The 3rd Annual International Pharmacoeconomics Forum (IPEF) took place in Riyadh, Saudi Arabia on November 12 and 13, 2021. The IPEF is an annual meeting that focuses on bringing together subject experts to discuss important topics that enhance the access to quality therapeutics. The 3rd IPEF forum was held in a hybrid format in Saudi Arabia, supported by a scientific committee and faculty, as well as with the institutional support of Alfaisal University, the International Society for Pharmacoeconomics and Outcomes Research (ISPOR)–Saudi Chapter, and the Global Journal on Quality and Safety in Healthcare.
The IPEF has the goal of encouraging stakeholders to improve patients' access to quality medications by learning about value-based healthcare, evidence-based medicine, health technology assessment (HTA), real-world experiences, and approaches to optimize access to healthcare. More recently, the forum fostered best practices on overcoming the effect of COVID-19, namely on the topics of healthcare organization and access to medicines, diagnostics, and wider impacts.
The 2021 conference was structured on the following six main topics: (1) the future of health economics in Gulf Cooperation Council (GCC) and Arab countries; (2) value-based medicine; (3) HTA methodologies and access to innovative medicines; (4) evidence-based medicine; (5) health economics experiences in the region; and (6) impacts of COVID-19 in access to healthcare. This article highlights the relevance of these discussions and how they can be leveraged for future academic and empirical work in those areas.
PRESENT AND FUTURE OF HEALTH ECONOMICS IN ARAB COUNTRIES AND GCC
The driver for discussions is common to similar stakeholders in the most developed countries of the world. There is the side of a commitment toward global health and universal coverage, but the population is increasing, with demographic challenges and technologies, albeit more promising outcomes also accrue in costs. Pressure on budgets requires a pragmatic vision of the process of decision and systemic management of healthcare.
Two panels discussed the future and assessed the present regional experiences with health economics in Arab countries and GCC. It is clear that in these countries, disciplines like health economics are increasingly being implemented. They are beyond a mere theoretical or academic perspective on society and healthcare organization, supporting investment decisions, horizon scanning, allocation decisions, and broader health policy analysis. Recommendations from experts provided relevant insights for a roadmap, built on regional and international experiences, to HTA governance across countries. They recommended implementing national HTA bodies and governance frameworks and to set out the key principles to follow when doing so; the speakers also showed the value of cross-border cooperation in HTA, public health, and health economics in general. Strong case examples were presented as well. Overall, participating countries and subsystems are working toward implementation in areas including data generation, procedures, budgets allocation, training, regulatory readiness, quality, and interoperability of systems. Efforts to support the implementation and dissemination of HTA as a tool for the development of the value chain of healthcare will proceed with a focus on resilience, data management, quality, financial efficiency, and overall access to innovative care.
CHALLENGES ON IMPLEMENTATION AND CASE STUDIES
Data and evidence-based knowledge about healthcare systems are key for any decision. The main challenges to implementation come from the fact that systems still lack improved tools for recording and processing data. Data science requires committed infrastructures (human and physical), and for that there is a need to increase the culture of registry among clinical staff, pharmacists, managers, and software developers. Possibly, we could then apply the health economics experience from the current heavy users to include other stakeholders in the industry.
The uses are diverse: from formulary management to post-authorization market studies and managed entry agreements; support for academic research and early research and development with pharmaceutical and medical device companies; and broader topics in disease management and investment planning.
Just as health economics is key to the future of healthcare systems, academic research is fundamental to the quality discussion of increasing use of economic assessment methodologies in healthcare. First, peer-reviewed publications are a means to properly register the initiatives and usage of specific tools and methodologies, thereby adding reproducible and reliable data to the evidence base. Second, moving beyond a list of case studies, an academic perspective opens the vision toward sharing experiences in a systematic way, allowing for integration and comparison with international initiatives. Third, publishing and curating data allow for international benchmarking, which supports health policy decision-makers. Finally, reporting of rigorous implementation studies provides supportive evidence for using health economics and related disciplines to improve outcomes and efficiency in healthcare.
This is clearly the direction the region is taking because there is a growing number of relevant publications, namely in Saudi Arabia, Egypt, and the United Arab Emirates. Certainly, there are challenges, for example, regarding the nature of measures. However, researchers are responding with sophistication and creativity to overcome problems and limitations. The positive message is that the work is being done and the human factors exist to make it possible, together with institutional, university, hospital, and government support for these ventures. It is clear the successful cases presented and the academic support regarding the outcomes of these initiatives are drivers for future adoption of these technical and theoretical lenses (e.g., health economics, HTA, pharmacoeconomics) and support health management or health policy decisions.
Another pillar that supports the development of health economics and HTA is rooted in clear visions for institutions, for example, from government perspectives. The 3rd IPEF provided positive examples from Egypt for other Arab countries. The case of Saudi Arabia summarizes the following perspective that is certainly shared by all governments: they seek out better economic opportunities with the support of health investments, and healthcare fosters efficient, transparent, and accountable services. In summary, healthcare improves societies and elevates the potential of citizens and civilizations to a degree that clearly supports governments' transformation of the sources of wealth and development.
