- Email: [email protected]
Sustainable drug prices at market launch: Policy proposals and their empirical evidence
abstracts
Annals of Oncology
Table: 1658P QI
Description
Type
1 2 3 4 5 6 7 8 9
Symptoms and disease progression Assessment of tolerance to treatment Management of patients receiving oral therapy Quality of the liaison document Composite score for supportive care Patient therapeutic education Medication reconciliation Unscheduled admissions Declaration and follow-up upon serious adverse events in clinical pathway Patient’s experience (PREMS)
Structure Process Structure Process Structure Structure Process Outcome Structure
10
Outcome
Conclusions: This approach will be developed further by presenting the IQs to patient associations and primary care physicians in order to gather their feedback, refine, adapt and ultimately create a representative set of indicators. Legal entity responsible for the study: The authors. Funding: Novartis Oncology France. Disclosure: All authors have declared no conflicts of interest.
1660P
N. Olympios1, M. Lacaud2, S. Cousse3, J-C. Dupont4 Laboratoire Ethique Me´dicale, Universite´ Paris Descartes, Paris, France, 2Oncologie Me´dicale, Centre Henri Becquerel, Rouen, France, 3Pneumology Department, Rouen University Hospital, Rouen, France, 4Assistance Publique des Hoˆpitaux de Paris (APHP), Hospinnomics - Paris School of Economics, Paris, France
1
Background: Immune checkpoint inhibitors (ICI) have revolutionized treatment of advanced NSCLC. In France, concerns have been raised as to the financial burden of these therapies and fear that potential patients may be ruled out. The reality of budgetary restrictions implies for choices to be made considering both the quality of life these treatments procure as well as the financial burden they represent. From a physician’s point of view, due to financial constraints on public health facilities, physicians could restrain themselves from prescribing innovative expensive therapies. Methods: This qualitative study questions the potential impact of drug prices on prescription choices made by thoracic oncologists. Ten French oncologists and two hospital pharmacists voluntarily underwent a semi-structured interview conducted by a student in an Ethics master’s degree. Interviews consisted of two distinct parts: one clinical case where treatment choices had to be made in the first-line and second-line advanced NSCLC setting and a second part consisting of open-ended questions. Results: Qualitative analysis of the interviews brings out that immunotherapy has radically changed the history of cancer treatment but that hopes in advanced NSCLC need to be tempered. Efficacy in a real-world setting is difficult to predict and efforts need to be made to identify accurate biomarkers. Financial matters are a source of discussions between fellow physicians and clinical pharmacists but not with patients. Physicians consider they have a duty to strictly respect guidelines particularly in a French universal healthcare system. Conclusions: Rising costs of innovative drugs in oncology is a reality that forces a reconsideration of healthcare and drug regulation systems in order to be able to provide access to innovation for all eligible patients in the French universal healthcare system. Addressing this issue with physicians provides important insight on how treatment choices are made, their expertise and their involvement in this matter. Physicians are concerned about access to innovation for their patients and consider they ought to remain aware of these issues in order to participate in healthcare arbitration discussions. Legal entity responsible for the study: Laboratoire Ethique Me´dicale - Universite´ Paris Descartes. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
1661P 1659P
Sustainable drug prices at market launch: Policy proposals and their empirical evidence
N. Fanzen1, W. van Harten1, V. Retel2, W. Schats3 Psoe Department, Netherlands Cancer Institute/Antoni van Leeuwenhoek hospital (NKI-AVL), Amsterdam, Netherlands, 2Psoe Department, The Netherlands Cancer Institute, Amsterdam, Netherlands, 3Library, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital (NKI-AVL), Amsterdam, Netherlands
Impact of financial considerations on French physicians’ prescription choices for advanced non-small cell lung cancer (NSCLC)
The direct medical cost of breast cancer in a Belgian hospital
H. Lemhouer1, D.M.E.C. Verhoeven2, V. Corluy3, D. De Graeve1 Economy, University of Antwerp, Antwerp, Belgium, 2Oncology, University of Antwerp, Antwerp, Belgium, 3Finance, AZ KLINA, Brasschaat, Belgium
1
1
