Working Together to Advance Sustainable Access to Breast Cancer Care Judith A. Prestifilippo, M.D. Novartis Oncology August 16, 2006
National Conference of State Legislatures Stamping Out Disease: A Look at the Leading Causes of Death in Women Gaylord Opryland Resort & Convention Center- Nashville, TN
The impact of cancer is far reaching…
Every single day, about 1,500 people in the United States die of cancer* The annual direct, indirect costs in the United States exceed $100 billion And yet, cancer is largely controllable through prevention, early detection and treatment States have worked diligently to combat the disease through funding services, basic research into disease causes • Examples: – Mandating insurance coverage for cancer screening tests – Establishing tumor registries
*From Cancer Facts and Figures 2006, American Cancer Society
While inroads have been made, breast cancer still a significant challenge worldwide... Breast cancer has the second highest incidence of cancer worldwide
In the US, breast cancer has the most new cases of all cancers each year among women
Breast cancer has the second highest death rate among cancers in women
Source: Globocan 2002
Access to breast cancer care has led to improvements in death and survival rates… Today A brighter outlook for lifespan due to innovative research, increased access and awareness:
Yesterday A bleak picture 30 years ago with high mortality rates, few treatment options: 1975-1990: rate of deaths went up 0.4% each year In the 1940s, only 72% of women with breast cancer lived 5 years
1990-2002: rate of deaths went down 2.3% each year
By 2002, 88.5% of women with Government, Patient Groups, Patients, Industry, Academia Research/Access/ Legislation/Awareness/ Education/Advocacy
breast cancer were 5-year survivors
Increased awareness, accessibility to mammography Better understanding of nutrition and exercise Treatment Advances
From: Breast Cancer Facts and Figures 2005-2006, American Cancer Society
Chemotherapy, radiation not the only treatment options Better understanding of molecular pathways; targeted therapies Hormone therapy gives new option for postmenopausal breast cancer patients
Public/Private partners all have key roles to play in increasing access, improving patient outcomes Government
Medical Professionals
Academia
Patient Advocates
HC Environment
Education and Information
Regulatory, policy situation Means of access
Patient Needs
Clinical Outcomes
Ongoing studies Improve diagnosis and monitoring Adherence and persistency
Industry
Prevention/Awareness Diagnosis/Treatment Long-term outcomes
Scientific Collaboration
Improve, support cooperation among scientists and clinicians Driving forward on identifying “appropriate” patients based on molecular pathways, signals, physiology of tumor, etc.
There are a number of ways to help women with breast cancer… X
$5,000,000
Others
$4,500,000
Kineret
$4,000,000
Remicade
$1,600,000
D2E7
$1,400,000
Kineret
$3,500,000
Remicade
$1,200,000
Others
$3,000,000
Enbrel
Sales $ (000s)
Sales $ (000s )
$2,000,000 $1,500,000 $1,000,000 $500,000 $0 1999
X
$1,000,000
$2,500,000
Sustainable Market Access to Breast Cancer Care
Enbrel
$1,800,000
D2E7
$800,000
$600,000 $400,000 $200,000 $0
2004
2009
2014
1999
2004
2009
2014
MMA, Medicare & Medicaid, private insurance, industry access programs
Causes of Breast Cancer
Research Drug discovery and clinical development/trials Potential treatment
Regulatory and Public Policy Environment
Comprehensive Broad and Deep Approach to Breast Cancer Care
Breast Cancer Awareness
Prevention Information/ Education, Advice
Healthcare policies Cancer Plans
New Breast Cancer Diagnostic Tests
Screening and Diagnosis
Pharma companies can be a valuable team player in sustainable access and education...
Expanding focus on discrete patient populations with “niche” indications/significant unmet medical needs, exploring potential relevance to large disease populations Building new approaches to target discovery at the interface of cellular pathways and chemistry
Others
$4,500,000
Kineret
$4,000,000
Enbrel
$1,800,000
Remicade
$1,600,000
D2E7
D2E7
$1,400,000
Kineret
$3,500,000
Remicade
$1,200,000
Others
$3,000,000
Enbrel
$2,000,000 $1,500,000 $1,000,000 $500,000 $0 1999
X
$1,000,000
$2,500,000
S ales $ (000s)
X
$5,000,000
Sales $ (000s)
Significant scientific contributions advancing oncology community needs
$800,000 $600,000 $400,000 $200,000 $0
2004
2009
2014
1999
2004
2009
2014
Pharma companies can be a valuable team player in sustainable access and education... Facilitating better understanding of patients needs
Life After Breast Cancer project – improving life after diagnosis (Novartis) • Life ABC, a nationwide public education project conducted by the Society for Women’s Health, explores the way women with early breast cancer perceive overall risk of breast cancer recurrence and how the complexities of communicating about this risk between women and healthcare professionals may contribute to these perceptions Cancer Support Network (Astra Zeneca) • Provides access, reimbursement information, helpful support services for healthcare professionals and patients from live operators in 150+ languages
Patient assistance programs – addressing access issues facing the indigent, uninsured, underserved populations
E-PASS, GIPAP (Novartis) innovative programs that offer comprehensive assistance to patients. GIPAP is a worldwide program in more than 80 countries Partnership for Prescription Medicine (pharma companies) a national program to help patients in need of access to prescription medicines
Strong public-private partnerships can help improve outcomes by involving the entire community impacting oncology…
Address healthcare equality in medically underserved communities • Examine population with worst cancer survivorship rates, address barriers • Improve outreach, education to minorities, economically disadvantaged – Grassroots initiatives with customized messages – and messengers
• Increase preventive, follow-up screenings; enhance Medicare coverage • Adapt quicker Medicare coverage of new therapies
Expand clinical trial recruitment • Address barriers to clinical trial recruitment • Educate medically underserved about clinical trial benefits, correct misperceptions • Provide support to enhance participation of minority groups in clinical trials
Strong public-private partnerships can help improve outcomes by involving the entire community impacting oncology…
Identify ways to reduce cancer incidence and increase survivorship – look at where the serious problems exist!
African American women have highest death rate of any racial or ethnic group Only 38% of Hispanic women aged 40+ have regular mammograms Nearly one-quarter of women with early breast cancer who had completed treatment, and 40% of women still receiving therapy, said they had never discussed risk of recurrence following completion of treatment with their healthcare professional The Institute of Medicine finds that for uninsured women with breast cancer, the risk of dying increases by 30-50% over insured women
Strong public-private partnerships can help improve outcomes by involving the entire community impacting oncology…
Create/grow existing state cancer programs • Drive grassroots initiatives at state, municipal levels to foster cancer education/awareness and treatment access – Create, provide educational information – Address barriers such as transportation for clinical trial patients to treatment, child care
Create an environment that is supportive of patient rights, with access to effective interventions
Strong public-private partnerships can help improve outcomes by involving the entire community affecting oncology…
Partnerships can help advance the treatment and care of breast cancer, and increase the chance of better outcomes for patients Therefore, we must seek to build successful partnerships by continuing open dialogue and looking for areas of collaboration to benefit the cancer patient
Novartis Contact Information
For more information, contact: • Barbara Boner Associate Director, State Government Affairs Novartis Pharmaceuticals W: 303-948-7319 C: 303-810-9812
Thank you
