EU Physician and Payer Forum

March 2013

The Dynamic Prostate Cancer Landscape: How Will European Payer and Prescriber Attitudes Shape This Competitive Market?

Report Authors
Rachel Webster, M.A., M.Sc., D.Phil.

Introduction:

Prior to 2011, there was a lack of effective treatment options available for metastatic castrate-resistant prostate cancer (mCRPC) patients who had previously received docetaxel (i.e., second- and subsequent-line settings). However, after a long period of stagnation, intense R&D activity has come to fruition, making 2011 a landmark year for drug approvals in this patient population. Sanofi’s Jevtana (cabazitaxel) and Johnson & Johnson/Janssen Biotech/Janssen Cilag’s Zytiga (abiraterone) were approved by the European Medicines Agency for mCRPC previously treated with docetaxel-containing chemotherapy in March 2011 and September 2011 and have now launched across the EU5 (except for Zytiga in Italy). European first-line label extension for the use of Zytiga in asymptomatic or minimally symptomatic chemotherapy-naive mCRPC followed in January 2013.

Continuing the wave of drug development activity in the prostate cancer space, multiple market authorization applications of novel mCRPC drugs were made in 2012: Dendreon’s Provenge (sipuleucel-T), Medivation/Astellas Pharma’s Xtandi (enzalutamide), and Algeta/Bayer’s radium-223 (formerly Alpharadin). The mCRPC market is therefore poised to become increasingly crowded and competitive. As the EU5 countries continue to tighten their healthcare belt, payers are charged with balancing clinical need with diminishing budgets, and physicians will be challenged in making economical prescribing decisions and determining the optimal sequence of treatments. In this cost-constrained environment, what market access hurdles are Jevtana and Zytiga encountering, how might these evolve, and how can emerging agents hoping to compete in the prostate cancer market by the end of 2015 secure optimal pricing and reimbursement, and maximal uptake?

Questions Answered in This Report:

  *   Analyze the Impact of Reimbursement and Payer Policy on Use of Current Prostate Cancer Brands: What does an analysis of oncologist prescribing patterns in the EU5 reveal about the impact of payer policies on reimbursement and uptake of Jevtana and Zytiga to date? How will Zytiga’s label extension be received across the EU5? And how will this shape current prescribing patterns? How does prescribing of these agents vary between and within EU5 countries? How will this evolve over the next two years? How and to what extent do healthcare authorities monitor prescribing? How do funding/budgetary/reimbursement constraints rank against other market access hurdles?

  *   Examine Payer and Physician Perspectives on Emerging Agents for Prostate Cancer: What are physicians’ perceptions of the clinical profile of key emerging therapies such as Provenge, Xtandi, radium-223, and orteronel? Considering reimbursement constraints, do physicians anticipate that emerging agents will be incorporated in their treatment algorithm? If so, in which patient populations do they expect to most frequently prescribe these agents? What are the top reimbursement-related constraints on prescribing emerging therapies? Do physicians and payers believe that emerging therapy clinical profiles are commensurate with their anticipated price premiums? What factors will persuade physicians to prescribe novel emerging agents over currently marketed same-class agents? What are physicians’ prescribing expectations for select emerging therapies based on pricing scenarios? How might evolving healthcare reforms and increasing cost-containment strategies affect reimbursement and uptake of novel agents?

Scope:

Decision Resources’ European Physician & Payer Forum report “The Dynamic Prostate Cancer Landscape: How Will European Payer and Prescriber Attitudes Shape This Competitive Market?” explores the many clinical and funding/budgetary/reimbursement factors that affect the use and sales of Jevtana and Zytiga in France, Germany, Italy, Spain, and the United Kingdom, as well as the dynamics that will influence reimbursement, pricing, and overall market access of key emerging agents. The report is based on a survey of 250 medical oncologists in the EU5, as well as 31 urologists in Germany only, and on interviews with 15 European payers. Interviewed payers have influence at a national or regional level and include the following:

- France: Advisers to the Comité Economique des Produits de Santé (CEPS; Economic Committee). Hospital Pharmacy Director.

- Germany: Member of the Gemeinsamer Bundesausschuß der Ärzte, Zahnärzte, Krankenhäuser und Krankenkassen (GBA; Joint Federal Committee of Physicians, Dentists, Hospitals, and Health Insurance Funds); Key opinion leaders and chief hospital pharmacists involved in hospital tendering process and drug formulary review boards.

- Italy: Prontuario terapeutico ospedaliero regionale (PTOR; Regional Hospital Formulary) committee members; member of regional ethics committee board, and Aziende sanitarie locali (ASL; local health authorities) coordinator

- Spain: Consultant to the Spanish Ministry of Health and member of the Dirección General de Farmacia y Productos Sanitarios (DGFPS; General Directorate of Pharmacy and Health Products); a key opinion leader and university economics professor; regional hospital Pharmacy Director and member of regional formulary committee.

- United Kingdom: Regional Program Director and National Institute of Health and Clinical Excellence (NICE) technology appraisal (TA) committee member; Chief Health Board and member of the All Wales Medicines Strategy Group (AWMSG);  KOL and NICE reviewer.


Search Reports

Mentioned in this report:

  • - Active Biotech
  • - Ageta
  • - Astellas Pharma
  • - Bavarian Nordic
  • - Bayer Healthcare
  • - Bristol-Myers Squibb
  • - Dendreon
  • - Exelixis
  • - Ipsen
  • - Janssen Biotech
  • - Janssen Cilag
  • - Johnson & Johnson
  • - Medivation
  • - Millennium
  • - OncoGenex
  • - Sanofi
  • - Takeda
  • - Teva
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