an Economist Intelligence Unit business healthcare
East Midlands Specialised Commissioning Group
Percutaneous Aotric Valve Replacement (PAVR) is a new and innovative technique for replacing defective heart valves whereby an artificial valve is mounted on a catheter and delivered to the heart via a major artery. In comparison to open heart surgery – the way valves are traditionally replaced – PAVR is minimally invasive. Consequently PAVR is mostly used in people deemed too frail for open heart surgery, however it has the potential to expand beyond this current indication to become a more commonly used procedure.
One factor limiting the broader adoption of PAVR: its clinical efficacy is not clearly established. Randomised controlled trials are underway, but a blanket refusal to fund PAVR until the results are available risks stifling innovation and risks denying patients access to emerging best practice. Clearly a sensitive approach to funding PAVR is required – one which balances the need for innovation with the need for evidence-based service and pathway design.
East Midlands Specialised Commissioning (EMSCG) recognised the potential of PAVR and wanted to systematise the processes for funding it, moving from an ad-hoc approach to a more systematic one.
A number of deliverables and tools would be required for change to happen, and stakeholders would have to be kept on board throughout the process. Working collaboratively with EMSCG we developed:
The project created real and lasting changes. The main outcomes were that:
“The work done on PAVR with Bazian brought together commissioners, clinicians and academics to ensure that the commissioning of this new, innovative procedure will be based on sound evidence. This will benefit future NHS patients, and has demonstrated that we can introduce new technologies through a robust research-led approach. It also provided a model for introducing innovations to the NHS in the future through a collaborative process based on World Class Commissioning.”
Kate Caston, Director of EMSCG