christoph böhmer president international biotronik march 25, … · 2017-07-19 · 2010 vs. 2000...
TRANSCRIPT
![Page 1: Christoph Böhmer President International BIOTRONIK March 25, … · 2017-07-19 · 2010 vs. 2000 in % Share of pharmaceuticals and medical technology costs in 2010 in % of total](https://reader033.vdocument.in/reader033/viewer/2022050117/5f4de717457c72380929b49e/html5/thumbnails/1.jpg)
Christoph BöhmerPresident InternationalBIOTRONIKMarch 25, 2014
![Page 2: Christoph Böhmer President International BIOTRONIK March 25, … · 2017-07-19 · 2010 vs. 2000 in % Share of pharmaceuticals and medical technology costs in 2010 in % of total](https://reader033.vdocument.in/reader033/viewer/2022050117/5f4de717457c72380929b49e/html5/thumbnails/2.jpg)
The end of the welfare state –The view of the European manufacturer
Christoph BöhmerPresident InternationalBIOTRONIKMarch 25, 2014
BIOTRONIK //
140325 EHRA Summit 2014
2
![Page 3: Christoph Böhmer President International BIOTRONIK March 25, … · 2017-07-19 · 2010 vs. 2000 in % Share of pharmaceuticals and medical technology costs in 2010 in % of total](https://reader033.vdocument.in/reader033/viewer/2022050117/5f4de717457c72380929b49e/html5/thumbnails/3.jpg)
Introduction
Insurers : Reassuringly confident – or complacent?
Physicians: Running the rat race
Social Scientists: Many concepts, few proven solutions
Politicians: Always looking for the next populistic fix
Device Industry: Creative destruction: Chasing for the
next innovation
Patients: Looking for a cure, facing higher premiums
140325 EHRA Summit 20143
![Page 4: Christoph Böhmer President International BIOTRONIK March 25, … · 2017-07-19 · 2010 vs. 2000 in % Share of pharmaceuticals and medical technology costs in 2010 in % of total](https://reader033.vdocument.in/reader033/viewer/2022050117/5f4de717457c72380929b49e/html5/thumbnails/4.jpg)
The end of the welfare state –The view of the European manufacturer
Headwind becomes stronger
Healthcare cost cutting seems to be dominant tool
All stakeholders started to adapt their strategies
Reinforce your presence at the gateways of future revenue streams
140325 EHRA Summit 20144
![Page 5: Christoph Böhmer President International BIOTRONIK March 25, … · 2017-07-19 · 2010 vs. 2000 in % Share of pharmaceuticals and medical technology costs in 2010 in % of total](https://reader033.vdocument.in/reader033/viewer/2022050117/5f4de717457c72380929b49e/html5/thumbnails/5.jpg)
Demand for procedures still high – and increasing in countries with below average penetration
Therapy penetration in 2012 – EHRA member countriesin implantations per mil inhabitants
IPG: Displayed are only countries with available numbers for 2012, mean number of implantations is weighted by population (excluding AL, AZ, DZ, FI, LB, LY, MD, SY, TR, XK); ICD: Displayed are only countries with available numbers for 2012, mean number of implantations is weighted by population (excluding AL, AM, AZ, DZ, FI, LB, LY, MD, SY, TR, XK); CRT (CRT-D and CRT-P): CRT = CRT-P + CRT-D, Displayed are only countries with available numbers for 2012, mean number of implantations is weighted by population (excluding AL, AZ, DZ, LB, LY, MD, SY, TR, XK); Ablation: Displayed are only countries with available numbers for 2012, mean number of ablations is weighted by population (excluding AL, AZ, DZ, IL, IT, LB, LY, MD, SY, TR, XK)
140325 EHRA Summit 20145
EHRA White Book 2013
757 – 1,311608 - 756
<= 233not available
234 - 607
153 - 40487 - 152
not available
14 - 86<= 13
78 - 22154 - 77
<= 16not available
17 - 53
322 - 589178 - 321
<= 55not available
55 - 177
Ø Ablation rate* = 216
Ø ICD implant rate* = 96
Ø CRT implant rate* = 73
Ø IPG implant rate* = 556
Only latest available countries of the EHRA White Book 2013. Method: Countries clustered equally in quartiles via overall no. of available countries per analysis, *Ø implantation rates are weighted by population
