Immunology In The Clinic

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In pursuit of excellence: an integrated care pathway for C1 inhibitor deficiency

1. A. L. Manson¹, 
2. A. Price⁴, 
3. J. Dempster¹, 
4. P. Clinton-Tarestad⁵, 
5. C. Greening², 
6. R. Enti⁶,
7. S. Hill³, 
8. S. Grigoriadou¹, 
9. M. S. Buckland¹,
10. H. J. Longhurst^1,*

Article first published online: 6 JUN 2013

DOI: 10.1111/cei.12083

© 2013 Crown Copyright. This article is published with the permission of the Controller of HMSO and the Queen's Printer for Scotland

Issue

Clinical & Experimental Immunology

Volume 173, Issue 1, pages 1–7, July 2013

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Keywords:

• angioedema;
• C1 inhibitor;
• commissioning;
• icatibant;
• integrated care pathway

Summary

There are estimated to be approximately 1500 people in the United Kingdom with C1 inhibitor (C1INH) deficiency. At BartsHealth National Health Service (NHS) Trust we manage 133 patients with this condition and we believe that this represents one of the largest cohorts in the United Kingdom. C1INH deficiency may be hereditary or acquired. It is characterized by unpredictable episodic swellings, which may affect any part of the body, but are potentially fatal if they involve the larynx and cause significant morbidity if they involve the viscera. The last few years have seen a revolution in the treatment options that are available for C1 inhibitor deficiency. However, this occurs at a time when there are increased spending restraints in the NHS and the commissioning structure is being overhauled. Integrated care pathways (ICP) are a tool for disseminating best practice, for facilitating clinical audit, enabling multi-disciplinary working and for reducing health-care costs. Here we present an ICP for managing C1 inhibitor deficiency.

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