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How to deal with the affordability of oncology drugs?
From personalised medicine to personalised
reimbursement models
Jero...
Doing now what patients
need next
Political and public discussions
Bron: www.minvws.nl; KWF, 2015
The Netherlands compared to other EU
countries
Source: Healthcare costs of cancer per person in European Union (Luengo-Fer...
Spending over the last years
Out-patient vs hospital setting
Outpatient drugs
Hospital drugs
Spending in bln €
Drug expenses in 2015
Health care expenses 2015 Increase
Health care budget (Budget Kader
Zorg)
€73 billion -
Drugs (total...
Budget cap for hospitals
Maximum growth 1% per annum
• Agreement between MoH, NVZ,
NFU, NPCF, ZKN, ZN, OMS.
• Cap on growt...
Sounding the alarm on drug prices
Pricing by Roche
Roche only develops innovative drugs
Population size ValueR&D
• Drug prices depend on economic situation,...
How to warrant affordability and accessibility in
the future?
Are we not able to pay for it or we just don’t
know how?
• S...
Is a fixed CE-threshold is appropriate for decision
making?
Metastatic versus early setting
• First introduction of new on...
How to optimize ‘value’?
• Increase in value
– Personalised medicine
• Biomarker testing
• Rational pharmacotherapy agreem...
Challenge: future combination therapies
• Expected Combination Regimen Launches in Oncology
Drugs of different companies being combined
• Potential Combination Therapies Launching by 2021
From volume to value
Increasing levels of patient based information
Undifferentiated price
per vial
Episode-of-
care
Unit ...
Takeaways
• A fixed cost-effectiveness threshold for drugs in the metastatic setting is
not desirable
• Personalised medic...
Doing now what patients
need next
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160929 roche presentation molecule to business

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Roche, How to deal with the affordability of oncology drugs?From personalised medicine to personalised reimbursement models. Presentation by Jeroen van Dijk during 'From Molecule to Business' event by SMB Life Sciences and Health Valley at NovioTechCampus, Nijmegen, The Netherlands on September 29, 2016.

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160929 roche presentation molecule to business

  1. 1. How to deal with the affordability of oncology drugs? From personalised medicine to personalised reimbursement models Jeroen van Dijk, Sales Director, Roche Nederland September 29th 2016
  2. 2. Doing now what patients need next
  3. 3. Political and public discussions Bron: www.minvws.nl; KWF, 2015
  4. 4. The Netherlands compared to other EU countries Source: Healthcare costs of cancer per person in European Union (Luengo-Fernandez et al - Lancet Oncology, 2013)
  5. 5. Spending over the last years Out-patient vs hospital setting Outpatient drugs Hospital drugs Spending in bln €
  6. 6. Drug expenses in 2015 Health care expenses 2015 Increase Health care budget (Budget Kader Zorg) €73 billion - Drugs (total) €5 billion 6% Inpatient drugs €2.06 billion 6% ‘Expensive’ inpatient drugs €1.62 billion 9% ‘Expensive’ oncology drugs €810 million 15% Source: Farminform, 2016
  7. 7. Budget cap for hospitals Maximum growth 1% per annum • Agreement between MoH, NVZ, NFU, NPCF, ZKN, ZN, OMS. • Cap on growth rate: • 2012-2013: 2,5% p.a. • 2014: 1,5% p.a. • 2015-2017: 1% p.a. Healthcare Insurance Act € 45,9 billion Longterm care € 19,9 billion Wmo € 6,7 billion Other € 0,4 billion NationalHealthcareBudget:€72,9billion Hospital care € 23,0 billion (Incl. hospital drugs) Ref: National Budget 2016 (2015); Administrative Agreement 2012, 2013 Outpatient drugs
  8. 8. Sounding the alarm on drug prices
  9. 9. Pricing by Roche Roche only develops innovative drugs Population size ValueR&D • Drug prices depend on economic situation, governmental priorities and health care system • Therefore differentiation of drug prices among EU countries is crucial for the accessibility to drugs for patients in Europe
  10. 10. How to warrant affordability and accessibility in the future? Are we not able to pay for it or we just don’t know how? • Several measures are used in the NL to maintain affordability and accessibility in the future, such as: – Rational pharmacotherapy (‘gepast gebruik’) • E.g. Start-stop criteria – Financial arrangements to constrain the budget impact • Initiated by Ministry of Health (‘buro prijsarrangementen geneesmiddelen’) – Value-based health care • Cost-effectiveness
  11. 11. Is a fixed CE-threshold is appropriate for decision making? Metastatic versus early setting • First introduction of new oncology drugs is in metastatic setting • According to current models used, the ‘value’ of the drug is always lower here compared to the early setting* • Is that right? • What does a cost per QALY mean in the metastatic setting? • What does this mean for price setting? *Dvortsin et al. PLoS ONE 11(1): e0146551. doi:10.1371
  12. 12. How to optimize ‘value’? • Increase in value – Personalised medicine • Biomarker testing • Rational pharmacotherapy agreements • How to measure value – Gather Real World Evidence • Clinical outcomes – Value for society Personalised medicines  personalised reimbursement models
  13. 13. Challenge: future combination therapies • Expected Combination Regimen Launches in Oncology
  14. 14. Drugs of different companies being combined • Potential Combination Therapies Launching by 2021
  15. 15. From volume to value Increasing levels of patient based information Undifferentiated price per vial Episode-of- care Unit based pricing Personalised Reimbursement Models Today Future Combinations + Reimbursement driven by volume of therapy used Reimbursement driven by value therapy delivers to the patient National registries Multiple indications Pay for response ?
  16. 16. Takeaways • A fixed cost-effectiveness threshold for drugs in the metastatic setting is not desirable • Personalised medicine asks for personalised reimbursement models – Nationwide registries warranted – How to deal with combination therapies? • Collaboration between all relevant stakeholders needed in order to keep the health care system affordable and sustainable
  17. 17. Doing now what patients need next

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