Potential economic impact on hospitalisations of the Palliative Care Clinical Studies Collaborative (PaCCSC) ketamine randomised controlled trial
Nikki McCaffrey A G , Janet Hardy B , Belinda Fazekas C , Meera Agar D , Linda Devilee C , Debra Rowett E and David Currow FA Palliative Care Clinical Studies Collaborative (PaCCSC) & Flinders Health Economics Group, Flinders University, Room 55, Level 1, Block A, Repatriation General Hospital, Daws Road, Daw Park, SA 5041, Australia.
B Mater Research Institute – The University of Queensland, and The Department of Palliative and Supportive Care, Mater Health Services, South Brisbane, QLD 4101, Australia. Email: Janet.hardy@mater.org.au
C Palliative Care Clinical Studies Collaborative (PaCCSC), Palliative and Supportive Services, Flinders University, 700 Goodwood Road, Daw Park, SA 5041, Australia. Email: Belinda.fazekas@flinders.edu.au; linda.devilee@flinders.edu.au
D Ingham Institute of Applied Medical Research, Locked Bag 82, Wetherill Park, NSW 1851, Australia. Email: meera.agar@sswahs.nsw.gov.au
E Repatriation General Hospital, Daws Road, Daw Park, SA 5044, Australia. Email: Debra.rowett@health.sa.gov.au
F Palliative & Supportive Care, Flinders University, Bedford Park, SA 5042, Australia. Email: david.currow@health.sa.gov.au
G Corresponding author. Email: nicola.mccaffrey@flinders.edu.au
Australian Health Review 40(1) 100-105 https://doi.org/10.1071/AH15012
Submitted: 22 January 2015 Accepted: 20 April 2015 Published: 22 June 2015
Abstract
Objective The aim of the present study was to estimate the potential healthcare cost savings associated with reduced prescribing of subcutaneous ketamine for the treatment of chronic cancer pain after publication of the Palliative Care Clinical Studies Collaborative (PaCCSC) ketamine randomised controlled trial (RCT), to provide further reasons to modify ketamine prescribing practice in this setting.
Methods Potential cost savings in this setting were estimated from a health system perspective using a 1-year impact model. The model was populated with estimates derived using an epidemiological approach informed by morbidity and prevalence data, the PaCCSC feasibility study, ketamine RCT and national ketamine utilisation survey results, as well as clinical opinion.
Results The total estimated annual hospitalisation costs associated with subcutaneous ketamine prescribing were A$3 899 600 (2605 bed-days). A 17% reduction in ketamine prescribing lowered hospitalisation costs to A$3 236 668 (2162 bed-days), a reduction of A$662 932 (443 bed-days) because of reduced in-patient stays associated with ketamine toxicity and prescribing process.
Conclusions The findings from the modelled impact analysis suggest that dissemination of the PaCCSC ketamine RCT results may have saved the Australian healthcare system approximately A$663 000 in annual hospitalisation costs and freed up 443 in-patient bed-days, although there was high uncertainty within the study. Wider dissemination over time and targeted, local de-adoption strategies could result in further savings.
References
[1] O’Mara AM, St Germain D, Ferrell B, Bornemann T. Challenges to and lessons learned from conducting palliative care research. J Pain Symptom Manage 2008; 37 387–94.| 18715749PubMed |
[2] Chen EK, Riffin C, Reid MC, Adelman R, Warmington M, Mehta SS, Pillemer K. Why is high-quality research on palliative care so hard to do? Barriers to improved research from a survey of palliative care researchers. J Palliat Med 2014; 17 782–7.
| Why is high-quality research on palliative care so hard to do? Barriers to improved research from a survey of palliative care researchers.Crossref | GoogleScholarGoogle Scholar | 24885960PubMed |
[3] Currow DC, Shelby-James TM, Agar M, Plummer J, Rowett D, Glare P, Spruyt O, Hardy J. Planning Phase III multi-site clinical trials in palliative care: the role of consecutive cohort audits to identify potential participant populations. Support Care Cancer 2010; 18 1571–9.
| Planning Phase III multi-site clinical trials in palliative care: the role of consecutive cohort audits to identify potential participant populations.Crossref | GoogleScholarGoogle Scholar | 20091059PubMed |
[4] Rowett D, Ravenscroft PJ, Hardy J, Currow DC. Using national health policies to improve access to palliative care medications in the community. J Pain Symptom Manage 2009; 37 395–402.
