Clinical trials could save the health system millions

Mother and baby clinical trials could save the health system $290 million over five years

Not only do findings from clinical trials save lives and improve people’s health, they potentially lead to health savings of millions of dollars – so investing in them is a “no-brainer”, a researcher and neonatologist says.

A team of researchers in New Zealand and Australia have crunched the numbers from 23 clinical trials in the area of mother and baby health which began recruitment in 2008 and completed by 2015. According to their calculations, the studies generated potential savings of up to NZ$290.4 million (AU$262.8 million) over five years -– almost 13 times the funding investment.

The findings are published in the Medical Journal of Australia but apply to both Australia and New Zealand.

The 23 trials – which include the high-profile “Sugar Babies” trial led by Liggins Institute Distinguished Professor Jane Harding that transformed the treatment of low blood sugar in newborn babies - had together received NZ$22.4 million (AU$20.3 million) in funding.

Treatments tested in six of the trials with results available were proven to be superior to existing practice. The authors calculated that if only 10 percent of eligible patients received those six superior interventions, it would save the health system an estimated NZ$25.8 million (AU$23.3 million) over five years, paying off the investment. But, if all eligible patients received them, it would save NZ$290.4 million (AU$262.8 million) over the same period – a thirteen-fold return.

“Our analysis provides further evidence that investing in clinical trials should be a no-brainer - it actually saves the health service money, and so the more high quality trials that are done, the more there will be savings in health care expenditure that can be invested elsewhere,” says Professor Frank Bloomfield, one of the report authors and Director of the University of Auckland-based Liggins Institute.

Professor Bloomfield, who is also a neonatologist at National Women’s Health, Auckland City Hospital, says New Zealand compares “very poorly” to other OECD countries in terms of the percentage of GDP invested in research, which includes health research

“The recent increase in Health Research Council funding, for example, although extremely welcome and critically important, only puts us back to where we were 10 years ago in terms of actual spending power when it comes to clinical trials.”

The gap between the costs of clinical trials and investment from funding agencies has also grown as a result of funding contract restrictions - most public good funding contracts in New Zealand have budget caps that are too low for high quality clinical trials. Recruitment timelines in clinical trials can also be unpredictable, and the growing pressures to stick to schedules despite this unpredictability is another challenge.

Fellow author Dr Katie Groom says: “Ongoing research is essential for healthcare professionals to be confident that they are doing the best they can for patients. It is crucial to use treatments that have been shown to be effective - and, equally, not to use treatments that do not have proven benefit or, worse, have been proven to be ineffective, even though this still occurs.”

Dr Groom is a senior lecturer in obstetrics and gynaecology at the University of Auckland’s Faculty of Medical and Health Sciences and maternal fetal medicine specialist at National Women’s Health. She says the dramatic difference in savings between 10 percent and 100 percent uptake highlights the importance of communicating new research findings to patients and getting clinicians to change their practice. “This ‘translation’ work is a major focus for us, too.”

Medical researchers routinely rely on philanthropic donations to top up or replace government funding. This week, the Liggins Institute received NZ$1 million over four years for maternal health research from the Hugo Charitable Trust.

“We are hugely grateful for this generous gift, and to all our philanthropic donors,” says Professor Bloomfield. “The research it funds promises to lead to improved care for mothers and babies in the future and considerable savings to New Zealand’s health-care system.

“Hopefully analyses of cost-effectiveness like this one will help demonstrate to funders that their investment in clinical research is well spent.”

The other study authors were Research Fellow Clarabelle Pham, Professor Jonathan Karnon and Professor Ben Mol from the University of Adelaide, Philippa Middleton from the Robinson Research Institute, and Professor Caroline Crowther from the Liggins Institute.

The analysis follows one published earlier this year by the Australian Commission on Safety and Quality in Health Care and the Australian Clinical Trials Alliance (ACTA). It found that if the results of 25 trials, including those in maternal and perinatal health, were implemented in just two-thirds of the relevant groups of patients for one year, AU$1.4 billion (NZ$1.5 billion) would be saved through improvements in patient outcomes, and a further AU$580 (NZ$641.8) million in health cost savings. For each $1 invested in clinician-driven clinical trials in Australia, the estimated potential benefits was $5.80.

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