NSLHD Research

Cost-effectiveness of pembrolizumab plus chemotherapy for metastatic non-small cell lung cancer: a head-to-head trial vs. real-world comparison

2026-05-06T02:21:16Z

Title: Cost-effectiveness of pembrolizumab plus chemotherapy for metastatic non-small cell lung cancer: a head-to-head trial vs. real-world comparison Authors: Teppala, Srinivas; Koo, Juhee; Clarke, Stephen John; Lu, Christine Y Abstract: Real-world evidence (RWE) is increasingly used in health technology assessment (HTA) to address uncertainties surrounding the generalizability of randomized clinical trial (RCT) data. Pembrolizumab plus platinum-based chemotherapy improves survival in metastatic, non-small cell cancer (mNSCLC); however, existing economic evaluations primarily rely on RCT inputs. This study aimed to provide a within-model comparison of cost-effectiveness estimates derived from RCT and population-based RWE for pembrolizumab plus platinum therapy versus platinum therapy alone. A cost-utility analysis was conducted using a semi-Markov approach over a 3-year time horizon. Survival parameters were sourced separately from RCT and RWE datasets. Costs were estimated from the Australian payer perspective. Decision uncertainty was examined through one-way and probabilistic sensitivity analyses. Using RCT-based data, pembrolizumab plus platinum therapy increased total costs by AU$97,661 and provided a gain of 0.29 quality-adjusted life years (QALYs) compared with platinum therapy alone, resulting in an incremental cost-effectiveness ratio (ICER) of AU$336,196/QALY. RWE-based inputs, led to incremental costs of AU$79,471, a gain of 0.16 QALYs, and an ICER of AU$496,007/QALY. Probabilistic analyses indicated a < 5% probability of cost-effectiveness at willingness-to-pay (WTP) thresholds of AU$75,000/QALY for both evidence sources. Pembrolizumab plus platinum therapy is unlikely to be cost-effective for mNSCLC. The higher ICER with RWE compared to RCT data suggests that trial-based outcomes may overestimate effectiveness in routine practice. These findings highlight the importance of incorporating RWE into post-approval reassessment for high-cost oncology therapies.

Uptake of sentinel lymph node biopsy following a melanoma diagnosis: an Australian population-based study

2026-09-14T01:14:44Z

Title: Uptake of sentinel lymph node biopsy following a melanoma diagnosis: an Australian population-based study Authors: Watts, Caroline G; McKeown, Janet; Lo, Serigne N; Ma, Victoria J; Saw, Robyn P M; Scolyer, Richard A; Smith, Andrea L; Spillane, Andrew John; Thompson, John F; Varey, Alexander H R; Cust, Anne E Abstract: Discussion about sentinel lymph node biopsy (SLNB) is recommended for clinical management of patients whose melanomas meet certain criteria, however previous studies have shown relatively low uptake. It is unclear if SLNB uptake has changed over time. A population-based study using record linkage was conducted in Australia for persons (n = 26,760) with a primary invasive melanoma diagnosis (Breslow thickness ≥0.75 mm) reported to the New South Wales (NSW) Cancer Registry between 2003 and 2018, which were linked to hospital records. We examined whether a SLNB was performed within six months of the melanoma diagnosis and factors that influenced uptake. Between 2003 and 2018, the annual numbers of melanoma diagnoses and SLNB procedures both increased, while the proportion of patients undergoing SLNB remained stable (between 34% and 39%) over time. The average proportion of patients who received a SLNB during the study period was 36% for those with an invasive melanoma ≥0.75 mm in Breslow thickness, 24% for Breslow thickness 0.75-1.2 mm and 43% for Breslow thickness >1.2 mm. Factors independently associated with uptake included age, Breslow thickness, body site, melanoma subtype, socio-economic status and geographic remoteness. There was minimal change to the proportion of patients receiving SLNB between 2003 and 2018, with the proportion remaining relatively low despite evolving clinical practice guidelines. Lower uptake among patients living outside major cities and for those with greater socio-economic disadvantage indicates possible inequities in care.

AI education at NSLHD Libraries: starting, scaling, and sustaining

2026-09-07T03:14:34Z

Title: AI education at NSLHD Libraries: starting, scaling, and sustaining Authors: McKnight, Katie; Marsh, Geraldine; Wormleaton, Nicola Abstract: In 2024, Northern Sydney Local Health District (NSLHD) Libraries implemented a librarian led program to introduce artificial intelligence (AI) tools for evidence retrieval and research workflows to clinicians and hospital staff. The initiative focussed on learning, testing, and teaching safe and appropriate AI use within a health service environment. In 2025, the program expanded to include advanced training and clinical collaborations. This article describes the program’s origins, key design decisions, and developed resources. It also examines early impacts and lessons learned relevant to health library practice.

Online adaptive radiotherapy: International strategies for AI-enabled workflow efficiency and radiation therapist-led delivery for sustainable practice

2026-07-17T03:55:52Z

Title: Online adaptive radiotherapy: International strategies for AI-enabled workflow efficiency and radiation therapist-led delivery for sustainable practice Authors: Shepherd, Meegan; Williams, Bethany; Dinkla, Anna; Geary, Brayden; Barrett, Sarah Abstract: Online adaptive radiotherapy (oART) represents a significant advancement in personalised radiation cancer treatment, offering improved daily dose to targets and optimised organ exposures with reduced toxicity. Implementation remains challenging due to resource intensiveness, workflow complexity and workforce limitations. This article presents international insights on optimising oART delivery with a focus on practice development and workforce transformation. Strategies are explored to improve workflow efficiency, integration of artificial intelligence (AI) and the role of both therapeutic radiographers and radiation therapists (RTTs) in leading adaptive workflows. Credentialing frameworks for RTTs are examined as a mechanism to support sustainable oART delivery and reduce clinician console time. The discussion synthesises practical innovations from across multiple international healthcare systems, highlighting reproducible models for efficiency, workforce training and AI integration. These insights aim to guide global efforts in scaling oART delivery through efficient and collaborative practice models that align with safe, accessible patient-centred care.