Overall summary
Epilepsy is a common neurological disorder characterised by recurring, unprovoked seizures. There is no definitive diagnostic test and waits for diagnosis can be long. Earlier diagnosis allows for quicker initiation of treatment and reduces the risk of hospital admissions.
Nelli® is a remote monitoring device that allows patients to be monitored at home. The device consists of a small camera on a stand which records patients while they are asleep or resting. These recordings are then analysed by artificial intelligence (AI), which identifies and classifies seizures enabling clinicians to accurately diagnose the patient and prescribe appropriate treatment.
The Oxford AHSN (now Health Innovation Oxford and Thames Valley) carried out a real world evaluation to generate the evidence required for a business case to support the adoption and spread of Nelli® in the epilepsy diagnosis pathway within the NHS in England. Environmental and cost benefits analysis were also carried out.
This was funded as part of a joint grant application (with NeuroEvent Labs, Oxford University Hospitals NHS Foundation Trust and The Royal Wolverhampton NHS Trust) from NHSx Digital Transformation, now the NHS Transformation Directorate.
What is the challenge?
Epilepsy is a common neurological disorder that is estimated to affect approximately one person in every 100 in the UK. There is currently no definitive test that can diagnose this condition, and clinicians rely on electroencephalogram (EEG) readings, telemetry recordings and patients self-reporting seizures. A significant number of patients with epilepsy also have intellectual disabilities that mean that they cannot tolerate an EEG cap – meaning that they often have to wait longer for a definitive diagnosis.
Patients are often incorrectly diagnosed due to the limitations of current testing, resulting in avoidable emergency department attendances and admissions. In 2019, the total reported cost for non-elective admissions for epilepsy was £89 million in England, with 20% of patients accounting for 60% of the total due to poorly managed epilepsy, or difficulties in diagnosing the type of epilepsy and start appropriate treatment.
What did we do?
The Oxford AHSN (now Health Innovation Oxford and Thames Valley) made a successful bid for funding from NHSx (now the NHS Transformation Directorate) which supports the digitisation of health and social care with the Buckinghamshire, Oxfordshire and Berkshire West Integrated Care System (BOB ICS) receiving £115,656.
The Oxford AHSN supported NeuroEvent Labs with the application for Digital Technology Assessment Criteria (DTAC) which is required for the technology to be used in an NHS and social care setting, before the evaluation commenced.
The service evaluation was conducted across two sites – Royal Wolverhampton NHS Trust and Oxford University Hospitals (OUH). The evaluation looked at whether Nelli® would fit into the clinical pathway as anticipated and would yield benefits both for the system and patients. As part of this evaluation, two focus groups were established to gather the views of patients and carers with epilepsy and gauge their willingness to potentially adopt the technology when it comes to the market. The overall response was extremely positive.
In addition, the York Health Economics Consortium (YHEC) created a health economics model to support further potential adoption which showed a saving of £431 per patient. Savings resulted from a reduced need for further complex tests which are currently required to obtain a diagnosis. The Environmental Sustainability Lead for the Kent Surrey Sussex and Oxford Health Innovation Networks established the carbon footprint reduction of 0.2 tonnes of CO2 related to this evaluation of 36 patients due to reduced patient visits to clinic to retrieve and return the equipment. In the current clinical pathway patients go to an epilepsy clinic for their initial assessment and have to return at a later date to obtain their monitoring equipment and return it 2 days later. The modified pathway with Nelli® involves shipping the equipment to the patient directly from the manufacturer, and a courier retrieving it after 2 weeks . This extrapolates up to a potential saving of 229 tonnes of CO2 if all 41,372 patients in England with epilepsy used Nelli® for their diagnosis. This is the equivalent of 229 flights between Paris and New York.
What has been achieved?
The health economics report found that Nelli® has the potential to aid in the diagnosis and classification of epilepsy with a potential cost saving of £431 per patient, based on the assumption that patients only go through one round of diagnostic testing, whereas many patients go through more than one before obtaining a diagnosis.
The service evaluation suggested that introducing Nelli® into the care pathway could reduce waiting times due to the increased capacity of the service, as NHS trusts are usually limited by the amount of telemetry equipment available. Nelli® also allows for a longer recording period, increasing the likelihood of capturing an event – thus reducing the need for multiple investigations or attending specialist centres that may necessitate significant additional travel time and cost. The use of AI to analyse the telemetry recordings also significantly reduces the clinicians’ workload – OUH reported that Nelli® freed up more than 11 hours in time previously taken to review the data presented and make a diagnosis. This can now be spent with other patients.
What people said
“As the challenges of long waiting lists, shortages of specialist healthcare professionals and rising costs face health care systems, the team at NEL are extremely grateful for the UK organisations that supported this important real-world evaluation. The data reinforces our existing global findings – highlighting the positive impact on patients, and significant improvements in efficiency and cost-saving. We are especially grateful for the support offered by Health Innovation Oxford and Thames Valley. As we roll out the technology across the UK, we are excited to play our part in utilising the power of AI to improve patient diagnostics.”
Kaapo Annala, CEO Neuro Event Labs (NEL)
What next?
The two NHS trusts which took part in the service evaluation are creating business cases to support procurement of the technology – and there is also interest from other NHS trusts. In addition, OUH is exploring alternative uses for Nelli®, such as diagnosis of REM sleep disorders.
Contact
Ashley Aitken, Senior Programme Manager, Health Innovation Oxford & Thames Valley Ashley.aitken@healthinnovationoxford.org