Is balancing value demonstration for payers and patient interests a feasible notion? A Health System Perspective

Professor Adrian TowseDirector of the Office of Health Economics, London

Visiting Professor, London School of Economics

Presentation at ISPOR 19th Annual European CongressNovember 2, 2016

IS BALANCING VALUE DEMONSTRATION FOR PAYERS AND PATIENT INTERESTS A FEASIBLE NOTION?

A Health System Perspective

Balancing Value Demonstration

What is the role for patents? (i) • Principal agent theory

• Clinicians are imperfect agents for patients• Payers have an agency relationship with patients and with

the people who pay premiums / taxes to finance the system• Ex ante versus ex post willingness to pay

• Advocacy versus expertise• Is it a false dilemma? We must recognise that patients are

advocates. So are manufacturers. The role of the evidence assessment process is to challenge. However the patient voice must be there

• What HTA bodies should want to understand is the impact on the patient, and the preferences of the patient. They should be taken into account. They do not determine the decision


What is the role for patents? (ii)

• Incentives• Regulator and HTA body approaches will drive

investment further upstream• But companies need to collect evidence

• Qualitative versus quantitative approaches – the importance of evidence• Too often HTA bodies only look at costs and effects

because those are the only things they have evidence on. Quantification of “effect size” is important for “weight” to be given it in a deliberative process, whether structured or not.

ACA/AHA ASCO ICER Sloan Kettering NCCN

Clinical benefit X X X X X

4

What are “attributes” of value?



Toxicity/safety X X X X X




Treatment novelty X




Treatment novelty X

Condition rarity and condition burden X




Treatment novelty X


Budget impact X




Treatment novelty X


Budget impact X

Cost-effectiveness X X

Reproduced with permission from Peter Neumann, Tufts University


Garrison et al. (2016) EPEMED Report

HTAi Tokyo May 2016

Extract

HTAi Tokyo May 2016

Step : Results of weighting

Per cent‘Experts’ workshop

‘Patients’ workshop

Extent to which treatment is available in the absence of the new medicine 19.5 11

Disease’s mortality impact with current SoC 14 11.5

Morbidity and disability with the disease with current SoC 12 15

Impact of the disease on patients’ and carers’ daily lives with current SoC 8 15

Sub-total weight for impact of disease / extent of unmet need 53.5 52.5

Evidence of treatment clinical efficacy and patient clinical outcome 27.5 17.5

Drug safety 8 7.5

Social Impact of the treatment on patients’ and carers’ daily lives 11 17.5

Treatment innovation 0 5

Sub-total weight for impact of new medicine 46.5 47.5

Total 100 100

2


Examples of initiatives

• SMC uses a Patient and Clinician Engagement (PACE) process

• Myeloma UK establishes patient preference partnership with NICE

• The CADTH Scientific Advice Program includes patient input as part of the process for developing Scientific Advice

Evaluation Results

Patient Input Summaries

CADTH Review Protocols

119 things that matter to patients

89 / 119included

75%

Clinical Trials

61 / 119included

50%

67 / 119included

56 %

CDECRecommendation

& Reasons

Source: Brian O’Rourke. Reproduced with permission


References• Blinman, P., King, M., Norman, R., Viney, R. and Stockler, M.R., 2012.

Preferences for cancer treatments: an overview of methods and applications in oncology. Annals of Oncology, 23: 1104-1110.

• Garrison L, Zamora B, and Mestre-Ferrandez J. 2016. The Value of Knowing and Knowing the Value: Improving the Health Technology Assessment of Complementary Diagnostics. Available at: http://www.ohe.org/sites/default/files/WP_EpemedOHE_final.pdf

• Messina, J., Grainger, D.L., 2012. A pilot study to identify areas for further improvements in patient and public involvement in health technology assessments for medicines. Patient, 5: 199-211.

• Shah, K.K., Mestre-Ferrdandiz, J., Towse, A., and Smyth, E.N., 2013. A review of health technology appraisals: case studies in oncology. International Journal of Technology Assessment in Health Care, 29:101-109.

• Towse, A. and Barnsley, P. 2013. “Approaches to identifying, measuring, and aggregating elements of value.” International Journal of Technology Assessment in Health Care. 29(4), 360-364.

http://www.ohe.org/sites/default/files/WP_EpemedOHE_final.pdf

http://www.ohe.org/sites/default/files/WP_EpemedOHE_final.pdf

Presentations & Public Speaking

Is balancing value demonstration for payers and patient interests a feasible notion? A Health System Perspective