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Australian Medical Research and Innovation Five Year Strategy
Title: SUBMISSION from the Australian Cardiovascular Alliance to the MRFF Strategy
Submitted by: Australian Cardiovascular Alliance
Contact information: Professor Jaye Chin-Dusting (Chair), jaye.chin-dusting@monash.edu
The establishment of the Medical Research Future Fund (MRFF) as a dedicated vehicle for investment in medical research has been greatly welcomed by the research community. The MRFF was established amid a growing recognition that the current funding environment is failing our medical research workforce; in particular younger researchers, female researchers and researchers within certain specialist disciplines, including cardiovascular disease (CVD). The Australian Cardiovascular Alliance(ACvA) welcomes this opportunity to provide a submission to the Australian Medical Research Advisory Board to consider when advising the Minister for Health on the Strategy for disbursing funding to the health and medical research sector.
For reasons outlined below, the Australian Cardiovascular Alliance recommends, as a matter of urgency, that research into CVD be a funding priority of the MRFF, to address the major gap that currently exists between CVD research capacity and the burden of CVD. This will lead to major improvements in CVD health outcomes, ensuring that the Australian population receives the world’s best cardiovascular care, as well as addressing the massive and growing economic burden that CVD currently poses. Specifically, by ensuring targeted investment into CVD research the following four mandatory concerns of the MRFF outlined in its 2016 Consultation Paper will be addressed.
1. BURDEN OF DISEASE ON THE AUSTRALIAN COMMUNITY
CVD (which includes coronary heart disease and stroke) is Australia’s leading cause of death for both men and women, causing 29.3% of all deaths.1 Over one in five Australian adults (22%) — approximately 3.7 million people — have reported that they were living with CVD.2 Cancer and CVD have a similar health impact on our society, with cancer representing 19% of our burden of disease, followed closely by CVD at 15%.3
However, costs for CVD represent the highest level of direct health expenditure for any disease group, costing $7.6 billion or 12% of health expenditure in 2008/09.4 In comparison, cancer contributed to 7% of all healthcare expenditure in that time. 5 As a direct result of effective research, the overall death rate from acute CVD has fallen since the 1960s.6However this trend has plateaued and coronary heart disease remains the leading cause of premature death of people under the age of 75.7 At this point in time, moreover, the death rate for CVD is rising again due not only to the increase and aging of our population, but also to the increase in obesity and diabetes, which accelerate CVD onset and progression. According to the Australian Institute of Health and Welfare, a large proportion of premature death and chronic disease is preventable. 3Research into CVD is essential to curb the rising economic and health costs to our society. In addition cardiovascular research delivers the highest return on investment with a benefit-to-cost ratio of 6.1 (cancer research is second highest at 2.7). 8
2. MRFF FUNDING SHOULD COMPLEMENT AND ENHANCE OTHERASSISTANCE PROVIDED
Australia needs a long-term, whole-of-government, whole-of-sector vision and strategy to ensure health and medical research has maximum impact. As the MRFF Consultation Paper has noted, the MRFF needs to complement existing funding schemes including the National Health and Medical Research Council (NHMRC) and Australian Research Council (ARC) schemes and to comply with the approaches of the National Innovation and Science Agenda and the Commonwealth Science Council. It is imperative that the MRFF and NHMRC work together to ensure that fundamental, basic, discovery research in the biological sciences is not overlooked in the current environment, as it is essential to driving medical innovations in the long-term. The research community requires that allocation for discovery research be protected, perhaps within the NHMRC framework, if the MRFF accepts responsibility for funding medical translation.
That said, the chief concern of this paper is that research into CVD is not adequately supported in this country. This has caused a significant lack of capacity in this field which will have a flow-on effect and will limit the ability of the MRFF to achieve its aims of addressing medical research priorities, drive innovation and improve delivery of healthcare. Although CVD ranks alongside cancer as one of the top two leading health burdens, by virtue of its current processes, NHMRC invests substantially more in cancer research than in CVD research. Over the past five years, the NHMRC has allocated $932.80m to cancer research (23% of the NHMRC budget) and only $601.10m on CVD research (14% of the budget);9 a gap of $332m over five years.
