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1、THE POWER OF HOLISTIC INSIGHTChris Teale Senior Vice President,Market Access Alessandra Franceschetti Senior Director,Global Oncology Monitor Aye Levent Senior Vice President,Molecular Diagnostics Monitor Pete Duncan Head of Healthcare Social Intelligence Analytics CoE November 2022Understanding why
2、 real-world treatment in oncology can be sub-optimal and what can be done about it Ipsos 2022 All rights reserved.3Chris Teale,Senior Vice President,Market AccessAlessandra Franceschetti,Senior Director,Global Oncology MonitorAye Levent,Senior Vice President,Molecular Diagnostics MonitorPete Duncan,
3、Head of Healthcare Social Intelligence Analytics CoEThe Power of Holistic Insight Understanding why real-world treatment in oncology can be sub-optimal and what can be done about it IntroductionTraditionally,research into the management and treatment of patients tends to focus on a single stakeholde
4、r type typically the physician,sometimes the patient,payer or policymaker.However,real-world treatment decisions are rarely driven by one stakeholder in isolation.Multi-stakeholder research is therefore essential and provides a far deeper level of insight and value,but even this may not be sufficien
5、t for a company that wishes to understand the full picture.Real-world treatment is influenced by multiple stakeholders and multiple external factors,such as bureaucracy,assessment,timing,preference,affordability,value for money,and more.Looking ahead,the insight challenge is set to become greater st
6、ill,thanks to the gradual evolution and incorporation into treatment of innovations with both diagnostic and predictive elements.These include:Biomarker-informed disease management:genomics/proteomics with companion and complementary diagnostics indicative of disease or treatment response Real-time
7、informed disease management:digital health technologies(DHTs)and wearables Intelligent smart disease management:advanced analytics,software,algorithms and artificial intelligence.These developments,which make treatment more personalised and precise,are opening the door to enhanced efficiency and eff
8、ectiveness of healthcare delivery and a future in which treatment and outcomes are delivered increasingly through multi-component disease management,rather than by drugs or interventions in isolation.4THE POWER OF HOLISTIC INSIGHT Ipsos 2022 All rights reserved.Understanding holismTo understand this
9、 increasingly complex multi-component world we need HOLISTIC INSIGHT.Holistic insight focuses on complete systems and rejects analysis of the component parts.According to the Merriam-Webster dictionary,“Holism generally opposes the Western tendency toward analysis,the breaking down of wholes into pa
10、rts sometimes to the point that you cant see the forest for the trees.”i The concept of holism is particularly pertinent to healthcare itself,with holistic medicine seeking to treat the whole person versus his/her individual symptoms.In the context of this paper,holism relates to the incorporation o
11、f all(relevant)stakeholders and the non-human elements of multi-component disease management.Essentially,holistic insight can lead us to understand why real-world treatment and outcomes may be sub-optimal and,importantly,what can be done about it.How do we develop holistic insight?It need not be dif
12、ficult or expensive.Much can be achieved through a two-step process:STEP 1:Build on the strong foundation of tried and tested insight approaches(ensuring that the study design is appropriate)Figure 1:The convergence of digital and genomic technologies mHealthWearables,health apps,and real-time/real-
13、world dataPatient-level real-time/real-world data sourced through digital monitoring+Interventional disease management+Predictive AnalyticsImprovements in:Economic,Clinical and HumanisticOutcomes (ECHO)Rx(pharmaceutical)+Dx(diagnostic)GENOMICDiagnosticsBiomarkers,Companion&Complementary diagnosticsD
14、IGITALSource:IpsosUNDERSTANDING WHY REAL-WORLD TREATMENT IN ONCOLOGY CAN BE SUB-OPTIMAL AND WHAT CAN BE DONE ABOUT IT Ipsos 2022 All rights reserved.5 5 Ipsos 2022 All rights reserved.An Example from Oncology Oncology treatment guidelines(ASCO,ESMO,NCCN,etc.)may be considered a proxy for how patient
