2. THE RATE OF INCIDENCE OF CANCER IN CHINA INCREASED
NEARLY 10% BETWEEN 1990-2013
2
Http://oncology.jamanetwork.com/article.aspx?articleid=2294966
3. THE PROGNOSIS IS THAT CANCER GROWTH IN DEVELOPING
COUNTRIES WILL EXCEED THAT IN
INDUSTRIALIZED COUNTRIES IN CASES AND MORTALITY
3
Www.nih.gov
Mortality By Smoking
4. "ERRARE HUMANUM EST" - IN THE US THERE IS A 20% RATE OF
MISCLASSIFICATION OF CANCERS; IN DEVELOPING COUNTRIES IT
IS ESTIMATED AS BETWEEN 20-30% * - AGGRAVATING THE PROBLEM
TYPES OF DIAGNOSTIC ERRORS
RATE OF ERRORS IN
ONCOLOGY DISCOVERED BY JOHNS HOPKINS
UNIVERSITY (USA)
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
Misdiagnosed Misclassification
US based Error Rate
Misdiagnosed Misclassification
4
HTTP://Abcnews.go.com/wnt/story?id=131047&page=1
Source: Johns Hopkins Medical Center* Interviews by TestAnalytika of oncologists at UMiami and UCSF
Misclassification
leads to treatment
errors
• Diagnostic errors or delayed diagnosis
• Misuse/misinterpretation of test
results
• Use of obsolete tests
• Lack of correct action based on test
results
5. THE CAUSES TEND TO BE SYSTEMIC AND TRANSCEND THE INDIVIDUAL
CAPABILITIES OF THE PHYSICIANS
•In Developing Countries , even with top medical training and prestigious and internationally
renowned MD’s, physicians encounter adverse factors beyond their control
•These factors limit the capacity of response and impact the quality of diagnostics
•This is especially important in cancers that are more advanced and where there is a lack of local
experience or of the most advanced technical equipment
• In many cases, it is not only experience, but access to the most advanced technologies that
determines the accuracy of diagnosis
"Often it takes a good amount of experience, as well as technology, to make the accurate
diagnosis"
- Dr. Leonard Zwelling The MD Anderson Cancer Center.
5
Http://es.slideshare.net/sanidadyconsumo/los-sistemas-de-notificacin-de-eventos-adversos-anlisis-de-situacin
6. REMOTE CANCER ADVISORY SERVICES CAN ADD VALUE AND
HELP MINIMIZE THE PROBLEM
FOR THE PATIENTS
Clarifies the information that has been
provided to them and the decision factors
guiding the doctor or doctors
Gives security that the treatment
recommended seems to be the most
appropriate and free from doubt
Offers a validation and demonstrates that
there is unanimity on the diagnosis
FOR THE DOCTOR
Supports in the recommendation of difficult or
uncertain courses of action
Increases the degree of confidence; provides a
positive and helpful advisory service
Creates opportunities for
professional development, growth and "networking"
6
ELIMINATING ANY DOUBTS HAD BY THE PATIENT STRENGTHENS HIS/HER PSYCHOLOGICAL STATE TO DEAL WITH
THE NECESSARY THERAPIES AND CREATES POSITIVE ENCOURAGEMENT TO FIGHT THE DISEASE
7. ON THE OTHER HAND, WHILE CANCER HAS BEEN TREATED
FOR DECADES BY THE SAME STRATEGIES, NOW THERE ARE
ADVANCES IN GENOMICS AND GENETICS…
7
8. THE RESULTS CAN TAKE SEVERAL DAYS OR WEEKS. NOT ALL THE GENOMIC MUTATIONS CAN BE ASSOCIATED TO A TREATMENT
WE CAN TAKE A TUMOR SAMPLE AND FIND ITS GENOMIC
MUTATIONS IN A SPECIALIZED LABORATORY
8
9. ONCE YOU HAVE COMPLETED THE ANALYSIS IN THE LAB, THE DOCTORS
INTEGRATE THIS ANALYSIS WITH THE PATIENT'S MEDICAL RECORD TO
DEFINE THE BEST TREATMENT - "PERSONALIZED MEDICINE"
9
10. THE GENOMIC EVIDENCE UNDERPINS ‘PERSONALIZED
MEDICINE’
There is a false-negative rate of approximately
15-20% for EGFR and ALK results between the
multiple tests now commercially available
… (a leading genomic test) served to detect at
least one variant clinically useful in the 76% of
the samples (N = 2200) with an average of
1.57 Variants Clinically Useful detected by the
sample (range: 0 to 16)
"There are sarcomas in up to 20% of patients that
are resistant to conventional treatment; with the
genomic tests we have identified who they are"
- Researcher UMiami
"Recent advances in sequencing technology
provide new opportunities for genomic medicine.
