Pharmacoepidemiology and Pharmaceutical Policy Group
Team Leader
Dr Sallie Pearson
Main Interest Area
To better understand access to, and use of medicines in real world clinical practice.
Listed below are three project streams conducted by the Pharmacoepidemiology and Pharmaceutical Policy Group:
1. Health Services Research
One of the biggest challenges facing health care systems today is providing patients with access to drug treatments, and at the same time ensuring funding sustainability. This is especially apparent in cancer care, where hospitals and private health insurers are under considerable pressure to fund the medicines not subsidised under the Pharmaceutical Benefits Scheme. Despite this, economic evidence is rarely used to support funding decisions made at the local level. As such, there is a need to develop user–friendly economic models adaptable to local circumstances. The Economic Models for Cancer Protocols (EM–CaP) study is a five year NHMRC funded program, in collaboration with the Centre for Health Economic and Evaluation (CHERE), developing economic evidence about the cost effective use of cancer medicines for local decision makers. This program will make the following important contributions to field of health economics and decision–making:
- Producing high quality economic evidence relevant to local decision–makers and available in the public domain
- Improving methods for systematically producing economic evidence alongside clinical protocols
- Quantifying the costs and cost burden of cancer treatment protocols within the context of the Australian health care system
2. Prescribing Practice and Physician Behaviour Change
In the last few decades considerable global effort and attention has focussed on implementing electronic decision support (EDS) systems in medical practice. While the healthcare industry has lagged behind many other sectors in applying information systems to improve processes and outcomes, there has been intense interest in closing this gap in recent years. EDS is espoused as a powerful tool for improving patient safety and quality of care. With the ever-expanding medical evidence base, much of which is stored electronically, it is unreasonable to expect clinicians have the time or necessary skills to critically evaluate and apply this evidence in their day-to-day practice. As such, health care organisations are turning increasingly to EDS to assimilate this information and provide targeted guidance to health care professionals to support clinical decision making.
We have two projects addressing the uptake of electronic decision support in clinical practice.
- The National Prescribing Service and Universities of Newcastle and New South Wales established a research partnership in August 2006 to examine strategies to improve the uptake of evidence-based drug information and decision support in community practice, specifically primary care.
- The Cancer Institute Standard Cancer Treatment (CI-SCaT) program is an evidence-based online reference tool for the use of cancer clinicians at the point-of-care Our research focuses on evaluating the use of CI-SCaT within NSW hospitals, and implementing and evaluating the impact of educational interventions to increase CI-SCaT use.
The emergence of effective cancer medicines is one of the major medical advances of the 20th century. Given the pace of technological innovation and the ‘promise’ of cancer treatments, regulatory and funding bodies are under increasing pressure to fast track the approval of potentially life-saving medicines. However, regulatory and subsidy decisions are based on the assumption that clinical trial outcomes can be extrapolated to the general population. As such, approval bodies face significant uncertainty when considering the adoption of new treatments because clinical trials are conducted in highly selected patient populations under standardised conditions. The uncertainty for approval bodies has been further exacerbated due to the increasing number of decisions based on interim trial data and surrogate endpoints, before drug benefits and risks have been fully quantified. While no clinical trial could ever be large enough or long enough to quantify all clinical outcomes, risks or otherwise, the current situation has created a need to better understand how cancer medicines are prescribed in real world clinical practice, how safe and effective they are under conditions of actual use, and how benefits and risks are distributed among patient groups. Our aim is to make best use of existing health data sets to link cancer diagnoses and medicine exposure to outcomes in real world clinical practice in Australia.