The guidelines include recommendations on the use of chest drains including details on chest drain insertion, image guidance, aseptic technique, securing the drain, the drainage system used, and management of a chest drain. The British Thoracic Society (BTS) has previously published guidelines on pleural disease. However, no previous guidance on chest drain management has been issued by NICE. The insertion of chest drains has been recommended by NICE in their guideline for major trauma. In 2016–2017 there were 32,317 chest drain insertions of the pleural cavity, 10,821 drainages of the pleural cavity and 7336 instances of chest tubes of the pleural cavity requiring attention in England. This includes, but is not restricted to, chest drainage following pulmonary resection and pneumothorax. īackground to the Condition and TechnologyĬhest drains are required for the treatment of a number of procedures/conditions that affect the thoracic cavity.
PLEUR EVAC ATRIUM SERIES
This paper is part of a series that provides an insight into the development of NICE MTG. Thopaz+ chest drain management systems are manufactured by Medela. Cedar is a healthcare technology research centre formed through collaboration between Cardiff and Vale University Health Board and Cardiff University, and was responsible for producing the assessment report.
PLEUR EVAC ATRIUM PORTABLE
This paper reports on how Cedar’s assessment report was used to inform MTG on the Thopaz+ portable digital system for managing chest drains.
The report is used, in addition to the manufacturer’s submission, by the Medical Technologies Advisory Committee (MTAC) during its decision-making process. The results of the review and critique are presented in an assessment report. External assessment centres review and critique the manufacturer’s submission. The submission contains both clinical and economic evidence in order to make a case for adoption of the technology. Briefly, technologies are selected based upon company notifications on their medical device or technology those selected have a scope published by NICE and this is followed by a submission by the company. The process of completing these evaluations, known as Medical Technologies Guidance (MTG), has previously been described in detail. The programme provides support for National Health Service (NHS) technology adoption and generates guidance on diagnostic technologies and medical devices. The Medical Technologies Evaluation Programme (MTEP) of the National Institute for Health and Care Excellence (NICE) evaluates innovative or new medical technologies. Thopaz+ received a positive recommendation in Medical Technologies Guidance 37. However, the MTAC received details of an unpublished audit of Thopaz+ which confirmed its efficacy in treating patients with pneumothorax. The sub-group analysis was based on a single comparative study.
PLEUR EVAC ATRIUM DRIVER
The main cost driver for the model and sub-group analysis was length of stay. Cedar also carried out a sub-group analysis of the use of Thopaz+ instead of conventional drainage in patients with pneumothorax where a cost saving of £550.90 was observed. The model was improved by Cedar and showed a cost saving of £111.33 per patient when Thopaz+ was used instead of conventional chest drainage in patients following pulmonary resection. No economic evidence was submitted by the manufacturer, but a simple decision tree model was included. One comparative study of the use of Thopaz+ in patients with spontaneous pneumothorax was identified and showed shorter drainage times and a shorter length of hospital stay compared to conventional drainage. Clinical evidence showed that the use of Thopaz+ led to shorter drainage times, a shorter hospital stay, lower rates of chest drain re-insertion and higher patient satisfaction compared to conventional chest drainage when used in patients following pulmonary resection.
Due to a lack of clinical evidence submitted by the manufacturer, Cedar carried out its own literature search. The manufacturer, Medela, submitted a case for the adoption of Thopaz+ that was critiqued by Cedar, on behalf of NICE. The Thopaz+ portable digital system was evaluated by the Medical Technologies Advisory Committee (MTAC) of the National Institute for Health and Care Excellence (NICE).
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