The Company and ProductKimal Plc is a UK company based in Uxbridge and Worcestershire and specialises in both the distribution and manufacture of medical devices and electromedical equipment. Turnover in 2008 is forecast to reach £25 million with exports forming nearly 40% of turnover. They export to customers in over 70 countries.

The Aquadex Flexflow system is designed to remove fluid in patients suf-fering from decompensated congestive heart failure (CHF). In particular, those patients with diminishing renal function or inability to achieve weight loss with usual pharmacological therapy. Aquadex uses the concept of ultrafiltration (UF), to allow rapid, safe, controlled isotonic removal of salt and water. Aquadex therapy can be performed in a day-case/outpatient or inpatient setting. Presently 3 UK hospitals are evaluating the system. The Centre for Evidence based Purchasing (CEP) - part of the NHS Purchasing And Supply Agency (PASA) have performed a fully worked-up technology review on Aquadex. The completed study can be found at:http://www.pasa.nhs.uk/PASAWeb/NH-Sprocurement/CEP/outputs/Genmedso-cialcare.htm#cardiacCEP 07017 Evaluation report: CHF Solutions Aquadex Flexflow ultrafiltration systemCEP 07016 Ultrafiltration therapy for fluid overload in heart failure Evidence review and Interactive cost impact analysis

Benefits and examples■ The therapy is beneficial to patients as it allows fluid to be removed quickly and safely, without compromising renal func-tion or producing other side effects seen with aggressive pharmacological therapy. It also improves weight loss, response to diuretics and neurohormonal activation.■ Published data suggest that treating fluid overload with UF can reduce hos-pital stay by up to 50% compared with conventional medical care. ■ It also suggests that readmission rates and unscheduled outpatient visits are reduced by over 40%. ■ The NHS spends £625 million treating CHF, of which 60% is inpatient bed costs. The average inpatient stay for CHF is over 13 days. ■ Typically a treatment will cost £600 (cost of one circuit). Some patients can require up to 4 treatments. The cost of the console, which may be loaned, is around £12,000.

Issues■ Gaining funding for new technologies- especially those with capital equipment attached is very difficult. ■ The cost of each circuit looks expensive compared to drug therapy, but the length of stay and readmissions are reduced leading to improved efficiency, bigger savings and better long term value.

■ Benefit to Patient: The therapy allows fluid to be removed quickly and safely, without compromis-ing renal function or producing other side effects seen with aggressive pharmacological therapy.

■ Benefit to NHS: Offers the potential to reduce bed costs significantly and readmission rates. Plus improve patient outcomes (weight loss, response to diuretics, neurohormonal activation).

■ Problems: Gaining funding for new technolo-gies- especially those with capital equipment at-tached is very difficult.

■ Solutions: An improved NHS procurement process which takes into account new innovation, value and effectiveness as well as cost.

Summary

Aquadex: ultrafiltration treatment for congestive heart failure

CASE STUDY

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