Medicine economic model creates negative health outcomes

26 March 2019

Profit-driven production of antibiotics has held back the development of vital medical breakthroughs, according to a new report. Analysis from a leading strategy consultancy suggests that a change in economic model and new incentives could prompt pharmaceutical giants to develop cures to major diseases, which could be affordable at scale.

The much maligned pharmaceutical industry has long been criticised for its failure to focus on deep seated issues in public health. For instance, there is increasing concern around microbial resistance, with some bacteria now resistant to all known antibiotics. Combating that requires new antibiotics – but drug companies see little profit in the field, and therefore have not seriously invested in it. Another instance of concern is a focus on treating symptoms rather than curing the diseases themselves, with such treatments requiring long-term payment to mitigate symptoms, rather than one-time cures being delivered.

Cases like the so-called “Pharma Bro” Martin Shkreli – who received widespread criticism when his company obtained the manufacturing license for the antiparasitic drug Daraprim and raised its price by a factor of 56 (from US$13.5 to $750 per pill – underline the failing of this system to meet the needs of society. New analysis from Boston Consulting Group (BCG) seeks to challenge the current economic model and its inherent failures in favour of a model that creates greater social good while also generating steady reliable returns for pharma companies. The analysis appears in the firm’s ‘Aligning Economic Incentives to Eradicate Diseases’ report.

Different pricing model makes cures more accessible

One example is Hepatitis C. The disease is massively damaging to human life, with considerable negative impacts on patients and society. Treatments have existed for decades, which manage the virus but did not cure it. These treatments had significant side effects however, which saw people not complete rounds – which then resulted in expensive emergency care and secondary health costs.

In 2013 a treatment was developed that effectively cured the virus in 8-12 weeks. The treatment has few side effects and works in most patients. However, five years later fewer than 10% of people globally with the virus have had the cure – largely because of prohibitive costs. The ambition to remove this disease and its large negative drag on the lives of millions by 2030 is becoming increasingly unlikely. The issue is cost.

The current economic model used by pharmaceutical companies mean that early adopters pay sky high prices as the company seeks to recoup costs, with the price eventually coming down to levels at which a larger segment can afford to access the drug – before its generic releases sees mass uptake. This model creates considerable initial barriers, and long-term social costs.

The report subsequently proposes a different pricing model that would see the price of a new drug kept at a constant level for its lifetime but have that level set considerably lower than the current model - which is focused on recouping costs immediately. Under the firm’s model, within 12 years of the Hepatitis C drug’s discovery, up to 96% of the population could be cured, at a cost 30% lower than the UN model and with a cure rate almost 50 percentage points higher than the base model.

The PLA scenario has better social outcomes than the traditional model

A change in model would, according to the firm’s analysis for HCP, triple the number of patients cured within 2 years, reduce the number of liver disease deaths by 60%, reduce total costs to payers by 30% (due to fewer additional costs on healthcare systems), while creating higher and more predictable revenue streams for pharma companies.

“There are many barriers to curing this population, but the dilemma created by current pricing models is one of the biggest,” said Dave Matthews, a BCG Principal and study co-author. The firm adds, “The dilemma results because a high price per patient makes treating everyone prohibitively expensive while an affordable price is too low for pharmaceutical companies to earn back their investments.”

Matthews concluded, “Switching to a population-based model such as the PLA not only makes the cure affordable, but also creates strong motivation to identify, diagnose, and treat as many patients as possible before the license expires.”

Related: Ten year deal activity in pharmaceuticals industry stands at $2.4 trillion.


Privately-owned UK pharmaceutical companies are thriving

04 April 2019

Britain’s 50 fastest-growing privately-owned pharmaceutical companies have all increased sales by at least 10% in each of their last two financial years, new research reveals, facing down headwinds such as Brexit and NHS spending pressures to deliver outstanding performance. 

According to data by Alantra, a corporate finance firm with over 280 professionals globally (of which 70 are based in the UK), pharmaceutical companies in the country are thriving. “These companies have achieved remarkable rates of growth,” said Tom Cowap, a Director in Alantra’s UK advisory business. “Many of UK’s smaller and privately-owned businesses often lead their markets globally.”

The fastest-growing pharma player in the industry – Qualasept Pharmaxo, a specialist pharmacy provider and clinical homecare company – achieved annualised sales growth of 77% over its last two financial years. The analysis reveals that firms that have made the prestigious list differentiate themselves through their ability to isolate and then communicate a diverse set of value drivers, including societal issues such as the economic case for a product, as well as patient outcomes. 

One fast grower, Prescient Healthcare Group, is focused on advising drug development and commercialisation teams (executives) for some of the largest pharmaceutical companies, as well as the smaller firms and biotechs. “We help them differentiate their assets and brands and understand the priorities of the key stakeholders who will influence and enable commercial success and patient access,” said Rakesh Verma, the company’s President of EMEA and APAC.

Pharmaceutical companies in the UK are thrivingAt Oxford PharmaGenesis, Chief Operating Officer Richard White agrees. “We no longer refer to ourselves as a medical communications business because that is too narrow,” he said. “We think HealthScience communications is a better representation of our wider range of activities: in growing areas such as value demonstration and patient communications, for example, but also in talking to a wider audience that still includes physicians, but also spans payers, patients, regulators and even policymakers.” 

For Mark Jeffery, a founding director of The Research Partnership, this shift has meant his firm now provides its specialist market research to pharmaceuticals working at every stage of the product cycle. His company is as at home researching how a marketplace might change over the next 15 years as its is analysing demand for a specific new product or forecasting future sales of an established product going off-patent. “This is a global market, with emerging market customers becoming more and more important to us,” Jeffery says. “Our value driver is the strategic direction we can give clients based on the data.” 

This is not to suggest a broader product offering will erode the importance of specialist skills. Nucleus Global Chairman Stephen Cameron said, “The complexity of the compounds that clients are developing means they need real specialist expertise in niche areas – we invest heavily in recruiting and retaining the right people to meet those needs, and talent is going to be a battleground for our sector.” Nevertheless, burgeoning demand is driving a wave of consolidation amongst the consultants. The last 12 months alone have seen medical communications group Fishawack acquire creative consultant Blue Latitude and Peloton Advantage buy Open Health Communications. Private equity interest in the sector has also been heightened.

Alex Marshall, Partner at CIL Consultants, a management consultancy with specialist teams covering this space, expects this to continue. “This is a rare opportunity to invest in a market where the leading players are generating organic growth of 10% or more each year,” he says. “It’s an industry that remains reasonably fragmented, plus emerging trends such as digitalisation and the growing importance of health economics are only just getting going.” 

Expect international expansion to be an important theme too, especially in developing and emerging markets. Prescient Healthcare Group’s Rakesh Verma says the growth of the middle classes, particularly in developing economies, will underpin a sustained increase in demand for healthcare, even if economic and political instability present short-term challenges. “These markets are going to be hugely important over the longer term, as their middle class populations grow and their governments move towards universal healthcare models,” Verma says.

“This presents new challenges for commercialising products, as pharma and biotechs have to navigate regulatory regimes they are less familiar with. The key will be to focus on individual countries, rather than falling into the trap of targeting regions or country grouping acronyms; you need to build the right infrastructure and pricing model for each specific market.”