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Exploring Pharmacist's Role In Palliative Care: A Qualitative Study
A894
VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 8 0 7 – A 9 1 8
patients (n= 182) had a biopsy performed. 71.0% had a biopsy performed before diagnosis. 85.3 % (n= 185) of patients had a biomarker test (BMx), 85.0% (n= 158) of whom had NSq histology. 69.0% (n= 109) of the NSq histology had positive EGFR mutation status. Majority of the BMx tests (92.0%, n= 170) were performed before start of 1LT. Across all histologies, the most common 1LT regimens were gefitinib (50.0%, n= 108), pemetrexed (7.0%, n= 15) and cisplatin+pemetrexed (7.0%, n= 15). 32.0% (n= 50) patients received single agent for 2LT, most commonly pemetrexed (11%, n= 17). 53.0% (n= 48) received anti-EGFR/anti-ALK therapy for 3LT, most commonly erlotinib (48.0%, n= 44). Median OS for Taiwan from start of 1LT & 2LT was 25.47 and 15.77 months respectively. The total number of hospital inpatient admissions was 683. The overall average inpatient length of stay, regardless of line of therapy was 10.94 days per admission. Conclusions: Anti-EGFR/anti-ALK therapy is commonly used in 1LT; single agents are commonly used in 2LT. More than 85% patients received a BMx test. PCN58 Government Sponsored Health Insurance Schemes for Reimbursement of Cancer Treatment in India Singh S, Rai MK, Bhutani MK, Singh R, Gollala M, Rana P Tata Consultancy Services, Mumbai, India
Objectives: Various estimates by World Health Organization (WHO) and other authorities suggest that incidence of various types of cancers in India is on rise. As cancer treatment is costly, health insurance can save significant financial burden on cancer patients and their families. The purpose of this research is to identify major government sponsored schemes for reimbursement of cancer treatment in India and population coverage under such schemes. Methods: Secondary research was conducted to analyze the relevant information from government websites, review articles, research articles, World Bank reports and special task force reports. An overall summary pertaining to reimbursement entitlement under different schemes was prepared and analysed. Results: Major government sponsored health insurance schemes that together cover 82 million government employees for reimbursement of cancer treatment in India, include, Central Government Health Service (CGHS), Employee State Insurance Scheme (ESIS), Retired Employees Liberalized Health Scheme (RELHS), railway health service and Ex-servicemen Contributory Health Scheme (ECHS). Entitlements under above mentioned schemes are comprehensive and include reimbursement for primary, secondary and tertiary medical care including outpatient charges, medicines, special diagnostics and lab-based tests. There is no per-capita limit on expenditure under these schemes. For poor population, central government funds Rashtriya Swasthya Bima Yojana (RSBY) to insure 70 million Below Poverty Line (BPL) families for hospitalization related expenses of up to INR 30,000. Aarogyasri, Kalaignar and Yeshasvini are some of the state-sponsored schemes that cover state specific 114 million BPL population for hospitalization related expenses in the range of INR 1,00,000-1,50,000. Conclusions: Together these schemes cover almost 266 million people and protect them from catastrophic expenditure of cancer treatment. However, there is a large amount of population that remains uncovered. It is also important to increase the provisions under statesponsored schemes and RSBY as they do not provide comprehensive coverage for cancer treatment.
