J&J global boss warns Aust missing innovation train

19 June 2024

Australia is at risk of being left behind in the push for better and more effective treatments if the HTA Review fails to abandon what Johnson & Johnson Innovative Medicine’s Chief Global Value and Access Officer Christoph Glaetzer sees as out-dated concepts such as the use of lowest cost comparators.

“The train hasn’t left the station yet, but it’s the last call to everybody involved in Australia to jump on the train and not totally miss out,” Glaetzer told MedNews when we sat down in Seville at the HTAi conference, almost a year after Glaetzer spoke about the opportunity for Australia at HTAi in Adelaide.

“Last year, there was a bit more optimism than I see right now,” he said. “But I call myself a realistic optimist so there’s still a chance for you guys to jump on the train, but you need to do it now.”

The key factor riling Glaetzer is what he describes as “the extreme way” Australia relies on lowest cost comparators – a legislative requirement that means rather than comparing a new therapy with that most likely to be displaced, it looks at the cheapest comparator.

This can see a new medicine compared with another that is 20 years old and rarely used in clinical practice. As companies present clinical evidence using the comparator they consider most likely displaced, the PBAC’s need for evidence comparing the newcomer to the oldest therapy means such evidence cannot be provided.

“This is unique to Australia, this extreme focus on budget consideration and delinking the innovation from the treatment options the Government wants to provide for the people in the country and asking, what do we need?” says Glaetzer. “The disconnect is huge.”

Glaetzer said the fact the lowest cost comparator was retained in the HTA Review Options Paper was concerning, “because if we continue down this road, it leads to an inappropriate level of recognition of the next innovation and a risk that Australia misses the train.”

He explains that science evolves through incremental innovation, while clinicians learn by using products in clinical practice. The proposal to make medicines seeking cost-minimisation (arguing the same safety and effectiveness as existing medicines) to take a reduced price risks also devaluing incremental innovation.

Glaetzer said countries like Australia that relied on cost-effectiveness have been shown to have slower access to new innovations than countries that rely on clinical effectiveness.

“Australia tries to reduce everything to a single measure and the markets that use this concept have significantly less innovations than markets that use clinical effectiveness,” he said. “The starting point should be clinical differentiation and comparing one treatment to another from a clinical viewpoint, not mixing it with economic considerations using an outdated methodology.”

Glaetzer said governments assume innovations come to market and HTA puts the innovation “in one or the other basket”.

“If it continuously goes in the wrong basket as being not considered innovative, then there will be no innovation coming,” he says. “It is not a given. Innovation doesn’t happen by accident. It only happens if there is recognition of the innovation in a sustainable way and concepts like lowest cost comparator do not recognise innovation.

“This is not reasonable from a scientific point of view because the lowest cost comparator does not represent what is best for the patient, what is being used, and definitely not what should be used. If you want to participate in innovation, then you need to adapt the standard of care.

“I am personally very concerned that we are seeing a deviation in standard of care across countries, not for scientific reasons, because the innovation available and benefits for the patient are more or less the same in every health system.”

“If you miss out twice on innovation, the standard of care is so out-dated that it is not even possible to compare a new innovation to your standard of care. At the end it is the patient who is missing out.”

Glaetzer defines innovation as the treatment that is most appropriate for the patient while unmet need does not mean no treatment options.

“We have to shift the debate and make it clear that innovation is treatment options where patients benefit,” he said. “Australia is missing the opportunity to treat patients in the most appropriate way.

“Having one treatment does not mean the disease is solved. We know patients respond differently to different treatment options and build resistance to options. If you were to say, only one treatment was needed, then we would not have progressed beyond chemotherapy for breast cancer because it was an effective treatment.

“If you take multiple myeloma, yes there are many treatment options available, but still there are patients that don’t respond and patients that relapse, or who need combination therapies. If a treatment is available, the healthcare community learns how to use this treatment in a specific patient population. Every new option adds value.”

While Glaetzer has a global role that sees him interact with all healthcare systems, he says no one system is perfect and each is unique to the needs of the country, but he says every system is evolving and the uptake of innovation contributes to the speed of evolution.

“The reason I am so passionate about the discussion in Australia right now is because we need to make sure everybody understands that topics like lowest cost comparators don’t sound too bad, but they lead to politicians making decisions not to allow access to treatment options that patients and society would benefit from.”

When it comes to Australia’s ability to keep up with innovation, Glaetzer says he remains “a little bit hopeful” that Australia will yet make the innovation train.

“The engine is running and you may still catch the last carriage, but you need to run fast.”

©MedNews 2024