EHFG 2016 Sustainable and equitable cancer care: tomorrow s reality or science-fiction?

Transcription

1 1 Approval number

2 EHFG 2016 Sustainable and equitable cancer care: tomorrow s reality or science-fiction? 28 th September 2016

3 The Oncologist s perspective What can and should be changed in order to optimise the efficiency and quality of cancer care and improve clinical outcomes? Professor Richard Greil University Hospital Salzburg, SALK, Austria 4 ONCAT16NP

4 Disclaimer This presentation was developed by Professor Richard Greil for a workshop sponsored by Bristol-Myers Squibb (BMS). BMS provided support for formatting and artwork, however Professor Richard Greil is solely responsible for the content of this presentation. Any of the topics or in this presentation are not /shall not be focused on (nor biased towards) any particular treatments or products. 5 ONCAT16NP

5 Treating Cancer is to Enable state-of-the-art research & development Efficiently allocate resources Develop effective policies 6 ONCAT16NP

6 Some ideas to improve outcomes Patient centricity approach Centralization vs. peripheralization Address different interests of stakeholders: i.e. intra- vs. extramural Need of stringent policies/cancer plans Focus on efficiencies in cancer care Consider follow-up costs vs treatment costs Establish quality management 7 ONCAT16NP

7 The health economic landscape of cancer in Europe Bengt Jönsson, Professor Emeritus of Health Economics Stockholm School of Economics 8 ONCAT16NP

8 Disclaimer This presentation was developed by Professor Emeritus Bengt Jönsson for a workshop sponsored by Bristol-Myers Squibb (BMS). BMS provided support for formatting and artwork, however Professor Emeritus Bengt Jönsson is solely responsible for the content of this presentation. Any of the topics or in this presentation are not /shall not be focused on (nor biased towards) any particular treatments or products. 9 ONCAT16NP

9 Luxembourg Netherlands Germany Austria Belgium Denmark France Sweden Finland Spain Portugal ( 2 ) Greece Slovenia ( 2 ) Cyrus Czech Republic Slovakia ( 2 ) Hungary Lithuania Poland Croatia Estonia Bulgaria ( 2 ) Latvia ( 3 ) Romania United States Switzerland Norway Canada ( 2 ) Australia ( 2 ) Iceland ( 2 ) Japan ( 2 ) New Zealand ( 2 ) South Korea Rationale for taking a European perspective One market but many health care systems with similar needs and great differences in health care spending 7, , , , , ,000 1, Private expenditure (PPS per inhabitant) (left-hand scale) Public expenditure (PPS per inhabitant) (left-hand scale) Current health expenditure (% of GDP) (right-hand scale) ( 1 ) Countries are ranked on total (public + private) healthcare expenditure in PPS per inhabitant. Denmark, Cyrus, Portugal, Iceland, Norway and Swirtzerland: provisional. Ireland, Italy, Malta and the United Kingdom: not available. ( 2 ) ( 3 ) Source: Eurostat (online data code: hlth_sha_hf) Reference: Accessed September ONCAT16NP

10 Annual growth in per capita health spending Increasing demands but no increase in expenditures 6% 5% 4% OECD OECD (EU) OECD (non-eu) 3% 2% 1% 0% -1% Reference: OECD, Health Statistics Available at: Accessed September ONCAT16NP

11 The changing demographics of cancer 500, , , , , , , , ,000 50, male female Number of new cancer cases by age group and gender in the EU, Notes: cancer ZICD-10 C00-97/C44. EU Z European Union. Reference: Jönsson B et al. Eur J Cancer 2016; 66: ONCAT16NP

12 Disease burden 2000 and % Cardiovascular disease 18% Cancer 11% Mental and behavioural disorders 10% Injuries 7% Musculoskeletal diseases 21% Cardiovascular disease 19% Cancer 12% Mental and behavioural disorders 9% Injuries 8% Musculoskeletal diseases Reference: Jönsson B et al. Comparator Report on Patient Access to Cancer Medicines in Europe, Revisited Available at: Accessed September ONCAT16NP

13 Deaths due to cancer as a share of all deaths by age group in the EU, % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% < Cancer deaths Deaths due to other causes Deaths due to cancer as a share of all deaths by age group in the EU, Notes: cancer = ICD-10 C00-97; other causes = ICD-10 A00-Y89 excluding S00-T98 and C References: Jönsson B et al. Eur J Cancer 2016; 66: ONCAT16NP

