HEALTHCARENational Innovation Centre www. nic. nhs. uk Case study - prostate cancer - the WIBGI approach In summer 2009, the British Urological Insti-tute and the Devices for Dignity HTC identified a number of important clinical needs within the Urology service. They said: " Wouldn't It Be Great If. we had improved biopsy analysis for suspected prostate cancer cases". The organi-sations also suggested desired solutions, the business opportunities they might present and other requirements that might be needed to bring the concept to market. Here's what they said about the need: . PSA tests have led to a large increase in sus-pected cases of prostate cancer requiring an invasive biopsy of the prostrate. . The biopsy of the prostrate requires samples taken from multiple sites to ensure a rep-resentative tissue sampling, it is inaccurate and unpleasant for the patient and has sig-nificant complications. . In around 70% of cases, the biopsy process does not reveal a clinically significant pros-tate cancer which requires further surgical intervention. Here's what they said about desired solution attributes: The main features should be: . Improved ergonomics for patient and surgeon; . Design to allow multi- site testing from single insertion; . Less painful for the patient; . A ' one- click' test; . New access route; . Metrics to identify aggressive cancer; . Less pain through local anaesthetics; . Less pain through ' micro- needles'; . Combine diagnostic with therapy; . Improved needle guidance; . Visualisation of prostate; . Less post- op bleeding; . Infra- red tissue imaging from rectum; . Contrast imaging for prostate; . Contrast that sticks to PSA; . Improved biopsy analysis to avoid need for cone biopsy; . Improved needle design ( to avoid needle stick risk); . Acceptable cost to Trust. Here's what they said about business opportunities: . Men live longer lives; . Read across to/ from other procedures; . 50% of world's population as potential patients; . Market size to make business case; . No other solution imminent so wide window of opportunity; . Global market size; . Other solid organ cancers; . Reduce cost to NHS; . Cost to develop technology; . Risk: NHS not accepting the benefits; . Disposable commodities: business opportunities for service; . What is the purchaser's view and tariff; . Screening entire population will follow if prognostic tests are effective; . Other cancer biopsy opportunities; . Cannot understand market failure; . IP; . Four/ five different technologies need to come together; . Pharmaceutical solution would make device approach redundant. Here's what they said about research requirements: . Gather stats on outcomes of current surgical procedures; . Health economic questions; . How men die of prostate cancer after a reassuring biopsy result; . What percentage of cancers are aggressive; . Is oral/ local pain therapy of any value; . Is workflow optimised; . Isolating/ storing tissue for research; . Industry interest; . How to improve prostate contrast; . How many cancers are upgraded or downgraded by full prostatectomy; . Review surgical environment to be more procedure friendly; . Proper evaluation of disruptive technologies; . How many refuse biopsy because it is so awful; . Pain management: before, during, after . Idealised theatre layout; . Cost of ' missing' in first biopsy- CT; . Market drivers minimum sample size for validity; . Research technologies used in other areas ( endoscopy etc); . What is approach in US/ Japan; . Understanding risk factors, genetics, lifestyle, hormonal effects. Here's what they said about enablers: . Seed funding ( e. g. for improved tool design); . Public health awareness of prostate cancer . Cool technology ( e. g. Da Vinci machine); . Better treatment outcomes; . NHS approved; . Articles in lay press; . Pressure groups; . Competition incentive for industry to get involved. For further information and application forms, see: http:// competitions. nic. nhs. uk/ ChallengeList. aspx Urology needs Non- intrusive rapid diagnosis Clinicians attending a Urology WIBGI said that there was a priority need for accurate, non-intrusive rapid diagnosis of prostate cancer
INNOVATION UK HEALTHCARE Showing the solution works in the real world Demonstrating that a product works and validating its use is a critical part of the NIC's func-tion. Examples currently include software that helps protect staff from violent patients; the potential benefits to staff and the NHS are significant, and the system is be-ing assessed in a growing number of Trusts. Another innovation is a technology that cleans instru-ments of bacteria ( prions) that cannot be eradicated by traditional autoclaving. The NIC is aiming to set up demonstrations to show the efficacy of the process on known contaminated instruments Sharing the results Although the NIC's job finishes once a product is market ready, it has strong links with the NHS Sup-ply Chain who can give an early as-sessment of market potential and are kept informed of any products that are getting near to market. The NIC also selects examples of excellent innovation and show-cases them on its website www. nic. nhs/ showcase. It then brings this to the attention of the rel-evant interested clinical communi-ties. Showing a new product every month, the NIC selects from across the innovation landscape, both UK and internationally. Using video footage and animations to illus-trate the innovation, the Show-case offers an economic analysis of the value to the patient and the NHS as well as access to related re-search. In October 2009, the site will also have a ' chat room' where interested parties can discuss the innovation privately with users. Current Showcase examples in-clude a new surgical procedure in tracheal transplant, a clinical waste management system and a virtual reality ( Haptics) training simulator. Stimulating the market As well as proactively identify-ing needs, the NIC also receives hundreds of ideas each year that arrive unprompted from innova-tors. In order to respond to the huge number of ideas, the NIC has developed an innovation manage-ment system via a set of online tools www. nic. nhs. uk and offline services. These provide a one- stop shop for innovators who want to assess their ideas and access com-mercial advice. The key tool is a Scorecard that allows innovators to assess their ideas for themselves. As the in-novator works through the Score-card's exacting analysis, he can get access to a wealth of additional information that will help him ne-gotiate more rapid entry into the NHS. All of the NIC web- based tools comply with EU commission-ing requirements and are ISO9001 accredited. Estimated costs of violent be-haviour towards staff in the NHS run to millions of pounds each year. The NIC's Scorecard allows innovators to assess their ideas for them-selves in confidence. The NIC's Showcase acts as an open innovation platform where companies from the UK and overseas can have their products demonstrated, and where relevant financial organisations can learn about investment opportunities.