![Page 6: Christoph Böhmer President International BIOTRONIK March 25, … · 2017-07-19 · 2010 vs. 2000 in % Share of pharmaceuticals and medical technology costs in 2010 in % of total](https://reader033.vdocument.in/reader033/viewer/2022050117/5f4de717457c72380929b49e/html5/thumbnails/6.jpg)
According to the NICE standards for CRT, 37 EHRA-countries do not meet the targeted medical need
CRT therapy penetration 2012 – EHRA member countriesin implantations per million inhabitants
Only latest available countries of the EHRA White Book 2012 and 2011 with available data for both years. Excluded are Sweden, Kazakhstan, Morocco, Macedonia FYR, Egypt
140325 EHRA Summit 20146
EHRA White Book 2013
Lith
uani
aSer
bia
Gre
ece
Port
ugal
130 NICE target
Ukr
aine
Bel
arus
Bos
nia
& H
erze
govi
naArm
enia
Rus
sian
Fed
erat
ion
Spa
inEs
toni
aLu
xem
bour
gSlo
vaki
aIr
elan
dSan
Mar
ino
Sw
itzer
land
Slo
veni
aFi
nlan
dPo
land
Nor
way
Bel
gium
Mal
taH
unga
ryAus
tria
Uni
ted
Kin
gdom
Isra
elN
ethe
rlan
dsCze
ch R
epub
licFr
ance
131
Den
mar
kIt
aly
Ger
man
y
Icel
and
Latv
ia
Geo
rgia
Rom
ania
Cro
atia
Tuni
sia
Cyp
rus
Bul
garia
Mon
tene
gro
Medical need not met
145667713232528
29323539424552535359
6161626670
7273
77778389
107110118
124127
170
194
221
![Page 7: Christoph Böhmer President International BIOTRONIK March 25, … · 2017-07-19 · 2010 vs. 2000 in % Share of pharmaceuticals and medical technology costs in 2010 in % of total](https://reader033.vdocument.in/reader033/viewer/2022050117/5f4de717457c72380929b49e/html5/thumbnails/7.jpg)
Car manufacturers experience willingness to pay for more value. The medical device industry does not.
Average prices 2007-2013 – Automotive vs. ICDs in Europein €
Automotive: Average selling price of average car, above inflation (1,4% p.a.); Source: Universität Duisburg; Infographik, Die WeltICD: Devices only Sources: (Europe): Eucomed Q4/2013; Europe = FR, AT, BE, CH, CZ, DE, DK, ES, FI, GB, GR, IE, IT, NL, NO, PL, PT, SE, TR
140325 EHRA Summit 20147
Cars ICDs
0
10.000
20.000
30.000
2010 2012
+6%x2
1980 20001990 2007 2013
-32%
![Page 8: Christoph Böhmer President International BIOTRONIK March 25, … · 2017-07-19 · 2010 vs. 2000 in % Share of pharmaceuticals and medical technology costs in 2010 in % of total](https://reader033.vdocument.in/reader033/viewer/2022050117/5f4de717457c72380929b49e/html5/thumbnails/8.jpg)
While willingness to pay is decreasing, Industry is financing the health care sector with open receivables that peaked at ~1 billion € in 2012
Receivables of CRM-industry 2009-2013 – 10 core markets in Europein €m
Source: Receivables = unpaid sales; Assumptions based on internal analysis and market situation
140325 EHRA Summit 20148
2013
968
2012
975
2011
902
2010
896
2009
909
NLITGBESDECZCHBEATFRother
10 core markets in Europe representing
almost 90% of market
![Page 9: Christoph Böhmer President International BIOTRONIK March 25, … · 2017-07-19 · 2010 vs. 2000 in % Share of pharmaceuticals and medical technology costs in 2010 in % of total](https://reader033.vdocument.in/reader033/viewer/2022050117/5f4de717457c72380929b49e/html5/thumbnails/9.jpg)
New technology that helps increasing efficiency will need longer to be brought to market due to new MDD
FDA review time is increasing
Incremental FDA approval time vs. CE-mark for MedTech products
Josh Makower, MD consulting Professor of medicine, Stanford University et al., FDA Impact on U.S. Medical Technology Innovation: A Survey of Over 200 Medical Technology Companies. November 2010
140325 EHRA Summit 20149
Source: The Boston Consulting Group: A comparison of the FDA and EU Approval Processes and their Impact on Patients and Industry, June 2012 Source: BIOTRONIK CRM market experience
European approval timesreaching FDA-level soonIn monthsExample: CRM products
47
38
0
10
20
30
40
50 +24%
2006-20112000-2005 CNUSJEU
LeadsIPG
NewMedical Device
Directive?
