Advancing the Responsible Use of Medicines: Avoidable Costs and Considerations for Korea s Health System

Transcription

1 Advancing the Responsible Use of Medicines: Avoidable Costs and Considerations for Korea s Health System Murray Aitken, Executive Director, IMS Institute Sungkyunkwan University, School of Pharmacy March 26, 2014

2 Today s discussion Introduction to the IMS Institute for Healthcare Informatics Overview of our global research on the responsible use of medicines Considerations for Korea s health system 2

3 Established in 2011, the IMS Institute has a research agenda around five areas The Institute s mission is to provide key policy setters and decision makers in the global health sector with unique and transformational insights into healthcare dynamics derived from granular analysis of information Effective use of information Performance of medical care Global role for biopharmac euticals Innovation in health systems products, processes and delivery systems Developing nations 3

4 About the IMS Institute Unbiased Information Academic Research Public Policy Support 4

5 Why focus on responsible use of medicines? Medicines are an integral part of healthcare But often managed in isolation from other parts of care. $1 Trillion will be spent on medicines globally in

6 Our technical report had four objectives Establish a globally relevant framework of where the value from responsible medicine use can be gained Develop a quantitative analysis for avoidable costs from a medicine and non-medicine spend perspective Identify best practice policy options and case study examples of addressing lost value and realizing benefits Provide a set of prioritized and pragmatic recommendations for health system leaders Drawn primarily on middle- and high-income countries though approach & implications should be relevant for all 6

7 Total global spending on medicines will reach about $1.2Tn in 2017, an increase of $ Bn from 2012 Global spending and growth, $ Bn $234Bn $1,170-1,200 Bn $965Bn $731Bn Source: IMS Health Market Prognosis, September

8 ABSOLUTE GROWTH CONST $USBN Annual spending growth on medicines will accelerate over the next five years, particularly in developed markets Global Growth, Growth $217Bn Growth $ Bn Developed Pharmerging Rest of World Source: IMS Health Market Prognosis, September

9 The responsible use of medicines places emphasis on the stakeholders The responsible use of medicines implies that the activities, capabilities and existing resources of health system stakeholders are aligned to ensure patients receive the right medicines at the right time, use them appropriately and benefit from them 9

10 The focus of study was limited to six areas where there is opportunity to increase the value of medicines Medicine access and pricing were not addressed Medication nonadherence Delayed evidence-based treatment Antibiotic misuse Medication errors Suboptimal generics use Mismanaged polypharmacy Improvement in health outcomes Decline in healthcare costs Increase in medicines value and health system performance 10

11 We applied a five-step process for the global quantification effort Process Step 1: Consolidated existing data across countries on the avoidable cost opportunity across six levers in countries Step 2: Assessed the drivers of differences in the avoidable cost opportunity across countries with a focus on measurability, global relevance and comparison. This resulted in five factors supported by global datasets: Health system infrastructure Affordability Medicine intensity Elderly in the population Non-communicable disease risk Step 3: We then assessed the relationship between these five factors and our six levers, developing a weight for each relationship. Source Gray literature and peer reviewed articles Government sources IMS Health data IMS Institute IMS Health WHO World Bank IMS Institute Step 4: Developed an algorithm to estimate avoidable costs for 186 countries using weights, existing avoidable cost figures and global data on the five factors IMS Institute WHO Step 5: Identified error margins based on the differences between actual and modelled data for countries where it exists and the quantity of data requiring estimations IMS Institute 11

12 We drew on case studies and supporting evidence from a wide set of countries to inform what ministers can do -19 country case studies -12 different geographies -Supporting evidence from over 30 countries 12

13 We also consulted with over a dozen external reviewers to assess sections and specific recommendations 13

14 Sources Process # We identified 5 high impact recommendations out of 54 using a prioritization process Prioritizing recommendations 54 Criteria 14 Criteria Top 5 Coverage 9 distinct levers Stakeholder focus across physicians, pharmacists, nurses and patients Factors relevant for health system leaders: - Level of spending - Health outcome improvement - Time from initiation to impact Coverage: 5 distinct levers Focus on nonadherence Multiple stakeholder focus Factors relevant for Ministers of Health: -Leadership -Policy-making -Financing Coverage: Focus on 5 levers with spillover effects on others Pharmacist focus Peer-reviewed and gray Pragmatic literature review covering literature sources Case study development Primary interviews with different healthcare professionals 14