15、s should be optimally treated.In the real world,however,treatment approaches may deviate significantly from these recommendations and for multiple reasons as highlighted by the following example.Figure 2:Treatment of ER-positive/HER2-negative MBC STEP 2:Merge the resulting insights in a meaningful w
16、ay to generate a more holistic picture,on which clear decisions and actions may be based(paying attention to the inter-relationship between the components,i.e.,system dynamics).Example:HER2-HR+Metastatic Breast CancerRecent clinical trials(PALOMA-2ii,MONARCH-3iii)demonstrated the superior efficacy o
17、f CDK4/6 inhibitors,a new class of agent,versus more established chemotherapies and endocrine therapy(ET).CDK4/6s are now considered the new Standard of Care(SoC)therapy unless patients experience organ failure requiring a temporary use of chemotherapy.Figure 2,from the Annals of Oncologyiv,explains
18、 this in more detail.Patients with ER+/HER2-MBCET-CDK4/6 inhibitor I,Aa,eFulvestranta(+CDK4/6 inhibitor if not used previously)Everolimus-exemestanea I,B or Everolimus-fulvestranta,b II,BIf PIK3Am+:fulvestrant-alpelisib I,B;MCBS 2;ESCAT I-Ac,dIf germline BRCA/PALB2m+:PARP inhibitor I,A;MCBS 4;ESCAT
19、I-Ac,d Somatic mutation testing(tissue or liquid)Germline BRCA1/2 testing+PALB2No risk of organ failureImminent organ failureSource:Annals of OncologyivPD after several lines of ET+targeted therapiesPDChTChTIf imminent organ failureA.Gennari et al.ANNALS OF ONCOLOGYPurple:general categories or strat
20、ification Green:combination of treatments or other systemic treatmentsWhite:other aspects of management Blue:systemicAt PD6THE POWER OF HOLISTIC INSIGHT Ipsos 2022 All rights reserved.Are these clinical guidelines being reflected in the real-world treatment of HER2-HR+metastatic breast cancer?If not
21、,why not?To answer that question,we need to understand the perspectives of the four key stakeholders impacting real-world therapy choice and outcomes.These include:In our first step towards holistic insight,we used real-world evidence from Ipsos Global Oncology Monitor(see About the Research).The Mo
22、nitor provides real-world physician and treatment insights that help us to answer our WHAT,HOW and WHEN questions.From an analysis of 2,648 patient audit charts from treating physicians in EU4&UK(Jan-March 22),we were able to ascertain that:60%of the 1st line mBC HER2-,HR+patients treated by our sam
23、pled doctors received CDK4/6 agents.For the remaining 40%,other classes of drugs were preferred.This raises several questions:Why not a higher use of CDK4/6 at 1st metastatic line?Who or what is influencing this?How might this,in turn,be influenced?And what type of evidence is required?How does this
24、 vary by patient characteristics and outcomes of previous treatments?What sequential strategy do physicians have in mind?How might this change over time as new biomarkers and new therapies are introduced into routine clinical practice?1.Insight Through the Physician LensPHYSICIANPATIENTPAYERPATHOLOG
25、ISTUNDERSTANDING WHY REAL-WORLD TREATMENT IN ONCOLOGY CAN BE SUB-OPTIMAL AND WHAT CAN BE DONE ABOUT IT Ipsos 2022 All rights reserved.7Additionally,we found that:The HER2-HR+patients who received a CDK4/6 as their 1st metastatic treatment versus an ET monotherapy were statistically more likely to:Be
26、 younger(average age of 65 vs.69)Be fitter(ECOG 0-1 of 89%vs.72%)Have no comorbidities(27%vs.16%)Show metastases to the bones(66%vs.47%)Show metastases to the lungs(25%vs.17%)Have already relapsed on previous drug or non-drug therapies(24%vs 10%).In 23%of cases where a CDK4/6 was prescribed,particip
27、ating physicians stated that they would increase their prescribing of this therapy in the next 6 months.Just 9%said the same of ET monotherapy.The reasons CDK4/6s were prescribed included:Standard of Care therapy SoC was mentioned as a reason for prescribing CDK4/6s in 58%of cases vs.24%for ET monot
28、herapy Relative efficacy due to its proven efficacy in 49%of cases vs.32%for ET monotherapy Patient involvement patient involvement was greater when CDK4/6s were prescribed(32%of cases vs.21%for ET monotherapy).ET monotherapy was more likely than CDK4/6s to be chosen to maintain/improve quality of l