ENHANCING ACCESS FOR PATIENTS
Access to care and medicine for patients, in any country or system, has a dimension of political analysis and decision-making, but it is also dependent on appropriate tools and implementation conditions. So, IPEF has introduced a set of three work flows devoted to the specifics of implementing health economics (i.e., HTA) at a local level. These work flows encourage discussion on the concept of value-based medicine, the use of evidence-based medicine, and relevant experiences from other countries and systems.
Sustainable access to care is contingent on several conditions, namely formal access assumptions, such as research and development supply chain resilience, manufacturing capabilities, regulatory development, and HTA of the healthcare system. Sustainable access to care also depends on the nature and the organization, so that the optimization of treatments and the choice of innovative therapies can be associated with effective care delivery and efficiency.
Infrastructure should focus on relevant outcomes, for example, optimization and integration of the value chain using data management systems. These resources are of paramount importance for HTA to support the development of the healthcare continuum. Naturally, there are several stakeholders involved, and all have to be summoned to interact at different extents—from being accountable for specific problems to cooperating with other stakeholders to address others.
For the future, the challenge of better managing the data that become available is enormous. This links well with the principles of evidence-based medicine. Decisions will be made with varying degrees of evidence quality, but the systems can develop significantly in the production and systematization of such evidence. Oncology is an established specialty on valuing multidisciplinary assessment, integration of care, and leveraging data, including real-world data. Discussions should continue on the best methods to manage data and other topics, such as the best outcome measures. These are contingent and certainly evolutive—the pressure to use surrogate and novel outcomes will increase as technologies try to differentiate novel perspectives. It is the regulator's role to guide researchers toward the most valued (by patients, by society, and by payers) outcome measures, on top of the usual overall survival or quality of life indicators.
In addition, there was great interest in managed entry agreements among conference attendees. Speakers presented cases of some systems or countries and how they are preparing themselves for the regular use of these agreements as a tool to manage access and efficiency overall. The conference also covered the perspective of these contracts in Europe and the United States. In all geographies, value-based contracts or managed entry agreements are relatively new; however, they are changing rapidly, so we must consider which conditions are required to maximize the benefit from this opportunity. Benefits go in all the directions. There is access from the perspective of patients; there are savings opportunities from the perspective of payers; there is the chance of improving decision making and having the best technologies available from the perspective of providers; and certainly, from the perspective of suppliers there is the opportunity to further differentiate their value-adding products. Catching this momentum is contingent on factors, such as the availability of data, the regulatory context, the ability to have contracts defined in terms of value, and the possibility of using the insights from the process of managing data, to further improve integration and the way care is provided to patients.
THE EFFECT OF COVID-19
The recent pandemic brought novel challenges to healthcare systems in many aspects. The pandemic accelerated trends, like the adoption of digital technologies, and posed some access challenges that the last panel discussed. Every supply chain block experienced significant decreases in air cargo capacity, sea freight, and transport logistics. The challenge to overcome export restrictions by supplier countries is related to both COVID-specific and non-COVID commodities; for example, India has banned a number of essential active pharmaceutical ingredients. This will lead to the development of more agile systems, reinforcing industrialization, and diversification of value chains. Disruptions in logistics cause temporary bottlenecks, but over the long term should foster development of simulation models and digital-based management of supply chains.
These trends—together with the overall technological pressure, search for efficiency, disruption of classical supply chains, and so on—will increase emphasis on real-time decision-making and real-world evidence. In fact, decisions will have to be much more grounded in practice. As a consequence, we will be watching a shift in the timing and use of clinical data; these data can be used for many improvement processes, not just clinical follow-up. The panelists were very clear about these effects and discussed valuable cases and examples, aiming at supporting health policy guidance.
According to the participants of the forum, it is clear that (1) HTA supports the development of efficient, equitable, ethical, and effective policies; (2) HTA guides the development of patient-focused programs; and (3) that systems can rely on HTA methodology to achieve the best value based on their long-term vision.
Naturally, the results of HTA will depend on the nature of the adoption by each country. In fact, implementation studies will demonstrate how these methodologies can be routinely used in practice, which will unfold their full potential. Several speakers addressed this topic of local or national adaptation, which is also consistent with the literature. There are many benchmark opportunities and perspectives, for which international cooperation supports the practical use of HTA; for example, joint activities within the European Union that cooperate in some dimensions but differ significantly in others.
The forum also concluded that awareness campaigns on diseases and prevention could lead to better allocation of resources. This would happen by means of including patients and listening to their voices. Such testimonies can leverage the construction of treatment pathways and the design of prevention campaigns and education programs.
The reason that education is also a keyword of the conclusions of the forum is because literacy will continue to promote health economics as a science. It will not just increase awareness on relevant topics (e.g., efficiency) but actually leverage investment in educational areas. Such areas include life sciences, decision sciences, data science, management, clinical education, and so on; these will all be in partnerships with government and/or private institutions to procure healthcare technologies and manage larger investment ventures.
The future is about hope and humanism in healthcare. The means to achieve these goals include efficiency, effective use of real-world evidence, improving HTA methodologies, developing political tools for budget allocation or investment decisions, and the ability of decision-makers to justify healthcare-relevant decisions based on value for money and outcomes for the population.
Source of Support: None. Conflict of interest: None.