Welcome to the June issue

By David Woods (david.woods@rxcomms.com)

Speaking at the March World Health Care Conference in Washington , DC , Joshua J Ofman, MD, vice president, global coverage and reimbursement for Amgen, said that the value of drug information is poorly understood.

Part of the reason for this, he said, is that we've traditionally viewed value as being difficult to capture because it isn't viewed comprehensively. We need to measure inputs to the value equation, he said, noting that this has traditionally included the price of the product... and the value of the product being established before we fully understand its true performance. This means uncertainty about some key issues, among which, he said, is the need to assess value to society... not just to the payer but to employers, families, the patients themselves, and to quality of life issues, and productivity.

Dr. Ofman also believes that taking a societal perspective requires a better job of looking beyond patent life, and he cites Prozac as an example of the benefits society derives long after patent expiry. This means working through the methodological challenges, he says, and dealing with uncertainties at the time of product launch. It may mean adjusting price according to the value proposition. You can start to pave the way towards proving value by engaging in public debate at the national level, engaging with payers and engaging with thought leaders, while continuing to enhance the work and reputation of health economists.

Dr Ofman believes that all of this ties in to the pharmaceutical industry's overall image. Sometimes a product's claims may lead to questions of their credibility, and even to suggestions of inappropriate pricing. These issues, he says, also call for dialogue and transparency.

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By David Woods (david.woods@rxcomms.com)

While the Golden Age of the pharmaceutical industry is over, and its reputation similar to that of the tobacco and oil industries, there is hope at hand – according to former Merck CEO Roy Vagelos.

In a keynote address to the third annual meeting of the International Society for Medical Publication Professionals, Dr Vagelos suggested that a future golden age could be characterised by understanding genetics, producing as a result effective drugs for Alzheimer's, cancer, etc, and thus re-establishing the pharmaceutical industry's reputation.

For the present, though, he suggested three areas of concentration. The first has to do with pricing: how do you assess value? Productivity and lifespan factors have to be taken into account. “Most drugs are a terrific bargain,” he said, “but you have to weigh $25,000 a year to treat the once deadly HIV; or $50,000 for a cancer drug that extends life by four months.” The first represents value; the second does not, according to Vagelos.

The second area is in doing good works in the developing world. For example, Merck and other pharmaceutical companies are providing free drugs to combat river blindness and HIV in Africa... and a hepatitis B drug in China . Vagelos acknowledged that while these efforts are made for humane reasons “eventually these countries will be markets for us.”

The former Merck executive then turned to a third issue: the industry's credibility. Some of this, he said, hinges on how well the company handles, for example, the Vioxx question. “Credibility will be restored as we respond appropriately,” he said. He went on to say that the FDA is undermanned, under resourced, and works with information technology that's 25 years old, that drugs are coming off patent, and the fact that pharmaceuticals are no longer a growth industry means that clinical studies and manufacturing will both be outsourced.

Touching finally on the current debate over pharmaceutical reps' access to physicians, Dr Vagelos acknowledged that some approaches might be inappropriate, giving the impression that physicians can be bought with free meals and trinkets. He chaired a meeting of 26 academics and for industry CEOs who came up with the idea of scheduled meetings in which pharmaceutical company scientists would explain drugs to academics and physicians. The committee also suggested training for physicians and for medical students about what drug development is all about.

“I would like to see our patients and our public cease their vain strivings after longevity, and to realise it is better to live for seventy years without fussing, than to achieve the age of eighty with elaborate, painstaking care.”
Richard Asher, British endocrinologist and author (1912–1969)

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By Julie Stauffer (julie.stauffer@rxcomms.com)

Staying on top of new developments can be a daunting task in today's hyper-connected world. If you're feeling swamped in a sea of information, make the most of your reading time by zeroing in on these top picks.

To compile this list, we've drawn on different rankings from researchers around the world and thrown in a few personal choices for good measure. We've concentrated on publications that specialise in pharmacoeconomics and outcomes research, together with a few key health policy journals.

Where it exists, we've included the journal's impact factor – a measure of how frequently its articles are cited in other publications.

The European Journal of Health Economics (previously HEPAC Health Economics in Prevention and Care): A good choice for insight into health care systems in Europe , offering a practical focus as well as academic rigour. Members of the International Health Economics Association receive a special rate.

Expert Review of Pharmacoeconomics and Outcomes Research : A peer-reviewed journal that offers commentary and analysis from leading experts, served up in an easily digested format. It covers the complete spectrum of outcomes research, including cost-benefit and pharmacoeconomic issues.