| Using national health policies to improve access to palliative care medications in the community.Crossref | GoogleScholarGoogle Scholar | 18722748PubMed |
[5] Hardy J, Quinn S, Fazekas B, Plummer J, Eckermann S, Agar M, Spruyt O, Rowett D, Currow DC. A randomised, double-blind placebo controlled study to assess the efficacy and toxicity of subcutaneous ketamine in the management of cancer pain. J Clin Oncol 2012; 30 3611–17.
| A randomised, double-blind placebo controlled study to assess the efficacy and toxicity of subcutaneous ketamine in the management of cancer pain.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC38XhslSkur3K&md5=9ab0986f24c4fcf749d3a6d5245454b9CAS | 22965960PubMed |
[6] Hardy JR. A randomised, double-blind placebo controlled study of subcutaneous ketamine in the management of cancer pain. Protocol 001/07 V1.3.8. Adelaide: Palliative Care Clinical Studies Collaborative, Flinders University; 2010.
[7] Hardy JR, Spruyt O, Quinn SJ, Devilee LR, Currow DC. Implementing practice change in chronic cancer pain management: clinician response to a phase III study of ketamine. Intern Med J 2014; 44 586–91.
| Implementing practice change in chronic cancer pain management: clinician response to a phase III study of ketamine.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC2cXhtVenu7%2FM&md5=276f53bcd501ca0dea981d826b12b88fCAS | 24720500PubMed |
[8] Australian Institute of Health and Welfare. Australian cancer incidence and mortality (ACIM) books: all cancers combined for Australia. 2015. Available at: http://www.aihw.gov.au/acim-books/ [verified 20 September 2014].
[9] Deandrea S, Montanari M, Moja L, Apolone G. Prevalence of undertreatment in cancer pain. A review of published literature. Ann Oncol 2008; 19 1985–91.
| Prevalence of undertreatment in cancer pain. A review of published literature.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD1cjlsFeisw%3D%3D&md5=26794e6718d83cca3794868d8a16d749CAS | 18632721PubMed |
[10] Currow D, Shelby-James T, Agar M, Plummer J, Rowett D, Glare P, Spruyt O, Hardy J. Planning Phase III multi-site clinical trials in palliative care: the role of consecutive cohort audits to identify potential participant populations. Support Care Cancer 2010; 18 1571–9.
| Planning Phase III multi-site clinical trials in palliative care: the role of consecutive cohort audits to identify potential participant populations.Crossref | GoogleScholarGoogle Scholar | 20091059PubMed |
[11] Australian Institute of Health and Welfare (AIHW) and Australasian Association of Cancer Registeries. Cancer in Australia: an overview 2012. Canberra: AIHW; 2012.
[12] Gaudreau JD, Gagnon P, Harel F, Tremblay A, Roy MA. Fast, systematic, and continuous delirium assessment in hospitalized patients: the nursing delirium screening scale. J Pain Symptom Manage 2005; 29 368–75.
| Fast, systematic, and continuous delirium assessment in hospitalized patients: the nursing delirium screening scale.Crossref | GoogleScholarGoogle Scholar | 15857740PubMed |
[13] Rizzo JA, Leo-Summers L, Williams CS, Acampora D, Inouye SK. Multicomponent targeted intervention to prevent delirium in hospitalized older patients: what is the economic value? Med Care 2001; 39 740–52.
| Multicomponent targeted intervention to prevent delirium in hospitalized older patients: what is the economic value?Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3Mvgs12jsg%3D%3D&md5=7d4ff17e1753d774cd6173106aba5ae7CAS | 11458138PubMed |
[14] Zaubler TS, Murphy K, Rizzuto L, Santos R, Skotzko C, Giordano J, Bustami R, Inouye SK. Quality improvement and cost savings with multicomponent delirium interventions: replication of the hospital elder life program in a community hospital. Psychosomatics 2013; 54 219–26.
| Quality improvement and cost savings with multicomponent delirium interventions: replication of the hospital elder life program in a community hospital.Crossref | GoogleScholarGoogle Scholar | 23489646PubMed |
[15] Markar SI, Karthikesalingam A, Low DE. The clinical and economic costs of delirium after surgical resection for esophageal malignancy. Ann Surg 2013; 258 77–81.
| The clinical and economic costs of delirium after surgical resection for esophageal malignancy.Crossref | GoogleScholarGoogle Scholar |
[16] Australian Institute of Health and Welfare (AIHW). Australian hospital statistics 2009–10. Canberra: Australian Institute of Health and Welfare; 2011.
