January 2023
Guest editor: Graham Cookson | CEO
The start of the year is a time of hope and optimism.
But optimism is hard when much of the Northern Hemisphere’s health system is struggling with the triple whammy of seasonal flu, respiratory syncytial virus (RSV), and the ever-evolving COVID-19. The US is now in a flu epidemic, according to the Centers for Disease Control and Prevention (CDC). In the UK, Health Secretary Steve Barclay has said that flu and COVID-19 have put "massive pressure" on the NHS, but
longer-term issues of workforce shortages and underinvestment are critical factors. It is self-evident that our healthcare systems are not very resilient.
One of OHE’s areas of focus for 2023 will be measuring the resilience and sustainability of healthcare systems through the development of a new index. Commissioned by LSE Health Policy, early work using data from five high-income countries was presented at ISPOR Europe and to the OECD. In 2023, the country-level healthcare system sustainability and resilience index (HSSRI) will be expanded, facilitating better understanding and monitoring of healthcare system's relative weaknesses and strengths. This will empower policymakers to design interventions that improve resilience and sustainability.
We will expand our work on another type of health system sustainability by building on our 2022 programme on the start of a green era for pharmaceuticals. Leaning on our existing work, combined with our extensive expertise in HTA methods and policy, we will turn our attention to how environmental sustainability can be incorporated into HTA decision-making to support the ambition of a net-zero life sciences sector.
In 2023, we will also be pushing at two other boundaries of HTA. Firstly, in Digital Health Technologies (DHTs) we will work towards the harmonisation and convergence of methods for their value assessment as well as continuing work on the development of an evidence standard framework to enable this. Second, we will launch an exciting new programme utilising Artificial Intelligence to collect, collate, and analyse HTA decision data from around the world including the deployment of AI tools for Real-World Evidence generation.
These are all under-researched yet incredibly important topics for health economics, and OHE will continue to fund activities in these areas. We will also continue to work on other “hot topics” across the life sciences sector including understanding and implementing volume-delinked payment models for new antibiotics, incorporating the value of health innovations for carers into decision-making, exploring the feasibility and implementation of new payment models to support continued innovation, and across a plethora of major policy issues such as the rollout of the Inflation Reduction Act in the US, the forthcoming negotiation of the Voluntary Pricing and Access Scheme in the UK, and the consideration of new and contentious legislation as part of the EU Pharmaceutical Strategy.
Whilst there is much to be concerned about as we face a tough winter, for researchers interested in improving health and healthcare there is much to be hopeful about and an incredible amount of work that needs to be done.
So, let’s get started.
MY TOP READ OF THE MONTH
“By 2021 the UK was importing just 14% more medicines by cash value than 11 years earlier: the smallest increase in another country, France, was 36%. This trend is not driven by COVID-19 vaccines, and in fact is even more pronounced if vaccines are removed, with the UK actually seeing a 5% decline in non-vaccine medicines”
It is no surprise that a major finding is that Brexit has impacted recruitment and retention of staff, exacerbating a workforce shortage at a time of unprecedented waiting lists. The impact of Brexit on wealth, and therefore ultimately on health, may also be expected. But it is worth reading the report for the interesting findings on the impact of Brexit on accessing essential medicines, including unusual spikes – five-fold jumps – in medicines shortages since the UK left the single market in 2021.
Whilst disruption of manufacturing by the pandemic and global price rises associated with the war in Ukraine offer a partial explanation, Brexit has contributed through a drop in sterling, a shortage of goods vehicle drivers, and additional barriers at the border. This is seen in the sustained problems the UK has encountered compared to similar
countries such as France and Germany, claim the authors.
The report also notes a divergence in the availability of new drugs in the UK since Brexit, citing analysis by Imperial College London showing that in 2021 the EMA approved 40 novel drugs, compared to 35 in the UK. It is unclear whether this illustrates the lesser appeal of the UK as a smaller market or well-reported capacity constraints at MHRA.
