#EAPM: Europe too slow at bringing innovation into health-care systems 

‘Innovation’ is always a buzzword and is, of course, key to progress, not least in a healthcare sense with all the challenges we face. But just how well is the EU doing, asks

According to the European Commission’s most recent annual publication of its ’European Innovation Scoreboard’, performance of what it calls ‘the EU innovation system’ improved by 2% between 2010 and 2016.

It notes, however, that not all elements have been improving at the same rate, and that the same timeframe saw a welcome 54.2% increase in ‘International scientific co-publications’, which the report says has been the main driver of the performance increase for attractive research systems.

Unfortunately, and this is high-impact, performance has declined for both ‘Public R&D expenditures’ and ‘Venture capital investments’, having a knock-on effect for innovators.

Generally, performance differences can be small between member states and among strong and moderate innovators, although differences between what the report calls ‘Innovation Leaders’ and the afore-mentioned strong innovators are relatively high for research systems and linkages.

Performance in the dimension that the report calls ‘Linkages’, shows that Belgium is the overall leader in this dimension, while Luxembourg, also dubbed a Strong Innovator, performs well below the EU average. Ireland and France also perform below the EU average. Moderate Innovator Lithuania shows a strong performance above the EU average.

The highest rates of performance increase in this area between 2010-16 were seen in Austria (16.0%), Slovakia (11.3%), and Lithuania (8.7%).

“For 20 EU Member States, performance decreased, most notably in Estonia (-51.3%), Cyprus (-40.9%), Denmark (-37.9%), and Finland (-37.4%). Other strong decreases are observed in Croatia, Hungary, and Luxembourg. The EU average decreased by 4.7% between 2010 and 2016,” the report says.

The authors of this complex report, which relies on various indicators that leave many elements open to interpretation, come to the overall conclusion that EU innovation performance will continue to increase for the majority of indicators, leading to an increase in EU innovation performance by 2% over the next two years.

The report states that the EU performance gap with respect to Japan and South Korea is expected to increase, that the gap in respect of the US is expected to decrease, and that the performance lead over China is expected to decrease.

The share of ‘Most-cited scientific publications’ has been increasing consistently between 2008 and 2015. However, what the report calls ’Opportunity-driven entrepreneurship’ has shown a consistent decrease between 2009-015, followed by an increase in 2016.

For ‘R&D expenditures in the business sector as a percentage of GDP’, the report concludes that larger EU companies expected their R&D expenditures in the EU to increase, on average, by 0.5% for 2016-2017. Hardly a massive leap.

So what about innovation in health care? Well, the future is hardly looking bright and shiny. Yet it needs to.

There is plenty of great science in Europe, brilliant research and quality innovation, especially in healthcare. The question is how to fully integrate this into national healthcare systems.

Personalised medicine is a growing trend but, despite its proven efficacy in certain areas and vast potential in others, it remains a struggle to embed innovative personalised medicine into the EU’s health-care systems.

This is not helped by the fact that health care is a member state competence under the treaties, so the European Commission can only do so much.

The fact that a new medicine or innovative product usually takes more than a decade to get from bench-to-bedside is not only undesirable but is arguably unacceptable in the 21st century.

There is clearly a need, for example, for an up-to-date incentives and rewards structure to push forward research, and Europe needs to look at this seriously and quickly.

The elephant in the room is that industry has a problem with producing new drugs, especially for smaller markets - rare cancer sufferers, for example - as the chances of them getting their money back under current systems are slender without charging high prices.

This, in turn, leads to a lack of take-up of the drugs by healthcare systems across the EU.

Pharmaceutical companies have to walk a tightrope between eventual market prices and the heavy costs of research and development.

On top of this, health-care system managers have to weigh-up the pros-and-cons of new, often expensive drugs bearing in mind their efficacy and the amount of people who would benefit, while patients obviously want a cure and/or better quality of life. That big question of ‘value’…

Despite some incentives, there is clearly a big gap between what drugs are out there and what medicines are authorised. The labyrinthine regulations that govern such products need to be simplified to ensure a swifter take up of such drugs while obviously bearing in mind safety and efficacy in all cases.

EAPM has often pointed out that, while existing systems were indeed designed and developed to support innovation and access for patients to innovative medicines and treatment, these systems are falling short and need to be reassessed.

Essentially, and demonstrably, Europe has been slow in taking account of new technologies. The Commission report hardly makes for optimism that this will change any time soon.

The Alliance has often cited that one major cause for concerns is the level of fragmentation between EU member states in the area of health technology assessment (HTA).

The coexistence of a centralized procedure for marketing authorisation together with a great number of national (sometimes regional) pricing and reimbursement systems was seen by many as an obstacle to market innovation.

Since the latter is a matter of national competence, a possible solution would be greater coordination of health technology assessment at European level.

Fortunately, attempts to tackle this are currently being made due to a recent proposal by the Commission to reduce repetition among HTA bodies, among other issues.

EAPM will be holding several workshops this year with experts and MEPs to try to establish what is needed in this area, and pass this stakeholder knowledge and conclusions by consensus onto decision makers.