This blog post submitted by: Shelby Reed, PhD, Professor of Medicine, Duke General Internal Medicine, and newly elected President of ISPOR, 2017-2018.
The International Society for Pharmacoeconomics and Outcomes Research, better known as ISPOR, held its 19th Annual European Congress in Vienna this past week. I have been a member of ISPOR for about twenty years during which time the organization has grown from having a few hundred members to more than 20,000 members across 85 countries. Last spring, I was elected to serve as President of the organization in 2017-2018.
ISPOR’s mission is to promote health economics and outcomes research excellence to improve decision making for health globally. With over 4,800 health policy makers, researchers from public and private sectors, biopharmaceutical and device manufacturers, and patient advocates in Vienna presenting new research findings, debating issues and forging new collaborations, ISPOR is clearly making strides to fulfilling its mission.
As President-Elect, I had the opportunity to attend a full-day roundtable discussion prior to the meeting with about 30 representatives of health technology assessment groups across Europe, including EUnetHTA, the European Commission, NICE, IQWIG, the World Health Organization and others. There was a great deal of discussion about coordinating efforts to avoid multiple evaluations of the same technology, but there was also recognition that each assessment requires adaption to a local context for coverage decisions and the timing needed for decision-making varies across jurisdictions. As someone who has spent most of my career conducting cost-effectiveness analysis in the U.S., I was envious to observe the exchanges between European analysts and decision makers discussing pragmatic ways to improve the usefulness of health technology assessments for policy application.
These discussions were reflected in the opening of the Congress. Senior Medical Officer of the European Medicines Agency (EMA), Hans-Georg Eichler kicked off the first plenary session by explaining that pay-for-performance is not a new idea. Years ago in Vienna when bread loaves were not baked to be at least as large as the city standard (a circle approximately 10 inches in diameter on the façade of the city’s church), the baker would be dunked into the cold waters of the Danube while the citizens cheered. After Dr. Eichler’s entertaining story, plenary speakers from the EMA, EUnetHTA, the European Commission and the pharmaceutical industry discussed potential synergies between regulators and health technology assessment agencies across Europe.
The second plenary also debated a highly-relevant public policy issue: pricing of medicines in Europe. With speakers from the WHO, the Belgian National Institute of Health and Disability Insurance, the Office of Health Economics in London and the London School of Economics and Political Science, the session melded economic theory, political realities and policy levers to address issues of drug pricing and access in Europe. The speakers argued that differential pricing (i.e. charging higher prices to wealthier countries and lower prices to poorer countries) improves economic efficiency. However, European Union law requiring parallel trade of goods throughout Europe makes differential pricing difficult. Countries have responded by referencing (lower) prices in other countries to support their pricing negotiations and have secured confidential discounting, resulting in a less efficient system overall and limited access to new therapies in lower-income countries.
In addition to attending plenary sessions, I delivered a podium presentation reporting on two methodological approaches to evaluating taste heterogeneity in patient preferences from a discrete-choice experiment designed to evaluate benefit-risk tradeoffs that older individuals were willing to make in the context of medications that could delay onset or slow progression of Alzheimer’s disease. Dr. Reed Johnson from Duke was a coauthor on the abstract. Reed also presented on challenges in eliciting patient preferences for complex medical technologies using a case study in whole genome sequencing. Reed and I also had an opportunity to highlight a themed section that was recently published in ISPOR’s journal Value in Health on use of stated-preference research to inform regulatory decision making. I served as Guest Editor for the section, and Reed led the paper reporting on the US perspective featured in the section.