Greater Manchester Cancer
Vanguard Innovation
The Pharma Challenge
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 by reception
 We 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
Greater Manchester Cancer
Vanguard Innovation
The national Cancer Vanguard
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
Greater Manchester Cancer
Vanguard Innovation
Project Team
Text here if required
Why a medicines
optimisation workstream?
Greater Manchester Cancer
Vanguard Innovation
Greater Manchester Cancer
What we have
achieved
in
Year
1
24 July 2016:
November 2016:
Vanguard Innovation
th
4th
May 2016:
Chief pharmacists
meet to discuss
“Pharma Challenge”
Kick off meetings with
successful companies to
start drafting PID
24th June 2016:
39 responses received
from Industry
May 16’
17th May 2016:
Engagement with
ABPI & EMIG
June 16’
July 16’
Aug 16’
5th July 2016:
Evaluation event undertaken
and a shortlist of projects
was compiled to be
developed further as part of
the Cancer Vanguard
21st September 2016:
First Joint MO Group
meeting and
ratification of 2 PIDs
Sept 16’
Signing Joint Working
Agreements - Sandoz
& 1st Amgen project
Nov 16’
23rd August 2016:
Second evaluation event
and more projects
shortlisted
Dec 16’
December 2016:
Ratified PID with
QuintilesIMS
and Celgene.
Greater Manchester Cancer
Vanguard Innovation
What we have achieved so far…….
 Amgen (Denosumab) – Breast (UCLH leading)
 Contribute to and share evaluation of service modelling outcomes
 Taking 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.
Greater Manchester Cancer
Vanguard Innovation
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.
Greater Manchester Cancer
Vanguard Innovation
Biosimilars in cancer
Greater Manchester Cancer
Vanguard Innovation
Greater Manchester Cancer
Vanguard Innovation
Biosimilars
Greater Manchester Cancer
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
Vanguard Innovation
Greater Manchester Cancer
Vanguard Innovation
What does the pathway look like?
Patient flows are assessed for variation using the QuintilesIMS
Pathway Insights + knowledge discovery platform
Analysis Overview:
• Patient Insights + uses Sankey 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.
Greater Manchester Cancer
Vanguard Innovation
What data do we collect?
CVG Trust adheres to NICE guidelines as many patients
have Biological Therapy with Chemotherapy as 1st line
CVG Trust: Line of Treatment drugs analysis
NICE adherent pathways
Potential cases with referral from other
hospitals (continuing care)
Potential unwarranted variation
(divergence from NICE guidelines and TA)
Example Insight
1.
For a CVG trust, a total of 124 mCRC pathways have been identified with drugs data, including biological therapy and
chemotherapy.
2.
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.
3.
A proportion of 1st line treated with BT proceed with another line of treatment, generally Chemotherapy (30).
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.
Visualising adherence to NICE Quality Standards
Example Analysis
MAB1 : non-NICE recommended
Potential unwarranted
variation (divergence
from NICE guidelines
and TA)
MAB2 : NICE recommended
Adhering to NICE
guidelines and TA
MAB3 : NICE recommended
Example Findings
1.
Out of a total of 124 mCRC pathways analysed, it was found that around 65% of them were adhering to NICE Guidelines.
2.
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.
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.
Example insight: Providing MAB1 as 1st line costs
less and generates fewer readmissions than MAB2
Resource cost per secondary care treatment type pathway - example
MAB1 : non-NICE recommended
MAB2 : NICE recommended
MAB3 : NICE recommended
Example Findings
1.
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.
2.
The average cost and 30 days readmissions per pathway is lower for MAB2 when comparing against MAB3.
3.
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)
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.
Greater Manchester Cancer
Vanguard Innovation
PROMS/PREMS and UMOTIF
Greater Manchester Cancer
Vanguard Innovation
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
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
Greater Manchester Cancer
Vanguard Innovation
Uptake of the app
Greater Manchester Cancer
Vanguard Innovation
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
Greater Manchester Cancer
Vanguard Innovation
Greater Manchester Cancer
Vanguard Innovation
Vanguard Innovation
Email: [email protected]
Web: gmcancervanguardinnovation.org
Twitter: @GM_Ca_Vanguard