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Rising to the Challenges of Cancer Care Rising to the Challenges of Cancer Care

Advancements in the Private SectorAdvancements in the Private Sector

Cancer Care SummitCancer Care Summit

FEBRUARY 22, 2012

Presentation Overview

• Introductions

• The Scope of the Challenge

• Cancer: Definition, Prevalence and Drivers

• Development and Treatment Trends


• Development and Treatment Trends

• Assessing Value for Cancer Therapeutics

• Rising to the Challenge

• Bernie Manente– Background in human resources, consulting

– Managed private sector relationships for large pharmaceutical company

– Focused in oncology for last 10 years working with health care stakeholders

Profiles

Introductions


• Stephanie Mazzei– Background in science/research

– Managed Oncology business for large pharmaceutical company (national and international)

– Focused in oncology for last 25 years working with health care stakeholders

Why the Neanderthals became extinct

Complex Problems


A Complicated Journey

Patient Journey from Suspicion to Treatment


Source: http://umanitoba.ca/faculties/medicine/units/chi/media/CHI_April_6-09_Improving_Cancer_Patient_Journey_TE.pdf

Disease

Recurrence

Made Even More Complicated

Optimal treatment

not funded

Seek private sector

funding

Funding not

available: consider

Patient Journey from Suspicion to Treatment


Disease

Recurrence

available: consider

out of pocket

Select alternative

treatment

Source: http://umanitoba.ca/faculties/medicine/units/chi/media/CHI_April_6-09_Improving_Cancer_Patient_Journey_TE.pdf

• Cancer is not just one disease - there are more than 100 different types of cancer.

• The main categories of cancer include:

– Carcinoma (skin)

– Sarcoma (bone or other tissue)

What is Cancer?

Cancer Overview


– Leukemia (blood-forming tissue)

– Lymphoma and myeloma (immune system)

– Central nervous system cancers (brain and spinal cord)

• Orphan diseases are defined as having a prevalence of fewer than 5 cases per 10,000 people (EU definition – no formal definition for Canada)

How prevalent is cancer?

Cancer Overview


Canada)

• According to this definition, howmany types of cancer are not considered orphan diseases?

• Incidence is the number of new cases of a disease in a given period

• Prevalence is the pool of individuals actively managing their disease (new and recurring)

• Survivorship represents all individuals who

Incidence versus Prevalence versus Survivorship

Cancer Overview


• Survivorship represents all individuals who have previously had cancer, were treated and are now alive

• All are important but which measure should be of most relevance to employers?

Private Sector Impact

Cancer Overview

60,000

80,000

100,000

120,000

140,000

160,000

NSCLC

Prostate

CRC

Breast


0

20,000

40,000

60,000

Public

Private

Public

Private

Public

Private

Public

Private

Public

Private

Public

Private

Public

Private

Public

Private

Public

Private

Public

Private

2012 2013 2014 2015 2016 2017 2018 2019 2020 2021

Breast

• Lifestyle

– Smoking

– Diet

– Infections

• Demographics

Growth Drivers

Cancer Overview


• Demographics

– Aging population

• Public Health initiatives

– Detection and screening

– Vaccination

Development Overview

Development is driving shifting patterns of treatment and care

OLD MODEL NEW MODEL

Acute remitting care Chronic care

Development and Treatment Trends


Development OverviewShotgun approach

Passive in-patient

Patients differentiated based on primary tumour site

Targeted approach

Active outpatient

Patients differentiated based on primary tumour site and tumour growth drivers


Number of New Cancer Drugs in Development by Type of Cancer






Marketed Products and Development Programs





Development Pipeline by Class





• Oral drugs represent what percentage of drugs in development

A) 15-20%

The Pipeline for Orals


Development OverviewA) 15-20%

B) 20-25%

C) 30-35%

D) 35-40%



• Cancer chemotherapy is a major medical advance from the last few decades.

• Chemotherapy drugs have a narrow therapeutic index resulting in often unpredictable responses

• Targeted therapies in contrast are directed

Definition and Profile of Targeted therapies


Development Overview• Targeted therapies in contrast are directed against cancer-specific molecules and signalling pathways resulting in more limited toxicities.

