Since the onset of the COVID-19 pandemic, healthcare providers worldwide have struggled to avoid disruptions in access to oncology care. Between delays in diagnosis, changes to on-going care, and suspension of clinical trials, the pandemic has had profound short- and long-term effects on oncology patients. Against this backdrop, at the 2021 European Health Forum Gastein virtual event “Financing cancer care: Insights from the Cancer Policy Grants Program”, a panel of grantees from the MSD Global Oncology Policy Grant Programme Cohort 2 and leading experts in oncology policy discussed the future of cancer care in the post-COVID era.
The panel event, moderated by Dr. Panos Kanavos from the London School of Economics and Political Science, included presentations from Dr. Claudio Jommi from Bocconi University, Dr. Manuel Garcia Goñi from Complutense University of Madrid, and Dr. Maria Libura from University of Warmia and Mazury, followed by a panel discussion by Antonella Cardone from the European Cancer Patients Coalition, Jenelle Krishnamoorthy from MSD, Stefan Craenen from the European Commission and Francesca Colombo from the OECD.
Launched in 2019, the MSD Global Oncology Policy Grant Program provides annual grants to health policy researchers across the globe, generating evidence to inform policy to promote long-term improvements in cancer care. Thus far, grantee research has addressed four key themes related to oncology policy: the social value of cancer care, financing approaches and access, innovation in cancer treatment and cancer and COVID-19. The research has resulted in evidence-based and forward-thinking recommendations which will deliver better health outcomes for cancer patients in the long term, as well as created a community of discourse on cancer policy made up of policymakers, payers, patients, and other key stakeholders within countries and across geographies.
Watch this video providing an overview of the research from cohort 2 of the grant program:
Despite tremendous progress in the development of screening tools, diagnostics, and novel therapies over the past decade, significant inequities exist in access to care and more importantly, in health outcomes for cancer patients. Improving cancer services moving forward will undoubtably require collaborative efforts at all levels of oncology care.
Important in this context is the need to ensure that patients have timely access to life-saving therapies and do not face unnecessary delays. Claudio Jommi’s research on the Italian Innovation fund highlights how bespoke drug funds can help accelerate access to innovative medicines, provided they are implemented with clear and transparent criteria. The research recommended the use of dedicated funds on top of resources allocated to the Italian National Health Service and the use of a clear criteria to determine the level of innovativeness for a given drug, based on therapeutic need, added therapeutic value, and quality of evidence.
Healthcare systems need to remain flexible and adaptable in response to long-term fiscal challenges which have been exacerbated by the COVID-19 pandemic. The development of cell and gene therapies, personalised medicine, machine learning tools and medicines approved for use across multiple therapeutic indications require novel, tailored financing solutions, as health insurers attempt to achieve value-based pricing. Manuel Garcia Goñi’s research on indication-based pricing explores pricing policy in Spain on medicines developed for use across multiple indications. In this context there is a clear trade-off between administrative simplicity and value-based pricing, as indication-based pricing solutions are data-intensive and difficult to regulate but are likely to reflect differential value more accurately at indication level. Research resulted in recommendations, including the creation of registries of patient data and clinical information, combining economic evaluation with budget impact analysis, setting and revising prices, and consideration of the evolution of regulation with transparent guidelines.
While advances in big data analytics and machine learning offer exciting potential to improve diagnosis and care pathways, health policy has been slow to react and implementation of these tools has been highly fragmented across settings. Maria Libura’s research on the use of healthcare data in oncology care in Poland identifies key limitations in how data is currently collected, stored, and used to improve cancer care. Fragmented responsibility, unclear standards and a lack of shared vision and goal in data-driven policy are key obstacles to overcome. Recommendations made to combat these challenges include preparing and implementing long-term strategy for oncology in Poland, building mechanisms for ensuring on-going dialogue for key stakeholders, investing in the implementation of data interchange and collection standards, financing data analysis centres in key institutions, and creating a legal framework friendly to medical registries development.
Some answers for improving cancer care may lie in the European Commission’s Europe’s Beating Cancer Plan and Horizon Europe’s Mission on Cancer, two well-funded multi-stakeholder initiatives with clear targets for improving cancer outcomes, evidence-based frameworks, and robust governance structures. Europe’s Beating Cancer Plan focuses on all key stages of disease including prevention, early diagnosis, treatment and care. The plan aims to complement member states’ existing national cancer plans and initiatives with an emphasis on disease prevention, reduction in knowledge gaps, dissemination of best practices, reduction in access inequities, and capacity/skill building. The Beating Cancer Plan will be reinforced by the recently launched Mission on Cancer. This involves several promising initiatives including implementation of a European Cancer Patient Digital Center and a network of Comprehensive Cancer Infrastructures across all member states, providing resources and services to support, improve and integrate cancer care, research, training of care professionals and education for cancer patients, survivors, families and carers.
When questioned on the future of cancer care, panellists at the event expressed optimism at the current pipeline of innovation and numerous initiatives to improve cancer care being implemented globally. They stressed the need to adopt patient-centered approaches, foster collaboration across stakeholder groups and the need to remain flexible and adaptive in policy making. Enhanced emphasis on prevention and diagnosis will help to ease the fiscal burden for healthcare systems, but greater public spending in the health sector is needed.
Finally, it is critical to draw broader lessons from country-specific research like the studies conducted as part of the Global Oncology Policy Grant Program. Policymakers will need to continue to think outside the box and generate creative solutions to improve outcomes for oncology patients and reduce inequities in access to care. Bespoke drug funds and indication-based pricing are just two examples of novel financing tools available to health systems to help accelerate access to innovation and promote value-based pricing, providing that the appropriate regulation and data-infrastructure is in place.
Fragmentation across different levels of cancer care is a key barrier to improving quality, experience and outcomes. While there is unlikely to-be a one-size-fits-all approach to financing cancer care, it is clear that policy tools should be data-driven, patient-centred and transparent.
As health systems continue to respond to the COVID-19 pandemic it will be increasingly important to remain vigilant in promoting effective oncology care through collaborative initiatives, inclusive of all stakeholder groups. In the interim, we look forward to future cohorts of the MSD Global Oncology Policy Grant Program and the policy research that will emerge, which will continue to bring crucial issues to the fore and stimulate the global discourse on the policy challenges and opportunities for improvement, for the benefit of patients everywhere. In 2022, grantees from Cohort 3 will present research from an additional seven countries and continue to contribute to this evidence base and policy conversation.
George Wharton is a Senior Lecturer in Practice at the LSE Department of Health Policy.
MSD Project members: Mackenzie Mills, George Wharton, Dr Panos Kanavos, Prof Elias Mossialos