15 Annual avoidable costs were estimated for each of the six areas Annual Avoidable Costs (2012) Medication nonadherence $269 Bn Delayed evidence-based treatment Antibiotic misuse Medication errors Suboptimal generics use $62 Bn $54 Bn $42 Bn $30 Bn Total Annual Avoidable Costs: $475 Bn = ~8% THE Mismanaged polypharmacy $18 Bn 15

16 This opportunity exists across all health system, and ranges from 4 to 9% of total healthcare expenditure THE = Total Healthcare Expenditure Western Europe 34 Bn or ~8% of THE Central and Eastern Europe 19 Bn or ~7% of THE North America 234 Bn or ~9% of THE Japan 38 Bn or ~9% of THE Latin America & Caribbean15 Bn or ~5% of THE EU5 100 Bn or ~8% of THE Africa & the Middle East 7 Bn or ~4% of THE Asia Pacific 25 Bn or ~5% of THE 16

17 These costs represent avoidable healthcare services utilized by millions of patients $213 Bn Millions of lives affected 10 million hospitalizations million outpatient visits 246 million prescriptions million emergency room visits Avoidable Costs, US ($Bn) Utilization Source: Avoidable Costs in U.S. Healthcare Study 17

18 Nonadherence is the biggest area of opportunity, multi-faceted in nature and can be improved Nature of the challenge Possible interventions References/Examples Multi-faceted: Several risk factors that operate in combination Relies on behavior change: Patients belief system matters yet that is often beyond the control of healthcare professionals Apply a patient-centered approach Support data collection efforts to enable targeted interventions Adopt cross-disease learnings Strengthen role of healthcare professionals, particularly pharmacists to support adherence interventions Simple tactics: peer support groups, self-initiated reminders At the point of prescription and during medication intake Cardiovascular disease and HIV Pharmacy-based management programme can trigger a return on in investment (e.g., 3 USD for every 1 USD spent) and improve adherence levels 18

19 A few countries track adherence progress in spite of existing challenges Examples Brazil monitors adherence for TB and HIV medicines Current challenges Various terms: Adherence, compliance, persistence? Denmark tracks adherence among asthma, elderly and other at-risk patients Recent CMS reform mandating adherence tracking as key components of quality care Inconsistent definitions: thresholds, dichotomous methods Lack of reliability in selfreported methods 19

20 A number of cross-country learnings can be leveraged to foster improvement across other levers Ensure timely medicine use Primary recommendations Leverage economic evaluations Country evidence Thailand Optimise antibiotic use Develop patient education programs and public campaigns France Prevent medication errors Implement technologysupported solutions Sweden Use low-cost generics where available Ensure supply-side measures Germany Manage polypharmacy Risk-stratify patients at high risk of inappropriate use of concurrent medicines US 20

21 Our global research developed five top recommendations based on outcome impact, timing and cost 1 Support greater role of pharmacists to own medicines management 2 Invest in medical audits targeting elderly patients 3 Implement mandatory reporting of antibiotic use 4 Encourage a no blame culture towards error reporting 5 Support targeted disease management programs for prevalent non-communicable diseases 21

22 Pharmacists can play critical roles in a large number of potential improvement areas Examples of high value pharmacist role Medication nonadherence Delayed evidence-based treatment Antibiotic misuse Medication errors Suboptimal generics use Direct and meaningful patient engagement Tailored programs in support of segments of patients likely to be nonadherent Availability of low barrier/cost diagnostics Medication therapy management programs Patient awareness of appropriate antibiotic use Monitoring and reporting of atypical utilization No-blame culture of error reporting Systematic approach to developing corrective actions Active substitution efforts where permitted Mismanaged polypharmacy Medication therapy management programs Priority for elderly patients 22

23 Other factors There are other qualitative factors that affect the suboptimal use of medicines Description Regulation and its enforcement Coordination in the health system Ability to track metrics related to medicine use Policies exist to support responsible use of medicines across different stakeholders Incentives underpin activity related to medicine use to support policy implementation Particularly key for antibiotic use, generic use and polypharmacy Most relevant for low and middle income countries Healthcare professionals are supported in ensuring treatment is provided an aligned fashion between different clinicians and pharmacists Information is shared between clinicians on patient health progress and medicine use Particularly key for timely medicine use, antibiotic use, polypharmacy and adherence Information collection is encouraged and supported to ensure tracking of progress and setbacks with respect to medicine use issues The use of existing data is optimized to track medicine use even if it is not a perfect mechanism Key for all areas The use of medicines and assessment of whether it is optimal or not is not systematically tracked within or across countries, making it difficult to understand the value of medicine use in the broader health system context and how countries can improve 23

