A giant leap forward for access to quality healthcare

A breakthrough clinical medicine access programme by ISIMO Health aims to revolutionise the way in which patients can access expensive medicines and will make unprecedented amounts of relevant medical data available for immediate academic and commercial interpretation.

In a first for South Africa, doctor-driven healthcare organisation ISIMO Health has launched an “expensive medicine” access programme aimed at using targeted research to reduce healthcare costs and eliminate the guesswork which is often employed in selecting the correct treatment protocols for patients.

“The Phase 4 Medicine Access Programme (Registry) will provide usable data where funders are currently guessing,” says Dr Jacques Snyman, CEO of ISIMO. “Real-life, accurate data usually matures long after medicines have been registered by the regulatory authorities and this programme will fast track this data collection in the South African community.”

Currently there are clinical access programmes in place, but these are largely driven by Big Pharma and are often just follow-on programmes on clinical research studies. The ISIMO programme will be the first independent one of its kind in South Africa allowing needs-driven access to care within a structured funding environment.

The ISIMO programme, one of multi-criteria decision analysis (MCDA), was unveiled at the Independent Clinical Oncology Network’s (ICON) annual conference on 12 August 2016. ICON is a subsidiary of ISIMO and pioneered an approach, which brings together medical specialists, funders and patients to drive the use of evidence-based systems and treatment protocols for maximum benefit for patients. ICON’s focus is on cancer care, while ISIMO has a broader focus.

Research indicates that there is a sore need to drive down the costs of healthcare in general and cancer care in particular. An estimated increase in cancer survivors of 30% by 2020 has been projected along with a 10.5% year-on-year increase in the costs of cancer treatment, while the disease prevalence and incidence are on the rise in Africa. Patients in other disciplines are also subject to rising costs. General medical costs in private care are said to have increased by 300% in ten years.

“Wasted healthcare expenditure is rife, both in private practice and state sector and the only way forward is to acknowledge this and form aligned partnerships with each other while restructuring reimbursement models,” says Snyman.

ISIMO’s clinical, medicine access programme – a further step towards increasing access to cost-effective care – will involve a crucial yet impartial interaction with the pharmaceutical industry, in order to facilitate greater understanding of the products delivered and how best they can be targeted.

Additionally, says Snyman, the programme – and its high-tech IT back-end support – represents a unique way to collect data which can almost immediately be translated into relevant real life treatment response information.

“At the moment, we might have the information that a certain treatment will work for one out of eight patients. But we don’t necessarily know which of the eight will respond to the treatment,” he explains. By gathering the relevant data – the likes of which are available nowhere else in South Africa – and delivering the information to the academic sphere rapidly, the programme will start to minimise the “guesswork” in practice when selecting patient treatment.

“In this way, the programme’s research will help clinicians identify who is most likely to benefit from which treatment, eliminating wasted costs and increasing patient access to care that works. Improving cost-effectiveness and access will ultimately also help lower the cost of effective treatments overall – so that ultimately more people are able to receive treatment. It’s a win-win-win innovation.”

Funding, Snyman stresses, will be driven towards where there is real evidence of improved outcomes. At the same time, pharmaceutical companies will gain invaluable understanding of how their products work in the marketplace. Data will also be provided to funders (medical schemes and state) allowing for the development of risk sharing or differential pricing models that are product specific.

“Treatment becomes more cost-effective because it is operating in a cost-effective environment,” explains Snyman.
Cost-effectiveness does not only apply to the initial cost of the treatment, Snyman stresses. If, for example, the cost of treating a cancer patient is R2 million and extends their life by a year, the investment in the patient is relatively high. If, however, patient and treatment are matched efficiently and the life of the patient is extended by 18 years, the cost per year of life is considerably lower. The patient receives more value, while also extending their opportunity to contribute to the economy and the shared pool of funds in their medical scheme.

Ultimately, says Snyman, the access programme’s potential for increasing access and gathering accurate, usable, readily available data could make a tangible difference to treatment protocols and patient outcomes throughout the healthcare industry.

Chief Operating Officer of ISIMO Ernst Marais says: “A crucial task is the bringing of a multi-disciplinary approach to lowering the cost of cancer and other treatments. Effective communication with clinicians, who investigate the most effective treatment methods, helps educate funders about the treatments most worthy of funding This in turn assists patients in navigating the often difficult path of illness.”