Is Belgium ready for access to innovative medications and treatments?

Conclusions from the 'Oncology Horizon Scanning Project'

The Vlerick Healthcare Management Centre is publishing the results of its Oncology Horizon Scanning project which examines whether Belgium is ready to provide access to the innovative, personalised treatments and medications which are in the pipeline. These are mainly for Cancer, the second most common disease in Belgium and a therapeutic field which is currently characterised by a great deal of progress and innovation. In these times of economic austerity and budgetary constraints in the healthcare sector, it is a social challenge to nonetheless provide access to this new generation of drugs which offer significant therapeutic benefits yet also involve significant costs. The conclusions of the study and the concrete recommendations were revealed yesterday.

On the threshold of a breakthrough in personalised drugs and treatments

Over the next five years, we will see plenty of new but often also expensive Cancer treatments coming onto the global market, mainly innovative personalised treatments and immunotherapies. This was recently confirmed at the ASCO (American Society of Clinical Oncology) conference. The diagnostic tools are also evolving at a rapid pace. These are being used to ensure the more targeted use of treatments and for screening, monitoring and optimising treatments.

In view of these promising prospects in the area of Cancer treatments, the Oncology Horizon Scanning project conducted by the Vlerick Healthcare Management Centre formulates recommendations on how the Belgian healthcare authorities might ensure that patients are able to gain access to these targeted treatments in the near future.

Currently, 5% of the total Belgian drug budget (EUR 4 billion) is spent on innovative, targeted Cancer treatments. The study predicts that this figure will rise to between 8.9% and 9.5% of the total budget in 2020, which represents a sum of over 500 million euros. Over a period of seven years, this would mean tripling the budget which was spent on Cancer drugs in 2013. It should be clear that this evolution constitutes a major challenge, certainly if you bear in mind the historically stagnating (and sometimes even decreasing) budgets. In addition, alongside the medicines budget, the waiting times for these treatments and drugs are also regarded as a fundamental problem for which the Belgian healthcare system needs to find a solution.

Need for better discussion between the CTG and TGR

In order to deal with these innovative and personalised Cancer treatments, the researchers behind this study suggest that the CTG (Commission for the Reimbursement of Medicines) and TGR (Technical Medical Council) should guarantee the market access for drugs and treatments by mutual agreement. A method is being proposed for the joint evaluation of the repayment levels. In the current system, proposals relating to treatments and diagnostic tests are considered separately by the two committees, leading to delays and unsynchronised budget management.

Need for a five-year budget plan

In order to anticipate the market introduction of the pipeline innovations, which is inherently uncertain, the study looks ahead to 2020 and proposes an advanced transversal budgeting mechanism. In accordance with this mechanism, which extends the horizon of the prediction from the current 1 year to 5 years, this will greatly improve the forecasts. In addition, in order to increase the reliability of the predictions, this exercise must be carried out at an international level. The innovation pipeline will then need to be financed in a structured way at a national level. This can be achieved by means of price decreases in the current drug portfolio or a possible increase in the drug budget, but also through the possible reduction of repayments and transversal savings on the healthcare budget. After all, as a result of the transversal nature, the more personalised and targeted drugs will help to avoid expenditure in other healthcare sectors.

Without taking the latter transversal component into account, an innovation forecast based on a period of three years could be financed to a level of 84%, which would not be a problem if the budget increases. However, a five-year forecast shows that a problem exists nonetheless. Without a budget increase or gains from budgetary transfers, it will be possible to finance only 66% of the innovations. Mapping out the innovation pipeline has therefore clearly demonstrated that a forecast based on five years instead of the current one year will lead to far more accurate predictions and the ability to respond to the specific requirements in a prepared manner.

In our study, we wanted to draw attention to the need for a longer-term vision in order to ensure access to innovation. One of our recommendations also shows the importance of closer collaboration between the various institutions which are responsible for the healthcare policy in Belgium and Europe. This is certainly the case if we also want Belgian patients to be able to benefit from the therapeutic innovations which will be made available in the near future,” explains Prof. Walter Van Dyck, partner of Vlerick Business School, Director of the Vlerick Healthcare Management Centre and the primary author of this study.

Impact on the healthcare budget

A simulation of this advanced transversal forecasting method has shown that, in order to finance the innovation pipeline in personalised cancer drugs at the current prices, over the next five years the total drug budget would need to rise by a constant growth percentage or CAGR (Compound Annual Growth Rate) of between 0.89% and 2.05% each year, as long as the budget for conventional drugs remains constant or rises in line with the historical growth rate.

This required increase in the drug budget can be reduced only if a decision is made to take into account the possible effects of the reduction of repayments or the transversal budgetary impact. The essence of the proposed transversal forecasting methodology is that the innovative drugs make it possible to avoid expenditure in other healthcare sectors. The budget impact of doing so is being tentatively calculated for the first time. In this case, it would be a good idea to use some of the reduced expenditure in other sectors to partly fund repayments for the innovative drugs. The simulations show that the order of magnitude is not insignificant and is between EUR 208M and EUR 461M over the next five years. However, an operational data infrastructure which integrates both scientific and medical-economic data is indispensable for the application of this transversal forecasting methodology in practice. It goes without saying that this cannot be created overnight.

About the study

This study took place in 3 phases: the initial phase involved the establishment of a literature study on the health policy, the general economic opportunities and challenges of these new treatments and their implementation in the Belgian healthcare system. In a second phase, exploratory interviews were held with stakeholders of the Belgian National Institute for Health and Disability Insurance (RIZIV) and with care providers and research institutes in oncology, among others. This second phase also charted the conclusions of studies relating to the Belgian healthcare system since 2005. The researchers used this as a basis for formulating their hypotheses. The concrete research questions also stemmed from these first two phases.

In the third and final phase, two decision-making systems were elaborated in order to promote  access to these new drugs in Belgium: a synchronised repayment system at a Belgian level for both personalised treatments and diagnostic tests and a sophisticated rolling 5-year budget forecasting system.

The results and recommendations of the study were then presented to an external validation panel, in particular consisting of Dr. Ri De Ridder (RIZIV), Prof. Lieven Annemans (UGent) and Prof. Leo Neels (Advisory Board Chair of Vlerick HCM).

About the Vlerick Healthcare Management Centre

The Vlerick Healthcare Management Centre (HMC) is an independent European think tank and higher education institute which is based in Brussels and puts forward innovative and workable management and policy solutions in the fields of healthcare and life sciences. Vlerick HMC is fully owned by Vlerick Business School and is financed by subsidies from public institutions and private organisations. Currently, it has a Roche Research Chair and an unconditional grant from AstraZeneca. It has the MSD as a knowledge partner and the hospitals 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 and Maria ziekenhuis Noord-Limburg as members of MINOZ Research.

Vlerick HMC is headed by Prof. Walter Van Dyck, a partner of Vlerick Business School who works as the director of the centre. Vlerick HMC's research agenda is established by the director in consultation with the International Advisory Council of Vlerick HMC, which is chaired by Prof. Leo Neels and consists of the following members: Prof. Richard Barker (CASMI, UK), Mr. Jo De Cock (NIHDI, BE), Prof. Denis Lacombe (EORTC), Prof. Kjeld Moller Pedersen (COHERE, DK) and Prof. Maarten Postma (RUG, NL).

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