24 The most effective and innovative approaches are possible only through collaboration among multiple healthcare stakeholders POLICYMAKERS PROVIDERS PHARMACEUTICAL MANUFACTURERS Areas of Avoidable Costs PHARMACISTS PAYERS PATIENTS 24

25 We see a set of common principles applied to successful improvement programs Consistent focus on high-risk patients most vulnerable to suboptimal medicines use and require costliest interventions Steadfast engagement with patients as responsible and capable partners Rigorous assessment of impact and ROI in design and implementation of interventions for optimum avoidable cost reduction Continuous measurement and accountability as basis for multi-stakeholder approaches Alignment of compensation/incentive models with new healthcare delivery models 25

26 We identified five success factors which can also be supported by Ministers of Health for implementation Policy Collaboration Education and Capacitybuilding Informatics Incentives Regulations or laws that support improvement s in medicine use downstream among prescribers, dispensers and patients. Engagement between healthcare professionals and patients in the public and private sectors. Education efforts directed to healthcare professionals and patients through training and/or public awareness campaigns. Applied data collection or medicine use monitoring to inform decision making, including the application of information technology (IT) and non- IT based methods. Alignment of incentives among healthcare professionals to drive change in clinical and/or dispensing practice. 26

27 The report offers messages for all stakeholders across the health system There is an overall need to... Key stakeholder relevance 1 Revitalize discussions on what works to improve adherence and health outcomes given new interest, supporting information and evidence All, ideally in a multi-stakeholder approach 2 Consolidate experiences on how stakeholders in the health system improve medicines management and impact the nonmedicine part of the health system Pharmacists Pharmaceutical industry 3 Ensure mechanisms are in place to support the responsible use of medicines in countries where healthcare service and medicine access is increasing Governments Payers Wholesalers 27

28 Our modelling suggests there is an avoidable cost opportunity of 7.8% of total health expenditure in Korea or KRW 7.5 Tn Annual magnitude of the opportunity across the health system Total KRW Tn These are nonmedicine and medicine-related avoidable costs Untimely medicine use (23%) Suboptimal generic use (15%) Mismanaged polypharmacy (3%) Nonadherence (39%) Antibiotic misuse/overuse (13%) Medication Errors (7%) This quantification effort is intended to trigger a meaningful discussion on how to assess the impact of responsible medicine use and not on the exact figures 21

29 South Korea s health system has some distinctive factors that likely affect medicine use Are policies in place to ensure appropriate use? S. Korea indexed to highincome country average While obesity rates are lower in S. Korea, alcohol and tobacco use are higher S. Korea has a lower elderly population Healthcare infrastructure NCD Risk factor Affordability Elderly Medicine intensity S. Korea has fewer physicians compared to the average Affordability for healthcare is very high in S. Korea with much lower OOP on healthcare S. Korea has more medicines /capita including new chemical entities and antibiotics A combination of factors make the health system more or less vulnerable for suboptimal medicine use 29

30 Suboptimal medicine use risk score The risk of suboptimal medicine rises as countries have greater availability of medicines Morocco Brazil Vietnam Dominican 4 Indonesia Republic Bangladesh Cambodia Cameroon 3 Colombia China Oman India 2 Ghana Zambia 1 Suboptimal medicine use risk score vs medicine intensity Russian Federation United States Spain United Kingdom Finland Australia France Ireland S. Korea Austria Canada Switzerland Germany Egypt, Arab Rep. Netherlands South Africa Jordan Thailand Saudi Arabia Costa Rica Japan The more medicines there are in the health system, the greater the risk for suboptimal use without mechanisms in place to ensure appropriate use ,000 1,100 1,200 Oral standard units per capita Source: IMS MIDAS, 2009; World Bank and WHO indicators, 2009; IMS Institute for Health Informatics, 2012; Select countries invited to the Ministers Summit 30 30

31 Considerations for Korea What level of attention is given to the responsible use of medicines? Are mechanisms in place to track responsible use of medicines? e.g. Medication adherence levels by patient segment and therapy area Timeliness of diagnosis and initiation of treatment for key diseases Efficiency of the generics market Level of inappropriate use of antibiotics Medication safety levels in hospitals and community care Proactive management of polypharmacy What programs have been highly successful at improving responsible medicine use and avoiding healthcare costs? Do healthcare stakeholders collaborate effectively to improve medicine use? 31

32 For more information Apple itunes store/ims Institute 32

33 Advancing the Responsible Use of Medicines: Avoidable Costs and Considerations for Korea s Health System Murray Aitken, Executive Director, IMS Institute Sungkyunkwan University, School of Pharmacy March 26, 2014