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My PhD Title: Health economics analysis of external beam radiotherapy compared with targeted intraoperative radiotherapy in early breast cancer
Supervisor(s): Professor Steve Morris & Dr Nora Pashayan
Lay summary: Intraoperative radiotherapy (TARGIT) is a novel technique which allows radiotherapy to be deployed to the tumour bed at the time of surgery. The aim of using TARGIT is to deliver both surgery and radiotherapy at a single point, saving patients several trips to hospital and reducing the side effects of external beam radiotherapy. The Targit A Trial (NCT00983684) is a multi-centre, international, randomised controlled phase III trial, which compares TARGIT to external beam radiotherapy (EBRT) in women with breast cancer. The trial showed TARGIT to be non-inferior to EBRT with respect to local recurrences.
This thesis includes:
A cost utility analysis
A cross-sectional observation study to assess the health status in women with early breast cancer,
A discrete choice experiment to establish what factors influence patients, clinicians and the general public's preferences for radiotherapy treatments in women with early breast cancer.
The cost utility analysis has been completed. The results of the analysis showed that in the base case, TARGIT represents a cost saving.
Work on deriving utility data has commenced all the documents required for submission to REC and HRA have been sent to the governance sponsor for review.
Preparation of documentation for the DCE study is in progress.
My Background: As part of my MBA I delivered a thesis on cost benefit analysis of clinical trials, this gave me a profile amongst triallists and I was then approached and asked to project manage the ATAC trial (DOI: https://doi.org/10.1016/S1470-2045(07)70385-6). Which then led me to the TARGIT Trial team, where the chief investigator offered me the opportunity to gain a PhD qualification in health economics as part of the project.
I have had the opportunity to work on trials that change clinical practice, and that really does inspire me. Furthermore, I have worked in industry but I must admit I enjoy working in the academic environment, meeting great minds and being able to engage with them, question, challenge, explore.
Qualifications
BSc Agricultural Sciences (with a specialisation in Food Science). Nottingham University
MBA Project Management. Imperial College, London
MSc Health Economics, City University, London
Awards
Gold Duke of Edinburgh
Publications
Kasivisvanathan et al. (2018) MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis. New England Journal of Medicine, doi: 10.1056/NEJMoa1801993
Grey et al (2018) The CADMUS trial - Multi-parametric ultrasound targeted biopsies compared to multi-parametric MRI targeted biopsies in the diagnosis of clinically significant prostate cancer. Contemporary Clinical Trials, doi 10.1016/j.cct.2017.10.011
Vaidya, A., Vaidya, P., Both, B., Brew-Graves, C., Bulsara, M., & Vaidya, J. S. (2017). Health economics of targeted intraoperative radiotherapy (TARGIT- IORT) for early breast cancer: a cost- effectiveness analysis in the United Kingdom. BMJ Open. doi:10.1136/bmjopen-2016-014944
Vaidya etal (2016). An international randomised controlled trial to compare targeted intra-operative radiotherapy (TARGIT) with conventional post-operative radiotherapy after conservative breast surgery for women with early stage breast cancer (The TARGIT-A trial). Health Technology Assessment.
Vaidya, J. S etal (2015). In Regard to Hepel and Wazer. International Journal of Radiation Oncology Biology Physics, 92 (5), 953-954. doi:10.1016/j.ijrobp.2015.05.038
Vaidya, J. S. et al (2015). Pride, Prejudice, or Science: Attitudes Towards the Results of the TARGIT-A Trial of Targeted Intraoperative Radiation Therapy for Breast Cancer. International Journal of radiation oncology biology physics, 92 (3), 491-497. doi:10.1016/j.ijrobp.2015.03.022
Vaidya, A., Vaidya, P., Both, B., Brew-Graves, C., & Vaidya, J. (2014). Cost effectiveness analysis of targeted intraoperative radiotherapy alone (TARGIT-A) in early breast cancer patients. Value in Health, 17 (7), A640. doi:10.1016/j.jval.2014.08.2306
Brew-Graves, C., Morris, S., & Alvarado, M. (2014). Health economics of TARGIT. Targeted Intraoperative Radiotherapy in Oncology (pp. 157-165). doi:10.1007/978-3-642-39821-6_20
Williams, N., Pigott, K. H., Brew-Graves, C., & Keshtgar, M. R. S. (2014). Intraoperative radiotherapy for breast cancer. Gland Surgery, 3 (2), 109-119.
Vaidya, J. S. et al (2013). Risk-adapted targeted intraoperative radiotherapy versus whole-breast radiotherapy for breast cancer: 5-year results for local control and overall survival from the TARGIT-A randomised trial. The Lancet. doi:10.1016/s0140-6736(13)61950-9
Eaton, D. J.et al (2012). In vivo dosimetry for single-fraction targeted intraoperative radiotherapy (TARGIT) for breast cancer. Int J Radiat Oncol Biol Phys, 82 (5), e819-e824. doi:10.1016/j.ijrobp.2011.11.012
Vaidya, J. S et al (2011). Long-term results of targeted intraoperative radiotherapy (Targit) boost during breast-conserving surgery. Int J Radiat Oncol Biol Phys, 81 (4), 1091-1097. doi:10.1016/j.ijrobp.2010.07
Appointments
Deputy Director Operations SITU 2013 - 2017
Director Operations, SITU, 2018 - ongoing
Contact details Chris Brew-Graves, Surgical & Interventional Trials Unit, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London, Charles Bell House, 43-45 Foley Street, London W1W 7JN
Tel: +44 (0)20 7679 9280
Fax: +44 (0)20 7679 9290
web: www.ucl.ac.uk/SITU
ORCID 0000-0002-0266-0315