New European Clinical Trial Regulation: perception and expectations in Italy

Background

In July 2012, the European Commission formalized the proposal for a European Clinical Trial Regulation that should replace the European Clinical Trials Directive 2001/20/CE. The new Regulation 536/2014 entered into force in June 2014 and it was expected to be applied not earlier than May 2016. Indeed, at the time, all required central tools are not yet available and new forecasts indicate it will become effective at the end of 2018. The aims of the Regulation are the promotion of higher standards in patient's safety and increasing transparency in Clinical Trials, also by changing the application process.

Methods

An online survey was conducted among the Italian's Clinical Research Coordinators and Clinical Investigators to examine the perception and knowledge about the upcoming changes in Clinical Trials. A total of 190 Clinical Research Coordinators and 80 Clinical Investigators were surveyed.

Results

Clinicians are less aware of the content of the Regulation than Clinical Research Coordinators, who demonstrate an extensive expertise on the topic (84.4%), mainly reached through self-training. The majority of the Investigators (74%) believes that their site's facilities and staff already met all the requirements imposed by the Regulation while Clinical Research Coordinators are less optimistic: 65.2% of them believes that the site staff is not yet fully aware of changes associated to its implementation.

Conclusions

The general opinion of the interviewed is that the new Regulation will strongly affect the trial management regardless of their type and phase, and the fulfillment of the imposed requirements represents an opportunity that Italy should not miss to increase its attractiveness to the pharmaceutical market.

Abstract P3-12-06: Saving in clinical trials: A possible challenge for improving health care for breast cancer patients

Background: The economic crisis that has characterized recent years has required a careful spending review worldwide and particularly in Italy Health Care System. This resulted in substantial cuts in terms of services and drugs prescriptions.

For this reason, it becomes very important to adopt measures aimed to save health care costs, maintaining at the same time the highest standard of health care. The enrollment in clinical trials (CTs) may encourage this goal, making high-cost drugs available.

Methods: We compared the overall expenses for an oncology patient treated with standard therapy (reference: public hospital price list) to a similar patient enrolled in a CT. The cost comparison was made considering a patient affected by Her2 positive breast cancer in three different settings: neoadjuvant, adjuvant, and advanced/metastatic disease. We considered three categories of cost: diagnostic procedures; drug purchase; drug management. All analyses were performed considering an average treatment period and dose, calculated on a middleweight patient.

We take into account the absolute saving in Euro (€) and the percentage one.

Results: The data show a saving in all treatment lines, referring to the analyzed cost groups.

In neoadjuvant setting, the estimated patient standard cost is 92.829,00€; we calculated a saving of 92.451,00€ (93,74%), of which 1.226,00€ for diagnostic procedures charge (65%), 89.205,00€ for drug purchase (100%) and 2.020,00€ for drug management (116%).

In adjuvant setting, where the estimated standard cost is 25.527,00€, we observed a saving of 23.332,00€ (51%): 22.392,00€ (98% of drug purchase) and 940,00€ (54%) for drug management; no saving for diagnostic procedures.

Regarding the metastatic breast cancer treatment, we calculated a saving of 115.158,00€ (88%) compared to 115.571,00€, that means the estimated standard cost. In this case the saving is allocated as follows: 750,00€ for diagnostic procedures (64.5%), 113.508,00€ for drug purchase (100%) and 900,00€ for drug management (100%).

Conclusions: CTs are useful in order to save money in the overall patient management, allowing them to have access to expensive innovative drugs.

Moreover, we have to consider the additional fees provided by Sponsor for each enrolled patient.

This basic model of cost analysis could be used by Institutional Health Care stakeholders for spending review strategies.

The public institutes with the characteristics of Comprehensive Cancer Center are essential to recruiting the needed study population for Sponsorized CTs, and the cashed and saved money can be reinvested for improving Breast Cancer patients care.Background: The economic crisis that has characterized recent years has required a careful spending review worldwide and particularly in Italy Health Care System. This resulted in substantial cuts in terms of services and drugs prescriptions.

For this reason, it becomes very important to adopt measures aimed to save health care costs, maintaining at the same time the highest standard of health care. The enrollment in clinical trials (CTs) may encourage this goal, making high-cost drugs available.

Methods: We compared the overall expenses for an oncology patient treated with standard therapy (reference: public hospital price list) to a similar patient enrolled in a CT. The cost comparison was made considering a patient affected by Her2 positive breast cancer in three different settings: neoadjuvant, adjuvant, and advanced/metastatic disease. We considered three categories of cost: diagnostic procedures; drug purchase; drug management. All analyses were performed considering an average treatment period and dose, calculated on a middleweight patient.

We take into account the absolute saving in Euro (€) and the percentage one.

Results: The data show a saving in all treatment lines, referring to the analyzed cost groups.

In neoadjuvant setting, the estimated patient standard cost is 92.829,00€; we calculated a saving of 92.451,00€ (93,74%), of which 1.226,00€ for diagnostic procedures charge (65%), 89.205,00€ for drug purchase (100%) and 2.020,00€ for drug management (116%).

In adjuvant setting, where the estimated standard cost is 25.527,00€, we observed a saving of 23.332,00€ (51%): 22.392,00€ (98% of drug purchase) and 940,00€ (54%) for drug management; no saving for diagnostic procedures.

Regarding the metastatic breast cancer treatment, we calculated a saving of 115.158,00€ (88%) compared to 115.571,00€, that means the estimated standard cost. In this case the saving is allocated as follows: 750,00€ for diagnostic procedures (64.5%), 113.508,00€ for drug purchase (100%) and 900,00€ for drug management (100%).

Conclusions: CTs are useful in order to save money in the overall patient management, allowing them to have access to expensive innovative drugs.

Moreover, we have to consider the additional fees provided by Sponsor for each enrolled patient.

This basic model of cost analysis could be used by Institutional Health Care stakeholders for spending review strategies.

The public institutes with the characteristics of Comprehensive Cancer Center are essential to recruiting the needed study population for Sponsorized CTs, and the cashed and saved money can be reinvested for improving Breast Cancer patients care.

Citation Format: Taverniti C, Bonfadini C, Pradotto M, Cagnazzo C, Demartini P, Rossi L, Ignazzi G, Arizio F, Beano A. Saving in clinical trials: A possible challenge for improving health care for breast cancer patients [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-12-06.