Background: A strong scientific and public interest exists in the sustainability of pharmaceutical research and development and particularly the issue of anticancer drug prices. Despite of the number of publications, articles seem often opinion-based. To facilitate an evidence-based discourse, we reviewed the literature and produced an inventory of policy proposals. We then analyze the available quantitative evidence. Methods: Due to the broad nature of the research question, a scoping review was performed. We combined multiple search strategies to get a systematic overview of the current body of literature. Results: In total, we screened 4775 articles and categorized 23 proposals. 22 of 85 included articles used quantitative models. Overall, the quantitative evidence was inconclusive to deduct real world effects and evidence- based recommendations. We however identified promising solutions for further investigation: Royalty payments, prizes and rewards, two-part-pricing, price transparency, increased translational public research, and public clinical trials. At ESMO, we will present this list of promising solutions, their degree of disruptiveness and their empirical evidence. Furthermore, we will share feedback on selected solutions from a survey among European experts in the field of oncology and health regulation. Finally, we will discuss techniques of evidence based solutions facing high complexity and the need of additional data for choosing policy options. Conclusions: Despite of the urgency of the matte of drug prices, we must realize that system consequences need careful considerations as implications for access and finances can be substantial. We advise testing promising solutions with experiments, dynamic simulations, and policy pilots. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
v680 | Public Policy
Background: Breast cancer accounts for 10 to 20 percent of the total cancer cost. The direct cost of cancer care are the health care expenses directly related to prevention and cancer treatment. The indirect cost, 2-3 times the direct cost include presenteeism, disability to work, absenteism and workers compensation. The aim of this study is to achieve a better understanding of the direct cost and the importance of the variables. Methods: This retrospective descriptive study used the administrative data of AZ KLINA linked to the Cancer Registry of Belgium. The study comprised women diagnosed with breast cancer between July 2015 and December 2015. The direct health care costs were calculated for the diagnostic and treatment phase up to 365 days after diagnosis. The costs were grouped according to the different kinds of medical interventions. Regression analyses were performed for 3 dependent variables i.e. the patient contribution, the health insurance cost and the total cost. The type of room, age, chemotherapy, radiation therapy, antibody therapy, disease stage, number of hospital visits and right for increased reimbursement were independent variables. Results: The study population included 107 patients. The total mean cost of the diagnostic phase was 817 e, divided into the personal contribution of 80 e and the health insurance cost of 737 e. The mean patient cost of the treatment phase was 1.712 e, for the health insurance 17.282 e. The regression analyses revealed the number of hospital visits was significantly associated with total cost, patient cost and health insurance cost. The patient cost was highly predictive by the choice of the room. The total cost of the diagnostic phase for 107 patients was 87.377 e. Imaging 32.742 e and pathology 32.895 e were most important, followed by pharmacy 9.641 e and consultation 6.598 e. In the treatment phase radiotherapy 436.247 e, antibody treatment with trastuzumab 326.961 e were most important, followed by chemotherapy 189.729 e, hospitalisation cost 153.026 e, pathology cost 144.239 e, and surgery cost 134.251 e. Conclusions: In our study an estimation was given of all direct medical costs of breast cancer of the diagnostic and treatment phase. The results can inform hospital executives and policy makers to determine further strategic decisions for financing breast cancer care. Legal entity responsible for the study: University of Antwerp. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
Volume 30 | Supplement 5 | October 2019
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz263.030/5576906 by guest on 25 October 2019
Methods: A systematic review of available QI describing the oncological clinical pathways in the literature was conducted. The list of selected QI was presented to an expert panel (oncologists, pharmacists and SRNs) of various hospitals in France. The selection involved a two-step process: a preliminary selection was conducted based on the title and rationale of the QI by consensus (nominal group), assigning a value to each QI reviewed on the basis of its appropriateness and its feasibility (1st working group). The pre-selected QI were then described in detail and presented to the expert panel (2nd working group) in order to validate the selection. Results: 5731 QI were identified in the literature review and 131 included. 17 indicators were pre-selected by the experts (1st working group). After presentation of the 17 detailed descriptors, the QIs were clustered or eliminated. Ultimately, 10 QI were selected (Table): outcome (2), process (3) and structure (5).
