Nuevos medicamentos y tratamientos de alto

costo: proyectos de riesgo compartido

Jose F Tomás MD PhD

Medical Director BUPA-ELA

Santiago de Chile Junio 2017

Foro “Juntos por la Salud de los Chilenos”

¿Es todo innovación? Costo/beneficio

Innovación terapéutica

Beneficios marginales para muchos de los nuevos

tratamientos, con algunas innovaciones relevantes o

excepcionales

Costes de los nuevos tratamientos con incrementos

exponenciales

JAMA Otolaringology 2014 epub

BUPA Overview

Keeping you informed, keeping us connected 7

Introduction to Bupa Cancer Data

Keeping you informed, keeping us connected 8

PMI

Expenditure

UK Australia Spain Global

Cancer spend £ 248,401,000 £95,794,000 £86,482,000

Total spend £1,200,000,000 £1.995,700,000 £710,700,000

% of spend on

cancer

21% 4.8% 12% 24%

PMI Cancer spend trends:

1. We spend about 28% of our total claims expenditure on cancer and this is rising at a CAGR of around 6%

2. There are some start differences in the profiles of cancer spend across market unit

3. Overall Bupa spends the most on breast cancer (£90m) which represents 30% of total spend, with prostrate (£65m),

colon (£30m), skin (£30m) and lung (13.5m) being the next largest spend area – these largely accord with global

epidemiological data

Cancer provision:

1. We have a growing cancer provision in Spain, Poland (LuxMed) , Chile and the UK,

2. The contribution to total provision revenue from oncology services is significant. Particularly in the UK where it

oncology makes up 20% of total revenue and 50% in LuxMed

3. The cancer specific diagnostic pathways and self referral are USPs in market in LuxMed

Cancer drugs:

1. We estimate that our spend on cancer drugs globally is about ~ £200m.That represents around 24% of our total

expenditure on drugs ~ £825m

2. The top ten drugs represent around 45% of total expenditure

Bupa´s Control of Cancer Delivery

1.- Classical checking (BAU)

. Evaluation of Centers ( Law Requirements,, Evaluation of Quality and Safety

programs, Medical Results,)

. Prestige

. Claims

2.- Spain

. Benchmarking of our UCCO with other providers

. A “fast track” pathway for rapid diagnoses

. Innovation ( liquid biopsy, genetic profiles , new therapies)

3.- UK

. Bupa Cancer Promise

4.- Australia

.Goverment PolicyKeeping you informed, keeping us connected 9

Hacia donde vamos?

1.- PROVISION (Providing access to advice and care that´s right for me)

.Corresponsabilidad

.Identificación de procesos

.Programas de previsión de gasto

.La especialización como una oportunidad

.UCCO

“The Strategy that will fix Health Care” Harvard Business Review October 2013

Hacia donde vamos?

2.- INDUSTRIA FARMACEUTICA (Obsessive about making quality healthcare affordable and accessible)

.Acuerdos de colaboración en Investigación , Formación Continuada , I+D (Acceso a la innovación)

.Programas de previsión y seguimiento del gasto

.Programas de personalización del costo

-Riesgos compartidos

-Tratamientos combinados

-Tratamientos crónicos

-Costos por unidad de tratamiento (viales, presentaciones…)

.Compartimiento del know-how

Objetivo y estructura del acuerdo

Generación de un marco de colaboración permanente articulado

mediante la creación de un comité de seguimiento estratégico y un

subcomité para cada uno de los pilares del Acuerdo

Formación

científica y el

fomento de la

I+D

Colaboraciones

comerciales e

institucionales

Acuerdo Marco Roche-Sanitas

Introducción y

acceso a la

innovación

Comercial y

financiero

Comité de seguimiento estratégico

Áre

as d

e

trab

ajo

Objetivo y estrutura del acuerdo marco Roche-Sanitas

RWD/RWE: Resultados en Salud

Previsibilidad y estabilidad presupuestaria

Modelos personalizados de reembolso

Minimización de la incertidumbre de gasto

Optimización de la adecuación del coste al beneficio

Maximización de la eficacia

Iniciativas para favorecer el acceso

de manera sostenible

Ejemplos1

2

3

Hacia donde vamos?

3.- ORGANIZACIONES SANITARIAS, CIENTIFICAS Y DE PACIENTES RELACIONADAS CON EL

CANCER

(Obsessive about making quality healthcare affordable and accessible)

.Papel de liderazgo

.Crear opinión

.Colaborar en foros de expertos

.

Hacia donde vamos?

4.- PACIENTES

(Obsessive about making quality healthcare affordable and accessible)

.

.

NUESTRO COMPROMISO ES PODER OFRECER AL PACIENTE :

EL MEJOR TRATAMIENTO ( patient-centeredness)

CON LA MAYOR SEGURIDAD

ABORDABLE y GARANTIZE SOSTENIBILIDAD

EN UN FUTURO TRABAJAR CON:

CLINICAL OUTCOMES

PRONS

BUPA UK

Keeping you informed, keeping us connected 16

Bupa’s Cancer Promise

OUR QUALITY ASSESSED NETWORKS OFFER

THE BEST OUTCOMES

18

Bupa’s unique5 Cancer Provider Quality

Assessments

We are the only insurer to conduct quality

assessments on our cancer centres and their

clinicians to ensure best outcomes

Bupa Approved Diagnosis and Treatment Units

• Breast Cancer Diagnosis and Treatment Network

• Bowel Cancer

• Prostate Cancer

Networks provide access to:

• The latest evidence-based pathways and

technology

• Specialist consultants

• Advanced therapies for all indicated conditions

• Surety that they will be reviewed at MDT (multi-

disciplinary team meetings) to ensure peer-

reviewKeeping you informed, keeping us connected

Links to expert external cancer

organisations

Over 20,000 undergoing some

form of treatment per year

Over 3,000 inbound calls per

week, 1000 + outbound calls

SPECIALIST ONCOLOGY SUPPORT TEAM

45 trained advisers and

experienced oncology nurses

Over 11,000 newly diagnosed

cancer patients per year

19Keeping you informed, keeping us connected

Breast and Bowel Direct Access

20

Over 2300 calls

0ver 600 referrals

18 customers with a cancer diagnosis

PPV - Positive Predicative Value 3%

Wait for GP Referral 14 days

Wait for Consultant Referral

No Waiting

5.3 - 7.3%

5 - 11 days 14 days

Wait for Treatment following

Diagnosis23 Days* 62 days**

*From first contact with Bupa **From date received by hospital ie 93

days from symptoms recognised

Not Achieved

Bupa

IN HEALTH CARE, THE DAYS OF BUSINESS AS USUAL

ARE OVER

Obsessive about making quality healthcare affordable

and accessible

Keeping you informed, keeping us connected 21