The Pharma Challenge PowerPoint Presentation, PPT - DocSlides

celsa-spraggs | 2018-01-12 | General Rob Duncombe,. Director of Pharmacy,. The Christie NHS Foundation . Trust. 27 June 2017. Greater Manchester . Cancer. Vanguard Innovation. Housekeeping. There are no scheduled fire drills. Toilets are .

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Slide1

The Pharma Challenge

Rob Duncombe,Director of Pharmacy,The Christie NHS Foundation Trust

27 June 2017

Greater Manchester

Cancer

Vanguard Innovation

Slide2

Housekeeping

There are no scheduled fire drills

Toilets are by receptionWe will be taking photos – please let us know if you don’t want your picture takenThe presentation will be online after the eventPhones on silent please

Vanguard Innovation

Greater Manchester Cancer

Slide3

The national Cancer Vanguard

Vanguard Innovation

Greater Manchester Cancer

To develop and test new ideas to deliver more responsive and personalised cancer services, addressing inequalities and supporting the NHS in ‘

Achieving World Class Cancer Outcomes’.Two-year programme to look at improved cancer care, cancer outcomes, cancer patient experience and resource efficiency

Slide4

Vanguard Innovation

Project Team

Greater Manchester Cancer

Text here if required

Slide5

Why a medicines optimisation workstream?

Vanguard Innovation

Greater Manchester Cancer

Slide6

What we have achieved in Year 1

Vanguard Innovation

Greater Manchester Cancer

4

th

May 2016:Chief pharmacists meet to discuss “Pharma Challenge”

May 16’

17

th

May 2016: Engagement with ABPI & EMIG

June 16’

24

th

June 2016:39 responses received from Industry

July 16’

5

th

July 2016:Evaluation event undertaken and a shortlist of projects was compiled to be developed further as part of the Cancer Vanguard

24

th July 2016:Kick off meetings with successful companies to start drafting PID

Aug 16’

23

rd

August 2016: Second evaluation event and more projects shortlisted

Sept 16’

21

st

September 2016: First Joint MO Group meeting and ratification of 2 PIDs

Nov 16’

November 2016:

Signing Joint Working Agreements - Sandoz & 1

st Amgen project

Dec 16’

December 2016:

Ratified PID with QuintilesIMS and Celgene.

Slide7

What we have achieved so far…….

Amgen (Denosumab) – Breast (UCLH leading)

Contribute to and share evaluation of service modelling outcomesTaking delivery of care out of the hospital setting Celgene (GM leading)Presenting SACT data in a user-friendly format to clinicians to identify possible areas for improvement.

Vanguard Innovation

Greater Manchester Cancer

Slide8

What we have achieved so far…….

BMS (UCLH leading)

Adverse event monitoring of patients undergoing immuno-oncology therapies.Amgen (UCLH leading)Developing models of care for the home delivery of SACT.

Vanguard Innovation

Greater Manchester Cancer

Slide9

Biosimilars in cancer

Vanguard Innovation

Greater Manchester Cancer

Slide10

Vanguard Innovation

Greater Manchester Cancer

Slide11

Vanguard Innovation

Greater Manchester Cancer

Biosimilars

Slide12

Vanguard Innovation

Greater Manchester Cancer

Slide13

Vanguard Innovation

Greater Manchester Cancer

Wouldn’t it be wonderful if…

We could take all this data we collect about patients with mCRC and use it to see if there is unwarranted variation between different centres, and furthermore enhance care through the use of an app. Hmmmmm

Slide14

Vanguard Innovation

Greater Manchester Cancer

What does the pathway look like?

Slide15

Patient flows are assessed for variation using the

QuintilesIMS Pathway

Insights + knowledge discovery platform

Knowledge discovery tool

Analysis Overview:

Patient Insights + uses

S

ankey diagrams to visualise pathway flows. This type of visualisation was chosen as it best visualises multidimensional data flows across a system, facilitating comparisons across a

wide range of

indicators. Indicators are shown in thickness (volume in this case) and colour (average revenue in this case) of the path.

Slide16

Vanguard Innovation

Greater Manchester Cancer

What data do we collect?

Slide17

CVG Trust adheres to NICE guidelines as many patients have Biological Therapy with Chemotherapy as 1

st

line

Drugs Analysis

Example InsightFor a CVG trust, a total of 124 mCRC pathways have been identified with drugs data, including biological therapy and chemotherapy.A big proportion of pathways are following mCRC NICE prescription guidelines, where Biological therapy is recommended as first line of therapy in conjunction with Chemotherapy. A proportion of 1st line treated with BT proceed with another line of treatment, generally Chemotherapy (30).

CVG Trust: Line of Treatment drugs analysis

This information is published with permission of IMS Health Technology Services Limited. All rights are reserved. No further copying or reproduction of this information is permitted without consent from IMS Health Technology Services Limited Ltd. Data Source: HES data Hospital Episode Statistics. Re-used with the permission of the Health and Social Care Information Centre. All rights reserved.

