1 Approval number
The health economic landscape of cancer in Europe Bengt Jönsson, Professor Emeritus of Health Economics Stockholm School of Economics 2
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. 3
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 18 6,000 15 5,000 12 4,000 9 3,000 6 2,000 1,000 3 0 0 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 ) 2011. ( 3 ) 2010. Source: Eurostat (online data code: hlth_sha_hf) Reference: http://ec.europa.eu/eurostat/statistics-explained/index.php/file. Accessed September 2016. 4
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% 2001 2004 2007 2010 2013 Reference: OECD, Health Statistics 2015. Available at: http://www.oecd.org/health/slow-growth-in-health-spending-but-europe-lags-behind.htm. Accessed September 2016. 5
The changing demographics of cancer 500,000 450,000 400,000 350,000 300,000 250,000 200,000 150,000 100,000 50,000 0 0-14 15-39 40-44 45-49 50-54 male 55-59 60-64 65-69 70-74 75+ female Number of new cancer cases by age group and gender in the EU, 2012. Notes: cancer ZICD-10 C00-97/C44. EU Z European Union. Reference: Jönsson B et al. Eur J Cancer 2016; 66: 162 170. 6
Disease burden 2000 and 2012 25% 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 2000 2012 Reference: Jönsson B et al. Comparator Report on Patient Access to Cancer Medicines in Europe, Revisited. 2016. Available at: http://www.ihe.se/access-to-cancer-medicines-in-europe.aspx. Accessed September 2016. 7
Deaths due to cancer as a share of all deaths by age group in the EU, 2012 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% <1 1-4 5-9 10-14 15-19 20-24 25-29 30-34 Cancer deaths 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 Deaths due to other causes 75-79 80-84 85-89 90-94 95+ Deaths due to cancer as a share of all deaths by age group in the EU, 2012. Notes: cancer = ICD-10 C00-97; other causes = ICD-10 A00-Y89 excluding S00-T98 and C00-97. References: Jönsson B et al. Eur J Cancer 2016; 66: 162 170. 8
Changes in the composition of total cancer costs 100 80 75.7 83.5 83.2 60 40 50.5 54.5 61.2 54.2 52.6 66.6 66.6 49.9 64.1 48.6 20 0 9.1 16.8 19.1 h-exp. m-loss h-exp. m-loss h-exp. m-loss h-exp. m-loss h-exp. m-loss 1995 2000 2005 2010 2014 Expenditure on cancer drugs Other health expenditure Components of the total cost of cancer in the EU (in billion ; 2014 prices), 1995 2014. 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: 162 170. 9
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Kg per case Innovation and progress in cancer care Trastuzumab use in five countries Survival rates for breast cancer 0,007 Belgium 1997-2002 2004-09 64.7 0,006 Malta Austria 60.8 57.1 63.1 0,005 0,004 0,003 France Finland Netherlands Sweden Germany 58.5 58.9 61.8 57.9 61.0 57.3 60.7 53.3 60.4 0,002 EU10 Portugal 51.8 57.4 57.4 0,001 Slovenia Denmark 45.5 55.8 50.1 55.5 0 United Kingdom Ireland 48.1 53.3 49.0 52.9 Czech Republic 41.1 49.6 France Germany Italy Spain UK Latvia 38.6 Breast cancer five-year relative survival rate, 1997-2002 and 2004-09 (or nearest period). Note: 95% confidence intervals represented by H. Reference: Jönsson B et al. Eur J Cancer 2016; 66: 162 170.; OECD (2012), Health at a Glance: Europe 2012, OECD Publishing. http://dx.doi.org/10.1787/9789264183896-en Norway Iceland 57.0 63.1 66.1 0 25 50 75 100 Survival (%) 10
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% 0 10 20 30 40 50 60 Months of survival Diagnosed 2007-11, therapy Diagnosed 1996-2000, therapy Diagnosed 2007-11, notherapy Diagnosed 1996-2000, no therapy Reference: Howard D et al. Health Affairs 2016; 35: 1581 1587 11
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 300 802 25000 20000 <= 3 years 3-5 years >5 years 250 200 15000 150 10000 100 50 5000 0 1996 1998 2000 2002 2004 Approval date 2006 2008 2010 2012 2014 References: Howard D et al. J Econ Perspect 2015; 29(1): 139 162; Jönsson B et al. Comparator Report on Patient Access to Cancer Medicines in Europe, Revisited. 2016. Available at: http://www.ihe.se/access-to-cancer-medicines-in-europe.aspx. Accessed September 2016. 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 The newest drugs makes up a fairly small and stable share of total sales 12
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 1996-2000 to 2007-11 Breast cancer Therapy No therapy 2.0 13.2 9 72 Lung cancer Therapy No therapy 0.7 3.9 4 23 Kidney cancer 7.9 45 Chronic myeloid leukemia 22.1 142 0 10 20 30 0 50 100 150 200 Months of survival gained Cost increase ($1,000s) Reference: Howard D et al. Health Affairs 2016; 35: 1581 1587 13
Outcome P 2 0 2 0 2A Innovation and efficiency Creative challenge and destruction of existing patterns of care 0 1 P 1 0 1A R Resources 14
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 2016. 15
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 2016. 16
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 17