6 th Asia-Pacific Conference, 2014 Issue Panel, IP5 THE PATIENT VOICE IN CHINA: WHAT IS THE WEIGHT OF PROs IN THE REIMBURSEMENT AND ACCESS DECISIONS OF PAYERS TODAY? GfK 2014 1 Stephen Potts Regional Lead, Healthcare, Asia Based in Singapore Healthcare Marketing Consultant for the past 20 years. 6 years in the UK 14 years in Asia Fact-based consulting to the sales and marketing functions and the market access functions within healthcare companies Kantar Health: 2002 2012 GfK: 2012-2014 Extensive experience across many areas, including Cardiovascular Disease and Diabetes, Oncology, Respiratory Medicine, Pain, Dermatology, Psychiatry and Vaccines. Stephen Potts Regional Lead, Asia GfK Healthcare Stephen.Potts@gfk.com Tel: +65 6826 8656 2 Page 1
Agenda 01 02 03 04 Introduction Stephen Potts, Regional Lead Asia, GfK Healthcare The physician perspective (breast cancer) Dr Lin Cheng, Peking University People s Hospital, Beijing The physician perspective (lung cancer) Dr Hong Wang, People s Liberation Army Hospital No. 307, Beijing The payer perspective Stephen Potts, Regional Lead Asia, GfK Healthcare 05 Summary and questions 3 Healthcare funding is a universal issue What weight should the patient voice carry, in terms of quality of life and health utility? Benefit Cost 4 Page 2
Can we look at the level of publications activity as a marker of the importance of the patient voice? PubMed literature review, 2012-2013, restricted to oncology publications Assess the number of publications relative to the ASIR (age-standardised incidence rate) across a range of countries Evaluate the proportion of publications including patient-reported outcome (PRO) measures, restricted to Chinese publications (170) 5 Ratio of number of publications to the ASIR for each country Country Ratio USA 0,81 United Kingdom 0,77 Japan 0,46 China 0,35 India 0,32 Brazil 0,23 Germany 0,22 Australia 0,20 Korea 0,18 France 0,16 Italy 0,14 Spain 0,12 Turkey 0,09 Belgium 0,05 Mexico 0,04 Russia 0,01 6 Page 3
% of publications per topic % of publications per topic 16% of publications referenced quality of life or health utility measures 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% 5% 5% 4% 4% 3% 3% 2% 2% 1% 1% 0% 16% Incidence / Survival / Prognosis 4% 14% 12% Quality of Life Tumour staging / Metastases evaluation / cell evolution 4% 4% Disease Genetic testing symptoms (e.g. pain) and control Surgery outcome / complications / time / length of stay 4% 8% Depression / Fatigue / Anxiety / Distress / Mental evaluation 3% Blood tests / Diagnostic test biopsy results evaluation (sensitivity / specificity) 7% Functional assessment / performance / follow up 2% Health Economic Modelling and ability to pay 6% 6% Treatment safety / Toxicity / Complications / Tolerability 2% 2% Patient adherence / satisfaction with treatment Treatment / Disease management efficacy 5% Patient profile / Patient Expertise / Treatment history 1% 1% HRQOoL / Length of stay Health Utility / hospital / ICU QALY Caregiver support 7 Does this analysis reflect real-world practice? What emphasis do physicians place on PROs when treating breast cancer patients? Dr Cheng What emphasis do physicians place on PROs when treating lung cancer patients? Dr Wang What emphasis do payers place on PROs when considering access to new oncology treatments? Results of preliminary payer research study 8 Page 4
THE ROLE OF BREAST CANCER PATIENTS IN THEIR TREATMENT DECISION CHENG lin MD & PhD, Professor of Surgery Breast center Peking University People s Hospital. 9 Dr CHENG lin MD & PhD, Professor of Surgery Breast Center Peking University People s Hospital Education background 2003: Peking University Health Science Center MD & PhD 2007-2008: Vienna Medical University, postdoctoral training Working specialization Breast cancer diagnosis and comprehensive treatment 10 Page 5
History of PKU People s Hospital 1918 Peking Central Hospital 1946 Zhonghe Hospital 1950 Central People s Hospital 1956 Beijing People s Hospital 1958 People s Hospital, Beijing Medical College affiliate 1985 Beijing Medical University People s Hospital 2000 Peking University People s Hospital 1918 11 11 Facts and Figures (2013) Total Beds: 1,700 Outpatient: 2.6 m Surgeries: 67,204 Total Employees: 5,095 Physicians: 852 Annual Revenue: 3.1 bn 12 Page 6
Working specialization Breast cancer diagnosis - imaging diagnosis Comprehensive treatment - surgery - systemic treatment 13 Peking University People s Hospital Breast Center The first comprehensive center for breast disease Founded in University in 1992 700 newly-diagnosed breast cancer patients each year - 600 cases received surgery in PKUPHBC - 40% received BCT - 18% DCIS - 70% SLNB 14 Page 7
Routine treatment procedure 1. Outpatient clinic 2. Doctor consultation: physical examination 3. Imaging evaluation 4. Suspicious CNB or lumpectomy 5. Breast cancer surgery 6. Chemo, RT, endocrine, targeted 15 Most breast cancer patients will be anxious For example, some patients worry about the safety of CNB may refuse this procedure If refuse, we have to select the open biopsy. 16 Page 8
Most breast cancer patients will be anxious For example, mammography - Most diagnosis performed by mammography followed by ultrasound in western countries In China, it is contrary - Reasons: - Money - Comfortable - Anxiety about irradiation 17 Most breast cancer patients will be anxious For example, BCT - Most patients want to preserve the contour of themselves - Actually, some patients will give up - Worry about the cancer recurrence - The relatives and friends suggest RT 18 Page 9
Most breast cancer patients will be anxious For example, systemic treatment(chemo, target) - Most patients are even more anxious about chemo than surgery - Reasons - side effects - money (international company and local company) - insurance cover 19 Treatment is given by doctors + Treatment is received by patients So doctors must consider the patients desire As for any new treatment doctors must balance the benefit and side effects, meanwhile must consider the financial burden of patients. 20 Page 10
Summary The importance of patient-reported measures will increase in the future, in both the clinical practice setting and the approval process for new oncology treatments 21 Thanks for your attention! 22 22 Page 11