Princeton, NJ, USA, June 2, 2015–The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) held its 20th Annual International Meeting May 16-20, 2015 in Philadelphia. The Meeting marked ISPOR’s 20th anniversary and focused on the theme of Integrating Big Data, Patient Data, and Cost-Effectiveness into Clinical Practice: Promise and Prospects.
“ISPOR was pleased to welcome over 3700 attendees, representing 78 countries, from research, academia, policy makers, payers and patient groups. The quality of the meeting content and the discussions, networking, and collaborations associated with this global meeting drive debate and help build consensus,” said Nancy S. Berg, ISPOR CEO and Executive Director.
In the First Plenary Session, held Monday, May 18, 2015 and entitled “Taking Stock of the Learning Health Care System: What Have We Achieved and Why Does it Matter?” moderator Penny Mohr, MA, Senior Program Officer, Improving Healthcare Systems, Patient-Centered Outcomes Research Institute (PCORI) said that the vision for a learning health care system is evidence-based, value-driven and patient-centered. “This includes drawing on best evidence to provide care, learning to deliver what is of most value, while emphasizing prevention and health promotion,” explained Mohr. “Patient-centered means providing the care most appropriate for each patient.”
According to speaker Sarah Greene, MPH, Associate Director, CER Methods and Infrastructure, PCORI, what is needed to build a true and rapid learning health care system is both ‘will and skill.’ “There is a steep hill to climb,” Greene told attendees. “We want research to add value, but the value proposition is relative. We need to consider what changes and trade-offs are needed to be able to more seamlessly integrate research and practice and consider what those investing in such a system will get in return.”
Greene also discussed the development of PCORnet, a systemic network to enable rapid, large-scale, patient-centered clinical research. “It will be the world’s first network infrastructure to be based primarily on EHR data rather than claims data,” promised Greene.
Lewis G. Sandy, MD, FACP, Senior Vice President, Clinical Advancement, United Health Group in Minneapolis offered suggestions and caution. He noted that 30 percent of US health care spending is “waste” and that purchasers, both public and private, are demanding action.
Regarding the Learning Health Care System, Sandy said that the playbook is known, but there needs to be better execution, adding that the Learning Health Care System might be “too organizationally focused rather than network focused” and that building a better bridge is necessary. Sandy said that he liked the concept of PCORnet while advocating for better measurement alignment and clinical alignment.
Speaker Sachin H. Jain, MD, MBA, Chief Medical Officer, CareMore/Anthem and Lecturer in Health Care Policy, Harvard Medical School, looked at the issue of building a Learning Health Care System at two levels – the ‘change layer’ and the ‘reality level.’ “Change is often too slow,” he said, suggesting that at times where there is smoke there is no real fire below. “We need to close the gap between the possible and the actual, between best science and best practices.”
Jain pointed toward paying more attention to the “site of delivery” and to create a clinical and business culture where innovative ideas are encouraged that can challenge the status quo, even while others cling to the status quo.
In the Second Plenary Session held Tuesday, May 19, 2015 and entitled “Cost-Effectiveness and Clinical Practice Guidelines: Have We Reached a Tipping Point?” questions were raised about what impact could this step have on insurers, medical practitioners, patients and their families in an era when health care costs are rocketing upward. Do physicians have a responsibility to society to help control the costs of medical care, especially in the face of devastating diseases such as cancers where the costs of the newest medications have in some cases become astronomical?
Moderator Lou Garrison, PhD, Professor, Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, Seattle, noted that in 2014 the American College of Cardiology and the American Heart Association “embraced” cost-effectiveness analysis in their development of clinical treatment guidelines.
Will other stakeholders follow suit?
According to Mark A. Hlatky, MD, Professor of Health Research and Policy and Professor of Medicine at Stanford University School of Medicine, cardiovascular disease is the leading cause of death in the U.S and world-wide, but there are new and quite expensive devices and therapies that are increasingly applied for treating lower risk patients although cardiology is very numbers-driven. What if a treatment or device was not utilized even for a low-risk patient? “We have a great concern that if someone had a heart attack or died we would feel very bad about that,” said Hlatky.