(HKL) and Hospital Selayang (HS) in Malaysia. Purposive sampling technique was used to recruit healthcare professionals from the Department of Radiotherapy and Oncology of HKL and Palliative Care Unit of HS. Informed consent was taken and all the interviews were audio-taped, transcribed verbatim and subjected to thematic analysis. Ethics approval was granted by the Medical Research Ethics Committee, Ministry of Health, Malaysia. Results: Respondents believed that pharmacists possess remarkable knowledge and skills in managing pharmaceutical care issues. They emphasised that if integrated within the clinical team, pharmacists can complement both doctors and nurses in many ways by providing accurate and timely information regarding drug-related issues. Pharmacists were often consulted by physicians and nurses for individualisation of patients’ drug therapy. However, pharmacists reported that they had to play multiple roles as they were also involved in reconstitution of cytotoxic drugs. Time limitation and multitasking may reduce the quality of pharmaceutical care service. Conclusions: The role of pharmacists in palliative care is well recognised and valued by other health care professionals. Nevertheless, more pharmacists need to be allocated in palliative care in order to allow clinical pharmacists to work in a multidisciplinary team and to be able to fully concentrate in the pharmaceutical care management. PCN61 Mapping The Policy Response To Breast Cancer In Asia Lovell AD EIU Healthcare, London, UK
Objectives: Once largely confined to Western countries, breast cancer is now a major Asian healthcare issue. To examine how well governments are tackling breast cancer, we created a scorecard to map policy response to breast cancer in ten countries/territories: Australia, China, Hong Kong, India, Japan, Malaysia, Singapore, South Korea, Taiwan and Thailand. Methods: The scorecard was developed through a review and thematic analysis of the literature. Five key policy areas emerged: Awareness-raising; early detection; treatment quality and access; palliative care; and data collection. Not so prominent in the literature but of increasing importance, is the shift towards survivorship. Therefore we added a sixth theme: Long term survivor support and openness to advocacy. These six themes (domains) formed the basis of the scorecard. Further reviews of the literature and primary research (interviews) were used to assign countries scores from 0 to 48 for each domain. Results: First, wealth correlates with breast cancer control policy. Australia, with its strong reputation in cancer control, had the highest score, followed closely by other high-income countries. Good policy does not depend solely on income however – the next tier included Malaysia and Thailand, which have similar scores even though the former has a higher GDP per capita. Second, the focus of breast cancer control tends to be at the front end – awareness-raising, detection and treatment scores were higher than those for long-term support and palliative care. Third, while policy is crucial, it is not everything. Although outcomes broadly correlate with the scorecard results, important exceptions exist. Malaysia’s outcomes, for example, are as poor as India. Conclusions: Defining metrics is a challenge and comparable national information was rare on the ground. Inevitably, the results of such an exercise are indicative rather than precise. Nevertheless, they are a useful starting point for discussing the state of breast cancer control.
PCN59 Risk Share Agreements (RSA), Product Listing Agreements (PLA) or Patient Access Schemes (PAS) - All the Same or Different?
PCN62 Prioritizing Medication Problems in Care of People with Cancer and Solutions For These: A Prioritize Study
1University
Kim H1, Harrison JP2, Moshyk A3, Liew D4 of Melbourne, Parkville, Australia, 2Bristol-Myers Squibb, Uxbridge, UK, 3BristolMyers Squibb, Saint-Laurent, QC, Canada, 4Monash University, Melbourne, Australia
Tudor Car L Imperial College London, London, UK
Objectives: Australia, Canada and the UK are ‘mature’ health technology assessment (HTA) markets that allow special (undisclosed) arrangements between sponsors and payers so that drugs can be conditionally listed on reimbursement schedules but with limitation of economic uncertainty for payers. These agreements are called risk share agreements (RSA) in Australia, product listing agreements (PLA) in Canada and patient access schemes (PAS) in the UK. However, it is not clear what differences, if any, exist in these arrangements across the 3 markets This qualitative study sought to compare special arrangements between drug sponsors and payers in Australia, Canada and the UK. Methods: This is a qualitative review of publicly available information and the expert opinion from Australia, Canada and the UK. Experts were selected from industry and academia. Results: All three countries allow simple agreements like a list price versus a net price. Complex arrangements, which may seek to address clinical as well as financial uncertainty, are also known to occur, but in the UK are usually by exception. Furthermore, in the UK, arrangements are proposed by sponsors and generally require approval by the relevant bodies prior to first consideration by the decision maker. In Canada, recommendations for PLAs are made by HTA agencies and negotiations take place after the HTA reviews. In Australia, RSAs can be proposed by either sponsors or payers. Implementation of agreements also vary between countries. In Australia, because drugs are funded by the federal government, implementation of RSAs occurs centrally. In the UK and Canada, local payers implement the agreements. Conclusions: Special arrangements in Australia, Canada and the UK serve a common purpose but there are important differences among the 3 countries which may lead to different benefits and barriers in implementation. Detailed information on agreements were limited due to the confidential nature of these agreements.
