1 Greater Manchester CancerVanguard Innovation The Pharma Challenge Rob Duncombe, Director of Pharmacy, The Christie NHS Foundation Trust 27 June 2017
2 Housekeeping There are no scheduled fire drillsGreater 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
3 The national Cancer VanguardGreater 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
4 Project Team Greater Manchester Cancer Text here if requiredVanguard Innovation Text here if required
5 Why a medicines optimisation workstream?Greater Manchester Cancer Why a medicines optimisation workstream? Vanguard Innovation
6 What we have achieved in Year 1Greater Manchester Cancer What we have achieved in Year 1 Vanguard Innovation 24th July 2016: Kick off meetings with successful companies to start drafting PID November 2016: Signing Joint Working Agreements - Sandoz & 1st Amgen project 4th May 2016: Chief pharmacists meet to discuss “Pharma Challenge” 21st September 2016: First Joint MO Group meeting and ratification of 2 PIDs 24th June 2016: 39 responses received from Industry May 16’ June 16’ July 16’ Aug 16’ Sept 16’ Nov 16’ Dec 16’ 5th July 2016: Evaluation event undertaken and a shortlist of projects was compiled to be developed further as part of the Cancer Vanguard December 2016: Ratified PID with QuintilesIMS and Celgene. 23rd August 2016: Second evaluation event and more projects shortlisted 17th May 2016: Engagement with ABPI & EMIG
7 What we have achieved so far…….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.
8 What we have achieved so far…….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.
9 Greater Manchester CancerVanguard Innovation Biosimilars in cancer
10 Greater Manchester CancerVanguard Innovation
11 Greater Manchester CancerBiosimilars Vanguard Innovation
12 Greater Manchester CancerVanguard Innovation
13 Wouldn’t it be wonderful if…Greater Manchester Cancer Wouldn’t it be wonderful if… Vanguard Innovation 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
14 What does the pathway look like?Greater Manchester Cancer What does the pathway look like? Vanguard Innovation
15 Knowledge discovery toolPatient flows are assessed for variation using the QuintilesIMS Pathway Insights + knowledge discovery platform Knowledge discovery tool 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.
16 Greater Manchester CancerWhat data do we collect? Vanguard Innovation
17 Drugs Analysis 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 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 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.
18 Adhering to NICE guidelines and TADrugs Analysis Visualising adherence to NICE Quality Standards Example Analysis MAB3 : NICE recommended MAB2 : NICE recommended MAB1 : non-NICE recommended Potential unwarranted variation (divergence from NICE guidelines and TA) Adhering to NICE guidelines and TA 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. 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.
19 Drugs Analysis Example insight: Providing MAB1 as 1st line costs less and generates fewer readmissions than MAB2 Resource cost per secondary care treatment type pathway - example MAB3 : NICE recommended MAB2 : NICE recommended MAB1 : non-NICE recommended 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 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.
20 PROMS/PREMS and UMOTIFGreater Manchester Cancer PROMS/PREMS and UMOTIF Vanguard Innovation
21 UMOTIF EQ5D at the start Patient Experience questionsGreater Manchester Cancer UMOTIF Vanguard Innovation 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
22 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 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 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
23 Greater Manchester CancerUptake of the app Vanguard Innovation
24 Reflections on Pharma ChallengeGreater Manchester Cancer Reflections on Pharma Challenge Vanguard Innovation 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
25 Greater Manchester CancerVanguard Innovation
26 Email: [email protected] Web: gmcancervanguardinnovation.org Greater Manchester Cancer Vanguard Innovation Vanguard Innovation Web: gmcancervanguardinnovation.org