29、ife(23%vs.10%),for its tolerability(29%vs.18%)and/or due to COVID-19 impact(12%vs.1%).Finally,47%of 2nd line patients receiving CDK4/6 therapy(21.4%)were treated with ET monotherapy at 1st line,potentially suggesting an intent to prescribe the two classes of drug sequentially rather than as a combin
30、ation therapy.The above example suggests that there are some clinical and experience-driven rationales behind a potential misalignment between what the guidelines say and what physicians do in the real world.Armed with an understanding of physicians real-world treating behaviour,we can add another l
31、ayer of insight by directly accessing the patients world.Social Intelligence Analytics(SIA)can give us an unfiltered view of patients attitudes,opinions,concerns and preferences.Using Ipsos SIA platform,Synthesio,we collected public data from multiple online sources between August 2021 and August 20
32、22.The keywords selected were indicative of influence on therapy choice and linked with products,disease states 2.Insight Through the Patient Lens8THE POWER OF HOLISTIC INSIGHT Ipsos 2022 All rights reserved.and outcomes related to HER2-HR+metastatic breast cancer.We focused on the EU4 and UK market
33、s to align with the geographical scope of data collected by the Global Oncology Monitor.We also filtered on personal language to ensure patient rather than professional posts were collected and paid particular attention to brand mentions from the forum data,ultimately focussing in on a sample of 1,5
34、21 posts.Most common terms used within the discussions are shown in Figure 3(the larger the word,the higher the number of mentions).Figure 3:Key terms used in breast cancer discussions online Among the three CDK4/6 inhibitors that are EMA-approved,one was clearly top of mind palbociclib(Ibrance),whi
35、ch was mentioned almost four times as often as either ribociclib or abemaciclib.Other notable findings were the positive sentiment regularly expressed by patients(Think positive)and their comfort using technical words such as inhibitor,CDK4,HER2,lymph,and node.Once cancer affects someones life there
36、 is a clear tendency to seek as much information as possible and evidently many patients are more capable of mastering technical healthcare terminology than physicians typically perceive them to be.Other verbatims highlight that,in some cases,patients and physicians viewpoints diverge.For example,so
37、me patients seem to better tolerate or are more willing to tolerate side-effects than some physicians fear.Another hot topic was lack of clarity around a physicians reasons for choosing/changing a specific therapy,even among patients with a medium-high level of education.Finally,there was also conce
38、rn among patients around what governments decide to reimburse versus what needs to be covered privately,once a new drug receives EMA approval.This is not a new topic,but the broader access to information that patients have nowadays likely increases the level of frustration experienced by some.Along
39、with physicians perceptions and/or experience with certain treatments,the above findings illustrate that although clinical guidelines are an important driver of prescribing,other key stakeholders(e.g.,patients and payers)and other factors are also likely to affect what patients receive.Source:Synthe
40、sio,an Ipsos Company UNDERSTANDING WHY REAL-WORLD TREATMENT IN ONCOLOGY CAN BE SUB-OPTIMAL AND WHAT CAN BE DONE ABOUT IT Ipsos 2022 All rights reserved.9 Current treatment guidelines for HER2-HR+metastatic breast cancer refer to PIK3CAm+and BRCA 1/2+PALB2 testing.However,additional diagnostic tests
41、will be required in the future to inform therapy choice as knowledge of the genomics of breast cancer evolves.This will include Estrogen Receptor 1(ESR1)mutations and,as therapies are licenced,potentially high TMB,TP53 mutation,PTEN loss of function mutation,RB1 pathway alteration,AURKA mutation/amp
42、lification,and BRIP1/MYC/RAD51C amplification.We looked more broadly at breast cancer treatment using Ipsos Molecular Diagnostics(MDx)Monitor,which captures an in-depth view of biomarker testing from both physician and pathologist perspectives(see About the Research).Specifically,we used data collec
