1. Horizon scanning: why & how to launch it in Lithuania??
Horizon scanning: why & how to launch it in Lithuania??
Per Troein, VP Strategic Partners

2. Europe saw 2015/16 a growth “bubble”
HepC was the main driver - after the initial effect, HepC has declined through competition
Traditional medicine show overall a steady volume increase but now value growth – thanks to ongoing savings from generics
Specialty drugs shows a long term sustained growth ~10%
Source: IQVIA MIDAS MAT Q3 2017; Recent Hep C launches included: SOVALDI, HARVONI, VIEKIRAX, DAKLINZA, EPCLUSA, EXVIERA, PEGASYS, SOVRIAD, COPEGUS, ZEPATIER

3. The value of innovation
The promise is first a better medical outcome
Comes at a cost - but It is also likely to change the mix of drug cost and other care cost
Do we need more than one product in each class?
Normally variations in effect/side effect between products – value differences for individual patients
More products creates competition – competition leveraged reduces cost
 Require early awareness and planning

4. What do we need to scan for?
New break-through innovation
Incremental innovation to be leveraged
New indications
Price shifts as from biosimilare competition

5. New break trough, examples of innovative product classes/ platforms
10/13/2018
Product class/platform
Overview
Impact on current treatment
Volume of innovation
Alzheimer’s therapies
High unmet need means even a moderate efficacy would have a high impact on patients/HC system
High
Targeted + checkpoint comb.
Combinations are showing step changes in patient benefits and will be high budget impact items
CAR-Ts
Offer step change in treatment and potentially a cure in indications where there is high unmet need
Antibacterial mAbs
Work by binding to bacteria and neutralising them; address need for novel solutions to resistance
Gene therapy
Offers symptomatic relief and potential cure within rare indications with poor prognosis and QoL
Cell therapy
Offers a step-change in treatment across a range of prevalent chronic diseases
Moderate
QI EFPIA Horizon Scan | July 2017

6. Incremental innovation
New products in a class frequently offers some differentiation
Different side effect profile
More convenient dosing
Etc
The intensity in completion tend to require 3-4 product in a class
Service differentiation
Price or rebate agreements
Etc
Hep C is an example of the rapid development of alternatives
daklatasvir (Daklinza)
dasabuvir (Exviera)
elbasvir/grazoprevir (Zepatier)
glekaprevir/pibrentasvir (Maviret)
ombitasvir/paritaprevir (Viekirax)
simeprevir (Olysio)
sofosbuvir (Sovaldi)
sofosbuvir/ledipasvir (Harvoni)
sofosbuvir/velpatasvir (Epclusa)
sofosbuvir/velpatasvir/voxilaprevir (Vosevi)

7. New indications Case studies Anti TNF – Humira Cancer - Revlimid
Rheumatology, Gastro, Psoriasis
 moderate increase of patient population
Cancer - Revlimid
New cancer types, New combinations
 each a small patient volume
NOACs, Prostate cancer
New indications of larger size
 large patient volume

8. Biosimilare entries
The largest biological products have/will shortly have Biosimilare competition Competition, well managed, drives down price/gives rebates What will the effect be/should be on usage? What is the effect on cost?
Source: IQVIA MIDAS MAT Q3 2017; IQVIA Institute Jan 2018; *Approved by EMA / FDA and on market

9. The Swedish County Council collaboration model

10. Horizon Scanning new pharmaceuticals
The Swedish model
Preliminary
evaluation
Identification
Filtering
Experts +
Filtering criteria
Patient population
Morbidity
Clinical advantages
Innovative way to treat the condition
Budget impact
Need to reorganize health care
Effect on guidelines/recommendations
Safety issues
Media/patient interest
Risk of to fast/slow introduction
Legal/Ethical/Political interest
Experts
Pharmaceutical companies
Agencies
Organizations
Media
Etc.
Experts

11. To be considered as a strategy
Build knowledge
Model Impact
Take decision
Need for local experts
Standardize the format of what to asses
Leverage other international work
Aim for ”trails”
Understand present cost
Asses cost implication
Consider issues with budget “silos”
Get agreement on budget impact
Leverage knowledge to all relevant prescribers
Monitor outcome

12. Horizon scanning: why & how to launch it in Lithuania??
Horizon scanning: why & how to launch it in Lithuania??
Per Troein, VP Strategic Partners