14 Changes in the composition of total cancer costs h-exp. m-loss h-exp. m-loss h-exp. m-loss h-exp. m-loss h-exp. m-loss Expenditure on cancer drugs Other health expenditure Components of the total cost of cancer in the EU (in billion ; 2014 prices), Notes: Cancer is defined as ICD-10C00-D48 for health expenditure and ICD-10 C00-97, B21 for production loss due to premature mortality. EU = European Union; h-exp = health expenditure on cancer; m-loss = production loss due to premature mortality from cancer during working age. Reference: Jönsson B et al. Eur J Cancer 2016; 66: ONCAT16NP

15 Kg per case Innovation and progress in cancer care Trastuzumab use in five countries Survival rates for breast cancer 0,007 Belgium ,006 Malta Austria ,005 0,004 0,003 France Finland Netherlands Sweden Germany ,002 EU10 Portugal ,001 Slovenia Denmark United Kingdom Ireland Czech Republic France Germany Italy Spain UK Latvia 38.6 Breast cancer five-year relative survival rate, and (or nearest period). Note: 95% confidence intervals represented by H. Reference: Jönsson B et al. Eur J Cancer 2016; 66: ; OECD (2012), Health at a Glance: Europe 2012, OECD Publishing. Norway Iceland Survival (%) 16 ONCAT16NP

16 Survival rate Changes in the composition of total cancer costs Breast cancer patient survival rates, by period of diagnosis and treatment 100% 80% 60% 40% 20% 0% Months of survival Diagnosed , therapy Diagnosed , therapy Diagnosed , notherapy Diagnosed , no therapy Reference: Howard D et al. Health Affairs 2016; 35: ONCAT16NP

17 Thousands of 2013 dollars Sales (million ) Innovation, value and price Are new medicines cost-effective? Drug Price per Life Year Gained versus Drug Approval Date 100 Source of survival benefit: Trial, overall survival 350 Trial, progression-free survival Modeling study <= 3 years 3-5 years >5 years Approval date References: Howard D et al. J Econ Perspect 2015; 29(1): ; Jönsson B et al. Comparator Report on Patient Access to Cancer Medicines in Europe, Revisited Available at: Accessed September The newest drugs makes up a fairly small and stable share of total sales 18 ONCAT16NP

18 Innovation and price of new drugs New Anticancer Drugs Associated With Large Increases In Costs And Life Expectancy Changes in life expectancy and increases in lifetime medical costs for patients from to Breast cancer Therapy No therapy Lung cancer Therapy No therapy Kidney cancer Chronic myeloid leukemia Months of survival gained Cost increase ($1,000s) Reference: Howard D et al. Health Affairs 2016; 35: ONCAT16NP

19 Outcome P A Innovation and efficiency Creative challenge and destruction of existing patterns of care 0 1 P 1 0 1A R Resources 20 ONCAT16NP

20 Innovation and efficiency Removing inefficient practices Practices to remove inefficiencies: Denmark - Coordination of cancer services (pakkeforløb) to reduce waiting times and regional variation across examination, diagnosis, treatment and aftercare UK Urgent two-week referral pathways: 93% of urgent referral patients should be seen by a specialist within 14 days of a referral from a GP Reference: Office of Health Economics and Swedish Institute for Health Economics. Improving Efficiency and Resource Allocation in Future Cancer Care. June ONCAT16NP

21 Creating the right incentives Right incentive 25% smoking reduction = Savings of 6 bn per year in Europe Wrong incentive Strict separation of inpatient and outpatient care Payment systems that stands in the ways for appropriate treatment decisions Appropriate use of generics and biosimilars between 2015 and 2020 = 7.1 bn estimated total savings Reference: Office of Health Economics and Swedish Institute for Health Economics. Improving Efficiency and Resource Allocation in Future Cancer Care. June ONCAT16NP

22 Conclusions Health care expenditures on cancer are low in relation to the burden of the disease Health care expenditures on cancer has been stable as a share of total health care expenditures But the content of expenditures have changed Innovation in cancer diagnosis and treatment challenges existing patterns of care Issues related to an efficient resource allocation comes on top of the agenda 23 ONCAT16NP

23 The patient perspective on resource allocation What does value in cancer care looks like to patients? Alfonso Aguarón Project Manager, Myeloma Patients Europe 24 ONCAT16NP

24 Disclaimer This presentation was developed by Alfonso Aguarón for a workshop sponsored by Bristol-Myers Squibb (BMS). BMS provided support for formatting and artwork, however Alfonso Aguarón is solely responsible for the content of this presentation. Any of the topics or in this presentation are not /shall not be focused on (nor biased towards) any particular treatments or products. 25 ONCAT16NP

25 A brief overview of Myeloma Patients Europe European umbrella organisation of myeloma patient groups Registered as a NGO in Belgium in October members across 27 countries in large Europe Elected Board of Directors, mostly patient or relatives 3 full-time and 1 part-time employees 2 main objectives: To build capacity among our members groups To advocate at European level for the best possible research and equal access to the best possible treatment and care 26 ONCAT16NP

