Savings on medication costs in industry-sponsored clinical trials must be reflected in hospital accounts

It is a no-brainer that hospital management and political leadership must address this, he believes.

Money saved is money earned

By conducting clinical drug trials, the hospital saves money on medications that would otherwise have been used to treat patients, as the experimental treatment is covered by the company. The company also pays for all trial-specific examinations required, as well as for the time spent by the investigator and study nurse on trial visits and other work related to participation.

Kersten points to the Oslo Myeloma Centre, which has documented that during the period from 2015 to 2021, 27 clinical trials at the centre contributed to a saving of 275 million kroner in medication costs. He also refers to the master's thesis by Anita Berg Pedersen at the oncology department of Akershus University Hospital. She found that the total savings for 13 studies per year amounted to 26 million kroner. The average saving per study per year was over 1.7 million kroner.

- I believe hospital management should say, "We will have one industry trial for every 3-4 researcher-initiated trials to make it work." Industry trials are important; after all, it is the medications that come from the industry that have saved the most lives in clinical trials over the past 10 years. If the department head operates on a large scale and organises well, it becomes easier to finance more research nurses and other resources related to research, such as radiology, pathology, and biochemistry, says Kersten.

Research nurses are essential

First and foremost, it is research nurses who are needed to carry out trials, he believes.

- They are the ones who get the job done, so research nurses must take the lead if we are to succeed with industry trials. When the research nurse says "jump!", the doctor must jump! Then everything is done accurately and properly, and on time, and the doctor actually gets to work more efficiently, says Kersten.

It was at the first NorTrials Arena in history that Kersten, along with others including Jon Riise, head of the Department of Cancer Treatment at Oslo University Hospital (OUS), discussed what they believe is necessary to secure enough time and resources to conduct more clinical studies.

OUS head of department agrees

Department head Jon Riise wholeheartedly agrees with Kersten.

- At the Department of Cancer Treatment at OUS, we are working on this and want to make it happen. The benefits of conducting industry trials, both in terms of increased expertise and better treatment for patients, as well as in terms of saved medication costs, should be made visible. The challenge is that we have an impossible funding system that only considers costs and does not highlight the benefits. So I completely agree with Christian; we must understand the entire economy of this and achieve the right balance between industry-initiated trials and academic trials. We need to make the pie bigger while also sharing it with those who have actually baked it. I am very curious to see if there are any powerful measures in the new action plan, says Riise.

Some issues can be resolved with ISF

He believes much can also be resolved through existing structures such as ISF, Activity-Based Funding (Norwegian). ISF is an activity-based model where hospitals receive funds based on the number of patients treated.

ISF is weighted with DRG points, which reflect the cost of standard treatment and thus provide a relatively good estimate of the average cost per treatment.

In practice, one can either do as Christian suggested – making visible what is saved – or one can take an even simpler approach and say that the department retains the ISF reimbursement regardless of whether the patient is part of a clinical trial or not. This is the income the hospital would have received if the patient had not participated in a trial. If the income is retained while medication costs are reduced, the savings will become immediately visible.

This would be a strong incentive to conduct more clinical trials, as it becomes easier to demonstrate the benefits for the clinic leader, department head, and hospital management. Additionally, there are quality gains from improved treatment and increased expertise among healthcare personnel, so in my opinion, it is a no-brainer. We just need to turn it on, said Riise.

NorTrials Arena is a brand new meeting series designed to bring together healthcare professionals working on clinical trials so they can collectively find solutions to common challenges.

- We have seen that there are many networks, limited to specific fields or regions. In all the networks, the same issues and solutions are often discussed. The idea behind NorTrials Arena is to have a common platform where everyone working with clinical trials in Norway can exchange experiences and draw inspiration from one another. One of the biggest bottlenecks for conducting clinical trials at Norwegian hospitals is the allocated time and resources, which today's topic reflects, says Signe Fretland, head of the NorTrials coordinating unit. Together with study coordinator at NorTrials Cancer, Charlotte Melby, she gathered nearly 200 participants digitally at the first meeting.