The EARLY study: Economic evAluation of a novel pRostate cancer gLYcan-based diagnostic tool

Early detection of prostate cancer uses methods that are controversial and lead to uncertainty in care; this leads to a lot of overdiagnosis and overtreatment in men who are healthy or have inactive disease. We recently developed a test using a sugar found on aggressive cancer cells that acts as a biomarker to detect high-risk cancer in patients and support biopsy decision-making. But, for this test to be taken up in Canada to improve patient care, it needs to be evaluated for its potential value for money for the healthcare payer. This pan-Canadian project is the first analysis of the cost-effectiveness of a new sugar-based prostate cancer diagnostic tool. It will tell us whether the maximum possible gains from the new test versus status quo (or other new technologies) are worth their costs, and in which subgroups of patients we see the most positive net benefit.

The leading PI is Dr. Conklin, assistant professor at UBC’s Faculty of Pharmaceutical Sciences and scientist at UBC’s Centre for Health Evaluation and Outcome Sciences (CHEOS). Dr. Conklin’s BC-based team include Drs. Wei Zhang and Larry Lynd (also Scientists at CHEOS) and Dr. Williams (inventor of the new sugar-based test); the team also includes Dr. Liu, a clinician collaborator from Sunnybrook Hospital in Toronto.

MSFHR is providing match funding to the economic evaluation project which is funded by the Canadian Glycomics Network through the GlycoNet Collaborative Team Cycle II renewal application grant. It will address a critical gap in test development early on to avoid the pitfall of creating an economically non-feasible test. The output of this project could contribute to improved patient care and to better decision-making of patients, guideline developers and health ministers.

Please visit Canadian Glycomics to learn more about this project.

Improving chronic cardiovascular disease management in ethnocultural patients

Cardiovascular disease is a leading cause of death and disability worldwide. Long-term disease management approaches are effective at reducing the risk of death and disability in patients with cardiovascular disease. Canadians of South Asian and Chinese ancestry are more likely to die from heart disease or stroke than other Canadians and there is emerging evidence that these groups may have poor chronic disease management. Optimal chronic heart disease management may be significantly impaired by language barriers, a limited understanding of health determinants, and potentially differing cultural views of heart disease and treatments. The goal of Dr. Nadia Khan’s research program is to improve chronic cardiovascular care for Canadians of South Asian and Chinese ancestry. She is currently undergoing a very large study of 600 South Asian, 600 Chinese, and 600 Caucasian patients discharged with acute heart attack or unstable angina from hospitals in Vancouver, Toronto, and Calgary. The objectives of her research program include: (1) determining differences in chronic cardiovascular disease management between South Asian, Chinese, and Caucasian patients; (2) identifying the underlying patient barriers associated with poor care for each of these groups; and (3) using this information to develop targeted and culturally sensitive interventions in chronic cardiovascular disease management. Working alongside health care workers, ethnic community members, and decision makers, Dr. Khan will be developing and testing the new strategies to ensure that they are acceptable and practical for each ethnic group. This is the first program to systematically evaluate how different ethnic groups manage coronary artery disease and to identify the cultural factors that may be linked with poor care. The evidence obtained from this study will be used to plan culturally sensitive care programs for those with heart disease who are from South Asian or Chinese ancestry. This program of research will partner with community members, health care workers, and decision makers to ensure that the interventions are relevant to policy and practice.

SALOME (Study to Assess Long-term Opioid Medication Effectiveness): double blind randomized controlled trial comparing the effectiveness of diacetylmorphine vs. hydromorphone for the treatment of …

Injection-drug users are extremely susceptible to drug-related health risks, including HIV, hepatitis C and overdose. Although treatments for drug addiction are available, they are not always effective for those with the most severe cases of addiction. A key issue is many members of this vulnerable population remain outside the health care system, which exposes injection-drug users and those in their immediate communities to drug-related health risks. Previous research studies in Europe and Canada have shown that medically prescribed heroin can effectively attract and retain injection-drug users into the health care system and can ultimately improve the health of this vulnerable population. Unfortunately, the negative stigma attached to the medical use of heroin is a barrier to its implementation in many settings. However, an alternative strategy was suggested by a Canadian study, which demonstrated that a small group of participants receiving a licensed pain medication experienced similar health improvements as those receiving medically prescribed heroin.

Dr. Eugenia Oviedo-Joekes’ research is studying whether alternative drug addiction treatments can be used to reach vulnerable populations remaining outside the health care system. She is conducting an innovative clinical trial to test whether licensed pain medications can successfully treat the most severe cases of heroin dependency and is studying how this approach compares to medically prescribed heroin. After patients are effectively stabilized with injection treatment, she will determine if pain medication administered as an oral liquid can be used instead of injections.

Dr. Oviedo-Joekes is focusing her work on a subpopulation of women and Aboriginal people that have experienced high rates of victimization, including physical and sexual abuse, or violent or traumatic experiences, which dramatically impact their health. She hopes these treatments will directly benefit those with the most severe cases of heroin addiction and she will also measure the beneficial impacts in their communities.

A cross-national evaluation of opioid dependence treatment service systems in Canada and the United States

Methadone maintenance treatment (MMT) is the most effective form of treatment for opioid dependence, a chronic, recurrent disease. However, the availability and means by which MMT is delivered varies greatly, both locally and internationally. Understandably, the resulting accessibility, quality and comprehensiveness of care provided through the various treatment practices have important public health implications, and require careful consideration. Notably, there are vast differences between the drug treatment systems in California and British Columbia. Treatment for opioid dependence remains restricted in California due to regulatory constraints on treatment settings, (i.e. registered drug treatment centres), and physician practice, (i.e. limits on the number of patients per physician). Nonetheless, treatment through drug treatment centres may offer some advantages. In comparison, access to MMT in BC has improved following administrative transfer from the federal government to provincial colleges of physicians and subsequent deregulation through the introduction of community-based treatment (i.e. office-based prescription and dispensation in community-based pharmacies). Community-based treatment may maximize access, albeit at a relatively high cost, although the economic merits of maximizing access are well-established. Building on his earlier research in this area, Mr. Nosyk is working to identify differences in patient characteristics, treatment outcomes and costs of opioid dependence treatment systems in both the countries, with a specific focus on the performance of the treatment systems in terms of effectiveness, efficiency and equity. The knowledge gained from his research can be extended to estimate the health and economic impact of introducing treatment services at the population-level, and corresponds with long-term recommendations to expand services to provide more comprehensive treatment for substance users in BC.