Ljubljana, 9 October 2018 - Participants at the 7th strategic Value of Innovation Conference - Without Rest Towards a Better Tomorrow, that took place at the National Council of the Republic of Slovenia, emphasised the importance of good access to medicines, integrated assessment and early introduction of innovations and assurance of a sustainable healthcare system for effective management of the growing burden of chronic non-infectious diseases and their complications in a long living society. The assurance of timely, effective and comprehensive healthcare and sustainability of the healthcare system with an aging population requires investments in prevention, additional support networks in local communities, innovative technologies and constructive dialogue of all stakeholders in healthcare and other social subsystems. Participants also emphasised that the cost efficiency of innovations and their effects need to be assessed independently and comprehensively over a longer period of time. 

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Developments in science, particularly in medicine and pharmacy, have extended our lives and the lives of our descendants are set to be longer still. Innovative medicines, therapies and vaccines save lives, changing once deadly diseases into chronic ones and improving the quality of patients lives. Two of three cancer patients now live for at least five years after receiving their diagnosis. New therapies have reduced cancer mortality by 21 % since 1991. Innovative therapies have also contributed to reducing the mortality of HIV/Aids patients by 80 % over the last 20 years. Vaccines now save two to three million lives around the world. Healthcare innovations are also a profitable investment as they reduce mortality, disability, need for additional treatments, hospitalisation, absenteeism while improving the quality of patients’ lives. According to OECD data medicinalproduct costs in Slovenia are the lowest among countries with a similar range of medicines. Switzerland uses 898 Euros per inhabitant per year for a similar range of medicines, Germany uses 543 Euros and Slovenia uses 229 Euros. Representative of the organiser of the 7th strategic Value of Innovation Conference - Without Rest Towards a Better Tomorrow, Secretary General of the Forum of International Research and Development Pharmaceutical Companies Barbara Stegel commented: “Even though population aging is causing the consumption of medicines to increase each year, the share of the Health Insurance Institute of Slovenia’s expenditures for medicines and foodstuffs has not grown. It has remained steady between 2010 and 2017 and has even reduced somewhat, showing that the innovative pharmaceutical industry has already made a substantial contribution to the sustainability of the healthcare system. Expenditures of the national health insurance institute for medicines and foodstuffs amounted to 15.67 % in 2010 and in 2017 the share has decreased slightly to 15.16 %. Cost efficiency of innovative medicines can be illustrated using the example of the Clinical Department of Rheumatology at Ljubljana’s University Medical Centre, where the number of acute hospitalisations due to inflammatory rheumatic diseases has been halved from 2004 to 2014 due to innovative technologies. This does not only mean lower costs of direct health and social care, but also reduced absence from work and above all a higher quality of life for chronic patients and their families. Representatives of the innovative pharmaceutical industry in Slovenia wish and expect for new and innovative medicines and therapies to reach those who need them as soon as possible.”

Slovenian healthcare spending per capita amounts to just under 2,000 Euros per year, corresponding to 71 % of the European average, while the costs of managing chronic non-infectious diseases and their complications are rising rapidly. General Director of the Health Insurance Institute of Slovenia Marjan Sušelj said that the Institute will be adopting different measures in the future to maintain patient access to effective, quality and safe medicines and introduce innovative medicines into the financing system: “For this purpose the Institute will adopt different measures to assure quality and financially sustainable prescription of medicines and their safe and correct use by their respective users. Rapid development of innovative medicines is bringing new opportunities for successful treatment, but the financial burden of such medicines has been so great that it could cause a suspension of development in other equally important areas of health technology. That is why the Institute is planning additional systemic measures to share upcoming financial risks with medicinal product manufacturers.”

The valuation of information as a key investment in effective management of chronic diseases requires comprehensive economic evaluation, warns izr. prof. dr. Petra Došenovič Bonča from the Faculty of Economics of the University of Ljubljana: “Effective management of chronic diseases is not just a cost, it is an important investment that needs to consider the costs as well as achieved effects. From a payer’s viewpoint such effects of an investment into innovative medicines can include reduced expenditures for other healthcare services and compensation for long term absence due to disease. Since we finance healthcare collectively under the principles of solidarity, we need to view effects from a wider social standpoint. We should thus include minor losses of productivity due to absenteeism, presentism, care for family members and early mortality. With elderly and retired people we should also consider effects caused by maintaining quality of life in daily activities, unpaid work at home and care for our youngest.”

