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Clinical Trials in Australia
Clinical Trials in Australia
Clinical Trials in Australia
Clinical Trials in Australia
Clinical Trials in Australia
Clinical Trials in Australia
Clinical Trials in Australia
Clinical Trials in Australia
Clinical Trials in Australia
Clinical Trials in Australia
Clinical Trials in Australia
Clinical Trials in Australia
Clinical Trials in Australia
Clinical Trials in Australia
Clinical Trials in Australia
Clinical Trials in Australia
Clinical Trials in Australia
Clinical Trials in Australia
Clinical Trials in Australia
Clinical Trials in Australia
Clinical Trials in Australia
Clinical Trials in Australia
Clinical Trials in Australia
Clinical Trials in Australia
Clinical Trials in Australia
Clinical Trials in Australia
Clinical Trials in Australia
Clinical Trials in Australia
Clinical Trials in Australia
Clinical Trials in Australia
Clinical Trials in Australia
Clinical Trials in Australia
Clinical Trials in Australia
Clinical Trials in Australia
Clinical Trials in Australia
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Clinical Trials in Australia

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A presentation by Australia's Chief Medical Officer, Professor Jim Bishop AO, COSA 37th Annual Scientific Meeting - Melbourne

A presentation by Australia's Chief Medical Officer, Professor Jim Bishop AO, COSA 37th Annual Scientific Meeting - Melbourne

