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Research about the economics of implementing new clinical pathways in the NHS wins King's Outstanding Thesis Award

Dr Tiago Duarte de Oliveira Rua has been awarded a 2021 King’s Outstanding Thesis Award for his doctoral research conducted at Guy’s and St Thomas’ NHS Foundation Trust, which examined how the innovative use of advanced imaging could contribute to the financial sustainability of the NHS, as well as improve clinical outcomes and patient satisfaction.

Guy's and St Thomas' NHS Foundation Trust

Dr Rua’s research bridged the gap between the economics and medical imaging fields by applying health economics methodology across three clinical conditions and imaging modalities.

It examined the use of MRI in the management of suspected scaphoid fractures (injuries to one of the small bones in the wrist) compared to relying on a conventional radiograph only; the direct referral from primary care to MRI in case of chronic headaches, as opposed to the standard referral to a neurology clinic; and the use of CT colonography as the first-line imaging method for patients with low-risk colorectal cancer, compared with optical colonoscopy, a more invasive and costly procedure.

The findings challenged the established paradigm that advanced imaging, being more expensive and less available than basic modalities (such as radiographs and ultrasound) should be reserved until the later stages of diagnosis.

They showed that the early use of accurate and definitive diagnostic tools, which streamline the diagnostic and, if needed, treatment pathway, ultimately lead to improvements in both clinical and patient outcomes whilst reducing overall costs of care.

By involving real-world patients, clinical pathways and challenges, the study provided observed data, which has served as a basis for practical changes in the NHS.

As a result of Dr Rua’s research, the use of immediate MRI in the emergency department at Guy’s and St Thomas’ NHS Foundation Trust has been added to standard care in the management of suspected scaphoid wrist bone fractures.

In addition, two existing imaging-based pathways for the management of chronic headache and suspected colorectal cancer patients were promoted as alternatives in selected cases. These three interventions hold the potential to improve the clinical care of over 3,000 patients annually at GSTT.

Dr Rua’s PhD was funded by the Transforming Outcomes and Health Economics Through Imaging (TOHETI) programme. Running between 2014-2019, TOHETI aimed to evaluate the innovative use of medical imaging applied to real-world clinical pathways. The programme was funded by Guy’s and St Thomas’ Charity and led to the provision of some of the world’s most advanced imaging technologies at GSTT.

A special thank you to the Guy’s and St Thomas’ Charity for the £13 million grant that allowed not only the purchase of equipment (MRI and CT scanners) but also the evaluation of using those scanners in the context of real-world patients and pathways. I would also like to thank Professor Reza Razavi and Ms Jo Turville for their guidance and mentoring throughout this process as well as my academic supervisors Dr James Shearer, Professor Vicky Goh and Professor Paul McCrone. – Dr Tiago Duarte de Oliveira Rua, Care Redesign Improvement and Innovation: Head of Engagement, Research and Outcomes, Guy’s and St Thomas’ NHS Foundation Trust

Dr James Shearer, Lecturer in Health Economics at King’s Health Economics, and Dr Rua’s primary academic supervisor said: “What was recognised as exceptional about Tiago’s thesis was the immediate benefit it had to our NHS and patients. His thesis brought his expertise in health economic evaluation to bear at the hospital department level providing the real-world evidence essential to justify investment in innovative and effective treatments.”

Professor Vicky Goh, Chair of Clinical Cancer Imaging at the School of Biomedical Engineering & Imaging Sciences reiterated: “This was a well-deserved award acknowledging the quality and clinical impact of his research thesis”.

In this story

Vicky  Goh

Vicky Goh

Chair of Clinical Cancer Imaging

James Shearer

James Shearer

Lecturer in Health Economics