Innovatie in de zorg vraagt innovatie van de zorg

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1 Innovatie in de zorg vraagt innovatie van de zorg Lieven Annemans Universiteit Gent MIC Genk December 2015

2 Inhoud Investeren in gezondheid = investeren in innovatie Kosteneffectiviteit en HTA Adviezen voor de toekomst 2

3 Moeder waarom innoveren we in de gezondheidssector? 1. Omdat gezondheid een interessante markt is en we een stuk van de taart willen 2. Omdat we nog heel wat kunnen verbeteren aan de gezondheid van de bevolking 3. Een combinatie van 1 en 2 3

4 = aantal verloren gezonde levensjaren per jaar in België

5 Wat veroorzaakt de grootste verliezen?

6 QALY = Quality Adjusted Life Years INDEX ( utility level ) Perfect health QALYs 25 QALYs 90 QALYs Death TIME 6

7 Gain in QALY by avoiding an event INDEX Perfect health 1 With prevention 0.5 QALY gain Without prevention Death 0 TIME 7

8 Gain in QALY by delaying progression INDEX Perfect health With new treatment Death 0 TIME 8

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10 Art.168. A high level of human health protection shall be ensured in all EU policies and activities

11 de innovatiecyclus Value deficit The Market usage challenge The Development challenge Provide Value for money Add value The Market access challenge 11

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13 Telematica- en data-innovatie TELEPREVENTION 13

14 Kunnen we onze hoofdprincipes behouden? KWALITEIT SOLIDARITEIT DUURZAAMHEID 14

15 Oplossing: meer kosteneffectiviteit Federaal regeerakkoord oktober

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17 cost-effectiveness Cost Current care Prevention cost Savings Savings Net C Health effect (QALYs) L. Annemans. Health economics for non-economists. Academiapress 17

18 cost-effectiveness threshold Cost NOT C-Eff New Current care New C-Eff New Dominant Health effect (QALYs) L. Annemans. Health economics for non-economists. Academiapress 18

19 PROBLEM: where is the threshold? HISTORICAL +/- 50,000 per QALY: = cost-effectiveness of caring for a dialysis patient (extra cost = 200,000, QALY gained = 4) WHO: GDP per capita (e.g. Belgium = 35000) Willingness to pay! 19

20 = average value of a healthy life year (according to European citizens)

21 Why care about the health of others? Altruistic Paternalistic Egoistic

22 Inequality related losses of health account for J. Mackenbach, Rotterdam of the total costs of health care

23 ALTRUISM adds another 40,000 to the value of health

24 Examples of reimbursed medicines and organized screenings in Belgium/Flanders Treatment Champix for Smoking cessation Cost per QALY gained ( ) (= ICER) dominant Screening/2y voor darmkanker (56-74y) 3,000 Procoralan Chronic Heart Failure 6,000 Brillique Acute Coronary Syndrome 14,000 Screening/3y voor cervixkanker (25-64y) 15,000 Prezista HIV 16,000 Screening/2y for breast cancer (50-70y) 23,000 Velcade multiple myeloma 30,000 Alimta NSCLC 40,000 Tysabri MS 47,000 CTG/CRM (RIZIV) ICER = Incremental cost-effectiveness ratio 24

25 Medical need (Scitovsky) Low medical need no funding High medical need more solidarity invest more Acceptable health

26 PROPOSAL Health is a state of ACCEPTABLE physical, mental and social well-being

27 Budget impact (Birch & Gafni) 27

28 BUT: those focussing only on cost savings are WRONG 28

29 Health technology assessment 1. Synthesising health research findings about the effectiveness of different health interventions 2. Evaluating the economic implications of the interventions 3. Analysing their cost effectiveness 4. Assessing social and ethical implications of the diffusion and use of health technologies 5. Assessing organisational implications of the diffusion and use of health technologies 6. Identifying best practices in health care 29

30 Extra problem: uncertainty Give us more evidence that your technology is value for money PAYER INDUSTRY Allow us first to the market (reimburse it) and then we will be able to show real life evidence

31 Hoe moeten we nu verder?

32 Solution: to be adaptive 32

33 Adaptive pathways 33 Eichler et al. Clin Pharmacol Ther Mar

34 CORRECT GEBRUIK BIG DATA ehealth Terug naar de innovatiecyclus Value deficit GAAT DEZE INOVATIE ZIJN GELD WAARD ZIJN? KUNNEN WE ZE SNELLER EN GOEDKOPER ONTWIKKELEN? SAMENWERKING OVERHEID- INDUSTRIE! The Market usage challenge The Development challenge Provide Value for money Add value The Market access challenge MAATSCHAPPELIJKE GRENZEN (gemoduleerd) RISCO-DELING 34

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36 Investeren we wel genoeg in kosten-effectieve preventie en gezondheidspromotie?

37 Neen! 2% van de totale uitgaven aan gezondheidszorg gaan naar primaire preventie = ondermaats Gemiddelde in de EU = 3% 50% meer investeringen in preventie nodig om middelmatig te worden > 250 Mln extra per jaar nodig voor preventie 37

38 Prevention that acts on persons indirectly, by altering their physical or social environment, is most cost-effective Chokshi et al, NEJM 2012

39 Re-investing in health! Overuse Cost-effective Prevention & Innovation

40 Nieuwe functies, taken en beroepen

41 Maar wel in netwerken GP, office based and hospital based specialists, pharmacist, psychologist, physiotherapist, ergotherapy, logopedist, dietician,... Zie CORTEXS project KULeuven, UGent, AMS, Uhasselt en TNO (cortexs.be) 41

42 En met een menselijke toets Holistic assessment Redesigned care process Patienttailored integrated care Self management support Humanomics Network collaborating professionals Shared decision making Pro-active prevention FitzGerald, Chest 2014;146(1):10-12

43 nieuwe betalingsmechanismen nodig. Federaal regeerakkoord 43

44 Initiatieven in de EU Austria Denmark Estonia Pay for Quality Pay for Coordination France X X X X X Bundled Germany X X Hungary X X Netherlands Portugal UK X X X Tsiachristas et al., Health Policy 113 (2013) , adapted

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47 Conclusie 1. Innovate the way we innovate Adaptive, anticipating, PPP, 2. Innovate the way society deals with innovations Boundaries (modulated) of what is acceptable Risk sharing agreements 3. Innovate the health care system (reform it to keep it) Prevention, payment mechanisms, new professions, networks, E-health, humanomics, 47

48 Innovatie in de zorg vraagt innovatie van de zorg Lieven Annemans Universiteit Gent MIC Genk December 2015