Rising to the Challenges of Cancer Care Advancements in ... · Advancements in the Private Sector...
Transcript of Rising to the Challenges of Cancer Care Advancements in ... · Advancements in the Private Sector...
Rising to the Challenges of Cancer Care Rising to the Challenges of Cancer Care
Advancements in the Private SectorAdvancements in the Private Sector
Cancer Care SummitCancer Care Summit
FEBRUARY 22, 2012
Presentation Overview
• Introductions
• The Scope of the Challenge
• Cancer: Definition, Prevalence and Drivers
• Development and Treatment Trends
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• Development and Treatment Trends
• Assessing Value for Cancer Therapeutics
• Rising to the Challenge
• Bernie Manente– Background in human resources, consulting
– Managed private sector relationships for large pharmaceutical company
– Focused in oncology for last 10 years working with health care stakeholders
Profiles
Introductions
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• Stephanie Mazzei– Background in science/research
– Managed Oncology business for large pharmaceutical company (national and international)
– Focused in oncology for last 25 years working with health care stakeholders
Why the Neanderthals became extinct
Complex Problems
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A Complicated Journey
Patient Journey from Suspicion to Treatment
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Source: http://umanitoba.ca/faculties/medicine/units/chi/media/CHI_April_6-09_Improving_Cancer_Patient_Journey_TE.pdf
Disease
Recurrence
Made Even More Complicated
Optimal treatment
not funded
Seek private sector
funding
Funding not
available: consider
Patient Journey from Suspicion to Treatment
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Disease
Recurrence
available: consider
out of pocket
Select alternative
treatment
Source: http://umanitoba.ca/faculties/medicine/units/chi/media/CHI_April_6-09_Improving_Cancer_Patient_Journey_TE.pdf
• Cancer is not just one disease - there are more than 100 different types of cancer.
• The main categories of cancer include:
– Carcinoma (skin)
– Sarcoma (bone or other tissue)
What is Cancer?
Cancer Overview
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– Leukemia (blood-forming tissue)
– Lymphoma and myeloma (immune system)
– Central nervous system cancers (brain and spinal cord)
• Orphan diseases are defined as having a prevalence of fewer than 5 cases per 10,000 people (EU definition – no formal definition for Canada)
How prevalent is cancer?
Cancer Overview
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Canada)
• According to this definition, howmany types of cancer are not considered orphan diseases?
• Incidence is the number of new cases of a disease in a given period
• Prevalence is the pool of individuals actively managing their disease (new and recurring)
• Survivorship represents all individuals who
Incidence versus Prevalence versus Survivorship
Cancer Overview
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• Survivorship represents all individuals who have previously had cancer, were treated and are now alive
• All are important but which measure should be of most relevance to employers?
Private Sector Impact
Cancer Overview
60,000
80,000
100,000
120,000
140,000
160,000
NSCLC
Prostate
CRC
Breast
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0
20,000
40,000
60,000
Public
Private
Public
Private
Public
Private
Public
Private
Public
Private
Public
Private
Public
Private
Public
Private
Public
Private
Public
Private
2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Breast
• Lifestyle
– Smoking
– Diet
– Infections
• Demographics
Growth Drivers
Cancer Overview
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• Demographics
– Aging population
• Public Health initiatives
– Detection and screening
– Vaccination
Development Overview
Development is driving shifting patterns of treatment and care
OLD MODEL NEW MODEL
Acute remitting care Chronic care
Development and Treatment Trends
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Development OverviewShotgun approach
Passive in-patient
Patients differentiated based on primary tumour site
Targeted approach
Active outpatient
Patients differentiated based on primary tumour site and tumour growth drivers
Development Overview
Number of New Cancer Drugs in Development by Type of Cancer
Development and Treatment Trends
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Development Overview
Development and Treatment Trends
Development Overview
Marketed Products and Development Programs
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Development Overview
Development and Treatment Trends
Development Overview
Development Pipeline by Class
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Development Overview
Development and Treatment Trends
Development Overview
• Oral drugs represent what percentage of drugs in development
A) 15-20%
The Pipeline for Orals
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Development OverviewA) 15-20%
B) 20-25%
C) 30-35%
D) 35-40%
Development and Treatment Trends
Development Overview
• Cancer chemotherapy is a major medical advance from the last few decades.
• Chemotherapy drugs have a narrow therapeutic index resulting in often unpredictable responses
• Targeted therapies in contrast are directed
Definition and Profile of Targeted therapies
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Development Overview• Targeted therapies in contrast are directed against cancer-specific molecules and signalling pathways resulting in more limited toxicities.
