New Zealand s Medicines Landscape 2017

Transcription

1 New Zealand s Medicines Landscape 2017 Better health outcomes for New Zealanders

2 Message from the Chair New Zealand is dragging its feet when it comes to accessing breakthrough world-class medicines and treatments. Many comparable countries have access to these approved modern medicines but the current model that New Zealand works under produces significant delays for publicly funded access. This makes it difficult for healthcare professionals to provide a specific personalised approach when treating patients. Often the argument is around the costs of these medicines and due to our system having a capped funding model, sacrifices have been made. This has repercussions on patients publicly accessing the best possible treatments and the health system missing out on potential long term savings. However, when costs are publicly announced they are typically the full list price to access these modern medicines. What is not mentioned is the discounts due to a competitive negotiation process. These discussions lead to substantial rebates (44% on average) from pharmaceutical companies once the contract has been confirmed. Improving New Zealand s access to modern medicines can improve the well-being of patients and provide long-term cost-effective savings for our health system. While New Zealand is still trying to make decisions on what to give access to whom, patients are receiving outdated and less than optimal treatments impacting on individual patient well-being and the wider economy. I believe patients need to have equitable access to the right medicines at the right time. It s time to address our inequity with the world, improve patient well-being and start reaping the costsaving benefits of modern medicines. The real cost of medicines in New Zealand 1 44% Full list price (often used by media) Average rebate Real cost (price reduction using rebate) Pharmaceutical companies provide a price reduction using confidential rebates for publicly funded medicines in New Zealand. Modern medicines include a more generous rebate than generic medicines. 1 Medicines Landscape 2017

3 MIND THE GAP New Zealand s combined medicines budget in real terms 2 Vote health 6.2% 2007 Inflation and population growth 3.6% 2017 Vote health $682M is required to return the budget back to the equivalent of Since 2007 the medicines budget has consistently been underfunded. Minor investments have not kept up with New Zealand s increasing population and inflation. Other countries invest more of their total healthcare spending to publicly fund medicines 3 Australia 10% UK 11% France 13% Spain 12% The gap between comparable countries 3 New Zealand 22% Australia 45% UK 86% Modern medicines that have been registered and then publicly funded. New Zealand 26% Australia 44% UK 92% All possibly available first in class modern medicines that have been funded. The time it takes to fund a modern medicine days 134 days 329 days 370 days 517 days 543 days Germany UK France Australia New Zealand Portugal 1. PHARMAC Official Information Act (OIA) response to Medicines New Zealand: 24 March NZIER. (2017). Community pharmaceutical expenditure trends. Wellington, New Zealand. 3. Medicines Australia. (2017). Comparison of access and reimbursement environments (COMPARE) 3rd edition. Canberra, Australia. 2 Medicines Landscape 2017

4 MEDICINES WAITING LIST How a prescription medicine is funded Most common process for funding modern prescription medicines in New Zealand. Medsafe registration PTAC recommendation for funding The waiting list Pharmac funding decision Patient The Pharmacology and Therapeutics Advisory Committee (PTAC) reviews funding applications for new medicines. PTAC makes recommendations on which medicines should be funded by PHARMAC. The waiting list only includes medicines recommend by PTAC for funding, and excludes other modern medicines which have been registered for use in New Zealand. Medicines New Zealand actively updates this waiting list to increase transparency around PHARMAC decision making, timelines for listing and help with budget forecasting. Medicines wait to be funded 1 Over 80 medicines have priority to be funded and sit on the medicines waiting list. Patients wait longer for access 1 Medicines recommended for funding but sitting on waiting list Waiting up to years 10 PTAC high priority recommendations Waiting up to 6.75 years 3 Medicines Landscape 2017

5 Number of various types of medicines on the waiting list 1 Depression Hepatitis C Schizophrenia Arthritis Cancer Diabetes A growing number of patients wait for access 2,3 For only 1/3 of medicines on the waiting list ,000+ patients are waiting for access. That s more than the population of Otago! Other countries already have access to these medicines 2,3 Available in comparable OECD countries and over 45 other countries including: Cyprus Estonia Greece Slovenia Lebanon Moldova 1. Della Barca, C. (2017) Funding medicines in New Zealand: revision of the medicines waiting list. Auckland, New Zealand: Subscripts limited. 2. PTAC minutes ( ). 3. MNZ member survey responses (2018). Wellington, New Zealand. 4 Medicines Landscape 2017

