COVID-19 – calling all HEOR stakeholders! Inside the plenary ahead of Virtual ISPOR 2020

Written by Ilana Landau, Editor

To kick off Virtual ISPOR 2020 (18–20 May), the society held a pre-conference plenary aptly dedicated to exploring the key roles health economics and outcomes research (HEOR) stakeholders can play in helping inform health and policy decision making during – and beyond – the pandemic.

The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) is a global professional society for all health economics and outcomes research (HEOR) stakeholders.

Due to the COVID-19 outbreak, the society’s annual meeting — due to be held in Orlando (FL, USA) over 18—20 May 2020 — will instead be taking place over the same dates virtually!

To launch the newly redesigned, virtual annual meeting, ISPOR held a pre-conference plenary session on Thursday 14 May 2020, fittingly dedicated to exploring the key roles HEOR stakeholders can play in helping inform health and policy decision making during — and beyond — the pandemic.

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The session featured a Keynote presentation by Mark McClellan (Duke-Margolis Center for Health Policy, DC, USA), followed by a panel discussion moderated by Jalpa Doshi (University of Pennsylvania, PA, USA), featuring Nuria Oliver, (Commissioner for AI and COVID-19 at the Valencian Government, Spain), Leo Yee-Sin (Executive Director of the National Centre for Infectious Diseases, Novena, Singapore), John Powers (University of Maryland School of Medicine, MD, USA) and Andrew Briggs (London School of Hygiene and Tropical Medicine, UK).

Read on to discover my key takeaways from the session! You can still register to view the session on demand, here>>

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This pandemic is a ‘transformative’ pandemic

As a civilian population, this is not the first time that we have been faced with an outbreak of an infectious agent against which we have no targeted treatment readily available. Though vaccine devolvement against COVID-19 is the undisputed end goal of many research efforts, until one is effectively and safely developed, early pandemic response protocols — namely ‘non-pharmaceutical interventions’ and surge capacity measures — will be key to disease management.

The big question facing HEOR: how far off is vaccine procurement?”

McClellan explained that these processes, particularly surge capacity, are essential for ensuring already pressured healthcare systems are equipped to cope with large-scale admissions of disease cases; without adequate planning, this could create a critical bottleneck in healthcare delivery.

However, there is recognition that deeply impactful stay-at-home schemes that have been implemented in many countries are not sustainable in the long-term. As a result, governments the world over face making deeply challenging, so called, ‘reopening’ decisions — decisions on when and how nations can slowly, vigilantly, ease restricted movement procedures to allow daily activities to resume. Abrupt relief of these measures could have devastating consequences and result in mortality spiking due to rapid, unmitigated disease spread.

HEOR, McClellan explained, is essential for helping inform these tough decisions, as well as the development and feasibility testing of diagnostics and contact-tracing software protocols. A ‘test and trace’ approach, with appropriate surveillance, will be critical and HEOR data may highlight a need to temporarily reinstate physical distancing.

This pandemic is a transformative one and its effects on the global economy and provision of healthcare will far outlast the time scale of the pandemic itself. As Yee-Sin described already taking place in Singapore, healthcare systems will need to be redesigned to be more flexible and adaptive. HEOR will further be critical for helping inform this, as well as changes in the development, use and payment of medical technologies.

Capacity management — the story of this pandemic

Reaching the right people

A great amount of work — and money — is being invested in vaccine and therapeutic development, as well as more advanced testing protocols.

However, during the plenary, it was highlighted that, in fact, advancements in these areas are only one side of the challenge; another pressing issue concerns how we will cope with the large-scale manufacture and distribution of these agents — how will we get these to the people who need them most?

Indeed, Oliver emphasized the importance of interdisciplinary collaboration — not just between experts of different academic specialities, but between members of the public and senior policy makers too — and increased adoption of mobile technologies to help reach at-risk patient populations and improve reporting. Better reporting will lead to better evidence-based policy.

Better reporting will lead to better evidence-based policy.”

McClellan highlighted how parallel, interdisciplinary collaboration will be key to expediting research and policy decision making. Increased use of mobile technologies will be important for extending reach of resources to those who need them most.

