Health minister: This time Belgium could mine healthcare data instead of coal

Belgian health minister Maggie De Block: "Belgium has an enormous wealth of digital data. The possibilities and ideas exist to become a new 'mining' country." [Photo by Sarantis Michalopoulos]

Belgium has an enormous wealth of digital data, which could help it become a new “mining” country. “We could mine data instead of coal”, Belgian Health Minister told in an interview.

“It is necessary to explain to citizens what the added value of data is for our society and how it is a form of responsible citizenship. However, we should never collect data without their informed consent to use real-world evidence data for scientific research or to optimise screening programs,” she added.

Maggie De Block is Belgium’s Health Minister. She spoke to EURACTIV’s Sarantis Michalopoulos on the sidelines of the European Cancer Forum on 28 January.

We hear a lot about access to cancer treatments and what member states are doing. Could you give us more insights into how Belgian patients can access innovative cancer treatments?

We sped up the reimbursement procedure, meaning that people will now be reimbursed within one month.

The results of this approach have been overwhelming. Calculations by Professor Lieven Annemans demonstrated that this fast-tracking resulted in a gain of more than 9,700 quality-adjusted life years (QALY), whereas the usual procedure would have gained only 5,900 QALY.

Immunotherapy is one of the innovative therapies that became eligible for reimbursement, thus more accessible. It is important to grant patients access to it and Belgium was the first country to make that happen.

In Belgium, next-generation sequencing (NGS) diagnostic tests are reimbursed as well. By detecting tumour mutations, we can rule out which drugs will be effective. This leads to more effective use of drugs.

We also reformed the procedure to make the reimbursement of the tests and drugs more coherent. We agreed to limit these tests to 10 networks of laboratories. All test results are registered in a centralised database. The goal is to collect data in order to assess how well personalised-medicine performs.

Similarly, gene expression profiling tests (GEP), such as Mammaprint and Oncotype Dx, are reimbursed. These tests can rule out whether or not women can benefit from adjuvant chemotherapy. This approach has several advantages. Firstly, these women do not need to deal with the side effects of needless therapy. Secondly, by avoiding this therapy, the corresponding healthcare budget can be spent in a more useful way.

When looking at Europe, how can we make sure that all EU patients have access to these treatments while ensuring the sustainability of health systems?

Managing healthcare more efficiently is necessary to create sustainability. The next-generation sequencing project (NGS) and gene expression profiling tests (GEP) help to reduce unnecessary use of expensive drugs. More precise assessment will avoid patients taking drugs that do not work. Of course, affordable drugs remain a challenge for the future.

Pricing issues in terms of access to new drugs is a complex and difficult matter. In order to guarantee sustainability, we need to set up a series of innovative approaches. The Pact of the Future with the pharmaceutical industry outlines the guidelines. Budget overrun is limited by emphasising a patent cliff strategy and more budget was made available by promoting competition in the off-patent market. In 2019 and 2020, we raised the budget for medicines in order to grant access to innovative therapies.

The new Commission is working on a European cancer plan. What should be in there and what are your priorities as MoH of Belgium?

The European Cancer Plan needs to take into account that some member states have already made important investments. France implemented two nationwide cancer plans. Belgium invested in its cancer plan in the past decade. An investment of over €340 million per year and that figure does not even comprise access to new drugs.

The European Commission already developed guidelines to implement a cancer plan. The Joint Action EPAAC designed this roadbook. When we consider these cancer plans, the measures with the highest added value are those that immediately impact patients.

This is what we need to focus on: investing in access to new therapies, offering patients a cardio-oncology rehabilitation plan, supporting initiatives to return to work, cost-free onco-freezing, providing high expertise reference centres, etc. In short, the European Cancer plan should act as a leverage to help member states improve the quality of life of their patients.

What should the ultimate objective of this cancer plan be?

Claiming that we will be able to exterminate cancer as a disease would be far too populist for it is not possible. However, we must strive to cure as many cancers as possible in a sustainable way.

The plan should be realistic, tangible and pragmatic. As a first step, we could reinforce screening and early diagnosis. The earlier cancer is detected, the better the chance of cure and survival. And now that more people are surviving cancer, we should focus on survivorship as well. As a society, we need to do whatever we reasonably can in order to guarantee the highest quality of life possible.

How can we make sure that the east-west gap when it comes to handling cancer is narrowed?

There is still a gap in welfare between the different European countries, but this is not just limited to the East-West divide in the EU.

The European Parliament noticed the differences in availability, pricing and ruling across the EU and called on the Commission to draw up an action plan. The Parliament also noted there is room to improve the reimbursement procedures in a number of member states with regard to prescriptions, orphan drugs, pharmaceutically compounded medication and follow-up care.

The gap can be narrowed through cooperation and solidarity among European countries. International collaboration is the key to tackle those issues, especially pricing.

Therefore, I started the BeNeLuxA initiative. Its aim is to ensure sustainable access to innovative medicine at an affordable cost for our patients. I hope the support for this project will keep growing within Europe.

What’s the role of digital health, in this case for screening programs, in tackling cancer? Should healthcare systems earmark more money in this direction? What’s the case of Belgium?

When all available data becomes accessible, the potential for designing efficient and cost-effective screening programs becomes feasible. Such programs would make it possible to detect citizens with a medium or high risk of cancer and screen them instead of every one (of a certain age) every year.

Obviously, it is not likely nor desirable that all existing real-world evidence data collected in health organisations are used for such smart systems. In my opinion, it is necessary to explain to citizens what the added value of data for our society is and how it is a form of responsible citizenship. However, we should never collect data without their informed consent to use real-world evidence data for scientific research or optimal screening programs.

Belgium has an enormous wealth of digital data. The possibilities and ideas exist to become a new “mining” country. But this time we could mine data instead of coal.

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