6 ILL HEALTH IN NEW ZEALAND Arthritis 1 There are currently 624,000 patients with Arthritis This is expected to rise to 650,000 by 2020 Currently it costs New Zealand $3.2 billion 5 biologic medicines are available in other countries including Australia that can reduce ongoing damage and 6 arthritis medicines that can treat personalized conditions. Diabetes 2,3 There are currently 257,000 patients diagnosed with type 1 and type 2 diabetes. Nearly 40 people per day are diagnosed The estimated costs for New Zealand is $1.7 billion by 2021, a 30% increase Management of diabetes has been stated as a Government health priority, yet three types of type 2 diabetes treatments are not funded in New Zealand going against international guidelines. Cancer 4,5,6 In 2014 over 20, died from cancer Cancer is a rising estimated annual cost to New Zealand People were diagnosed with cancer in New Zealand $880 million Average cancer rate 7 New Zealand s average cancer rates are over 62% higher than the world average. World average 183 New Zealand 295 Age standardised rate per 100,000. All cancers excluding non-melanoma skin cancer rates. 1. Arthritis New Zealand. (2017). Taking the next steps for arthritis: an Arthritis New Zealand election manifesto. Wellington, New Zealand. 2. Ministry of Health. (2009). New Zealand cost-of-illness studies on long-term conditions. Wellington, New Zealand. 3. Ministry of Health. (2017). Virtual Diabetes Register Wellington, New Zealand. 4. Ministry of Health. (2014) 5. Ministry of Health. (2014) 6. Blakely, T., et al. (2015). Med Care. 53: WHO International Agency for Cancer. (2012). Estimated cancer incidence, mortality and prevalence worldwide in Medicines Landscape 2017

7 HEALTH INEQUITY IN NEW ZEALAND Diabetes impacts our ethnic communities more significantly 1,2,3,4 Indian 1 in 5 Pacific Island 1 in 9 Asian 1 in 15 Maori 1 in 16 Diabetes is most common among Indian and Pacific communities. New Zealand is second to the United States in the years of life lost to diabetes. Maori have increased health burdens 5,6,7,8,9 27% 3x x 1.5 Māori make up 27% incidences of cancer Māori are 5 x more likely to: 12% of Māori families with ill children cannot afford prescription costs Māori children are 1.5 x more likely to develop asthma and are 3 x more likely to be hospitalised with eczema The total cancer mortality rate is 1.5 x higher for Māori than non-māori R.I.P Wait longer for chemotherapy Have less lymph nodes removed Require emergency surgery Die after elective surgery Ethnicity affects life expectancy 1,2 Māori men Māori women Pacific Island men Pacific Island women 6.8 years less life expectancy 7.3 years less life expectancy 5 years less life expectancy 4.5 years less life expectancy 1. Ministry of Health. (2016). Ala Mo ui progress report. Wellington, New Zealand. 2. Ministry of Health. (2015). Tatau Kahukura: Māori Health Chart Book rd edition, Wellington, New Zealand. 3. Statistics New Zealand. (2013). profile-and-summary-reports/quickstats-culture-identity/asian.aspx. 4. Danaei. G. et al. (2011) Lancet. 378: Ministry of Health. (2014). The Health of Māori Children and Young People with Chronic Conditions and Disabilities in New Zealand (series II). Wellington, New Zealand. 6. Rameka, R. (2006). He Arakanihi ki te Oranga. Wellington, New Zealand. 7. Ministry of Health (2015) National Cancer Programme: Work Plan 2013/14. Wellington, New Zealand. 8. Ministry of Health (2015) Māori Health Unequal Impact II. Wellington, New Zealand. 9. Moore S. P., et al. (2015) Lancet Oncol. 16: Medicines Landscape 2017

8 BENEFITS OF INNOVATION Medicines make a huge impact on public health 1 Reduction in the incidence of the following diseases since the introduction of a vaccine. 100% 100% 99.9% 99.9% 97.4% 96.6% 87.2% Polio Smallpox Rubella Measles Mumps Tetanus Chicken pox Modern medicines increase survival 2,3 83% 2 out of 3 people diagnosed with cancer survive at least 5 years of survival gains in cancer are attributable to new treatments Modern medicines have contributed to a decline in Cancer mortality rates 2 (since 1991). Canada 21% Mexico 18% Australia 26% Modern medicines can treat and cure chronic disease 4,5,6 Hepatitis C Now curable in more than 90% of treated patients with only 8-12 weeks of treatment. Diabetes death rates have declined 48% in Korea and 31% Canada. Korea 48% Canada 31% HIV Has been transformed from a death sentence to a manageable disease. 1. Roush, S. and Murphy, T. (2007). JAMA. 14: American Cancer Society Statistics Centre (2016). 3. Sun, E. et al. (2008).The determinants of recent gains cancer survival: an analysis of surveillance, epidemiology and end results SEER database: J. Clin. Oncol suppl PHRMA. (2014). 25 years of progress against hepatitis C. 5. PHARMA. (2015) Biopharmaceutical research industry profile. 6. WHO mortality database (2016). 7 Medicines Landscape 2017

