Advanced therapy medicinal products and health technology assessment principles and practices for value-based and sustainable healthcare

BACKGROUND

Advanced therapy medicinal products (ATMPs) are beginning to reach European markets, and questions are being asked about their value for patients and how healthcare systems should pay for them.

OBJECTIVES

To identify and discuss potential challenges of ATMPs in view of current health technology assessment (HTA) methodology-specifically economic evaluation methods-in Europe as it relates to ATMPs, and to suggest potential solutions to these challenges.

METHODS

An Expert Panel reviewed current HTA principles and practices in relation to the specific characteristics of ATMPs.

RESULTS

Three key topics were identified and prioritised for discussion-uncertainty, discounting, and health outcomes and value. The panel discussed that evidence challenges linked to increased uncertainty may be mitigated by collection of follow-on data, use of value of information analysis, and/or outcomes-based contracts. For discount rates, an international, multi-disciplinary forum should be established to consider the economic, social and ethical implications of the choice of rate. Finally, consideration of the feasibility of assessing the value of ATMPs beyond health gain may also be key for decision-making.

CONCLUSIONS

ATMPs face a challenge in demonstrating their value within current HTA frameworks. Consideration of current HTA principles and practices with regards to the specific characteristics of ATMPs and continued dialogue will be key to ensuring appropriate market access.

CLASSIFICATION CODE

I.

An Overview of the Tissue Engineering Market in the United States from 2011 to 2018

IMPACT STATEMENT

This report seeks to provide an update of the current landscape of the tissue engineering market in the United States from an unbiased point of view by analyzing the financial reports provided by tissue engineering companies, as well as data from publicly available clinical trials with relevant tissue engineering applications.

CIRM and UKRMP: Different Ways to Invest in Regenerative Medicine

The California Institute for Regenerative Medicine (CIRM) and the UK Regenerative Medicine Platform (UKRMP) have similar objectives, but their histories, funding mechanisms, and governance could hardly be more different. Here, we compare the two programs and explore their impact in translating stem cell research into clinical applications.

REIMBURSEMENT OF CELL-BASED REGENERATIVE THERAPY IN THE UK AND FRANCE

Cell-based regenerative therapies are presented as being able to cure the diseases of the twenty-first century, especially those coming from the degeneration of the aging human body. But their specific nature based on biological materials raises particular challenging issues on how regulation should frame biomedical innovation for society's benefit regarding public health. The European Union (EU) supports the development of cell-based regenerative therapies that are medicinal products with a specific regulation providing their wide access to the European market for European patients. However, once these medicinal products have obtained a European marketing authorisation, they are still far away from being fully accessible to European patients in all EU Member States. Whereas there is much written on the EU regulatory system for new biotechnologies, there is no systematic legal study comparing the insurance provisions in two EU countries. Focussing on the situation in the UK and France that are based on two different healthcare systems, this paper is based on a comparative methodological approach. It raises the question of regulatory reimbursement mechanisms that determine access to innovative treatments and their consequences for social protection systems in the general context of public health. After having compared the French and English regulations of cell-based regenerative therapy regarding pricing and reimbursement, this papers analyses how England and France are addressing two main challenges of cell-based regenerative therapy, to take into account their long-term benefit through their potential curative nature and their high upfront cost, towards their adoption within the English and French healthcare systems. It concludes that England and France have different general legal frameworks that are not specific to the reimbursement of cell-based regenerative therapy, although their two current and respective trends would bring more convergence between the two systems while addressing the main challenges for the reimbursement of these therapies. Nevertheless, despite their current differences, neither the English nor the French national healthcare system has yet approved the reimbursement of cell-based regenerative therapies. The paper highlights where both systems could be learning from each others' experiences to favour the adoption of cell-based regenerative therapies through the adaptation of their reimbursement methodologies. It also emphasises the gap between market access and patients' access, and it calls for research and discussions through reflexive agencies such as the Regenerative Medicine Expert Group in the UK.

Developing Induced Pluripotent Stem Cell-Based Therapy for the Masses

The discovery of induced pluripotent stem cells and the ability to manufacture them using clinically compliant protocols has the potential to revolutionize the field of regenerative medicine. However, realizing this potential requires the development of processes that are reliable, reproducible, and cost-effective and that at the same time do not compromise the safety of the individuals receiving this therapy. In the present report, we discuss how cost reductions can be obtained using our experience with obtaining approval of biologic agents, autologous therapy, and the recent approval of cord blood banks. Significance: For therapy to be widely available, the cost of manufacturing stem cells must be reduced. The steps proposed in the present report, when implemented, have the potential to reduce these costs significantly.

