Policy developments in the Asia-Pacific region to fast-track precision medicine innovations

As new high-cost cancer interventions challenge the sustainability of healthcare systems, the international healthcare community met together at the Virtual ISPOR Asia Pacific 2020 Conference to discuss opportunities to ensure both patient access and value-for-money.

Dr Koen Degeling and Martin Vu from the Cancer Health Services Research group, of the University of Melbourne Centre for Cancer Research and School of Population and Global Health, reported on this online meeting, which took place from 14 to 16 September, for a special issue of the Value and Outcomes Spotlight publication by the Professional Society for Health Economics and Outcomes Research (ISPOR).

Maarten IJzerman group
Pictured: Martin Vu (bottom, right) and Koen Degeling (top, second from right) with Professor Maarten IJzerman's Cancer Health Services Research group

Research and development of precision medicine technologies is expensive and focused on increasingly fragmented patient populations, which has complicated how evidence is produced.  Consequently, innovations in precision medicine, such immunotherapies and CAR-T, often come with a hefty price tag and pre-mature evidence on their long-term health outcomes. This has made it difficult for health technology assessment (HTA) agencies to appraise their value-for-money by comparing the effectiveness and harm of such interventions, to their cost.

Other important policy challenges include substantial upfront investments for technologies such as CAR-T, and supporting healthcare systems to integrate clinical genomic sequencing as part of cancer care, Mr Vu said.

“Countries all across Asia Pacific are recognising the benefits of using genomic information to tailor cancer care for each individual patient, but the issue for many of these countries including Australia is translating the health economic benefits for the patient for the health system.

“For example, CAR-T therapy for certain types of blood cancer is expensive, but some of the challenges that were raised at this meeting relate to whether this therapy should be evaluated as if it was a pharmaceutical, like what the UK has done, or as a medical device like here in Australia.

“This is an important consideration because there are different regulatory assessment processes to understand efficacy, safety, quality and cost-effectiveness of this technology depending on this dichotomy between drug or device.”

Countries in the Asia-Pacific region have adopted a variety of strategies to control the impact precision medicine technologies on healthcare budgets, while focusing more on the patients perspective by promoting equitable access, said Dr Degeling.

“We are seeing policy success in several countries to stimulate early access of new cancer treatments, while controlling expenditure through risk-sharing agreements between pharmaceutical companies and payers and post-reimbursement evaluations using real-world data.

“For example, South Korea has implemented a system to monitor the health economic impact of high-cost pharmaceuticals after drug listing on the public health system, as the evidence continues to mature and a better understanding of the value of new cancer drugs is developed. A similar approach has been observed in Japan, where they reprice pharmaceuticals based on the premium, sales and cost-effectiveness of treatment.”

To reduce financial toxicities for patients, which may face substantial out-of-pocket expenses to access high-cost treatments through reimbursement caps on public insurance programs, countries like China are implementing multi-level insurance plans.

Read more on regulatory reimbursement processes in the Asia-Pacific for high-cost innovations as discussed at the Virtual ISPOR Asia Pacific 2020 Conference and reported by Dr Koen Degeling and Martin Vu.