Thinking critically about the value and cost of drugs: managing patients with invasive fungal disease

We developed a framework to help clinicians and decision-makers think systematically about how to compare patient management options whilst considering the full costs to the healthcare provider, and a toolkit based on this framework for patients with invasive fungal infection in England. Adopting this framework can help healthcare providers move towards a more holistic understanding of drug treatment and management costs that may help the NHS save money, freeing up resources for better health care.

presentation_iconAdams EJ, Kendall E, Horner J, et al. Thinking critically about the value and cost of drugs: managing patients with invasive fungal disease. ECCMID 2015. 25 – 28 April 2015. Copenhagen, Denmark.

 

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Estimating the true costs of splitting HIV antiretroviral drugs

Problem: A regional UK commissioning decision in 2010 mandated that when the component drugs of Combivir—a combination therapy for HIV—come off patent, doctors must prescribe the individual drugs instead. This was driven by a perception that the generic component drugs are cheaper in the immediate-term and so more efficient overall. As our pharmaceutical client’s HIV combination drug was soon to come off patent, they wanted to help commissioners understand the full healthcare costs of such a policy, to inform future decisions.

 Approach: We worked with our client and clinicians in Nottingham University Hospital’s HIV clinic who had patient-level care data before and after the commissioning change. We planned the analysis and identified which costs would be used and which data were required.

 Impact: Our work contributes to the evidence-base of the costs of prescribing patients a single dose therapy over multiple doses. It has changed people’s perceptions of the costs of treating long-term conditions with combination drugs, and helped commissioners to make policy decisions about mandating use of particular drugs without taking a holistic view of healthcare.

 

Testimonial

“Aquarius provided a professional yet personal level of support with our project. We found the statistical support invaluable, and felt that they went the extra mile to ensure the project went smoothly and on time.”

  • Dr Ruth Taylor, Consultant in Genitourinary Medicine, Nottingham University Hospitals NHS Trust

 

Related publications

 publication_iconTaylor R, Carlin E, Sadique Z, Ahmed I, Adams EJ. The financial and service implications of splitting fixed-dose antiretroviral drugs – a case study. Accepted Mar 2014, Int J STD AIDS

 

The true cost of treating invasive fungal infections in hospitals

Problem: Our client’s drug is recommended in most guidelines as a first line treatment for invasive fungal infections in immunocompromised patients. But because its acquisition cost can be comparatively high, health care purchasers have tended to favour its lower-cost competitors. To challenge this perception, our client wanted to know what the total healthcare costs were of treating patients with invasive fungal infection with its drug compared to alternatives, and to help customers understand the wider costs of patient management.

Approach: We took a two-pronged approach. First, we assembled a multidisciplinary team, to work closely with our client’s market access and medical teams in the UK, Ireland, and internationally. We reviewed the published evidence base of the side-effects, effectiveness and costs of its drug and its alternatives, and built a simple, user-friendly Excel tool that could be used with their customers to demonstrate the total treatment costs of theirs and competitors’ drugs. National data for the baseline values in the tool were used, but we incorporated a simple interface so that customers could use local patient data and costs for a personalised result.

Next, we worked with clinicians at Kings College Hospital NHS Foundation Trust to analyse data collected prospectively as part of a study of haematology patients receiving antifungal treatment in hospital. This patient level analysis explored the costs of antifungal and antibiotic drugs, diagnostic tests, and hospital stay. We found that the driver of costs was the underlying inpatient stay, which was much higher than the cost of antifungal drugs.

Impact: Our client’s sales team have reported that our tool has been integral in their work and as part of their evidence base. They can help their customers understand the total costs of different treatment strategies, and it has prompted several clinics to audit their own local data and then use it in the tool to estimate the impact of drug use on their overall costs. Results from the analysis at Kings College Hospital provided much needed evidence of the costs of care for IFD patients, which can be used to inform local and national tariffs. More generally, the project has helped raise awareness of the wider issues of cost, rather than focusing on the drug acquisition cost alone.

 

Testimonial

“Through working with Elisabeth and her team I have been able to develop excellent tools which have been relevant to our customers and valuable to our sales team. Aquarius is flexible to my needs and able to adapt their approach as situations and demands change. I have always found Elisabeth to be very knowledgeable and professional and I thoroughly enjoy the partnership we have developed. I would definitely recommend working with Aquarius!”

  • Manager, Market Access & Reimbursement, pharmaceutical company

“The Aquarius team conducted an analysis of individual patient data from our hospital. They were very proactive and responsive throughout our collaboration, and although we had quite complicated data, they delivered excellent results ending in a peer-reviewed publication.”

  • Dr Tony Pagliuca, Clinical and Transplant Director, Chair of DH BMT CRG, and Professor of Stem Cell Transplantation, King’s College Hospital NHS Foundation Trust
  • Dr M. Mansour Ceesay, Consultant Haematologist, King’s College Hospital NHS Foundation

 

Related publications

publication_iconCeesay MM, Sadique Z, Harris, R, Ehrlich A, Adams EJ, Pagliuca A. Prospective Evaluation Of The Cost Of Diagnosis And Treatment Of Invasive Fungal Disease In A Cohort Of Adult Haematology Patients In The United Kingdom. J Antimicrobial Chemotherapy. 2014; doi: 10.1093/jac/dku506.

presentation_iconAdams EJ, Kendall E, Horner J, Marsh R. Thinking critically about the value and cost of drugs: managing patients with invasive fungal disease. ECCMID 2015. 25 – 28 April 2015. Copenhagen, Denmark.

Managing Mycoplasma genitalium as an STI

Mycoplasma genitalium is a prevalent sexually transmitted infection that causes significant morbidity in men and women and is a co-factor in HIV transmission. However, commercial diagnostic tests are not generally available for M. genitalium and sub-optimal treatment is often given. Diagnostic tests are needed to reduce the risk of the development of antimicrobial resistance and improve patient care.

publication_iconHorner P, Blee K, Adams E. Time to manage Mycoplasma genitalium as an STI: but not with azithromycin 1g! Curr Opin Infect Dis. 2014; 27:1:68-74.

 

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The cost of managing haematology patients with invasive fungal disease

We aimed to estimate the cost of care for patients with invasive fungal disease (IFD) in England. We analysed prospectively collected data from adult haematology patients in a large hospital in London. We found that the attributable cost of managing IFD was greater than £50,000 per case, with the inpatient stay accounting for 3/4 of costs. Costs for inpatient stay far outstrip the cost of antifungal drugs.

publication_iconCeesay MM, Sadique Z, Harris, R, Ehrlich A, Adams EJ, Pagliuca A.
Prospective Evaluation Of The Cost Of Diagnosis And Treatment Of Invasive Fungal Disease In A Cohort Of Adult Haematology Patients In The United Kingdom. J Antimicrobial Chemotherapy. 2014; doi: 10.1093/jac/dku506.

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