Gottfried Endel, Main Association of Austrian Social Insurance Institutions, Austria for 2017 European Patients' Rights Day in Brussels, "The payers' perspective on access to innovation"

1. European & National Medicines Regulatory Systems:
challenges for an equitable, timely and suitable access
to innovation
Brussels, 10.5.2017
The payers’ perspective on access to
innovation
HVB AUSTRIA
Dr. Gottfried Endel

2. Payers perspective on innovation
Content
Dr Gottfried Endel
• COI
• Innovation – definition
• Perspectives of stakeholders
• Evidence based Medicine and Health Technology
assessment
• Pricing and Transparency
• Discussion
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3. © HVB-EBM
METHODS
BIOETHICS
AUTONOMY
NON MALEFIZIENZ
BENEFIZIENCE
JUSTICE
AS FOUR DIMENSIONS TO KEEP IN BALANCE
ALSO TO BALANCE PREFERENCES OF INDIVIDUALS WITH
ENGAGEMENT OF INDIVIDUALS
17.1.2011 Dr. Gottfried Endel
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Bernward Gesang „Eine Verteidigung des Utilitarismus“; Reclam
Dieter Birnbacher; „Bioethik zZwischen Natur und Interesse“

4. Payers perspective on innovation
COI
Dr Gottfried Endel
I WORK IN THE AUSTRIAN SOCIAL INSURANCE. SO MY POINT OF VIEW IS THE
RESPONSIBILITY OF A
• SUSTAINABLE
• APPROPRIATE
• SAFE
• EFFICIENT/EFFECTIV
• ACCESIBLE AND
• ACCEPTABLE
HEALTH CARE SYSTEM FOR ALL CITICENS/INSURED PEOPLE.
THATS THE PERSPECTIVE OF A PAYER WITH RESPONSIBILITY AND POLITICAL
ACCOUNTABILITY
USUALLY I REFERE TO THE AUSTRIAN SYSTEM
AS I AM NOT A NATIVE ENGLISH SPEAKER, PLEASE FORGIVE ERRORS IN GRAMMAR,
SPELLING OR UNUSUAL WORDING
ALSO I DID NOT TRANSLATE ALL OLD SLIDES
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5. Payers perspective on innovation
Messwerte
Dr. Gottfried Endel 4

6. Austria a Welfare State based on
solidarity
5Joint HTA 4.5.2017

7. Payers perspective on innovation
Innovation - definition
Dr Gottfried Endel 6
COST
LYG
QALYs
DOMINANT

8. © HVB-EBM
WILLINGNESS TO PAY
Payers perspective on innovation
Dr. Gottfried Endel
7
WNP
-50.000,00 €
450.000,00 €
950.000,00 €
1.450.000,00 €
1.950.000,00 €
AR
WNP
WNP -30.000,00 -15.000,00 -7.500,00 € -3.800,00 € -1.900,00 € - € 3.800,00 € 7.600,00 € 15.200,00 30.400,00 60.800,00 121.600,00 243.200,00 486.400,00 972.800,00 1.945.600, 2.000.000,
AR
Low absulut risc
Cut off for sicknessfunds
High absolut risc
High willingness to
pay
Traditional health insurance
Prevention

9. Roles and responsibilities
Dr. Gottfried Endel
Role Respronsibility
Patients Health literacy, self awarness, coping, self control…
Provider/Professionals Professional skills, CME, communication, scientific
excellence, transparency (prices)…
Politicians Framework of the health care system, societys
perspective…
Regulators Market access, infrastructur decisions…
Payers Reimbursement decisions, quality, sustainability…
Citicens Providing sustainable financial basis, societys
perspective…
Differents stakeholders Different objectives
Other political fields Other political interests
International organizations International comparisons
…. ….
8Payers perspective on innovation

10. © HVB-EBM Dr. Gottfried Endel Payers perspective on innovation 9
VERSICHERTER
insured person
VERTRAGSPARTNER
contracting party
SOZIALVERSICHERUNG
social insurance
Abrechnung,
Antragstellung
accounting, applikation
Zahlung, Kontroll
payment, controle
VERTRAG Contract
BENEFIT IN KIND
HTA
• Scientific evidence
• Political/societal priorities
• Health system research
EBM
• Scientific evidence
• Patient preferences
• Experience of the provider

11. Payers perspective on innovation
Pricing and Transparency
Dr Gottfried Endel
• Price as „non disclosure“ clause
• Melphalan for multiple myeloma – essential!
– „old“ substance
– no competitor
– Pricing after GSK sold patents to Aspen Holding + 4.000% (https://www.thetimes.co.uk/article/drug-giant-s-secret-
plan-to-destroy-cancer-medicine-75rg6wt2n download 9.5.2017)
• adenosine-deaminase-deficient severe combined
immunodeficiency (ADA-SCID)
– Gene therapy : one treatment for the child  promise: cured (no other treatment available; real innovation)
– Value based pricing discussion: Value of the total life of the child for society (life expectancy in years X yearly
contribution of a person to the GDP) : quoted from a coffe discussion at a rare diseases conference
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12. Payers perspective on innovation
Discussion
Dr Gottfried Endel
• We want / need innovation
• We deal with uncertainty
– HTA
• Balance of pricing for services - especially innovations,
research and development costs and sustainability of
the health care system is a priority.
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13. Payers perspective on innovationDr Gottfried Endel
Thank you for your attention
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