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ISPOR Europe Number 17 – How Will Payers Pay For Healthcare in the Future?

10 November 2014 Gustav Ando

The 17th European Congress of ISPOR kicked off in a combative fashion this morning with a plenary session devoted to how to create sustainable health systems in Europe. This large, complex topic was tackled through a series of discussions on delivering affordable cancer care, the harmful effects of international reference pricing, and moves towards integrated care.

Dr. Sullivan of the Kings Health Partners Institute questioned whether current high income models of cancer control can be affordable within the context of universal health coverage, essentially maintaining that expensive cancer treatments potentially do not fit in with attempts to expand access to healthcare in many emerging economies. In particular, he focused on early access to oncology medicines where the evidence to support their use is not yet readily available, and that in some cases there is an inverse relationship between increasing spend on cancer care versus the outcomes gained from the medications. After all, around half of current oncology medications fail the new guideline thresholds that have been created at ASOC over clinically meaningful outcomes. And in an age where new technologies are reaching the market at an unprecedented rate in prostate cancer, melanoma, colorectal cancer, breast cancer and various other oncology indications, this was a highly challenging statement from the plenary session - indeed there are several upcoming sessions on early access schemes and adaptive licensing that potentially sit uncomfortably with this line of thinking.

Dr Rutten-van Molken of the Erasmus University followed this with a discussion on health inequalities and the challenges these present in an age where patients are increasingly faced with multiple diseases and comorbidities -but healthcare systems generally still incentivise towards treating each disease in isolation. She mapped out the various payment systems, and how pay for coordination, pay-for-performance, and all-inclusive payment schemes can help reduce expenditures - with all-inclusive schemes potentially reducing annual growth in outpatient care spend by up to €800 per capita.

Finally, Dr. Kalo from the Syreon Research Institute discussed the generally unseen implications of international reference pricing on lower-middle income economies - with this highly visible in the fact that the EU conducted a wide-ranging survey on the potential benefits of price convergence in Europe, but that these benefits are confined to high income markets, and no study was conducted on the negative consequences in Eastern Europe. ISPOR began this highly pertinent discussion in a breakout session several years ago and correctly highlighted that this would be a growing concern - and the fact that it is now being discussed at a plenary session only serves to reinforce this. Essentially, with the downward pressure on price in higher income countries, there is a corresponding upward pressure on price in lower income economies as the prices converge to the average. This leads to inefficient healthcare and pharmaceutical spend and poor value for money (and outcomes). Dr Kalo emphasised the need for new thinking on international reference pricing and guarantees that higher income markets refrain from referencing prices in lower income markets.

Ultimately, it is clear that payers are under unprecedented pressure, and it has never been less clear how they will manage their healthcare budgets in the future - this lack of coherent thinking and consensus on how best to ensure that innovative, effective treatments are funded represents perhaps the biggest challenge to the modern pharmaceutical industry. ISPOR has set up the key burning topic - hopefully the rest of the conference will deliver strong best practice recommendations!

We are at booth 809 and can talk with you in more detail about IRP.

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