Potential unwarranted variation (divergence from NICE guidelines and TA)

Potential cases with referral from other hospitals (continuing care)

NICE adherent pathways

Slide18

MAB

3

: NICE recommended

MAB2 : NICE recommended

MAB1 : non-NICE recommended

Visualising adherence to NICE Quality Standards

Drugs Analysis

Example

Findings

Out of a total of 124 mCRC pathways analysed, it was found that around 65% of them were adhering to NICE Guidelines. NICE guidelines recommend the use of two monoclonal antibodies (MAB 2 and MAB 3) as 1st line in conjunction with Chemotherapy agents, and does not recommend the use of these as 2nd line of treatment.

Example Analysis

This information is published with permission of IMS Health Technology Services Limited. All rights are reserved. No further copying or reproduction of this information is permitted without consent from IMS Health Technology Services Limited Ltd. Data Source: HES data Hospital Episode Statistics. Re-used with the permission of the Health and Social Care Information Centre. All rights reserved.

Potential unwarranted variation (divergence from NICE guidelines and TA)

Adhering to NICE guidelines and TA

Slide19

Example insight: Providing

MAB1 as 1

st line costs less and generates fewer readmissions than MAB2

Drugs Analysis

Example FindingsOut of a total of 115 mCRC pathways that have been administered Biological therapy as 1st line, 69 are providing MAB2 to patients, representing a 5-fold difference when compared to MAB3 (12), both NICE recommended drugs. The average cost and 30 days readmissions per pathway is lower for MAB2 when comparing against MAB3. MAB1 is not recommended to be used as 1st line of treatment for mCRC patients, so we suggest this might be either unwarranted variation or caused by referral patterns (i.e its actually not 1st line but 2nd line of treatment)

Resource cost per secondary care treatment type pathway - example

This information is published with permission of IMS Health Technology Services Limited. All rights are reserved. No further copying or reproduction of this information is permitted without consent from IMS Health Technology Services Limited Ltd. Data Source: HES data Hospital Episode Statistics. Re-used with the permission of the Health and Social Care Information Centre. All rights reserved.

MAB

3

: NICE recommended

MAB2 : NICE recommended

MAB

1

: non-NICE recommended

Slide20

Vanguard Innovation

Greater Manchester Cancer

PROMS/PREMS and UMOTIF

Slide21

Vanguard Innovation

Greater Manchester Cancer

UMOTIF

EQ5D at the start

Patient Experience questions

How are you feeling today questions

Breathing; Eating and Drinking; Sickness; Mouth Pain; Diarrhoea; Constipation; Skin; Numbness; Tiredness; Appetite

Slide22

How do we collect useful PROMs data?

Symptoms were reported through a web-based interface that could be accessed on tablets or computers. The primary outcome was QOL, measured with the EQ-5D questionnaire. OS was a secondary outcome. Dr. Basch said the trial was powered to assess QOL.

The study enrolled 766 patients between June 2007 and January 2011. OS analysis was conducted in June 2016, after two-thirds of the patients had died, at which time median follow-up was 7 years. Characteristics were well balanced between arms at baseline. Patient age ranged from 26 to 91, and the median age was 62 and 61 in the standard-care and self-reporting arms, respectively.

Patients self-reported symptoms 73% of the time when prompted to do so, even among elderly patients. Nurses took action in response to alerts 77% of the time with interventions including

counselling,

referrals to emergency services, and chemotherapy dose modifications.

In the primary outcome of QOL at 6 months compared with baseline, 31% more patients in the self-reporting arm experienced benefits compared with the standard-care arm (34% vs. 18%, respectively; p < 0.001).

Median OS was 5 months longer for patients in the self-reporting arm compared with standard care

(31.2 vs. 26.0 months; p = 0.03). This translated to a 5-year absolute survival benefit of 8%. The difference remained significant in multivariable analysis (adjusted hazard ratio [HR] 0.832, 95% CI [0.696, 0.995

]).

PRESENTED at

ASCO meeting 2017.

http://

am.asco.org/online-tool-reporting-symptoms-extends-survival

Slide23

Vanguard Innovation

Greater Manchester Cancer

Uptake of the app

Slide24

Vanguard Innovation

Greater Manchester Cancer

Reflections on Pharma Challenge

Example of joint leadership across the country

Strong

existing pharmacy

network

Don

’

t

wait to be

asked

Pacesetting, collaborative

Systems wide leadership

Not afraid to fail

Slide25

Vanguard Innovation

Greater Manchester Cancer

Slide26

Vanguard Innovation

Greater Manchester Cancer

Vanguard Innovation

Email

:

cancervanguard.gm.@nhs.net

Web

:

gmcancervanguardinnovation.org

Twitter

: @GM_Ca_Vanguard

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