Track 1: Conocimiento clínico y gestión de la innovación: de la idea al mercado 1.4. La visión de la industria

1. The Industry Vision
Session S 1.4 Roundtable
The importance of innovative technologies in healthcare
COCIR’s viewpoint
Nicole Denjoy
COCIR Secretary General
25 May, Barcelona (Spain)

2. COCIR

3. What is COCIR?
• It represents the industry leading
voice in Europe and beyond for:
• Medical Imaging,
• Health ICTs,
• Electromedical Industry.
June 17, 2009, page 3

4. COCIR Member Companies

5. COCIR National Trade Associations
Belgium Hungary Italy UK
Spain Netherlands Finland Netherlands
France Germany Sweden Turkey Germany

6. COCIR’s focus:
improve market access
• Provide COCIR’s members with competence towards policy
makers in Europe and outside
• Contribute to sustainability of healthcare systems through
integrated care approach
• Promote Research and Innovation as a key enabler for
economic growth
• Drive global regulatory convergence (registered once,
accepted everywhere)
• Optimise use of International standards
• Push for national and regional deployment (eHealth)
• Pro-active in Green Technology (Eco-Design)

7. Strategic Global Presence
IMDRF
June 17, 2009, page 7

8. Challenges

9. Challenges
1 35 million deaths from chronic disease
2 60% of all deaths result from chronic
disease
3 Deaths from chronic disease will increase by 17% by 2015
2 17.5mm
Chronic disease deaths
Worldwide
7.6mm
4.1mm
1.4mm
Cardiovascular diseases Cancer Chronic Diabetes
respiratory disease

10. Societal health challenges
• An ageing population
• Growing prevalence of
chronic diseases
• A declining labour force
• Rising health care costs
June 17, 2009, page 10

11. Challenges for our Industry
• Highly regulated industry (under revision!)
• Lack of harmonisation in regulatory
framework globally & insufficient use of
international standards
• Various HTA & reimbursement systems in EU
• Still fragmented business in eHealth
• Lack of proper research funding &
insufficient use of structural funds in health
June 17, 2009, page 11

12. The industry cannot solve alone some key
challenges faced by innovations
• Investment and research are associated with high risks
 Toward personalized medicine (niche markets) versus ROI
 Innovative technologies to be integrated into a new, not yet defined
Healthcare System paradigm
• Low speed of adoption of new technologies with derived
clinical and economic benefits
 New role of diagnostic & reimbursement issues
(biomarkers, companion diagnostic,…)
• Lack of standards to accelerate research and defragment
the market (globally)
 Need for large clinical trials led by Clinical/Scientific experts groups
(e.g: AD taskforce, EORTC,…) supported by EC/EMA to validate new
medical practices to be reimbursed
June 17, 2009, page 12

13. Proven successes
2 examples

14. Innovation in Medical Devices …
support improving outcomes in Cardiology
US Life Expectancy at Birth
1950-2000
80
75
70
Cancer Heart 65
1950 1960 1970 1980 1990 2000
Disease
Heart Cancer 5 out 7 years gained due
Disease to better heart care
Sources: NCHS,
Cutler 2006
“Around 70% of the survival improvement in heart attack
mortality is a result of changes in technology.”
Cutler & McClellan, 2001
June 17, 2009, page 14

15. Innovation in Medical Devices …
support improving outcomes in Oncology
Prostate cancer deaths Breast cancer deaths Colorectal cancer deaths
60 45 45
Per 100K females
Per 100K males
Per 100K pop
Deaths down 4.9%
40 30 30
Breast Male
Prostate
20 15 15
Female
Deaths down 4.1% Deaths down 3.5% Deaths down 4.5%
0 0 0
1975 2003 2008 1975 2003 2008 1975 2003 2008
• Prostate cancer mortality continues to fall: screening, PSA
• Breast cancer mortality decreased 3.5%: first drop in 20 years
• Colorectal cancer 5yr survival: 10% late stage; 90% early detection
“The decline in cancer has little to do with improvements in late stage
treatment...but more to do with screening, earlier detection and
treatment."
Prof. Gordon McVie, European Institute of Oncology, Milan
June 17, 2009, page 15

16. Opportunities

17. Medical Imaging innovations can turn
societal challenge into growth
• Yesterday
 Patient stratification
 Patient monitoring
• Tomorrow
 Early diagnosis
 Targeted treatment selection
 Minimally invasive treatment
 Treatment efficacy monitoring
Better quality & access to healthcare
Lower healthcare cost
INNOVATIONS
Quicker recovery of patients, quicker
return to daily activities
Economic Growth
(incl. jobs in EU for global markets)
June 17, 2009, page 17

18. Medical Imaging sector is strong in Europe…
• 3 of the global medical imaging industrial leaders are
headquartered in Europe, with strong R&D presence in
Europe
• Strong academic presence and Intellectual Property in
Europe can be leveraged for innovation (Patents registered
in 2010: 39% European, 26% US, 18% Japan and 5%
China and Korea)
June 17, 2009, page 18

19. Leverage the Power of Health ICT
Hospital
Government Polyclinic
• Healthcare IT and eHealth  proven high clinical and
societal value
• Telehealth  linking patients with care providers Home
Central
Pharmacy Patient’s
• IT infrastructure  ensure that systems derive maximal EHR
value from medical technology (Cloud computing)
Laboratory
• IT connectivity through IHE (Integrating the Healthcare
Enterprise)  improving quality and reducing cost
• More investment in eHealth  best-practice clinical
pathways / patient’s mobility throughout Europe
June 17, 2009, page 19

