For many people, medicines are an indispensable part of their daily lives. By using medicines effectively, people live longer, healthier and with a better quality of life.

Innovative medicines in the field of cancer have led to an increased chance of survival in many types of cancer over the past decades. Not only for adults, but for children as well. Cancer, like HIV and diabetes, is increasingly becoming a chronic rather than a deadly disease. Quality of life is also improved considerably by medication. For example, there are better treatments for hepatitis C and psoriasis.

Unfortunately, there are still diseases for which there are no effective medicines, despite all efforts. This is applicable for certain rare diseases but also for very common disorders such as Alzheimer’s disease. Because there is still no proper drug for dementia patients, it is good to know that much can be achieved with prevention. Only 3% of the people with dementia have a hereditary version.

VALUE-BASED HEALTHCARE IN PRACTICE: THE MARTINI KLINIK

COMPARISON OF PROSTATE CANCER RESULTS ON THE THREE MAJOR VALUES FOR PATIENTS

Source: Martini Klinik, kanker.nl, 2018

The German Martini Klinik focuses on results that the patient finds important. This produces good results in prostate cancer. For example, in prostate cancer, that is continence or the retention of sexual potency.
The five-year survival rate of patients in this clinic is higher than the average in the Netherlands. It is also striking that the sexual potency of patients treated in this clinic is relatively high.
Furthermore, the continence of patients treated in the Martini Clinic is somewhat better than the Dutch average. In the Netherlands, several pilots are already running with result-oriented care.
Current care practice often considers whether a treatment has been successful in a technical sense. And billing usually occurs on the basis of quantity, rather than quality. But in value-based healthcare, the patient is asked in advance which results he/she finds the most important. Ultimately, a different manner of reimbursement is also required there. Therefore, it is important that healthcare insurers be involved in these pilots.

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MAJOR OUTCOMES AT A GLANCE

IDENTIFIED WHAT PATIENTS FIND MOST IMPORTANT FOR VARIOUS DISEASES

International outcome sets have already been created for a number of diseases. That means that for those diseases, it is clear which outcomes from a treatment are most important for the patient. The one patient, for example, finds it very important to be able to continue to exercise and to work, while the other mainly wants to be rid of the pain. These outcome sets were created by ICHOM (International Consortium for Health Outcomes Measurement).

Outcome sets are an important building block for value-based healthcare. Healthcare ­professionals, insurers, patient organisations and drug companies look together how they can optimise the treatment for the patient. The government wants half of all healthcare outcomes to be transparent in 2021. Many members of the Dutch Association Innovative Medicines already have a project for value-based healthcare, or will soon start one.

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Source: ICHOM 2019

CHANCE OF SURVIVAL INCREASED FOR PATIENT WITH CANCER

INCREASE IN FIVE-YEAR SURVIVAL RATE OF PATIENTS WITH DIFFERENT TYPES OF CANCER

Source: www.cijfersoverkanker.nl, 2018

The five-year survival rate for many types of cancer continues to rise. Thanks to innovative medicines, skin, prostate, breast and thyroid cancers have in many cases become chronic diseases in recent years. Indeed, the five-year survival rate for skin cancer is 93%. That is good news for patients. Meanwhile, many innovative medicines are being developed for cancers that are less easy to treat.

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LIFESTYLE DECREASES RISK OF DEMENTIA BY 30%

Only about 3% of all variants of dementia are hereditary. In all other forms of this disease, lifestyle can have great influence. When a young adult has already adopted a healthy lifestyle, the risk of dementia can be reduced by about 30%. The most important lifestyle rules to this end are: sufficient exercise, not smoking, and maintaining a healthy body weight. Mental challenge, diabetes, high blood pressure and depression also influence the risk of dementia.

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Source: Norton, Matthews, Barnes, Yaffe, Brayne
Potential for primary prevention of alzheimer’s disease: an analyse of population based data. Lacet neurol, 2014

TREATMENT OPTIONS FOR NERVE PAIN

Bron: Dworkin et al, 2007. Pharmacologic management of neuropathic pain: evidence-based recommentations

Nerve pain, or neuropathic pain, is an ailment that can very negatively affect the quality of life. This pain often occurs as a result of other diseases, such as cancer and diabetes. Nerve pain can be treated or suppressed in approximately half of the patients. Medicines play an important role here.

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A BETTER LIFE WITH DIABETES

More than 1.2 million Dutch inhabitants have a variant of diabetes (type 1 or 2). The number of people who die on an annual basis with diabetes as the main cause of death is steadily ­decreasing. That is for a significant part due to good medicines. In addition, sufficient exercise and healthy nutrition are also important.

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Source: Statistics Netherlands, 2017

VACCINS HELP TO ELIMINATE DISEASES

NUMBER OF DEATHS HAS DECREASED SINCE GOVERNMENT VACCINATION PROGRAMME

Source: Volksgezondheidenzorg (Public health and Healthcare), 2018

Vaccines have drastically decreased the number of deaths due to whooping cough, tetanus and polio. In 1950, a total of 184 Dutch inhabitants died from these three diseases. That number dropped to three in 2017.

The government is concerned about the immunisation rate for measles, among other diseases. A vaccination rate of at least 95% is required in order to be able to keep virus outbreaks under control. For years, the Netherlands was above that rate, but in recent years that rate has ­fluctuated around 94%.

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GLOBAL ACCESS TO MEDICINES

MEDICINES AND/OR VACCINES IN DEVELOPMENT FOR 64% OF THE DISEASES (SUCH AS HIV, TUBERCULOSIS AND MALARIA) THAT PRIMARILY AFFECT DEVELOPING COUNTRIES, ACCORDING TO THE WORLD HEALTH ORGANISATION (WHO)

Drug companies aim to make their medicines more widely available for people from third world countries, as is apparent from the latest Access to Medicine Index, which appeared in 2018. Medicines and/or vaccines are in development for two-thirds of the diseases that primarily affect third world countries, according to the World Health Organisation (WHO). The ­pharmaceutical sector is particularly committed to combatting malaria, HIV and tuberculosis.

The Access to Medicine Index considers seven factors: management, compliance to laws and regulations, research & development, pricing, patents, building capacity and donations. In the 2018 Index, GSK, Novartis, Johnson & Johnson, Merck and Takeda scored the best, in that order.

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Source: Access to Medicine Index, 2018

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