How to deal with the affordability of oncology drugs?From personalised medicine to personalisedreimbursement modelsJeroen van Dijk, Sales Director, Roche NederlandSeptember 29th 2016

Doing now what patients need next

Political and public discussions

Bron: www.minvws.nl; KWF, 2015

The Netherlands compared to other EU

countries

Source: Healthcare costs of cancer per person in European Union (Luengo-Fernandez et al - Lancet Oncology, 2013)

Spending over the last years

Out-patient vs hospital setting

Outpatient drugs

Hospital drugs

Spending in bln €

Drug expenses in 2015

Health care expenses 2015 Increase

Health care budget (Budget Kader

Zorg)€73 billion -

Drugs (total) €5 billion 6%

Inpatient drugs €2.06 billion 6%

‘Expensive’ inpatient drugs €1.62 billion 9%

‘Expensive’ oncology drugs €810 million 15%

Source: Farminform, 2016

Budget cap for hospitals

Maximum growth 1% per annum• Agreement between MoH, NVZ,

NFU, NPCF, ZKN, ZN, OMS.

• Cap on growth rate:

• 2012-2013: 2,5% p.a.

• 2014: 1,5% p.a.

• 2015-2017: 1% p.a.

Healthcare Insurance Act

€ 45,9 billion

Longterm care

€ 19,9 billion

Wmo € 6,7 billion

Other € 0,4 billion

Na

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na

l H

ea

lth

ca

re B

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t: €

72

,9 b

illio

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Hospital care

€ 23,0 billion

(Incl. hospital drugs)

Ref: National Budget 2016 (2015); Administrative

Agreement 2012, 2013

Outpatient drugs

Sounding the alarm on drug prices

Pricing by RocheRoche only develops innovative drugs

Population size ValueR&D

• Drug prices depend on economic situation, governmental priorities and health

care system

• Therefore differentiation of drug prices among EU countries is crucial for the

accessibility to drugs for patients in Europe

How to warrant affordability and accessibility in

the future?Are we not able to pay for it or we just don’t know how?• Several measures are used in the NL to maintain affordability and

accessibility in the future, such as:

– Rational pharmacotherapy (‘gepast gebruik’)

• E.g. Start-stop criteria

– Financial arrangements to constrain the budget impact

• Initiated by Ministry of Health (‘buro prijsarrangementen

geneesmiddelen’)

– Value-based health care

• Cost-effectiveness

Is a fixed CE-threshold is appropriate for decision

making?

Metastatic versus early setting

• First introduction of new oncology drugs is in metastatic setting

• According to current models used, the ‘value’ of the drug is always

lower here compared to the early setting*

• Is that right?

• What does a cost per QALY mean in the metastatic setting?

• What does this mean for price setting?

*Dvortsin et al. PLoS ONE 11(1): e0146551. doi:10.1371

How to optimize ‘value’?

• Increase in value

– Personalised medicine

• Biomarker testing

• Rational pharmacotherapy agreements

• How to measure value

– Gather Real World Evidence

• Clinical outcomes

– Value for society

Personalised medicines personalised reimbursement models

Challenge: future combination therapies

• Expected Combination Regimen Launches in Oncology

Drugs of different companies being combined

• Potential Combination Therapies Launching by 2021

From volume to value

Increasing levels of patient based information

Undifferentiated price

per vial

Episode-of-

care

Unit based pricing Personalised Reimbursement Models

Today Future

Combinations+

Reimbursement driven by

volume of therapy used

Reimbursement driven by value therapy delivers to the patient

National registries

Multiple indications

Pay for response

?

Takeaways

• A fixed cost-effectiveness threshold for drugs in the metastatic setting is

not desirable

• Personalised medicine asks for personalised reimbursement models

– Nationwide registries warranted

– How to deal with combination therapies?

• Collaboration between all relevant stakeholders needed in order to

keep the health care system affordable and sustainable

Doing now what patients need next