NICE guidance on new device will benefit cancer patients with abdominal fluid retention

NICE, the healthcare guidance body, today (21 March) publishes final guidance supporting the use of a new device that can help reduce the severe abdominal fluid retention experienced by some cancer patients.

The medical technology guidance says that the PleurX peritoneal catheter drainage system for vacuum-assisted drainage of treatment-resistant, recurrent malignant ascites should be considered for use in patients with this condition. Ascites is the build up of too much fluid between membranes lining the abdominal wall, and can be a symptom of different types of cancers. The large volume of fluid causes pain, a very swollen abdomen, nausea, difficulty in breathing and getting around, and psychological distress.

The evidence suggests that using the PleurX system can improve patients' quality of life for those with treatment-resistant, recurrent malignant ascites, is clinically effective, and has a low complication rate. The device fits into the abdominal wall, and enables the fluid to drain out via a catheter into a vacuum bottle. One important benefit of the PleurX system is that the fluid can be drained at home as needed, so it's not necessary to wait for an uncomfortably large volume of fluid to build up for removal in hospital as is currently the case. The system is also likely to save the NHS around £679 per patient compared with hospital inpatient large-volume paracentesis (fluid drainage).

Professor Carole Longson, Health Technology Evaluation Centre Director at NICE said: "For some people with cancer, ascites is a difficult and serious complication, so we're delighted to issue final guidance supporting the use of the PleurX peritoneal catheter drainage system to relieve the severe abdominal fluid retention experienced by these cancer patients. The independent NICE Medical Technologies Advisory Committee was convinced by evidence showing that the PleurX system appears to offer benefits to both patients and the NHS, by enabling early and frequent draining of malignant ascites at home, rather than waiting for hospital inpatient treatment.

"In addition, the use of this system is estimated to save the NHS around £679 per patient compared with inpatient large-volume paracentesis. Across the NHS in England, implementing the guidance could mean an estimated annual saving of nearly £900k. It's vital that oncology and commissioning staff, along with cancer patients, are aware of this option for managing ascites, so that both patients and the health service can benefit as quickly as possible. We therefore hope that this new medical technology guidance will encourage health professionals to adopt the PleurX system."

Commenting on the new NICE guidance, Duleep Allirajah, Head of Policy at Macmillan Cancer Support, said: "Ascites is a symptom of many types of cancer and can be very distressing. We support any device which helps to relieve the pain and discomfort of this side-effect. Its use will enable more cancer patients to receive good palliative care in a community setting."

The guidance PleurX peritoneal catheter drainage system for vacuum-assisted drainage of treatment-resistant, recurrent malignant ascites, is available at: mtg9 .


Notes to Editors

About the guidance

1. The PleurX peritoneal catheter drainage system is distributed by UK Medical Ltd.

2. The costs for the PleurX peritoneal catheter and the PleurX drainage kit with a 1 litre vacuum bottle are £245 and £64 per unit respectively.

3. The current commonly used method of draining ascites in hospital - paracentesis - involves inserting a catheter, often under local anaesthetic, into the peritoneal cavity to drain ascitic fluid. During large-volume paracentesis the catheter stays in place until most of the ascites has been drained, which often exceeds 5 litres of fluid. Some patients may require a hospital stay for one or more nights for the procedure to be completed.

4. Implementation tools to support this guidance are available at mtg9.

About the Medical Technologies Evaluation Programme

5. Established by NICE in 2009, the focus of this new area of work is specifically on the evaluation of innovative medical technologies, including devices and diagnostics. The types of products which might be included are medical devices that deliver treatment such as those implanted during surgical procedures, technologies that give greater independence to patients, and diagnostic devices or tests used to detect or monitor medical conditions.

The independent Medical Technology Advisory Committee (MTAC) has two core remits: selecting medical technologies for evaluation by NICE guidance programmes and also developing medical technologies guidance itself. In producing medical technology guidance, MTAC looks at whether a device offers benefits to the patient and NHS at a lower cost compared with similar products, or increased benefits for equal cost. The guidance applies to the NHS in England, and is not mandatory.

More information is available at /guidance/mtg3/resources/medical-technologies-evaluation-programme.

About NICE

6. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health.

7. NICE produces guidance in three areas of health:

  • public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
  • health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
  • clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

8. NICE produces standards for patient care:

  • quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
  • Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients

9. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.

This page was last updated: 20 March 2012