Dr. Stanislav Primožič, acting Director of the Public Agency of the Republic of Slovenia for Medicinal Products and Medical Devices explained that decisions on adopting technological innovations in national healthcare systems must be based on the evaluation of medical technologies - HTA: “Fundamentally the system includes a comparative evaluation of medicines and medical devices, performed by national authorities competent for HTA. Its aim is to establish the relative effectiveness of a new technology in relation to a certain comparative and standard product or procedure. The assessment of added value in HTA processes can serve as an objective basis for determining medicinal product prices and associated negotiations, as well as our decisions on financing a medicinal product with public funds. Collaboration in the field of HTA is very important at a regional and EU level (EUnetHTA project). The perspective of this collaboration greatly depends on the results of discussions on the proposed EU regulation that was drafted in early 2018 by the European Commission and is currently being reviewed by the Council of EU and the European Parliament. The latter has voted in support of the regulation last week and the document could, in the part that regulates clinical assessments, became law in the entire EU over the coming few years. For Slovenia, a small country with about 0.1 % of the value of the global medicines market, which is still establishing its HTA institution, the collaboration at EU level is exceptionally important.”

Head of the Chronic Diseases Prevention Centre at the National Institute of Public Health Rade Pribakovič Brinovec emphasised the importance of preventative and screening programs for the reduction of chronic non-infectious diseases: “All persons with mandatory health insurance in Slovenia have access to preventative healthcare examinations such as the national program of integrated prevention of chronic noninfectious diseases (from age 30 onwards) and screening programs for early detection of cancer Dora, Zora and Svit. Vaccinations are also an important part of preventative programs, of which we currently promote vaccinations against HPV, hepatitis B, influenza and pneumococcus. Each of these programs contributes to better health of our inhabitants and reduced burden of chronic non-infectious diseases. Slovenia as a rapidly aging society also needs support environments in local communities, including day centres and services that provide assistance at home.”

Good access to modern diagnostics and various effective forms of treatment of cancer patients have contributed to transforming many cases of cancer from a deadly disease into a treatable or chronic disease over the last 20 years. With appropriate comprehensive treatment, patients can return to their pre-disease lives. "Patients and their advocates expect that the country will employ appropriate strategies to enable such development in the future without encroaching upon the rights of cancer patients,” said Kristina Modic, Executive Director of the L&L Society at the presentation of the innovative pilot project of comprehensive rehabilitation of blood cancer patients called Together on The Way to Health, and added: “Experienced patient organisations are acting with increasing professionalism, have a mass of knowledge, good connections with the profession and health politics and are developing ever better and more comprehensive support programs that seemingly take over a part of the services that the healthcare system should provide for. We are able to prepare and execute demanding projects such as the complex pilot program of comprehensive rehabilitation. In the future we wish for our pilot program to become a regular program that is accessible to patients all over Slovenia. We have also prepared solutions to expand and add to the program to further contribute to a faster and better motivated return of patients to the working environment.”

Assurance of quality healthcare and a sustainable healthcare system will become more and more demanding in the future due to demographic trends. That is why investments into prevention and evidence based and comprehensively evaluated information technologies, information and efforts towards a constant constructive dialogue and cooperation of stakeholders in healthcare and other social subsystems are more important than ever before.

Developments in science, particularly in medicine and pharmacy, have extended our lives and the lives of our descendants are set to be longer still. Innovative medicines, therapies and vaccines save lives, changing once deadly diseases into chronic ones and improving the quality of patients lives. Two of three cancer patients now live for at least five years after receiving their diagnosis. New therapies have reduced cancer mortality by 21 % since 1991. Innovative therapies have also contributed to reducing the mortality of HIV/Aids patients by 80 % over the last 20 years. Vaccines now save two to three million lives around the world. Healthcare innovations are also a profitable investment as they reduce mortality, disability, need for additional treatments, hospitalisation, absenteeism while improving the quality of patients’ lives. According to OECD data medicinalproduct costs in Slovenia are the lowest among countries with a similar range of medicines. Switzerland uses 898 Euros per inhabitant per year for a similar range of medicines, Germany uses 543 Euros and Slovenia uses 229 Euros. Representative of the organiser of the 7th strategic Value of Innovation Conference - Without Rest Towards a Better Tomorrow, Secretary General of the Forum of International Research and Development Pharmaceutical Companies Barbara Stegel commented: “Even though population aging is causing the consumption of medicines to increase each year, the share of the Health Insurance Institute of Slovenia’s expenditures for medicines and foodstuffs has not grown. It has remained steady between 2010 and 2017 and has even reduced somewhat, showing that the innovative pharmaceutical industry has already made a substantial contribution to the sustainability of the healthcare system. Expenditures of the national health insurance institute for medicines and foodstuffs amounted to 15.67 % in 2010 and in 2017 the share has decreased slightly to 15.16 %. Cost efficiency of innovative medicines can be illustrated using the example of the Clinical Department of Rheumatology at Ljubljana’s University Medical Centre, where the number of acute hospitalisations due to inflammatory rheumatic diseases has been halved from 2004 to 2014 due to innovative technologies. This does not only mean lower costs of direct health and social care, but also reduced absence from work and above all a higher quality of life for chronic patients and their families. Representatives of the innovative pharmaceutical industry in Slovenia wish and expect for new and innovative medicines and therapies to reach those who need them as soon as possible.”

