Calculating the real value of clinical trials
At the beginning of her career as a hematologist in the United Kingdom, Annette Hay was constantly reminded of the high priority assigned to clinical trial work within the national health care system. “As a trainee in the UK, every week we had to present the files of new patients that we’d recently seen to the multidisciplinary team,” she recalls. “If there was ever a clinical trial opportunity that you should have offered the patient but didn’t, you were in trouble.”
She has brought this perspective with her to the Queen’s Cancer Research Institute, where she joined the Cancer Clinical Trials Division as a senior investigator in 2014. Here she is dedicated to demonstrating the virtues of conducting this work to help patients directly and to advance the cause of medical research.
“While there are up-front costs to conducting a clinical trial,” she acknowledges, “there may well be benefits and savings.”
By way of example, she points to the fact that many patients obtain drugs and pathology testing through their participation in a trial rather than through the public health care system. In a formal study of Canadian clinical trials from 1999 to 2011, she and her colleagues estimated the resulting reduction in fees, predominantly to the health care system, at more than $32 million.
“This is cost-saving for the government,” she argues.
In addition, Hay suggests that a great deal of information collected through a clinical trial might already have been filed in administrative databases elsewhere.
She points to Ontario’s Institute for Clinical Evaluative Sciences (ICES), a not-for-profit organization that assembled this kind of data for research purposes. The contents of the ICES database could mirror the personal details that doctors and other staff take from trial participants, which can be among the most time consuming and expensive parts of the clinical trial process.
It's the culture and the ethos that patients should be given the opportunity to participate in clinical trials, where they can access emerging treatments and contribute to advances for future generations.
According to Hay, much of this work could be eliminated by matching trial patient records to those already filed with ICES. When she explored the possibility of using identifying details such as year of birth to correlate these records, she discovered that it was possible to combine the two in about 90% of cases. And, she maintains, that rate could be further improved if even more identifiers can be employed.
Such research represents much more than an academic exercise in cost-accounting and streamlining bureaucratic procedures. Hay meets every week with patients at the cancer centre – encounters that put a very human face on her efforts. Even technicians who handle lab work behind the scenes, she says, will closely follow the progress of patients they have never met.
“It keeps the research real,” she concludes. “There’s a rationale for what you’re doing.”
“It's the culture and the ethos that patients should be given the opportunity to participate in clinical trials, where they can access emerging treatments and contribute to advances for future generations.”
(e)Affect Issue 8 Fall/Winter 2015
Learn more about: Dr. Hay's research