Health Affairs : Cited by the Washington Post as “the bible of health policy”. Boasting an impact factor of 3.369, this peer-reviewed, non-partisan journal of health policy and research covers US and international issues.

Health Economics : A must-read, with an impact factor of 2.030. Health Economics covers economic theory, empirical studies and analyses of health policy from an economic perspective. Members of the International Health Economics Association receive a special rate.

Journal of Health Economics : Another must-read with a similar impact factor. You'll find peer-reviewed articles on the production of health and health services, demand and utilisation of health services, etc. Members of the International Health Economics Association receive a special rate.

The Milbank Quarterly : A venerable publication with a consistently high impact factor – most recently, 6.794. This multidisciplinary journal of population health and health policy offers a mix of peer-reviewed original research, policy review, in-depth analysis and commentary from academics, clinicians and policy makers.

PharmacoEconomics : A benchmark journal with an impact factor of 2.242 that offers practical, authoritative articles on applying pharmacoeconomics and quality-of-life assessment to drug therapy and health outcomes.

PharmacoEconomics and Outcomes News : Looking for a distillation of the latest research news? These bi-weekly summaries are selected by expert scientific editors from 1,400 biomedical publications and 50+ scientific meetings. You'll find coverage of the economic impact of drugs and diseases, quality of life research, prescribing trends, regulatory news, etc – all in an easy-to-read format.

Quality of Life Research : A multidisciplinary publication with an impact factor of 2.037. This rapid-communication journal offers original research on topics spanning biometry, philosophy, social science, clinical medicine, health services and outcomes research.

Value in Health : The official journal of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). This multidisciplinary publication with an impact factor of 3.433 offers an outlet for discussion and debate about the principles and substance of pharmacoeconomics and outcomes research.

And of course may we modestly append Health Outcomes Communicator...

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By Ruth Whittington (ruth.whittington@rxcomms.com)

Many of us in health economics and outcomes research look at Canada as one of the leaders in the field; along with Australia , Canada was one of the first countries to demand evidence of cost-effectiveness as a prerequisite for drug approval. To those of us not intimately acquainted with its healthcare system, the recent presentation by Richard Alvarez, President and CEO of Canada Health Infoway, may have come as a bit of a shock. He described a system almost wholly reliant on paper records – a system where 37–43% of recommended treatment is never delivered, of 30–40% of women at risk of cervical cancer not being screened, of 32% of patients presenting at emergency rooms with vital pieces of their healthcare information missing. A country where it is estimated one in nine patients receives the wrong medication, and where over 24,000 patients die annually from preventable adverse events from treatment. Small wonder, then, that he is attempting to drag the ten provinces, three territories and numerous health regions into the 21st century by instituting electronic patient healthcare records.

Canada Health Infoway is a primarily government-funded organisation working with the provinces (which provide 25% of its funding) to integrate and coordinate healthcare, and Alvarez firmly believes that electronic record keeping will help solve several of their major issues. Information technology, he believes, will improve access, quality and productivity in healthcare provision, and although it may cost $CAN10 billion to institute it, ultimately all Canadian citizens will benefit from a better healthcare service.

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Next month we cover www.PatientsLikeMe.com , the need to educate regulatory groups about PROs, and the role of health economics as pharma comes under attack.

HOC is your publication, so please send us your requests or comments to duncan.dibble@rxcomms.com

If you have missed any of our earlier issues, email duncan.dibble@ rxcomms.com for a copy. Just a few of our previous articles are Getting drugs accepted, Healthcare blogs and How to make the most of conferences. A full list is available at http://www.rxcomms.com/hocezine.asp

HOC is available for print in pdf format – free

You can of course print this e-newsletter straight from your inbox (for best results select landscape in your printer’s print set up), but HOC is also available as a professional 4-page A4 newsletter in pdf format for you to print and keep for reference. Simply email duncan.dibble@ rxcomms.com for past copies. If you would like to be sent a pdf version each month let us know and we’ll send one as soon as it is available.

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Healthcare Outcomes Communicator is designed to help you explain and enhance your role and value as healthcare economists and outcomes researchers. But we need input from you – the professionals working "in the trenches". So we encourage you to give us your feedback about how we're doing – to communicate with us so that we can better communicate with you.

Yours sincerely
David Woods and the Rx Communications team

This material is published in good faith and is subject to editorial scrutiny before publication, however no warranty or guarantee of its accuracy is expressed or implied. No liability will be accepted by Rx Communications for any loss resulting from use of this resource. Our regular readership are assured that their details will not be passed on or used in any other promotional activity without permission.
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