On November 3rd 2017 the UK Government published its endorsement of the Accelerated Access Review (Making a reality of the Accelerated Access Review: Improving patient access to breakthrough technologies and treatments in a cost-effective model). At the core of the Accelerated Access Review is the proposal to get strategically important, cost-effective products into the NHS as rapidly as possible within NHS resource constraints. The Government is looking to industry to develop innovations and technologies that deliver better outcomes for patients, but do so with improved value for money. But what does value for money mean? Are we now in a position to shape what value really looks like?
The whole-system value proposition really excites me, how new pharmaceutical innovations have the potential to add value to healthcare systems beyond patient outcomes, patient experience and cost, to provide solutions to some of the biggest challenges healthcare systems face. During our advisory boards and market research studies we take great care to explore all the avenues of value, testing these concepts with payers and clinicians until we arrive at a consolidated vision for the value proposition. The vision, most often than not, is whole-system value.
So how does Industry respond to this exciting opportunity? It is still early days. The industry innovators are taking hold of this opportunity with both hands and running with it, reshaping their value propositions and their customer conversations to speak to whole-system value, and importantly gaining traction. By adopting this approach the true value of these innovative new medicines can be fully recognised.
However, what we know from diffusion of innovation theories is that only 2.5% of the participants in a system are innovators. This is a missed opportunity, for patients, for the NHS and for Industry. If Industry is unable to articulate value in this way, then the NHS will be unaware of the potential. It is our responsibility to lay this out, otherwise we will be in the value equals cost argument. A lower acquisition cost is not the only way to derive value in a healthcare system.
We know there are cost pressures, which must be delivered on. The NHS in England spends over £16 billion on medicines, this is significant spend. It is also growing and driven largely by the costs of hospital medicines. Medicines optimisation is a significant and realisable opportunity for the NHS with the Carter Review highlighting that unwarranted variation in use and management of medicines costs the NHS at least £0.8 billion per year that could be re-invested elsewhere.
This is the basis of the Hospital Pharmacy Transformation and Medicines Optimisation CQUIN. A key priority within the CQUIN is for the faster adoption of best value medicines with a particular focus on the uptake of best value generics and biologics as they become available. The use of ‘best value’ here in relation to acquisition cost I can absolutely get on board with, when comparing like with like. However, when we start to look at ground breaking innovations that offer step changes in treatment and opportunities across the whole-system, value takes on a whole new meaning.
Demand increases and no real increases in funding or efficiency are giving rise to the £30 billion 2020 funding gap, a stark reality of NHS pressures. The Five Year Forward View (FYFV) is the delivery strategy to close this gap and highlights where the opportunity for value creation really lies. The buzz words here are prevention, new models of care and dealing with rising demands e.g. an ageing population, workforce issues and capacity pressures. The FYFV cites that the ‘right care, at the right time, in the right setting, from the right caregiver’ could avoid the need for another 17,000 hospital beds, equivalent to opening 34 extra 500-bedded hospitals over the five year strategy.
These are the real customer ‘jobs to be done’. By satisfying these needs we can take value conversations to a whole new level. This is the new era of value. These new innovations allow us to redesign and improve pathways, provide solutions to capacity and workforce issues and can be the catalysts for new models of care. We need to explore the full potential of these ground breaking medicines across the whole-system.
The 2017 Life Sciences Industrial Strategy agrees, outlining that pharmaceutical innovations can be used to change whole pathways of care, ideally reducing costs and improving outcomes. The strategy recognises that constraints in funding innovative products provides one mechanism for limiting expenditure in a financially-pressed healthcare system, but states it would prove more sustainable if efforts were made to increasingly use innovation to improve efficiency more widely to meet the rapidly growing demand.
Building on the recommendations in the Accelerated Access Review there is recognition that a resource impact assessment and clinical pathway change analysis should form part of the appraisal process for new innovations, with an NHS adoption plan being published, alongside positive final guidance on the clinical pathway change required for the successful implementation of the treatment.
So what do we need to do as an Industry? We need to be bold, try new things and follow the innovators on their adoption journey. This isn’t easy, in many instances it will take a shift in organisational mind-set, not just in market access departments, but across the matrix team.
We need to uncover the true value of our brands and celebrate the innovation in all its glory. But most of all, we need to effectively communicate the value our technologies bring to the whole healthcare system. It is a travesty if the value of these innovative new medicines is not fully recognised, that patient access is limited and services remain under pressure. At the heart of the Government’s vision for accelerated access is a system which can embrace the innovations patients need: delivering faster patient access to life-changing innovations. The Government outlines ‘there is energy and hunger for innovation, with much already in train and even more in prospect’. Let’s innovate!
Criteria for considering health-system value beyond cost;
- magnitude of health gain;
- impact on unmet need;
- alignment with NHS England’s clinical priorities and other national priorities;
- impact on system efficiency;
- opportunity for clinical pathway transformation.
Criteria adapted from the AAR