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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
Joanna Coast: Clinical Research & the NHS… and Economics
Why economics?
Joanna Coast: Clinical Research & the NHS… and 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
Joanna Coast: Clinical Research & the NHS… and Economics
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.
Joanna Coast: Clinical Research & the NHS… and Economics
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
= 1/3 cochlear implant
= 1 heart bypass
1 course of IVF
costs £2700
= 1/3 cochlear implant
= 1 heart bypass
= 3 cataract removals
1 course of IVF
costs £2700
= 1/3 cochlear implant
= 1 heart bypass
= 11 cataract removals
= 150 MMR vaccinations
Joanna Coast: Clinical Research & the NHS… and Economics
“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
Joanna Coast: Clinical Research & the NHS… and Economics
Health, economics & clinical research
Joanna Coast: Clinical Research & the NHS… and Economics
Which interventions give the greatest
benefit for the resources available?
Joanna Coast: Clinical Research & the NHS… and Economics
Joanna Coast: Clinical Research & the NHS… and Economics
Joanna Coast: Clinical Research & the NHS… and Economics
$
£
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Joanna Coast: Clinical Research & the NHS… and Economics
$
£
€
Joanna Coast: Clinical Research & the NHS… and Economics
Identifying, measuring & valuing costs
Measure in terms of physical resources
Value using Unit costsN=? N=?
N=?
N=? N=?
N=? N=?
Joanna Coast: Clinical Research & the NHS… and Economics
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=?
Joanna Coast: Clinical Research & the NHS… and Economics
Economic evaluation
Research with clinical teams
Often alongside RCTs
Multidisciplinary
– Recent trial on PhysioDirect included GPs Physiotherapists Qualitative researchers Statisticians Health economists
Joanna Coast: Clinical Research & the NHS… and Economics
A case study of governance for economics research
Joanna Coast: Clinical Research & the NHS… and Economics
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
Joanna Coast: Clinical Research & the NHS… and Economics
Challenging process (1)
Sponsorship
– Through University
Sub-contracting
– To hospice for assistance with recruitment– University contract services & Marie-Curie contract
services
Joanna Coast: Clinical Research & the NHS… and Economics
Challenging process (2)
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
Joanna Coast: Clinical Research & the NHS… and Economics
Challenging process (2)
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
Joanna Coast: Clinical Research & the NHS… and Economics
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.”