Sipko: The Dutch health care budget for medicines is 6,5 billion euros. It’s important to realize that 20 percent of that budget consists of oncolytic medicines. In the last five years, the costs for these medicines and the number of patients who use them have almost doubled. If we don’t do anything, they will keep rising. At the ministry of Health, Welfare and Sport, we realize that we must talk about that as a society. That’s why we’re enthusiastic about Oncode’s goals and activities in the field of affordability of future therapies and diagnostics.

Henk: For me, as a researcher, Affordable Health Care is mostly about new research and new developments that benefit the patient, and whether they are affordable or not. That’s important to both of us. We’re trying to make treatments cheaper through increasing our knowledge of individual patients and repurposing existing drugs. Oncode is founded to make new developments and take them from the lab to clinical practice and the patient, and we’re glad the ministry helps us with that goal.

Henk Verheul. Radboudumc, Clinical oncologist & Oncode Clinical Advisory Board.

Henk: We’re researching whether we can screen patients with esophageal cancer before treatment, to establish if they will benefit from it (together with the group of Jan Paul Medema, an Oncode Investigator). We can scan blood from patients for certain biomarkers. If they possess them, we know it’s no use to give them that treatment and we must find an alternative. Another project revolves around the smarter application of costly medicines, such as tyrosine kinase inhibitors. These are designed to be administered daily. At Oncode, we are currently researching whether we can assess the sensitivity of a single patient to these drugs. That allows us to determine whether they do need a daily dose, or less – say one every two weeks. We’re also researching the existence of patient subgroups that are more sensitive to certain drugs than others. That may allow us to make treatments more tailor-made and therefore more affordable.

Sipko: Henk and I know each other from about twenty-five years ago, when we both did research in academia. It still makes me proud to see that our country has so many institutes and facilities in which top-of-the-line research is done. I see a lot of that pride in Oncode Institute. We’re trying to stimulate that research wherever possible to overcome any challenges.

Henk: Pharmaceutical companies are usually not eager to support repurposing initiatives such as ours. They’re not sure whether they will profit from them, and alternative research on a drug might cause negative publicity. Also, those companies have no incentive to invest in a drug that’s almost out of patent. That means it’s sometimes hard to make that drug available for our research, and to arrange funding for the clinical trials that follow from our research.

Sipko: Our main challenge is getting affordability on the agenda at both pharmaceutical companies and in research institutions. We respect commercial interests, but at the same time try to contribute to a discussion by mediating or adding to the conversation from our own expertise. We can stimulate affordability by adding certain conditions to research grants, and we can negotiate with pharmaceutical companies on a national or multinational level. There are a lot of levers we can pull, but we cannot do it alone.

Sipko Mülder. Ministry of Health, Welfare and Sport - member of the management team on pharmaceutical products and medical technology.

Henk: The social awareness about affordability is higher than ever before. We also sense that in the Oncode community as well as patient communities we talk to. From the lab to the clinical trials, we realize how expensive it is to make drugs affordable. It’s important to try and make that better.

Sipko: It’s a disturbing message which I think we all realize: healthcare costs, especially those of oncologic drugs, will keep rising if we don’t do anything. Affordability is one of the main subjects that politicians will have to deal with in the coming years. In my opinion, the research from Oncode Institute in the field of Affordable Health Care is tackling exactly that subject. I think it’s important to be prepared for what is coming.

Sipko: Affordability is going to be a big political theme in the coming years. We appreciate the fact that Oncode pays attention to it as well, and we value what they have reached until now in terms of the translation of research results. We try to support them wherever possible, keep the conversation going, and set new common goals.

Henk: I think the most important thing to realize is that Oncode Institute is no commercial company but has a scientific basis. That allows us to do research without any incentive, except the profit for the patient. I think our organization is unique in that. We’ve been successful in reducing costs while making new therapies and diagnostics available. That’s where the interests of the ministry and of Oncode meet.

Sipko: We’re in the process of organizing a new coordinating platform – it’s called FAST: Future Affordable and Sustainable Therapies. The ministry of Health, Welfare and Sport, together with the ministry of Economic Affairs and Climate Policy, aims to coordinate governmental support for the development of novel therapies, by public-private cooperation and by other means. Our ambition with FAST is to accelerate the development of novel therapies for unmet medical needs that are not picked up by the market. FAST will coordinate the AHC development as one body to streamline the process. The spearheads of FAST are likely to be in the areas of personalized medicine including rare diseases and infectious diseases. In that sense there will be a place for Oncode Institute at the table.

Henk: I think FAST and Oncode Institute go together nicely in terms of priorities. It’s a good development that AHC is further institutionalized in this way. As for science, Oncode is in the process of developing more clinical proof of concept initiatives. One of those is the application of immunotherapy, depending on the immune status of patients. We’re going to hear more of that in the next few years.

Credits: interview by Koen Scheerders; photography by Marloes Verweij, Laloes Fotografie