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 ID: 623114
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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 InnovationSlide2
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 taken
The presentation will be online after the event
Phones on silent please
Vanguard Innovation
Greater Manchester
CancerSlide3
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 efficiencySlide4
Vanguard Innovation
Project Team Greater Manchester Cancer
Text here if requiredSlide5
Why a medicines
optimisation workstream?Vanguard Innovation
Greater Manchester CancerSlide6
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’
5th July 2016:Evaluation event undertaken and a shortlist of projects was compiled to be developed further as part of the Cancer Vanguard 24th July 2016:Kick off meetings with successful companies to start drafting PID Aug 16’
23rd 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
CancerSlide8
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
CancerSlide9
Biosimilars in cancer
Vanguard Innovation Greater Manchester CancerSlide10
Vanguard Innovation
Greater Manchester CancerSlide11
Vanguard Innovation
Greater Manchester Cancer
BiosimilarsSlide12
Vanguard Innovation
Greater Manchester CancerSlide13
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. HmmmmmSlide14
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 Insight
For 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 1
st 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 pathwaysSlide18
MAB
3 : NICE recommendedMAB2 : 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 2
nd
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 TASlide19
Example insight: Providing
MAB1 as 1
st
line costs less and generates fewer readmissions than MAB2
Drugs Analysis
Example
Findings
Out 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 1
st
line but 2
nd
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.MAB3 : NICE recommendedMAB2 : NICE recommended
MAB
1
: non-NICE recommendedSlide20
Vanguard Innovation
Greater Manchester Cancer
PROMS/PREMS and UMOTIFSlide21
Vanguard Innovation
Greater Manchester Cancer
UMOTIF
EQ5D at the startPatient Experience questionsHow are you feeling today questionsBreathing; Eating and Drinking; Sickness; Mouth Pain; Diarrhoea; Constipation; Skin; Numbness; Tiredness; AppetiteSlide22
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-survivalSlide23
Vanguard Innovation
Greater Manchester Cancer
Uptake of the appSlide24
Vanguard Innovation
Greater Manchester Cancer
Reflections on Pharma Challenge
Example of joint leadership across the countryStrong existing pharmacy
network
Don
’t wait to be asked
Pacesetting, collaborativeSystems wide leadership
Not afraid to failSlide25
Vanguard Innovation
Greater Manchester CancerSlide26
Vanguard Innovation
Greater Manchester
Cancer
Vanguard Innovation
Email
:
cancervanguard.gm.@nhs.net
Web
:
gmcancervanguardinnovation.org
Twitter
: @GM_Ca_Vanguard