43、ted between October and November 2020 from 108 physicians/pathologists in the US.Our analysis suggests challenges to the adoption of a greater precision medicine approach.HER2 testing is engrained/universal in clinical practice testing for other biomarkers lags behind but is increasing over time:Acc
44、ording to our Oct-Nov 2020 data,approximately 86%of the Stage IV breast cancer patients treated by our participating physicians underwent HER2 testing.Testing for other biomarkers is lower(43%for BRCA 1/2 blood germline testing POST-diagnosis,41%for dMMR/MSI),but increasing over time.The diagnostic
45、ordering mechanism in breast cancer is more complicated than in other solid tumors,such as NSCLC,CRC and Melanoma,because multiple specialties are involved;this represents a considerable challenge to increased testing.Stakeholders included pathologists(because of reflex testing for HER2),surgeons,OB
46、/GYNS and genetic counsellors(to provide guidance on inherited mutations and assess familial risk).Despite these barriers,patient involvement appears to be a greater force in driving testing in breast cancer.Patients are typically more vocal,possibly better informed,and often more involved in the ma
47、nagement of their disease than patients affected by other types of cancer.Given much of current testing is down to standard hospital protocol,the patient is an important driver when it comes to testing.Compared to the other solid tumours we monitor,we saw“patient request”coming through more strongly
48、 in breast cancer(e.g.,17%in BC vs.9%in NSCLC in our Q3 2020 data).Patients who are not tested for biomarkers are“placed on hold”until they progress:In our data,placed on hold accounted for 22%of reasons for not testing.This could be driven by cost issues and/or by some mutations occurring precisely
49、 because of the received drug treatments(importance of sequence).Reflex testing(i.e.,blanket-testing samples irrespective of whether an oncologist has ordered biomarker testing)is mostly seen for HER2.All other genes were tested mainly if the physician had ordered them specifically.3.Insight Through
50、 a Pathology&Molecular Diagnostic Lens10THE POWER OF HOLISTIC INSIGHT Ipsos 2022 All rights reserved.Ultimately,cost/reimbursement appears to represent a major hurdle to adopting a greater precision medicine approach in breast cancer.Representing 16%of mentioned barriers,Test cost and reimbursement
51、issues was the second most frequently listed hurdle to testing patients for genomic alterations.Compared to other cancer types,predictive molecular testing is more ingrained in this tumour.Nonetheless,as the number of genomic alterations that are relevant to the treatment of breast cancer is set to
52、increase,guidelines must also evolve and must do so to include the role of all stakeholders involved in the delivery of care for the patient.Achieving licensure(marketing approval)requires three hurdles to be overcome:demonstration of efficacy,safety,and quality.The payer,however,often remains a fou
53、rth hurdle to patient access to medicines.A key payer hurdle to be overcome in many countries is Health Technology Assessment(HTA).Achieving a positive HTA recommendation requires evidence of clinical-and cost-effectiveness.There are significant differences in evidentiary requirements between the Eu
54、ropean Medicines Agency and the European Health Technology Assessment of Oncology Drugs,and significant differences between country requirements.(This is outlined in more detail in a recent article published by Sharon Wolters et al in Value in Healthv).An absence of relevant evidence can result in a
55、 product being licenced but not accessible for use in patients.Another important factor is timing.According to a study reported at ESMO 2018 by T Hwang et al,“some European countries take more than twice as long as others to reach health technology assessment(HTA)decisions to reimburse new cancer dr
56、ugs following their approval by the EMA”vi.The same study found that decision time averages over a year in some countries and that clear country-by-country differences exist;median EMA approval of the cancer drugs studied was two to three times longer in England and Scotland versus Germany and Franc
