Spending the health dollar wisely
Costs as well as benefits must be considered when assessing medical programs, according to a key researcher in Cancer 2015, a project that will develop, test and implement a new model of cancer diagnosis and treatment.
Cancer 2015, led by the Peter MacCallum Cancer Centre and funded by the Victoria Cancer Agency, is one of the world’s largest prospective longitudinal, population-based, molecular studies. A co-investigator on the study, Associate Professor Paula Lorgelly of Monash University’s Centre for Health Economics, is leading the health economics aspects.
“It’s not enough, especially in austere times, to show that treatments work. We need to show that they are cost-effective – that as a country, we can afford them,” Associate Professor Lorgelly said.
Cancer 2015, still in its initial stages, will eventually study 10,000 patients from 14 Victorian hospitals. Its goals include implementing molecular methods of screening newly diagnosed tumours for mutations that are vulnerable to targeted drugs in the rapidly advancing field of personalised medicine.
Patients at the hospitals who are starting treatment for any cancer are eligible for inclusion. All will have their tumour genetically profiled, and their progress tracked, to determine such things as their quality of life during and after treatment.
The approach goes beyond purely medical issues.
Associate Professor Lorgelly is interested in such things as how much we might be willing to pay for the treatment of rare cancers or for treatment for people near the end of their lives; how rural patients fare compared with those in urban areas; and the difference, if any, in survival rates between patients in the public and private system.
In general, she is seeking to find a balance between a fixed amount of money, the degree of improvement a drug brings, its cost, and the number of people who are likely to benefit.
“It’s not just about the cost of the drug per unit of improvement you get,” Associate Professor Lorgelly said. “It’s also about the prevalence in society –a drug can be quite expensive, and if a lot of people are going to need it, it’s really going to affect the budget.”
As well as information obtained from patient interview and questionnaires, the researchers (with the patients’ consent) will have access to state hospital data and links with the federal database for Medicare, providing information about such things as the costs of primary care, radiology and pharmaceuticals.
“The central thing is about determining the best treatment that the country can afford,” Associate Professor Lorgelly said.
“Given that we can’t afford everything, we must make sure we spend our money in the best possible places.”