balancing needs and resources in medicines delivery
DESCRIPTION
Presentation delivered by Mr Shaun Flanagan, Corporate Pharmaceutical Unit, Health Service Executive at the Irish Pharmaceutical Healthcare Association Annual Meeting 2009.TRANSCRIPT
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Balancing needs and resources in medicines delivery
The ChallengeNOW and into the future
Shaun Flanagan,Corporate Pharmaceutical Unit
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Medicine Supply: Core Principles 2006 Public access to innovative and other
medicines through reimbursement based on: affordability sustainability continuity and security of
supply value for money
Strategic view / available resources
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Making Room for Innovation:Finding the Balance 2006 IPHA agreement
Pricing new products: expanded basket reviews: early launch patent expiry: price reductions
Health technology assessment (HTA) clinical innovation, benefits new or existing therapies budget impact
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2006 Agreement
€250M reduction in the rate of escalation over 4 years (Clause 6)
Not a net reduction in costs to the state
All reductions re-invested by the state in the provision of medicines
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High Tech arrangements
4049
61
80
104
141
169
207
239
275
320
0
50
100
150
200
250
300
350
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 (f) 2010 (f)
€ (M
illio
ns)
0
5
10
15
20
25
30
35
40
% In
crea
se y
ear o
n ye
ar
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Where are we now?
Where are we likely to go?
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2009 Economic Reality
Department of Finance Monthly Economic Bulletin November 2009
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Projecting the Impact of Demographic Change on the Demand for and Delivery of Healthcare in Ireland
Layte, Richard (ed.) Barry, Michael (TCD) Bennett, Kathleen (TCD) Brick, Aoife Morgenroth, Edgar Normand, Charles (TCD) O'Reilly, Jacqueline Thomas, Stephen (TCD) Tilson, Leslie (TCD) Wiley, Miriam M Wren, Maev-Ann (TCD)
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2006 → 2020 (ITEMS 2021)
Current use model Items increase from 54M → 75M Ingredient costs €1.1Bn → €1.5Bn
Projected use model Items increase from 54M → 110M Ingredient costs €1.1Bn → €2.4Bn
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Limitations of Predictions Assumptions made
Recent changes to schemes not included Changes to eligibility in over 70 year olds January 2009 - 15% reduction post-patent Any future changes to IPHA / APMI
Only public spending
New treatments, changing expectations, changing disease epidemiology not possible to predict
High Tech Arrangements not included
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Health system - Challenges
In an overall healthcare context the need to deliver better care for less money
How can access to new and innovative medicines be provided for in the context of an aging population and forecasted declining health expenditure?
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Clinical Care & Quality
Deliver better care for less money Chronic disease management
programmes including Asthma Diabetes Cardiovascular diseases
Clinician led Multidisciplinary support
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Clinical Care & Quality
Guidelines Structured Care pathways Right Healthcare professional @ right time Early intervention Target resources in these areas Reduce long term complications and
improve population health No overall increase in investment Pharma programme
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Medicine Supply:Core Principles 2010
Access to innovative and other medicines through reimbursement based on: affordability sustainability continuity and security of supply value for money
Strategic view / Economic reality
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Investment in Innovative medicines
Ensure that any medicine to be reimbursed is cost effective
Health technology assessment
Cost effectiveness and price
No additional funding is expected
Difficult choices ahead
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Investment in Innovative medicines
Balance between rapid access to medicines and planned use of scarce resources
Meeting very short timescales specified under current agreements is and will be challenging
May not always be conducive to strategic decision making
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Medicines for Orphan Diseases
Should (can) the state pay a premium for orphan medicines particularly those which would not satisfy standard cost effectiveness requirements?
Opportunity costs versus unmet clinical needs
Often a bridge to further therapeutic advances
What is a reasonable premium?
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Core Principles
Generate financial headroom to support the predicted growing pharmaceutical needs of an aging population
Allocative decisions must be made in the context of a full understanding of opportunity costs
Increased role of experts in informing decisions about investment in medicines
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Financial Headroom
Continue the movement of prices towards the EU average
Maximise the potential of generic market to provide headroom for innovative medicines
Identify medicines which are not cost effective (Health technology assessment)
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Financial Headroom
Review all supply chain costs and methods of delivery to identify inefficiencies
Improve Adherence
Improve Efficacy in use
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Financial Headroom – efficacy in use
Modern medicines deliver significant benefits to individuals and society
However complications do arise and some of these are avoidable
Priority of the new directorate and DOHC to address patient safety issues
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Adverse drug reactions (ADR) as cause of admission to hospital
BMJ 2004 Vol 329; 15 19
Pirmohomad et al. BMJ 2004 Vol 329; 15 19
UK Study
ADR caused 1225 (6.5%) admissions.
107 “definitely avoidable”
773 “possibly avoidable,”
880 might have been avoidable (4.7%)
23 patients died (0.15%)
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TORCH:(NEJM 356;8 Feb 22 2007)
A randomised, double-blind trial comparing combination therapy with a long acting
beta agonist (LABA) and inhaled corticosteroids (ICS)
LABA alone ICS alone Placebo
Patients with Chronic Obstructive Pulmonary Disease (COPD) followed over 3 years
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TORCH:(ClinicalTrials.gov number, NCT00268216.)
6112 patients, 42 countries, 444 centres
Overall 875 (14.3%) of patients died within the 3 years
All-cause mortality rates 12.6% Combo group 13.5% LABA alone 16% ICS alone 15.2% Placebo
Reduced exacerbations, improved health status and spirometric values
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TORCH:POST HOC REVIEW OF ADHERENCE DATA
Adherence to inhaled therapy, mortality and hospital admission in COPD
Post hoc review of TORCH data
Good aherence defined as > 80% use of study medication
Poor adherence defined as < 80%
Vestbo et al Thorax 2009;64:939-943
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Vestbo et al Thorax 2009;64:939-943
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BMJ 2009;339:b2803
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Summary
Innovative medicines important in improving health outcomes
Demonstration of cost effectiveness is required
Financial constraints require that we deliver better care at a lower cost
Optimisation of medicines use can help fund future healthcare needs (and access to new innovative medicines)
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Contact Details
Corporate Pharmaceutical Unit,Dr. Steevens' Hospital, Dublin 8.
Telephone: 01-6352672
Email: [email protected]
http://www.hse.ie/eng/about/Who/Corporate_Pharmaceutical_Unit.html
Thank you