The inclusion of patients in drug development and regulatory decision making has been steadily increasing over the past several years. Various initiatives have come from a range of stakeholders including regulators, pharma companies and academia. This has been a progressive step in the right direction, but there are many people (most notably, patients!) who believe that even more needs to be done to actively engage patients in all stages of drug development so they can truly benefit from the medicines they take.
One could say that health technology assessment (HTA) bodies, in their push for patient-based evidence, have been the impetus for change. HTA bodies inform decision makers on whether new drugs should be made available in healthcare systems; however, they are often lambasted for creating obstacles to market access. This is because once a medicine is approved for marketing, HTA bodies – more often than not – seek additional evidence that the drug will really provide value to patients before they will recommend its reimbursement on national healthcare systems.
It’s difficult to obtain all the data these HTA bodies are looking for from clinical studies because, by their very nature, the studies are not carried out in a “real-world” healthcare setting. Hence, they seek real-world evidence from sources including observational studies, databases, registries and patient-reported outcome measures, which traditionally have not been part of the drug approval process.
This gap between the data regulators use to approve a product for marketing and that which HTA bodies need in order to recommend the go-ahead for reimbursement delays patient access to innovative products and increases costs for pharma companies…resulting in criticism from all corners.
Convergence of thinking as regulators realise that patients are the key
Finding a way to resolve this disconnect between the evidence needed for a drug’s approval and reimbursement has become a HUGE issue. Nobody is benefitting from the status quo, least of all the patients. To address this, regulators worldwide are inching their way towards a more “HTA” way of thinking in terms of the need for real-world evidence, and they recognise that this comes largely from an increased focus on the end users themselves. In some countries, patient involvement in the drug development and approval process is even being mandated by legislation.
In the US, for example, the Prescription Drug User Fee Act (PDUFA V), which was reauthorised last July as part of the Food and Drug Administration Safety and Innovation Act (FDASIA), explicitly states that the health secretary “shall develop and implement strategies to solicit the views of patients during the medical product development process and consider the perspectives of patients during regulatory discussions”. Under PDUFA V, the FDA has also committed to providing “a more systematic and expansive approach” to involving patients in the drug review process. To this end, the agency has, among other actions, launched the Patient-Focused Drug Development initiative to get input from patients on specific diseases where little is known about the burden of the disease or where outcome measures to determine benefit are lacking.
Moreover, the President’s Council of Advisors on Science and Technology (PCAST) emphasises that patients should play a central role in drug development and evaluation. For example, in its September 2012 Report to the President on Propelling Innovation in Drug Discovery, Development, and Evaluation, PCAST calls for patient involvement in a new Partnership to Accelerate Therapeutics aimed at promoting “innovation and improvement in the discovery, development, and evaluation of new medicines for important public health needs”.
A senior official at Health Canada recently told me that Canadian lawmakers will also be focusing squarely on the patient as they overhaul the entire legislative framework for pharmaceuticals, beginning with the new approval pathway for orphan drugs. As for Health Canada itself, the regulator is listening to patients more than ever to ensure drug reviewers consider “clinically meaningful” evidence of a drug’s benefits and harms (they are phasing out the term “risk”) – it’s all about being socially responsible, the official explained.
The European Medicines Agency (EMA) already includes patient representatives in certain scientific committee meetings, but the agency acknowledges that it needs to do more. In its Roadmap to 2015, the EMA says that one of its main objectives is to improve the decision-making process by taking into account patient experience. This is expected to help optimise the safe and rational use of medicines.
The European Commission is also keen to make sure patients are well informed so they can have a voice in drug development and eventual commercialisation. One example of its efforts in this regard is the European Patients’ Academy on Therapeutic Innovation (EUPATI), a project the Commission is funding along with the European pharmaceutical industry federation, EFPIA. Under the patient-led initiative, which runs from 2012-2017, a 29-member consortium will develop training courses, educational material and an online public library that will empower patients to engage more effectively in the development and approval of new treatments.
The theme of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 18th Annual International Meeting bears testimony to this trend. “Patient-Centered Outcomes: Focusing on the Patient” is scheduled for 18-22 May 2013 in New Orleans, LA, USA, and will feature three plenary sessions:
- Finding the patient in health research and policy
- Finding the patient in the drug development process
- Assessing the evidence for better patient care: A health care decision-maker toolkit
The programme for the first plenary states: The new buzz words are ‘patient-centered’ and ‘patient-focused’. Why is the focus on the patient? Why wasn’t the focus on the patient before now?
That is precisely what I’d like to know, too.