Nearly half a century after the inception of the National Cancer Act in 1971 and U.S. President Nixon’s declaration of “war on cancer” great progress in understanding cancer biology, developing new therapeutics and diagnostics, and improving patient access has been made; however, the incidence of cancer has been rising and efforts to reduce overall cancer mortality have disappointed.
The Economist staged an informative healthcare forum aimed at reinvigorating the “War on Cancer” debate. Held in London on October 20, 2015, this meeting attracted global leaders in oncology and provided a platform for discussion on policy and financing, innovation in prevention, treatment, and diagnosis, and explored the role of society. Some thought-provoking messages that emerged are:
European Policy and Financing—Improving Cancer Control Systems
- Heterogeneity in cancer spending across Europe. Spend per head ranges from €35 in Poland and €180 in Germany1; these countries are among those with the highest and lowest cancer mortality, respectively. There is a clear link between national cancer aspirations of EU countries and associated budgets and outcomes.
- Spiraling cost burden on healthcare systems. According to the EC, the majority of healthcare systems cost is due to cancer. In 2009, the Commission put plans in place to make a sustainable contribution to reducing the burden on cancer in the EU—15% reduction in cancer incidence by 2020—a target that most member states have already met2.
- A multi-stakeholder adaptive pathways approach. Adaptive pathways are intended to maximize positive impact of new drugs on public health by balancing the need for timely access with a drug’s benefits and risks. Approximately 60 adaptive pathway pilots are in progress3. Through early dialogue with all stakeholders patient access could be potentially accelerated by shorter time to approval and/or reimbursement decision.
Easing the Human and Financial Burden—Innovation across the Treatment Pathway
- Soaring cancer drug costs are drowning payers. The median monthly cost of cancer drugs in the United States has risen by more than 700% since 19904. Innovative drug expenditure has increased by 40% in Spain5. These are two such examples that are putting pressure on payers to stem the tide of oncology drug costs by limiting patient access. Panelists called for more flexible and dynamic pricing systems to avoid being “held hostage to price”.
- Under-utilization of radiotherapy. Many European countries are facing severe risk of radiotherapy shortage in the next decade and some African countries have no access! 27 million extra lives could be saved within the next 20 years with increased access to and investment in radiotherapy, a clear cost-benefit solution6.
- Going beyond cure. Janssen are exploring the concept of disease interception by developing treatments for premalignant conditions with the opportunity of preventing multiple myeloma. An exciting concept, but developers will inevitably face high hurdles if changing the paradigm of treating cancer before it becomes cancer were to become reality.
Role of Society—Widening the Net of Cancer Stakeholders
- Empowering the patient. There is a drive to develop well-conceived and -executed cancer control plans at a national level, putting patient experience on a par with clinical outcomes.
- Assessing costs and redefining perceptions. The economic cost of cancer spreads beyond cost of prevention, diagnosis, and treatment. The number of cancer patients of working age continues to rise with a direct impact on the economy. Good health is an economic asset and not just valuable to the individual concerned.
The central thread running through the meeting was the need to balance clinical need with affordability.
“The safest drug that no one can afford or that arrives too late is of no benefit to the patient”
Healthcare is undergoing a major transformation and with the cost of cancer treatment becoming stratospheric, there is mounting pressure on payers and regulators to provide access to the most-promising therapies. Personalized medicine has been around for more than a decade, but could even greater precision in treatment be the key to bending the cancer cost curve? The resounding message voiced at this meeting was for early dialogue between industry and regulators to ensure timely and appropriate access to drugs, balanced with assessment of benefits and risks—the EC adaptive pathways pilot project is one way this issue is being addressed. With price and value clearly at the heart of the healthcare ecosystem, panelists also called for dynamic pricing and flexible funding models and for industry to have a greater understanding of payer constraints.
The exorbitant rise in cost of cancer treatment and the debate over “value” is also at the heart of Decision Resources Group’s oncology product offerings. For insights into the game-changing trends that will shape tomorrow’s oncology market, look to Spectrum’s streamlined strategic analysis; and for insight to optimize market access strategy, check out Physician and Payer Forum with primary market research from physicians and payers.
- Annie Pannelay (Principle—Healthcare and Life Sciences, Economist Intelligence Unit). EIU Briefing: Enlisting Innovative Policy to Fight Cancer. 2015
- Commission of the European Communities. Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee of the Regions on Action against Cancer: European Partnership. 2009.
- Hans-Georg Eichler (Senior Medical Officer, European Medicines Agency). The Regulatory Perspective: Rallying the European Community behind a Multi-Stakeholder Adaptive Licensing Approach. 2015
- Peter Bach (Memorial Sloan Kettering Cancer Center, Center for Health Policy and Outcomes). Price and Value of Cancer Drugs. 2015.
- Silvia Ondategui-Parra (Partner, MED Healthcare and Life Sciences Leader; Commercial Market Access Leader, EY). Panel Discussion: The Patient/Payer Debate—Balancing Clinical Need and Affordability
- Cai Grau (Professor, Department Oncology, Aarhus University Hospital). Radiotherapy—Defining a Role in the Battle. 2015.