Speaking with Laura Dormer, Editorial Director at Future Science Group (London, UK), after the plenary, she emphasized: “A lot of actions to date have had to be reactive, but moving forward we’ll need to be proactive to make evidence-based adjustments to policies as data emerge — i.e., reporting of new cases, adjustments in the extent of social distancing measures, revisions in testing policies etc.”

At-risk capacity management and production

Taking the tough questions concerning ‘reopening’ and capacity management even further, another critical challenge that HEOR will play a central role in concerns ‘at-risk’ capacity management and production.

COVID-19 is everywhere; once developed, a vaccine or therapeutic product will need to be made readily available, globally, as rapidly as possible. The manufacturing force required to achieve this is immense and could take months in and of itself.

In a bid to mitigate this delay, companies may be progressing large-scale production of millions of units of potential therapeutic and vaccines candidates, so that in case one seems promising, even very early on, there are reserves of it to be rapidly disseminated and administered if it is later proven effective. These are critical HEOR decisions as, at the same time, this will likely result in the waste of billions of dollars in product units as these are being produced ahead of definitive data proving their effectiveness.

COVID-19: what of its collateral impacts?

Another key theme highlighted throughout the session concerns the collateral impacts of COVID-19, encompassing mental and emotional health impacts, as well as impacts on care provision to the millions of individuals worldwide with chronic conditions that require ongoing medical care.

Once again, HEOR research into the extent and long-term implications of these effects is essential, which will further help inform ‘reopening’ strategies.

We need to stop thinking linearly; we need to think dynamically and reactively.

Briggs described some of his work on quality-adjusted life expectancy estimates for individuals with and without chronic conditions and the impact of COVID-19 on these. He stressed that COVID-19 is having an unintended, collateral impact life expectancy. The importance of this cannot be neglected.

Telemedicine — the medicine of the future?

Triggered by COVID-19, we have seen a great surge in the provision of telemedicine as a means for remotely maintaining essential healthcare services, to mitigate patient—provider contact and COVID-19 transmission.

Whilst many speakers highlighted this as positive, they also spoke of the great optimization required to ensure the capabilities of these service are maintained.

Real-world data during COVID-19

Due to unprecedented nature of this pandemic, information and data are significantly lacking concerning the safety and clinical effectiveness of potential treatment strategies against COVID-19. McClellan suggested that as clinical trials of vaccines and therapeutic candidates are carried out, it is likely that as soon as a product demonstrates even modest therapeutic effectiveness and survival benefits, approvals for the product will be sought and compassionate use etc. may be granted.

Real-world data will become invaluable as they will represent the mainstream means of tracking the clinical safety and effectiveness of novel agents as they are rapidly progressed into clinics, in the absence of complete data from traditional clinical trials.

Overall, I think there were several positive opportunities that came out of the plenary, including potential increased adoption of real-world evidence to help guide policies, which would be great to see…”

This could have significant consequences on how real-world data and evidence may be viewed and considered in the future.

An opportunity to socialize outcomes measurement

During the panel discussion portion of the session, Powers attested that is not only important to know how to measure outcomes, but equally important to know what to measure and how to analyse this.

The current pandemic provides not only an opportunity to demonstrate the value of HEOR research to decision making, but also for implementation science to socialize the measurement of clinical outcomes; if you learn from patients and what to ask them about their symptoms, you will ultimately get meaningful outcomes and data.

A message to HEOR stakeholders

HEOR, clearly, has an important role to play during — and beyond — this pandemic to inform decision making; rounding off the session, the speakers emphasized that stakeholders of the HEOR community should be proactive, make their voices heard and reach out to offer their insights.

Briggs highlighted that we need to stop thinking linearly; we need to think dynamically and reactively. Infectious disease modellers are the experts in this, so this should be left to them; rather, HEOR data can providing layering to build on existing epidemiological data.

Dormer commented: “I found it very interesting to hear the different presenters from the USA, Europe and Singapore, as I’ve mainly been exposed to UK-based news. I think it will be important to encourage collaboration, via organisations like ISPOR, as there’s so much we can learn from different countries’ responses.”

“Overall, I think there were several positive opportunities that came out of the plenary, including potential increased adoption of real-world evidence to help guide policies, which would be great to see, as well as the acceleration of digital medicine — though the key will be to how to sustain this — and the role of the existing decision analytics techniques to help make the right decisions quickly,” Dormer concluded.

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