Identification of

Specific Challenges in Africa

Raymond Abratt

Opportunities

I have no conflicts of interest

‘Cape Tones’ by Joanne Taylor

The model

• Clinical Excellence

• Health Personnel

• Evidence Based Medicine

• Environment

• Risk Management

Clinical Excellence: Uphold Value-Based Medicine

Increase in Costs

Outcome

Shallow increase

Steep increaseA

B

CD

Abratt - SAMJ 2016

V

Value =Outcome/Cost

A Positive for Value-Based Medicine: Low cost cures with RT / Chemo - Ca Cervix Stage IIB:

0

20

40

60

80

100

120

6 12 18 24 30 36 42 48 54 60

% S

urv

ival

Months

RT ONLY

C + RT

GSH Data (1984-2010) - L van Wijk

A Positive for Value-Based Medicine:Our most prevalent treatment is inexpensive

%

Curative - Definitive 0%

Curative - Adjuvant 65%

Hormonal 59%

TAMOXIFEN 51%

LETROZOLE / ANASTRAZOLE / EXEMESTANE 41%

TAMOXIFEN & GOSERELIN / LEUPROLIDE 7%

Chemotherapy 19%

Radiotherapy 16%

Supportive Agents (With Facility Fee) 4%

Bisphosphonates 2%

Breast cancer (2015)Most common cancer Patients = 1974

A Negative is the cost of some drugs:

Big Picture Information!

In SA, the number of patients with HER2 positive breast Ca, who do NOT get adjuvant trastuzumab = 90%+

How do we respond to order to benefit patients?

• Engage with Pharma & Funders

• Choose treatments to uphold value-based medicine

1. Drug costs to benefit 1 patient varies in prognostic groups: • For Baseline SR = 90%, drug cost to benefit 1 pt = R 13,8 million

• For Baseline SR = 60% , drug cost to benefit 1 pt = R 4,0 million

2. 12 mo. vs 6 mo. trast has a lower Value • Incidence of cardiotoxicity is higher with 12 mo. trast

5.7% vs 1.9% NNH = 26

• Gain is small with 12 mo. tras: 2 yr. DFS.93.8% vs 91.1% NNT = 37

For 12 mo. vs 6 mo. trast , the drug cost to benefit 1 pt. = R 7,6 million

Abratt - SAMJ 2016 & 2017

Health Personnel: Expand competency training with modern technology

SA College of Rad Onc’s –Portfolio of practical experience

Virtual technology -Develop skills in teams & in a safe setting

Evidence Based Medicine: Increase publications relevant to our regions

Have our own voice

Peer reviewed publications are the gold standard for our knowledge

Publications get cited & build knowledge

We can create awareness of relevant developments by creating links in social media

Sajo.co.za

Environment: Establish high quality & patient friendly facilities

Audits will have a positive impact if they are user friendly & there is helpful follow up

“Was the feedback* helpful in formulating a continuous improvement plan in your unit?”

There were minor or major changes in 96% of units

Results of a survey of users in 56 units:

Risk Management: Prevent adverse incidents

Radiotherapy:

• RTT’s, Med Phys & Rad-Onc’s, are an interdependent team

• Protocol based techniques

Chemotherapy:

• Chemo-Nurse, Pharmacist, & Onc are an interdependent team

• Protocols for treatment & administration

Conclusion: Opportunities from our challenges in oncology

• Uphold Value Based Medicine

• Expand competency training with modern technology

• Increase publications relevant to our region

• Establish high quality & patient friendly facilities

• Prevent adverse incidents