Objectives: Cancer treatment includes the use of different antineoplastic agents along with other medicines. The use of multiple concomitant medications and the involvement of a greater number of clinicians in treatment have been shown to increase the possibility of medication errors. Our aim was to identify priorities for cancer medication safety according to cancer care professionals using a novel priority-setting approach. Methods: We developed and implemented a new priority-setting approach called PRIORITIZE. We invited North West London cancer care clinicians to identify and prioritize main causes for, and solutions to, medication errors in cancer care. Forty cancer care providers submitted their suggestions which were thematically synthesized into a composite list of 20 distinct problems and 22 solutions. A random group of 26 clinicians scored these suggestions using predetermined criteria and an overall ranking was derived. Results: The top ranked problems focused on patients’ poor understanding of treatments due to language or education difficulties, clinicians’ insufficient attention to patients’ psychological distress and poor information exchange among healthcare providers. The top ranked solutions were guidance to patients and their carers on what to do when unwell, an appropriate pre-chemotherapy work up for all patients and improved staff training. Overall, clinicians considered better communication between healthcare providers, quality assurance procedures during prescription and monitoring stages and patient education as key strategies for improving cancer medication safety. Conclusions: Clinician-identified priorities for reducing cancer medication errors covered wide dimensions of care. The central finding is that, according to clinicians, cancer medication safety can be improved with interventions requiring relatively minor investment. PRIORITIZE is a timely, informative and scalable priority-setting approach and could be implemented as a routine preventative system for determining patient safety issues by frontline staff.
PCN60 Exploring Pharmacist’s Role In Palliative Care: A Qualitative Study Sundus A1, Gnanasan S1, Ismail NE2 1Universiti Teknologi MARA, Puncak Alam, Malaysia, 2MAHSA University, Selangor, Malaysia
Objectives: The aim of the study was to explore the expectations and perceptions of healthcare practitioners regarding the role of pharmacists in palliative cancer care. Methods: A qualitative study involving in-depth interviews from nine doctors, seven nurses and four pharmacists was carried out at Hospital Kuala Lumpur
PCN63 Imatinib Discontinuation and Tki Switching Patterns in the Retrospective and Prospective Cohorts in Simplicity, A Study of Chronic-Phase Chronic Myeloid Leukemia (CP-CML) Patients (PTS) in Routine Clinical Practice Zyczynski T1, Khoury J2, Goldberg S3, Mauro M4, Michallet M5, Paquette R6, Foreman A7, Subar M1, Turner M7, Manley Daumont M8, Hehlmann R9, Simonsson B10 1Bristol-Myers Squibb, Princeton, NJ, USA, 2Winship Cancer Institute of Emory University, Atlanta,
VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 8 0 7 – A 9 1 8
patients (n= 182) had a biopsy performed. 71.0% had a biopsy performed before diagnosis. 85.3 % (n= 185) of patients had a biomarker test (BMx), 85.0% (n= 158) of whom had NSq histology. 69.0% (n= 109) of the NSq histology had positive EGFR mutation status. Majority of the BMx tests (92.0%, n= 170) were performed before start of 1LT. Across all histologies, the most common 1LT regimens were gefitinib (50.0%, n= 108), pemetrexed (7.0%, n= 15) and cisplatin+pemetrexed (7.0%, n= 15). 32.0% (n= 50) patients received single agent for 2LT, most commonly pemetrexed (11%, n= 17). 53.0% (n= 48) received anti-EGFR/anti-ALK therapy for 3LT, most commonly erlotinib (48.0%, n= 44). Median OS for Taiwan from start of 1LT & 2LT was 25.47 and 15.77 months respectively. The total number of hospital inpatient admissions was 683. The overall average inpatient length of stay, regardless of line of therapy was 10.94 days per admission. Conclusions: Anti-EGFR/anti-ALK therapy is commonly used in 1LT; single agents are commonly used in 2LT. More than 85% patients received a BMx test. PCN58 Government Sponsored Health Insurance Schemes for Reimbursement of Cancer Treatment in India Singh S, Rai MK, Bhutani MK, Singh R, Gollala M, Rana P Tata Consultancy Services, Mumbai, India
Objectives: Various estimates by World Health Organization (WHO) and other authorities suggest that incidence of various types of cancers in India is on rise. As cancer treatment is costly, health insurance can save significant financial burden on cancer patients and their families. The purpose of this research is to identify major government sponsored schemes for reimbursement of cancer treatment in India and population coverage under such schemes. Methods: Secondary research was conducted to analyze the relevant information from government websites, review articles, research articles, World Bank reports and special task force reports. An overall summary pertaining to reimbursement entitlement under different schemes was prepared and analysed. Results: Major government sponsored health insurance schemes that together cover 82 million government employees for reimbursement of cancer treatment in India, include, Central Government Health Service (CGHS), Employee State Insurance Scheme (ESIS), Retired Employees Liberalized Health Scheme (RELHS), railway health service and Ex-servicemen Contributory Health Scheme (ECHS). Entitlements under above mentioned schemes are comprehensive and include reimbursement for primary, secondary and tertiary medical care including outpatient charges, medicines, special diagnostics and lab-based tests. There is no per-capita limit on expenditure under these schemes. For poor population, central government funds Rashtriya Swasthya Bima Yojana (RSBY) to insure 70 million Below Poverty Line (BPL) families for hospitalization related expenses of up to INR 30,000. Aarogyasri, Kalaignar and Yeshasvini are some of the state-sponsored schemes that cover state specific 114 million BPL population for hospitalization related expenses in the range of INR 1,00,000-1,50,000. Conclusions: Together these schemes cover almost 266 million people and protect them from catastrophic expenditure of cancer treatment. However, there is a large amount of population that remains uncovered. It is also important to increase the provisions under statesponsored schemes and RSBY as they do not provide comprehensive coverage for cancer treatment.
