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Jornadas #PatientInHTA · François Houyez

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Presentation in the framework of the International Conference "10th anniversary of the Spanish Network of Health Technology Assessment Agencies. Towads patient and public engagement in HTA" Zaragoza 27-28 April 2017

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Jornadas #PatientInHTA · François Houyez

  1. 1. Director of Treatment Information and Access European Organisation for Rare Diseases Zaragoza, 27-28 April 2017 PATIENTS’ AND CONSUMERS’ WORKING WITH THE EUROPEAN MEDICINES AGENCY François Houÿez
  2. 2. Disclaimers EURORDIS is one of the signatories of the “Code of Practice between Patients’ Organisations and the Healthcare Industry” Read here
  3. 3. Disclaimers EURORDIS is one of the signatories of the “Code of Practice between Patients’ Organisations and the Healthcare Industry” Read here
  4. 4. EMA started its activities in 1995 April 1996: CPMP met with 6 patients’ representatives • 2002: workshop on how to work together • 2006: the framework of interaction with patients and consumers adopted by EMA • 2016: 770 occasions where patients and consumers were involved in EMA activitie Moving away from a situation where 12 Member States could take different decisions on marketing authorisations To a European Union with a marketing authorisation valid in 28 Member States Norway, Iceland and Liechtenstein, serving 508 millions citizens • With same product name, same information for patients and healthcare professionals: all documents for the public are reviewed by patient and consumer
  5. 5. When to consult with patients? Horizon scanning
  6. 6. How to evaluate medicines? Do we have the right outcome measurement tools? Patients participate in guidelines development
  7. 7. A framework of interaction developed with the Patients’ and Consumers’ Working Party (see more here): Guidance and policy adopted by the EMA management board The role of patients as members of the EMA human scientific committees Pilot phase to involve patients in benefit / risk discussions at CHMP meetings Reporting EMA’s interaction with patients, consumers, healthcare professionals and their organisations - 2015 Rules Criteria to be fulfilled by patients’ and consumers’ organisations involved in EMA activities Evaluation of financial information from patients’ consumers’ and healthcare professionals’ organisations for assessment of EMA ‘eligibility’ Training strategy Involvement of patient representatives in scientific advice procedures at the EMA
  8. 8. 2016: the PCWP celebrating its 10th anniversary!
  9. 9. Involvement across different activities 2009-2016 9
  10. 10. Necessary steps to involve patients
  11. 11. How does it mean in terms of days for EURORDIS? Members of scientific committees at the EMA (volunteers) 7 (COMP, PDCO,CAT, PCWP) Total days spent in 2016: 286 Average days / volunteer: 41 / year (7-88) Members of EURORDIS staff working on patient engagement / EMA 1.5 FTE 3 different staff Member of EMA Management board 1 Total days : 22 / year Number of EMA SA/PA procedures 386 (2015) =154 reviews for EURORDIS (orphan Numbers of patients invited to scientific advice 76 (2015) Of whom 25 EURORDIS patients Number of patients trained (EURORDIS Summer School) since 2008 300+ 1 FTE for training programme Other services: Contact database maintenance, e-learning tools development, administration, communication to member
  12. 12. EURORDIS Summer School (training): how to minimise the influence of industry? Example of a case study CHMP invited 2 patients to an oral explanation with MAA Two hours before CHMP meeting, MAA, patients, clinicians who had been working on the product for years all together met in a hotel Mentor explained the issue advised not to have the meeting finally left the room and informed the EMA about the incident • What happened • Impact • CHMP agreed to have the patients they invited in the room • CHMP chair explained the situation before the meeting started • CHMP agreed to proceed • It could have stopped there
  13. 13. How? Informing on the evaluation once made? Consulting during the evaluation? Involving when communicating decision? 1 person? 2? 5? Patient expert own opinion, or organisation views? Patient preference elicitations Extrapolation? 30 or 300 patients? More? Other deliberative methods? Panel of patients ? Citizens’ jury ? Focus groups? Face to face? Video-conferences? In writing? Patient who participated in clinical trial, or not? Time for more pilots
  14. 14. Success factors High quality dialogue Patients are considered on the same level than other experts A dedicated unit at the EMA for stakeholders’ involvement Training materials (videos, face to face…) Adequate resources and budget Costs covered Daily allowance, doubled for volunteers Rules for involvement defined together with stakeholders For all aspects Revised as often as needed “With a high qualit dialogue, patients a regulators can onl agree.” Jean-Michel Alexandre Former CHMP chair, E
  15. 15. Patients’ satisfaction for invitations at CHMP oral explanations with the applicant (14 patients involved, 6 meetings)
  16. 16. Barriers, obstacles Patients’ advocates are few (availability, language) Time commitment (e.g. committee members) and time spent unpaid Advising the developer or advising the regulators (CofI policy)? Not both Rapid regulatory timelines, and the time it takes to involve patients Younger patients gather on social networks, no longer in registered organisations with statutes, general assemblies, board of directors etc. No impact assessment when defining a new role for civil society (EU legislation making): training needs, contact database maintenance, support, guidance…
  17. 17. The role of patients in EU legislation on medicines REGULATION EC 726/2004 establishing EMA Article 65 - The Management Board: Two representatives of patients' organisations shall be appointed by Council in consultation with EP Article 14 - The package leaflet shall reflect the results of consultations with target patient groups REGULATION EC 141/2000 on orphan medicinal products Article 4 – COMP: Three members nominated by the Commission to represent patients' organisations REGULATION EC 1901/2006 on medicinal products for paediatric use Article 4 - Paediatric committee: Three members and three alternates appointed by the Commission in order to represent patient associations REGULATION EC 1394/2007 on advanced therapy medicinal products Article 21 - Committee for Advanced Therapies: The Committee for Advanced Therapies shall be composed of two members and two alternates to represent patients associations REGULATION (EU) No 1235/2010 on pharmacovigilance Article 61a: one member and one alternate member in order to represent patient organisations
  18. 18. What can be improved? Next steps Public Hearings (PRAC, safety concern and therapeutic context) Updated patient information: graphic visualisation, changes in patient leaflet, videos etc. IMI PREFER project: how to integrate Patient Preferences Elicitations into the evaluation process? PRIME: Priority Medicines – Very early scientific advice, with patients A new status for trained patients participating in CABs/Scientific advice: “patient investigator” To conduct research together E.g “Patient Reporting in the EU: Analysis of EudraVigilance Data”, Drug Safety, (), 1-17, DOI10.1007/s40264-017-0534-1 IMI projects (EUPATI, PROTECT…) Synergies with HTA
  19. 19. IMI PROTECT: how to integrate these results in the package leaflet? (June 2017 PCWP meeting) Preferred by 54% by 21% by 25%
  20. 20. Patients fully integrated in the centralised procedure for marketing authorisations in the EU Bringing the best expertise in the decision making, including the patients With equal credibility as other experts Impact of patient engagement difficult to assess, but being able to witness the process is a major achievement To conclude
  21. 21. Patients at EMA: legal background EU Treaty (Declaration 17 of the Annex) “(…) Transparency of the decision-making process strengthens the democratic nature of the institutions and the public’s confidence in the administration.” 3

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