will clearly identify or confirm the first signs of exacerbation with sufficient reliability and clarity for the patient to know when to take medication and when to seek medical attention. The second product is Rightstart, for use at home or in primary care to identify whether to use antibiotics or corticosteroids. Early identification of COPD exacerbation has the potential to reduce the severity of exacerbations by allowing faster treatment and reducing the need for GP and emergency visits to A&E. Use of Rightstart to identify the cause of the exacerbation helps ensure the correct treatment is given and also has the potential to reduce unnecessary antibiotic treatment which supports the UK governments strategies for Antimicrobial Stewardship. This project will conduct clinical trials of the Rightstart and Headstart products in conjunction with clinical experts from the Respiratory groups at Leicester Hospital and Prince Philip Hospital. The design of these trials and analysis of the results is being assisted by the Diagnostic Evidence Cooperatives (DEC) and Academic Health Science Networks (AHSN) at Oxford and Newcastle. They have developed healthcare economic models to assess the potential benefits and costs savings to the NHS from the use of Headstart and Rightstart and will use the results of the trials to further update and refine their models. In addition, they will also work throughout the project to help identify the best ways to integrate these products into existing care pathways within the NHS. Because COPD patients have multiple points of contact with the NHS including their GPs, respiratory specialists in hospital based clinics, Out of Hours Services and A&E it is important to be able to integrate and provide education on the product across a broad range of clinicians and locations with the NHS. To gain support for the product's use requires the ability to demonstrate the patient value and cost saving potential to both Clinical Commissioning Groups (CCGs) who make decisions on the Care pathways for COPD and the Prescription Pricing Agency which decides which diagnostic tests are available for prescription by GPs. The AHSN and DEC groups at Oxford and Newcastle will be providing the expertise and analysis required to support the adoption of the product by both CCGs and clinicians. In addition, patient support groups including the British Lung Foundation and Breathe Easy will be engaged to provide ongoing patient perspective and support the education and training on the products.