Finally, the report highlights UK drug imports which, ignoring Covid vaccines, are in decline. The report lays the blame mostly on Brexit, in particular its impact on the HGV driver shortage and customs barriers, and the data is consistent with that. However, the report also notes that the very high Voluntary Pricing and Access Scheme levy may incentivise suppliers to reduce supply to the UK market.
NEW RESEARCH
This new OHE report summarises the UK digital health landscape including regulation, value assessment and reimbursement, and efforts to increase population digital literacy. It provides valuable lessons for decision-makers beyond the UK hoping to get their health system digital-ready.
Bill Morgan, a former Conservative special adviser, explores what prevents ministers taking meaningful, long-term action to address NHS workforce shortages.
It sets out both the scale and impact of the workforce crisis and identifies the causes as difficulties in workforce forecasting, a tendency to train too few staff in the UK, and the insufficiently strategic use of international migration to compensate.
For those that missed the Health Foundation’s REAL Challenge lecture by Andy Haldane, it’s now available as a report for downloading from their website.
In it, he argues that health has rarely mattered more to the UK's strength and growth. Yet trends in health performance across the country, among both young and old, suggest a lack of resilience in outcomes and systems. This is having ‘increasingly visible and material side effects’, from lower growth to staff shortages, greater vulnerability to shocks, and increased precariousness in fiscal finances. The messages should also resonate beyond the UK.
NEWS HIGHLIGHTS
A feature article in ISPOR’s Value & Outcomes Spotlight interviews three global experts, including myself, on the controversial topic of pharmaceutical price transparency. All agree that transparency isn’t the silver bullet for tackling access challenges in LMICs that advocates believe it to be.
The New York Times covered the Pasteur Act a $6 billion proposal before Congress that would reconfigure the way antimicrobial drugs are developed and sold.
It cited research by OHE’s Adrian Towse and CDG’s Rachel Silverman which has estimated the global Return on Investment of a new antibiotic incentive scheme over the next 30 years as 125:1 saving 9.9 million lives from developing 18 new antibiotics to tackle 6 priority pathogens.
The article reports on a warning from the ABPI and member companies, following the announcement of a 26.5 per cent payment rate for 2023 under the Voluntary Pricing and Access Scheme.
The levy is designed to limit the NHS medicines bill, but the amount has risen from £563 million to £3.3 billion in three years which companies claim is unsustainable and is undermining investment in the UK life sciences sector.
UPCOMING EVENTS & ON-DEMAND
7 February | Virtual
Drawing on global experience, our panel will deep-dive into two key questions: Are we still overlooking the true value of vaccines? And is the Vaccine Task Force approach employed in the UK to tackle COVID-19 one to be emulated as we tackle four of our most pressing healthcare issues: cancer, obesity, mental health, and addiction.
Providing examples from the UK’s COVID-19 Vaccine Task Force, the Department of Health and Social Care in England and OHE research on the global socio-economic value of vaccines, this webinar provides a deep dive into the world of Vaccines and Task Forces.
Register for your free ticket today.
On-demand | Virtual
In our final webinar of the year, we are reflecting on the highlights of the past year, which OHE research trends have had the biggest impact and discussing the emerging issues in 2023.
Join our industry-leading experts as they reflect on; 60 years of OHE, the 'silent pandemic', Caring for carers, and Innovation, precision and value. The final presentation explores major policy issues including sustainability and digital health technologies, that OHE predicts will lead the field in 2023.
24 January | Hybrid
'How can policymakers design a system to generate fair prices that balances access and innovation throughout the lifecycle of medicines?'
Join us for the 2022 OHE Innovation Policy Prize award ceremony, where the winner will present their solution – an original, globally feasible, and theoretically grounded piece of research. You will also hear from our expert judging panel who will discuss the challenges we’re facing regarding ‘fair pricing’ and the broader range of ideas and solutions we received.
Register for your free ticket today.
