TCRN Conference Grant Series: Dr. Richard Norman, Centre for Health Economics Research & Evaluation

TCRN Member Richard Norman; Conference Grant recipient TCRN Member Richard Norman; Conference Grant recipient

Putting a Price on Quality of Life

The current uncertainty regarding the appropriate methods for the collection, analysis and interpretation of HRQOL data in clinical trials presents many complexities for the translation of promising research discoveries into improved health outcomes for patients with cancer. From the perspective of Health Technology Assessment, and more specifically health economics, this is a crucial issue in how we as a nation make decisions regarding public reimbursement for new (and often expensive) technologies and pharmaceuticals, both in oncology and more broadly.

Public decision-making through, for instance, the Pharmaceutical Benefits Advisory Committee or the Medical Services Advisory Committee, generally considers health economic evidence as one of the major determinants in their discussions. When identifying the improved outcomes associated with any new technology, the standard approach is to combine issues surrounding QOL with mortality. The reason for doing so is it aims to facilitate sensible comparison between interventions which improve one, the other, or both. While mortality is a clearly defined endpoint, quality of life measures are subject to uncertainty. How do we ask patients to describe their health? How often over the course of their treatment? How do we place a value of the subsequent health profile? These remain live and highly policy-relevant questions, and are the subject of much research both in Australia and internationally.

A major source of uncertainty arises when clinical trials choose not to include a QOL measure amenable to economic evaluation. In these circumstances, submissions for public subsidy require quality of life scores derived from other sources. This can often lead to uncertainty in generalisability, and delays listing of worthwhile drugs (and hence access for patients in need). While groups undertaking trials must be mindful of the burden that extra data collection can have on often very ill patients, it should be noted that much work at the intersection of health economics and QOL has focused on reducing this burden by producing small instruments (through, for instance, factor analysis), which are able to capture QOL changes in a variety of different settings in cancer and beyond.

Dr Richard Norman is a Core Member of the Centre for Health Economics Research & Evaluation; University of Technology, Sydney. He was recipient of a TCRN International Conference Grant for attendance at the International Society for Quality of Life Research (ISOQOL) Annual Conference, held in October 2012 in Budapest, Hungary.

Click below to learn more from Richard on how we can maximise the collection of health economic data in QOL evaluations to appropriately inform public decision-making.

Health Economics in Public Decision-Making