4 Committee discussion
4.1 The committee noted that the evidence presented for Thopaz+ was mainly for its use in patients after pulmonary resection. The clinical experts confirmed that this reflected their experience in the NHS. The committee considered that Thopaz+ has clear clinical advantages compared with conventional chest drainage using wall suction in patients after pulmonary resection, including a shorter drainage time and a shorter length of stay in hospital.
4.2 The committee recognised that the evidence to support the use of Thopaz+ for chest drains inserted after a pneumothorax was relatively limited. Nonetheless, the committee noted that the studies available appeared to demonstrate clinical benefits that were comparable with those observed after pulmonary resection. One clinical expert noted that audit data from their NHS hospital had indicated that Thopaz+ showed similar clinical advantages in both patient populations. The committee therefore concluded that the clinical benefits of the technology are likely to be generalisable to patients with pneumothorax.
4.3 The committee considered the use of Thopaz+ in other patients who need chest drainage. None of the experts had experience of using the technology in children, but they did report the use of Thopaz+ in other patients needing chest drainage (such as after cardiac surgery and trauma). The clinical experts explained that if devices are available on wards they may be used safely for a broad range of patients who need chest drainage, but evidence to support clinical or system benefits in these circumstances is currently lacking.
4.4 The clinical experts stated that there are other potential benefits that may not be reflected in the published evidence. They described improved decision-making because Thopaz+ can objectively measure the rate of air leakage and total fluid drainage. The clinical experts also advised that Thopaz+ is portable and easy to manage, allowing increased mobility which aids recovery and patient satisfaction. The committee concluded that there may be additional advantages for patients not captured in the published studies.
4.5 The clinical experts explained that using Thopaz+ allows treatment across wards to be standardised, because it provides objective measurements of air leakage and fluid loss. These data make it easier to assess and record patients' progress. This, in turn, may help clinicians determine when is best to remove the chest drain. One clinical expert explained how the use of Thopaz+ had helped them redesign the logging system for chest drain management.
4.6 The committee heard that managing chest drains with Thopaz+ is easier than with conventional chest drainage and this may release nurse time. Patients may also need fewer chest X-rays with the use of Thopaz+.
4.7 The clinical experts explained that using Thopaz+ improves patient safety. The system has in-built alarms that warn users of potential problems such as a blocked tube, full canister or low battery. When visiting the X-ray department, people may be safely accompanied by non-nursing staff because of the alarm. If the device is accidentally switched off, it changes to a normal, single-way valve chest drain. The committee concluded that the safety features of the technology increase staff confidence in managing chest drains.
4.8 The committee noted that the estimated cost savings with Thopaz+ of £111.33 per patient in people after pulmonary resection was largely attributable to a reduced length in hospital of up to 1.5 days (average 0.4 days) per patient compared with conventional chest drainage. The committee considered the implications of this reduced length of stay and whether it was realisable in practice. The clinical experts explained that the continuous, objective monitoring possible with Thopaz+ helps reliable decision-making and encourages earlier chest drain removal and discharge. The committee noted that Thopaz+ remained cost saving even with a difference in length of stay of only 0.071 days.
4.9 The EAC explored device utilisation in a sensitivity analysis. In its base case, the company assumed 50% device utilisation. The committee heard from 2 clinical experts who use Thopaz+ that device utilisation in their own units was closer to 100%, and that once introduced Thopaz+ rapidly became the standard of care for patients with chest drains. The committee concluded, therefore, that the device utilisation in the company's base case was conservative.
4.10 The committee considered the different options through which Thopaz+ is available (that is, purchase or rental). It noted that the EAC scenario analysis based on a £3,400 purchase price resulted in increased savings of £124.76 per patient. However, including the purchase of 5-year warranties reduced the cost savings by £1.90 per patient. The company stated that leasing arrangements are available and that volume purchasing discounts are available; for example, buying over 20 devices would reduce the individual purchase price to £2,700.
4.11 The committee also noted that given the potential additional savings in staff time that had not been captured either in the published evidence or cost model (such as through non-clinical staff escorting patients to X-ray), the estimated total savings were likely to be conservative. Furthermore, the model did not include additional factors such as improved clinical decision-making based on objective data monitoring and reduced rates of complications.
4.12 The committee concluded that cost savings are also likely in people with pneumothorax. It noted that the EAC's scenario analysis, which produced a cost saving of £550.90 per patient, was based on a single comparative study. This reported a larger difference in length of hospital stay between Thopaz+ and conventional chest drain use in people with pneumothorax compared with people after pulmonary resection (1.9 days compared with 0.4 days). The clinical experts clarified that shorter drainage times and lengths of stay were plausible in this patient group. The committee concluded that Thopaz+ is likely to be cost saving in people with pneumothorax, but that the evidence is more uncertain than in people after pulmonary resection.
4.13 The committee concluded that using Thopaz+ is likely to lead to significant clinical and system benefits compared with conventional chest drainage in people who need chest drainage after pulmonary resection or pneumothorax.