These opportunities come with the promises of
PERSONALIZED MEDICINE that are changing the
practice of oncology."
- MAY 27, 2014
"EVIDENCE ON GENOMIC TESTS"
10
11. THESE
GENOMIC TESTS ACHIEVE
‘ACTIONABLE' RESULTS
IN 65-85%
OF THE CASES EVALUATED…
FOCUSED ON THOSE WITH
GREATER INCIDENCE
- LUNG
- BREAST
- PROSTATE
- COLORECTAL
- STOMACH
'Actionable' includes validation of
the conventional
treatment , elimination of alternatives
and recommendation of alternative
treatments not previously considered
Source: Globocan.IARC.fr 11
CANCER RATES IN CHINA (2012) (ASRW)
12. LINKING REMOTE ADVISORY SERVICES IN THE US WITH
GENOMIC TESTING CREATES A POWERFUL DIAGNOSTIC TOOL
12/3/2015 CONFIDENTIAL AND FOR DISCUSSION ONLY 12
• The United States with its
multiple institutes of
advanced cancer is a world
leader
• Extending this intellectual
capital to a foreign country
is a challenge, but, if
successful, would support
the objectives of
institutional development
and the fight against cancer
• In the United States, Genomic
Laboratories focus on the US
market, but their skills and
knowledge can accelerate an
improvement in the care of
cancer globally
• The limitations for this approach
are operations, logistics and
payment mechanisms plus lack of
insurance coverage; all these limit
their capacity to grow abroad
• Global support from the US
cancer centers would make
theses services more accessible
internationally
13. THERE ARE THREE BARRIERS FOR INTERNATIONAL PATIENTS
AND THEIR DOCTORS TO HAVE LOCAL ACCESS TO THESE
SERVICES
13
Access Problems
• Lack of knowledge
• High costs
• Language barriers
Problems in follow up
• Lack of contacts
• Interphase
problems
• Time and access
barriers
2
Difficulty in
interpretation of Lab
Results
• Lack of experience
and context for the
local MD to
interpret and use
Genomic Test
results
14. FOR THOSE WHO WISH TO STAY AT HOME, ACCESS TO THE
REMOTE CANCER DIAGNOSIS IS POSSIBLE, BUT NOT EASY; THE
GENOMIC TESTS ARE EVEN MORE COMPLICATED
FOR GENOMIC TESTING
Lack of appropriate knowledge to interpret
Genomic Tests
High costs for testing
Problems of follow-up of the progress of the
evidence
Certification of translations of medical reports
and results
FOR STAY AT HOME
• Ignorance of contacts and procedures for Remote Advisory
Services
• Certified translations of reports and results of the external tests
• Lack of follow-up and a known contact within the cancer centers
• Lack of close coordination with the local doctor for follow up after
diagnosis
".. .Many of my colleagues do not speak english." -Peruvian
physician
"The process is slow, expensive and complicated ... it would be
interesting to have an easier method ... through our agreement
with Johns Hopkins, we have access to their treatment protocols
and views, but the process is very slow and complicated. "- Chilean
physician
14
15. THE LACK OF APPROPRIATE KNOWLEDGE ABOUT GENOMIC
TESTS IS EVIDENT EVEN IN THE USA
25%
57%
18%
What percentage of patients would you perform genomic tests on?
n=160 US MD's
Over 90%
In between
Less than 10%
12/3/2015 CONFIDENTIAL AND FOR DISCUSSION ONLY 15
Even in the US
there is an
enormous gap in
awareness of
Genomic Testing
16. THESE BARRIERS ARE BROKEN THROUGH AN INTEGRATED
SERVICE
16
Access Problems
• Lack of knowledge
• High costs
• Language barriers
Problems in follow up
• Lack of contacts
• Interphase
problems
• Time and access
barriers
2
Difficulty in
interpretation of Lab
Results
• Lack of experience
and context for the
local MD to
interpret and use
Genomic Test
results
• Links with US providers
and knowledge base
• Insurance Payment
Platform
• Certified translation
system
• Concierge Service
• Case Manager assigned to
each case
• Genomic specialist
assigned to review laboratory
results and make clinical
recommendations
17. WE BELIEVE THE METHOD TO GET THE MOST OUT OF THESE ELEMENTS IS BY
INTEGRATING THEM WITH SUPPORT THAT MAKES THEM MORE ACCESSIBLE AND
USEFUL TO INTERNATIONAL MDS AND PATIENTS
Financial-Education
Logistics Support
Technology Platform
DDS
Genomic Testing
Cancer Center
Advisory
Services
12/3/2015 CONFIDENTIAL AND FOR DISCUSSION ONLY 17
TESTANALYTIKA
INTEGRATED
SERVICE
18. DESCRIPTION THE INTEGRATED SERVICE WITHIN
AN INSURANCE POLICY OR GROUP PLAN
◦ Access to Long Distance Cancer Advisory Services by top ranked Cancer Centers in the US, offering an expert review of the
case by the most renowned specialists in the world, without the Patients having to leave their place of origin.
