PP45. GEOGRAPHICAL INEQUALITIES OF ACCESS TO 5-AMINOLEVULINIC ACID IN THE UK – BARRIERS TO IMPLEMENTING RESEARCH FINDINGS INTO CLINICAL PRACTICE

Abstract

AbstractAIMS: Evidence based medicine aims to improve patient care by applying evidence from research studies. This implies that new research findings can be implemented into routine clinical practice. All too often, particularly in the current cash-strapped NHS, it is not possible to implement these research findings. When it is implemented it is often patchy, leaving patients with a ‘post-code lottery’ of whether they will be able to benefit from these findings. To explore this, I have used uptake of 5-aminolevulinc acid (5-ALA) fluorescence guided surgery for glioblastomas as an example of implementing research findings. A multicentre Phase III study was published in 2006 showing improved rate of complete resection of enhancing tumour, improved progression free survival and reduced re-operation rate without impact on neurological function. These findings were confirmed on another prospective cohort study. Subsequent studies have shown improved survival where complete resection of enhancing tumour is achieved. Despite this evidence the uptake in the UK has been patchy. This study aims to identify the geographical distribution of 5-ALA usage in the UK 10 years after publication of this trial. METHODS: A survey of the UK was undertaken by contacting neuro-oncology surgeons at each unit. For each unit the approximate geographical catchment area was estimated from the hospitals that referred tumour patients to these units. Usage of 5-ALA was classified as full use, limited access (including where it is paid for with charity funds) or no access. Where there was no access, the reasons for this were explored. In addition, the training log kept by Medac GmBH was reviewed to identify units without trained surgeons. A map of the uptake of 5-ALA was created from this data. RESULTS: Data was available from 24 of the 30 adult neuroscience units. Full access was available in 8/24 (33%) of the units where data was available, limited access in 7/24 (29%) and no access in 9/24 units (38%). The geographical distribution shows good access in Scotland and the south east of England but limited access in the north of England. There was no access in the south west of England and southern Wales as well as across areas of the midlands and Northern Island. In the units with no access the primary reason is the cost of 5-ALA. Data from the Medac training logs show there are trained surgeons in every neurosurgical unit in the UK. CONCLUSIONS: 10 years after publication of this study there still is limited uptake of 5-ALA in the UK with clear geographical variation. The main reason for this is lack of funding despite favourable published cost-effectiveness data. Further work is needed to explore the decision making process around implementing research findings into clinical practice.