ISPOR Europe 2023 daily round-ups: Day 3

Written by The Evidence Base
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The final day of ISPOR Europe 2023 (November 12–15, 2023; Copenhagen, Denmark; #ISPOREurope) completed the programming for the conference, which included 450 speakers delivering 150 sessions over 3 days. The Evidence Base thank the program committee for putting together a comprehensive agenda, led by: 

Here, we summarize some of the presentations that took place over Day 3.

Click below to read the coverage of Days 1 and 2.

Day 1 Day 2

Breakout sessions 

Day 3 of ISPOR Europe 2023 kicked off with seven concurrent Breakout Sessions exploring a range of topics covering precision medicine, value-based pricing and longitudinal qualitative research. 

Session 300 on “An Evidence Analysis Framework for Digital Health” was brought by the ISPOR Digital Health Special Interest Group. Discussants talked the audience through the development of the PICOTS-ComTeC framework, designed to address the variability of digital health interventions and increasing need for a structure to guide health economic and outcomes research (HEOR) and health technology assessments (HTA) by defining these technologies. The panel included Zsombor Zrubka (Óbuda University, Hungary), Artem Boltyenkov (Siemens Healthcare Diagnostics Inc., PA, USA), Rossella Di Bidino (A. Gemelli Teaching Hospital, Italy) and Anke-Peggy Holtorf (PCIG @ HTAi.org, Switzerland). 

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Dalia Dawoud (NICE, UK) introduced a panel session on the topic “Point-of-Care Diagnostics for Antimicrobial Resistance. Will the Experience of the COVID-19 Pandemic Increase the Likelihood of Their Uptake?”, which included Alec Morton (University of Strathclyde, UK), Fatima Salih (NICE, UK) and Jean-Louis Tissier (bioMérieux, France). Dawoud set the scene for the discussion explaining the emerging global pandemic of antimicrobial resistance (AMR), its impact on global health and the role of point-of-care (PoC) diagnostics. Morton reflected on some of the challenges for the economic and HTA assessment of interventions for AMR, with the roll out of PoC diagnostics and best practices for their use varied across Europe. Morton likened the challenges of AMR to those seen with climate change, providing several analogies between the two throughout the presentation. Despite work being carried out over the past 10 years, there is still no consensus on how to assess the value of AMR. 

Tissier reinforced Dawoud’s introduction stressing the global burden and dramatic economic consequences of AMR. Tissier explained rapid diagnostic tests have a key role to play in antimicrobial stewardship to ensure the right patient has the right drug at the right time for the right indication and at the right dose. Healthcare ‘value’ is less well established for diagnostics, with multiple factors impeding the determination of the value for POC diagnostics. Tissier called for robust, harmonized, standardized HTAs of in vitro diagnostics as well as creative methods to determine their value and geographic and economic considerations. 

Salih introduced the VALUE-Dx program, the Innovative Medicines Initiative-funded project helping to build the economic case for rapid diagnostics as a public good in the fight against AMR. Salih shared several learnings from the use of POC in the COVID-19 pandemic, which has given the healthcare community an opportunity to explore new approaches to the development, evaluation and implementation of POC diagnostics. Salih, along with the expert advisory panel convened for the IMI VALUE-Dx project, agreed with Tissier that a formal, standardized approach to the assessment and reimbursement of diagnostics, is needed, carried out in a holistic manner that incorporates the benefits to individuals, health systems and society. 

In breakout session 304, moderator Blythe Anderson (Flatiron Health, NY, USA) was joined by speakers discussing the topic, “Real-world issues with real-world data when balancing populations of cancer patients who have histories, treatment sequences and biomarkers”. Anik Patel (Kite Pharma, CA, USA) spoke first, and began by discussing why we need external control studies, including for accelerated approvals. He used the example of the accelerated approval of Axi-cel CAR-T cell therapy in relapsed and refractory follicular lymphoma, describing the SCHOLAR-5 trial, which was submitted as part of global HTA submissions along with ZUMA-5. Helene Vioix (Merck Healthcare KGaA, Germany) gave a further example of MetEx14 – a mutation in NSCLC, before the final speaker, Anthony Hatswell (Delta Hat, UK) tied together the two case studies. Anderson posed the question to the panel of what can be done to make the evidence more convincing, and how it might be more effectively communicated. Patel felt that the academic community received the methods well, but with payers this acceptance dwindled. Scientific rigor isn’t always translated into a positive decision, and this might be something that will improve with time. Vioix felt the evidence can be convincing regarding treatment sequences, while Hatswell suggested the evidence can be provided more persuasively by encouraging regulators to look around at other countries where there are approvals occurring based on this type of evidence. 

Spotlight session 

In the Day 3 Spotlight session (session 319), entitled “Behavioral Economics to Inform Healthcare Decisions”, moderator Shelby Reed (Duke University School of Medicine, NC, USA) was joined by speakers Yannick Vandenplas (HICT, Belgium), Isabelle Huys (KU Leuven, Belgium) and David Asch (University of Pennsylvania, PA, USA).