◦ These Services are Physician to Physician, respecting the need for Patient confidentiality, professional ethics and best practices.
◦ Access to world renowned Genomic Testing laboratories with the latest technology in the evaluation of genomic mutations in
the cancer Patient (subject to the request of the Patient’s Physician).
◦ Both solid and liquid tumors are covered.
◦ Diagnostic Decision Support for the Genomic Test results and a review of the test results by a genomics specialist and
pathologist in the US, comparing the results of the genomic test with the clinical history of the Patient.
◦ Quality Control of incoming and outgoing medical communications by a qualified bilingual MD ensuring that both the US
medical professional and the international physician receive the information they need
◦ Review of Patient’s Medical Records for completeness, increasing efficiency and effectiveness in the management of the
Patient’s case
◦ Payments to the US based medical service suppliers, making the Service accessible to institutions and individuals overseas
◦ Follow up on case progress to achieve the mínimum delivery times possible
◦ Certified Translations as per US medical center requirements
◦ Logistics support and tracking of biopsies and incoming and outgoing hard copy information
◦ Third Party Administrator services as required to provide a seamless process flow for all parties involved
◦ Medical Education and outreach to ensure full understanding of the benefits of the Services
◦ Support in identifying relevant International Clinical Trials
◦ Other genomic and genetic testing in the best interest of the insurance company (see list at the end).
18
19. OUR PROPOSAL IS TO DEVELOP AN INSURANCE BASED SYSTEM OF
COVERAGE WHICH WILL ALSO SUPPORT SELFPAY/PREPAY AND
ULTIMATELY LEAD TO PUBLIC SECTOR ADOPTION
Prepay
TAK INTEGRATED
SERVICE
MEDICAL ,
FINANCIAL
INSTITUTIONS
AND MDs
Insurance
TAK INTEGRATED
SERVICE
BROKERS,
INSURANCE
COMPANIES,
AFFILIATED MDs
Public TAK INTEGRATED
SERVICE
PUBLIC SECTOR
INSTITUTIONS
12/3/2015 CONFIDENTIAL AND FOR DISCUSSION ONLY 19
PAYMENT CHANNEL EXECUTION/FULFILLMENT OUTREACH
FIRST PHASE
LATER PHASES
20. OUR SUMMARY OF THE INSURANCE COVERAGE PROPOSED
12/3/2015 CONFIDENTIAL AND FOR DISCUSSION ONLY 20
CureSeq as preferred provider of Genomic Test; Diagnostic Decision Support performed by one of the leading US Cancer Centers ; liquid tumor pending approval
21. OUR CLINICAL ALLIES ARE ORGANIZATIONS OF THE
FIRST ORDER IN THE U.S.
GENOMIC LABORATORIES
CureSeq - Analysis of the tumor based
on solid tissue with response time of
less than a week.
◦ Covers Lung, Colorectal, most Cancers in
general with panel of 25 genes.
◦ Each panel includes the genes as
approved by NCCN in mutations of
interest; e.g. EGFR, ALK, RET, ROS, KRAS,
HER2 (lung)
China based lab avoids logistics
and legal problems
Liquid tumors pending
CANCER CENTRES
Sylvester Cancer Center at The
University of Miami
MD Anderson Cancer Center
Abramson Cancer Center at UPenn
Memorial Sloan Kettering Cancer
Center (Support in Critical Cases )
21
22. ONCOLOGIST/ATTENDING PHYSICIAN:
• Access to technology and consulting capabilities of one of the world’s most recognized
institutions.
• A better diagnosis for their patients.
• Compare points of view and clarify doubts about treatments and protocols with foreign
colleagues; positive Medical Education opportunities.
• Recognition in a group and international “Networking“ capabilities.
PATIENT:
• Obtain Long Distance Cancer Advisory and scientific guidance on your case.
• Learn about treatment alternatives to have greater certainty regarding the course of
action that has already been proposed.
