I was invited to come and present the results of a study we conducted for EFPIA and EBE on the value of personalised medicines. The idea of this study was to look at what are the benefits of personalised treatments in healthcare and in oncology, both to patients but also more widely to healthcare systems and to society.
What were some of these benefits?
We looked at obviously a variety of benefits, mainly the clinical benefits which were an important element in terms of more effective treatment options when you target a specific mutation and have better overall survival but also reduced side effects. But more broadly we also looked at the benefits to the healthcare systems and more widely to society in terms of the economic benefits of targeting treatments and reducing overall waste but also making sure you put patients on the right treatments that are the most effective for them. Also the reduced cost in terms of reduced hospitalisation costs and some more effective treatment pathways linked to personalised care and what are the implications of that to society in terms of making sure patients get back to work quicker. So there are a variety of cost savings as a result of targeted therapies.
What are your recommendations?
Beyond just the benefits we also looked at some of the hurdles and the barriers that are experienced across different healthcare systems in Europe. So we looked at five different case study countries and what the wider landscape is in terms of accessing these therapies. What we realise is that there are some key barriers both in terms of the strategy that comes out of to what extent countries have prioritised personalised care but also in terms of the organisation of care and to what extent care is coordinated and centralised. So that’s a second key component of the study.
We also looked at access to diagnostics and screening, to what extent countries have an active screening strategy and access to companion diagnostics compared to more of the next generation technology like next generation sequencing in terms of diagnostics. But also to what extent treatments are actually covered by the healthcare systems and reimbursed and what are the factors that are going to affect the reimbursement of this care.
Is anyone doing it right?
A good question. We’re seeing a variety of different approaches, clearly we’re seeing that in terms of strategy we’re seeing some countries that have introduced active strategy, either a genomic strategy more focussed on the next generation sequencing element and the panel testing but also the countries who have introduced national cancer plans. Most countries who have done active strategy have done this as part of the national cancer plan, we’re seeing this in France and Denmark, that has been really effective – mechanisms to really have a comprehensive strategy – whereas other countries have done a more specific personalised care strategy.
In terms of diagnostics there’s clearly some good progress in Denmark and France who have taken a lab-based approach to ensuring access to diagnostic services. Whereas countries like the UK and even Poland, who are using a hospital-based tariff system to reimburse diagnostics, have struggled a bit in terms of reimbursing companion diagnostics. But there has been a leapfrog jump in England where there has been quite a lot of investment into genomic strategy and that’s going to be a good, useful set of investments to ensure access to the next generation treatments.
We also looked at the quality of the diagnostics test and to what extent there needs to be active external quality assessment of tests in labs to ensure you have quality tests and accurate tests. That’s going to be essential. The entire diagnostics landscape is going to be an essential part of the personalised medicine strategy of a country, to what extent you’re actively ensuring diagnosing and screening patients but also ensuring quality tests. But also obviously in terms of access to therapies it’s going to be around how quickly you can make these treatments accessible to patients. There have been a number of mechanisms like early access pathways, like in England, for example, the EAMS programme or the ATU in France, who have accelerated access to a certain number of therapies before reimbursement.
We’re also seeing more pragmatic mechanisms in terms of HTA really increasing access and speeding up access to patients. To what extent you’re going to consider the available evidence and how you actually review and assess these new treatments and how quickly you can get them through the reimbursement process, that will speed up certainly access to care. As I mentioned, this whole idea of coordination of care and centralisation of care in hospitals is going to be also an important component of speed of access to treatment.
In regards to cost, how important is efficiency? Or is getting the best possible care most important?
There’s a huge element of efficiency especially in terms of personalised care; the whole concept of personalised care and personalised medicine is about increasing efficiency of care. Making sure that the right patients get on the right treatment and that you reduce waste and that has a huge implication, both in terms of clinical benefits but also in terms of economic benefits. So while we recognise that some of these treatments are costly, there are also huge savings to be delivered from the appropriate uptake and use of these technologies.
What are the main stumbling blocks for these ideas?
Clearly one of the biggest stumbling blocks is the funding and the reimbursement process which can be a massive hurdle to access. So there needs to be clear funding associated with a personalised care strategy to ensure that you both fund the screening and the diagnosis and also fund and reimburse treatments. There needs to be maybe a more coordinated approach to reimbursing and integrating the reimbursement of diagnostics and the treatments themselves and the therapies. Some countries have taken a more active approach to doing that whereas others still consider the two very much separately and that can create a significant hurdle to access.
