An example of the impact that clinician-led research can have for New Zealanders is evident in work funded by the HRC and the NHMRC and led by the Australia and New Zealand Intensive Care Society Clinical Trials Group (ANZICS CTG).
ANZICS CTG recognises that adequately powered, definitive clinical trials to answer important clinical questions for the treatment of the critically ill can only be undertaken collaboratively, as part of multi-centre trial teams.
The result in this case is estimated to have saved the New Zealand health care system well over $150 million per year over the past 10 years, with hundreds of people admitted to New Zealand’s ICUs every year now surviving as a result of the practice changes that have occurred in response to the groups’ trial findings.
Dr Colin McArthur, a clinician based in Auckland DHB, and Dr Paul Young, a clinician based in Capital and Coast DHB and the Medical Research Institute of New Zealand have led game-changing HRC-funded research:
- ANZICS CTG has made a substantial contribution to worldwide clinical practice through its research in fluid therapy. Findings from the SAFE study (Saline versus Albumin Fluid Evaluation) have influenced ICU practice around the world: they showed that the expensive albumin fluid ($332/litre) was not better than more affordable saline fluid ($1.60/litre), and that it was actually harmful in patients with traumatic brain injury, increasing their risk of disability and death. Saline is now preferred to albumin in ICUs, leading to better health outcomes for patients and an estimated cost savings of ~$137 million per year for the NZ health system.
- The NICE-SUGAR study (Normoglycemia in Intensive Care Evaluation – Survival Using Glucose Algorithm Regulation) evaluated the effect of “tight” control of blood sugar – the global standard of care at the time for treating blood sugar levels, which are commonly elevated in critical illness. Contrary to expectations, the research team found that tight blood sugar control of ICU patients – where insulin is used to keep blood sugar in the normal range, which costs more and is highly resource-intensive – actually increased mortality. As a direct result of this study, tight blood sugar control is not routinely practiced in New Zealand and has changed clinical practice around the world. Every year this research is estimated to prevent three deaths for every 100 patients treated in ICUs.