Forward thinking health research
How HCEC collaborates to innovate and translate valuable research into practice for patient and public benefit Health and Care Economics Cymru (HCEC) is an all-Wales collaborative research infrastructure group funded by Welsh Government via Health and Care Research Wales. Its mission is to provide world-class health economics expertise (through an agile, integrated all-Wales approach) to enable excellent health and social care research and development in Wales to the benefit of patients, the public and the economy. Health and care resources are limited, and every choice we make on how to allocate our scarce resources has an opportunity cost. This means we need to sacrifice one thing in order to provide another, and every decision will have unintended negative health and care consequences, with some groups within society disproportionally affected. We therefore must know the value for money, or cost-effectiveness, of the health technologies, interventions and services we provide. So, we can reduce inequalities, promote a fair prioritisation of resources, and ensure sustainability of our health and care system. HCEC makes a strong contribution to that evidence base and endeavours to translate research into practice. Here are two case studies that demonstrate how HCEC collaborates on big research projects and real-world evaluations to make a change for the people of Wales.
Empowering oesophageal cancer patients at the end of life Patients with advanced oesophageal cancer have a median survival of three to five months. Most will require intervention for dysphagia (difficulty in swallowing), which usually comprises of oesophageal self-expanding metal stent insertion. However, recurrent dysphagia and re-insertion is common. The ROCS multi-centre, open-label, randomised controlled trial was funded by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme and led by the Centre for Trials Research at Cardiff University in collaboration with Tayside Cancer Centre, Birmingham University, University of Southampton, and Marie Curie and Velindre Cancer Centres. The trial examined the clinical and cost-effectiveness of external beam radiotherapy (EBRT) following stenting compared to usual care
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(no EBRT after stent) in maintaining swallow and quality of life in palliative patients.
needed a programme that was affordable and implementable with a strong evidence base.
Berni Sewell, Mari Jones, Katherine Cullen and Deb Fitzsimmons designed and conducted a comprehensive health economic analysis alongside the ROCS trial, including a de-novo economic model to assess the cost-effectiveness of the ROCS intervention. A detailed chapter was submitted in the NIHR report which, on peer review, received excellent feedback on the quality of analysis.
An effective, brief lifestyle intervention pioneered by the Afan Valley cluster was identified as suitable for implementation in Wales, together with a supporting pathway designed by the All Wales Diabetes Implementation Group (AWDIG). Establishing the value of the AWDIG pathway, compared with ‘usual care’, in a primary care setting for people with pre-diabetes was a vital step in planning for implementing such an intervention in Wales. AWDIG had very limited budget to invest in any research to estimate the value of rolling out the pre-diabetes intervention, so this placed constraint on the scope of the evaluation. Timing was also crucial in order to be able to present evidence at key Welsh Government and NHS Wales meetings.
The ROCS trial, named a ‘landmark’ trial in the field of palliation, concluded that radiotherapy alongside stenting was not a clinically or cost-effective option in the palliative management of dysphagia. This evidence will inform clinical management in this group, empowering practitioners and oesophageal cancer patients who had self-expanding metal stents to make informed end-of-life health and care choices. These results are expected to inform national guidelines on the use of this palliative treatment across the UK in line with the ‘Palliative and End of Life Care Delivery Plan’ (2017) on how the NHS and its partners can provide care and support for people at the end of their life, as well as their families. For more information, please see the full study publication: Palliative radiotherapy after oesophageal cancer stenting (ROCS): a multicentre, open-label, phase 3 randomised controlled trial. The Lancet Gastroenterology & Hepatology.
Value Assessment of a Lifestyle Intervention for People with Pre-diabetes across Wales Wales currently has no national diabetes prevention programme. Whilst English and Scottish Diabetes Prevention Programmes (DPPs) are in place, it was judged that the costs were too high for implementation in Wales. Additionally, the evidence around the DPP showed that it was ineffective in areas of socio-economic deprivation. Wales
Pippa Anderson and Shaun Harris collaborated with AWDIG and the Diabetes Research Unit Cymru and undertook a model-based economic evaluation, as well as an implementation and roll-out costs analysis for all Wales. The results of the health economic evaluation showed that the pre-diabetes pathway proposed by AWDIG is less costly and more effective than current care of people with pre-diabetes. Using Cwm Taf Morgannwg and Cardiff and Vale University Health Boards as examples to represent the best and worst levels of pre-diabetes in Wales, investing in the AWDIG pathway will cost £44 per recipient of the programme and will save NHS Wales resources in the order of £6 million in each Health Board over a ten-year period. These savings result from avoiding the healthcare costs of managing people with diabetes. Furthermore, the personal and quality of life impacts of having type 2 diabetes are also avoided. The findings of the evaluation were received well by a variety of audiences, with the case study being an Award Winner at the Quality in Care Awards at the end of 2019. In March 2021, Welsh Government announced that, based on this collaborative research, it will invest £1million in the first diabetes prevention programme for Wales as an initial step of a National roll out. This decision, based on our evaluation, has the potential to save and improve countless lives and to help make NHS
Wales more sustainable for the future.
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