[Anti-aging medicine: science or marketing ?]

Anti-aging medicine is self defined as a preventive medicine, combining nutritional recommendations, dietary supplements, prescriptions for hormones and various aesthetic techniques. The essential aim is to reduce the risk of aging, both psychically, physically and aesthetically. Although many scientific studies in animals or in vitro models have demonstrated the deleterious role of oxidative stress and of hormonal, vitamin or trace elements deficiencies, the transposition to humans of these findings is marginal and does not justify the therapeutic proposals advocated by the anti aging medicine. These practices are mostly not based on any scientific basis both in the diagnostic and therapeutic fields. These approaches are particularly costly for gullible patients in search of well being and abused by a carefully organized marketing involving tacit complicity of doctors, laboratories and firms producing hormones and dietary supplements and various substances devoted for aesthetic purposes.

[Clinical and organizational way of innovative development of regenerative medicine in security agencies]

The article covers organizational aspects of development of innovative technologies in the field of regenerative medicine. It is shown that for the effective design and implementation into medical practice of regenerative medicine requires a united complex of military health care, military medical research and education. The main goal is to formate a biological insurance of personnel to treat different consequences of radiological incidents, burn disease, identification of the remains of the victims; the maximum returning to action after disturbed as a result of health services. Proposes the creation of "Interdepartmental Clinical Research and Education Center for Regenerative Medicine", combining research, clinical, industrial and educational potential of the leading institutions of various departments that will enhance the national security of the Russian Federation.

The Netherlands advancing to the forefront of regenerative medicine

The country, and especially Limburg, the most southern province, is making major leaps forward in the commercialization of regenerative medicine. Chemelot Campus, a major business park, is making a massive commitment with the creation of "Regeneration Street"; 50,000 m² of world leading research, development, manufacturing and innovation in regenerative medicine.

Veterinary applications of induced pluripotent stem cells: regenerative medicine and models for disease?

Induced pluripotent stem cells (iPSCs) can now be derived from a tissue biopsy and represent a promising new platform for disease modelling, drug and toxicity testing, biomarker development and cell-based therapies for regenerative medicine. In regenerative medicine, large animals may represent the best models for man, and thereby provide invaluable systems in which to test the safety and the potential of iPSCs. Hence, testing iPSCs in veterinary species may serve a double function, namely, developing therapeutic products for regenerative medicine in veterinary patients while providing valuable background information for human clinical trials. The production of iPSCs from livestock or wild species is attractive because it could improve efficiency and reduce costs in various fields, such as transgenic animal generation and drug development, preservation of biological diversity, and because it also offers an alternative to xenotransplantation for in vivo generation of organs. Although the technology of cellular reprogramming using the so-called 'Yamanaka factors' is in its peak expectation phase and many concerns still need to be addressed, the rapid technical progress suggests that iPSCs could contribute significantly to novel therapies in veterinary and biomedical practice in the near future. This review provides an overview of the potential applications of iPSCs in veterinary medicine.

The Alpha Stem Cell Clinic: a model for evaluating and delivering stem cell-based therapies

Cellular therapies require the careful preparation, expansion, characterization, and delivery of cells in a clinical environment. There are major challenges associated with the delivery of cell therapies and high costs that will limit the companies available to fully evaluate their merit in clinical trials, and will handicap their application at the present financial environment. Cells will be manufactured in good manufacturing practice or near-equivalent facilities with prerequisite safety practices in place, and cell delivery systems will be specialized and require well-trained medical and nursing staff, technicians or nurses trained to handle cells once delivered, patient counselors, as well as statisticians and database managers who will oversee the monitoring of patients in relatively long-term follow-up studies. The model proposed for Alpha Stem Cell Clinics will initially use the capacities and infrastructure that exist in the most advanced tertiary medical clinics for delivery of established bone marrow stem cell therapies. As the research evolves, they will incorporate improved procedures and cell preparations. This model enables commercialization of medical devices, reagents, and other products required for cell therapies. A carefully constructed cell therapy clinical infrastructure with the requisite scientific, technical, and medical expertise and operational efficiencies will have the capabilities to address three fundamental and critical functions: 1) fostering clinical trials; 2) evaluating and establishing safe and effective therapies, and 3) developing and maintaining the delivery of therapies approved by the Food and Drug Administration, or other regulatory agencies.