• Tyrosine kinases play a role in the modulation of growth factor signalling and a variety of new targeted therapies have emerged in recent years.

• TBD – use info gathered

Impact of shift to orals


Private Sector Drug Expenditures


Source: CIHI Health Expenditures in Canada Report, 2010




Source: Report Card on Cancer 2008, Cancer Advocacy Coalition


$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$35,000

$40,000

$45,000

(000's

of

$)

Private

Public

Metastatic RCC Treatment Costs


$0

$5,000

SU

TE

NT

AF

INIT

OR

NE

XA

VA

R

VO

TR

IEN

T

TO

RIS

EL

OT

HE

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NT

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2003 2011

Metastatic RCC has grown to a $65 million market of which $14 million is funded by the private sector.

Source: OncoEdge®

Forecasting Platform,

IMS CD&H data

Projected Treatment Costs for Metastatic Prostate Cancer


$60,000

$80,000

$100,000

$120,000

$140,0003rd Line Other

3rd Line MDV3100

3rd Line Jevtana

3rd Line Abiraterone

2nd Line Other

2nd Line MDV3100

2nd Line Jevtana

2nd Line Docetaxel

2nd Line Abiraterone


$0

$20,000

$40,000

Pri

va

te

Pu

blic

Pri

va

te

Pu

blic

Pri

va

te

Pu

blic

Pri

va

te

Pu

blic

Pri

va

te

Pu

blic

Pri

va

te

Pu

blic

Pri

va

te

Pu

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Pri

va

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Pu

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Pri

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Pri

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2012 2013 2014 2015 2016 2017 2018 2019 2020 2021

2nd Line Abiraterone

CPRC - M1S Other

CPRC - M1S MDV3100

CPRC - M1S Jevtana

CPRC - M1S Docetaxel

CPRC - M1S Abiraterone

CPRC - M1A Other

CPRC - M1A MDV3100

CPRC - M1A Jevtana

Source: OncoEdge® Forecasting Platform

• Trials designed to assess value

• Design, approaches,

Clinical trials

Assessing Value


• Design, approaches, endpoints

• PFS versus OS and rationale for surrogates

• Numerous hurdles exist in Canada to ensure value

• Health Canada

• P-Codr

Assessing Value

Evidence Based Views


• P-Codr

• KOL approaches to incremental benefits

• What does this mean?

• “Successful” Canadian oncology products are able to achieve about 3% of US sales of the same product (Rituxan®, Herceptin®, Gleevec®, Eloxatin®)

Evidence Based Views

Assessing Value


• Some recently launched oncology products have only reached about 1% of US sales (Avastin®, Alimta®, Tarceva®)

• Payer approaches and the evidence based view in Canada have a downside effect on the sales of novel oncology drugs

• Prices are set by the Patented Medicines Pricing Review Board (PMPRB) and pricing is influenced by category

• Increasingly drugs are category 3 “provide moderate, little or no therapeutic advantage over comparable medicines.”

Pricing

Assessing Value


medicines.”

• Prices are determined based on median of international prices

• Seen numerous examples where products will not be launched in Canada due to international pricing effects

• Safety net

• Employee attraction and retention

Rationale for Benefits

Rising to the Challenge


retention

• Moving from paternalistic to shared responsibility

• Cost containment

• What percentage of Canadians will face catastrophic drug costs (greater than 3% of net income)?

A) <5%

The Impact of Downloading



A) <5%

B) 5-7%

C) 8-10%

D) >10%

• RCC model and prostate model

• Future considerations need to look at ROI, interconnectivity of components

• Clearly quantify scope of issue

Internal Sustainability



• Clearly quantify scope of issue

• Innovate in plan design (basic/catastrophic)

• Exception handling

• Contrast with employee need

• Private role in leadership

• KOL fatigue

Creating a Dialogue



• KOL fatigue

• Stake in the system

• Need to look ahead in strategic way – examine connections in components rather than cost

Fostering Strategic View of Health



components rather than cost islands

• Health Evidence

• OncoEdge Private sector model

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