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Jo Hanlon
Project Director, YHEC
YHEC tackles a wide range of projects, from complex challenges to practical, real-world solutions. One such example is our collaboration with the NHS Innovation Accelerator scheme. In this blog, we speak with Jo Hanlon, Project Director at YHEC, who recently co-authored a peer-reviewed publication on the economic impact of a wearable device for diagnosing sleep apnoea, highlighting how our work supports the assessment of healthcare innovation and practical healthcare improvements.
Tell us a bit about yourself and your role.
I’ve been at YHEC for just over 10 years, and I’m a Project Director in the NHS and Public Sector team. My main role as a Project Director is overseeing and leading projects that are predominantly with, or for, the NHS and other parts of the public sector, such as the Department of Work and Pensions. This involves advising on the appropriate approach to take to the analysis, within the project resources available. My role is also to ensure robust project management process and to quality assure the project deliverables to meet the client’s needs.
Our team also gets involved in projects from the Health Innovation Network that tend to be real-world evaluations of new interventions or services in practice. These evaluations are not always limited to the economic aspects – we also evaluate staff and patient experience and quantitative impact data, as well as monetising what we can and undertaking early economic analysis. Today, I will be discussing one of these projects that was recently published in BMC Health Services Research.
Why was this project commissioned?
This project came to YHEC from the NHS Innovation Accelerator scheme. Through this scheme, innovators are supported over three years to develop their innovation with research that may support its use in clinical practice. YHEC was commissioned to undertake economic impact case studies for some of the innovators, to identify the costs, benefits and value of their innovations, using existing evidence and potentially adding implementation data as well.
What was the question you were trying to address?
Sleep apnoea is a disorder where breathing is interrupted during sleep which can result in people waking up during the night and having poor quality sleep. This could lead to fatigue throughout the day, which may impact productivity and work [1].
Sleep apnoea is a substantial problem because, although it is quite prevalent, not everyone gets diagnosed and treated [1, 2]. There is a recognised pathway for diagnosis that involves either home respiratory polygraphy (wearing a chest strap with a sensor while you sleep at home) or two nights at a sleep clinic (in-clinic polysomnography) to monitor a person’s sleep, including their breathing, blood oxygen saturation, and how often they wake up [3].
We undertook a cost-minimisation analysis of a smaller, simpler, wearable medical device for people to monitor their sleep at home. The theory of change for this innovation was that it might be cheaper than the standard of care, and there was evidence that it may work better in some cases. Other potential benefits included releasing resources to identify and diagnose additional patients.
Who else do you think might be interested in this project?
Primarily, I think clinicians working in this clinical area would be most interested in this research because it provides another option in terms of the technology available for diagnosing sleep apnoea. NHS commissioners, departmental managers, clinical directors or anyone who is responsible for determining how an NHS Trust delivers care and how they run their diagnostic services may be interested in these findings too. I’m sure members of the public, particularly those who have sleep apnoea, would also be interested in the research.
Can you briefly summarise the methods that were used?
We undertook a cost-minimisation analysis and ran several scenarios that varied the number of people using the medical device, the cost per use, and how many more additional cases of sleep apnoea could be diagnosed. It’s worth noting that we used available evidence from the literature, where possible, and only used primary data in terms of costs.
The methods used were partly determined by the nature of the larger NHS Innovation Accelerator project, and it wasn’t in scope to do a full cost-effectiveness analysis. Also, the audience of the NHS Innovation Accelerator case studies are usually hospital managers or clinicians, so it was more efficient to undertake a shorter case study to identify if there were cost savings to be made.
The main endeavour was to identify the costs of implementing the medical device into practice so we looked at not just the costs of running the test but also any costs for training clinicians. We compared this with the standard of care costs. We also looked at the net benefit value across the health and social care system of diagnosing people with sleep apnoea. For example, if a person has undiagnosed sleep apnoea for years, they are at a higher risk of hypertension, cardiovascular events and road traffic accidents, which cost the NHS money to deal with. We calculated the return on investment to explore other potential cost savings.
What were the results and impact of the project?
This research found the medical device to be cost saving. For 500 uses over 1 year, the net benefit value would be in excess of £100,000, and this would increase with higher usage. There was a positive return on investment, which would increase proportionately according to how widely the medical device was implemented. The additional cases of sleep apnoea diagnosed due to released capacity could result in direct cost savings to the NHS of between £25,000 to £4.7 million, based on the scenario analyses conducted.
If someone was to do the project again, would you recommend that they do anything differently?
If there was a broader scope, we would have aimed to do a cost-effectiveness analysis. For these case studies, we always calculate return on investment because of the brief and the fact that return on investment is meaningful within NHS commissioning.
What this doesn’t include is the patient benefit and the impact on the patient, which I’m sure there would be a lot to say about as well.
If you wanted people to take away one thing from this project, what would it be?
My takeaway message would be that doing some very simple economic analysis can be very informative, especially when you have a range of scenarios to keep it realistic (which is what we did in this project). If you’ve got a reasonable amount of data, a bit of evidence, or other literature that you can draw from, you can do quite a bit with not very much! You can do some quite simple, realistic analysis that is useful in the real world.
How can YHEC help clients who have an innovation?
YHEC can help clients to consider the economic impact of their intervention and to identify the theory of change underpinning the intervention. For example, what are the input costs, the resources needed to put it into practice, the short- and long-term outcomes and the metrics needed to measure them, and then which of those outcomes can be monetised?
We can help clients to identify what data they would need to collect or, if they already have data, can advise on (and develop) the most appropriate economic evaluation or other analysis, whether that be a cost-minimisation, return on investment or cost-effectiveness analysis. We don’t always have to do loads of literature searching and have lots of robust evidence – we can develop early models where there isn’t a lot of data or evidence, but there is a pretty sound theory underpinning the intervention.
Contact us
To find out more about how YHEC can support you with early economic analysis and other research that may support the use of your innovation in clinical practice, please contact us at yhec@york.ac.uk.
References
1. Harvard Medical School Division of Sleep Medicine. The price of fatigue: The surprising conomic costs of unmanaged sleep apnea. 2010. Available from: https://sleep.hms.harvard.edu/sites/default/files/assets/Images/The_Price_of_Fatigue.pdf.
2. Benjafield AV, Ayas NT, Eastwood PR, Heinzer R, Ip MS, Morrell MJ, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. The Lancet Respiratory Medicine. 2019.7(8):687-98.
3. NICE. Obstructive sleep apnoea/hypopnoea syndrome and obesity hypoventilation syndrome in over 16s [NG202]. 2021. Available from: https://www.nice.org.uk/guidance/ng202.
Posted: 07 May 2025
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