Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Can advances in health monitors lead to new generation of pay by performance schemes? Focsa S Executive Insight AG, Zug, Switzerland [email protected] Introduction Current and future advances in health monitors As advances in health monitors are being developed the opportunity for them to be integrated into daily healthcare infrastructure is also expanding. Many healthcare systems are facing increasing budgetary pressure and are finding it hard to make decisions about what treatments to cover. The willingness to pay a fair price for the benefits of healthcare is present; however, the current infrastructure and evaluation process has limitations. Patients can gain different benefits from the same treatments and still incur in the same cost. Drug evaluations are lengthy and complex processes, especially for those that have multiple indications, subpopulations and formulations to consider. Market restrictions of having one price per brand often lead to access restrictions not allowing patients to benefit fully from the treatments available. Furthermore, costs for noncompliant patients and adverse events are also covered by current healthcare providers, meaning that the benefits gained per cost of treatment are often not representative. In recent years, there have been advances and increases in the number of ways we can monitor how our bodies are performing. This coupled with a greater medical understandings has created the opportunity for health monitors to be more extensively used in the healthcare setting and potentially be used in measuring the performance of drugs. Fixed drug price method Measures2,3,4&5 • Heart rate • Temperature • Physical activity • Glucose monitoring • Sleep • Adherence monitoring (Otsuka’s Abilify®) Methods2,3,4&5 • Skin (MC10) • Contact lens • Pill sensor • Wearable activity bands (e.g. Fitbit) Continuous monitoring of patients could pave the way forward for scalable, accurate and effective payment by result systems that will allow patient benefits to be directly linked to the cost of treatment. Typically drugs are launched in a sequence were they can optimize price Established and safer strategy Patient Benefits Drug Optimal drug prices achieved Achievable price Cost Limited uptake in some indications Access delays Access restrictions Not addressing patient unmet need effectively A B C E F Indication Launch sequence A pay by performance system would incentivize simultaneous launches into different indications at different prices Less established and riskier strategy Indication A Drug Benefits Cost Achievable price Patient Low or no fixed price as a fall back Less limited uptake across indications Indication B Indication C Indication D Indication E Fewer access delays Fewer access restrictions Address patient unmet need effectively Launch sequence Pay by performance method Limitations of pay by performance in the past Conclusion Previous and existing pay by performance schemes have had limited success or market penetration due to the type of endpoints that can be measured and the administrative burden put on healthcare systems, both in terms of measuring performance of drugs and processing these through a financial system. Pay by performance schemes have proved that longer term patient follow-up outside the trial setting can reduce the uncertainties about dug performance and outcomes of a drug; however, this is dependent on healthcare staff collecting and processing data from patients1. Also, data collection for previous pay by performance schemes has been limited to fixed time intervals not allowing for fluctuations in the severity of the disease to be captured1. The use of hard endpoints such as mortality, disease progression or even re-hospitalizations are reliable proxies of drug performance but they are limited to a number of diseases and sometimes require the use of specialized diagnostic equipment coupled with an accurate and reliable data capturing systems, something that is not commonly available. Even when the right endpoints for a disease can be measured and the tools and systems are in place, there is still a lack of incentive for healthcare systems to contribute time, money and resources to accurately measure the benefit delivered by products from manufactures. If monitors can accurately evaluate the amount of benefit each patient gains from treatment, they can effectively remove the need for drug pricing as a whole. Only a cost per unit of health would need to be established and healthcare systems would pay for the total benefits gained by the population, similar to how electricity or gas is paid for using a meter. This change could allow drugs to enter markets with fewer restrictions and be used optimally by physicians where they feel they add the most benefit to patients. Furthermore, patient compliance and adverse events would become the financial responsibility of the drug providers, leading them to enforce monitoring, compliance and to incentivize “on-label” use to provide the maximum patient benefits. Despite the potential advantages of moving healthcare systems towards a pay by performance model, there are still practical hurdles that would need to be overcome, including deciding on the metrics by which performance is measured, changing the mindset of payers and insurance companies as well as considering the applicability across diseases and markets5. Generating such a change in the industry is unlikely to come from governments or payers but could be an opportunity for pharmaceutical companies to drive who have an interest in delivering benefits to patients and also ensuring their products bring a return on investment after achieving regulatory approval. 1 - Boggild M et al. “Multiple sclerosis risk sharing scheme: two year results of clinical cohort study with historical comparator“; BMJ; 2009; 339:b4677 2 - http://www.mc10inc.com/ 3 - http://www.forbes.com/sites/robertglatter/2015/09/14/proteus-digital-health-and-otsuka-seek-fda-approval-for-worlds-first-digital-medicine/ 4 - http://www.wsj.com/articles/novatis-google-to-work-on-smart-contact-lenses-1405417127 5 - http://www.bloomberg.com/news/articles/2015-10-08/drugs-could-soon-come-with-a-money-back-guarantee