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01.02.19

Nearly everyone has been touched by cancer, either through relatives or friends, or through the own diagnosis. One in five people develop cancer before age 75 worldwide, according to the recent update of International for Research in Cancer (IARC).[1] In the UK it is one in three people.[2] Cancer is about to become the disease with the highest burden for society.[3]

Guiding our thinking in cancer

Many governments and stakeholders recognize this.[4] At EFPIA we have created the EFPIA Oncology Platform and recently launched our discussion paper on collaboration in cancer together with various stakeholders.

We know about the challenges, but we also must know where to focus on in the future. Three data points came to my attention recently. I consider them as helpful in our fight against cancer:

 

Deepak Khanna

Deepak Khanna is Senior Vice President and Regional President, EMEAC Oncology for MSD. Deepak took on this new...
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Data point 1: Cancer mortality
In the Nordics cancer mortality has continuously decreased since the 1960s, despite increasing incidence.[5] This is mostly due to prevention, better diagnosis, screening, surgery and more effective medicines.[6] Data point 1 indicates that cancer care is generally on the right track.



Data point 2: Healthcare expenditure
Healthcare expenditure growth is about to align with GDP growth.[7] For many years there was a wide gap with healthcare expenditure growing much faster than the economy of most OECD countries. Recent developments show that sustainability mechanisms are working and a balance between access, incentives for innovation and affordability is possible.
Data point 3: Access to cancer medicines
Taking the example of chronic myeloid leukemia (CML): Most patient diagnosed with CML who receive treatment will have a normal or near normal life expectancy. Not everyone has access to cancer medicines. The lower income countries have markedly lower adoption overall compared to middle- and higher-income countries.[8]

Cancer outcomes = access to cancer care
Inequalities in access are reflected in cancer outcomes. Five-year survival in Bulgaria is much lower than in Sweden.[9] This means mortality could be decreasing even more if more people had access to cancer care.


Improving access is not simply providing a medicine. It means time to access, affordability and availability. How fast do patients get access to medicines? Is innovation affordable? Are the medicines prescribed, i.e. are they available to patients?
 
Access is a mutual responsibility
Everyone has an interest in access: patients, governments and industry. Access is a mutual responsibility between governments, payers, clinicians, patients and industry. In some circumstances industry and payers disagree on what is the right endpoint to measure efficacy. In other circumstances, the national legal framework limits the ability to create access agreements. All of them have in common that better collaboration between stakeholders are critical for better access.
 
The Belgian government developed a medicines strategy together with industry, the so-called “Pact for the Future” which reduced time to access more than ten times while securing budget predictability. Italy installed an innovation fund which secures the availability of innovative medicines, including cancer. And the UK created with the new Cancer Drugs Fund (CDF) a mechanism which allows for early access where evidence is still uncertain.
 
Focus on collaboration in access
Maybe there is a fourth data point: collaboration. All the examples mentioned above were co-developed by industry and stakeholders.
 
The EFPIA Oncology Platform is a concrete example at an international level. All this shows that mutual responsibility will also ensure mutual benefit.
 
[3] Jönsson, B., Hofmarcher, T., Lindgren, P., Wilking, N. Comparator report on patient access to cancer medicines in Europe revisited. IHE Report 2016:4, IHE: Lund, p. 9
[4] The European People’s Party (EPP) wants to double EU spending on cancer research by 2024, committing itself to fighting cancer. Recently Manfred Weber, “Spitzenkandidat” for post of President of the Commission, called for a “Master Plan for fighting cancer”.
[5] http://gco.iarc.fr/today/data/factsheets/cancers/39-All-cancers-fact-sheet.pdf
[6] Jönsson, B., Hofmarcher, T., Lindgren, P., Wilking, N. Comparator report on patient access to cancer medicines in Europe revisited. IHE Report 2016:4, IHE: Lund
[7] OECD (2018); http://www.oecd.org/health/health-systems/Health-Spending-Latest-Trends-Brief.pdf
[8] Jönsson, B., Hofmarcher, T., Lindgren, P., Wilking, N. Comparator report on patient access to cancer medicines in Europe revisited. IHE Report 2016:4, IHE: Lund, p. 114
[9] Jönsson, B., Hofmarcher, T., Lindgren, P., Wilking, N. Comparator report on patient access to cancer medicines in Europe revisited. IHE Report 2016:4, IHE: Lund, p. 26

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