EFPIA opinion on the Health at a Glance: Europe 2018

EFPIA welcomes the publication of the Health at a Glance: Europe 2018 report, starting the next cycle of the State of Health in the EU process. EFPIA sees this process as a valuable contribution to analysing the performance of Member States’ health systems from a health perspective, and we are looking forward to the next step of the cycle that will be the country profiles and updated companion report to be published in late 2019 as it will enable an in-depth discussion on European health systems.
Mental health
The first part of the report highlights the significant human and societal costs of poor mental health in Europe. Mental health is an area with significant unmet needs. The situation is exacerbated by a huge variation in treatment patterns and patient pathways for treating mental health conditions, many of which are poorly understood. There is therefore a great need for better information on mental health conditions and their effects in order to inform policy makers and healthcare decision makers. EFPIA believes that a more comprehensive approach to measure patient-relevant outcomes in mental health would be an important contribution to achieve progress in this field, and to that end welcomes that mental health is one of the pilot areas for the OECD PaRIS project to create more internationally comparable patient reported outcomes measurements.
Reducing wasteful spending in healthcare
The report also sheds light on reducing wasteful spending in healthcare, looking specifically at hospitals and pharmaceuticals. In particular, the document highlights that one-fifth of healthcare expenditure could be reduced or eliminated without undermining quality of care. EFPIA welcomes that inefficient, low-value and wasteful healthcare expenditure is gaining attention on the policy agenda at European and national level, and EFPIA is ready to work together with all stakeholders to find sustainable solutions to these issues.
EFPIA believes that the pharmaceutical sector together with all other healthcare stakeholders has a crucial role to play to tackle low-value care and the inefficiencies of the healthcare systems as a whole. Tackling wasteful spending on health has indeed the potential to bring strategic savings, and value-based approaches could be a key enabler in bringing this about. Reducing wasteful spending will free up important resources for interventions that bring more value to patients and healthcare systems, including innovative technologies.  Innovative pharmaceuticals, digital health tools and telemedicine can help reducing costs in other parts of the health and social care system, for example by reducing the need for primary care visits, hospitalisation, and social care services.
When it comes to pharmaceutical policy, EFPIA supports the European Commission proposal to implement joint clinical assessments of pharmaceuticals in the EU in order to reduce duplication of national HTA procedures, seen as a way to ensure value for money and moving towards value-based healthcare, and speed up access to new medicines. Health technology assessment can provide policy- and decision-makers with the right evidence to support healthcare decision-making and management, including for pricing and reimbursement. EFPIA therefore believes that Member States should implement value assessments for all parts of healthcare as a way to ensure value for patients and societies of healthcare services, and reduce wasteful spending in all segments of healthcare budgets. A systematic and standardised measurement of patient-relevant outcomes throughout the healthcare systems would enable such an approach.
EFPIA furthermore agrees that an effective and competitive off-patent market for generics and biosimilars is important to generate savings that can be reinvested in innovation. However, EFPIA is not in favour of so called “internal price referencing” which groups together different medicines without taking into account their different value to different patient groups, thereby stifling innovation, or event mixes generics and on-patent medicines. The report furthermore highlights the importance of rational use of medicines, in particular for avoiding overuse of antibiotics, and that limited adherence to prescribed treatment is a major problem that leads to significant waste and unnecessary utilisation of healthcare resources, estimated to cost European healthcare systems around 125 billion euros annually.
Pharmaceutical companies already take action to reduce wasteful spending, including through programs tackling low adherence to medication. EFPIA believes that many actions for reducing wasteful spending in healthcare at scale can only be introduced by working together across silos. For example, reducing avoidable hospitalisations cannot be solved by the hospitals but must be tackled in coordination with primary care providers, and improving rational use of medicines needs to be a collaborative effort including healthcare professionals, pharmacies and the pharmaceutical industry.  
Health indicators in Europe
Comparable health indicators are very important to give policymakers and healthcare decision-makers evidence for health system reform and implementation of good practice, and all efforts to expand the scope and quality of international health information systems should be supported. As noted in the State of Health in the EU: Companion report 2017, most internationally comparable health data concern health system inputs and processes rather than patient relevant health outcomes, and EFPIA therefore welcomes the OECD PaRIS initiative to develop internationally comparable Patient Reported Outcomes Measures in different disease areas. As the report shows, in areas where there are available indicators (such as mortality following AMI or stroke), there are significant variations in health outcomes both between and within countries, and the report rightly highlights that making such indicators openly available can bring about important changes to decrease unwarranted variation.[1] Increased availability of comparable data would certainly highlight unwarranted variation in further disease areas, and could inform best practice sharing, quality improvement initiatives and resource allocation.  EFPIA calls on the European Commission to support the implementation of standardised measurement of health outcomes throughout European healthcare systems, as a key enabler for more outcomes-based, patient-centred and sustainable health systems.
EFPIA agrees that effective prevention and disease interception is key to better health for the EU population and more sustainable healthcare systems, and that more work is needed to understand how preventive interventions can be made more effective and how to reallocate healthcare spending for this purpose. Vaccines play a very important role in preventing several highly debilitating infectious diseases, such as measles and hepatitis B, which have resurged in some parts of Europe and posing threats to the health of Europeans, and EFPIA supports measures to increase the vaccination coverage and tackling misinformation around vaccination. Medicines also play an important role for secondary and tertiary prevention, to the benefit of both patients and healthcare systems. For example, medicines such as aspirin, beta blockers and statins, prevent serious complications from cardiovascular disease, and has led to a 75% reduction of myocardial infarction among high-risk individuals. Once introduced as innovative medicines, these classes of drugs are now available as generics at very low cost for health systems, with huge savings both in patient lives and health system resources every year.
The report also highlights the deployment of ehealth solutions including Electronic Health Records and e-prescriptions. EFPIA welcomes the European Commission initiatives to empower citizens to have access to their health data and to promote exchange of electronic medical records among health care providers across the EU. In addition to providing better and more coordinated care for individual patients, secondary use of health data from EHR’s and other data sources has a huge potential for research, understanding unmet needs, advanced analytics and real-world effectiveness studies. To that end, EFPIA companies and public partners have joined forces under the Innovative Medicines Initiative to develop a European Health Data and Evidence Network (EHDEN) which has the ambition to harmonise 100 million electronic health records and enable large-scale research through a federated network. 

[1] See page 152