Slovenian healthcare spending per capita amounts to just under 2,000 Euros per year, corresponding to 71 % of the European average, while the costs of managing chronic non-infectious diseases and their complications are rising rapidly. General Director of the Health Insurance Institute of Slovenia Marjan Sušelj said that the Institute will be adopting different measures in the future to maintain patient access to effective, quality and safe medicines and introduce innovative medicines into the financing system: “For this purpose the Institute will adopt different measures to assure quality and financially sustainable prescription of medicines and their safe and correct use by their respective users. Rapid development of innovative medicines is bringing new opportunities for successful treatment, but the financial burden of such medicines has been so great that it could cause a suspension of development in other equally important areas of health technology. That is why the Institute is planning additional systemic measures to share upcoming financial risks with medicinal product manufacturers.”


The valuation of information as a key investment in effective management of chronic diseases requires comprehensive economic evaluation, warns izr. prof. dr. Petra Došenovič Bonča from the Faculty of Economics of the University of Ljubljana: “Effective management of chronic diseases is not just a cost, it is an important investment that needs to consider the costs as well as achieved effects. From a payer’s viewpoint such effects of an investment into innovative medicines can include reduced expenditures for other healthcare services and compensation for long term absence due to disease. Since we finance healthcare collectively under the principles of solidarity, we need to view effects from a wider social standpoint. We should thus include minor losses of productivity due to absenteeism, presentism, care for family members and early mortality. With elderly and retired people we should also consider effects caused by maintaining quality of life in daily activities, unpaid work at home and care for our youngest.”

Dr. Stanislav Primožič, acting Director of the Public Agency of the Republic of Slovenia for Medicinal Products and Medical Devices explained that decisions on adopting technological innovations in national healthcare systems must be based on the evaluation of medical technologies - HTA: “Fundamentally the system includes a comparative evaluation of medicines and medical devices, performed by national authorities competent for HTA. Its aim is to establish the relative effectiveness of a new technology in relation to a certain comparative and standard product or procedure. The assessment of added value in HTA processes can serve as an objective basis for determining medicinal product prices and associated negotiations, as well as our decisions on financing a medicinal product with public funds. Collaboration in the field of HTA is very important at a regional and EU level (EUnetHTA project). The perspective of this collaboration greatly depends on the results of discussions on the proposed EU regulation that was drafted in early 2018 by the European Commission and is currently being reviewed by the Council of EU and the European Parliament. The latter has voted in support of the regulation last week and the document could, in the part that regulates clinical assessments, became law in the entire EU over the coming few years. For Slovenia, a small country with about 0.1 % of the value of the global medicines market, which is still establishing its HTA institution, the collaboration at EU level is exceptionally important.”

Head of the Chronic Diseases Prevention Centre at the National Institute of Public Health Rade Pribakovič Brinovec emphasised the importance of preventative and screening programs for the reduction of chronic non-infectious diseases: “All persons with mandatory health insurance in Slovenia have access to preventative healthcare examinations such as the national program of integrated prevention of chronic noninfectious diseases (from age 30 onwards) and screening programs for early detection of cancer Dora, Zora and Svit. Vaccinations are also an important part of preventative programs, of which we currently promote vaccinations against HPV, hepatitis B, influenza and pneumococcus. Each of these programs contributes to better health of our inhabitants and reduced burden of chronic non-infectious diseases. Slovenia as a rapidly aging society also needs support environments in local communities, including day centres and services that provide assistance at home.”

Good access to modern diagnostics and various effective forms of treatment of cancer patients have contributed to transforming many cases of cancer from a deadly disease into a treatable or chronic disease over the last 20 years. With appropriate comprehensive treatment, patients can return to their pre-disease lives. "Patients and their advocates expect that the country will employ appropriate strategies to enable such development in the future without encroaching upon the rights of cancer patients,” said Kristina Modic, Executive Director of the L&L Society at the presentation of the innovative pilot project of comprehensive rehabilitation of blood cancer patients called Together on The Way to Health, and added: “Experienced patient organisations are acting with increasing professionalism, have a mass of knowledge, good connections with the profession and health politics and are developing ever better and more comprehensive support programs that seemingly take over a part of the services that the healthcare system should provide for. We are able to prepare and execute demanding projects such as the complex pilot program of comprehensive rehabilitation. In the future we wish for our pilot program to become a regular program that is accessible to patients all over Slovenia. We have also prepared solutions to expand and add to the program to further contribute to a faster and better motivated return of patients to the working environment.”

Assurance of quality healthcare and a sustainable healthcare system will become more and more demanding in the future due to demographic trends. That is why investments into prevention and evidence based and comprehensively evaluated information technologies, information and efforts towards a constant constructive dialogue and cooperation of stakeholders in healthcare and other social subsystems are more important than ever before.

 Address of the President of the National Council (.pdf)