Over two hundred new therapies will become available in the next few years, mainly aimed at treating cancer. This is good news for patients waiting for treatment. The question is whether we can continue to afford this wave of innovative treatments.

Annual healthcare spending has now passed the 100 billion mark. This is not only due to the arrival of new drugs. The Netherlands is aging, the menu of possible treatments is expanding and people in health care have to earn a decent salary. Hospitals have to absorb a good portion of these developments. In the process, they are seeing more and more of their budgets go into costly cancer drugs. In 2017, the figure was over 500 million nationwide; now the tally stands at two billion euros a year.

Social necessity

Therefore, there is a need to be smarter about drugs and to conduct research into the most effective use of existing and new (oncology) drugs. Here we cannot expect much from pharmaceutical companies; they have already done their homework within the current framework of clinical studies. From the social need to prevent unnecessary care, it is therefore others’ turn.

Non-responders

There are already good results from various studies (see e.g. the SONIA study), which show that we can reduce the budget impact of new drugs by adjusting the dosage and use of drugs in certain patients. Research into “non-responders” is also bearing fruit, in which it can be determined before treatment whether a drug will work. If the results of these studies ultimately lead to changes in guidelines, this will have a major impact on healthcare, with savings of millions of dollars. The health benefits remain the same, while the costs of overtreatment decrease.

Revolving fund

To date, these studies are often conducted separately from each other, by enthusiastic and persistent healthcare professionals and funded with temporary resources. As a result, the broad impact on the quality and budget of oncology care is still limited. Huge opportunities lie in combining different datasets from well-defined patient cohorts, from data from IKNL, PALGA, DICA and Hartwig Medical Foundation. By bringing these data together, we can learn faster, adjust guidelines and reduce overtreatment. This is how we develop a learning healthcare system with “real world data.

This requires a national approach and structural funding, a “revolving fund. With this we can invest in systematic evaluation of dosage and effectiveness of costly oncolytics, starting in the lock phase.

National approach

Point of attention is defining and recording the outcome measures of medication efficacy. These are not currently recorded structurally in oncology care, other than in clinical trials. It is hopeful that by 2025 the NKI/AVL has begun to track this structurally, including outside of study settings. Tools are in place at SANTEON hospitals to do this. What is missing is a national approach.

To get this done, it is important that different parties work together, including health insurers and ZonMw (as funders), hospitals through their umbrella organizations NVZ and NFU, the professional group NVMO (experts guidelines) and data partners, with IKNL in the lead.

Payback

This fund “pays for itself” through the appropriate use of medication, the identification of non-responders and the resulting possible modification of treatment guidelines. In addition, a revolving fund can help the government and insurers get an earlier grip on expected spending when introducing new drugs. This can ensure shorter lock-in time and thus faster availability of working drugs at a reasonable price.

World champion

The Netherlands may not have the best reputation as a ‘incubator’ for new drugs, but we are world champions in collecting and analyzing real world data, which is crucial for effective treatment protocols.

We are missing out on opportunities if we don’t better research how new drugs perform in practice. The government is cutting itself in half by cutting back on this type of research. The advent of new drugs is positive for patients, but that is only the beginning. By using these resources effectively, we can actually realize the benefits. It is essential that we create a learning healthcare ecosystem so that we can also make oncology care even smarter, more effective and affordable. An independent center of excellence for therapy development, such as FAST, plays an important role in this.

About Hans van Snellenberg

Hans van Snellenberg is one of the founders of Hartwig Medical Foundation, and its director since its inception in 2015. Originally a business economist, he has a broad financial, IT and managerial background, including as managing director at PinkRoccade.

His life took a sharp turn when his father died of esophageal cancer in 2006. From then on, Van Snellenberg focused on improving the treatment of patients with cancer. Starting as a fundraiser for foundations established with friends (Barcode for Life and Stelvio for Life), with the goal of raising money for Emile Voest-led DNA research on tumors. With a large donation from the Hartwig Foundation, this led to the establishment of Hartwig Medical Foundation in 2015.

About Hartwig Medical Foundation

Hartwig Medical Foundation is an innovative organization dedicated to the optimal treatment of patients with cancer. As of 2015, it performs complete DNA sequencing and analysis of patients with metastatic cancer in the Netherlands. The results of these analyses are made available to hospitals so that doctors have the most complete information to make a decision about the right treatment together with the patient.

Hartwig has partnered with 44 hospitals to create a DNA database. Created with the help of patients willing to share their data, the Hartwig Medical Database contains all genetic and clinical data provided by or through hospitals of patients with metastatic cancer. It is the largest database of its kind in the world. This data is made available “free of charge” for national and international research. Thus, with today’s patient data, the treatment of tomorrow’s patient is improved, and Hartwig contributes to a learning healthcare system in oncology.