• Tyrosine kinases play a role in the modulation of growth factor signalling and a variety of new targeted therapies have emerged in recent years.
• TBD – use info gathered
Impact of shift to orals
Development and Treatment Trends
Private Sector Drug Expenditures
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Source: CIHI Health Expenditures in Canada Report, 2010
Impact of shift to orals
Development and Treatment Trends
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Source: Report Card on Cancer 2008, Cancer Advocacy Coalition
Development and Treatment Trends
Impact of shift to orals
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Source: Report Card on Cancer 2008, Cancer Advocacy Coalition
Development and Treatment Trends
Impact of shift to orals
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Source: Report Card on Cancer 2008, Cancer Advocacy Coalition
Development and Treatment Trends
$5,000
$10,000
$15,000
$20,000
$25,000
$30,000
$35,000
$40,000
$45,000
(000's
of
$)
Private
Public
Metastatic RCC Treatment Costs
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$0
$5,000
SU
TE
NT
AF
INIT
OR
NE
XA
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RIS
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HE
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SU
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2003 2011
Metastatic RCC has grown to a $65 million market of which $14 million is funded by the private sector.
Source: OncoEdge®
Forecasting Platform,
IMS CD&H data
Projected Treatment Costs for Metastatic Prostate Cancer
Development and Treatment Trends
$60,000
$80,000
$100,000
$120,000
$140,0003rd Line Other
3rd Line MDV3100
3rd Line Jevtana
3rd Line Abiraterone
2nd Line Other
2nd Line MDV3100
2nd Line Jevtana
2nd Line Docetaxel
2nd Line Abiraterone
Cancer Care SummitCancer Care Summit
$0
$20,000
$40,000
Pri
va
te
Pu
blic
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va
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Pu
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2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
2nd Line Abiraterone
CPRC - M1S Other
CPRC - M1S MDV3100
CPRC - M1S Jevtana
CPRC - M1S Docetaxel
CPRC - M1S Abiraterone
CPRC - M1A Other
CPRC - M1A MDV3100
CPRC - M1A Jevtana
Source: OncoEdge® Forecasting Platform
• Trials designed to assess value
• Design, approaches,
Clinical trials
Assessing Value
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• Design, approaches, endpoints
• PFS versus OS and rationale for surrogates
• Numerous hurdles exist in Canada to ensure value
• Health Canada
• P-Codr
Assessing Value
Evidence Based Views
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• P-Codr
• KOL approaches to incremental benefits
• What does this mean?
• “Successful” Canadian oncology products are able to achieve about 3% of US sales of the same product (Rituxan®, Herceptin®, Gleevec®, Eloxatin®)
Evidence Based Views
Assessing Value
Cancer Care SummitCancer Care Summit
• Some recently launched oncology products have only reached about 1% of US sales (Avastin®, Alimta®, Tarceva®)
• Payer approaches and the evidence based view in Canada have a downside effect on the sales of novel oncology drugs
• Prices are set by the Patented Medicines Pricing Review Board (PMPRB) and pricing is influenced by category
• Increasingly drugs are category 3 “provide moderate, little or no therapeutic advantage over comparable medicines.”
Pricing
Assessing Value
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medicines.”
• Prices are determined based on median of international prices
• Seen numerous examples where products will not be launched in Canada due to international pricing effects
• Safety net
• Employee attraction and retention
Rationale for Benefits
Rising to the Challenge
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retention
• Moving from paternalistic to shared responsibility
• Cost containment
• What percentage of Canadians will face catastrophic drug costs (greater than 3% of net income)?
A) <5%
The Impact of Downloading
Rising to the Challenge
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A) <5%
B) 5-7%
C) 8-10%
D) >10%
• RCC model and prostate model
• Future considerations need to look at ROI, interconnectivity of components
• Clearly quantify scope of issue
Internal Sustainability
Rising to the Challenge
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• Clearly quantify scope of issue
• Innovate in plan design (basic/catastrophic)
• Exception handling
• Contrast with employee need
• Private role in leadership
• KOL fatigue
Creating a Dialogue
Rising to the Challenge
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• KOL fatigue
• Stake in the system
• Need to look ahead in strategic way – examine connections in components rather than cost
Fostering Strategic View of Health
Rising to the Challenge
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components rather than cost islands
• Health Evidence
• OncoEdge Private sector model