The carrying out of clinical trials in Spanish hospitals and research centers has very positive consequences for the agents involved. For the health system, because the trials attract economic investments for the centers. For health professionals, because they add reputation and experience to complement their work with the researcher. For the pharmaceutical industry, because it can count on health professionals and adequate clinical facilities to boost its research activity and the development of new medicines. And, above all, for the patients, who, thanks to the trials, can have early access to the most innovative treatments, still not authorized, which in certain pathologies and when other treatments have failed can mean their own survival.
To all these factors we must add another, less explored but which already point to several studies and scientific publications: clinical trials save money to the hospitals that host them and, therefore, to the National Health System.
In the last decade, at least eight scientific studies have been published, mostly elaborated by the hospital pharmacy services of the hospitals themselves, which strongly support this thesis. These publications quantify the cost avoided for the center by conducting clinical trials at its facilities, due to the economic cost of the drugs that the patients included in the trials should have received according to the protocol and that the hospital did not have to pay for, as it is the promoter of the trial (a pharmaceutical company in more than 80% of the cases) that finances both those treatments and the investigational drugs. The studies do not include the concomitant medication or other expenses associated with the treatment (personnel, material, etc.), which are also borne by the promoter of the trial and which increase the potential savings.
These are isolated studies, which certify what happens in a specific center and in a specific period, so it is not possible to obtain conclusions for the entire Spanish health system, but they do point out the positive economic impact of clinical trials in the accounts of a hospital.
The latest of these publications, released in early April, refers to clinical trials conducted in the area of ??oncology at the University Hospital La Paz, Madrid, between 2017 and 2018. After the analysis of 50 trials, with the participation of 155 patients, the costs avoided to the center were 1,564,943 euros. The cost avoided per patient was 10,096 euros.
A similar figure for patients included in oncological clinical trials arises from the analysis carried out by the Oncology Service of the Hospital Vall d’Hebron, in Barcelona, ??in the 2014-2016 period. In the Catalan center 889 trials were carried out during that time, with the participation of 2,879 patients. The cost avoided was 20,306,131 euros, 9,137 euros on average per patient.
In fact, in March, at the Conference of Research Platforms, in Madrid, the director of the Vall d’Hebron Research Institute, Joan Comella, estimated the savings generated in his center by the research activity in 2018 in 25 million euros. euros in total, 18.5 million only in oncology. Comella explained that one of every three patients with cancer treated in their center is in a clinical trial, with zero cost for the hospital.
In a somewhat earlier investigation, carried out in the Oncology Service of the Virgen de la Salud Hospital in Toledo, over the period 2004-2013, it was determined that the participation of 106 patients in 23 clinical trials generated a savings for the center of 1,475. 066 euros, with an average cost avoided per patient of 13,915 euros.
Oncology, rheumatology, rare diseases
These evidences are also manifested in other studies conducted on more specialized areas of oncology. This is reflected by the 6,875 euros of cost avoided per patient (474,428 euros in total) in the Maternal and Child Insular University Complex of Gran Canaria, in which 69 patients participated in 12 trials of lung cancer in non-small cells in 2016; the 5,744 euros avoided per patient (total of 722,116 euros) in the University Hospital Complex of A Coruña, with 136 participants in five trials of prostate cancer between 1996 and 2012; or the 10,756 euros of cost avoided in each of the 89 patients (957,246 euros in total) who participated between 2014 and 2016 in 37 clinical trials of breast cancer at the Gregorio Marañón Hospital, in Madrid.
The verification of the positive impact of conducting clinical trials in the expense accounts of the hospital that receives them does not only exist in oncology. There is also scientific evidence, although scarcer, in other areas. This is the case of the research carried out by the Pharmacy Service of the University Hospital Complex of A Coruña in the period 2001-2012. About 44 clinical trials in the field of rheumatology, in which 297 patients participated, an avoided cost of 2,813,590 euros was determined, with an average cost avoided per patient of 9,473 euros.
And there are even extreme cases, in treatments for rare diseases, such as the estimation of the cost avoided in medicines in clinical trials of congenital coagulopathies in the University Hospital of A Coruña. There, between 2009 and 2014, and in 11 clinical trials in which 19 patients participated, a total avoided cost of 2,689,494 euros was established, with an average of 141,552 euros of disbursement avoided for the hospital for each patient included.
All data, even isolated, point to the same conclusion: conducting clinical trials in Spanish hospitals is good for patients, good for the health professionals who serve them, good for the center that treats them, good for the pharmaceutical industry that investigates and develops new medicines to cure them and good for hospital bills and for the sustainability of the National Health System.
At Distefar we trust that our work contributes to bringing the most innovative treatments to our patients.