Improved management of anaemia could save the NHS millions

• Led by University College London (UCL), PREVENTT was initially a Health Foundation Shine 2010 project. It aimed to improve the management of anaemia in surgical patients and reduce the need for routine blood transfusions.
• The success of the project led to a large scale clinical trial, plus international collaboration in the field of patient blood management.
• If adopted into full clinical practice in the UK it’s thought the PREVENTT approach could generate £35m in direct cost savings to the NHS a year.

About PREVENTT

Back in 2010, a team from the Division of Surgery and Interventional Science at UCL, in collaboration with NHS Blood and Transplant (NHSBT), set out to improve the management of anaemia and blood transfusion in patients undergoing elective surgery. They were funded by a £75,000 grant from the Health Foundation’s Shine 2010 programme.

An audit carried out by the Shine team found that one in three surgery patients were anaemic before their operation and that these patients used over twice as much blood as other patients and spent twice as long in hospital. The team wanted to test out the use of a new iron product, Ferinject, which could give a one year supply of iron via a 15 minute injection, reducing the need for transfusions among these patients.

Overcoming challenges

‘The NHS spends millions every year on blood transfusions and transfusion products. Although Ferinject was a new cost, we wanted to test whether it could generate overall cost savings by reducing the need for blood transfusions’, explains project lead for PREVENTT, Toby Richards, who is also a consultant and a professor at UCL.

Removing the risk of complications associated with anaemia, which can lead to longer hospital stays, also promised to improve patient safety and experience. ‘The aim was to improve patient welfare and outcomes following surgery as well as to reduce length of stay’, he says.

However, the team faced challenges getting the project off the ground. ‘We were trying to use a new product in a new indication before a formal clinical trial had taken place’, Toby explains.

‘As there was a lack of evidence that this idea (no matter how good it appeared) was actually effective clinically, the pharmacy committee refused to accept Ferinject into the hospital’s formulary’.

Despite this, and with the aid of the British Blood Transfusion Society, Toby was able to establish a pilot trial of Ferinject at Kings Lynn Hospital.

From local success to national trial

After the project eventually got underway, a health economics analysis by the Shine team successfully showed that Ferinject, despite being more expensive, could generate direct cost savings through shorter hospital stays and reduced overall costs.

This data helped to justify a £3.7m multi-centre trial funded by the National Institute for Health Research. The PREVENTT trial is due to finish in 2016. If successful it will be assessed by NICE and the approach could be in full clinical practice by 2017 – potentially generating £35 million in direct cost savings to the NHS a year.

International impact and awareness

Despite the fact that the trial is still ongoing, this approach to anaemia management has already contributed to a new model of transfusion practice termed ‘patient blood management’. There is also now a widespread awareness that anaemia is a significant safety and efficiency challenge and that transfusion may not be the most effective solution.

Toby was invited to join a working group with the Department of Health which has developed Patient blood management – the future of transfusion medicine: an internationally recognised quality improvement programme to be adopted in the NHS this year.

As Toby says, ‘Blood transfusion is an excellent and precious resource and appropriate use is a pivotal to the welfare of patients. It’s great to see that since 2010, the number of blood transfusions needed in the UK has reduced by a third.’

The importance of funding innovation

In the five years since being funded by the Health Foundation, Toby has gone on to be awarded a further 18 grants and awards and written 79 academic papers. He now oversees six PhD students, and runs multiple national and international trials on iron therapy and patient blood management.

In 2015 he was promoted to Professor of Surgery at UCL. He sits on the NHSBT transfusion and audit committees and is the Lead for Patient Blood Management for the London transfusion committee with the aim to develop the Royal Free Hospital as a national centre for excellence. Toby has also acted as a consultant to a QI programme on blood transfusion in Australia which has delivered savings of $100m.

For its willingness to back his proposal back in 2010, Toby feels that the Health Foundation deserves thanks.

‘This has moved from an obscure issue to something very topical and important. I’m really grateful to the Health Foundation for its support, not many other funding bodies would have been prepared to back a new researcher operating in such an obscure area. They also stuck with the project despite its implementation difficulties and delays, and this sustained commitment was critical in paving the way for the national trial, the international interest in our work, and very significant NHS savings.’