The productivity and outcome of oncology pipeline

Global Oncology Trends 2019

IQVIA has released a report on current state of oncology treatments.

The 2018 launch of 15 new active substances (NASs) bring the total NAS launches since 2013 to 57 with 89 approved indications for 23 different tumor types Within the R&D oncologic pipeline, the most intense activity is for immunotherapies, with almost 450 in clinical development A total of 1,170 oncology clinical trials were initiated in 2018, an increase of 27 percent from 2017 and 68 percent from 2013 More than 700 companies across the globe have oncology drugs in late-stage development, including 626 emerging biopharma companies and 28 out of the 33 largest pharma companies

On costs in USA:

The average annual cost of new medicines continues to trend upward, although the median cost dropped $13,000 in 2018 to $149,000, and cost per product ranged between
$90,000 and over $300,000. The mean cost for new brands in 2018 was $175,578, down from $209,406 in 2017, but was above the $143,574 mean from 2012 to 2018.
Spending on cancer medicines is heavily concentrated, with the top 38 drugs accounting for 80% of total spending. Over half of cancer drugs earn more than $143.6 million in annual sales and in aggregate account for only 2.2% of oncology spending.

On value?

PS. Cancer drugs report 2018, Libro blanco terapia celular

Pharma R&D failure and success (2)

Estimation of clinical trial success rates and related parameters

The largest investigation thus far into clinical trial success rates and related parameters sheds light on the issue.

We find that the overall success rate for all drug development programs did decrease between 2005 (11.2%) and 2013 (5.2%), as anecdotal reports suggest. However, this decline reversed after 2013. The overall success rate is mainly driven by changes in POS1,2 and POS2,3. The timing of the upward trend coincides with the time period during which the FDA has been approving more novel drugs,compared to the historical mean.

Quite surprising. The accelerated approval by FDA ends with more drugs withdrawn from the market. Therefore, the probability of success is a flawed statistic. It should be adjusted according to regulator criteria.

The changing burden of disease

EVOLUCIÓN DE CARGA DE ENFERMEDAD YCOSTES ASISTENCIALES DE UNA COHORTE POBLACIONAL DURANTE 7 AÑOS

Today we've made a presentation at the Health Economics Conference. The rethoric of increasing chronic conditions requires a precise estimates and cohort analysis is the way to proceed. This is what we have done and you can check the details in p.70 of the abstracts book.

Long-term care funding mess

THE PUBLIC ECONOMICS OF LONG-TERM CARE. A SURVEY OF RECENT CONTRIBUTIONS

Everybody agree that long-term care funding is a complete mess. Ten years after enacting a law, access to services is constrained by funding restrictions and bad design of benefits. A lot of people wait for benefits until die and afterwards the family receive the approval for long-term care.
What should be done?. A recent article reviews the options.

LTC needs are increasing rapidly and neither the market nor the family seem to be able to meet such a mounting demand. Furthermore, the existing public programs are both insufficient and uncoordinated. For these reasons we advocate developing a full-fledge LTC public insurance scheme that would fulfill two objectives: assisting those who cannot count on any family assistance and do not have the financial means of purchasing LTC services and providing the middle class a program that would protect families against too costly spending

Is there enough public money to pay for this?

Obama by Kehinde Wiley 

Health microsystems as the unit of performance analysis

A comparative performance analysis of a renowned public-private partnership for health care provision in Spain between 2003 and 2015

A deep study has been released on performance of public-private partnerships in healthcare in Valencia compared to Spanish NHS. It is an:

Observational study on secondary data from virtually all hospital care episodes produced in 51integrated providers (i.e., administrative healthcare areas) and 67 hospitals, in 2003 and 2015. Alzira’s2015 performance (and its variation since 2003) was compared with all public-tenured peers in the SNHS,using 26 indicators analysing the differences in age-sex standardized rates of events or risk-adjusted mortality, severity-adjusted hospital expenditure and hospital technical efficiency

And the conclusion is:

 In this comprehensive comparative study on Alzira’s performance, this PPP has not generally outperformed public-tenured providers, although in some areas of care its developments have been outstanding.

I agree on the methodology, I can't asses the results and its conclusions because it requires data replication. What it is crucial is the clinical decision making within the health organization (the microsystem and its episodes of care), forget generalizations on public and private and focus on drivers for efficiency in each setting.

PS. Opioid Epidemic CDC data

Natalia Goncharova at Tate Modern 

Wellbeing economics: a prescription letter

A SPENDING REVIEW TO INCREASE WELLBEING
An open letter to the Chancellor

UK has setup an All-Party Parliamentary Group on Wellbeing Economics. That's great!. If there is one thing that should be on the public agenda is wellbeing. However, after reading the last report it's a little bit disappointing. The have decided 6 priorities to take into account in the spending review according to its importance on wellbeing.

1. Health: Scaling up treatment of mental illness
2. Education: Tackling children’s wellbeing in schools 
3. Further Education: A proper start to working life
4. Social care and community services: Investing in social support networks
5. Work: Better wellbeing leads to better productivity
6. Other priority areas

Not so easy...as they say, It's just a letter...

Cohen-Emanuel podcast

Ezekiel Emanuel on the Practice of Medicine, Policy, and Life

Ezekiel Emanuel is a reflection of his upbringing: a doctor for a father who loved to travel, a mother interested in policy and community activism, and all the competition and friendship that comes with growing up closely with two brothers. Put those together and you wouldn’t be surprised that the result is someone who has worked at both the highest levels of, medicine, policy and academia — though the intense interest in jam might surprise you.