Vandenplas spoke first on “What can we learn from behavioral economics to share healthcare policy?”. He discussed some specifics of behavioral economics, sharing relevant examples from healthcare. He spoke on the concepts:

  • Loss aversion – people are more motivated to avoid losses than to achieve similarly-sized gains. 
  • Social norms – our behavior is influenced by that of our peers. We tend to mirror the behavior of the people in our environment. 
  • Defaults – people have the tendency to stick to the default option and choose the path of least resistance, rather than changing to a better alternative. 
  • Present bias – present bias or hyperbolic discounting is the nonlinear and nonconstant tendency of individuals to prefer a smaller, sooner pay-off over a larger future pay-off. 
  • Framing – our decisions are influenced by how the options are presented. Even if both options are equivalent. 
  • Availability – we tend to overestimate the occurrence of events that are noticeable (more extreme) or salient. Salience refers to people being influenced in their decisions by new and visible events. 

Vandenplas went on to discuss how the concepts of behavioral economics can be applied to healthcare policy. There are limitations to the assumptions of neoclassical economics, and some countries are already using behavioral economics in the field of healthcare policies, including the UK and USA. Applications include:

  • Understanding underlying drivers (why) 
    • Behavioral biases help to understand decision-making processes 
  • Nudges (how) 
    • Changing the choice architecture in a subtle way, creating nudges to steer our behaviour to align with the collective interest 

Vandenplas also shared areas where evidence is being generated in a pharmaceutical context, including in improving medication adherence, examining prescribing behavior, and vaccination uptake. He concluded by discussing limitations and potential pitfalls, including the need to be ethical and in line with the collective interest; the thin line between libertarian paternalism and paternalism; the fact that behavioral economics needs to work hand-in-hand with traditional economics; and finally, that there is currently a scarcity of scientific evidence of behavioral applications in policy contexts.

Huys spoke next, on “The intersection between behavioral economics and patient preference research in healthcare”. She explained that a patient-centered healthcare system included the best medical treatment and also took into account unique patient needs and preferences – this is where patient preference studies come into play. Huys discussed healthcare decision-making, and where behavioral economics principles intersect with the cognitive biases patients might experience in making treatment decisions. She also highlighted the overlap in methodologies between patient preference and behavioral economics studies, including literature reviews, interviews, focus groups and surveys. She concluded with two examples of patient preference studies, including a case study in inflammatory bowel disease where a survey was developed applying principles of behavioral economics, and a further example in multiple myeloma. Her key takeaways were that behavioral economics could be very helpful to help avoid biases, help understand outcomes, and to set up dedicated studies.

Asch spoke on “It takes two to tango: the clinician–patient dance of behavioral economics”. He spoke about the science of motivation, which has evolved from:

  • Education (information) – assumes people don’t know, to 
  • Reward (standard economics) – assumes people are rational expected value maximisers, to 
  • Design (behavioral economics) – recognizes people are irrational, in predictable ways, with decisions affected by emotions, bias and social context 

Closing plenary 

For a deep dive into Plenary 3, check out our full coverage. In this session, moderator Adrian Griffin (Johnson & Johnson, UK) was joined by speakers Roisin Adams (National Centre for Pharmacoeconomics, Ireland & Trinity College Dublin, Ireland), Greg Rossi (AstraZeneca, UK), Bettina Ryll (Melanoma Patient Network Europe, and Past Chair of the ESMO Patient Advocates Working Group, Sweden) and Jose Valverde (European Commission, Belgium) to discuss “The calm before the storm of EU HTA”. 

For more insights from the third plenary at ISPOR Europe 2023, read my summary here >>> 

Posters 

The final poster session of ISPOR Europe 2023 on Day 3 rounded up the presentation of almost 2000 posters. Some of the research presented at ISPOR Europe 2023 Day 3 included: 

  •  A propensity score-based comparison of tepotinib versus immunotherapy with/without chemotherapy, using real-world data in previously untreated met exon 14 (METEX14) skipping non‑small cell lung cancer (NSCLC). Hook  et al. 
  • Treatment preferences among patients with relapsed/refractory (r/r) diffuse large b-cell lymphoma (DLBCL) in France, Germany, Italy, Japan, Spain, the United States, and the United Kingdom. Liu FF et al. 
  • The influence of value frameworks on payer and oncologist decision-making in the United States (US). Quintero T et al. 

The full list of posters can be viewed here >>> 

Digital conference pass 

This year, ISPOR are offering a new Digital Conference Pass option providing on-demand access to recordings of nearly all the educational sessions, plenaries, spotlights, and other content. The pass is available for purchase by conference delegates to upgrade their ISPOR Europe 2023 experience or separately for anyone unable to attend the meeting in person. Content will be available December 5 to January 9, 2024. 

Looking ahead 

The Evidence Base will be continuing our coverage of the ISPOR conferences in 2024, first at ISPOR Annual in Atlanta in May (5–8 May, 2024) and at ISPOR Europe in Barcelona next November (17–20 November, 2024). Our ISPOR coverage across the website and on social media generates significant engagement and interest from the HEOR and RWE community. If you are interested in leveraging this attention to showcase your thought leadership and expertise in the field during these conferences, then please get in touch. Sponsorship options include session deep dives, company/product profiles, expert interviews, videos, webinars, and more. 

Learn more on our Sponsorship page or contact Phil Garner, Co-Founder & CEO, for more information on how to partner with us for these important events.