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Interview with Madlaina Costa-Scharplatz, Head of Health Economics at Novartis Sweden

First of all, thanks for taking the time to talk to us. Can you tell us a little bit about yourself and what you do?

My name is Madlaina Costa-Scharplatz. I have worked in the field of health economics for the last seven years and am currently working as Head of Health Economics at Novartis Sweden. I’m responsible for developing the pricing strategy for Sweden, putting the whole dossier together to achieve reimbursement at a national level and generating value evidence and tools to secure regional and local funding.

Before moving to Novartis a year ago I worked in the global HEOR team at AstraZeneca. I have a background in pharmaceutical science and specialized in epidemiology and health economics during my PhD in Switzerland before moving to Sweden.

What do you see as the current and upcoming commercial pressures or trends in HEOR and market access?

I think there are three key trends. The first is on cost containment. This is an issue that affects the whole of Europe in general, and makes it more challenging to ensure access for innovative new drugs for patients. Especially when we think of ‘orphan’ drugs – drugs to treat a rare medical condition - it can be very challenging to get funding. These are generally very effective drugs but often more highly priced. For one of our orphan drugs we have for example only 14 treated patients in Sweden. To secure funding we have to follow those patients, include them in a registry and look at their outcomes, to assess and confirm the value of the treatments.

The second point is that HTA requirements are increasing. This is a general consequence of trying to contain the cost of care and has led to increasing requirements to demonstrate the value of a particular drug. The amount and comprehensiveness of our HTA dossiers have increased over the years. A particular example in Sweden is that more and more specialized hospital drugs are included in a comprehensive national HTA, which was not the case previously.

The third issue is decentralization of healthcare budgets. In Sweden, we have a decentralized system where, after getting reimbursement approval, we then have to achieve funding at a regional level. I would say that this is our highest hurdle. For primary care drugs it can take up to two or three years until they get included on the regional recommendation lists. Without being on this list a drug will not be prescribed to patients. I’d like to ask about the relationship between the HEOR and commercial teams.

What do you feel are some of the main challenges and disconnects between these two divisions?

I have sometimes experienced greater disconnect between the two functions at my previous global position. I feel that it works better locally as we have more interaction, and in Sweden there is quite a tradition of health economics in general. However, the challenge, what I see, is really to communicate the sometimes very technical and complex models to internal and external colleagues.

It’s really key for us to develop simple messages, and BaseCase has given us a technical tool that allows us to do it in a very efficient way. Since I started working with the BaseCase technology a year ago, I’ve tried to engage my commercial teams as much as possible in the development of any new tools. I found the tools got better, but especially the enthusiasm for using them. The more we collaborate from the beginning, the better the outcome is. Especially when it comes to value communication and the story around it, this is where the commercial teams come in.

How has BaseCase been used by the commercial teams?

How we use BaseCase is really for regional discussions. It’s an excellent tool to break down the economic analysis to the individual need, that’s really what I like about it. That you can make it relevant for an individual payer. You can easily adapt the tool for each region, and then even further down for the hospital level if you want.

I feel the greatest advantage is that I can develop the apps myself, so instead of generating some PowerPoint slides I can get an app that is interactive, nice looking, and allows me to cover individual payer needs in a simple way.

I really like the flexibility to be able to update the model at any time - so for example I can include price changes or additional evidence at any time and the tool will then automatically be updated for all the users, which ensures that they always use the latest updated version.

We have had very positive feedback so far, from both the key account managers and external affairs managers. They say it is easy to handle, nice to present. What they like most is that they can save an analysis on their own server space. We have also already gotten some positive feedback from the payers – they like the tool and the possibility to perform their analysis of interest.

The BaseCase tool works best as a discussion tool in my opinion. So, a simple analysis to engage the payer and support the discussion with some equations. It is key to simplify the message as much as possible and just extract the most important parameters of the model.

What do you think are the challenges in discussing HEOR data with payers and healthcare providers is Sweden?

This comes back to decentralization again. What makes it difficult is that we actually do have to create different analyses for each payer. In addition we have very limited time to present and discuss the health economic evidence with payers. So what we really need is to simplify, and to tailor the messages as much as we can. We have 21 regions and we do a budget impact analysis for each region as well as for individual patient populations. BaseCase allows us to present the data for individual patient populations in an interactive and easy way and this has been much appreciated when having discussions with hospital directors.

Another point is that pharma is very highly regulated, and the regulations are dynamic, always changing. There are many requirements we have to meet for reimbursement today but there will be different or additional ones in the near future. In Sweden they are bringing in international reference pricing, and this is one example of how we always have to adjust as the legislation is changing. You don’t know how it will be in two years. With regional and local payers it is even more complex, as it’s much less transparent concerning what the requirements are.

A final point is – I also feel that there is some disconnect between the relevance of a particular product for payers and pharma. We might want to discuss one product very deeply, but their interest is very distracted by several products as most of them are responsible for all healthcare expenditure at a certain level. So we are looking for a way to make meetings more efficient and discuss several brands in a meeting, to show opportunities of using the cost-savings with a particular brand for the higher costs of another brand.

Do you think pharmaceutical companies and technology applications fit together well?

It’s a crucial part of all the divisions. When it comes to health economics and market access the new technologies allow us to package and tailor the information in a more effective way. When I say ‘tailor’, I mean break it down to the interest of an individual payer - whether a payer has responsibility for a particular hospital or several hospitals. It’s important to make it relevant to them in order to capture their attention.

This is where BaseCase has given us a tool that allows us to create those kinds of messages in an easy way. I feel that I get so much positive feedback from the field that I think this is a tool that we are hopefully going to be using in the future.

Regarding BaseCase there is something that I have realized on the way – while working and developing some of these apps. At first I thought it would be an excellent tool to do cost effectiveness and budget impact models, but now I see it really as a discussion tool, to make discussions as simple as possible and just pick out the most relevant parameters and results of the budget impact model. Much more important is that we can really meet the needs of the individual payers and really break it down to, for example, the amount of patients someone has in a particular hospital.