Healthcare in Europe is changing and a new approach of "value for money" is being debated. © Public Domain Pictures
Healthcare is changing in Europe. The continent faces significant challenges with an ever-older population, the rise of chronic diseases and an increased resistance to antibiotics. European leaders vow to curb this threat while industry representatives call for a new patient-centred healthcare system.
The healthcare environment is changing at a fast pace. European countries are witnessing an aging population and an increased incidence of chronic diseases such as diabetes, obesity and cardio-vascular disease. This current reality has put a massive strain on already trembling healthcare systems throughout the European Union. Another reason for concern is the growing resistance to antimicrobials (AMR). This reality represents a major issue affecting the EU population and requires immediate action. The immunisation against antibiotics has increased admissions-rates of patients in hospitals, therefore increasing the burden of healthcare facilities.
Towards a new paradigm?
Given the current panorama of healthcare in Europe, industry and patient representatives have been conveying the need for a shift in how we look at health. Hence, the new paradigm focuses on a patient-centred healthcare system where healthcare research and delivery is being drawn to be customised for the individual patient, based on personalised medicine. This innovative concept has been on the spotlight during the past years. However, we must accept that this new science calls for new regulatory approaches if patients are to be provided with timely access to innovative medicines. On the other hand, the question of ethics and privacy plays a paramount role on this new methodology.
Speaking about innovation and outcomes in June 2016, Joseph Jimenez, Novartis’ CEO said, “Healthcare systems are not prepared for what’s coming.” Jimenez went on saying that “we need to help healthcare systems understand what type of innovations are coming and we need to help them to understand the impact on the system.”
Health Collaboration Summit 2016: an opportunity for dialogue
Bringing a forum for discussion, the Health Collaboration Summit 2016 (November 10 and 11), organised by the European Federation of Pharmaceutical Industries and Associations (EFPIA) in partnership with the Patient Think Tank, in Brussels, convened patient organisation representatives and industry leaders from across Europe. The summit encouraged dialogue and best practices across the continent and focused on voicing the importance of unlocking the potential of value-based healthcare while calling on the patients’ role to become more prominent on defining outcomes.
All patients are different and what works for one does not necessarily work for another. The shift to a patient-centred approach can empower patients who want to take ownership of their own health. Value-added medicines represent a radical change for the industry. By focusing on delivering outcomes, more value for money is expected as a result. As a consequence, it can contribute notably to the sustainability of healthcare systems by identifying and discontinuing interventions that do not deliver superior outcomes.
On his article “Value Pricing For Drugs: Whose Value, What Price?” for the Health Affairs Blog, Robert Rubin developed the concept of “value for medicines”. Rubin explained: “The idea that drugs should be ’value priced’ is consistent with current trends in American health care like value-based insurance design, the decline of fee for service (quality over quantity), and the move for payers to provide case mix adjusted payments where providers go ‘at risk’ for costs, outcomes, and quality (e.g., Accountable Care Organizations in Medicare).”
Paul van Arkel, Head of Corporate Strategy and Healthcare Systems at Novartis, said that outcomes-based health systems are a solution that may contribute to those problems of a growing elderly population and the rise of incidence of chronic diseases. “It’s not easy to set up outcomes-based projects. This requires technical infrastructure, structural changes to the system and financial support, which takes a lot of political will,” said van Arkel.
Healthcare systems reform: where to start?
To sustain the momentum of healthcare systems reform widely adopting an outcomes-based approach, healthcare professionals advocate progress in three different areas. First, social awareness of what outcomes-based healthcare really is. Hence, informing the public of the benefits of this practice is the primary step, which at this point seems to be very abstract and theoretical. If people are to be truly at the centre of the healthcare system, it is vital that they understand the changes that are about to happen. This way, people could actually have a say in the matter by getting involved.
Secondly, big data has become the new Holy Grail given the benefits it can bring to patients and to the sustainability of healthcare systems, if used responsibly. Data on outcomes and transparency on that same data has the potential to prevent future epidemics and discover new disease patterns that may help researchers bring about personalised healthcare. Once again, the patients’ anonymity must be guaranteed.
Lastly, the industry has expressed a need for financial incentives not only for research and development but also for providers. The industry wants to focus on providing the best outcomes for patients and to get rewarded for that and not rewarded just for the whole cost of putting drugs on the market. "Surely we want to reward new medicines based on what they deliver rather than how much they cost to develop," said Richard Torbett from the Association of British Pharmaceutical Industry (ABPI).
The idea of “value for money” has been in the spotlight for a few years and scientific experts and researchers are trying to make sense of this new concept. Sara Clifford and Karin S. Coyne authored the article “What is the value of medication adherence?” where they question the feasibility of this practice. “What should be the appropriate adherence threshold for different drug classes to meet clinical goals?” or “How can we value adherence when we are not even sure how accurate our measures of adherence are?” they ask.
Antimicrobial resistance: a growing threat
On the occasion of European Antibiotic Awareness Day (November 18), the European Commission announcedthe latest annual surveillance results. The assessment revealed that in 2015 antibiotic resistance continued to increase for most bacteria and antibiotics under surveillance. Resistance to last line antibiotics that treat pneumoniae (carbapenem) increased from 6.2% in 2012 to 8.1% in 2015. There have been single reports of resistance to the last-line antibiotic in the Czech Republic, France, Germany, Greece, Italy, Poland and Romania. As this phenomenon poses a threat to public health, studies have found that people aren’t engaged with curbing this hazard mainly because they don’t accurately understand it. Hence, it is fundamental to properly communicate this disease to different audiences.
European Antibiotic Awareness Day, November 18. © Flickr DES Daughter
European Commissioner for Health and Food Safety Vytenis Andriukaitis seized the symbolic day to deliver words of awareness: “With rising resistance and no action, we would be facing a return to the pre-antibiotic age, where people died from common infections and minor injuries. This would have major consequences for people's health and for the economy, not only in Europe, but right across the world,” said Andriukaitis.
The Commissioner announced the launch of a second AMR Action Plan in 2017. “I believe every Member State should – as a matter of priority – be equipped with a comprehensive action plan against AMR,” he advised. At a regulatory level, the European Parliament is ready to start negotiations on the Commission proposal, but the Council is still in the preparatory stage. The Health Commissioner called on the Member States to speed-up their discussions.