9 MODERN MEDICINES ARE A COST-SAVING SOLUTION Medicines have a direct saving on hospitalisations 1 $1 $3 - $10 saved For every dollar spent on new medicines $3 to $10 is saved on hospitalisations for adherent patients with congestive heart failure, high blood pressure, diabetes and high cholesterol. In 2011, modern medicines reduced hospital expenditure in Australia by 2 $7 billion Modern medicines help patients get back to work 3 4 out of 5 cancer patients around the world today are returning to work following diagnosis due to modern therapies. In Europe $330 Million is saved annually from averted GP visits, hospitalisations and lost work days as a result of seasonal influenza vaccinations 4 330m 1. Roebuck, C. et al. (2011). Health Affairs, 30: Lichtenberg, F. (2017). Econ. Record. 93: Amir, Z. and Brocky, J. (2009). Occup. Med. 59: Preaud. E. (2014). BMC Public Health. 14: Medicines Landscape 2017

10 INVESTING IN THE FUTURE OF HEALTH It takes an average of 12 years to develop a medicine 1 Drug discovery Clinical trials Regulatory review Safety monitoring 3-6 years 6-7 years years Indefinite On average only 1 in 6000 compounds makes it through the whole process. The average cost to develop a modern medicine is increasing 1 US$1 billion 1990s - early 2000s US$2.6 billion 2000s - early 2010s Key drivers include: Increased trial complexity and regulatory barriers. Increased focus on areas where science is difficult and failure risks high. Expanded research burden to meet payer demands medicines are currently in development around the world 2 In 2017 The FDA approved 46 new medicines 3 Of which 18 approved to treat rare diseases, 17 considered breakthrough therapies 1. Di Masi, J. A. et al. (2016).J. Health Econ. 47: Adis R&D insight database. (2016). 3. FDA (2017). CDER: new drug therapy approvals. Washington, D. C. 9 Medicines Landscape 2017

11 CLINICAL TRIALS AND NEW ZEALAND Clinical trials contribute to New Zealand s economy 1 Estimated $78 million per annum. Clinical trials are a cost effective option 2 What if I receive the placebo medicine? 2 $750,000 The estimate saved per year on medicine costs alone at Middlemore, Counties Manukau in As a minimum ethical requirement all participants receive the international standard of care medicines even if it is not available in New Zealand. Benefits of clinical trials to New Zealand 3 Patients receive earlier access to modern medicines. DHB staff gain additional knowledge. Every dollar spent at least four fold projected as a net economic benefit to society. Phase 4 studies can lead to cost savings. Opportunity for DHBs to derive income. Top clinicians seek to engage in clinical research and are likely to stay in NZ. Medicines New Zealand Members contribute to New Zealand 4,5 $384 million Our member companies help to generate over $384 million of GDP every year In New Zealand. $171 million Our members have undertaken 589 clinical trials over last 4 years investing $171 million $129 million Our members have purchased over $129 million of value added materials and ingredients over the last four years. 1. Dixion, S. Jarvis, G. (2018) Medicines New Zealand: Economic impact of clinical trials in New Zealand. Manuscript in preparation. 2. Middlemore Clinical Trials. (2017) Annual report. Auckland, New Zealand. 3. Health Select Committee. (2011). Inquiry into improving New Zealand s environment to support innovation through clinical trials. Wellington, New Zealand 4. Nana, G. Fareti, N. (2016) Economic impact assessment of Medicines New Zealand members New Zealand: BERL 5. Medicines New Zealand confidential R&D survey (2016). Wellington, New Zealand. 10 Medicines Landscape 2017

12 2017 Parliamentary Dinner Professor Ian Frazer The annual Medicines New Zealand Parliamentary Dinner brings top international speakers to New Zealand to provide perspective on international standards, treatments, collaborations and advancements in health. This year s speaker was Professor Ian Frazer, the founding CEO and Director of Research at the Translational Research Institute, Australia. Professor Frazer and his colleague Jian Zhou discovered and developed the HPV vaccine which now prevents thousands of New Zealanders contracting the HPV virus and cervical cancer. Professor Frazer spoke about the story of the HPV vaccine development and lessons learned. He provided insights on the importance of research to change health in order to improve patient health outcomes. The presentation also informed on the collaboration needed between public and private institutions for the advancement of health. The Dinner was hosted by the 2017 Chair of the Health Select Committee, Simon O Connor MP and was attended by MPs, dignitaries, health specialists, researchers, patient group representatives and pharmaceutical representatives Value of Medicines Award winner Professor Lisa Stamp The Value of Medicines Award aims to stimulate and reward contemporary research that improves the understanding, effectiveness or safety of the use of medicines or vaccines in New Zealand. Professor Lisa Stamp, Director of Arthritis Research at University of Otago, Christchurch, won the 2017 award for her and her colleagues influential research into the treatment of gout with Allopurinol. Her research was the first randomized controlled trial to demonstrate an improved dosing strategy for Allopurinol, helping more patients effectively manage their gout symptoms. Previously patients with chronic kidney disease would not be effectively managed with Allopurinol due to the increased risk of side effects. This research reveals that with gradual dose increases of Allopurinol over time, we can help these patients to better manage this disease without the further risk of side effects says Professor Stamp. The winning research was published in the top international rheumatology journal, The Annals of Rheumatic Diseases. 12 Medicines Landscape March 2017 info@medicinesnz.co.nz Copyright Medicines New Zealand 2018