Microfabricated biomaterials for engineering 3D tissues

Mimicking natural tissue structure is crucial for engineered tissues with intended applications ranging from regenerative medicine to biorobotics. Native tissues are highly organized at the microscale, thus making these natural characteristics an integral part of creating effective biomimetic tissue structures. There exists a growing appreciation that the incorporation of similar highly organized microscale structures in tissue engineering may yield a remedy for problems ranging from vascularization to cell function control/determination. In this review, we highlight the recent progress in the field of microscale tissue engineering and discuss the use of various biomaterials for generating engineered tissue structures with microscale features. In particular, we will discuss the use of microscale approaches to engineer the architecture of scaffolds, generate artificial vasculature, and control cellular orientation and differentiation. In addition, the emergence of microfabricated tissue units and the modular assembly to emulate hierarchical tissues will be discussed.

Meeting the need for regenerative therapies I: target-based incidence and its relationship to U.S. spending, productivity, and innovation

Regenerative therapies possess high theoretical potential for medical advance yet their success as commercial therapeutics is still open to debate. Appropriate data on target opportunities that provide perspective and enable strategic decision making is necessary for both efficient and effective translation. Up until now, this data have been out of reach to research scientists and many start-up companies-the very groups currently looked to for the critical advance of these therapies. The target-based estimate of opportunity presented in this report demonstrates its importance in evaluating medical need and technology feasibility. In addition, analysis of U.S. research spending, productivity, and innovation reveals that U.S. basic research in this field would benefit from greater interdisciplinarity. Overcoming the barriers that currently prevent translation into high value therapies that are quickly clinically adopted requires simultaneous integration of engineering, science, business, and clinical practice. Achieving this integration is nontrivial.

The legal landscape for advanced therapies: material and institutional implementation of European Union rules in France and the United Kingdom

In 2007, the European Union adopted a lex specialis, Regulation (EC) No. 1394/2007 on advanced therapy medicinal products (ATMPs), a new legal category of medical product in regenerative medicine. The regulation applies to ATMPs prepared industrially or manufactured by a method involving an industrial process. It also provides a hospital exemption, which means that medicinal products not regulated by EU law do not benefit from a harmonized regime across the European Union but have to respect national laws. This article describes the recent EU laws, and contrasts two national regimes, asking how France and the United Kingdom regulate ATMPs which do and do not fall under the scope of Regulation (EC) No. 1394/2007. What are the different legal categories and their enforceable regimes, and how does the evolution of these highly complex regimes interact with the material world of regenerative medicine and the regulatory bodies and socioeconomic actors participating in it?

Stem cell-based therapies: promises, obstacles, discordance, and the agora

Stem cell research has entered the public consciousness through the media. Proponents and opponents of all such research, or of human embryonic stem cell research specifically, engage in heated exchanges in the modern public forum where stakeholders negotiate, the agora. One common claim that emerges from the fray is that a particular type of stem cell research should be pursued as the most promising path toward the reduction of suffering and untimely death for all of humanity. Upon evaluation, experimental data regarding the potential role of stem cells in regenerative therapies for three conditions-spinal cord injury, type 1 diabetes, and cardiovascular disease-tell distinct, complex, and inconclusive stories. Further analyses in this article incorporate realistic considerations of a broad range of relevant factors: limited funding for biomedical research, media motives, the discordance hypothesis of evolutionary medicine, the relationship between religion and science, medical care in developing nations, and culture wars over abortion. Holistic investigation inspired by the current agora conversation supports the need to drastically change interactions regarding stem cell research so that its potential to benefit humanity may be more fully realized.

Regenerative medicine: the emergence of an industry

Over the last quarter of a century there has been an emergence of a tissue engineering industry, one that has now evolved into the broader area of regenerative medicine. There have been 'ups and downs' in this industry; however, it now appears to be on a track that may be described as 'back to the future'. The latest data indicate that for 2007 the private sector activity in the world for this industry is approaching $2.5 billion, with 167 companies/business units and more than 6000 employee full time equivalents. Although small compared with the medical device and also the pharmaceutical industries, these numbers are not insignificant. Thus, there is the indication that this industry, and the related technology, may still achieve its potential and address the needs of millions of patients worldwide, in particular those with needs that currently are unmet.

