President’s Message: ISPOR – The Only Way is Up!

The  ISPOR  12th  Annual  European  Congress held at Le Palais des Congres de Paris, Paris, France attracted over 2,700 delegates, a record number for any ISPOR meeting or congress and a real achievement for the Society and its members. The success of ISPOR is also reflected in the total number of members, including ISPOR regional  chapter  members  which  has  doubled over the past 5 years and now exceeds 7,700 members worldwide. We also note a change in the membership by geographic region with 42% of members now coming from Europe as compared with 41% from the USA, 9% Asia Pacific, Africa,  Russia,  5%  Canada  and  3%  from  Latin America.  This  increase  in  membership  from Europe (19% in the year 2000) may, in part, reflect the importance of pharmacoeconomics and outcomes research in supporting the increasing use of health technology assessment (HTA) in Europe. In the current fiscal climate, the role of ISPOR and its members assumes an even greater relevance as society aims to allocate scarce resources wisely, fairly and efficiently to optimise the provision of health care and public health.

I recall the ISPOR 2010 vision of ‘a fully international, educational and scientific organisation fostering excellence in the core disc-plines of pharmacoeconomics and outcomes research’. Having attended the 14th Annual International Meeting in Orlando, Florida, USA and the ISPOR 2nd Latin America Conference in Rio de Janerio, Brazil in addition to the 12th Annual European Congress, I believe this vision or goal will be achieved. In my view this is due mainly to the ongoing, generous support that all our members give to our Society, in addition to our marvellous ISPOR team. Many thanks to you all!

The Congress Program Committee and the Programme Chair, Claude Le Pen PhD, is to be congratulated for the exciting programme at the ISPOR 12th Annual European Congress in Paris. There were many highlights including the plenary sessions, issue panels, workshops, and educational symposia in addition to the research podium and poster presentations. The first Plenary Session (Sunday 25th October) discussed health care reimbursement systems in Europe with excellent contributions from Laurent Degos MD, PhD, Chairman, Haute Autorité de Santé (HAS), France , Sir Michael Rawlins MD, FRCP, Chairman, NICE, UK, and Peter Sawicki MD, PhD, Director, IQWiG, Germany. The speakers highlighted the variability of health care systems, HTA assessment and decision making processes across Europe and whilst coordination and collaboration is possible between the various agencies, HTA and reimbursement decisions will remain at the national level, at least for the foreseeable future.

For those of us involved in HTA and advising decision makers the pervasiveness of uncertainty is increasingly evident. We have uncertainty in relation to drug efficacy, effectiveness, adverse effects, economic models and the links between surrogate markers and long term outcomes in addition to uncertainty of the cost-effectiveness and budget impact of such products. This is against the background of increasing drug expenditure driven, in part, by new technologies such as biologic agents for the treatment of chronic conditions such as rheumatoid arthritis and inflammatory bowel disease. The biologic agents constitute the fastest growing segment of many pharmaceutical markets. The cost of these agents can be substantial e.g. imiglu-cerase (Cerezyme, Genzyme) for Gaucher’s disease may exceed $200,000 annually in the US or eculizumab (Soliris) for the treatment of paroxysmal nocturnal haemoglobinuria (PNH) which costs in the region of € 350,000 per patient per year in Europe. Not surprisingly, the issue of affordability arises.

In this context the 2nd Plenary Session was particularly relevant and discussed performance based agreements as one approach open to decision makers in the face of uncertainty. Sean Sullivan PhD, University of Washington, USA, provided a superb outline of outcomes based (conditional coverage, performance linked reimbursement) and non outcomes based (utilization or price cap, manufacturer funded treatment initiation) performance based schemes. Although such schemes will initially be likely focused on specialized medicines rather than a routine method of reimbursement they are generating increased interest at the payer level.

I have outlined just a few of the highlights at the 12th Annual European Congress and I am sure you can recall many more. The ISPOR meetings, congresses, and conferences are very important for the Society and its members and I am sure those of you who could attend availed of the opportunity to meet with fellow members to discuss areas of interest. This sharing of knowledge and understanding is an essential component for the further development of our discipline.

  Issues Index | 2009 Issues Index