(HKL) and Hospital Selayang (HS) in Malaysia. Purposive sampling technique was used to recruit healthcare professionals from the Department of Radiotherapy and Oncology of HKL and Palliative Care Unit of HS. Informed consent was taken and all the interviews were audio-taped, transcribed verbatim and subjected to thematic analysis. Ethics approval was granted by the Medical Research Ethics Committee, Ministry of Health, Malaysia. Results: Respondents believed that pharmacists possess remarkable knowledge and skills in managing pharmaceutical care issues. They emphasised that if integrated within the clinical team, pharmacists can complement both doctors and nurses in many ways by providing accurate and timely information regarding drug-related issues. Pharmacists were often consulted by physicians and nurses for individualisation of patients’ drug therapy. However, pharmacists reported that they had to play multiple roles as they were also involved in reconstitution of cytotoxic drugs. Time limitation and multitasking may reduce the quality of pharmaceutical care service. Conclusions: The role of pharmacists in palliative care is well recognised and valued by other health care professionals. Nevertheless, more pharmacists need to be allocated in palliative care in order to allow clinical pharmacists to work in a multidisciplinary team and to be able to fully concentrate in the pharmaceutical care management. PCN61 Mapping The Policy Response To Breast Cancer In Asia Lovell AD EIU Healthcare, London, UK
Objectives: Once largely confined to Western countries, breast cancer is now a major Asian healthcare issue. To examine how well governments are tackling breast cancer, we created a scorecard to map policy response to breast cancer in ten countries/territories: Australia, China, Hong Kong, India, Japan, Malaysia, Singapore, South Korea, Taiwan and Thailand. Methods: The scorecard was developed through a review and thematic analysis of the literature. Five key policy areas emerged: Awareness-raising; early detection; treatment quality and access; palliative care; and data collection. Not so prominent in the literature but of increasing importance, is the shift towards survivorship. Therefore we added a sixth theme: Long term survivor support and openness to advocacy. These six themes (domains) formed the basis of the scorecard. Further reviews of the literature and primary research (interviews) were used to assign countries scores from 0 to 48 for each domain. Results: First, wealth correlates with breast cancer control policy. Australia, with its strong reputation in cancer control, had the highest score, followed closely by other high-income countries. Good policy does not depend solely on income however – the next tier included Malaysia and Thailand, which have similar scores even though the former has a higher GDP per capita. Second, the focus of breast cancer control tends to be at the front end – awareness-raising, detection and treatment scores were higher than those for long-term support and palliative care. Third, while policy is crucial, it is not everything. Although outcomes broadly correlate with the scorecard results, important exceptions exist. Malaysia’s outcomes, for example, are as poor as India. Conclusions: Defining metrics is a challenge and comparable national information was rare on the ground. Inevitably, the results of such an exercise are indicative rather than precise. Nevertheless, they are a useful starting point for discussing the state of breast cancer control.
PCN59 Risk Share Agreements (RSA), Product Listing Agreements (PLA) or Patient Access Schemes (PAS) - All the Same or Different?