0
10
20
30
40
50
60
?
"The greater regulatory efficiency in the EU has not
sacrificedpatient safety!“
Prof. Josh Makower, Standford University
2010*
![Page 10: Christoph Böhmer President International BIOTRONIK March 25, … · 2017-07-19 · 2010 vs. 2000 in % Share of pharmaceuticals and medical technology costs in 2010 in % of total](https://reader033.vdocument.in/reader033/viewer/2022050117/5f4de717457c72380929b49e/html5/thumbnails/10.jpg)
The end of the welfare state –The view of the European manufacturer
Headwind becomes stronger
Healthcare cost cutting seems to be dominant tool
All stakeholders started to adapt their strategies
Reinforce your presence at the gateways of future revenue streams
140325 EHRA Summit 201410
![Page 11: Christoph Böhmer President International BIOTRONIK March 25, … · 2017-07-19 · 2010 vs. 2000 in % Share of pharmaceuticals and medical technology costs in 2010 in % of total](https://reader033.vdocument.in/reader033/viewer/2022050117/5f4de717457c72380929b49e/html5/thumbnails/11.jpg)
Annual average growth in GDP per capita (%)
European health care expenditures grew twice as much as the GDP since 2000
Annual growth in health expenditure and GDP 2000-2010
Annual average growth in health expenditure per capita (%)
Source: OECD health data 2012
140325 EHRA Summit 201411
x2x3x1
![Page 12: Christoph Böhmer President International BIOTRONIK March 25, … · 2017-07-19 · 2010 vs. 2000 in % Share of pharmaceuticals and medical technology costs in 2010 in % of total](https://reader033.vdocument.in/reader033/viewer/2022050117/5f4de717457c72380929b49e/html5/thumbnails/12.jpg)
The first step to control health care expenditures focused on the infrastructure and suppliers. However device prices of 0 Euro, would not solve the problem
Source: OECD Health Data 2012 for EU
140325 EHRA Summit 201412
Cuts in infrastructure and resource consumption in hospitals2010 vs. 2000in %
Share of pharmaceuticals and medical technology costs in 2010in % of total
Total Discharges
TotalHospital beds
Total Lengthof stay
Average GDP per EU capita24.055 EUR
2,9
‐15,0 ‐16,0‐16
‐12
‐8
‐4
0
4
9
Driven byUse of less invasive surgical procedures,changes in hospital payment methods (DRGs), and theearly discharge programs
2
GDP = 100
Healthcare
Medical GoodsDevices Devices
![Page 13: Christoph Böhmer President International BIOTRONIK March 25, … · 2017-07-19 · 2010 vs. 2000 in % Share of pharmaceuticals and medical technology costs in 2010 in % of total](https://reader033.vdocument.in/reader033/viewer/2022050117/5f4de717457c72380929b49e/html5/thumbnails/13.jpg)
Some cost cutting efforts have been successful
Reform targets and examples
Efficiency Evidence-based clinical pathways to
improve productivity Evidence-guided resource allocation and service provisions Increased Health Technology Assessment (HTA) Cost-containment Pay reductions or freezes Influencing patient behavior Prospective payment systems (DRGs) Introducing capped budgets for certain
technologies Increased attention to price-level of purchased
suppliesInsurer-driven quality improvements Pay-for-performance Selective contracting Insurers focusing on outcomes
Graph based on The Boston Consulting Group (2014) Competing on outcomes. Winning strategies for value-based health care. *3.2% of the payment are paid retroactively based on achieving certain outcome goals.
