Summary
Quick, accurate blood tests for pre-eclampsia (PE) are contributing to safer pregnancies and better outcomes for tens of thousands of pregnant women and their unborn babies every year. More accurate diagnosis reduces the need for admission and enables a clearer focus on women needing closer monitoring. The pandemic underlined the importance of safe and effective care, and minimising unnecessary hospital admissions. Within five years of the first real world evaluation in the Oxford region placental growth factor (PlGF) testing has been adopted into standard clinical practice in 90% of maternity units with continued support from the NHS MedTech Funding Mandate. This success is due in large part to a rapid adoption project led by Health Innovation Networks which understood the challenges to adopting new technology and helping the NHS and innovators work together to overcome them.
Background
Pre-eclampsia is a multi-system hypertensive disorder – a serious disease that complicates around four per cent of all pregnancies – usually in the latter stages. It adversely affects thousands of women and their babies every year and can lead to small birth weight babies, organ damage and – in extreme cases – death. It is not unusual to induce the baby early, even with mild pre-eclampsia. PE is difficult to diagnose. As a result, many women admitted to hospital for observation do not go on to develop the disease – while PE can be missed in others. This is not good for pregnant women, their unborn babies or NHS efficiency. It costs the NHS an estimated £9,000 per pregnancy to treat. Based on the NICE guidance DG23 Resource Impact Model hospital admissions related to PE could be reduced by more than one third. Two companies – Roche Diagnostics and Quidel – have developed PlGF testing for PE. The blood test was recommended by NICE in 2016, but initial uptake was slow.
Progress
In 2017, the Oxford AHSN (now Health Innovation Oxford and Thames Valley) initiated a project to increase uptake and adoption of PlGF testing which highlights women who are likely to develop PE within 7-14 days. The blood test can be taken as part of routine checks at between 20 weeks and 34 weeks + 6 days of pregnancy in line with NICE guidance. The test supports clinical decision-making by providing an objective measurement to combine with other clinical symptoms, such as high blood pressure, blurred vision or high protein in urine.
Working with the Oxford Patient Safety Collaborative and clinical leads, laboratory heads, finance and management functions, the Oxford AHSN helped three of the first hospitals in England to adopt PlGF-based testing into standard clinical practice.
This successfully demonstrated that by offering tests to women suspected of having PE, clinical teams were better able to identify women who did not have the disease, avoiding unnecessary hospital admissions. Later they were also better able to identify those with, or at risk of developing, PE and admit them to hospital for monitoring. It provided a platform for wider spread and adoption – both within and beyond the Oxford AHSN region. In 2018 the Oxford AHSN developed an implementation pack to support this work. This supported a collaborative, multi-disciplinary approach including changes required to pathways and practices. For each maternity unit AHSNs developed insight into their unique pathway and needs and provided project management and business support behind the adoption process.
The test was selected for the NHS England Accelerated Access Collaborative, Innovation Technology Payment and Rapid Uptake programmes which introduced an accelerated pathway to market for highly transformative innovations. From April 2019 providers of maternity services were able to adopt and implement either the Quidel Triage PlGF test or the Roche Elecsys sFlt-1:PlGF ratio test fully funded, as NHS England centrally reimbursed the suppliers directly. In April 2021 PlGF-based testing was one of four technologies included under the NHS MedTech Funding Mandate (MTFM) which continues to support the spread and adoption of the technology.
All AHSNs, led by the Oxford AHSN, worked together to ensure rapid and widespread adoption of the test into standard clinical practice in 90% of England’s maternity units with more than 41,000 pregnant women benefiting from the test every year. Projected annual savings in England are estimated at £4m per year relating to reduced hospital bed occupancy.
This initiative secured two prizes in 2019: an HSJ Partnership Award and a Univants of Healthcare Excellence Award. It was also a finalist in the HSJ Awards.
Feedback
“This test has improved our ability to make the right decision on admission. The right patients are being discharged, leaving us to focus on those women who are at greater risk of developing pre-eclampsia.” – Dr Sofia Cerdeira, obstetrician and research leader, Oxford University Hospitals NHS Foundation Trust
“The Oxford AHSN supported us all the way” – Chris Hudson, Roche Diagnostics, the manufacturer of one of the PlGF tests. Roche attributed five jobs and approximately £2 million revenue to this initiative. Read more of Chris Hudson’s feedback
Environmental impact
In July 2021 the Oxford AHSN and Sustainable Healthcare Coalition published a report highlighting how PlGF-based testing for pre-eclampsia has additional environmental benefits. In addition to the benefits of widespread PlGF testing outlined above, it concluded that the consequent cut in patient journeys and overnight hospital stays could potentially save 1,149 tonnes CO2e – equivalent to three million miles of car travel each year in England. Read more about the environmental benefits of testing to rule out pre-eclampsia in this case study