Published in: Health & Medicine, Business
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  • 1. CLINICAL TRIALS in AUSTRALIA COSA 37TH ANNUAL SCIENTIFIC MEETING MELBOURNE – 10 November 2010 Professor Jim Bishop AO Chief Medical Officer Australian Government Department of Health and Ageing
  • 2. OECD HEALTH DATA 2010 How Does AUSTRALIA Compare Health Expenditure per capita, public and private expenditure, OECD countries, 2008 ($US PPP)8,000 75387,0006,000 50045,000 4627 4210 4079 4063 39704,000 3793 3737 3696 3677 3540 3470 3359 3353 3129 3060 3008 2902 28703,000 2729 2687 2683 21512,000 1801 1781 1737 1437 1213 999 8521,000 767 0 1 Refers to insured po pulatio n rather than resident po pulatio n. 2. Current expenditure. 3. 2006. 4. 2007. So urce: OECD, OECD Health Data, June 201 . 0 Public expenditure on health Private expenditure on health
  • 3. AUSTRALIA’S RANKING AMONG OECD COUNTRIES 1987-2006 Source: AIHW Australia’s Health 2010
  • 4. Projected Burden of Major Disease Groups, 2010Source: AIHW Australia’s Health 2010
  • 5. Mortality-to-incidence ratio 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0 Ke ny a NiSource: IARC 2010. ge ria Eg yp Vi t et Na m Tu rk ey In di a Ch in a Ru So ss ut ia h Af ric a G re ec e Br az il Cz Ja ec pa h n Re pu bl ic Un ite Ita d ly Ki ng do m Ca na da G er m an Sw y Ne ed w en Ze al an d US Au A ratios for selected countries - 2008 st ra lia Males Females ALL CANCER – MORTALITY/INCIDENCE
  • 6. 5 YEAR SURVIVAL RATES 2004 NSW SEERNon small cell lung 13% 14%Colon 65% 67%Rectum 66% 69%Breast Cancer 89% 90%Lymphoma (DL) 53% 53% Source: Tracey et al – Cancer Institute NSW
  • 7. MILESTONES IN CANCER CONTROL Public health measures in smoking reduction, screening breast, cervix, bowel, health literacy Adjuvant treatment of breast, lung and bowel cancer New anti-cancer drugs and symptom control drugs Cancer research translated into practice Cancer registries, data linkage and analysis
  • 8. THE KEYS TO PREVENTION Tobacco Blood pressure Overweight/obesity Physical inactivity Blood cholesterol Alcohol Fruit/vegetables Illicit drugs Air pollution Total of 32% Unsafe sex 0.0 2.0 4.0 6.0 8.0 % DALYsSource: Table 4.1 AIHW Australia’s Health 2008
  • 9. AUSTRALIA’S RANKING AMONG OECD COUNTRIES 1987-2006 Source: AIHW Australia’s Health 2010
  • 10. OVERWEIGHT & OBESTITY Source: AIHW: Australia’s Health 2008
  • 11. OBESITY and CANCERIncreased Risk Body Fatness Oesophagus Pancreas Colorectal Breast (PM) Endometrum Abnormal Fatness ColorectalReduced Risk Physical exercise Colon Source:World Cancer Research Fund: Food, nutrition, physical activity and prevention of cancer, 2007
  • 12. Budget 2010-11Anti-smoking campaigns ($27.8m)COAG agreed• Increased tobacco excise• Plain packaging• Restricting internet advertising of tobacco products• Further funding for National Binge Drinking Strategy ($50m)• Survey of Australia’s Health ($54m) National Preventative Health Agency (Spring Session)
  • 13. NATIONAL PREVENTATIVE HEALTH AGENCY• Builds on the National Partnership Agreement on Preventative Health ($872.1m over 6 years)• Establishment and operational by early 2011 ($17.6m)• Specific responsibilities: - National Social Marketing ($102m over 4 years) - Preventative Health Research fund ($13.1m over 4 years) - Preventative Health Workforce audits and strategy ($0.5m over 2 years)
  • 14. REGIONAL CANCER CENTRE PRINCIPLES Demonstrated need/impact Align with Cancer Services Link to Comprehensive Cancer Care Provide equitable and affordable access Address sustainability and workforce Support Clinical Research Networks Monitor and evaluate performance
  • 15. Commonwealth Government Health and Hospital expenditure under the NHHN Source: Commonwealth Budget Papers, DOHA and PMC Analysis
  • 16. HEALTH REFORM Increasing expenditure to $15 billion 2010/11 Additional $7.3 billion over 4 years Local Hospital Networks (LHN) 60% Federal Funds (60% of research and teaching) Medicare locals (100% Federal funds) GP Superclinics – multi disciplinary teams (100% Federal Funds)
  • 17. BUDGET 2010-11e-Health – connecting patients, providers and information systemsThe Government will establish a personally controlledelectronic health record system ($466.7m)The system will:• Enable people – and their chosen health provider - to access online their key health information when and where it is needed, for their care across the health system.• Allow people to register online to establish a personally controlled electronic health record from 2012-13• Rigorous governance• Privacy maintained
  • 18. HEALTH REFORM KEY NEW STRUCTURES National Performance Authority Independent Hospital Pricing Authority Expanded Australian Commission of Safety and Quality in Health Care (ACSQHC)
  • 19. CLINICAL GUIDELINES SUPPORTS FOR CLINICAL DECISION MAKING Evidence Base Highest Impact Range of best practice tools Successful implementation methods Monitor and report
  • 20. CLINICAL GUIDELINES Highest Impact Greatest Burden of disease Greatest harm from poor practice Greatest demonstrated need: - New Standard of Care - Proven variation in practice Greatest time spent/cost to health system
  • 21. NON-COMMERCIAL CANCERRESEARCH EXPENDITURE, 2004 (A$ per CAPITAL) Source: Eckhouse et al (2007), ABS
  • 22. NHMRC STRAGEGIC PLAN 2010 -12
  • 23. NHMRC 2010Project Grants 2050Program Grants 61Fellowships 391Career Development 264 1273Early Career (Aust) 347Early Career (O/s) 211At 168 Institutions
  • 24. Project Grants - Success Rates 3600 3200Number of applications 2800 19% Not recommended for funding (score < 4) 2400 37% 24% 25% 2000 39% 3344 1600 58% 42% Fundable, but 44% 41% 43% not funded 48% 49% 33% 1200 42% 40% 800 37% 36% 36% 34% 34% 400 27% 27% 23% 21% 30% 23% 23% 22% 22% 21% Funded 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year of Application
  • 25. NHMRC Supported Research Workforce 10000NHMRC Supported Workforce 8000 6000 4000 2000 0 2003 2004 2005 2006 2007 2008 2009 2010 F u ll Tim e P a rt Tim e
  • 26. NHMRC Support for National Health Priorities Areas
  • 27. Percentage of Expenditure by Broad Research Area (2000 and 2010)
  • 28. NHMRC Clinical Research Total Expenditure 2008-2010 2008 2009 2010Clinical Research No. Expend. No. Expend. No. Expend.Scholarship, Fellowships 300 $14.1M 294 $14.5M 283 $16.0MResearch (projects, Programs) 552 $129.7 624 $156.9 655 $169.7Total 852 $143.8 918 $170.5 938 $185.7
  • 29. NHMRC Support for Translational ResearchTranslational funding mechanisms  Partnership Projects for Better Health  Partnership Centres for Better Health  Centres of Clinical Research Excellence  Centres of Research Excellence in Population Health Research, & Health Services Research  National Health Research Enabling Capabilities Scheme  Industry Development awards
  • 30. NHMRC Project Grants Clinical Trials Expenditure $70 300Millions $60 250 $50 200 $40 150 $30 100 $20 50 $10 $0 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Total Expenditure Number of Grants
  • 31. Harmonization of Multi-centred Ethical Review (HoMER) National Statement for Ethical Conduct of Human Research (2007) Process supported by AHMAC conducted by NHMRC Certification of ethical review processes – first round Roles, responsibilities, templates published NHMRC working with States and Territories
  • 32. AUSTRALIAN CLINICAL TRIALSTGA: CTX and CTN 2007/08 2792 2008/09 2986Clinical Trials – Gov Cancer and 922 AustraliaWHO International Cancer and 721 AustraliaANZCTR Cancer 588 ( Total 4592 : 13% cancer)
  • 33. CANCER PUBLICATIONS Australia Growth* World Australian Share2000 1,881 5.6% 88,604 2.0%2002 2,000 3.5% 97,035 2.1%2004 2,514 19.0% 110.390 2.3%2006 3,035 14.1% 125,934 2.4%__________________________________________________________________8 year period 17,917 70.4% 822,768 2.2%__________________________________________________________________* From pervious year Source: Cancer Institute NSW 2008
  • 34. CANCER CARE IN THE FUTURE Increasing burden of cancer Research and research information will drive improvement Integration of research findings into daily practice is everybody’s business Role delineation, sizing enterprises for function and multidisciplinary research interactions remain a major challenge
  • 35. CONCLUSIONS New health expenditure provides opportunities for clinical trials New reform structures need evidence for optimal interventions and guidelines HoMER supports further efficiency in trials Clinician and patient awareness of clinical trials requires ongoing development

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