140325 EHRA Summit 201413
0%
20%
40%
60%
80%
100%
120%
Post-surgicalcomplications
Revisions
Control group OrthoChoice
Example: Pay-for-performance*
Hip replacements, Stockholm, Sweden
![Page 14: Christoph Böhmer President International BIOTRONIK March 25, … · 2017-07-19 · 2010 vs. 2000 in % Share of pharmaceuticals and medical technology costs in 2010 in % of total](https://reader033.vdocument.in/reader033/viewer/2022050117/5f4de717457c72380929b49e/html5/thumbnails/14.jpg)
More focus on cost and therapy effectiveness to be expected due to ”avalanche” of healthcare evaluation agencies
Selected Health Economic Evaluation agencies in the EU
Source: http://www.eunethta.eu/contactus/all/356/allhttp://www.ispor.org/HTADirectory/Index.aspx
140325 EHRA Summit 201414
LBI-HTA BIQG
KCE
NCPHP NCPRMP
AAZ
MoH Cyprus
MoH Cz Rep SUKL
CRK DHMA DACEHTA
UTA
FIMEA THL STAKES
NSPH
ESKI EKMI GYEMSZI
HIQA
A. Gemelli Agenas AIFA Arsenàl.IT ASSR ORI Regione del Veneto Sihta UVT
NHS
VASPVT
IGSS CEM CMSS
DPA/MHEC
CVZ
NOKC
AHTAPol
INFARMED
NSPH MPD
MoHSlovak Republic
NIPH IER
AATRM / AIAQS
AETSA AQuAS AVALIA-t IACS ISC III Osteba SESCS UETS
SBU
SNHTA
IQWIG DIMDI
NICE
HAS
SMC
![Page 15: Christoph Böhmer President International BIOTRONIK March 25, … · 2017-07-19 · 2010 vs. 2000 in % Share of pharmaceuticals and medical technology costs in 2010 in % of total](https://reader033.vdocument.in/reader033/viewer/2022050117/5f4de717457c72380929b49e/html5/thumbnails/15.jpg)
Even if convincing clinical and economical proof is available new technology reimbursement is not guaranteed
Case Report: Reimbursement of remote monitoring in CIEDs
First RM technology CE-mark 13 years ago
Clinical and economic evidence available from various RCTs plus economic modeling
Reimbursement efforts hindered by budget silos (inpatient vsoutpatient sector) and irrational incentive schemes
140325 EHRA Summit 201415
Remote Monitoring reimbursed
![Page 16: Christoph Böhmer President International BIOTRONIK March 25, … · 2017-07-19 · 2010 vs. 2000 in % Share of pharmaceuticals and medical technology costs in 2010 in % of total](https://reader033.vdocument.in/reader033/viewer/2022050117/5f4de717457c72380929b49e/html5/thumbnails/16.jpg)
The end of the welfare state –The view of the European manufacturer
Headwind becomes stronger
Healthcare cost cutting seems to be dominant tool
All stakeholders started to adapt their strategies
Reinforce your presence at the gateways of future revenue streams
140325 EHRA Summit 201416
![Page 17: Christoph Böhmer President International BIOTRONIK March 25, … · 2017-07-19 · 2010 vs. 2000 in % Share of pharmaceuticals and medical technology costs in 2010 in % of total](https://reader033.vdocument.in/reader033/viewer/2022050117/5f4de717457c72380929b49e/html5/thumbnails/17.jpg)
Countries are opening the healthcare market to more private investors
Trends in private health concepts
Source: HOPE – Hospitals in Europe Healthcare Data; OECD Health Data 2012; DeutscherKrankenhausreport 2014
140325 EHRA Summit 201417
Hospital ownership- Germanyin % of total
Private health insurance in % of total
Non-profit
Public
Private
0
20
40
60
80
100
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Belgium France Germany
> 32 % increase in number of private hospitals
Industry experts estimate private ownership to grow up to 50% in the next years (Roland Berger Consulting)
Citizens allover Europeincreasingly contract private
health insurance.
