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ANNUAL RESEARCH REPORT 2015
VLERICK HEALTHCARE MANAGEMENT CENTRE
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04 About the Vlerick Healthcare Management Centre
06 The Oncology Horizon Scanning Project
08 On the Design of Custom Packs for Surgery
12 Digital Strategy at Merck Sharp & Dohme
13 Recent Publications
14 Ongoing Research
15 Further Information
ABOUT THE VLERICK HEALTHCARE MANAGEMENT CENTRE The Vlerick Healthcare Management Centre (HMC) is a European, Brussels-based non-profit independent think tank and education provider advancing innovative and actionable management and policy solutions in the fields of healthcare and the life sciences.
The Vlerick HMC research agenda is set by its Director after consultation with the Vlerick HMC International Advisory Board, which is chaired by Prof Dr Leo Neels and is composed of the following members: Prof Dr Richard Barker (CASMI, UK), Mr Jo De Cock (NIHDI, BE), Prof Dr Denis Lacombe (EORTC), Prof Dr Erwin Hans (UTwente, NL), Prof Dr Kjeld Möller Pedersen (COHERE, DK), Prof Dr Maarten Postma (RUG, NL).
Prof Dr Walter Van Dyck, Vlerick Business School Partner and Roche-Chaired professor, serves as the Vlerick HMC’s Director. Prof Van Dyck leads the biopharmaceutical and life sciences innovation & entrepreneurship, medical technology research design and market access research agenda of the Centre. Prof Dr Brecht Cardoen leads its hospital management and health services innovation and operations research agenda.
FINANCIAL AND COMPETING INTERESTS DISCLOSURE Vlerick HMC is fully owned by Vlerick Business School, a Public Utility Foundation, and funded by grants from public institutions and private organisations. To conduct its applied business and policy research, Vlerick HMC benefits from a Research Chair from Roche, focusing on patient access to medical innovation, and from MSD as a Knowledge Partner in hospital operations management with ASZ Aalst, AZ Alma, AZ Jan Palfijn, AZ Maria Middelares, AZ Nikolaas, AZ Sint-Lucas, AZ Sint-Maarten, AZ Sint-Maria, Jan Yperman Ziekenhuis, Jessa Ziekenhuis, Maria Ziekenhuis Noord-Limburg, united as MINOZ Research Members.
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INTRODUCTION At its creation one year ago, the Vlerick HMC was charged with working on the management game-changers facing the healthcare sector. As the largest employer and a major economic sector in Belgium, and accounting for 1 in 9 jobs in Europe, the health sector was claimed to merit our attention in management research and education.
Also, as medical technology and health services are important for population health and well-being, the right balance must be found between creating business value and societal value. For health technology providers, this implies the increasing need to formulate non-market strategies that complement their traditional market strategy. For budget-constrained healthcare service providers, this means ever increasing attention to running qualitatively efficient processes in ever more networked accountable care network organisations. For payers and regulators in times of austerity, this means organising for early dialogues with innovative medical technology manufac- turers and for clever tabooless budgeting with sufficient foresight (the latter conducted at an international level).
In its first working year, the Vlerick HMC conducted health management and policy research and provided executive education on the game-changers mentioned in its initial White Paper: ‘It’s time to invest more in our health’. Drawing predominantly upon our quantitative decision modelling, operations research and health technology assessment competences, we finished two research studies:
• First, the ‘Oncology Horizon Scanning Project’ studied the challenges and proposed solutions in the domain of access to innovation in the field of cancer treatment. This study received a lot of media attention and led to a parliamentary question to the Minister of Health.
• Second, the ‘On the design of custom packs for surgery’ study examined to what extent the (re)configuration of custom-made packages of disposable medical items can impact operational efficiency in material handling. This study has recently been accepted for publication in an international peer-reviewed academic publication.
In addition to finishing these research studies, we added a case to The Case Centre entitled ‘Digital strategy at Merck Sharp & Dohme’, which is available for international use in educational programmes.
The centre’s work at present, and on into 2016, builds further on these streams, extending them beyond decision modelling into hospital (network) IT strategy and into the use of real-world evidence in adaptive development and outcome-based market access for biopharmaceutical drugs in the field of cancer treatment.
Prof Dr Walter Van Dyck, Director Vlerick Healthcare Management Centre
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THE ONCOLOGY HORIZON SCANNING PROJECT WALTER VAN DYCK & TINE GELDOF
In the coming five years, lots of innovative - but often very expensive - cancer medicines will become available on worldwide markets. As recently announced at the annual ASCO (American Society of Clinical Oncology) congress, these will be predominantly personalised medicines and immunothera- pies. As treatments become more and more biomarker-driven, the need for diagnostic technologies is also on the rise, allowing earlier screening, drug-based therapies to be targeted and monitored.
At this moment, 5% of the total medicine budget of €4 billion a year in Belgium is spent on innovative drugs. Given the immediate future pipeline of innovative targeted drugs in the field of oncology, measures ensuring patient access in Belgium will have to be taken. This study investigates what needs to be done.
A very strong pipeline of oncology precision medicines will become accessible to patients now and in the immediate future. Over the next five years, a range of innovative precision medicines or targeted therapies will reach the market, followed by new immuno- therapies. Moreover, taking this growing targeted therapeutics pipeline as a basis, we showed an equivalently growing diagnostics pipeline, not only used for properly targeting precision medicines, but also more and more for screening, monitoring and treatment optimisation.
In this study, we investigated whether Belgium is ready to make this disruptive medical technology available to its citizens. With innovative precision medicines in
oncology currently at 5% of the total Belgian pharmaceutical specialties budget – but forecasted in this study to rise to 8.9-9.5% of the total budget in 2020 – the budget capacity and budgeting process to allow for this innovation to reach the Belgian market is considered to be inadequate and in need of review – especially in these times of austerity characterised by historically stagnating, or even declining, budgets. Second, next to the sheer size of the pharmaceutical specialties budget, access timing is considered to be a key problem to be resolved in the Belgian healthcare system.
To cope with the imminent innovation bubble of precision medicine therapies in the field of oncology, we propose, first, a case-based method to review personalised-medicine- based drug and diagnostic submissions in an EU-National harmonised and synchronised market authorisation and reimbursement process, in which the Drug Reimbursement Committee and the Technical Medical Council act in concert. Doing so will reduce access delays and increase reimbursement decision alignment. Second, to improve foresight and to channel budget means to the most promising innovative therapies becoming available, we propose a horizon-scanning- based transversal 5-year rolling budget forecasting concept and rationale, beginning with pharmaceutical specialties, and later for diagnostics.
As can be seen from the figure on the next page, taking a 3-year planning horizon does not raise a warning about the approaching PMx innovation bubble, whereas a 5-year horizon does warn about the uncertainty and is, hence, preferred.
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As a result for Belgium, from a simulation using the 5-year horizon-scanning-based transversal budgeting methodology we propose, this would mean that, in order to cope with the imminent innovative oncology precision medicine pipeline, the pharma- ceuticals specialties budget should rise by a compound annual growth rate (CAGR) above inflation ranging between 0.89% and 2.05% over the next 5 years, provided the budget for conventional medicine remains constant or grows at its historical rate.
This required pharmaceutical specialties budget growth rate can only be reduced if one decides to take into account possible effects from de-reimbursement or from transversal budget impacts, i.e. by funding pharmaceutical innovation using the savings projected to be made by precision medicine in other healthcare areas. Therefore, to cope wit