Annals of Oncology
Table: 1658P QI
Description
Type
1 2 3 4 5 6 7 8 9
Symptoms and disease progression Assessment of tolerance to treatment Management of patients receiving oral therapy Quality of the liaison document Composite score for supportive care Patient therapeutic education Medication reconciliation Unscheduled admissions Declaration and follow-up upon serious adverse events in clinical pathway Patient’s experience (PREMS)
Structure Process Structure Process Structure Structure Process Outcome Structure
10
Outcome
Conclusions: This approach will be developed further by presenting the IQs to patient associations and primary care physicians in order to gather their feedback, refine, adapt and ultimately create a representative set of indicators. Legal entity responsible for the study: The authors. Funding: Novartis Oncology France. Disclosure: All authors have declared no conflicts of interest.
1660P
N. Olympios1, M. Lacaud2, S. Cousse3, J-C. Dupont4 Laboratoire Ethique Me´dicale, Universite´ Paris Descartes, Paris, France, 2Oncologie Me´dicale, Centre Henri Becquerel, Rouen, France, 3Pneumology Department, Rouen University Hospital, Rouen, France, 4Assistance Publique des Hoˆpitaux de Paris (APHP), Hospinnomics - Paris School of Economics, Paris, France
1
Background: Immune checkpoint inhibitors (ICI) have revolutionized treatment of advanced NSCLC. In France, concerns have been raised as to the financial burden of these therapies and fear that potential patients may be ruled out. The reality of budgetary restrictions implies for choices to be made considering both the quality of life these treatments procure as well as the financial burden they represent. From a physician’s point of view, due to financial constraints on public health facilities, physicians could restrain themselves from prescribing innovative expensive therapies. Methods: This qualitative study questions the potential impact of drug prices on prescription choices made by thoracic oncologists. Ten French oncologists and two hospital pharmacists voluntarily underwent a semi-structured interview conducted by a student in an Ethics master’s degree. Interviews consisted of two distinct parts: one clinical case where treatment choices had to be made in the first-line and second-line advanced NSCLC setting and a second part consisting of open-ended questions. Results: Qualitative analysis of the interviews brings out that immunotherapy has radically changed the history of cancer treatment but that hopes in advanced NSCLC need to be tempered. Efficacy in a real-world setting is difficult to predict and efforts need to be made to identify accurate biomarkers. Financial matters are a source of discussions between fellow physicians and clinical pharmacists but not with patients. Physicians consider they have a duty to strictly respect guidelines particularly in a French universal healthcare system. Conclusions: Rising costs of innovative drugs in oncology is a reality that forces a reconsideration of healthcare and drug regulation systems in order to be able to provide access to innovation for all eligible patients in the French universal healthcare system. Addressing this issue with physicians provides important insight on how treatment choices are made, their expertise and their involvement in this matter. Physicians are concerned about access to innovation for their patients and consider they ought to remain aware of these issues in order to participate in healthcare arbitration discussions. Legal entity responsible for the study: Laboratoire Ethique Me´dicale - Universite´ Paris Descartes. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
1661P 1659P
Sustainable drug prices at market launch: Policy proposals and their empirical evidence
N. Fanzen1, W. van Harten1, V. Retel2, W. Schats3 Psoe Department, Netherlands Cancer Institute/Antoni van Leeuwenhoek hospital (NKI-AVL), Amsterdam, Netherlands, 2Psoe Department, The Netherlands Cancer Institute, Amsterdam, Netherlands, 3Library, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital (NKI-AVL), Amsterdam, Netherlands
Impact of financial considerations on French physicians’ prescription choices for advanced non-small cell lung cancer (NSCLC)
The direct medical cost of breast cancer in a Belgian hospital
H. Lemhouer1, D.M.E.C. Verhoeven2, V. Corluy3, D. De Graeve1 Economy, University of Antwerp, Antwerp, Belgium, 2Oncology, University of Antwerp, Antwerp, Belgium, 3Finance, AZ KLINA, Brasschaat, Belgium
1
1
