The innovation pathway: aligning ambition for successful adoption of new health technologies
The relationship between the life sciences industries and the health systems that they serve is complex. Patent protection in most jurisdictions provides a considerable period of market advantage to innovators, for whom the investment has been considerable and for which the risks, for a return on that investment may be considerable. For health systems and the institutions that deliver care in them, health technologies are an essential tool in delivering the outcomes their users want. In most diseases and conditions, clinical interventions offer improvements in quality of life or length of life or sometimes both but rarely, historically, a cure. So, for patients, the health services that care for them and companies, there is a shared interest in continuous innovation with the goal of improving outcomes.
That shared ambition can be frustrated when the approaches to valuing innovation and arranging its adoption, taken by health services and life sciences companies, are misaligned. This misalignment has a number of causes. Health systems are not always clear about what they want from the life sciences industries. Companies must ‘read’ their markets across the globe, not just in a single country; individual health systems are generally concerned only about their own priorities (vaccines and perhaps anti-microbial resistance are possible exceptions). Price at market entry stresses most health systems’ finances and for some, puts products beyond their reach. And in some health systems, the absence of arrangements to evaluate and manage the adoption of new products makes it harder to get innovation to patients quickly.
Health services and the industries can do a number of things to address this challenge. Health services can provide the life sciences industries with greater clarity about their priorities and ambitions for disease areas, outcomes, and system impacts, such as cost-lowering interventions. Improved upstream engagement, such as scientific advice and market access advice can provide signals to companies about how to get their products to patients. The health service in England is doing this through an initiative called the Accelerated Access Collaborative, which brings together the NHS, the life sciences industries, NICE, research funders and the main life sciences products regulator. Three main initial priorities have been identified: advanced therapy medical products, such as cell and gene therapies, tumour agnostic therapies, and the use of artificial intelligence in screening and diagnosis. And companies can ensure that they understand the ambitions and constraints of the health systems with which they work by crafting their value propositions, including the setting of prices, accordingly.
Close working between regulatory and evaluative agencies and companies is important, along with the use of managed access arrangements that incorporate price flexibility, data collection, clinical detailing and patient engagement. And it is important that guidelines on the position of new technologies in the care pathway are clearly set out for practitioners and patients, providing treatment sequencing information and choice for patients. Where appropriate, this information can be supplemented with patient decision aids.
The conditions for success in evaluating and adopting innovative new technologies in most jurisdictions are likely to be a combination of an evidence-based value assessment, the development of which is shared between the health system and the innovator and that is then used as the basis of access decisions. Processes should provide companies with structured opportunities to engage with payers so that health systems’ expectations of benefits from new technologies can be aligned as far as possible with companies’ expectations of a return on their investment. And company value propositions that recognise the ability of the health system to pay for new technologies can help pave the way for the access to new treatments.
Health systems and companies need to share the risks associated with uncertainty at market launch and look for flexible and creative solutions that work in the interests of patients and the health system. Clarity about the position of the new technology in the care pathway and active engagement with patients through shared decision-making can help ensure that new treatments are used where they can provide most benefit.
Find out more about the conditions for a successful pathway for innovation and hear some examples of initiatives in the UK to facilitate rapid access to new innovations from the keynote presentation of Sir Andrew Dillon at the IHF World Hospital Congress taking place in Muscat, Oman on 6-9 November 2019. Visit www.worldhospitalcongress.org for more details.