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Panel addresses increasing global costs of health care
At the Ophthalmology Futures European Forum, panelists touched on health care spending, drug development and milestone deals.
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AMSTERDAM, Netherlands — As the population ages and life expectancy increases, not only are people staying in the workforce longer but also aging bodies need tending for longer.
Health care spending is accelerating in developed nations, resulting in a significant financial burden, Jim Mazzo, operating partner at Versant Ventures, said here at the Ophthalmology Futures European Forum. Rising health care costs limit access to new technology and reimbursement, driving the need for alternative solutions for paying those costs, he said.
“We now expect patients to pay for some of these technologies. We’ve seen it in the United States, we’ve seen it in parts of Europe, and we’re starting to see it across Asia-Pacific,” Mazzo said.
“At the end of the day, government will say, ‘I cannot continue to pay for technologies unless they are very unlike the ones that you are trying to make obsolete,’” Mazzo said. Governments cannot afford to pay for similar technologies, and if they are introduced, they will not be reimbursed, he said.
Utility, society value, access and quality of health care are driving factors for reimbursement in the United Kingdom, panelist Joanne Holden, a technical advisor at the National Institute for Health and Care Excellence, said. New technologies are accepted through rational decision making that is evidence-based, she said.
Another factor to take into account for development of devices are the start-up costs, panelist Paula Wittels, program director for Translucency, said. Decisions take into account cost-effectiveness, but funds must be available at the start to develop the technology.
“It can be very difficult to get that technology started at a certain center because the money isn’t available to start it, and the cost saving or benefits further down the line are too far away for the technology to get over the hurdle of that initial budget impact,” Wittels said.
Unanswered questions hinder development of drops for macular disease
Too many unanswered questions hinder development of eye drops for delivery to the back of the eye, one corporate executive told colleagues.
“I find it, at this point, very, very difficult to develop eye drops for the back of the eye in the face of all the questions to which we don’t have answers,” Claudine Bruck, vice president and head of GSK Ophthalmology, said. For one, there is a need to identify which tissue — retinal or choroidal — to target. Whereas therapeutic levels of drug may penetrate one tissue, it may not penetrate the other, and which to target remains unanswered.
Patient compliance with a topical drug is another issue.
“Even though patients know they need to take the drops, they don’t,” Angela Macfarlane, president and CEO of ForSight Labs, said.
The potential for visual loss with age-related macular degeneration and diabetic macular edema, as well as the dosing requirements and types of formulations that would be necessary, were the impetus for the smaller company to take drops “off the table” as a potential macular therapy, she said.
“We didn’t want to have a great therapy and not have it used,” Macfarlane said.
Panelists debate rewards, risks of milestone deals
Venture capitalists do not generally like structured deals that stretch out payments when transitioning acquisitions, thus putting the payments at risk. However, such milestone deals can be successful, a representative of such a firm told colleagues.
“Venture has been under a lot of pressure because of low return, particularly in life sciences,” panelist Gil Kliman, a general partner with InterWest Partners, said. “So one of the pros of having a structured deal is that it allows us to get more ‘exits,’ by allowing the parties to negotiate to a price that will work for both the buyer and the seller.”
Larger corporations like structured deals, according to panelist Jane Rady, divisional vice president of business development at Abbott Medical Optics.
“The structured deal, in some respects, has an opportunity to hold the management team together for an extended period of time and see the project through to its conclusion,” Rady said.
If structured correctly, milestone deals can be beneficial to large corporations and small companies, she said. By staging the buyout, innovations that are in process continue in process and workers in jobs stay in their jobs until the deal is concluded.
“The issue for industry along with investors is to work together closely to make sure the structure of that deal does benefit the investors, the stockholders, the employees of the small company as well as the large industry,” Rady said.
Minimally invasive brachytherapy device shows promising results for wet AMD
A minimally invasive retrobulbar episcleral brachytherapy device improved vision in patients with AMD, manufacturer Salutaris Medical Devices announced in a news release at the forum.
The device is designed to let retina specialists administer brachytherapy and anti-VEGF injections in the same clinical setting. It uses a dose of episcleral brachytherapy in conjunction with intraocular anti-VEGF injections under local anesthesia.
Six patients received 24 Gy radiation for 5.5 minutes via an SMD-1 brachytherapy probe adjacent to the macular sclera. Patients also received adjuvant anti-VEGF injections and re-injections as needed.
At 3 months, best corrected visual acuity improved in all patients. At 24 months, two patients required no additional anti-VEGF injections and four patients had improved or stabilized BCVA (mean: 11.5 letters).
The treatment was well tolerated and posed no serious side effects, the release said.
“This device is distinguished by its precision and lesion-specific targeting, which enable the retina specialist to deliver precisely localized tissue irradiation, customized for each patient,” Laurence Marsteller, MD, Salutaris managing director, said in the release. – by Patricia Nale
Disclosures: Bruck is vice president and head of GSK Ophthalmology. Holden is a technical advisor at the National Institute for Health and Care Excellence in the U.K. Kliman is a general partner with InterWest Partners. Macfarlane is president and CEO of ForSight Labs. Marsteller is Salutaris managing director. Mazzo is operating partner at Versant Ventures. Rady is divisional vice president of business development at Abbott Medical Optics. Wittels is program director at Translucency.