Professor David Peiris from The George Institute for Global Health and UNSW has received $956,000 in NHMRC Partnership funding for a project that aims to strengthen health system performance in NSW.

“Widening inequities, large variations in the quality of care, and uncontrolled growth in health care spending - which now represents more than ten percent of GDP – are threatening the sustainability of Australia’s healthcare system and ultimately the nation’s prosperity” Professor Peiris said. 

“This project involves an exciting NSW policy reform program, Collaborative Commissioning, which will support formation of local alliances between Local Hospital Districts and Primary Health Networks.  These alliances, Patient Centred Co-commissioning Groups (PCCGs), will be tasked with developing new ways of working to achieve better patient outcomes more efficiently,” he added.

Several PCCGs are in the process of being established with a goal of having state-wide coverage in all ten NSW Primary Health Network regions. Populations to be serviced are diverse. For example, Western Sydney is focusing on community-based services for people with urgent care needs who would otherwise use the emergency department alongside providing services for cardiology patients in the community. Western NSW is focussing on improving quality and access to care for people with diabetes at high risk of complications. North Sydney is focussing a strategy to support elderly people with complex urgent health needs.

The project is a partnership between the New South Wales Ministry of Health (NSW Health), Local Hospital Districts (LHDs), Primary Health Networks (PHNs), the Consumers Health Forum (CHF) and health service researchers from The George Institute, UNSW’s Centre for Big Data Research in Health and the Menzies Centre for Health Policy at the University of Sydney.

A new study by The George Institute for Global Health has reviewed statistical methods used when conducting economic evaluation alongside stepped wedge trials (SWTs). We asked lead author and Head of the Statistics Division in Australia, Gian Luca Di Tanna, to tell us about the significance of this study for future clinical trials.

What is a stepped wedge trial?

An SWT is a multi-arm cluster randomised design, with a unidirectional cross-over: clusters switch from the control or routine care condition to the active intervention. In the most common design, all clusters begin in the control condition before crossing over at regular intervals to receive the intervention in a randomised order. This process continues until all clusters are exposed to the intervention. Due to their pragmatic design, SWTs have been used to assess the effect of new interventions in real-world settings where its not possible to apply the intervention across all clusters at the same time for logistical, financial or ethical reasons.

Why is this review important?

Stepped wedge trial design has become increasingly popular in health services research.  Many health services studies also include a health economic evaluation to assess the economic benefit of the intervention being investigated.  However, adequate documentation of appropriate methods of economic evaluation in an SWT is generally lacking in the literature.

What did you do?

We conducted a methodological systematic review of studies (protocols, trials results, cost effectiveness/utility analyses) that described an economic evaluation alongside an SWT.  We assessed their eligibility, findings, reporting of statistical methods and quality of reporting.

What did you find?

We looked at 69 studies that were eligible for our review. In around half of these, the reporting of statistical methods associated with the economic evaluation was incomplete.  Around half the remaining studies did not use appropriate statistical methods, failing to consider critical elements of an SWT such as correlation between costs and outcomes, clustering and time patterns.

What are the implications of this study?

This is the first attempt to review the statistical methodology of planned and conducted economic evaluation of SWTs to date. We intend to propose appropriate methods and perform a simulation study to assess the performance of SWTs to better inform methodologists and applied researchers interested in cost-effectiveness analyses of trials that are based on this design.

The George Institute for Global Health welcomes the sustained investment in medical research announced in the 2020-21 Budget announced on Tuesday evening.

The $6.6 billion investment over the next four years includes funding the Medical Research Future Fund (MRFF), the National Health and Medical Research Council (NHMRC) and the Biomedical Translation Fund (BTF).

Professor Bruce Neal said this investment will be appreciated by researchers at The George Institute.

“We welcome the funding for the MRFF and NHMRC grant programs, particularly the increase to the MRFF from $393 million to $580 million since last year,” he said.

“This increase in funding will give our researchers greater confidence in applying for medical research grants.”

“We note the budget was delayed by several months due to focus required to manage the impact of the COVID-19 pandemic on the health and the economy.”

“This was not a business-as-usual budget.”

“As people with non-communicable diseases are at higher risk from COVID-19, we encourage the government to prioritise preventative measures over the coming year,” Professor Neal said.