Access to pharmaceuticals is one of the biggest talking points in the healthcare profession, and to say it is multi-faceted would be an understatement.
The Organisation for Economic Co-operation and Development is investigating the topic with G7 endorsement. The European Commission is studying the operation of the intellectual property regime. The World Health Organisation is drawing attention to the need for fair pricing. New propositions for achieving prices related to the value a medicine continue to come forward.
Countries actively discuss cooperation on procurement. Scientific progress in immuno-oncology and personalised medicine add new questions to the equation. Populations continue to age. Public finances continue to be squeezed.
All of these areas sound like more than enough to try to handle when considering the access challenge, doesn’t it? Yet, as a recent European CanCer Organisation (ECCO) consensus position paper in the European Journal of Cancer makes clear, there is even more to the access discussion that must also gain attention.
To start with, it must be remembered that innovation in cancer care is about so much more than medicines. In my own field of oncology, cancer care has seen remarkable developments in such areas as:
- The speed and accuracy of diagnostic procedures;
- The effectiveness of surgery, radiation therapy;
- The power of information technology; and,
- The development of multidisciplinary, specialist-led approaches to care.
When it comes to thinking about access to innovation then, if we are to really meet the needs of patients and healthcare systems, we cannot afford to take a ‘pharma-only’ approach. Improvement in patient care and outcomes comes from achieving progress in all areas. We therefore need to stimulate, and gain sustainable access to, innovation in all areas. Hence, the access debate must broaden.
Additionally, and not an easy one for healthcare professionals, as we think of how to make health systems innovation-friendly and sustainable, it follows that some difficult thinking must be done about what interventions and treatments may no longer be fit-for-purpose or can now be seen as inefficient in a world of ever-advancing science and technology. That may mean confronting shibboleths within our own professions, never an easy thing to do, and it is a task for which thanks will not inevitably be returned. ‘Stop doing that’ can often seem a harder instruction than ‘start doing this’, but the challenge must be faced all the same.
In meeting these tests, of both assessing value of innovation and reassessing existing practices, we are at least aided by astounding developments in data capture and analysis. Here again however, matters cannot be left to fortune. The use of real world data has to be underpinned by quality frameworks, interoperability and appropriate and robust sharing protocols. This will not come into being by itself. It is pleasing therefore that the current Estonian Presidency of the EU is devoting significant attention to how to improve safe sharing of health data between countries and that the European Commission is consulting on how the EU’s Digital Single Market can be of greater aid to healthcare. However, all health stakeholders, healthcare professionals, patients and others have a duty to help maintain the political will among Governments and health systems to adopt the approaches that can truly unleash the power of data for better healthcare.
We should never discuss a topic as big as access without seeking and then emphasising the patient perspective. The ECCO position paper on access to innovation was developed with this principle firmly in mind. Our Patient Advisory Committee supplied a range of valuable views and experience on access. Something that patient advocates were very clear upon, and the position paper fully endorses, is the need to consider the value of new interventions from the patient's perspective. One would almost imagine that this is an obvious point, and yet it too appears to be another missing element of the access debate. A wide range of methodologies for assessing the value of innovation have been developed in recent years, but the extent to which they really take account of individual patient preference could certainly be questioned. A value methodology that only takes account of overall survival, for example, without weighting matters such as quality-of-life, might not be said to be fully reflective of the patient perspective.
Recognising access to innovation is about more than pharmaceuticals alone. Challenging our own professions to identify potential areas of inefficient or outdated practice and treatment. Bringing the use of real world data to the heart of the access debate. Never forgetting or ignoring the individual patient preference when discussing value. These, and more, are at the core of ECCO’s position on access to innovation.
ECCO’s position on access opens with an understanding of the responsibility healthcare professionals have to assist health systems achieve the balance between investment in innovation and financial sustainability. It’s part of our ethical duty to improving patient care. It’s why the consensus statement between cancer healthcare professionals is so necessary. It’s also why ECCO’s Access to Innovation paper is the start, not the end, of the organisation’s actions in this policy area.
It is with this new established mandate from its members in mind that ECCO will now:
- Commence a workstream to investigate the potential application of value-based assessment methodologies to innovations in non-pharmaceutical domains; and,
- Host the European CancerSummit on 7-8 September 2018 in Vienna in order to provide a spotlight on both the health economics and the organisation of cancer care delivery.
The European oncology calendar is certainly not short of scientific congresses, a positive and highly beneficial fact. However, there is a gap. The European cancer community needs a place and forum to come together and forge consensus about how to respond to the great themes and macro-challenges that the sector faces. It is hard to imagine a greater challenge than that of providing sustained and equitable access to (all) innovations in cancer care.
The debates around access impacts us all. We hope that all stakeholders involved in the debate will be able to engage in the discussion in Vienna in 2018. We believe solutions can be identified and implemented, but doing so means meeting, agreeing and forging consensus. It’s what summits are for.
By Peter Naredi, President of the European CanCer Organisation (ECCO). Through its 25 Member Societies - representing over 170 000 professionals - ECCO is the only multidisciplinary organisation that connects and responds to all stakeholders in oncology Europe-wide.
Article published in the September 2017 edition of Pharmafocus.
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ECCO’s position paper on access to innovation is available here.