Testing times for personalised healthcare
Today’s healthcare is not the same as it was just a generation ago. With the development of Personalised Healthcare, or PHC, patients can now benefit from targeted treatments based on the presence of specific genetic defects or “biomarkers in their tissue.”
Let’s look at breast cancer to illustrate the current opportunities for patients. We now know that breast cancer is not a single disease, but in fact a whole range of different diseases each with their own specific characteristics. A particularly aggressive type of breast cancer occurs in patients with a greater than normal amount of a particular protein on the surface of their cells, the HER2 receptor. Breast cancer patients are therefore tested for their HER2 level at diagnosis, and if they are found to be “HER2-positive” then the physician can prescribe a HER2-targeted therapy.
PHC has been part of cancer treatment for over a decade now and has resulted in a shift of healthcare knowledge and practice. While the benefits of PHC for patients are clear, this approach to therapy has significant implications for all other stakeholders within the healthcare system, e.g. physicians, healthcare providers, policy makers and regulators.
For example, regulatory agencies assess the benefits of targeted medicine accompanied by a specified diagnostic tool. Here, the U.S. Food & Drug Administration (FDA) has been at the forefront by establishing processes to assess both pharmaceuticals and companion diagnostics together. The last years have seen a steady increase of drugs being approved with companion diagnostics by the FDA, especially in the area of oncology:
For payers it is most important to evaluate the economic benefit of targeted treatments in times of limited budgets. Here PHC allows efficient use of resources by identifying patient groups that can benefit most from targeted medicines, avoid some of the side effects associated with chemotherapy, and save precious time with the right treatment at an early stage. Physicians recognise the opportunities that PHC brings to patients and act accordingly by, for instance, liaising with central laboratories about conducting the necessary diagnostic tests. And finally, patients are actively involved in demanding the best treatments and access to innovative medication.
PHC is a reality as we can see by the many drugs and diagnostics already on the market, but how far is the concept embedded with the different stakeholders? Is the knowledge consistently distributed across regulators, policy makers, payers, physicians, payers and patients? Or are there differences and if so, where are they? To answer these questions Roche conducted a survey of over 900 key stakeholders in the different healthcare systems of six countries: USA, UK, China, Brazil, Germany and Switzerland.
The good news is that physicians, especially oncologists and pathologists, are very familiar with PHC. However, looking at the results for the other stakeholders a clear knowledge gap became apparent. Overall, nearly 40% were not familiar with the PHC concept, rising to 44% within the payer group:
Drilling down deeper revealed another set of findings. Amongst the interviewees who claimed that they were aware of the PHC concept, both physicians and other stakeholders (e.g. regulators and payers) cited similar strengths and weaknesses. While better response rates and successful outcomes were seen as clear strengths of PHC, a perceived high cost for treatment was seen as a key barrier.
Understanding the molecular basis of disease and developing targeted drugs together with the right diagnostic tools is the way modern medicine is going. As a result, scientific advances and increased knowledge of diseases is shaping the way healthcare stakeholders are working already and it will become even more important in the future. At Roche we firmly believe that patients and healthcare systems benefit from this approach. To realize the full potential of PHC we want to ensure that all stakeholders have a shared understanding.
Our goal is to follow where innovation and modern medicine leads us. For Roche, PHC is a strategic cornerstone of our work and we continue to develop personalised treatments and diagnostics beyond cancer. With over 250 research projects evaluating PHC options and many PHC programmes in late stages of development in oncology, Alzheimer’s and other diseases, many more innovative and efficient treatments will hopefully become available for patients soon.