[17] Australian Institute of Health and Welfare (AIHW). Australian hospital statistics 2010–11. Canberra: AIHW; 2012.
[18] Al Hamid A, Ghaleb M, Aljadhey H, Aslanpour Z. A systematic review of hospitalization resulting from medicine-related problems in adult patients. Br J Clin Pharmacol 2014; 78 202–17.
| A systematic review of hospitalization resulting from medicine-related problems in adult patients.Crossref | GoogleScholarGoogle Scholar | 24283967PubMed |
[19] Leppert W. Ketamine in the management of cancer pain. J Clin Oncol 2013; 31 1374
| Ketamine in the management of cancer pain.Crossref | GoogleScholarGoogle Scholar | 23423750PubMed |
[20] Jackson K, Franco M, William L, Poon P, Pisasale M, Kenner D, Brumley D, Mewett G, Ashby M, Viney M, Kerr D. Ketamine and cancer pain: the reports of my death have been greatly exaggerated. J Clin Oncol 2013; 31 1373–4.
| Ketamine and cancer pain: the reports of my death have been greatly exaggerated.Crossref | GoogleScholarGoogle Scholar | 23423743PubMed |
[21] Hardy J, Quinn S, Fazekas B, Eckermann S, Agar MR, Spruyt O, Rowett D, Currow D. Reply to K. Jackson et al. and W. Leppert. J Clin Oncol 2013; 31 1375–6.
| Reply to K. Jackson et al. and W. Leppert.Crossref | GoogleScholarGoogle Scholar | 23662305PubMed |
[22] Mercadante S. Ketamine: to be or not to be. Ann Palliat Med 2013; 2 37–9.
| 25841742PubMed |
[23] Spruyt O, Le B, Philip J. Integrating new evidence about an old drug: growing pains as palliative medicine matures. J Pain Symptom Manage 2013; 46 e3–5.
| Integrating new evidence about an old drug: growing pains as palliative medicine matures.Crossref | GoogleScholarGoogle Scholar | 24176613PubMed |
[24] Spruyt O, Le BH, Philip J. Integrating new evidence about an old drug: authors’ reply to Franco et al. and Bell et al. J Pain Symptom Manage 2014; 47 e4–5.
| Integrating new evidence about an old drug: authors’ reply to Franco et al. and Bell et al.Crossref | GoogleScholarGoogle Scholar | 24679556PubMed |
[25] Franco M, William L, Poon P, Jackson K. Critical appraisal of randomized controlled trials: the beginning of thought… J Pain Symptom Manage 2014; 47 e1–2.
| Critical appraisal of randomized controlled trials: the beginning of thought…Crossref | GoogleScholarGoogle Scholar | 24480528PubMed |
[26] Berwick DM. Disseminating innovations in health care. JAMA 2003; 289 1969–75.
| Disseminating innovations in health care.Crossref | GoogleScholarGoogle Scholar | 12697800PubMed |
[27] Henshall C, Schuller T, Mardhani-Bayne L. Using health technology assessment to support optimal use of technologies in current practice: the challenge of ‘disinvestment’. Int J Technol Assess Health Care 2012; 28 203–10.
| Using health technology assessment to support optimal use of technologies in current practice: the challenge of ‘disinvestment’.Crossref | GoogleScholarGoogle Scholar | 22792877PubMed |
[28] Roman BR, Asch DA. Faded promises: the challenge of deadopting low-value carethe challenge of deadopting low-value care. Ann Intern Med 2014; 161 149–50.
| Faded promises: the challenge of deadopting low-value carethe challenge of deadopting low-value care.Crossref | GoogleScholarGoogle Scholar | 24781317PubMed |
[29] Hasson F, Keeney S, McKenna H. Research guidelines for the Delphi survey technique. J Adv Nurs 2000; 32 1008–15.
| 1:STN:280:DC%2BD3Mvps1Citg%3D%3D&md5=eb4769c5a7daf0371cfc17f800933d75CAS | 11095242PubMed |
[30] Andronis L, Barton P, Bryan S. Sensitivity analysis in economic evaluation: an audit of NICE current practice and a review of its use and value in decision-making. Health Technol Assess 2009; 13 1–61.
| Sensitivity analysis in economic evaluation: an audit of NICE current practice and a review of its use and value in decision-making.Crossref | GoogleScholarGoogle Scholar |
