4 NHS considerations

4 NHS considerations

System impact

4.1 Adopting Spectra Optia is claimed to have a range of system benefits (see section 2.4). Published evidence was presented on procedure times and treatment intervals (see section 3.16) but not on the other outcomes.

4.2 Clinical experts informed the committee that Spectra Optia may be operated by 1 appropriately trained nurse. In larger units with more than 1 machine, 1 nurse can potentially manage 2 patients having exchange procedures at the same time. The company provides initial and refresher training at no additional cost. Operator competency may be more difficult to maintain in areas with low numbers of patients.

4.3 Spectra Optia is a multifunctional device and is already in use at many hospitals for other indications. The low prevalence of sickle cell disease in some parts of the UK means that existing Spectra Optia devices could be made available as part of a device‑sharing scheme. The external assessment centre developed a scenario which explored the costs and benefits of this.

Committee considerations

4.4 The committee discussed the current lack of consistency in services for people with sickle cell disease. Most people with the disease live in major urban centres, so services in cities must be able to provide for a large sickle cell population. In contrast, in rural areas there may be only a small number of people with sickle cell disease. The clinical experts advised that around 75% of sickle cell patients are based in London, with significant populations in both Manchester and Liverpool. The committee was made aware that a review of services in England is being carried out by the NHS's clinical reference group advising on haemoglobinopathy (F05 Haemoglobinopathies) to ensure that there is 1 designated centre for each geographical area.

4.5 The committee noted that automatic exchange with Spectra Optia uses more packed red blood cell units than manual exchange, even taking into account the longer interval between procedures.

4.6 The committee noted that current levels of tariff remuneration may serve as a disincentive to the use of this technology. The committee was also advised by clinical experts that there is currently inequity of access to treatment with Spectra Optia and that the devices are more often used for other conditions and not necessarily offered to patients with sickle cell disease.

  • National Institute for Health and Care Excellence (NICE)