57、e.There is,however,a move towards accelerating access to oncology drugs,harmonising HTA across Europe and integrating real-world evidence within the regulatory and HTA assessment processes as outlined in an Ipsos poster presented at ISPOR Europe in November 2021vii.Although HTA can be a barrier to o
58、ptimal treatment and outcomes in the real-world,there are approaches(facilitators)that can be used to overcomes these such as Managed Entry Agreements based on financial and outcomes-based risk-sharing,and access restrictions to sub-populations where the greatest levels of clinical-and cost-effectiv
59、eness can be demonstrated.Ultimately,access to oncology drugs is increasingly driven by innovative pricing and market access solutions that bridge both drug and biomarker testing.Evidence-based demonstration of“co-dependent value”in an HTA context is critically important for optimal real-world treat
60、ment to be delivered.4.Insight Through the Payer Lens Ipsos 2022 All rights reserved.11Merging and integrating the insights As weve just seen,treatment monitoring and tracking systems give us the physicians real-world behaviour and perspectives.Diagnostics monitoring adds the pathologists view.Socia
61、l intelligence analytics enables us to capture and analyse the patients voice.Payer and HTA research identifies market access barriers and facilitators,and the ways in which these might be overcome.These approaches are ideal for answering the WHAT,HOW and WHEN questions but,individually,they only pa
62、rtially answer the WHY question.Combining and integrating these insights starts to indicate WHY current real-world treatment and outcomes may be sub-optimal.Further research is needed on top of the above to address the key questions raised by these insights,and which are often asked by pharmaceutica
63、l companies,physicians,payers and patients alike:what can be done to influence this?How can we improve clinical outcomes at both patient and population level?How can we increase the efficiency and clinical-and cost-effectiveness of oncology disease management?UNDERSTANDING WHY REAL-WORLD TREATMENT I
64、N ONCOLOGY CAN BE SUB-OPTIMAL AND WHAT CAN BE DONE ABOUT IT12THE POWER OF HOLISTIC INSIGHT Ipsos 2022 All rights reserved.Barriers to therapy use may include:Affordability,access and availability Of drugs,diagnostic testing,reimbursement Of data/evidence.Timing Delays in updating treatment guideline
65、s Delays in Health Technology Assessments and implementation Time lag in adopting technology Preference Influenced by context,personal experience,and outcomes of earlier treatment(s)Policy&priorities Power physician vs.payer;HTA vs.medical society;treatment guideline perspectives differing from pati
66、ents perspectives.Barriers to molecular diagnostic use may include:Funding Access to and availability of testing Testing methods and process:Difficulty of obtaining sample Complexity Turnaround time Test performance:Will the test be(perceived to be)insufficiently accurate or ambiguous?Population sel
67、ected for testing:Will the population tested be as broad as the drugs indication?Physicians adoption of the test proposition Patient demand for testing,and willingness to be tested Conversion rate Will physicians prescribe other drugs despite a“positive”test result?Barriers to optimal disease manage
68、ment in summary UNDERSTANDING WHY REAL-WORLD TREATMENT IN ONCOLOGY CAN BE SUB-OPTIMAL AND WHAT CAN BE DONE ABOUT IT Ipsos 2022 All rights reserved.13Barriers around stakeholders may include:Patients Willingness to be treated,influenced by:Patient preference and behaviours driven by experience/outcom
69、es of earlier treatments (Prospect Theory)Recommendations from HCPs and other patients,the internet,social media(as highlighted in the SIA example above).Physicians Willingness to test and treat,influenced by:Treatment guidelines Personal experience(e.g.,clinical trial involvement)Indirect compliant
70、 financial incentives(impact on income,gain-share,etc.).Payers Willingness to pay,influenced by:The incidence of the genetic mutation The cost of the therapy and diagnostic testing The magnitude of the clinical benefit demonstrated.Manufacturers Willingness to invest in evidence development and info
