This case study was presented at the 2013 Payers’ Forum in Berlin. It is reproduced here together with parts of the speech.
Madlaina Costa-Scharplatz, Head of Health Economics at Novartis Sweden, spoke at the eyeforpharma Payers’ Forum about her use of BaseCase to communicate clinical and economic value at the regional level.
She presented key insights from a recent project in the Nordic region, which sought to improve the way iPad apps for customer engagement are developed. In particular, the audience heard how to:
- overcome the challenges of the payer landscape in Sweden.
- discover innovative ways to present clear, transparent and tailored value propositions that meet both local and regional payer needs.
- present localized value propositions sooner by understanding how to optimize in-house development of iPad apps.
In the case study, Madlaina described a project for one of the products in the respiratory portfolio, detailing her efforts to secure market adoption for the new Seebri Breezhaler. Introducing the case study, she explained:
We have developed a new tool to communicate data in a different way, more efficiently, from our perspective, and where we are able to engage payers in a different way.
We have a public healthcare system in Sweden. All the key health authorities are national key players except the county councils. Each county council gets an annual national grant to cover the expense of reimbursed drugs. It’s then up to the county council - we have 21 in Sweden - how they allocate the annual grant to the different drugs. It varies quite a bit between the different county councils.
The link between the national decisions and the regional or local payer decisions is not always straightforward. Today, I’m going to focus mainly on the local and regional challenges that we face in Sweden.
Challenges at the regional level in Sweden
As this slide from the presentation shows, regional listing does not follow automatically from national approval. To complete the process of taking the Seebri Breezhaler to market, the challenge of engaging with budget holders at the county council level must be addressed:
In order to be used, we need to be on a regional recommendation list. Those lists are followed very rigorously - if we’re not on the list we’re hardly used.
So, the challenge that we face - particularly in the case of the respiratory portfolio - is on that regional level. It’s an additional difficult and time consuming hurdle that we have to overcome before patients have access to the new drug. The HTA assessment is not helping us all the way.
As Madlaina went on to consider several of the process-related and brand-related factors that influence regional listing for new drugs in Sweden, she picked out the communication of health economic evidence for consideration:
How can we increase communication from the key account manager about health economics? The aim was to create a value communication tool, where we can tailor the calculations to make it relevant for the individual we’re meeting, whether it’s on a regional level or a local level, and we want to engage with them effectively.
Using BaseCase to communicate health economics
It is with this aim in mind that the health economics team at Novartis Sweden have been using BaseCase, to develop a tool that communicates health economic data in a way that is both customer-specific and user-friendly:
Our developed tool offers two pathways. You can navigate to the interactive calculations on either a local or a regional level. What the tool allows me to do is link directly to my Excel spreadsheets, so I can pick out the key factors that I want to discuss.
So, for example, I have all the 21 regions here. If I meet a person in Stockholm I want to focus on the Stockholm region itself. I want to show the estimated direct total cost for COPD only for Stockholm’s county council, and those are data that I’ve calculated in the back (on an Excel spreadsheet). It just puts it into perspective, so we can really talk about what is relevant for that person.
Madlaina went on to describe how the app can be used to compare different kinds of data from different sources, to stimulate a discussion that is relevant to a particular client. As well as incorporating dynamic references, the app could include downloadable PDF reports or links to substantiate the economic and clinical argument. Health economic data in spreadsheet form could be used to present a cost comparison, budget impact analysis, or other HEOR-based models:
We are able to link it directly to data that we extract from other sources. So for example we can either use drug acquisition costs for different drugs that we have from last year for each region or we can use the data from regional decisions - if available - to estimate potential savings for them.
On the local level, we have an example of a simple budget impact argument. Here what you see is that in the discussion (I see it as a discussion tool, that’s how we use it in fact) you can really talk about how many patients you have yearly, how are they treated, and then show what the saving would be using the new drug. You really see the savings direct for all your scenarios. You can directly calculate the numbers on a regional or a local level. This is really the value of the tool.
One of the main attractions of BaseCase was that it helped meet the challenge of allowing non-experts to use health economic data to make this kind of argument. Key account managers and other staff were able to use the app to make economic and clinical points based on complex spreadsheets, without being experts in that field:
For us it has helped to support an account-centric approach. The challenge we face within health economics is - how can we communicate it? What is cost per QALY and how can we go further and use that data?
This tool has helped us incredibly to break it down, to make it relevant, because costs become more relevant if they impact you directly. We can stimulate discussions and thus, influence the listing process.
In conclusion, Madlaina summarized what she saw as the value of BaseCase in helping to meet the challenges of local and regional payer engagement:
In the case of Seebri we believe that the tool will support us to receive the listing earlier. For me, the most important point is the flexibility of the tool. We can develop it internally; but at the same time we can always get support from BaseCase to develop certain parts for us. Most importantly we can adapt it easily and quickly if needed.
We heard yesterday about the efficacy data, the medical data - they don’t change within three months. Well that’s right, but this is not the case within health economics. With the new competitors coming in, price changes have become more common. Particularly with biosimilars, there is a constant fight to be the lowest one in the market. I think for us this is really key, to have that flexibility, to adapt the changes right away when they appear so that the next day our field person can use the updated version.
Our thanks to Madlaina Costa-Scharplatz for her presentation.