Background and purpose
Colorectal Cancer (CRC) is the second most common cause of cancer death, causing 16,000 deaths in the UK annually, and mostly arising from pre-cancerous adenomas. Adenomas are detected by colonoscopy and the most important contemporaneous marker of colonoscopy quality is Adenoma Detection Rate (ADR). However, this varies widely between individuals in part due to folds in the colon limiting the field of view. Better ADR is linked to a decrease in both CRC rate and mortality risk through earlier detection. Therefore, Newcastle University investigated the effectiveness of Endocuff Vision (EV), an inexpensive and simple device which is used during colonoscopy to improve ADR.
Outcomes (achieved or projected)
The ADENOMA trial was one of the largest endoscopy trials performed and its impressive results led NHS England to fast-track EV into practice in April 2018, followed in 2019 by NICE recommendation. Further, EV adoption was supported by the Innovation Technology Payment (ITP) Scheme, which was an NHS England based programme which ran until April 2021 and was focussed upon the acceleration of innovative medical devices into practice.
The number of units supplied increased from 1,500 across 17 sites in 2017/18 to 39,000 across 101 sites in 2018/19. By 2019/20, 69,000 units were supplied across 119 sites, even in the context of the COVID-19 pandemic and the significant reduction in endoscopy capacity.
In the US, the success of EV drove the expansion of ownership and distribution rights to successively larger companies. Since July 2019, these rights moved region by region to Olympus, the world’s leading endoscopy company with more than 70% of the market share and an Endoscopic Solutions Division worth over £3 billion.
Who will benefit and how
The most important beneficiaries are patients at risk of CRC. Benefits include:
- Earlier detection of precancerous lesions so that they can be removed, and CRC prevented.
- Quicker procedures, which is better for patients and improves hospital efficiency.
- NHS cost savings compared with standard colonoscopy.
- Reduce future rates of CRC, by identifying pre-cancerous polyps, and allowing their removal.
How the NHIP contributed to the outcomes
The Academic Health Science Network for the North East and North Cumbria (AHSN NENC), a core member of NHIP and part of the AHSN Network, has a remit to support the Accelerated Access Collaborative and other NHS England and Improvement Programmes, aimed at accelerating the adoption of ground-breaking new treatments. Previously, the AHSN Network, and accordingly the AHSN NENC, supported the adoption of EV via the ITP Scheme. The AHSN NENC partnered with the Newcastle University team and local NHS partners to support both regional and national adoption of EV.
Contribution to reducing inequalities
NHIP, via the AHSN NENC, accelerated adoption of EV into national practice, thus helping to reduce inequalities by providing access to EV across secondary care, ensuring all patients had equal opportunity to access this important intervention.
Reflections and learnings
EV has provided an example of how academia, the NHS and industry can work in partnership to develop, test, and spread and adopt a novel technology.
We envisage that the approach applied to support the implementation of Endocuff Vision will become a physical embodiment of NHIP. We will continue to work in a cohesive fashion with the AHSN NENC by supporting a regional pipeline of innovations that can be developed and evaluated, prior to adoption on both a regional and national scale. Further, our partnership will support the co-creation of solutions (between industry and the NHS), which address unmet needs within healthcare. This activity will not only improve patient outcomes but also positively contribute to economic growth through the creation of new jobs and the securing of inward investment.
This work has been recognised in multiple awards for this work including: National Institute for Health Research and British Society of Gastroenterology Prize for Outstanding Research Contribution – July 2021; Royal College of Physicians Excellence in Patient Care Award – 2020; UK Healthcare Industry Award for Research – November 2018; AHSN NIHR Innovation Award for Research – November 2018; Medilink Healthcare Business Award for Research – March 2018, and the Health Service Journal Research Impact Award – 2016.