Working with the NHMRC and based on figures obtained from them, it has become clear that the funding discrepancy is a result of the substantially greater number of applications received for cancer research, rather than quality of research. NHMRC-funded CVD research is indeed more highly cited (by 29%) than oncology papers.10 However, in 2014 alone there were 1.6 times more applications in the cancer National Health Priority Area (NHPA) than in the CVD NHPA (1,177 applications for cancer research compared to 730 applications for CVD research). While grant success rates were the same for both NHPAs, absolute amounts awarded were substantially less for CVD, due to the smaller number of applications.11The ACvA is of the strong view that the significantly smaller number of applicants from CVD researchers reflects a capacity crisis in this specialist area.
This crisis in CVD workforce capacity is compounded by there being far fewer CVD charities and less state government support to this sector. We estimated that in 2014, there was at least 10 times the amount of funding available for cancer research (over $160.5m) from charities and specific government agencies with a single-disease focus (e.g. Cancer Australia, Cancer Institute NSW) compared to that for CVD ($16m). This enables capacity growth reflecting the burden of cancer, which then translates into an increase in the number of researchers applying for peer reviewed funding, and so feeds further capacity growth. This positive cycle is currently not present in the CVD sector.
Funding inequity has also resulted in young scientists being attracted to fields of research where more sustainable funding is available. The entry of fewer trainees into the CVD research field will flow on to reducing CVD research leadership, and erode the current international standing that Australia currently enjoys in this sector. The ACvA strongly advocates for the Advisory Board to address this gap between research capacity and burden of cardiovascular disease by highlighting CVD research as a high priority needs area in the disbursements of the MRFF. We also ask that the Advisory Board work with other government funding bodies such as the NHMRC and ARC to ensure a whole-of-government, consistent approach to this issue and to ensure long-term sustainability of the CVD research sector.
3. PRACTICAL BENEFITS – EMBEDDING RESEARCH IN THE HEALTH SYSTEM
The best clinical care is intrinsically linked to medical research and education. It is no coincidence that the highest-ranked hospitals for patient care in the USA are also the most research- and teaching- intensive.12 The research, education and clinical workforce need to be supported to work together to truly embed research in the health system. In Australia, cardiovascular clinicians at the major teaching hospitals in Australia have a diminishing number of researchers with whom to collaborate.
If Australia is aiming for a true “academic health science centre” model of healthcare, then we need to encourage researchers to enter those disciplines that have the greatest impact on our health system. A true partnership between hospitals, universities and research organisations will deliver the best outcomes and the most up-to-date and responsive healthcare. The underlying tenet of uniting the missions of patient care, research and education is to enable the rapid translation of innovations into clinical practice at the local level. This can only happen if each of the partners is able to meaningfully contribute to our healthcare system. Having a capacity gap in one area, such as CVD research, will drastically limit the ability of the healthcare system to adapt and change in that field.
4. THE GREATEST VALUE FOR ALL AUSTRALIANS
The MRFF Consultation Paper stated that an aim of the MRFF is to ensure “an excellent and responsive health and medical research system that improves lives.” Having a “research engaged workforce” and “embedding research across the health system” are essential to achieving this aim. The current strategy by government funding bodies of not allocating funding according to burden of disease or healthcare costs has curbed the linking of research and healthcare. Although burden-of-disease is not the only consideration when allocating research funding, it needs to be recognised that the current government and philanthropic funding system insufficiently supports CVD research. Thus, given the vital importance of CVD to our health system and our economy, incentives are urgently needed to entice Australia’s best and brightest researchers into this discipline.
