clinical research and the nhs … ….and economics?

Clinical Research and the NHS…

….and economics?

Joanna Coast

PERCAT Masterclass, April 2013

Clinical Research and the NHS…

….and Economics?

Joanna Coast

PERCAT Masterclass, April 2013

Joanna Coast: Clinical Research & the NHS… and Economics

Outline

Why economics?

Health, economics & clinical research

A case study of governance for economics research


Why economics?


February 13, 2007

New cancer drug to save a thousand lives a yearNigel Hawkes, Health Editor

More than a thousand women a year will survive breast cancer thanks to a type of drug that improves survival rates by 17 per cent, new research shows today.

A study of 4,742 post-menopausal women found that switching from the present gold-standard breast cancer treatment tamoxifen to the new drug

exemestane after two or three years resulted in the dramatic fall in death rates.

THE TIMES


The TelegraphMay 2010

New drug reverses even 'untreatable' cancers

– Cancer patients may be offered new hope in the form of a harmless virus which can reverse even apparently untreatable forms of the disease when injected into tumours.

– Tumours shrank or stopped growing in every patient who underwent radiotherapy coupled with a new drug, Reolysin, which contains particles of reovirus.


The Telegraph3 Jan 2011

IVF women given fresh hope by new fertility treatment

Women who have endured repeated IVF failures have been given fresh hope by a new fertility treatment that studies indicate can increase success rates fivefold.

1 course of IVF

costs £2700

1 course of IVF

costs £2700

= 1/3 cochlear implant

1 course of IVF

costs £2700


= 1 heart bypass

1 course of IVF

costs £2700


= 1 heart bypass

= 3 cataract removals

1 course of IVF

costs £2700


= 1 heart bypass

= 11 cataract removals

= 150 MMR vaccinations


“Economics is usually a rather doom-laden subject, and in this respect is linked indirectly with medicine through the observation that the only two things in life that are certain are death and taxes.”

Alan Williams


Health, economics & clinical research


Which interventions give the greatest

benefit for the resources available?


$

£

€


Identifying, measuring & valuing costs

Measure in terms of physical resources

Value using Unit costsN=? N=?

N=?

N=? N=?

N=? N=?


Identifying, measuring & valuing outcome

NICE (National Institute for Health and Care Excellence) recommends measures that:

– combine length and quality of life– have meaningful values – have general population values

Called QALYs (Quality-Adjusted Life-Years)N=? N=?

N=?


Economic evaluation

Research with clinical teams

Often alongside RCTs

Multidisciplinary

– Recent trial on PhysioDirect included GPs Physiotherapists Qualitative researchers Statisticians Health economists


A case study of governance for economics research


Simple design

New measure – ICECAP-SCM

People (and/or proxies) at end of life to complete the measure

Tape record while they complete

Transcribe tape recording

Analyse transcripts


Challenging process (1)

Sponsorship

– Through University

Sub-contracting

– To hospice for assistance with recruitment– University contract services & Marie-Curie contract

services



Ethics

– NRES generic form– Site specific form?– Not clear whether hospices are NHS or non-NHS– Complexities around people unable to consent for

themselves– Importance of having patient/carer input into

documentation



Governance

– Not clear whether NHS R&D Governance required Eventually decided yes… … but also no!

– R&D forms required– But ‘Research passport’ issues left to hospice

CRB checks Immunisations CV & training checks

– Hospice governance & permissions also required


A final word from Alan Williams

“We are not defeatist prophets of gloom and doom, obsessed with death and taxes, but active workers for improvement, concerned to improve the quality of people’s lives to the maximum feasible extent. That is why I think that health economics is the cheerful face of the dismal science.”

clinical research and the nhs … ….and economics?

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