Sowing into Good Ground: Using “personalized medicine” for optimal treatment value
As demonstrating value for the “average patient” becomes ever more difficult, Health Economics and Outcomes Research leaders can use “personalised medicine” to drive Research and Development rather than waiting for HTA agencies and decision-makers to impose segmentation on their terms. In this article, we outline the key activities, challenges and considerations for developing an HEOR-driven personalised medicine strategy: Identifying sub-groups with different risk and benefit profiles, demonstrating value and generating and communicating evidence post-launch. Long-term planning and additional organisational capabilities are needed in order to be successful, but the reward is successful products even in highly competitive disease areas.
A new perspective on personalised medicine and health-technology assessment
Born as much out of technological advances in genomics as from the challenge of finding the next blockbuster, “personalised medicine” has been a buzzword of promise for the life sciences industry for some time.
One downside of the one-size-fits-all concept is being routinely demonstrated by payers, who are increasingly unwilling to pay for marginal value in a broad patient population, making the “average patient” a challenging concept for demonstrating value. This is very apparent in the alarming number of HTA decisions which are either rejected or granted access for just a small sub-population of patients or only as a 2nd line or subsequent treatment.
As the chances of achieving premium prices, reimbursement and broad access for large homogenous patient populations are ever declining, identifying sub-groups with different risk and benefit profiles early on is vital for successfully demonstrating value in many new therapies. This is true especially in progressive, chronic diseases with long-term clinical and economic outcomes. Kinapse believes that, in these situations, healthcare companies and their HEOR functions can treat personalised medicine as an opportunity to demonstrate value rather than wait, reactively, for HTA agencies and decision-makers to impose segmentation on their terms.
However, a value-driven personalised medicine strategy requires long-term planning and additional organisational capabilities in order to be successful. In this article, we briefly outline some of the key activities, challenges and considerations.
HEOR and personalised medicine strategy
The first step for a value-driven personalised medicine strategy is to identify the targeted patient sub-population and a credible value proposition for these groups. Genetic markers or biomarkers can be used to assess disease risk, inform treatment selection and dosage of drugs or to perform prognostic testing and monitor treatment success. Each of these options provides an opportunity to improve the ratio of cost, benefit and risk for a particular patient population.
This initial step provides an opportunity to enter into a proactive dialogue with decision-makers, collaborating to identify unmet needs and expectations. Identification of targeted sub-groups and value propositions should be finalised by Phase IIb at the latest, allowing the Development engine to generate evidence in Phase III studies.
Linking genotype to outcomes
A key consideration for developing a successful personalised medicine strategy is linking a genotype or biomarker to relevant outcomes, and providing a robust value proposition to payers and decision-makers. Whereas the effects on clinical outcomes, such as reduced adverse events, are far easier to demonstrate and model, linking quality of life outcomes to genetic or biomarkers provides a significant challenge.
Again, this presents an opportunity to enter into a dialogue with decision-makers early on. Moreover, industry-academic partnerships should be considered at this stage to provide a strong evidence base.
In phase III studies, the challenge is to generate evidence, either through additional studies or by integrating endpoints into Phase III studies, and at the same time develop the diagnostic technology. The technology must not only reach performance thresholds for specificity and reliability, but also be integrated with typical patient pathways and clinical practice. Where organisations do not have the capabilities to develop diagnostic technology in-house, managing the relationship with a strategic partner provides an additional opportunity for value-creation.
Evidence generation and communication post-launch
Naturally, by moving from “average patient” claims to targeting value in specific sub-populations, the approach to product launch will change, possibly with narrower claims at launch which then can expand over time as data accumulates to demonstrate benefits in wider populations/indications. After a product has been launched successfully, continued evidence generation for long term outcomes and safety data will be supported by the HEOR function. The HEOR function will also have to support communication activities, such as educating healthcare providers through medical guidelines and other communications.
While personalised medicine poses considerable challenges, it can be proactively used by HEOR functions as a tool to demonstrate value rather than being feared as a hazardous market access and reimbursement risk. Rather than scattering the product widely, just sow into the good ground.
About the authors
Henrike Grund is a Consultant in the Consulting Practice at Kinapse Ltd.
Gavin Outteridge is a Vice President also in the Consulting Practice at Kinapse Ltd. He leads the Health Economics and Outcomes Research service line.
Both Gavin and Henrike will be attending ISPOR 2010 between the 6th and 9th November and would welcome the opportunity to discuss this article or other Market Access challenges with conference attendees.
If you would like to organise a meeting at the conference please contact Gavin directly: email@example.com
Kinapse provides consulting and outsourcing services to the life sciences industries, globally.
Our mission statement is: ‘Collaborating with our clients to innovate for exceptional results’. Kinapse clients include many of the world’s leading pharmaceutical, biotechnology, medical device and specialty pharmaceutical companies, government organisations and life sciences service providers.
For more information please visit http://www.kinapse.com
Other Kinapse thought articles can be found at http://www.kinapse.co.uk/insights/
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