Specialist commentator comments

Comments on this technology were invited from specialist commentators working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

Nine responses from specialist commentators were received. One specialist commentator had used this technology before, and 1 had heard of it.

Level of innovation

Three specialist commentators considered PleuraFlow Active Clearance Technology (ACT) to be a minor variation on existing technologies, 3 considered it to be a significant modification with potential for different outcomes, and 3 that it was thoroughly novel. One described it as both a minor and significant variation, because any promise needed to be proven in a large trial and any evidence is currently anecdotal. Another considered it to be only somewhat innovative because there are other technologies that provide a similar function.

Potential patient impact

The safe evacuation of blood clots, avoiding cardiac tamponade and decreased risk of tube occlusion and subsequent complications were identified as possible benefits for patients, as well as the opportunity to use a smaller and more comfortable tube. Specialist commentator opinion was mixed on the frequency and seriousness of the complications that the technology sought to avoid and how many patients would benefit.

Potential system impact

Two commentators considered that the technology would improve patient safety. Three noted that if it did reduce the incidence of complications including retained blood, this could reduce hospital stays. Two commentators felt that the device might lead to fewer reoperations for bleeding, and another noted that it could reduce the need for tube reinsertions and allow faster effusion draining. All but 1 of the commentators felt that training would be needed to use the device; 1 noted that it was easy to establish and use.

Although most of the commentators considered that PleuraFlow ACT would increase costs, particularly in the short term, 2 felt it had the potential to reduce costs through reducing complications, or if it were used instead of non-portable suction devices. One commentator felt that it would need to be used on a large a number of patients to generate any savings.

General comments

Four of the specialist commentators felt that the evidence was limited and that more evidence, particularly randomised controlled trials, would be needed to confirm the technology's promise.

One commentator said that it could be used for people at high risk of bleeding, but that using PleuraFlow ACT would not lessen the actual rate of bleeding.