Using clinical and economic evidence to inform local decision making in cancer care (EM-CAP)
This NHMRC Health Services Research Program grant is a collaboration between CHERE and researchers at UNSW and consists of a number of projects, three of which involve CHERE.
Key Objective
The outcome of this program is to produce and disseminate evidence about the cost effective use of cancer medicines in clinical practice. Freely available economic models in a readily accessible form integrated into local circumstances will allow decision makers, clinicians and patients to better determine suitable cancer treatments. Inherent in our implementation plan is the development of skilled academics, clinicians and policy makers who can continue our activities in the future
Developing an Economic Model for Treatment Side-effects
One of the key objectives for the EM-CaP program is to develop a model to estimate the resource use associated with managing chemotherapy side effects which is independent of the medicine under consideration. Alison Pearce, a PhD student enrolled at CHERE has undertaken a literature review to identify the previous work done in this area, including an analysis of methodological approaches. This led to eleven recommendations for best practice methodology to guide modelling of the resource use associated with managing chemotherapy side effects. The data requirements for the model have been identified. This includes the incidence of adverse events in clinical trials, adverse event management from clinical practice guidelines, and resource costs from administrative data. A number of additional projects have arisen from the work in this area to date. These projects will also form part of Alison’s PhD Program. These are;
• Exploring the management of adverse events outside clinical trials, including incidence, management strategies, compliance with management recommendations and resources use.
• Examination of the strengths and weaknesses of clinical trial data as an input to economic models.
Whilst work on the constructing the economic model continues, we have also been conducting a case study of how one NSW-based private health insurance company has approached the problem of access to high cost cancer medicines. In particular we have data from this private health insurer which will allow us to the way in which decisions to fund high cost drugs are made (mapping the decision making process), the details of the requests (clinical condition, indication, drug class, length of requested treatment), the patient populations seeking subsidy and gaining funded access, the relationship between the outcome of initial requests for a drug for a specific indication and the volume of requests thereafter, the timing of the request in relation to TGA listing and PBS approval and the costs of subsidy to the insurer and patients. A report has been submitted to the PHI company. A journal article based on this work will be submitted.
Elements of Care Study
This study, using primary data collected in hospitals in metropolitan and rural areas of NSW aims to identify the individual care elements involved in administering specific chemotherapy treatment protocols and estimate the costs associated with each care element and determine where these costs are borne. In 2009, 370 patients receiving chemotherapy were recruited in 11 hospital sites across NSW. The study will continue to recruit patients throughout 2010. In addition, we have successfully negotiated access to secondary data sources including: MBS, PBS, Admitted Patients Data Collection, Emergency Department Information System and NSW Central Cancer Registry on the patient cohort. The data are being cleaned and preliminary analysis will commence in 2011.
Developing General Economic Models of Administration of Chemotherapy Medicines
This project was completed in 2009 by a student from the University of Utrecht, Johan de Raad, who was based at CHERE for a period of six months. Johan’s research involved both review of chemotherapy protocols and field work at hospitals to estimate resource associated with chemotherapy administration. The major findings were that costs estimated in the field (ie in chemotherapy units) are higher than those typically reported in Australian costing data and that there are significant differences in costs between different types of protocols. This work features in a paper published in the Clinical Journal of Oncology Nursing.
Developing General Economic Models of Adverse Events associated with Chemotherapy Medicines
This work is the subject of a PhD being undertaken at CHERE by Alison Pearce.
Publications
1. de Raad, J., Van Gool, K.C., Haas, M.R., Haywood, P., Faedo, M., Gallego, G., Pearson, S. & Ward, R. 2010, 'Nursing takes time: Workload associated with administering cancer protocols', Clinical Journal of Oncology Nursing, vol. 14, no. 6, pp. 735-741.
Funding source
NHMRC Health Services Research Program Grant
CHERE staff
Marion Haas, Kees Van Gool, Jane Hall, Alison Pearce (PhD student), Rosalie Viney
Collaborators
Robyn Ward1, Margaret Faedo1, Sallie-Anne Pearson1, Carole Harris1 (PhD student)
1. Lowy Cancer Institute, UNSW, NSW Cancer Institute, SESI Area Health Service
