Cancer

#WorldCancerDay highlights need for cost-effective approaches to new medicines

Published

10 years ago

February 4, 2016

By European Alliance for Personalised Medicine (EAPM) Executive Director Denis Horgan

This week, on 4 February to be exact, sees World Cancer Day 2016, and it seems that, according to the World Health Organization, new cases of cancer globally are expected to increase by 70% over the next 20 years, from around 14 million to 25m.

Yet while the rain might seem to be tumbling down incessantly in Brussels, there will surely come a time when, in the metaphorical words of the song, we “can see clearly now, the rain has gone” - and not only in cancer, but also in diabetes and many other disease areas.

But, of course, there are cost issues and one ket area is to try to address them. Producing medicines has not become any cheaper. If anything, the opposite is true with development costs rising almost exponentially in recent decades.

Figures suggest that the average new medicine takes more than €1 billion and from ten-15 years to get from ‘bench to bedside’. At the same time, markets allowing for such heavy investments to be recouped are becoming much smaller – as a direct natural result of the increase in personalization of treatment.

So does the fact that it’s more expensive to produce medicines for fewer people necessarily mean that medicines are (or will be) unaffordable for health-care systems? The answer to this from the Brussels-based European Alliance for Personalised Medicine (EAPM) is 'no'. At least not necessarily.

EAPM believes that a key challenge for health care systems is to manage medicines spending – yet they must still also deliver on innovation. The Alliance has always maintained that, when and where it is possible to treat a patient to target using an older cheaper medicine, then it should be done.

One the other hand, if a patient needs a more modern treatment, access should be provided at reasonable prices that reflect both the added value and the volume across the market – with low volume treatments, naturally commanding a higher price. Getting this balance right will be tough, but will ensure that everyone wins.

This mantra has been taken up by others. Said Minister of Public Health for the Netherlands Edith Schippers: “Constraining costs to provide optimal care in the future is in our best interest, to work together with the industry, healthcare insurers, healthcare providers and the patient. This asks for clear roles and choices in the way that we arrange our pharmaceutical care. Nationally where possible and where needed also in Europe.

“Only in this way can we work towards a system that provides access to valuable medication for the need of the patients,” the minister added.

The Alliance, which brings together patients, medical professionals, health-care planners, scientists, industry and researchers, is working with the last EU Presidency Luxembourg and the current one, The Netherlands, on a variety of topics (including the former’s recently presented Council Conclusions on Personalised Medicine).

The stakeholder group believes that there has never been a better time to grasp the opportunities in cancer prevention using the latest discoveries in “omics” – including genomic science.

Due to these advances, for example, knowledge of common variants related to cancer risks has leaped from five to more than 450 and, genetically, scientists know a great deal more about what makes individuals susceptible.

Personalised medicine utilizes research, data and up-to-the-minute technology to provide better diagnostics and follow-up for citizens than is currently the case. It uses genetic information to discern whether a particular drug or regime will work for a particular patient and assists clinicians in deciding which treatment will be the most effective. It can also have a huge impact in a preventative sense.

Earlier diagnostics and earlier treatment have many benefits, among them fiscal, because while cost is a major issue – and there are key questions about the cost-effectiveness of new and even existing treatments – better diagnostics will ease the burden on health-care systems in two ways.

Firstly, it will allow a more preventative approach in that gene technology will flag up the likelihood of a particular individual developing a particular disease and provide a good idea of how it will develop, thereby encouraging early intervention.

Health Minister Schippers has not-coincidentally taken a line that EAPM has advocated during the last few years and, as recently as 29 January, in a letter to the Dutch Parliament, she wrote on the topic of ‘New medication quick access and acceptable prices’.

She explained: “Medication plays an important role in the quality of life of many Dutch citizens” adding that people recover faster thanks to medication, can keep working despite their disease and live independently.”

Concentrating on her own member state (although it is equally true for the rest of the EU-28) she gave the example that “More than a million people with diabetes can stay active in society, with the help of medication…More than four million Dutch citizens with blood pressure lowerers and cholesterol inhibitors, decrease their risk of heart and coronary diseases. But also people with cancer, complex diseases or rare diseases have a better quality of life thanks to better medication.”

Schippers pointed out that, in the past few years “we have tried to constrain the costs of medicines,” adding that the “responsibility of cost is with health care providers and insurers” and that the ‘preference policy’ is for generic instead of brand medicines.

She added that the costs of medication (in the Netherlands) have been around 9% of total health expenditure the last few years. This is not a relatively large sum, overall.

She also noted that patients want new medication while noting that some innovative medications are only suitable for a small group of people, while not working for others.

“These medications get insufficient chances in the current market admission system, leading to delayed access, or non, to patients,” the minister said.

As EAPM has stressed many times, this is clearly a Europe-wide problem. Schippers echoes statements made in the Luxembourg Council Conclusions when she says that it is essential to keep innovative medication accessible at acceptable prices, while acknowledging that, “if medicines don’t have an added value for health care, then it should be clear that we are not prepared to pay high prices”.

Luxembourg’s Health Minister Lydia Mutsch, speaking at a high-level conference during the Duchy’s Presidency, said: “The challenge to be addressed is to put into place a framework which allows to deliver the right treatment to the right patient at the right moment, in accordance with the principle of universal access to high quality health care.”

The conference also concluded that personalised medicine’s integration into clinical practice and daily care is proving difficult given the many barriers and challenges to timely access to targeted health care that still exist as of today.

World Cancer Day is a timely reminder that much work remains to be done to improve the lives of 500 million potential patient across Europe’s member states.

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