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Team:Dundee/Implementation/financial
From 2014.igem.org
Quantitative Impact
CF in Numbers
Introduction
An important aspect of how the L.A.S.S.O. could be usefully implemented into society was to understand the associated costs. Hence we constructed several financial models. We started by following the assumption that The Lung Ranger, and more specifically the implemented L.A.S.S.O., would yield faster, quantitative bacterial load readings than is possible with the present testing procedure. This would lead to faster treatment and thus create a healthier CF community requiring less hospital treatment. We used the data available from the CF Registry 2013 Annual Report and investigated the amount of time CF patients spend on IV treatment at home and at the hospital. We then introduced three test hypotheses: successful implementation of the L.A.S.S.O. could decrease the IV treatment duration by 10%, 30% and 50%, respectively. Following through with this idea we were able to see the impact this had with regards to the scale of the CF patient community, the UK National Health Service (NHS) and ‘UK PLC’.
Models
The CF patients remained at the core of our project; during our visits to the clinics, many patients expressed that they would rather continue treatment at home than in hospital when possible. This would help to minimise disruption to their working lives, the feeling of isolation in hospital and help to give patients some autonomy over their condition. Thus, we wanted to quantify the number of days a typical member of the CF community was absent from work/school for hospital IV treatment on an annual basis. We constructed two models; one based on the paediatric CF patients, Fig 1, and one based on those aged 16 or above in employment or full time study, Fig 2.
Currently on average, a working or studying CF patient is losing 40 days a year to IV treatment. With 10% implementation, these days could be cut down to 36 days, and then with 50% of the length of IV treatment cut down by The Lung Ranger this could cut down to 20 days.
Furthermore, a child with CF spends on average 30 days annually getting IV treatment; regularly missing school days due to the Monday-Friday schedule of clinics. With 10% implementation these days could be cut down to 27 days. With the length of IV treatment reduced by 50% by The Lung Ranger this could cut down to 15 days, changing the time lost from a month to a fortnight.
Whilst regarding the costs related to the NHS we investigated the cost associated with one day of hospitalization, which we discovered to be £264 per patient 1. We looked into the average number of days for which patients are hospitalized along with the number of patients and computed the reduction-hypotheses alongside this data. From this we concluded that if the length of hospitalized IV treatment could be cut down by 10%, it could save £1.5 million in costs for those patients on the CF Registry. However, if the long term tracking of lung infections could cut down the length of hospitalized IV treatment by 50%, the cost could be cut by half thus saving £7.7 million (Fig 3).
Finally, to investigate the implementation of the L.A.S.S.O. on the scale of the UK we considered the hours off work CF patients had to take due to IV treatment and the country’s Gross Domestic Product (GDP). We considered the GDP per person of the UK which is £22,3362 along with the average number of hours worked annually per employee in the UK; 1,669 hours3. From this we were able to estimate the average contribution of a person towards the GDP per hour, which was £13.38. Currently due to IV treatment the hours off work that CF patients are missing contribute to a loss in £26M to the UK GDP. From this we considered the possible recovered contribution in GDP based on our L.A.S.S.O. hypotheses, Fig 4.
Conclusions
If the L.A.S.S.O. could be successfully implemented at reasonable cost, the saving to the NHS and the wider financial benefits to society would be significant. However, most importantly, the successful implementation of a rapid diagnostic testing device, would allow mature CF patients to play a far greater and more active role in the workplace and those of school age to take full advantage of their educational and social opportunities.References
1 UK Government (2012) UK Government Reference Costs 2011-2012 [Online] Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213060/2011-12-reference-costs-publication.pdf [Accessed: 13th October 2014]
2
BBC News (2013) Scotland in numbers [Online] Available from: http://www.bbc.co.uk/news/uk-scotland-24866266 [Accessed: 13th October 2014]
3 OECD.StatExtracts (2013) Average annual hours worked per worker [Online] Available from: http://stats.oecd.org/index.aspx?DataSetCode=ANHRS [Accessed: 13th October 2014]
Welcome to Dundee's 2014 Wiki (Site Information)
Cystic Fibrosis is a genetic disease that results in the accumulation of thick mucus in the epithelial linings of the entire body, particularly the respiratory tract. Over the course of a patient’s life, the mucus-lined lung epithelium becomes repeatedly infected with pathogenic bacteria that stimulate an immune response; leading to inflammation, tissue damage, and ultimately, respiratory failure.
The microflora of the Cystic Fibrosis lung changes over time. In childhood, the major coloniser is Staphylococcus aureus, but as the patient matures other bacterial pathogens infect. The later-dominating pathogens, Pseudomonas aeruginosa and Burkholderia cepacia, are very difficult to eradicate and are associated with chronic decline in lung function. Burkholderia is so infectious that patients have to be isolated from one another, and can be denied lung transplants due to the persistence of this bacterium.
It is important, therefore, for medics to monitor and identify the levels of bacteria within the respiratory tract of a Cystic Fibrosis patient. Currently, patients must provide sputum samples and identification of bacteria takes between 72 hours and 2 weeks, by which point the bacteria can be in an antibiotic resistant state.
The Dundee 2014 iGEM project is focused on designing and testing a device that will rapidly and non-invasively identify the bacteria colonising a Cystic Fibrosis patient. Three biosensors will be developed that recognise external signal molecules produced by key bacteria, all of which are known to be in sputum samples of Cystic Fibrosis patients. A quinolone signal (PQS) is produced by Pseudomonas aeruginosa, a Diffusible Signal Factor (DSF) is produced by Stenotrophomonas maltophilia, an organism that is also associated with Cystic Fibrosis lung infection in adults, and BDSF is a related, but chemically distinct molecule that is produced by Burkholderia cepacia.
By engineering signal recognition and signal transduction proteins from these biological systems the Dundee iGEM team want to produce a portable electronic device that will identify infection outside of the clinic, so that patients do not have to travel great distances, and can be used to help health professionals make informed and rapid decisions on antibiotic treatments.
Read this again by clicking on Site Information in the navigation bar!
Bulletin Board (Policy & Practice)
Come look at the poster explaining how we involved the local and national Cystic Fibrosis community in our project, how we listened to people on the front line of the disease and how they affected our project.
School (Project)
Come in and learn about all the parts that make The Lung Ranger. The lab work that we carried out over the summer is explained here in detail, along with the modelling and implementation.
Library (Log Book)
Read about the experience the team has had over the summer. A week by week description of our work, how we carried out that work and some photos of our time together.
Saloon (iGEM community)
Come on in, take a seat and learn how we have interacted with the larger iGEM community. Who the team are, who helped them and how we helped others.
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