Acting with foresight in times of budget austerity

Summary
Horizon scanning is acknowledged to be one of the key components of a demand-driven healthcare system. We propose it to be a dynamic collaborative process driven by national unmet need matched with continued insight into the innovative pharmaceutical industry medicinal pipeline. Summer 2019 an international agreement was reached between payers to set up and commission an international horizon scanning initiative (IHSI), which is the international front-end of such a system. In this Policy Paper we propose a two-stage structure and organisation of the back-end national part of the horizon scanning process still to be implemented. This will lead to healthcare budgets managed with better foresight, a necessity in the face of breakthrough, some potentially curing therapies coming at a high cost. Taking the Belgian national component of the proposed horizon scanning system to implementation will require a pilot to be carried out. This to test the internal and external validity of the proposed design. 

Over the past years many new, innovative therapies came to market creating opportunities for patients for whom previously no (effective) treatment was available. Especially in the field of oncology many new drugs came available, starting with the targeted treatments focused at patients with specific mutations and followed by the immune-oncological drugs using the immune system of the patient to attack the cancer cells. Many more novel drugs are in the pipeline, among which gene therapies, which even have the potential to cure patients.

However, many of these new, innovative therapies come with high prices, making it challenging for payers to provide patients access to these therapies in times of budget austerity. In order to assure access to these promising therapies while maintaining a sustainable healthcare budget, pharmaceutical expenditure forecasting is essential. In a previous study we performed a 5-year budget forecast for oncology showing that there was not sufficient budget to fund the new innovative oncological therapies indicating that further budgetary measures would be needed. Systemically doing a horizon scan over a sufficiently long period is needed to reveal early enough whether there will be a problem funding new, innovative therapies.

In a first attempt to formulate policy starting from a horizon scan, the Minister of Health agreed with the pharmaceutical industry on a multi-year budgetary framework and accompanying growth path. In this Pact of the Future there is an agreement on a fixed annual growth rate of the pharmaceutical specialties budget, which offers the industry perspective and predictability, but at the same time, they have to contribute to budgetary efforts.

Moving forward, horizon scanning is an essential component of a demand-driven healthcare system, replacing the current pharmaceutical innovation supply-driven system. Such a system should be designed to dynamically match societal demand for health technology with the erratic supply of medical innovation. Societal demand for health technology expressed by patients’ unmet needs and national health objectives should drive the system. The supply of innovative medical technology should be monitored on an international basis and over a sufficiently long horizon in order to act with foresight. In an interactive dialogue with industry, the future horizon scanning system should evaluate the maturity and time to access of novel technologies, allocate budgets and set access priorities in a holistic portfolio –not the present product file-by-file– way.

At present, the International Horizon Scanning Initiative (IHSI) amongst the BeNeLuxA countries aiming to be fully operational in 2020, will provide foresight on the delivering pipeline of pharmaceutical innovation, and this in collaboration with industry. However, it has been convened that the final matching of this international medical innovation supply with health objectives and patient unmet needs and its translation into feasible health budgets should happen on a national basis.

After consultation of the various parties involved in the Belgian healthcare system, in this Vlerick Policy Paper we come with a set of working principles and recommendations on how this national dynamic demand-driven system for pharmaceutical expenditures can be shaped and put to work.

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