71、rmation dissemination/awareness,influenced by:Likely return on investment(RoI)in the context of overall product strategy and resource allocation The extent to which there is sufficient leverage in 3 key areas to result in higher revenues/profitability:Improved competitive position Premium pricing Ea
72、rlier use in treatment pathway.14THE POWER OF HOLISTIC INSIGHT Ipsos 2022 All rights reserved.Facilitators of optimal disease managementOnce barriers have been identified,we can explore options for facilitating their removal.Taking the payer perspective as an example,facilitators may include:Action
73、to promote early access and rapid uptake of innovation Removal of systemic and stakeholder barriers Creation of incentives Modification of healthcare IT systems Leveraging policy and patient advocacy Collaboration between stakeholders Integration of data,insights,and evidence from multiple sources.F
74、igure 4:Barriers to delivering the promise of digital&genomic technologiesSystemic BarriersStakeholder BarriersPayer&patient willingness to payPhysician&patient willingness to useRegulatory systemsHealth Technology Assessment (HTA)systemsCoding,payment,and funding systemsNew roles of patient,physici
75、an&data in disease managementSource:Ipsos UNDERSTANDING WHY REAL-WORLD TREATMENT IN ONCOLOGY CAN BE SUB-OPTIMAL AND WHAT CAN BE DONE ABOUT IT Ipsos 2022 All rights reserved.15Approaches and frameworks to support the generation of holistic insightThere is not one method that suits all.Approaches we f
76、requently use include:Modified Porter AnalysisPorters five forces model analyses the environment in which a product or company operates,focusing specifically on industry competition,threat of new entrants,power of buyers,power of suppliers and threat of substitutes.STEEPLE frameworksSTEEPLE(social,t
77、echnological,economic,environmental,political,legalðical)frameworks push us to consider how each factor will impact a business and how products and services will fit into future scenarios.Without such a tool,we tend to think the future will be much like the present.Delphi MethodThe Delphi method
78、is based on the principle that forecasts(or decisions)from a structured group of individuals are more accurate than those from unstructured groups.Comprised of multiple rounds of questions put to experts,Delphi essentially encourages respondents to reconsider their earlier answers in view of the res
79、ponses of others ultimately arriving at the correct answer as a group.Behavioural Science,Patient Preference&Prospect TheoryProspect Theory,which is rooted in psychology,explores how decisions are made when people are presented with alternatives that include uncertainty or risk.Powerful examples are
80、 included in KP Weinfurts 2007 article,Using Prospect Theory to Understand End-of-Life Decisionsviii.The author highlights how preferences may change for patients with grave prognoses.System DynamicsSystem dynamics is an aspect of systems theory used as a method to understand the dynamic behaviour o
81、f complex systems.The method recognises that a systems structure and the relationships between its component parts is often just as important in determining its behaviour as the individual components themselves.War gaming/competitive simulationAny company operating in todays dynamic,rapidly changing
82、 environment needs to gain market foresight into how the landscape may evolve in the future and the consequences of this for its R&D and commercial decision-making.It is vital to understand the inter-play and dynamics between the various stakeholders.(We recommend an experiential approach to market
83、foresight,called Dynamic Market Simulation(DMS)based on system dynamics methodology,sometimes called competitive simulation or war gaming)16THE POWER OF HOLISTIC INSIGHT Ipsos 2022 All rights reserved.Multi-source data integrationMulti-source data integration can be very useful for developing holist
84、ic insight,and sources include:Market insightThird Party External SourcesManufacturers Internal Data Proprietary syndicated data Data analytics with traditional market research Behavioural science Creative labs Social Intelligence Analytics(SIA)Prescription data Electronic medical records(EMRs)Healt
