Many people across the UK live with poor bowel health, suffering with chronic constipation and/or faecal incontinence, which can be debilitating and prevent those suffering from enjoying their best life possible. The ‘Cost of Constipation Report’ (2020), published by the Bowel Interest Group, documents that in fact one in seven adults are affected by constipation at any one time; while many people suffer in silence (Bowel Interest Group, 2020).  

Similarly, the group’s preceding ‘Cost of Constipation Report’ illustrates that a primary diagnosis of constipation led to 71,430 hospital admissions in 2017/18. Alongside this, NHS England spent £168 million on constipation and £87 million on laxative prescribing in 2018/19 (Bowel Interest Group, 2020). With the NHS operating under a post-Covid recovery plan and resources being stretched, ensuring cost-effective treatments that prevent the consumption of other healthcare resources is essential.  

For patients living with intimate healthcare needs, the product(s) they wish to use also forms an essential part of their healthcare rights as outlined in the NHS Constitution. These products provide solutions to the challenges people living with intimate health needs face and help to improve their quality of life. Every day, Coloplast UK and Ireland hear from patients using its products about how these have helped to transform their lives and improve health.  

Coloplast develops products and services to make life easier for people with deeply personal and private medical conditions. These conditions are often associated with trauma and taboo. The more intimate the condition for the patient, the greater the requirement to understand their world and develop solutions that are sensitive to their specific needs.  

Due to the nature of intimate health care — where products are typically prescribed by a specialist rather than a generalist; product choice for clinicians is in the first author’s clinical experience welcomed. Healthcare professionals in intimate health care need the flexibility to treat individual needs of diverse patients with the right product at the right time (Coggrave, 2012). It is already well documented that personalised care can, in turn, improve patient compliance and eliminate or reduce costly avoidable incidences of poor health for the wider health system (NHS England, 2022).  

TRANSANAL IRRIGATION (TAI)  

TAI is used as a treatment for patients with bowel dysfunction, helping to improve faecal incontinence and chronic constipation by facilitating the emptying of the bowels. When performed regularly, TAI can also help people with bowel dysfunction to regain control of bowel function, ‘including time and place of bowel movements’ (Mekhael et al, 2021).  

People will be introduced to TAI for a variety of reasons. It could be for neurological and non-neurological conditions — but, as with all intimate health care, for many, talking about it can still be extremely awkward. Therefore, in the authors’ opinion, knowledge is power — having choice of product combined with trusted clinical advice and guidance is important.  

At a time where shared decision-making is key, the guidance that the National Institute for Health and Care Excellence (NICE) provides can help patients and carers to ‘receive care that is based on the best available clinical evidence; Be accountable for their care and know they will be cared for in a consistently evidence-based way; Improve their own health and prevent disease’ (NICE, 2022a). NICE guidance and the implementation resources it provides also support commissioners to provide high quality, evidence-based services for patients and local populations (NICE, 2022a) by NICE’s Medical Technologies Evaluation Programme (MTEP). This programme takes the time to consider which technologies could offer benefits to patients and the health and social care system over current practice and develops guidance and recommendations to the NHS. Medical technology guidance not only helps people in the NHS make efficient, cost-effective and consistent decisions. 

Here, the ‘case for adoption’ was based on the claimed advantages of introducing Peristeen® compared with current management of constipation. This was reviewed against the evidence submitted, alongside expert advice, and the case for adopting Peristeen® was supported. In other words, the product was found to offer advantages to patients and the NHS. NICE states that: ‘Peristeen® can provide important clinical benefits in most people with bowel dysfunction, including improving quality of life and promoting independence’ (NICE, 2022b).  

More recently, NICE reviewed this medical technology guidance (MTG36) and proposed an amendment to reflect changes in the technology from Peristeen® to Peristeen® Plus (Figure 1) and revised the cost-savings which demonstrate that Peristeen® Plus is more cost effective than standard bowel care alone. 


Figure 1. Peristeen® Plus 

IMPORTANCE OF EVIDENCE  

HealthTech has become increasingly regarded as having the potential to reduce costs and increase the efficiency of healthcare systems (Association of British HealthTech Industries [ABHI], 2021a).  

For many years, Coloplast has invested in clinical studies to examine the effectiveness of its TAI system, Peristeen®. In 2016, the opportunity arose to have this data reviewed and assessed about adopting new medical technologies, but also supports innovation and transformation, improving healthcare delivery. 

COST-EFFICIENCY  

Given the impact bowel dysfunction has on patients and the healthcare system as a whole, healthcare professionals are always looking for clinically appropriate, cost-effective treatments to address these challenges. At a time when resources are stretched and healthcare professionals are working tirelessly to address the challenges brought about by the Covid-19 pandemic, it was important to see the updated NICE guidance reaffirming that, used routinely, Peristeen® Plus is a cost-effective solution to optimising bowel dysfunction and reducing the severity that chronic constipation can bring (NICE, 2022b).  

Indeed, by helping people with bowel dysfunction to better manage their condition, the device has been found to support cost-savings within the system by reducing the need for avoidable healthcare professional visits, facilitating fewer hospitalisations, reducing the incidence of urinary tract infections (UTIs), freeing up time for carers, and decreasing the additional costs associated with managing recurring episodes of faecal incontinence (NICE, 2022b). This combination of factors led NICE to advise that the NHS adoption of Peristeen® Plus could facilitate savings of £5,144 per patient over a 37-year time horizon and recommend that ‘it is likely’ that Peristeen® Plus ‘provides additional clinical benefits without costing more than standard bowel care’ (NICE, 2022b).  

  

CONCLUSION  

In conclusion, evidence-based practice provides healthcare professionals with a method to use critically appraised and scientifically proven evidence for delivering quality health care to a specific population. Reassuringly, the processes for the development of medical technology guidance at NICE means that patient benefits, system benefits and cost benefits have already been considered.