Creating Partnerships with the new NHS

Creating Partnerships with the new NHS David Fisher Commercial Director, ABPI October 2006

How?

Managing Long Term Conditions for the Long Term • Long-term conditions are a principal driver of healthcare cost • Pharmaceuticals are part of the solution, not part of the problem • But the system sets up barriers to holistic management, and frankly under-invests in long term solutions • Informing, engaging and empowering patients is key • NHS reforms offer the prospect of advancing or retarding LTC management • Industry poised to partner further with NHS to make a difference

Long Term Conditions are a principal driver of healthcare cost Unplanned and expensive inpatient episodes The Information Centre, NHS

Pharmaceuticals are part of the solution to better long term condition management • In all the above areas, pharmaceutical research has resulted in • New treatments for control or reversal • New formulations for easier/faster administration, better compliance • Improved tolerance, fewer complications

By 2010, it is predicted that 3m people in the UK will have diabetes (>5% of the population)UKCRC/UKCRN: 6 new clinical trials since June 06 Example: Diabetes

The system sets up barriers to long-term solutions • Coordination between primary and secondary care is patchy at best • Slow uptake of approved innovative therapies • PCT/practice non compliance with NICE guidance documents results in postcode lottery • Poor follow-up results in patient non-concordance

The UK is among the lowest in Europe in medicines usage, particularly for innovative products Medicines expenditure per head of population 2004 Share of market represented by products launched in previous five years 2005 Source: ABPI estimate from 2004 OHE Compendium, IMS World and OHE Source: ABPI calculations based on IMS World Review, 2006

Postcode lotteryAtypical antipsychotics market share (in 2004)…not achieving levels expected following NICE recommendation

But an holistic solution must be centred on the patient Management of medicines: a resource to support implementation of the wider aspects of MM for the diabetes, renal and LTCs NSFs, Department of Health, July 2004

Better patient information and engagement must be based on key principles • Patient’s health and outcomes will benefit from being better informed • There is a recognised health economic benefit linked to better informed patients • Informed patients are more likely to utilise medicines appropriately leading to therapeutic success • Patients and the public have a right to seek and receive information from any source • Nobody knows more about a medicine than the company that developed it

Pharmaceuticals developers have a key role • The ABPI is currently working on: • Developing the “information prescription” and other medicines information in conjunction with Ask About Medicines / patient organisations • Patient or patient group involvement considered in all relevant activities • Developing of benefit/risk communication materials relating to medicines • Developing strong working partnerships with relevant stakeholders in patient engagement

Reforms in the NHS offer the prospect of advancing LTC treatment • Commissioning best care, most joined-up care • Building NICE guidance implementation into Healthcare Commission standards and … • Quality and Outcomes Framework • Other incentives/funds for Find and Treat initiatives

Commissioning care for LTCs must: • recognise that most have both a primary care and secondary care component • incent early detection and preventative interventions • encourage a ‘continuum of care’ approach

Quality and Outcomes Framework Has Demonstrated the Power of Incentives Benefits from: • Cholesterol reduction • Blood pressure control for hypertension • Reduce the incidence of acute events (CHD, Strokes, Diabetes…) Successful QOF: • Good management • Leadership • Culture / structure • Teams • Performance management • Information systems Outcome – improved quality of care for patients

100% ‘Find and Treat’ Programmes could make a major impact Public Health Programmes More qualified clinicians ‘Find and treat targets’ incentives Diagnostic tools Therapy decision support NICE guidance reinforced Complaint investigated but not correctly diagnosed Diagnosed but untreated Treated but not optimally No contact with system In contact but no related complaint investigated Treated optimally Actual prevalence of disease

Industry already active in partnership with NHS on LTC management • Pfizer/Haringey Health Partnership • ABPI/Ashton Leigh & Wigan PCT initiative on diabetes, CHF • Pharmaceutical Oncology Initiative Partnership to advance planning of cancer capacity and funding • GSK/Pfizer/Boehringer-Ingelheim and East Lincolnshire PCT Project on COPD

Working with Ashton Leigh & Wigan PCT • Developing a ‘learning network’ to deliver high quality continuing professional development to their clinical and managerial staff • Ensuring contributions from innovative pharmaceuticals are valued and recognised • Improving access and dialogue for companies in this PCT • Focus on ‘find and treat’ programme in diabetes

The Asheville ProjectHow pharmaceutical care produced successful outcomes in diabetes patients in one North Carolina city Patients had the opportunity to meet with a pharmacist each month at no charge to be taught about diabetes mellitus, have their condition monitored, and undergo a physical assessment of their feet, skin, weight, and blood pressure.

Results • Employers’ mean insurance costs per patient per year decreased by $2704, $3609, $3908, $5480, and $6502 in the first through fifth follow-up years, respectively. • During the same years, the mean total prescription costs increased by $656, $1487, $1932, $1942, and $2188 per patient per year. • However the total mean direct medical costs per patient per year decreased between $1622 and $3356.

A long-term pharmaceutical care services programme • Total mean direct medical costs • Prescription costs

Innovative pharmaceuticals are a vital part of LONG TERM INVESTMENT to better manage LONG TERM CONDITIONS

Creating Partnerships with the new NHS