What might the current Westminster Government mean for ... - BOPA

Healthcare reform a
hot topic at HOPA
HOPA highlights
An informative and enjoyable boot
camp was a great way of refreshing
knowledge and questioning what you
think you know. Topics covered included:
Healthcare reform, and what this
is likely to mean for oncology
pharmacy, was one of the
hot topics at this years’ Hematology
Oncology Pharmacy Association annual
meeting, which took place on 24 to 27
March in New Orleans, US.
Keynote speaker, Joseph S Bailes,
an oncologist with experience in legal
and public policy, reviewed President
Obama’s Health Care Reform Bill,
the legislation having been passed in
Congress just two days previously. He
discussed innovative systems to deliver
cancer care, such as homecare and
treatment bundles, and suggested that the
comparative effectiveness of these options
could be examined by the National
Comprehensive Cancer Network.
Since the NCCN has a long history of
producing practice guidelines, which are
frequently used by insurance companies
and other ‘payors’ to help determine
which treatments to fund, the NCCN’s
findings are likely to be quickly and
widely accepted by the US equivalent
of NICE, Dr Bailes pointed out. Potential
effects of US healthcare reform on drug
evaluation included the development of an
approval pathway for biosimilars, with a
14 year exclusivity period for originators,
he continued.
Financial issues facing healthcare did
not seem ever to be far from participants’
minds, even in clinical sessions, with many
presenters commenting on whether benefits
were cost effective. A monoclonal antibody
against a CS1 glycoprotein expressed
relatively specifically and uniformly on
myeloma cells, with a manageable
toxicity profile, was among those agents
in development that stood out. This agent,
like many of those discussed, is potentially
additive to existing therapies, which begged
the obvious question to participants of how
such treatment advances will ultimately be
paid for – on both sides of the Atlantic.
The potential benefits (a trend towards
increasing survival) of the individualised
dosing of fluorouracil were also shown,
as were the limitations of the technology
to enable, for example, samples to be
analysed quickly enough so that circadian
rhythms can be taken into account and an
assessment to be made of whether plasma
exposure is a surrogate for tissue exposure.
Contributed by Bruce Burnett
• Chemotherapy induced nausea and
vomitting
• Pain management
• Myelosuppression
• Gastroinstestinal toxicities
• Paediatrics
• Oncologic emergencies
Continuing on the boot camp theme,
congratulations to Fionagh Ross and
Clint Wright who came second and
third respectively in the ladies’ and
men’s running races – ‘Rays of hope’ -
despite their excursion to Bourbon Street
the night before! They maintained the
UK participants’ successes at last year’s
‘Run in the sun.’
On behalf of the 16 UK HOPA
participants sponsored by Roche
Products Ltd, I would like to thank Roche
for providing us with an educational
grant to attend the conference and to
produce a slide set of our conference
highlights (a composite from all the
Roche-sponsored attendees), which is
available for local cancer network or
similar meeting presentation. Should
you see such events advertised, please
consider taking the time to attend.
Quality counts in Nice
Health
Improving quality and reducing costs
was the theme of the 15th Annual
International Forum on Quality and
Safety in Healthcare held in Nice, France
from 20 to 23 April.
The triple aim initiative was among the
topics covered by keynote speaker, Professor
Donald Berwick, President and CEO of
Insitute for Healthcare Improvement and
administrator of the Centers for Medicare
and Medicaid Services. Changing one of
the three “dimensions of care” (see diagram)
has consequences for the other two, either in
the same or opposite direction. For example,
improving health can raise costs; reducing
costs can create poor outcomes and a poor
experience of care, or both; and patients’
experience of care can improve without
improving health.
Professor Berwick explained the TAI in
the context of the US system. Here, the
10% of the population who spend the most
on healthcare account for 64% of the total
healthcare expenditure and so as healthcare
expenditure continues to escalate the overall
populations’ health status does not improve
at the same rate.
My personal thoughts
Professor Berwick’s speech prompted me
to think about how the TIA could apply
to UK practice. My thoughts are that
perhaps we need to look at how we
can manage patients more proactively
during chemotherapy to avoid emergency
admissions and to keep their length of stay
in an acute setting to a minimum. Using
appropriate pre- and post-chemotherapy
anti-emetics and/or growth factors as
prophylaxis against complications during
the ‘nadir’ period are potential methods that
spring to mind.
Considering whether we can deliver
chemotherapy safely outside a hospital
Experience
of care
Cost per
capita
setting (e.g. via a homecare company or
via a GP) also looks worthwhile in certain
circumstances. These models of care might
also help avoid incidences where GPs
passively and mistakenly continue oral
chemotherapy regimens when patients return
home.
Attending the forum has really broadened
my horizons and I would like to thank BOPA
for granting me the Travel Award and
LeoLab Pharma for their sponsorship.
Contributed by Trinh Ngyuen,
specialist oncology pharmacist at
Barts and The London NHS Trust
BOPA Bulletin Issue 1 Summer 2010