![Page 18: Christoph Böhmer President International BIOTRONIK March 25, … · 2017-07-19 · 2010 vs. 2000 in % Share of pharmaceuticals and medical technology costs in 2010 in % of total](https://reader033.vdocument.in/reader033/viewer/2022050117/5f4de717457c72380929b49e/html5/thumbnails/18.jpg)
Private investors are expecting regular growth of profit-margins of up to 15%, considerable pressure on medical staff in these newly privatized clinics
Development Plan per Hospital after Acquisition
140325 EHRA Summit 201418
![Page 19: Christoph Böhmer President International BIOTRONIK March 25, … · 2017-07-19 · 2010 vs. 2000 in % Share of pharmaceuticals and medical technology costs in 2010 in % of total](https://reader033.vdocument.in/reader033/viewer/2022050117/5f4de717457c72380929b49e/html5/thumbnails/19.jpg)
MedTech Industry investment in R&Din billion USD
0 0 0 0 0 0 00
3
6
9
12
15
2000 2002 2004 2006 2008 2010 2012 Trend
MedTech companies are balancing reduced revenue growth by – amongst others - reducing R&D investments
Source 2000-2012: Ernst & Young, Medical Technology Report 2013, company financial data (14 EU-based, 19 US-based); 2012-2014: BIOTRONIK estimation
140325 EHRA Summit 201419
R&D spending (actual) R&D spending assuming historic growth rates
If the historic growth rate has been sustained, these companies would have spent an additional US$12 billion on R&D between 2008 and 2012.
Average revenue growth p.a.
historic: 13 % recent: 7 %
-40%
![Page 20: Christoph Böhmer President International BIOTRONIK March 25, … · 2017-07-19 · 2010 vs. 2000 in % Share of pharmaceuticals and medical technology costs in 2010 in % of total](https://reader033.vdocument.in/reader033/viewer/2022050117/5f4de717457c72380929b49e/html5/thumbnails/20.jpg)
Commercial factors increasingly drive purchasing decisions. Get involved!
Level of relevance:
140325 EHRA Summit 201420
low medium high very high
University hospitals
Innovation Leaders
Public hospitals
Volume Leaders
Private hospitals
Profitability LeadersArea of co-operation
(Hospital & Industry)
Pre-clinical research
Scientific co-operation
Clinical studies
Training & Education
Remote Monitoring
EHR-Integration
Economical studies
Reimbursement
Risk sharing
Hospital marketing
E-commerce
Logistics & process management
Economic
focus
Medical
focus
![Page 21: Christoph Böhmer President International BIOTRONIK March 25, … · 2017-07-19 · 2010 vs. 2000 in % Share of pharmaceuticals and medical technology costs in 2010 in % of total](https://reader033.vdocument.in/reader033/viewer/2022050117/5f4de717457c72380929b49e/html5/thumbnails/21.jpg)
Decision-making power on medical products moved away fromphysicians to economics-driven stakeholders –Even the “empowered” patient does not change this trend
Decision impact on medical products
140325 EHRA Summit 2014140325 EHRA Summit 20142121
Physican
Hospital purchasingdepartments
Medicalfocus
Economicfocus
2000
+ Health politics+ Health insurances+ HTA institutes+ Group Purchasing Organisations
today
+ Patient
„Who can bring back the balance?“
![Page 22: Christoph Böhmer President International BIOTRONIK March 25, … · 2017-07-19 · 2010 vs. 2000 in % Share of pharmaceuticals and medical technology costs in 2010 in % of total](https://reader033.vdocument.in/reader033/viewer/2022050117/5f4de717457c72380929b49e/html5/thumbnails/22.jpg)
Physican
medical economical
today
+ Patient+ Health politics+ Health insurances+ HTA institutes+ Group Purchasing Organizations
All business partners need to re-prioritize their focus areas and re-direct their focus …
Current EHRA Committee sizes
Source: EHRA website; URL: http://www.escardio.org/communities/EHRA/about/Pages/committees.aspx; March 10, 2014
140325 EHRA Summit 201422
Congress ScientificProgram
61
Health Economics
6
„Answer: All of us!“
![Page 23: Christoph Böhmer President International BIOTRONIK March 25, … · 2017-07-19 · 2010 vs. 2000 in % Share of pharmaceuticals and medical technology costs in 2010 in % of total](https://reader033.vdocument.in/reader033/viewer/2022050117/5f4de717457c72380929b49e/html5/thumbnails/23.jpg)
The end of the welfare state –The view of the European manufacturer
Headwind becomes stronger
Healthcare cost cutting seems to be dominant tool
All stakeholders started to adapt their strategies
Reinforce your presence at the gateways of future revenue
streams
140325 EHRA Summit 201423
![Page 24: Christoph Böhmer President International BIOTRONIK March 25, … · 2017-07-19 · 2010 vs. 2000 in % Share of pharmaceuticals and medical technology costs in 2010 in % of total](https://reader033.vdocument.in/reader033/viewer/2022050117/5f4de717457c72380929b49e/html5/thumbnails/24.jpg)
Obviously health care bodies are beefing up. Are you?