In discussing guidelines and cost-effectiveness for cancer treatments, Peter P. Yu, MD, FACP, FASCO, Director of Cancer Research, Palo Alto Medical Foundation, Sunnyvale, CA and President, American Society of Clinical Oncology (ASCO) told attendees that the cost of cancer care in the U.S was $125 billion in 2010 and is expected to climb to $175 billion by 2020. There are many factors for rising costs –including an aging population and the complexity of cancer.
New classes of targeted drugs are playing a great role in rising costs, he said. However, discussions about potentially life-saving but expensive cancer drugs can be approached on both societal and “personal” levels, yet defining and increasing “value” holds unique challenges for oncology.
Yu laid out key principles that include the primary focus for physician-patient level decision making; patient access to clinical and cost information; the physician’s obligation to be “good stewards” of health care resources and; secondary impacts on pricing and coverage policy.
Michael Drummond, PhD, Professor of Health Economics, Centre for Health Economics, University of York, Heslington, York, UK, discussed the National Institute for Health Care Excellence (NICE) approach to the economic analysis of clinical guidelines, starting with determination of topics, establishing a guideline development group with medical experts and patient representatives, and a health economist for technical support. The group, said Drummond, will meet approximately 12 times before sending guidelines out for consultation and stakeholder comments. The process, he added, can take up to two years.
“What are the advantages on introducing cost effectiveness considerations?” he asked. NICE produced some examples of the savings through the use of guidelines, and you can save money using guidelines, Drummond noted. However, savings in the guidelines are potential savings that need to be realized in practice.
What are the disadvantages? Some guidelines have more compromises than some economists would like and the implementation of recommendations often involves ‘winning over hearts and minds’ since following guidelines are not mandatory.
In the Third Plenary Session, held Wednesday May 20 and entitled “Big Data, Big Systems, and Better Evidence: What Progress?” 2014-2015 ISPOR President Adrian Towse, MA, MPhil, Director, Office of Health Economics, London, UK, and plenary moderator reminded attendees that one of the previous year’s plenary sessions encouraged researchers to begin focusing on practical examples showing how health care had been improved through the use of “big data” and move from analytical methods to applications.
For speaker Ari Caroline, Chief Analytics Officer, Memorial Sloan Kettering Cancer Center, New York, NY, USA, application came in the form of developing ways to use data to benefit patients and physicians in selecting the right clinical trial. This, said Caroline, meant using both structured data, which Sloan Kettering has been collecting for 25 years and unstructured data, including observational data, requiring considerable effort to collect and add to a unique database. Caroline said that to do this they needed to become a “data science team” with added skill sets. The objective was to build a data system by which physicians could “click through” clinical trials eligibility criteria.
Caroline’s team was assisted in the task of developing a searchable database by IBM Watson Group. According to speaker Ami Ehlenberger, there had to be a better way to get knowledge into the hands of physicians rather than have them reading through journals. Ehlenberger discussed physician use of the database, built using EMR records, family history, pathology, and other data, to find treatment pathway options and clinical trials for patients.
“We want to get this into the hands of physicians as soon as we can,” said Ehlenberger.
Speaker Paul Wallace, MD, Chief Medical Officer & Senior Vice President, Clinical Translation, Optum Labs and Chair, Board of Directors, Academy Health, said that the technology Ehlenberger and Caroline explained had the potential to “free up time” so that physicians might be able to better understand their patients as unique individuals. Wallace noted that at Optum they have been working on creating better support for patient care and also deliver more value. “We can be a ‘node’ in the learning health care system by translating knowledge into action,” said Wallace. He discussed Optum’s collaborative work in “multi-year, multi-partner and multi-project research” in studies of heart failure and Alzheimer’s disease. “Research and learning are about improving health care outcomes, about being reliable, rapid and rigorous,” concluded Wallace. “What I worry about with precision medicine, which is a great idea, but we may delude ourselves into thinking that once we have done all the math that we can use a laser pointer and tell a patient exactly what they have to do because we figured it all out. The challenge is to take that information and integrate it in a way that is appropriate across a diversity of situations.”
The 2016 ISPOR Annual International Meeting will be held at the Washington, DC Hilton Hotel, Washington, DC, USA, May 21-25, 2016. Information will be available at http://www.ispor.org/