Value-based healthcare: What’s it worth to you?
It takes healthy people to make a healthy society – and that must be taken into account when we are talking about value-based healthcare.
What represents value to you? How much is quality of life worth, who gets the benefits and how can they be quantified?
These aren’t new questions, but they have taken on a greater urgency in recent years as advancing medical science collides with austerity-era budgets.
In the UK, there’s been a series of upsets over the National Institute for Health and Care Excellence (NICE) deciding several drugs were “not cost-effective”.
What’s in a QALY?
Qarziba (dinutuximab beta) for children with high-risk neuroblastoma and a number of MS disease-modifying therapies are among those to be rejected in draft guidance because of their price in the last year or so.
Appeals and consultations, discounts and access schemes – not to mention some collaboration between patient groups and industry – mean all these drugs are now back on the NHS table.
But the fact remains that basing cost-effectiveness decisions on the value of quality-adjusted life year (QALY) doesn’t consider the wider value of treatment.
According to NICE, QALYs are calculated by “estimating the years of life remaining for a patient following a particular treatment or intervention and weighting each year with a quality-of-life score (on a 0 to 1 scale)”.
It is usually measured in terms of the “person’s ability to carry out the activities of daily life, and freedom from pain and mental disturbance”. But what about the indirect costs of a condition?
Like so many things in the world around us, joined-up, society-wide thinking is needed if we want to understand the true, wider value of medicine.
Talking in eyeforpharma’s latest Trends in Marketing report, Fabrice Chouraqui, president of Novartis in the USA, summed it up.
“The true value of a treatment is looking at it holistically in a fair and balanced way, using transparent methodologies that take into consideration the value it brings to different players in the healthcare system,” he said.
“I see shrinking a tumour, for example, as the clinical value of a treatment, while the patient value comes from improving the quality of life for patients; the health system’s value can be illustrated through reducing the rate of rehospitalisation, but there is also the societal value, such as allowing the patient or even a caregiver to return to work.”
We know that we are living through something of a revolution in healthcare, but as treatments get ever more complex, they are ever more expensive. The definition of “cost-effectiveness” needs to widen.
In May and June, respectively, both the FDA and the EMA signed off on Aimovig® (erenumab).
The first monoclonal antibody for the prevention of migraine, Aimovig, which is being marketed by Novartis and Amgen, is something of a game changer.
It works by blocking the activity of a molecule that can trigger migraines, calcitonin gene-related peptide (CGRP), and is injected every four weeks to keep attacks at bay.
It’s a long-term treatment for a long-term condition – meaning it’s probably going to be expensive for healthcare systems.
Preparing the market access ground
In June, Novartis and Amgen published the results of My Migraine Voice, a survey of more than 11,000 people across 31 countries.
It found that 60 per cent of employed people with severe migraine missed an average of one week of work every month.
When taking into account indirect costs such as lost productivity, researchers estimated the total annual cost of the condition to be €27 billion in Europe and around $20 billion in the US.
This really does outline the value of reducing symptoms, as Paul Hudson, CEO at Novartis Pharmaceuticals, explained.
“Migraine is a debilitating neurological disease associated with significant personal, economic and societal burden,” he said.
“There is an urgent need for effective and well-tolerated preventive treatments that positively impact the lives of people with migraine.”
My Migraine Voice was the biggest global study of people living with migraine ever carried out and the two companies worked with the European Migraine and Headache Alliance (EMHA) to make it happen.
“Migraine is often dismissed as just a bad headache. These results shed light on an invisible, yet debilitating disease,” said Elena Ruiz de la Torre, executive director of the EMHA.
“Despite living with such an incapacitating condition, people living with migraine strive to be very productive but need better relief from symptoms, and support in the workplace to ensure they can achieve their full potential.”
This collaboration is key because, in the end, value intersects.
What matters to patients, caregivers, healthcare providers or pharma may differ, but we will all benefit if we work at the point where “value” overlaps. We could all do well from medicines that have society’s best interests at heart.
About the author:
Amanda Barrell is a health and medical education journalist, editor and copywriter. She has worked on projects for pharma, charities and agencies, and has written extensively for patients, healthcare professionals and the general public.