Overactive bladder patients who have tried conservative therapy, medication and second line interventions without effect (NICE 2013), would be offered PTNS. The Urgent PC machine uses expensive single use consumables, this was compared to the AS Super 4 machine with reusable leads.
The comparison shows that the AS Super 4 machine is equivalent in its effectiveness as the Urgent PC. Based on this the trust want to adopt the AS Super 4 machine to deliver all treatments for PTNS at this centre. Equating to a significant cost saving initiative, whilst delivering an effective treatment for patients.
The challenge
Urgent PC machine consumables are single use and each year the costs are increasing. The trust pays £51.59 per treatment lead and treat an average of 25 patients per week.
Urgent PC is the only device licensed for PTNS.
There are other needle stimulation devices that can be programmed to deliver the same continuous, square waveform, electrical stimulation of 200µs at a frequency of 20hz.
These can be used to deliver PTNS or other nerve stimulation via acupuncture needles. One device is the AS Super 4, this utilises reusable leads and the consumables consist of an
acupuncture needle and ECG electrode at a current cost of 43p per patient.
A comparison was of the two machines to assess if utilising the AS Super 4 could deliver the same effective treatment at a fraction of the cost.
The trust use Urgent PC to deliver PTNS, this utilises expensive single use consumables.
The AS super 4 can deliver the same treatment with a lower consumable cost.
Actions
Patients with overactive bladder were selected. Ten female patients completed a PTNS trial with the AS Super 4 machine and were compared to ten female patients who received a PTNS trial using the Urgent PC.
Four AS Super 4 machines were purchased. Initially the AS Super 4 treatment leads were not connecting well and subsequently did not deliver adequate stimulation.
A decision was made to replace the crocodile clip with a hook clip, similar to that used with Urgent PC machine.
After this the AS super 4 delivered good stimulation. Patients using the inadequate leads were not included in the evaluation.
Patients participating completed pre-treatment bladder diary and Electronic Patient Assessment Questionnaire – Pelvic Floor (EPAQ-Pf) recording how symptoms impacted on their quality of life. At the end of the trial the diary and EPAQ were repeated to assess the symptoms.
We compared the data from ten patients treated with AS Super 4 to ten patients treated with Urgent PC and found no statistical difference between the effectiveness of the two machines.
Results
The results showed more than 50% improvement in symptoms after 12 weeks of PTNS and continued with top up treatments in the Urgent PC Group in six out of 10 patients and in the AS Super 4 Group difference seven out of ten patients.
The EPAQ-Pf mean score for overactive bladder reduced from 49.4 to 39 for the Urgent PC Group and reduced from 48.1 to 33.9 in the AS Super 4 Group.
The mean urinary urgency episodes per day reduced from 7.4 to 4.2 in the Urgent PC Group and reduced from 7.3 to 3.2 in the AS Super 4 Group.
The mean urinary incontinence episodes per day reduced from 21.6 to 6 in the Urgent PC Group and in the AS Super 4 Group it reduced from 6.3 to 2.9
The mean urinary frequency per day reduced from 10.5 to 8.6 in the Urgent PC Group and reduced from 13.2 to 10.5 in the AS Super 4 Group. And finally in the Urgent PC Group the episodes of nocturia reduced from 1.3 to 1.1 and in the AS Super 4 Group reduced from 2.1 to 1.5.
Outcome
We found that the Urgent PC and AS Super 4 gave similar results. Both were effective at
reducing patient symptoms of overactive bladder.
This comparison has shown that the AS Super 4 machine is equivalent in its effectiveness as the Urgent PC. Based on this comparison the AS Super 4 machine can be adopted to deliver all treatments for PTNS at this centre.
This will equate to a significant cost saving initiative, whilst delivering an effective treatment for patients. The Super AS 4 allows for the use of reusable leads which reduces waste in relation to treatment.
The results from the comparison evaluation will be submitted to the trust’s clinical techniques, policies and procedures
Approval Group to seek approval to continue the use of AS Super 4 for delivery of all the PTNS treatment.
Gynaecology specialist nurse Colette Anderson said:
By implementing this change we estimate that we can make a saving of over £51.16 per treatment, equating to £66,508 per year. Implementation will not impact on quality of service or effectiveness of the treatment for the patient.
Contact details
- Colette Anderson – gynaecology specialist nurse – [email protected]
- Alistair Renton-Levett – principal clinical scientist – [email protected]
- Tony Alton – clinical technologist – [email protected]
- Sharon Brown – innovation portfolio manager – [email protected]