85、h resource utilisation(HRU)Claims data Real-time/wearable data Social media data Customer relationship data(CRM)Internal resource allocation17THE POWER OF HOLISTIC INSIGHT Ipsos 2022 All rights reserved.Which oncology business questions might be answered by the holistic insight approach?The simple a
86、nswer is“almost all”.However,two specific examples will,in the future,be of increasing importance:Identifying optimal treatment sequencing:Evaluating value in oncology treatment sequencing Exploring the challenges of measuring value along the treatment pathway from diagnosis to death/remission/cure
87、in oncology and the role that multi-source data,insight,and evidence integration can have in this.Attributing value in oncology treatment:Exploring how biomarker-informed treatment selection,predictive analytics and artificial intelligence can result in patients being treated with stacks of drugs(co
88、mbination and triple therapies)Understanding how payers should attribute value to the components informing willingness to pay and reimbursement,and the trade-offs that manufacturers will need to make in order for the overall disease management to be cost-effective Identifying how payment and reimbur
89、sement can be fairly allocated to the individual elements of multi-component disease management.Conclusions As weve demonstrated in this article,real-world treatment and outcomes are certainly influenced by treatment guidelines,but other key stakeholders and factors are likely to have a significant
90、influence on what patients receive in practice.Insight is required to understand WHY real-world treatment and outcomes may be sub-optimal and WHAT can be done to influence this.To help answer these key questions,on top of the real-world insights we began with,we need to consider:Systemic and stakeho
91、lder insights into the barriers and facilitators(drivers)to optimal disease management in oncologyExperiential insights through competitive simulation,wargaming,and mock negotiationsHolistic insights through multi-source data,insight,and evidence integration18THE POWER OF HOLISTIC INSIGHT Ipsos 2022
92、 All rights reserved.And what can be done about it?Change the frame of reference:Access and integrate data and insights from multiple sources involving multiple stakeholders Demonstrate the co-dependent value of Rx (the drug)and Dx(molecular diagnostic testing)Remove the barriers to optimal oncology
93、 disease management:Recognise the co-dependency of the different elements of the oncology patients disease management Recognise the importance of treatment sequencing from diagnosis to death or cure Patient outcomes are a key metric when defining optimality.Ensure you integrate the voice of the pati
94、ent into decision-making Ensure alignment of assessment systems(Regulatory,HTA,Pricing and,Reimbursement)in recognising this The 5 key barriers to successfully integrating a therapy The 8 key barriers to successfully integrating molecular diagnostics All stakeholders willingness to doUNDERSTANDING W
95、HY REAL-WORLD TREATMENT IN ONCOLOGY CAN BE SUB-OPTIMAL AND WHAT CAN BE DONE ABOUT IT Ipsos 2022 All rights reserved.19Ipsos Global Oncology Monitor The Ipsos Global Oncology Monitor is an online multi-country,multi-centre medical chart review.Participating physicians are geographically representativ
96、e and screened for treatment involvement levels and number of patients managed per month.Reporting on patients they see in consultation,participants provide date of diagnosis,current and historic treatment and reasons for prescribing/discontinuing anti-cancer drug treatment.Data on patients treated
97、with different classes of anti-cancer drugs are compared using descriptive statistics.Data referred to in this article were collected online from 443 oncologists/gynaecologists on 2,648 Stage IV,HER2-HR+breast cancer patients treated with anti-cancer drugs in France(n=599),Germany(n=516),Italy(n=518
98、),Spain(n=499)and UK(n=516)between January and March 2022.Ipsos Molecular Diagnostics(MDx)Monitor Solid Tumours The Ipsos Global Molecular Diagnostics Monitor is a multi-stakeholder,physician-reported syndicated patient and laboratory record database,capturing perceptions towards,and usage of,MDx te