20. Technology is advancing fast…..
Diagnostics Biotech & Genomics IT & bioengineering
• Faster, accurate imaging • Targeted therapy • eHealth/Telemedicine
• Molecular imaging • Proteomics/DNA • Mobile solutions
• Miniaturisation/portability • Biomarkers • BioSensors
• Point of Care diagnostics • Rapid screening tools • Computer Aided Diagnostics
• Therapy selection/monitor • Vaccine development • Patient monitoring
June 17, 2009, page 20

21. BUT…change is slow
 Needpolicies that facilitate disease
management approaches:
o Focus on disease risk stratification, prevention & screening
programmes
o Encourage ‘best practice’ patient centric processes
o Health ICT solutions to drive quality, safety and efficiency,
and telemedicine
o Encourage more integrated care delivery
o Use of regulatory & procurement to accelerate uptake of
proven technologies
June 17, 2009, page 21

22. Two COCIR initiatives:
1. PPP in Research and Innovation
2. More effective PPP models: key best
practices on integrated care at
hospital level
June 17, 2009, page 22

23. 1. PPP for Research & Innovation
• Create an industry driven public-private partnership (PPP)
to accelerate Research and Innovation
• Together with Academics, Research Centers and Public
Authorities
• Join forces with other industry sectors (pharma, cosmetics,
etc….)
… in the context of “Horizon 2020” objectives of the
European Commission
The third objective, 'Societal challenges' will see €31.7
billion allocated to tackling the major issues affecting
the lives of European citizens, including Health,
demographic change and wellbeing (€8.6 billion – up
from €6.1 billion in FP7).
June 17, 2009, page 23

24. Benefits for European Commission
and Member States
• Better quality and lower cost healthcare for the most
important disease areas in EU and globally
 Acceleration of efficient technology uptake, increasing ROI of
investments in healthcare technologies
• European Industrial and Scientific leadership
 Prioritization of R&I in line with the industry needs to tackle
major global societal challenges
 Better leverage of technology and clinical research outputs
 PPP collaboration leads to better insights to jointly address future
problems
• Growth
 Jobs creations derived from innovations commercialization
 Indirect economic benefits of better management of chronic
diseases
June 17, 2009, page 24

25. 2. Hospital Of Today (HOT)
What you plan Today will remain optimal Tomorrow
A COCIR Initiative to maximize
investments at hospital level on
integrated solutions
June 17, 2009, page 25

26. Characteristics of a PPP
PPP has a number of characteristics which differentiates it from more traditional
forms of contracting between the public and private sectors:
1. Long term –Typically contracting period of 25 – 30 years. Over this period of time the private sector will
operate and maintain the facility.
2. Transfer of risk – certain financial, technical and operational risks are passed to the private sector for the
duration of a PPP contract.
3. Limited recourse finance – the financing within the Special Purpose Vehicle (SPV) is secured against the
project cash flows rather than the balance sheets of the SPV’s shareholders.
4. Payments over life of PPP contract– the Procuring Authority pays an annual Unitary Charge to the private
sector once service delivery has commenced (or in the case of toll funded projects payments are made by the
users of the service).
5. Private sector ownership – the private sector usually owns the asset for the duration of the contract. Upon
completion of the contract term, ownership of the asset can be transferred to the Procuring Authority.
6. Involves a range of partners – a number of private sector entities come together to form a consortium to
deliver the project.
26 June 17, 2009, page 26

27. Alternative Model PPP
De-couple Infrastructure from Technology
Government
Hospital
Managed Building
Service Concession
Technology
Consortium
Partner
• Construction Company
– Turnkey DBFMO model to provide infrastructure on 20 – 30 years lease basis
Design Build Finance Maintain Operate
• Equipment Technology Partnership
– Via a Managed Service based on Service Model and Service Level Agreement
– Providing flexibility in 10 – 15 years term
June 17, 2009, page 27

28. Valencia Region South
Integrated Patient Care System
- Full integrated patient care
- No waiting lists
- Patient has free choice to choose
hospital
- 600 € per capita, per year
Capitated payment
Property refund to
Valencia
Government
Public and free healthcare
services Controlled Project
June 17, 2009, page 28

29. What we need….

30. Innovative technology will enable
a shift in care
• Focus on acute conditions  Focus on acute & long term conditions
• Hospital centred  Community centred
• Physician dependent  Team based
• Episodic, reactive care  Integrated preventive care
• Passive patient  Knowledgeable patient
• Slow uptake of technology  Localised integrated high tech solutions
• Budget silos  Fund continuum of care
Hospital Community Home
clinic
Utilization
PRESENT FUTURE
High Acuity Low
June 17, 2009, page 30

31. Importance of prevention & personal
initiative for healthier and more active lifestyles
• Industry strongly supports government policies
and educational programs that encourage
individuals to make informed choices and take
personal initiatives for leading healthier and
more active lives
June 17, 2009, page 31

32. Collaborative partnership approach…
• Non-communicable diseases are multi-factorial
in nature, thus requiring a multi-stakeholder
and horizontal approach to ensure healthier
and informed life-styles
• Effective strategies must involve all levels of
government as well as all key stakeholders
June 17, 2009, page 32

33. Expectations to foster an innovation-
friendly environment in Europe
1.Establish a mechanism to ensure a robust evaluation of
innovations during the product-development cycle
2.Enable rapid access to market for innovative products
and services with added value
3.Adopt a clear strategy at EU level to support innovations
4.Access to further financing Research and Development
investments
5. Better leverage the use of Structural Funds for Health
June 17, 2009, page 33