opportunities and challenges for hta in asia-pacific (part 1)

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Opportunities and Challenges for HTA in Asia-PacificPart 1 of 2

A roundtable interview.

AUDIO INTERVIEW!

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Opportunities and Challenges for HTA in Asia-Pacific

IMS Experts: Mandy Chui, Practice Leader, Pricing and Market Access, APJ

Jonathan Tierce, GM, Health Economics & Outcomes Research

Guest Speakers:Dr. Annie Chicoye, Associate Professor, ESSEC Santé Business School France - Singapore

Dr. Abdulkadir Keskinaslan, Market Pricing Director, APAC, Novartis Pharma AG Basel, Switzerland

Length: ~15 minutes

To download an MP3 of this interview, click here.

To download the PDF transcript, click here.

Questions? Comments? Fill out the form at the end of this presentation.

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http://www.imshealth.com/deployedfiles/imshealth/Global/Asia%20Pacific/Content/Static%20Files/Opportunities%20&%20Challenges%20for%20HTA%20in%20Asia-Pacific%20Transcript.pdf

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Hello and welcome to the IMS Asia-Pacific Insight interview. My name is Jonothan Tierce, the IMS General Manager of our Health Economics and Outcomes Research practice area. Today I am here with three experts who are going to talk about the opportunities and challenges for healthcare improvement and value in the deployment of medical technologies in emerging markets in Asia.


To download the PDF transcript, click here.

Questions? Comments? Fill out the form at the end of this presentation.

http://goo.gl/RAOhH


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To start, I would like to introduce Ms Mandy Chui. Mandy is Regional Practice Leader, Pricing and Market Access at IMS Health in Asia Pacific, where she leads engagements to help clients in China formulate growth strategies, optimize price and reimbursement, and address issues in business model, sales force and marketing optimization. Welcome Mandy.


To download the PDF transcript, click here.Questions? Comments? Fill out the form at the end of this presentation.Know more on IMS Health, click here

Mandy Chui (MC): Hello Jon.

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We are also joined by Dr. Annie Chicoye. Annie is an Associate Professor at ESSEC Santé Business School France - Singapore, with extensive experience conducting assignments related to medicinal products and medical devices, as well as health economics studies, healthcare organization and networks projects. Welcome Annie.

Annie Chicoye (AC): Thank you Jon.



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And finally our third panellist – Doctor Abdulkadir Keskinaslan. Abdulkadir is Market Pricing Director for the Asia Pacific region at Novartis Pharma AG, Basel, Switzerland. His professional experience encompasses health economics activities across a range of therapies. His recent areas of research are use of Health Economics for Pricing and Reimbursement Decision Making and Outcomes Based Innovative Pricing Schemes. Welcome Abdulkadir.

Abdulkadir Keskinaslin (AK): It’s a pleasure to be here Jon.



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So, let me see if I can set the context for our discussion. We could safely say that there are three global trends impacting healthcare worldwide. The first is the desire to improve access to healthcare for large populations.

Second, this is accompanied by a rise in healthcare expenditure and the potential to politicize the healthcare process.

And third, these are all set against the backdrop of a global economic downturn, which has the industry and buyers looking hard at how they are spending their money.

So, with that as the context, let’s turn to our panellists to learn from their insights into how this is playing out across Asia. To download an MP3 of this interview, click here.


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Mandy, let’s start with you. What are the opportunities and challenges in the Asia Pacific markets today?

MC: Well, Jon there are a number of opportunities we can identify, such as an emerging middle class, particularly in China and India. For example, the middle class (those with annual disposable income of US5 to 15K) has been rapidly growing from 16 mil to 124 mil households in the last 10 years, changing demographics brought on by an ageing populations, and the movement of treatment away from infectious disease to a rise in chronic disease such as we see in the developed markets today. All these mean more people are demanding more drugs and are able and willing to pay for it.



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Yes, these are positive trends for the pharma market in APAC. So what are the challenges?