The ACvA strongly urges that research into cardiovascular disease is a funding priority of the MRFF, and that a significant proportion of the MRFF disbursement reflects disease burden as well as the needs of both the clinical and research workforce. We also emphasise the importance of working with other government funding bodies such as the NHMRC on this issue and also to ensure the correct balance between supporting the entire research pipeline from basic to translational research. Because of the large burden of disease and costs to our health system, as well as the historical excellent returns on investment, investing in CVD research will have the greatest value for all Australians.
THE AUSTRALIAN CARDIOVASCULAR ALLIANCE
The Australian Cardiovascular Alliance (ACvA) is Australia’s first member-driven organisation dedicated to advancing research into heart, stroke and vascular disease through awareness, and promotion of the role of scientific research in combatting serious health issues in Australia. Established in 2015 by cardiovascular clinicians and researchers who were concerned with the research-funding crisis in Australia, the ACvA aims to increase the funding of cardiovascular disease research and improve awareness of cardiovascular diseases with governments, philanthropic bodies and the public. ACvA comprises individual members as well as the following 11 member organisations: Australian Atherosclerosis Society, Australian Vascular Biology Society, Baker IDI Heart and Diabetes Institute, Heart Research Institute, High Blood Pressure Research Council of Australia, International Society for Heart Research Australasian Section, Menzies Institute for Medical Research, Monash Biomedicine Discovery Institute – Cardiovascular Disease Program, South Australian Health and Medical Research Institute, The George Institute and Victor Chang Cardiac Research Institute.
REFERENCES
1 Australian Bureau of Statistics (2016) Causes of Death, Australia, 2014 (No. 3303.0).http://www.abs.gov.au/ausstats/abs@.nsf/mf/3303.0
2 Australian Institute of Health and Welfare (AIHW) Webpage: Cardiovascular Disease Prevalence 2011/12. http://www.aihw.gov.au/cardiovascular-disease/prevalence/
3 Australian Institute of Health and Welfare (2016). Australian Burden of Disease Study: impact and causes of illness and death in Australia 2011. Australian Burden of Disease Study series no. 3. Cat. no. BOD 4. Canberra: AIHW. http://www.aihw.gov.au/publicationdetail/?id=60129555173
4 Australian Institute of Health and Welfare (2014). Health care expenditure on cardiovascular disease 2008-09. (Cat. No. CVD 65). Canberra: AIHW. http://www.aihw.gov.au/publication-detail/?id=60129546381
5 Australian Institute of Health and Welfare (2013). Health care expenditure on cancer and other neoplasms in Australia 2008-09. (Cat. No. CAN 78). Canberra: AIHWhttp://www.aihw.gov.au/publication-detail/?id=60129545611
6 Australian Institute of Health and Welfare (2011). Cardiovascular disease: Australian facts 2011. (Cat. no. CVD 53). Canberra: AIHW. http://www.aihw.gov.au/publication-detail/?id=10737418510
7 Australian Institute of Health and Welfare (2015). Leading Cause of Premature Mortality in Australia Fact Sheet: Coronary Heart Disease. Cat. no. PHE 191. Canberra: AIHW.http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129552755
8 Deloitte Access Economics (2012) Extrapolated returns on investment in NHMRC medical research. Canberra: Australian Society for Medical Research.http://www.asmr.org.au/ExtrapolatedNHMRC12.pdf
9 NHMRC webpage: Research Funding – Disease/disorders or health condition based data collections. NHMRC expenditure by priority areas 2011 to 2015. Page Updated: 28-04-2016.http://www.nhmrc.gov.au/grants-funding/research-funding-statistics-and-data
10 National Health and Medical Research Council (2013) Measuring Up 2013. Canberra: NHMRC.http://www.nhmrc.gov.au/guidelinespublications/nh164
11 NHMRC (2016) National Health and Medical Research Council Research Funding Facts Book 2014. Canberra: NHMRC. Table 6, p14.http://www.nhmrc.gov.au/_files_nhmrc/file/publications/15460_nhmrc_fundingfacts2014_web.pdf
12 U.S. News Best Hospitals 2015-16 webpage. Accessed on 18/05/2016.http://health.usnews.com/best-hospitals/rankings
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