A way forward

Just over a year ago, Brigitte Nolet became President and CEO of Roche Canada, Pharmaceuticals. A Canadian with extensive global experience, Brigitte has met, connected and collaborated with many stakeholders since she’s been back in Canada. She highlights that the dialogue and learnings have been invaluable and there is a great desire to work together across industries and sectors to address today’s pressing healthcare challenges.

Throughout this four-part series with Brigitte, we’ve explored: the need to create a clear pathway to foster sharing, integration and use of standardized health data to inform timely healthcare decisions; how artificial intelligence can and must be utilized in healthcare delivery; and the need for increased collaboration to better inform patient care and health system decision making. But this is all in vain if the very diagnostic tools and medicines being developed do not reach the patients who need them. 

In Canada it takes two years (732 days) for Canadian patients to get access to a new drug in the public plan, whereas those with a private plan can get access in less than one year (226 days). In the final discussion in this series, we explore improving access to and availability of new medicines and get Brigitte’s thoughts on a constructive path forward where Canadians are able to access the innovations they need.

A: I was surprised to learn that after 8 years living and working abroad, access to new medicines has worsened over the last decade. The reality for Canadians is that the process to access new medicines is extremely complex and involves several different federal, provincial, and territorial agencies. When we look at the overall timeline to public listing for new medicines, we can see our regulatory and reimbursement processes are highly sequential, and involve many steps before patients receive access. Each of the steps introduces another opportunity for further delay.

So it is not a simple process to navigate, but I believe that in our country, we have governments at all levels that want to work toward better healthcare systems for all.

If we look at learnings from COVID-19: from rolling data submissions, meaning the ability to review data from early development while later stage clinical trials are taking place; digital health that blossomed (e.g. virtual care for patients); and, importantly, the innovative way in which the public and private sectors collaborated to ensure timely access to diagnosis and vaccination in unprecedented times - we know there is a better way to get new innovation to patients that need them. What we must ensure is that we don’t wait for another pandemic to deliver on the care and innovation needed now; regardless of disease, all patients deserve rapid diagnosis and a quick path to treatment - a cancer patient, a multiple sclerosis patient, or an influenza patient.

A: We must evolve the approval and reimbursement pathway for new medicines. Science and technology are advancing at a speed we could have never imagined 20 years ago, but our healthcare technology assessments haven’t kept up to pace.

I envision a future where a data collection plan is implemented throughout the life cycle of a medicine, collecting real-world data on patient demographics, disease characteristics and trajectory, patient experiences, and clinical, resource and societal outcomes.

This analysis enables decisions on whether to disinvest, continue with evidence development, or to implement and even expand access to these innovations based on that new evidence. 

This process, of making faster decisions based on available evidence and committing to collecting data, can enable earlier, sustainable care delivery for patients, as well as better clinical decisions and outcomes. This will lead to healthier, more productive communities and sustainable, resilient healthcare systems. 

A: I strongly believe we have all the necessary elements for success and world-class healthcare systems right here at home: smart people; diversity in our population; high education levels; a strong innovation mindset; open culture of collaboration; and we can’t overlook or underestimate a fundamental desire by governments at all levels to improve the quality of care for Canadians. 

To move from well-intentioned healthcare to systems that truly deliver exceptional care for Canadians, we must evolve the conversation about healthcare and treatments to not focus solely on the cost of treatments, but the value that they bring to patients and our healthcare systems. The way we assess the value of new technologies must keep up with the pace of innovation. All parties - from clinical research, to biomanufacturing, to regulatory approval, to reimbursement, funding and care delivery -  need to value healthcare innovations as an investment in people, healthcare systems, and society, rather than a cost. 

Secondly, we must look at innovative approaches to using real world evidence to inform data-driven healthcare decisions. An example of this is the PREDiCT project (short for Precision Oncology Evidence Development in Cancer Treatment). In PREDiCT, Roche has teamed up with BC Cancer and the Canadian Personalized Healthcare Innovation Network (CPHIN) to enable more timely and sustainable access to comprehensive diagnosis and targeted cancer therapies. We’re doing this by developing a framework that can be used for promising health technologies to enable decision makers to grant conditional access decisions to those that would benefit most from a treatment.

So far, PREDiCT has led to over 1,000 patients receiving high quality molecular panel testing through testing expansion within British Columbia. We’ve seen 50% of patients identified with 41 different genomic alterations. While not all genomic alterations can be treated on an individual basis at this time, what this information represents is a more precise understanding of each patient’s unique cancer, and where available, a targeted therapy.

In the context of healthcare innovation, we need to unpack what value means. Valuing innovation more broadly creates opportunities for better investment and treatment decisions.

For example, data-driven healthcare and precision medicine in oncology, as I mentioned in the context of the PREDiCT project, has the potential to address inefficiencies and waste in the system as patients receive the right therapy earlier in their cancer care journey. Equally, those who won’t benefit, do not receive the therapy or incur the associated cost. Mining and basing decisions on data can lead to fewer hospital visits, allow a patient and caregiver to return to daily activities like work or school, and give additional time with loved ones - all of these are prime examples of value beyond the cost of a test or medicine alone. I recognize this is no small feat, but if we are clear in what we want to achieve and open to working together - meaning, the public and private sectors - I am optimistic that we can and will find a constructive path forward. And with recent government announcements linking healthcare funding to data collection and insights-driven next steps, I am further encouraged that we are indeed coming together and will find the best way to value innovation in healthcare.  

I imagine a not-too-distant future where Canadians, first and foremost, have access to a timely and accurate diagnosis of a disease. And with all the challenges that come with a diagnosis, my hope is that they also gain access to new, life-saving medicines and innovative therapies – when and where they need them, and personalized to them. Very simply, I hope - and I believe - that Canadians can and should gain access to medicines at the same time their friends and family in the US and Europe do. And Roche Canada is ready and willing to look at a decision-making framework that integrates a broader, more holistic view of value beyond clinical and economic outcomes at one point in time. I know we can create  world-class healthcare systems where all Canadians benefit from the latest medical innovations and a thriving life sciences sector. The time is now - there are Canadian patients waiting for - and who deserve - better healthcare.