MC: Well, the biggest challenge is that most of the APAC countries do not have sufficient government funding for healthcare and they are non-reimbursed markets. Drugs are still largely paid out of pocket by the individual. At the bottom of the pile is India, typically with 80% of the health care expenditure paid by the individual. This is followed by China and the Philippines, with more than 50% of drug expenditure paid by the individual.



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I guess in these emerging markets, poor infrastructure continues to be a problem as well?

MC: Yes that’s right Jon. In many of these markets they do not even have enough doctors and hospitals and clinics to diagnose and treat the patients. For example, there is only one doctor per 10,000 population in Indonesia vs. 34 doctors for the same population in Germany. Even clean water or transportation is often not available to reach many of the patients in the rural and very remote areas. So, patients simply don’t have access to medical care facilities and remain under-diagnosed and under-treated.



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But healthcare reforms are ongoing in these emerging markets?

MC: Yes that’s true. Healthcare systems are being built and reformed across the region. Most countries are all growing their GDP at 5% or more but healthcare spending is not keeping pace. Thus, the government is under tremendous pressure to improve healthcare for its citizens, especially in providing basic healthcare or medicine to the general public.



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Can you give us some examples, Mandy?

MC: Yes of course. One example is China, where they have put together a very ambitious health care reform plan. The Chinese government is investing 125 billion US dollars in the next three years to broaden the access of medicine and also health care services to its population. The government has introduced 3 medical insurance schemes to cover 90% of its population by 2011. However in the Philippines, funding is still a major concern and they have implemented a number of significant price cuts towards a lot of the top selling drugs.



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And with these new burdens on the healthcare budget, is there a concern about increased costs?

MC: Yes, and this can be seen in government initiatives to cut prices, adopt international reference pricing, increased co-payment from patients, and practised generic substitution. The adoption of Health Technology Assessment, or HTA, however, is still at its infancy in this region.



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What countries are we talking about here, as an example?

MC: Well, Korea and Taiwan are more advanced in terms of adopting HTA to balance and optimize health care resources and allow for innovation for the drug industry.

Thailand is the next country fast catching up. However, countries like China or the Philippines, are still learning about this system and have not yet put things into practice.

AC: Jon, let me build on Mandy’s point. Conceptually, HTA definitely has been adopted as one of the ways to look at cost-effectiveness, and other measures of product value. The balance between providing better treatment options and adapting new technologies is the struggle for many of the governments in Asia.



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So there is a general push to adopt HTA in these emerging markets?

MC: There is, but the main challenge here is the lack of expertise and talent to help the health authorities to move this forward. There is also a shortage in terms of data; for HTA to work, you need a lot of local data: clinical data and healthcare resources data in order to assess cost effectiveness of various treatment options and healthcare resources usage.



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I see. Well Asia could certainly learn from experiences in Europe, where they have taken a long time to move from short-term cost-containment measures to now being more focused on looking and creating value in the system, in balancing the health care resources. Is that right Annie?

AC: Absolutely. I can give examples of how European governments -- with a long history of universal coverage and raising costs -- have tried to tackle cost containment measures, but with some concerns in the back of their minds about industrial policy, because pharma industry has been regarded in Europe as one of the high-tech strategic industries that also needed to be strongly supported. So, cost-containment measures have been developed side-by-side with industrial policies, with the specific balance between the two playing out in each country.



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MC: It’s interesting to see the different tools that have been used in cost containment.

AC: Yes, for example, the experience of price control in France, profit control in the UK, prescribing budgets in Germany and therapeutic national reference price in Germany. Each was able to integrate HTA progressively into the cost-containment measures to improve the efficiencies of the health expenditure regulations and to avoid the “side effects” of too basic cost containment measures.



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Can you give us some examples of these “side effects”?

AC: Sure. For example, in France, prices for the reimbursable drugs have been fixed by the government since 1948, but the implementation of the control for the first 35 years or so was inefficient, and not rewarding enough true innovation. Efficiency started to be imported into the system only in 1980, but it took time to design in collaboration with the pharmaceutical industry some sort of predictable model with clear rules and meanwhile other measures had to be put in place to improve the rationality of prescriptions, for instance by authorizing generic prescriptions by physicians and substitution by pharmacists.



