Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Sep 29, 2021
Date Accepted: Apr 30, 2022
The DICA Medicines Program: insights in medication use and clinical outcomes
ABSTRACT
Background:
The DICA Medicines program was set up in September 2018 to evaluate expensive medicine use in daily practice in terms of real-world effectiveness only using existing data sources.
Objective:
This study aims to report the first results of the DICA medicines program and the usefulness of these real-world data in patients with colorectal cancer, breast cancer, lung cancer, and rheumatic disease.
Methods:
Four existing data sources were linked. These included national population-based registries, financial data from the hospital pharmacy, the Dutch DBC information system including in-hospital activities, and survival data from health care insurers. Descriptive statistics were used to assess patient, tumor, and treatment characteristics. Time-to-next-treatment (TTNT) and overall survival (OS) were estimated with the Kaplan-Meier method.
Results:
A total of 21 Dutch hospitals participated in the DICA Medicines program, which included 7412 colorectal cancer patients, 1981 metastasized colon cancer patients, 3860 lung cancer patients, 1253 metastasized breast cancer patients, and 7.564 patients with rheumatic disease. The data were used for hospital benchmarking to receive valuable insights into medication use in specific patient populations, treatment information, clinical outcomes, and costs. Benchmarking of hospitals showed the initiation of new systemic therapies at the end of life in colon cancer patients varied between 4.2% and 27.8%. Detailed treatment information (duration and treatment steps) led to insights into differences in daily clinical practices. Furthermore, head-to-head comparisons between therapies were possible using clinical outcomes (TTNT and OS).
Conclusions:
Real-world data can provide valuable insights into the effects and unwanted effects of medicines. The DICA Medicines program has shown that monitoring the use and effectiveness of expensive medicines after registration studies can be of high value. Since these data became available with minimal registration burden and effort for hospitals, the DICA Medicines program method can be easily used in other population-based registries. Clinical Trial: N/A
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