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Realizing the benefits…

…by capturing the barriers.

The following table outlines the main benefits and common barriers identified during the NTAC project by members of the project teams at the NTAC implementation sites. The table aims to provide a succinct overview from the members’ experiences, categorized by patient, commissioner, clinical and Trust/Service Managers. [NHS TAC guide]


PATIENTS: POTENTIAL BENEFITS OF BLUE-LIGHT CYSTOSCOPY COMPARED TO WHITE LIGHT CYSTOSCOPY POTENTIAL BARRIERS TO IMPLEMENTATION OF BLUE-LIGHT CYSTOSCOPY
  • Much more complete tumor clearance at initial operation for bladder cancer (TURBT) leading to a reduction in tumor recurrence
  • More accurate initial tumor staging will allow earlier specific treatment for patients with high risk of tumor recurrence or progression (e.g. intravesical chemotherapy /immunotherapy)
  • Less frequent intervention, and therefore reduced inconvenience, for a cancer that will require continual management over a long survival period
  • Patients have welcomed the opportunity of potentially better treatment
  • No reluctance encountered to catheterization for the instillation of Hexvix®
  • Patients need to be catheterized prior to procedure

 

CLINICAL: POTENTIAL BENEFITS OF BLUE-LIGHT CYSTOSCOPY COMPARED TO WHITE LIGHT CYSTOSCOPY POTENTIAL BARRIERS TO IMPLEMENTATION OF BLUE-LIGHT CYSTOSCOPY
  • More certain understanding of a patient’s stage and grade of tumor leading to more appropriate treatment
  • More complete resection of tumor
  • Easier to identify CIS and areas of dysplasia not seen with conventional white light
  • Reduced recurrences after initial blue-light TURBT with associated improved outcomes
  • Reduced need for random biopsies
  • Blue-light cystoscopy supplements existing procedures, and therefore minimal training is required
  • Easy to use. Easy to assimilate into existing TURBT practice
  • Blue-light cystoscopy technique provides the opportunity for improved training for junior clinicians in more complete resections
  • Availability of staff to prepare and administer Hexvix®
  • Operational change to ensure Hexvix® is administered 1 hour prior to procedure (staff training)
  • Changes in theater scheduling to accommodate drug instillation
  • Time taken for clinician and management to work together on a business case
  • Increased rates of false-positive biopsies whilst learning the technique

 

TRUST/SERVICE MANAGMENT: POTENTIAL BENEFITS OF BLUE-LIGHT CYSTOSCOPY COMPARED TO WHITE LIGHT CYSTOSCOPY POTENTIAL BARRIERS TO IMPLEMENTATION OF BLUE-LIGHT CYSTOSCOPY
  • Provision of higher quality care to patients
  • Reduction in follow-up interventional procedures (flexible cystoscopy and TURBT)
  • Opportunity for discussion with commissioners on how best to utilize resource released in patient follow up, pre-op preparation, theater utilization, staff time, bed days etc.
  • Opportunity to discuss using freed up capacity as cost avoidance (i.e. avoid needing to lay on extra capacity during times of growth in other areas)
  • An implementation team is required to be resourced to ensure a structured, safe and sustainable service change
  • Loss of revenue-generating procedures along with potential for activity contracts to be modified
  • Lack of appropriate tariff to cover increased drug costs
  • Need to engage with commissioners to address the increase in provider costs incurred

 

OTHER KEY STAKEHOLDERS (E.G. COMMISSIONERS, CANCER NETWORKS, DEPARTMENT OF HEALTH): POTENTIAL BENEFITS OF BLUE-LIGHT CYSTOSCOPY COMPARED TO WHITE LIGHT CYSTOSCOPY POTENTIAL BARRIERS TO IMPLEMENTATION OF BLUE-LIGHT CYSTOSCOPY
  • Commissioners able to provide a higher quality service for the local health community
  • Improved patient outcomes
  • Improved surgical outcomes
  • Reduction in follow-up procedures
  • Resources released, through fewer interventional procedures overall
  • Potential reduction in progression of disease, leading to savings in later radical treatment costs
  • Commissioners able to demonstrate support for the introduction of a technology innovation
  • Understanding the utility benefits of the technology
  • Working with provider services to release the savings
  • Initial short term increase in costs