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MC: So, French patients now have access to very innovative drugs with a relatively short delay at international prices, because now innovation is a key criteria for drug approval.

AC: That’s right Mandy. As another example, we can look at the UK, which adopted PPRS, the Pharmaceutical Price Regulation Scheme. Its objective was primarily to control prices by controlling profits made on the sales through the National Health Service, but also to favour a thriving pharma industry. The result is that the British pharma industry has been very productive in discovering and marketing -- at a global level -- new drugs whereas its market value has been kept at a much lower share of the global market.



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MC: But, I understand that PPRS did not meet the need for the best use of the limited resources allocated to the National Health Service, so this was a problem.

AC: Yes. This is the reason why the National Institute for Health and Clinical Excellence, or NICE, was set up in 1999 with the mission -- based on HTA methods -- to issue recommendations to the NHS decision makers so that British citizens would spend their health care budget in a more optimized way. The new PPRS signed in 2009 adopts value-based pricing to an extent.



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Annie, would you say that a PPRS would be relevant in Asia-Pac countries?

AC: There may be a connection between the regulation of pharma expenditures that are imposed by governments and the attractiveness of the country in terms of pharma investments, whether it is research and development investments or production investments. But the example of the UK is to be really looked at very carefully. If HTA is not carefully introduced, it may provoke aggressive pricing and it may restrict access to care, which was actually a real issue in the UK in the 90s before NICE was introduced.



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So could we use any other country as a better example?

AC: We could look at Germany. The German government has also been very keen on fostering a strong pharma industry and free pricing with hardly any selection for reimbursement has been the case for decades. But the reunification of Germany and later on economic crisis made it necessary to adopt cost-containment measures.



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Such as?

AC: The first innovation was to fix limited budgets imposed on prescriptions to physicians. This policy has been implemented over many years and has had some painful side effects, such as inviting office-based physicians in outpatient care to refer patients to hospitals -- which is of course much more expensive -- to avoid the costs for prescriptions which otherwise would exceed their fixed budget.



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What did they learn from this?

AC: The lesson learned is that you have to negotiate with physicians and encourage good clinical practices before limiting budgets in order to maintain quality care. Defining good clinical or medical practise relies largely on HTA.



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And Germany adopted therapy-based pricing. What has been the impact of this cost-containment measure?

AC: Well, it can be viewed as successful in that it has been adapted across Europe. In this model, prices for reimbursed drugs remain free, but products are clustered together because they have the same key ingredient or because they have essentially the same therapeutic effect. Then, for all drugs in this area, a unique tariff is set for reimbursement.



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What happens if the company does not align the price to the reimbursed tariff?

AC: If the company does not align the price to the reimbursement tariff, it means that the patient has to pay for the difference. And if there are alternatives, doctors would be encouraged to prescribe the alternatives. This leads to all prices in that therapeutic class aligning on the tariff. As a result, this has been a very rapid and effective tool for price decreases.



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It sounds quite effective, but what are the “side effects?”

AC: Well, firstly, not all drugs can be easily be clustered from a clinical perspective, and it is a viable share of the expenditure that can be covered, depending on the entry of new drugs. Drawbacks are that companies tend to charge more for “non-clustered” products to compensate the price decreases on the referenced products.



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Thank you for listening to part 1! Be sure to listen to part 2, also available on SlideShare!

• To download an MP3 of this interview, click here.

• To download the PDF transcript, click here.

• Questions? Comments?

− Fill out the form at the bottom of this slide, or

− Visit www.imshealth.com or email [email protected].

opportunities and challenges for hta in asia-pacific (part 1)

Health & Medicine

ims health

health economics activities

health economics studies

asiapacific ims experts

pdf transcript

welcome mandy

welcome abdulkadir

welcome annie