Summary of Miia Turpeinen’s speech:
Miia Turpeinen, Senior Medical Officer at Oulu University Hospital catchment area (Erva), shared her personal views on the current state and future of the assessment of hospital medicines, at Medaffcon’s customer evening on 6 Apr 2016.
Currently, the assessment of hospital medicines is fragmented and scattered. Several different parties on different levels, such as catchment areas, network of Senior Medical Officers, Finnish Medicines Agency, Fimea and European network in Health Technology Assessment conduct assessments on hospital medicines. Turpeinen discussed the contradictory position of Fimea in HT assessment; Fimea being the authority granting marketing authorizations, it is subsequently expected to provide recommendations on the use of the medicines as well. The issue becomes even more complicated in cases of off-label use. Can an authority granting MA provide recommendations in such cases? Fimea’s HTA Advisory Board is to be run down, and the activities will not continue. Will the Council for Health Services of the Ministry of Social and Health Affairs assume a role in providing recommendations?
Regional assessments in catchment areas (Erva) are a common practise today, but not in the future, according to Turpeinen. Her pursuit is national assessment, but there is a long way ahead. After all, the aim of diverse assessments of cost-effectiveness is to create new knowledge to serve the field and authorities in need of such knowledge, and to increase justice and equality.
Currently there is a lot going on in the social and health care system, not least, the structures of the entire health care will be reassessed along with the social welfare and health care reform (SOTE). Changes in the policies, procurement and decision-making impact assessments. And currently there is hardly any cooperation in the assessment of medicines used in outpatient care and hospitals, nor in the assessment of other measures. We should thus capitalise on this moment and see that change is really an opportunity.
Interventions in the assessment and pricing of medicines should also be possible, since the current situation does not serve Finnish health care or the decision makers sufficiently well. As an example of this, Oulu University Hospital catchment area (Erva) has started independently test outcome-based pricing. It is not yet known where it will lead, which is why testing it is necessary. In addition, changes in the marketing authorization procedures (adaptive licensing) can contribute to the implementation of new innovations.
At the moment, hospitals have to make quick decisions for the benefit of the patients, and there is not enough provision for the market access of new medicines. Resources could be more targeted at Horizon Scanning type activities. After all, information on the products entering the markets is available, and advance provision would be possible. This could prevent surprises and hasty decisions.
Now is a good time to shake the procedures used for medicine assessment and to make them serve better everyone involved.