140325 EHRA Summit 201424
Be present at the gateway to future revenue-streams
Be physically present where decisions about your economic future are being made
![Page 25: Christoph Böhmer President International BIOTRONIK March 25, … · 2017-07-19 · 2010 vs. 2000 in % Share of pharmaceuticals and medical technology costs in 2010 in % of total](https://reader033.vdocument.in/reader033/viewer/2022050117/5f4de717457c72380929b49e/html5/thumbnails/25.jpg)
Obviously health care bodies are beefing up. Are you? Challenge us and work with us on projects with economical optimization scope
EHRA level Higher priority
health economic issues and processes
Influence HTAs Better „sell“
medical need for innovation to politicians and payers
140325 EHRA Summit 201425
Be present at the
gateway to future
revenue-streams
Be physically present where
decisions about your economic future are
being made
Individual level Understand and influence
purchasing processes in own hospital
Cooperate with industry on projects geared towards cost reduction
Focus more on the efficient implementation of innovations than on generating more research results
![Page 26: Christoph Böhmer President International BIOTRONIK March 25, … · 2017-07-19 · 2010 vs. 2000 in % Share of pharmaceuticals and medical technology costs in 2010 in % of total](https://reader033.vdocument.in/reader033/viewer/2022050117/5f4de717457c72380929b49e/html5/thumbnails/26.jpg)
We have a central location with lots of free. Available until 20xx ! All of Europe easy to reach from 29 €/flight
140325 EHRA Summit 201426
![Page 27: Christoph Böhmer President International BIOTRONIK March 25, … · 2017-07-19 · 2010 vs. 2000 in % Share of pharmaceuticals and medical technology costs in 2010 in % of total](https://reader033.vdocument.in/reader033/viewer/2022050117/5f4de717457c72380929b49e/html5/thumbnails/27.jpg)
Change the way you “run” the rat race…
![Page 28: Christoph Böhmer President International BIOTRONIK March 25, … · 2017-07-19 · 2010 vs. 2000 in % Share of pharmaceuticals and medical technology costs in 2010 in % of total](https://reader033.vdocument.in/reader033/viewer/2022050117/5f4de717457c72380929b49e/html5/thumbnails/28.jpg)
The end of the welfare state –Conclusion
We all have to convince governments and tax payers (you and I!) that their money is well-spent when you use it to treat your patients
To do that, EHRA and ESC need to leave paradise (here!) and literally sit on the steps of every single building that houses institutions that make decisions on healthcare funding
This takes Credibility of those making the argument
->therefore constructive participation in political hygene processessuch as the various sunshine activities is needed
Substance to the argument, i.e., hot air will not suffice-> therefore your involvement, but more importantly, full-time
dedicated, and capable professionals who do that for you, are needed
Focus on productivity increases by using productivity-enhancing innovation
Skill in “playing” the healthcare economics systems to implement all of the above
140325 EHRA Summit 201428