• Increase the chances of success in the recommended treatment.
• Access to alternatives that are more sophisticated and developed; possible clinical trials.
SPONSORING INSTITUTION:
• Payment in local currency for international costs.
• Cost savings per case to reduce trial and error in protocols and treatments.
• Elimination of costs in therapies with low probability of success
• Recognition as a company with innovative services.
• Increase in sales and new reason for talking with their customers and Affiliates
THE BENEFITS OF THE INTEGRATED SERVICE ARE NUMEROUS
22
23. THIS SERVICE COULD BE STRENGTHENED IF IT IS INCORPORATED WITHIN LIFE
INSURANCE AND INVESTMENT INSTRUMENTS TO BOTH PROTECT + CREATE WEALTH
AND FIGHT AGAINST CANCER
Life Insurance
Investment
and Asset
Protection
Genomic
and Remote
Advisory
Policy
Interviews with specialists in international
insurance have informed us about the
added value of integrating remote cancer
and genomic services with a life insurance
product attached to an investment
instrument.
Asian and Middle Eastern markets show
much affinity with this type of product.
Would create a differentiation for all of the
elements included plus would have a
number of advantages in cost for users
A Life Insurance + Investment +
International Diagnostic Oncology Service
23
24. IN China, THE CLASS ‘A’ POPULATION TARGET EXCEEDS
125MM PEOPLE - AN ATTRACTIVE TARGET MARKET OF HIGH
NET WORTH INDIVIDUALS
12/3/2015 CONFIDENTIAL AND FOR DISCUSSION ONLY 24
Analisis Lambda International Consultants, Information from Euromonitor
Using China’s cancer
incidence rate, this
represents 300,000
cancer cases per year
Country
Social Class A
Population MM
1 China 126.0
2 India 81.0
3 US 30.0
4 Indonesia 17.0
5 Brazil 13.0
6 Mexico 10.0
7 Russia 9.0
8 Japan 8.0
N/A Rest of LatAm 12.0
Total LatAm 35.0
Total Emerging Markets 268.0
Ranking
WORLD RANKING OF ‘SOCIAL CLASS A’ POPULATIONS 2013
25. OUR INTEGRATED SERVICE COMBINES PERSONAL ATTENTION
WITH TECHNOLOGY AND A SECURE PLATFORM
25
CHINA
27. TESTANALYTIKA IS RESPONSIBLE FOR THE OPERATIONAL DETAILS SO
THAT THE PROGRAM DOES NOT IMPLY GREATER COMPLEXITY TO THE
INSURER
27
BRAZILIAN EXAMPLE
28. WE CAN DESIGN A PROGRAM FOR AN INSURER FROM USD 15-
100 P/ADULT/ANNUAL COVERAGE FOR THE GENOMICS AND
REMOTE ADVISORY SERVICES – A VERY ECONOMIC SOLUTION
WITHOUT VAT; MINORS AT 10% of ADULTS; PROGRAM INCLUDES AGES UP TO 70 YEARS;REFERENTIAL PRICES;
SECURITY FACTOR @ 50%; LIQUID TUMOR DEPENDS ON EXPORT AUTHORIZATION
28
29. OUR ANALYSTS HAVE IDENTIFIED ACTUARIAL RATES THAT ARE
BOTH COMPETITIVE AND SAFE
Without VAT; Minors Age @ 10% Adult; Program Includes Until 70 Years; Price is Referential; Security factor@ 50%
29
FIGURES BASED ON CHINA
INCLUDES A 50% SAFETY
FACTOR AND OTHER
ADJUSTMENTS
MASC. USD 39.41 USD 106.93
FEM. USD 43.10 USD 87.03
No smoker Smoker
59.03$
30. THESE RATES ARE BASED ON A THOROUGH KNOWLEDGE OF
THE RISKS AND COSTS
Evaluation of the real risks of cancer incidence in the markets
By country and/or region
By social class
By age
By genre
By consumption of tobacco
Evaluation of the actual operating costs
Education of the medical profession
Outreach to partners and brokers
Overall operating costs
Competitive commissions
Use of cost advantages with suppliers
Favorable prices in cancer centers and genomic laboratories
Prices for the logistic and support services
30
31. "We've integrated the best solution
available for access to the most advanced
technology in diagnosis of cancer in the
United States. We support patients,
oncologists, insurers and employee
benefit funds. We offer very affordable
rates for the emerging middle class"
- Lin Giralt
CEO, TestAnalytika
WE HAVE ACHIEVED AN EXCELLENT SOLUTION
31
