Incremental Innovation Series: Lilly Weighs In...

Incremental Innovation Series: Lilly Weighs In...

04.02.13 | By

David Grainger, Global Public Policy Director, Eli Lilly and Company, is sharing with us a blog post he wrote about the value of innovative treatments for cancer, Health Technology Assessment and the overall theme of incremental innovation - which is a focus this week on the Catalyst:

Cancer is a disease that needs all the innovative treatments science can muster, right? Then why is it that some important innovations in cancer treatment get knocked back (or delayed) for funding in some health systems?

In many countries, decisions about paying for new drugs and other medical advances are made using a set of tools generally known as Health Technology Assessment (HTA) a broad concept that encompasses health outcomes research but also calculates other aspects of health care including societal, ethical and health system impacts of a technology. Like many things, the devil is in the details. HTA compares the new treatment with the current treatment for the condition in question within that health system. HTA systems are designed to focus on the size of the improvement in health that is associated with the use of the new drug or technology, compared to that current treatment. New drugs or technologies that demonstrate dramatically improved health outcomes are usually well-regarded by HTA processes -- with the result being they receive relatively rapid approval for reimbursement at prices considered by both payer and manufacturer to represent good value. Again, this sounds very logical.

A problem arises because in the real world, not all improvements in health outcomes result from a single "breakthrough" advance in technology. Certainly, there are some innovative products that are a real breakthrough that radically improves survival in certain cancers. However, there are other examples where medical science has achieved significant improvements in the outcome of a particular condition or disease, although these improvements have come in relatively small steps. In these cases, the improvement that is being assessed in the HTA process (compared to the current treatment) may only be a small gain.

When scientists are able to build on that small gain, significantly larger improvements come via a series of products that each delivers a modest improvement. We call this incremental innovation. Breast and colon cancers are good examples, where a series of relatively modest gains have resulted in significant improvements over a 10-year period. It is vital that HTA processes consider the innovation represented by these novel treatments that demonstrate modest health gains (compared to current practice) and don't deny reimbursement too readily. It is only by patients being able to access each new development and doctors being able to gain experience that step-wise progress is made. HTA processes need to be sensitive to incremental innovation and avoid prematurely cutting off the process of continuous development and improvement. This is especially important with cancer treatments.


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