Advancing Sickle Cell Disease Management in Africa

Drawing Lessons from the UK's NHS Investment in Automated Red Blood Cell Exchange Technology (Spectra Optia?)

Background

Sickle cell disease (SCD) remains a significant public health challenge across Africa, with 75% of SCD cases occurring in Sub-Saharan Africa (SSA). Without proactive measures, it is estimated that 50-90% of affected children do not survive beyond their fifth birthday [1].

However, recent advancements in treatment, particularly red blood cell exchange technologies, offer hope for improving patient outcomes.

In England, approximately 12,500 -15,000 people have SCD, with numbers increasing as approximately 350 babies are born with it every year [2]. Drawing inspiration from the United Kingdom’s National Health Service (NHS) recent investment in the automated Red Blood Cell Exchange (RBCx) technology, African countries have the opportunity to address healthcare disparities and enhance SCD management in their geographies.

Solution

The NHS England's investment in automated RBCx devices – Spectra Optia? Apheresis system manufactured by Terumo Blood and Cell Technologies, in 2023 represents a remarkable milestone in SCD management. With a focused allocation of ￡1.5 million, 25 red blood cell exchange devices are to be deployed across different NHS trusts, aiming to provide advanced treatment options for sickle cell patients.

The adoption of Spectra Optia (automated RBCx) compared to the manual RBCx, or top-up transfusion, has the potential to save the NHS up to ￡12.9m (￡ 18,100 per person) annually while reducing health inequalities [3].

The expected benefits include reduced transfusion dependency, better pain management, and mitigation of long-term complications like iron overload and depict innovation for impact.

The NHS investment targets to bridge healthcare disparities by ensuring equitable access to advanced treatment options for SCD across diverse geographical regions.

By deploying automated RBCx devices in both urban and underserved rural areas, the initiative aims to improve healthcare access and outcomes for all sickle cell patients, regardless of their location.

Innovation Ecosystem Linkage

This investment is made possible by the NHS MedTech Funding Mandate (MTFM) which is delivered by the Health Innovation Network, formerly known as the Academic Health Science Networks (AHSN). The investment aims to ensure patients and the NHS benefit from clinically effective and cost-saving medical technologies faster and more equitably.

Technologies supported are recommended by the National Institute for Health and Care Excellence (NICE) and meet the criteria to save costs and resources and make a return on investment within three years [4].

The role of policies like the MTFM in accelerating the adoption of innovative medical technologies cannot be overlooked. By ensuring affordability and effectiveness within healthcare systems, the MTFM paves the way for the widespread implementation of automated RBCx technology, thus improving patient outcomes and healthcare efficiency.

“This innovation is a great example of how working collaboratively across organizations helps accelerate the uptake of life-changing innovations. We are committed to bringing the best health technologies to patients more quickly, supporting the spread and adoption of medical devices, diagnostics, and digital products that are clinically effective.” Verena Stocker, Director of Research, Innovation, Life Sciences and Strategy, NHS England

Automated RBCx technology offers significant cost-saving potential for healthcare systems by reducing the need for frequent transfusions and managing complications associated with SCD more effectively. Beyond financial savings, the clinical benefits include enhanced patient well-being, reduced hospitalization rates, and improved quality of life.

Manual RBCx and top-up transfusions can lead to iron overload, which can have serious long-term consequences. Iron overload must in turn be treated with chelation therapy, poorly tolerated by some patients. Spectra Optia?, a key iron-neutral transfusion therapy, mitigates these challenges by reducing the need for iron chelation therapy and automating the RBCx process for faster treatment [5].

Lessons

Valuable lessons to be learned from this recent UK investment in SCD management are game-changing and The UK's NHS investment in automated RBCx technology serves as a pillar of hope for advancing SCD management in Africa.

These lessons include:

• Long-term strategic planning on the introduction/uptake of innovative medical devices and technologies through policy formulation to ensure patients benefit from clinically effective and cost-saving medical technologies faster and more equitably
• Promoting innovative medical devices and specific funding for the uptake of these technologies, with potential economies of scale and cost efficiencies for the public health system
• Collaboration with multiple partners including NHS England, Terumo Blood and Cell Technologies, NHSBT Cellular & Molecular Therapies Sickle Cell Society, and the Health Innovation Network, targeting those areas in greatest need using population health data, and talking to front-line staff and patients
• The use of evidence, health economic analysis, and diverse health and patient experts has been instrumental in informing the introduction of new technologies. The National Institute of Health Care and Excellence medical technologies advisory committee played a key role and developed key guidance documents to drive the adoption of the Spectra Optia Apheresis system [6]
• Recently, the UK received approval from the Medicines and Healthcare Products Regulatory Agency (MHRA) to implement the first gene therapy for SCD, showing the growing interest in adopting new medical interventions to avert the SCD chronic struggles of patients [7].

African countries can draw lessons from both similarities and differences between their healthcare landscape and the initiatives undertaken by NHS England. Identifying challenges such as limited resources, infrastructure gaps, and funding constraints, while also recognizing opportunities for collaboration and innovation, is essential for the successful implementation of such important health advancements and investments.

The potential impact of adopting automated RBCx technology in Africa is profound. Beyond improving patient outcomes and healthcare access, the widespread implementation of advanced treatment options for SCD can lead to significant reductions in healthcare costs, enhanced capacity-building, increased economic output, and the creation more resilient healthcare system overall.

Embracing lessons learned from across the globe, and leveraging innovative approaches to healthcare delivery, African countries have a unique opportunity to transform the landscape of sickle cell care, ultimately improving the lives of millions affected by this disease.

About Africa Health Business: is a dynamic and influential pan-African advisory and consulting firm driven by the compelling vision of “in Africa, by Africa, for Africa”. Headquartered in Nairobi, Kenya, AHB is dedicated to strengthening the private sector to play an impactful role in solving Africa’s healthcare challenges. We provide market insights and foster productive stakeholder engagements to enhance access to equitable healthcare across Africa.

References

1. Ambroise Wonkam & Julie Makani, “Sickle cell disease in Africa: an urgent need for longitudinal cohort studies” (2019) 7:10 The Lancet Global health e1310

2. “Voxelotor for sickle cell disease”

3. “NHS England — North East and Yorkshire?? Sickle cell patients in North East to benefit from national ￡1.5m technology investment”, online: <https://www.england.nhs.uk/north-east-yorkshire/2024/02/14/sickle-cell-patients-in-north-east-to-benefit-from-national-1-5m-technology-investment/>

4. “NHS England Chooses Spectra Optia? Apheresis System as Part of MedTech Funding Mandate for Expansion of Sickle Cell Disease Treatment | Terumo”, online: <https://www.terumo.com/newsrelease/detail/20220616/5311>

5. “Spectra Optia for automatic red blood cell exchange (Apheresis system) in people with sickle cell disease”

6. “Spectra Optia for automatic red blood cell exchange in people with sickle cell disease”

7. Associated Press, “World’s First Gene Therapy for Sickle Cell Disease Approved in Britain”, (18 November 2023), online: Voice of America <https://www.voanews.com/a/world-s-first-gene-therapy-for-sickle-cell-disease-approved-in-britain-/7358839.html>