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
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
THE TIMES
February 13, 2007
New cancer drug to save a thousand lives a year
Nigel 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.
Joanna Coast: Clinical Research & the NHS… and Economics
The Telegraph
May 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 Telegraph
3 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.
Joanna Coast: Clinical Research & the NHS… and Economics
1 course of IVF
costs £2700
= 1/3 cochlear implant
1 course of IVF
costs £2700
= 1/3 cochlear implant
1 course of IVF
costs £2700
= 1 heart bypass
= 1/3 cochlear implant
= 3 cataract removals
1 course of IVF
costs £2700
= 1 heart bypass
= 1/3 cochlear implant
= 11 cataract removals
1 course of IVF
= 150 MMR
vaccinations
costs £2700
= 1 heart bypass
“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
$
£
€
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
N=?
N=?
N=?
N=?
N=?

Value using Unit costs
Joanna Coast: Clinical Research & the NHS… and Economics
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 LifeN=?
N=?
Years)
Joanna Coast: Clinical Research & the NHS… and Economics
N=?
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.”
Joanna Coast: Clinical Research & the NHS… and Economics