Navn stilling i Kreftforeningen settes inn via “Sett inn” -> “Topptekst og bunntekst” PRIORITIZATION AND HEALTH CARE – THE PERSPECTIVE OF THE NORWEGIAN CANCER SOCIETY OLE ALEXANDER OPDALSHEI

Navn stilling i Kreftforeningen settes inn via “Sett inn” -> “Topptekst og bunntekst” Prioritizations in health care are done on different levels and arenas In an Emergency Departement (A&E): which patient to treat first? At the General Practitioner office: which patient to refer to a specialist? Hospital departments: which patient to treat, to discharge,e.g. Financial resources in hospitals are distributed between different departments/clinics There are a distribution of resources between different health areas at local government level And – not to forget – there is a superior distribution of funding between different areas of society – How much to use on health in a society?

Navn stilling i Kreftforeningen settes inn via “Sett inn” -> “Topptekst og bunntekst”

But the most important arena for prioritizations is between the patient and the health care worker…... where professional assessments, not economy, should be the guiding principle.

Navn stilling i Kreftforeningen settes inn via “Sett inn” -> “Topptekst og bunntekst” The National Program for the Introduction of New Health Technologies (methods) within the Specialist Health Service Everyone can submit a proposal for a method they consider relevant for a health technology assessment (HTA) at the national level. Members from the specialist health care and the Norwegian directorate of health meet regulary in a forum, “Bestillerforum RHF” to go through all incoming proposals. The forum decides which methods that should be evaluated at the national level The final decisions are done by “Beslutningsforum”. “Beslutningsforum” consist of the CEOs from the four Regional Health Regions. The decisions are final, no right of appeal, and the meeting are – in practice - closed (caused by secrecy of drug pricing).

Navn stilling i Kreftforeningen settes inn via “Sett inn” -> “Topptekst og bunntekst” Aim of the national program Improve patient safety by using methodological (technology) assessments before implementing new methods. Ensure that patients can, as soon as possible, have equal access to new methods, which have documented effect, and are safe and cost effective. Help to ensure that new methods that are ineffective or harmful for patients are not implemented in practice, and contribute to the phasing out of old methods. Cultivate a good foundation for prioritisation in secondary health services, built upon methodological (technology) assessments. Ensure rational use of secondary health services and societal resources. Implement a transparent and systematic methodology for the introduction of new methods, one which is based upon uniform processes for methodological assessment and decision making.

Navn stilling i Kreftforeningen settes inn via “Sett inn” -> “Topptekst og bunntekst” Do we prioritize on the right areas? By April 2015: Of the total number of decisions (n=18) in “Beslutningsforum”, 15 where cancer drugs.

- And it doesn’t help that government and industry blames each other Navn stilling i Kreftforeningen settes inn via “Sett inn” -> “Topptekst og bunntekst” But yes, new effective drugs come at a high price

We need new innovative medicines at a price we can afford – what can be done? Navn stilling i Kreftforeningen settes inn via “Sett inn” -> “Topptekst og bunntekst” Is the drug discovery “ecosystem” broken? Risk sharing approaches between medical industry and health care payers Develop new ways to conduct clinical trails Early adoption of new medicines combined with follow-up registration Increased number of patient included in clinical trails Recognise innovation as a part of the approval process New funding mechanism for drugs New thinking regarding the industries “business models”

A final remark: cancer treatment is more than cancer drugs (The Kings fund 2011) Tittel på presentasjonen 10