26 The importance of patient voice in value assessment Current scenario with limited resources real involvement of all the stakeholders (patients too) Advocacy community has made a great advantage in complex topics such as HTA, pricing, PRO, QoL measurement Defining whether a drug provides enough value to be available for all patients can be fuzzy and blurry needs to go beyond clinical endpoints ESMO MCBS 1 st step to provide a consistent approach to stratify a drug s clinical benefit A proper input from the patient side, based on evidence, can help to extend and update these tools. 27 ONCAT16NP

27 What does inefficiency and wastage in cancer care mean to patients? 28 ONCAT16NP

28 What responsibility do patients have in reducing health system wastage? Identifying an important research question and a selection of an appropriate study design is crucial Thinking beyond only efficacy Proper trained advocates can take part in the discussion and collaborate in a constructive way: Medical side: EHA, ESMO, ECCO Assessment side: ISPOR, EUNetHTA Regulatory side: EMA 29 ONCAT16NP

29 Inequalities and variations across Europe Access to new cancer drugs a major problem across all Europe The European Atlas of Access to Myeloma Treatment Impact assessment & update of evidence by umbrella organisation Observe & report back Identify local priorities Umbrella organisation gives strategic support Advocate Evidence Umbrella organisation creates evidence framework Strategy & advocacy plan Umbrella organisation gives guidance and coaching 30 ONCAT16NP

30 Survey finalised Sep 2015 Interactive map Nov 2015 Health system data finalised Dec 2015 Atlas microsite launch /ACP pilot kick-off Apr 2016 Atlas update and presentation of roadmap to members virtually ACP pilot kick off ACP pilot finalisation Sep 2016 Feb 2017 Impact assessment/measurement of success in implementing Atlas. Subsequently adapt Atlas to findings for next round of implementation 2017 and launch at EHA with target audience: clinicians, media, pharma, patient organisations 31 ONCAT16NP

31 Pilot implementation Call for expression of interest Start of pilot ACP May 2016 Sep 2016 Selection criteria MPE member Commitment to invest at a minimum of 20 hours Commitment to attend 2 day face to face meting Content End of pilot ACP Adaptation of ACP Feb 2017 Feb 2017-Sept 2017 Module 1: How to use the Atlas Module 2: Identifying barriers & priorities Module 3: Identifying key players Module 4: Creating a tailored strategy Module 5: Implementing your strategy Module 6: Evaluating success/adapting strategy to results Start of 2nd ACP Sept 2017 June 2017 Release of updated Atlas 32 ONCAT16NP

32 What responsibility do patients have in reducing health system wastage? Access issues are complex and country-specific To date, advocacy on access to treatment hasn t solved the issue Advocacy will only be effective if we: join forces have a thorough understanding of the underpinning issues and barriers have empirical evidence build a strategy, targeted solutions, skills support implementation at local level European Atlas of Access to Myeloma Treatment 33 ONCAT16NP

33 The role of the industry Emmanuel Blin BMS Chief Strategy Office 34 ONCAT16NP

34 Let s make Claus the norm 35 ONCAT16NP

35 36 ONCAT16NP

36 Cancer accounts for up to 40% of all deaths in the working population 37 ONCAT16NP

37 Rising burden Suboptimal resource allocation Substantial productivity loss Reduced resource availability 38 ONCAT16NP Disclaimer

38 60% of the burden of cancer is non-healthcare related 39 ONCAT16NP

39 With the right interventions, cancer patients like Claus return to work 40 ONCAT16NP

40 Improved outcomes Optimised resource allocation Minimised productivity loss Increased resource availability 41 ONCAT16NP

41 75% of patients are now returning to work within months following a cancer diagnosis 42 ONCAT16NP

42 1 in 5 National Cancer Control Plans lack sufficient funds for their implementation 43 ONCAT16NP

43 In Germany, health insurers could have saved 7.2 billion per year through improved ambulatory care 44 ONCAT16NP

44 45 ONCAT16NP

45 Policies for sustainable cancer care Lieve Wierinck MEP Group of the Alliance of Liberals and Democrats for Europe 46 ONCAT16NP

46 Disclaimer This presentation was developed by Lieve Wierinck for a workshop sponsored by Bristol-Myers Squibb (BMS). BMS provided support for formatting and artwork, however Lieve Wierinck is solely responsible for the content of this presentation. Any of the topics or in this presentation are not /shall not be focused on (nor biased towards) any particular treatments or products. 47 ONCAT16NP

47 Panel discussion 48

48 Closing remarks Vivek Muthu 49