PCN62 Prioritizing Medication Problems in Care of People with Cancer and Solutions For These: A Prioritize Study
1University
Kim H1, Harrison JP2, Moshyk A3, Liew D4 of Melbourne, Parkville, Australia, 2Bristol-Myers Squibb, Uxbridge, UK, 3BristolMyers Squibb, Saint-Laurent, QC, Canada, 4Monash University, Melbourne, Australia
Tudor Car L Imperial College London, London, UK
Objectives: Australia, Canada and the UK are ‘mature’ health technology assessment (HTA) markets that allow special (undisclosed) arrangements between sponsors and payers so that drugs can be conditionally listed on reimbursement schedules but with limitation of economic uncertainty for payers. These agreements are called risk share agreements (RSA) in Australia, product listing agreements (PLA) in Canada and patient access schemes (PAS) in the UK. However, it is not clear what differences, if any, exist in these arrangements across the 3 markets This qualitative study sought to compare special arrangements between drug sponsors and payers in Australia, Canada and the UK. Methods: This is a qualitative review of publicly available information and the expert opinion from Australia, Canada and the UK. Experts were selected from industry and academia. Results: All three countries allow simple agreements like a list price versus a net price. Complex arrangements, which may seek to address clinical as well as financial uncertainty, are also known to occur, but in the UK are usually by exception. Furthermore, in the UK, arrangements are proposed by sponsors and generally require approval by the relevant bodies prior to first consideration by the decision maker. In Canada, recommendations for PLAs are made by HTA agencies and negotiations take place after the HTA reviews. In Australia, RSAs can be proposed by either sponsors or payers. Implementation of agreements also vary between countries. In Australia, because drugs are funded by the federal government, implementation of RSAs occurs centrally. In the UK and Canada, local payers implement the agreements. Conclusions: Special arrangements in Australia, Canada and the UK serve a common purpose but there are important differences among the 3 countries which may lead to different benefits and barriers in implementation. Detailed information on agreements were limited due to the confidential nature of these agreements.
Objectives: Cancer treatment includes the use of different antineoplastic agents along with other medicines. The use of multiple concomitant medications and the involvement of a greater number of clinicians in treatment have been shown to increase the possibility of medication errors. Our aim was to identify priorities for cancer medication safety according to cancer care professionals using a novel priority-setting approach. Methods: We developed and implemented a new priority-setting approach called PRIORITIZE. We invited North West London cancer care clinicians to identify and prioritize main causes for, and solutions to, medication errors in cancer care. Forty cancer care providers submitted their suggestions which were thematically synthesized into a composite list of 20 distinct problems and 22 solutions. A random group of 26 clinicians scored these suggestions using predetermined criteria and an overall ranking was derived. Results: The top ranked problems focused on patients’ poor understanding of treatments due to language or education difficulties, clinicians’ insufficient attention to patients’ psychological distress and poor information exchange among healthcare providers. The top ranked solutions were guidance to patients and their carers on what to do when unwell, an appropriate pre-chemotherapy work up for all patients and improved staff training. Overall, clinicians considered better communication between healthcare providers, quality assurance procedures during prescription and monitoring stages and patient education as key strategies for improving cancer medication safety. Conclusions: Clinician-identified priorities for reducing cancer medication errors covered wide dimensions of care. The central finding is that, according to clinicians, cancer medication safety can be improved with interventions requiring relatively minor investment. PRIORITIZE is a timely, informative and scalable priority-setting approach and could be implemented as a routine preventative system for determining patient safety issues by frontline staff.
PCN60 Exploring Pharmacist’s Role In Palliative Care: A Qualitative Study Sundus A1, Gnanasan S1, Ismail NE2 1Universiti Teknologi MARA, Puncak Alam, Malaysia, 2MAHSA University, Selangor, Malaysia
Objectives: The aim of the study was to explore the expectations and perceptions of healthcare practitioners regarding the role of pharmacists in palliative cancer care. Methods: A qualitative study involving in-depth interviews from nine doctors, seven nurses and four pharmacists was carried out at Hospital Kuala Lumpur
PCN63 Imatinib Discontinuation and Tki Switching Patterns in the Retrospective and Prospective Cohorts in Simplicity, A Study of Chronic-Phase Chronic Myeloid Leukemia (CP-CML) Patients (PTS) in Routine Clinical Practice Zyczynski T1, Khoury J2, Goldberg S3, Mauro M4, Michallet M5, Paquette R6, Foreman A7, Subar M1, Turner M7, Manley Daumont M8, Hehlmann R9, Simonsson B10 1Bristol-Myers Squibb, Princeton, NJ, USA, 2Winship Cancer Institute of Emory University, Atlanta,