Background: A strong scientific and public interest exists in the sustainability of pharmaceutical research and development and particularly the issue of anticancer drug prices. Despite of the number of publications, articles seem often opinion-based. To facilitate an evidence-based discourse, we reviewed the literature and produced an inventory of policy proposals. We then analyze the available quantitative evidence. Methods: Due to the broad nature of the research question, a scoping review was performed. We combined multiple search strategies to get a systematic overview of the current body of literature. Results: In total, we screened 4775 articles and categorized 23 proposals. 22 of 85 included articles used quantitative models. Overall, the quantitative evidence was inconclusive to deduct real world effects and evidence- based recommendations. We however identified promising solutions for further investigation: Royalty payments, prizes and rewards, two-part-pricing, price transparency, increased translational public research, and public clinical trials. At ESMO, we will present this list of promising solutions, their degree of disruptiveness and their empirical evidence. Furthermore, we will share feedback on selected solutions from a survey among European experts in the field of oncology and health regulation. Finally, we will discuss techniques of evidence based solutions facing high complexity and the need of additional data for choosing policy options. Conclusions: Despite of the urgency of the matte of drug prices, we must realize that system consequences need careful considerations as implications for access and finances can be substantial. We advise testing promising solutions with experiments, dynamic simulations, and policy pilots. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
v680 | Public Policy
Background: Breast cancer accounts for 10 to 20 percent of the total cancer cost. The direct cost of cancer care are the health care expenses directly related to prevention and cancer treatment. The indirect cost, 2-3 times the direct cost include presenteeism, disability to work, absenteism and workers compensation. The aim of this study is to achieve a better understanding of the direct cost and the importance of the variables. Methods: This retrospective descriptive study used the administrative data of AZ KLINA linked to the Cancer Registry of Belgium. The study comprised women diagnosed with breast cancer between July 2015 and December 2015. The direct health care costs were calculated for the diagnostic and treatment phase up to 365 days after diagnosis. The costs were grouped according to the different kinds of medical interventions. Regression analyses were performed for 3 dependent variables i.e. the patient contribution, the health insurance cost and the total cost. The type of room, age, chemotherapy, radiation therapy, antibody therapy, disease stage, number of hospital visits and right for increased reimbursement were independent variables. Results: The study population included 107 patients. The total mean cost of the diagnostic phase was 817 e, divided into the personal contribution of 80 e and the health insurance cost of 737 e. The mean patient cost of the treatment phase was 1.712 e, for the health insurance 17.282 e. The regression analyses revealed the number of hospital visits was significantly associated with total cost, patient cost and health insurance cost. The patient cost was highly predictive by the choice of the room. The total cost of the diagnostic phase for 107 patients was 87.377 e. Imaging 32.742 e and pathology 32.895 e were most important, followed by pharmacy 9.641 e and consultation 6.598 e. In the treatment phase radiotherapy 436.247 e, antibody treatment with trastuzumab 326.961 e were most important, followed by chemotherapy 189.729 e, hospitalisation cost 153.026 e, pathology cost 144.239 e, and surgery cost 134.251 e. Conclusions: In our study an estimation was given of all direct medical costs of breast cancer of the diagnostic and treatment phase. The results can inform hospital executives and policy makers to determine further strategic decisions for financing breast cancer care. Legal entity responsible for the study: University of Antwerp. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
Volume 30 | Supplement 5 | October 2019
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz263.030/5576906 by guest on 25 October 2019
Methods: A systematic review of available QI describing the oncological clinical pathways in the literature was conducted. The list of selected QI was presented to an expert panel (oncologists, pharmacists and SRNs) of various hospitals in France. The selection involved a two-step process: a preliminary selection was conducted based on the title and rationale of the QI by consensus (nominal group), assigning a value to each QI reviewed on the basis of its appropriateness and its feasibility (1st working group). The pre-selected QI were then described in detail and presented to the expert panel (2nd working group) in order to validate the selection. Results: 5731 QI were identified in the literature review and 131 included. 17 indicators were pre-selected by the experts (1st working group). After presentation of the 17 detailed descriptors, the QIs were clustered or eliminated. Ultimately, 10 QI were selected (Table): outcome (2), process (3) and structure (5).