99、sts in solid cancer types.Participating drug-treating physicians are screened for specialty,level of seniority and number of drug-treated cancer patients seen per study wave and must be the primary decisionmaker for their patients.Participating pathologists must be involved with preparing samples,or
100、dering cancer-related MSx tests and/or performing/interpreting cancer-related MDx testing in solid cancers,and must be aware of the methodology and/or brand used for cancer-related MDx tests.Each wave,participants complete a perceptual usage and attitudes questionnaire,before providing de-identified
101、 information on a predefined quota of oncology patients seen in consultation/laboratory samples handled in practice,retrospectively(across a pre-defined list of solid tumour types).Data referred to in this article were collected online from 108 physicians/pathologists between October and November 20
102、20 in the US.Synthesio(an Ipsos Company)Data were collected in the Synthesio platform from social media networks and online forums in France,Germany,Italy,Spain and the UK,between August 15th 2021 and August 15th 2022.The query was a combination of keywords centred around metastatic breast cancer an
103、d treatment options,alongside personal pronouns,translated for each of the required markets.Posts were analysed qualitatively first and foremost,with particular attention paid to those from patient forums and those including a brand mention.Data are Ipsos 2022,all rights reserved.About the ResearchC
104、ontact us:Chris Teale:Chris.T Alessandra Franceschetti:Alessandra.F Aye Levent:Ayse.L Pete Duncan:Pete.D20THE POWER OF HOLISTIC INSIGHT Ipsos 2022 All rights reserved.i.Merriam Webster Dictionary(online),Accessed 12 Sept 2022,Holistic,Available at:https:/www.merriam- al,2022.Overall survival(OS)with
105、 first-line palbociclib plus letrozole(PAL+LET)versus placebo plus letrozole(PBO+LET)in women with estrogen receptorpositive/human epidermal growth factor receptor 2negative advanced breast cancer(ER+/HER2 ABC):Analyses from PALOMA-2.|Journal of Clinical Oncology.online Ascopubs.org.Available at:Acc
106、essed 15 September 2022.iii.Goetz,M.et al,2022.MONARCH 3:Abemaciclib As Initial Therapy for Advanced Breast Cancer|Journal of Clinical Oncology.online Ascopubs.org.Available at:Accessed 15 September 2022.iv.Gennari,A.et al,2022.online ESMO Clinical Practice Guideline for the diagnosis,staging and tr
107、eatment of patients with metastatic breast cancer.Available at:Accessed 15 September 2022.v.Wolters,S.et al,2022.Differences in Evidentiary Requirements Between European Medicines Agency and European Health Technology Assessment of Oncology DrugsCan Alignment Be Enhanced?online Value in Health.Avail
108、able at:Accessed 15 September 2022.vi.Hwang,T.et al,2018.Magnitude of clinical benefit of cancer drugs and time to health technology assessment(HTA)decisions in Europe.online Annals of Oncology.Available at:Accessed 15 September 2022.vii.Morrison S&Heinz S,Payer and Industry views on the legislative
109、 proposal for joint work on European Health Technology Assessment approach ISPOR,November 2021,Available at:ISPOR-POSC221 Payer and Industry Views on the Legislative Proposal for Joint Work on European Health Technology Assessment Approach Accessed 15 September 2022.viii.Weinfurt,K.et al,2022.Value
110、of High-Cost Cancer Care:A Behavioral Science Perspective|Journal of Clinical Oncology.online Ascopubs.org.Available at:Accessed 15 September 2022.1.“Generating and leveraging RWE to drive pricing&access the importance of multiple data source integration and value attribution in multi-component dise
111、ase management”World Evidence,Pricing&Access Congress 2022,Teale C2.“The Monitor Intervene Predict(MIP)value framework a structured approach to demonstrating how digital health can improve health outcomes and reduce burden of illness”HEOR Spotlight,September 2022(in publication),Teale CEnd notesRefe
112、rencesAbout Ipsos Healthcare Service LineWe are a global insight,analytics and advisory partner to the healthcare sector.Our multi-disciplinary teams deliver integrated services and proprietary real-world evidence across the product lifecycle.This enables our clients to act with clarity,certainty and