It comes as no surprise that cancer prevalence in Europe is on the rise. Across the continent, the leap from 2.6 to 3.4 million cases from 1995 to 2012 is equivalent to a staggering 31% increase. What’s more, were current trends to continue, cancer would become the leading cause of disability in Europe.
There are a number of factors that may be fuelling this growth, including: population increases; population ageing; and a range of risk factors, such as obesity and a lack of physical activity. Let’s not forget, though, the role played by better screening processes and more accurate diagnostics in uncovering more cancer cases each day.
While the health burden is indeed staggering, the economic cost to society is also a major concern. Cancer costs Europe some €139 billion annually. This can be broken down to 49% in healthcare costs, 37% in indirect costs – productivity loss due to premature mortality – and 14% in medicines costs.
Against this backdrop, there is, unfortunately, a common misconception that the cost of medicines is somehow driving a massive increase in expenditure on cancer care. The reality is quite different as the share of EU health budgets devoted to cancer has remained relatively stable – at 6% over the past 20 years –and innovative medicines have contributed to a decline in the overall number of patient hospitalisation days, which has resulted in savings elsewhere in the system.
Nevertheless, the pharmaceutical industry is focused firmly on tackling the cancer challenge, with numerous breakthrough therapies set to emerge from pipeline brimming with potential. These include CAR-T-cell therapy, already successfully employed against B-cell acute lymphoblastic leukaemia (B-ALL) and under exploration in the treatment of other haematological malignancies and solid tumours.
Next up is immunotherapy, which harnesses the human body’s own immune system to fight tumours. Today, immunotherapy drugs are already being used to treat a variety of cancers, including prostrate, breast, bladder, kidney and lung.
Many researchers think that immunotherapy drugs will be most effective when combined with other treatments, such as radiation or chemotherapy, or targeted treatments. Combination therapies offer the possibility to harness the power of a range of anti-cancer treatments by targeting multiple pathways at once. By doing this, we can unlock their potential to extend lives and even offer a cure to patients for whom a cancer diagnosis currently is considered terminal.
Nevertheless, the industry is well aware that medicines can only be effective in patients who take them, and that access is unequal across the continent. We know, for example, that patients in Germany and Norway are far more likely to receive treatment with innovative oncologics than those in Latvia or Romania.
The pharmaceutical industry is keen to work collaboratively with healthcare stakeholders across the board to address the accessibility issue. One element of this approach is refocusing the way in which health technology assessment (HTA) is undertaken. EFPIA members have already taken part in the European Network for HTA’s (EUNetHTA’s) joint pilots on Rapid Relative Effectiveness Assessment (REA), which are designed precisely to increase equality in access through more consistent and timely HTA. The idea is that a single European joint relative efficacy assessment (EU REA) could at a later stage be integrated fully into a comprehensive national HTA.
We are also engaging comprehensively with the concept of managed entry agreements for oncology medicines – these may be finance- or outcomes-based. Under an outcomes-based agreement, the payment would be linked to the actual health outcomes realised in patients, for example using rebates or paybacks if specific endpoints are not met in a number of patients. Payment based on outcomes is a concept that should be explored further, not only for individual managed entry agreements, but also as a broader principle for paying for medicines and healthcare services in general.
It is also important that public partners collaborate with the industry to plan for the introduction of future innovation, for example through joint horizon-scanning exercises to explore the current R&D pipeline and assess how forthcoming innovations may benefit patients and societies, and impact healthcare systems.
It is this spirit of collaboration that is essential to solving the access issue. If healthcare stakeholders work together with mutual respect and understanding, cancer patients would be the ultimate beneficiaries of life-saving innovation.2