News

Irish body says new cancer treatment diagnostic test is too expensive

The National Centre for Pharmacoeconomics (NCPE) which is funded by the Irish government has recommended that a new diagnostic test for detecting breast cancer in women should not be made available to public patients because it is too expensive. The Oncotype DX genomic test helps to suggest the type of cancer treatment a woman needs to get and it could also save women from having to undergo chemotherapy.

The decision by the NCPE not to recommend the test — which costs 3,000 Euro — was purely based on price and not on its efficacy. It is one of the few occasions that the NCPE has not given the green light to a new product because of price.

The diagnostic test is, however, available to private patients and the distributor, Genomic Health Ireland, has launched a public relations campaign to highlight its cost efficiency. The company also said that it was reviewing its application to the public and private health insurance systems.

The NCPE’s recommendations in relation to Oncotype DX — which must be set in the context of Ireland’s difficult economic climate — points to the need for medical device suppliers seeking to introduce new products into the Irish public reimbursement system to carefully review their pricing policy and to ensure that their projected Irish prices reflect those obtaining in other European countries.

Postscript: The NCPE has carried out a re-assessment of the cost-effectiveness of the test. This followed the conclusions of commercial negotiations between the Health Service Executive, the public sector healthcare funder and provider, and the distributor, that resulted in a reduction in the overall cost. The NCPE reviewed its initial assessment and confirmed that the test now represents value for money and is cost effective.

Important changes to Dutch hospital treatment reimbursement

From 2012 onwards, important changes will be made concerning the reimbursement of hospital treatments in the Netherlands. These changes will have a considerable influence on the provision of hospital services. Consequently, hospitals will have to review their treatments to see whether they are able to implement them whilst covering the costs or whether they can implement them profitably. In addition, the changes will force hospitals to increasingly specialise.

These changes can have a significant influence on the enterprises that distribute their products to the hospitals. Therefore, Agora’s partner in the Netherlands, Seijgraaf Consultancy, has made an overview of the most important changes:

The hospital financing system from 2012 onwards:

  • Decrease in existing fixed hospital budgets;
  • Hospitals need to negotiate with the healthcare insurers about more treatments (about 70% is free negotiable and about 25% is free negotiable with a maximum tariff);
  • Hospitals will have to use new codes to invoice to the insurers (4.000 so called ‘care products’ based on the ICD-10 system in stead of 30.000 DRGs based on the specialism involved)
  • Because of changes in risk equalisation, insurers will run a larger risk whilst purchasing hospital treatments.

Implications and points of attention:

  • Not every hospital shall be contracted for each treatment anymore. For the manufacturers this may mean a change in the hospitals buying their products;
  • Hospitals and medical specialists need to map which care products they will be able to invoice for a certain treatment, and subsequently they will have to negotiate a tariff that covers the costs with the healthcare insurers. For manufacturers it becomes of interest whether costs for products within the care profile will be included in the negotiations;
  • For a certain number of complex treatments in the UMSs (Academic teaching hospitals) negotiations with a maximum tariff are required. At this moment it is a point of attention for hospitals to find out whether these tariffs are sufficient to cover the costs;
  • The tendency is that specialised treatments in the home situation (outpatient care for which the hospitals are responsible) should be reimbursed increasingly through the hospital financing system. For manufacturers this may mean a shift from reimbursement through the Medical Device Act or the Expensive Drugs List to reimbursement through the new hospital financing system.

Difficult choices for German health insurers

In recent weeks, the number of messages regarding “distressed” health insurance companies has increased. Remediation approaches and forced mergers were the consequences. Wiwo.de reported on 28 May that another 22 health insurance companies are endangered. How will these health insurance companies deal with this situation?

It can be assumed that the health insurance companies, which still have a certain leeway, will try to reduce spending. That is why many health insurance companies will try to pursue new contracts in the next 12 month. This increases the pressure in the reimbursement market (including medical aid). There is little time for health care providers to adapt their own resources, or even to think about business model modifications.

For the next 12-18 months a widespread phenomenon can be assumed. Surely the health insurance companies, which are possible candidates for such action in question, can be identified to prepare for talks.

Google Health service to be discontinued

When the Internet giant, Google, presented the personalised digital medical records storage service, Google Health, in 2008, the expectations were high. Now the company has announced that the service will be discontinued at the end of the year. Users will be able to log in and use Google Health through January 1, 2012.