2010 World Stem Cell Summit--part 1. October 4-6, 2010, Detroit, MI, USA

The 2010 World Stem Cell Summit, held in Detroit, included topics covering new developments in the field of regenerative medicine. This conference report highlights selected presentations on government support for stem cell research in Michigan, financing stem cell development, regulatory and ethical considerations, Pharma's interest in allogeneic cell therapies, and the US Armed forces investment in regenerative medicine.

ISSCR 2009 Industry Panel Session: promoting translation and commercialization

This report presents the recommendations to the ISSCR leadership from the industry panel session at the 2009 annual conference. The seven recommendations address core issues essential for the promotion of stem cell and regenerative medicine translation and commercialization.

The economic value of investing in regenerative medicine

This article discusses the science of regenerative medicine and presents evidence that investments towards the development of this technology will reduce total health care output. Use of regenerative medicine will also be an important factor in eliminating chronic diseases such as diabetes, heart disease, and Parkinson's disease. Investment in regenerative medicine is a sound strategy for several reasons: human suffering will be reduced, if not eliminated; and the economy will be stimulated by creating employment opportunities, generating additional income and tax revenues, increasing worker productivity, creating new conglomerates, and reducing insurance costs. This article discusses some of the latest advances in regenerative medicine as well as the progress that has been made in the development of new stem cell therapies.

[Social effects in regenerative medicine]

Tissue engineering is a key for advanced medical technologies to cure incurable diseases. The technology gives not only medical progress but also economical impact. In the lecture, I should like to overview the approach to industrial application.

[Collaboration between academia and companies]

Recently the collaboration between academia and company has been recommended by the government and more than 1,000 venture companies have established since 2001. Indeed this situation caused the researchers active, on the other side many undesirable troubles has been increasing among researches in the university. In this paper the cause of these troubles related to the collaboration between academia and company has been analyzed and proposed the possible solutions for the problems.

[The industrialization of regenerative medicine--a potential market of $ 500 billion]

OBJECTIVE

To investigate the latest development of tissue engineered regenerative medicine in industrialization, with the intention to direct work in practical area.

METHODS

A complete insight of regenerative medicine in industrialization was obtained through referring to update publications, visiting related websites, as well as learning from practical experience.

RESULTS

The aerial view of the future of regenerative medicine was got based on knowledge of four different tissue engineering projects.

CONCLUSION

All present efforts should be devoted to regenerative medicine area meeting the industrialized trends.

Proposition 71 and CIRM--assessing the return on investment

Given that Californian voters authorized state coffers to sell $3 billion in bonds to fund the California Institute for Regenerative Medicine (CIRM) with the expectation of health and financial benefits, what benchmarks should be used to measure the initiative's success?

California dreaming? A new start for regenerative medicine in the Golden State. Interview with Dr. Zach Hall

The California Institute for Regenerative Medicine (CIRM) was established in 2004 with the passage of Proposition 71, the California Stem Cell Research and Cures Initiative. The statewide ballot measure, which provided US$3 billion in funding for stem cell research at California universities and research institutions, was approved by California voters, and called for the establishment of an entity to make grants and provide loans for stem cell research, research facilities and other vital research opportunities. Here, Dr Zach Hall, Interim President of the CIRM, outlines the ethos and aspirations of the CIRM to Regenerative Medicine. Dr Hall trained as a basic neuroscientist and became a faculty member and department chair at the University of California, San Francisco. In 1994, he was appointed Director of National Institute of Neurological Disorders and Stroke within the National Institutes of Health, and was responsible for a research program that awarded more than US$500 million a year in grants and contracts. Since that time, he has held senior positions in research administration within both the University of California, San Francisco, where he was Executive Vice Chancellor, and the University of Southern California. Full information about the CIRM can be found at www.cirm.ca.gov.

Stem cells and the heart: ethics, organization and funding

The application of stem cell biology to repair of the heart offers therapeutic potential. However, randomized, double-blind, controlled trials are required to clarify under what conditions it may be effective. The unprecedented nature of the discovery of a therapeutic role for autologous stem cells brings with it unprecedented challenges in clinical application of basic biology, ethics, funding and organization. It is suggested that the academic community should show leadership.

Regenerative medicine and the developing world

This is the first study to systematically identify and prioritize which applications of regenerative medicine are the most promising for improving health in developing countries.