Co-founder and Managing Director of Ingress Health, Bart Heeg has 14-years’ experience leading international HEOR projects, degrees in pharmaceutical science and clinical epidemiology, and a PhD pending in health economics.
We spoke about the trend towards more flexible reimbursement models in Europe, the use of BaseCase Interactive to communicate health economic evidence, and the unique perspective that compelled him to start his own consulting company.
Perhaps we can start by talking a bit about your background?
My background is in pharmacy, and I also did a masters in clinical epidemiology. I’m finalizing my PHD in modelling chronic disease for reimbursement purposes.
My professional career started at a consultancy group, as a junior consultant, and I ended up as European Director. We were mostly developing core health economic models. The types of project that we did included network meta-analysis, budget impact models, country adaptations, and all these materials were used in the end for reimbursement purposes.
After reimbursement, we also used BaseCase to create apps, for example explaining the budget impact of a new drug, for either the health authorities or hospital payers or regional payers.
Over the last several years have you seen any trends developing? Is the use of health economic evidence more important?
I think its role will change. I think pressure on healthcare budgets will rise, so health authorities will need to be tougher on products they allow, and prices they will pay.
Also, I think that for health authorities, showing relative efficacy is nice, but to demonstrate that in clinical practice is something else. In the end, health authorities want to pay for the effect that can be demonstrated ‘on the ground’, in clinical practice.
In future I think there will be more flexible pricing systems, so that, for instance, if you conduct a real-world evidence study and you have good results, then health authorities might negotiate with manufacturers about the price based on that evidence. The price can then partly be explained by using that updated real-world evidence in the health economic models.
So, I think for some drugs, it will change from reimbursement at launch, to a more adaptable system.
Are budget holders demanding more real-world data? What about economic evidence?
I think they are, but they are still not as well equipped as the national health authorities. So I do think that they’ve heard about it and they want to see the evidence, but whether they truly comprehend it or can put it in the right context, I think that will differ from one case to another.
I think that for local purposes, communicating with hospital budget holders etc., BaseCase tools will be very helpful. I just got a request from a client asking for a hospital negotiation tool for example.
There’s more demand for this kind of evidence and for the tools to present it, from both the life sciences industry and the payers. I think it helps manufacturers to demonstrate the case, so it helps.
What is your experience with BaseCase? Have you used the software?
Yes. I think it’s a very nice tool. The apps are very user-friendly both for ourselves and for our clients in the life sciences industry. The competition is just generic presentation tools, so in that sense BaseCase is very unique.
The focus is exclusively on pharma and for a consultancy like ours that’s great. It’s good to use a single platform so that we can produce the same quality over and over again.
One feature we talk about a lot is that you can simplify health economic evidence and make it accessible for non-technical people. Has that been your experience?
Yes, it’s a very flexible tool. One of the things I put on our website here at Ingress Health is: ‘If you have nice study results but nobody reads them, please see our dashboards’.
I think that even clinical trials can be presented on BaseCase. And I think for the European chart review studies, which produce a lot of information, it can be very useful. We produce very large reports, but if you put the summary results in an app then people can easily engage with it, it’s very intuitive.
I now have a large clinical database for example that is a good candidate to be turned into an app. I think that, for clinicians, this is potentially very useful. You can show what happens on first line, what happens on second line, what happens if you extrapolate with parametric survival models, what the mean survival rate is, which patient characteristics predict survival.
When the clinician enters this kind of data, you can get the result straight away - here’s the survival graph, here’s the data.
So you can tailor it to their needs…
Yes, and for our clients in the pharma industry that’s also important. Because, if they can show what the impact of their drug is, they help clinicians to understand and explain the disease to their patients.
Who are your clients? Can you speak a bit about your approach at Ingress Health?
Sure. Ingress Health is a European health economic and real-world evidence consultancy. We founded the company because we saw that there was a trend, as I mentioned, towards more flexible pricing systems and outcomes-based reimbursement schemes.
Increasingly, our clients in the pharmaceutical industry need to demonstrate real-world value and based on that the price or reimbursement might change. This directly affects hospital payers and other local budget holders also.
My background is in modelling chronic disease for reimbursement, and my partner, Thomas Wilke who is professor at the University of Wismar, has 12 years’ experience conducting German and international real-world evidence studies, like observational studies or claims database analyses. We use data from the EU5, The Netherlands, Austria, Switzerland and the Nordics.
So you’re focusing on the European market? Are the trends in the US the same?
For now we are, and expansion to the U.S. and Asia will follow.
A lot of the work we’re doing is initiated in the U.S. They tend to be less interested in the incremental cost-effectiveness of treatments - budget impact is most important. Comparative-effectiveness has also been talked about a lot in the American market.
Do you offer a full-spectrum service?
Yes, our main services are health economics, real-world evidence, education, evidence synthesis like network meta-analysis, literature reviews, and also strategic market access. We also develop global value dossiers and local reimbursement dossiers.