According to Google the ending of the service is due to the small number of users.

Our comment: The reasons for the low use of patient records are not only the fact that critics have warned about the storage of sensitive patient data by commercial companies. Other health data storage providers in Germany with higher security requirements, such as the patient file of the ICW or the Compugroup, have similar problems.

The cause lies in the lack of user friendliness. As long as documents and communication in healthcare are based on paper, the effort for all parties involved collecting them digitally is too high. Since there is no progress is expected in the foreseeable future in this area and also the electronic health card has been reduced to an insurance card with picture and emergency data, the digital health record market currently has no real prospects in Germany.

Larger projects will have better prospects, where digital medical records are managed by clinics, doctors, etc., and are shared with other institutions of care. Regional structures will have the greatest potential to succeed.

OECD: Government expenditure on healthcare declined in 2010

In 2009, healthcare spending in OECD countries rose by about 10 per cent. This trend declined in 2010 due to health policy restrictions, but the level remains stable.

The demand is there, the marketing efforts of companies are effective: only the intervention of the state prevents further growth. If these additional expenditures were covered by private reimbursements, further growth could be realised. This also means that the industry could grow if marketing was geared more towards private payers.

Therefore, an important task in the coming years is to plan new marketing activities and align them accordingly.

UK: Smart Solutions for Healthcare

The National Health Service (NHS) is offering suppliers of products and services involved in the treatment of heart diseases, cancer and other long-term conditions an opportunity to have them evaluated in a clinical setting. The Smart Solutions for Healthcare initiative aims to help the NHS make significant improvements in quality, innovation, productivity and prevention (QIPP). The NHS is on the lookout for smarter solutions and new ways of working and has been challenging industry and other innovation suppliers to help find the right solutions.

Smart Solutions for Healthcare addresses two healthcare priority areas — Cardiovascular Disease and Long Term Conditions — and is specifically seeking innovations that enable patients to have a greater role in managing their own health, help improve staff productivity and eliminate waste.

Smart Solutions for Healthcare is being delivered by TrusTECH – the North West NHS Innovation Hub, and is supported by NHS North West, NESTA, Northwest Development Agency (NWDA), England’s Northwest, Manchester City Council, Manchester: Knowledge Capital, and New Economy through the Innovation Investment Fund Partnership.

More information can be found on the Smart Solutions for Healthcare web site.

Agora Consulting announces new Belgian partner: HM3A


Agora Consulting is delighted to welcome its latest partner, HM3A, who will be responsible for the Belgian market.

Based in Brussels, HM3A is an independent specialist consultancy committed to delivering value and quality through objective and effective advice to clients, specialising in access to markets, and their maintenance, for pharmaceuticals and medical devices.

For more information, visit the HM3A web site.

Germany: Reform of the Market for Medicinal Products Act (AMNOG)

January 1, 2011, saw the coming into force of the Reform of the Market for Medicinal Products Act (AMNOG). The Act aims to curb the spiralling expenditure for medicinal products by the statutory health insurance funds. It paves the way for fair competition and a stronger orientation to patients' wellbeing.

The AMNOG creates a new balance between innovation and the affordability of medicines. From now on, the price of medicines will be determined by the added benefit they bring for patients. In addition, physicians will be relieved from burdensome paperwork and citizens better informed through independent patient counselling services.

For more information on AMMOG, visit the web site of the Ministry for Health.

Ireland: New government plans major health insurance changes

A new Irish government was elected in February 2011 and has committed itself to developing a universal, single-tier health service, which guarantees access to medical care based on need, not income. By reforming the model of delivering healthcare, so that more care is delivered in the community, and by reforming how Irish people pay for healthcare through Universal Health Insurance, the new government is seeking to reduce the cost of achieving the best health outcomes for citizens, and to end what it terms as the “unfair, unequal and inefficient two-tier health system.”

The new government is planning to introduce Universal Health Insurance with equal access to care for all (the majority government party, Fine Gael, has been a long-time admirer of the Dutch universal health insurance system. Under the proposed Irish system there will be no discrimination between patients on the grounds of income or insurance status.

The existing organisation, the Health Service Executive, which is responsible for overseeing existing reimbursement schemes will be phased out over time. Its functions will return to the Department of Health and Children or be taken over by the new proposed Universal Health Insurance system.

Additionally, the incoming government has also announced changes in relation to access to the Long-Term Illness and High-Tech Drugs schemes.