3 Strategies For Expanding Global Access To Your Medical Device: A Radiotherapy Case Study
By Tomas Puusepp, Elekta
Cancer is a large and growing global health challenge. Fourteen million people worldwide were diagnosed with cancer in 2012, and experts predict 22 million people will receive a cancer diagnosis in 2030.
The greatest increases in cancer diagnoses are anticipated in areas of the world undergoing the fastest population growth. These regions comprise predominantly low- and medium-resource countries, and patients in these countries have a higher likelihood of presenting with more advanced cancers due to the lack of, or lack of access to, medical care. Innovating new approaches to address the cancer treatment challenges in these countries is essential to achieving the World Health Organization’s (WHO) “25 by 25” target, a commitment from WHO member states to reduce premature mortality from non-communicable diseases by 25 percent by 2025. To attain this ambitious goal, we must prevent 1.5 million cancer deaths each year, and our best strategies for success include optimizing existing treatment modalities, developing new therapeutic approaches, and establishing novel models for partnership and collaboration among public and private enterprises, including the medical device industry.
Medical device manufacturers have made significant contributions toward enhanced quality of care and outcomes for patients living with a variety of cancer types. Our industry’s ability to increase access to existing therapies will be as impactful in the global war on cancer as our continued efforts to innovate new technologies and therapeutic approaches. Helping to increase access to cancer therapies in low- and middle-income countries can be good for business, as well as good for public health. Medical device manufacturers can do well by doing better — innovating practical and sustainable solutions that reflect the needs and resources of low- and medium-resource countries.
To that end, Elekta’s experience in broadening access to radiotherapy provides several examples that can readily be adapted by other members of the medical device community to improve the treatment of cancer patients and to create additional market value.
Radiotherapy: An Established But Underutilized Component Of Routine Cancer Care
Radiotherapy (RT) is a proven treatment modality in cancer care, both as monotherapy and in combination with a variety of surgical and pharmaceutical regimens. RT has particular utility in addressing the global cancer challenge because it already is an important treatment component for lung, breast, colorectal, prostate, and stomach cancer — the five cancers that account for nearly half the global incidence of cancer and 53 percent of cancer deaths worldwide.
Approximately 7 million patients globally received RT in 2012, and this number is projected to increase to 12 million by 2035. RT improves survival and can improve quality of life for cancer patients by providing local control of tumor growth. In 2012, RT provided a survival benefit to 580,000 cancer patients worldwide, and resulted in tumor growth control in another 1.5 million. These numbers are expected to grow to 950,000 and 2.5 million, respectively, by 2035.
Despite its demonstrated clinical benefits, RT is underutilized. Although RT is indicated for the treatment of localized disease or to provide local control and palliation in an estimated 50-60 percent of cancer patients worldwide, only 29 percent of U.S. patients received this treatment in the years 2003-2005. Utilization rates may be even lower in limited-resource countries, and could decline further globally if access to RT cannot keep pace with the increased demand resulting from aging populations and population growth. Realizing the full clinical value of RT requires making this life-saving treatment available to all who may benefit from it.
3 Strategies To Increase Global Access To Your Medical Device
Just as Vice President Joe Biden called for a “moon shot” initiative to address the growing cancer challenge in the U.S., the global medical device industry must take bold steps to increase access to RT around the world. The multi-prong approach must include the development of technologies and devices suitable for use in resource-constrained countries, support training for RT technicians and medical physicists, and help educating government agencies, health care providers, and patients about the important role of RT in treating cancer.
1. Don’t Discount — Design Devices Specifically For Resource-Constrained Settings
The costs and infrastructure requirements of most cutting-edge RT devices can be barriers to access in low- and middle-income countries. In an effort to overcome these barriers, Elekta evaluated the needs and constraints of healthcare centers that operate in these parts of the globe. Local physicians and hospitals provided insight into the types of RT devices and services that could be deployed and maintained in limited-resource settings. Rather than donating or discounting the RT devices that we market in resource-rich countries, or bypassing the markets in low- and middle-income countries entirely, we developed a new product line designed to address the space, cost, and maintenance challenges that limit access to RT in resource-constrained areas. This product line, the Compact linear accelerator, is designed to make high-quality RT more accessible in these countries, while simultaneously creating new markets for Elekta in areas where the cost of more complex RT platforms might be prohibitive.
Similar opportunities exist for other device manufacturers that design products to meet the economic and infrastructure needs of countries in the developing world.
2. Support Training Of Healthcare Personnel
Another barrier that limits the availability of RT in low- and middle-income countries is a shortage of appropriately trained personnel. This includes physicians specializing in radiation oncology, physicists who can support appropriate application of radiation technologies, technicians who can operate RT devices, and nursing staff with expertise in dealing with the potential side effects of RT treatment.
Addressing these personnel constraints is another way that device manufacturers can do well by doing better. Helping to train medical, nursing, and technical staff in the application and use of various medical devices can support improved patient outcomes while also creating increased demand for those devices and expanding manufacturers’ market opportunity.
The Elekta Training Center Cape Town — a collaboration between Elekta, Cape Town's Tygerberg Hospital, and Cape Peninsula University of Technology that opened in 2015 — is an example of the types of training that device manufacturers can support. The Center is designed to train physicists, radiation oncologists, radiographers, and neuroscience professionals from all African countries on Elekta's RT solutions. Elekta has similar training centers in the U.K., U.S., China, Sweden, the Netherlands, India, and Australia. Participants in these training programs gain expertise that benefits their home institutions, and Elekta gains a base of future customers who can speak to the features and benefits of its products when hospitals purchase additional RT machines. This model, applied to other therapeutic areas, would benefit patients and corporate sponsors alike.
3. Form Strategic Partnerships To Educate Governments, Hospitals, & Providers
Medical device manufacturers may also benefit from collaborating with international health organizations, such as the Union for International Cancer Control (UICC) and the Advanced Medical Technology Association (AdvaMed), to develop programs and materials that can be used to educate government agencies, hospital leadership, and providers on the economic and clinical value of their products. Such programs would ensure that healthcare policy and spending decisions are based on the most current data available, which could increase access to a variety of treatment options and, subsequently, expand or create new markets for medical devices.
For example, at no cost to the hospitals, Elekta recently repaired faulty RT machines at the Lagos University Teaching Hospital and the University of Benin Teaching Hospital in Nigeria, allowing about 100 patients at each center to receive RT. The next step is working with the Nigerian Ministry of Health to communicate the critical role that RT plays in cancer care, the importance of maintaining the country’s existing RT machines, and creative strategies that enable the country to acquire the approximately 200 additional RT machines needed to meet its current demand.
The medical device community has transformed the treatment of cancer and other diseases impacting millions of individuals globally. Now, the challenges of the growing global cancer epidemic are creating new opportunities for medical device makers to demonstrate their compassion and their capabilities — both of which are needed if we are to improve the lives of cancer patients around the world.
About The Author
Tomas Puusepp is the president and CEO of Elekta. He has over 30 years of experience in international medical technology and held various positions at the Research Institute for Atomic Physics, Scanditronix, and Ericsson before joining Elekta in 1988. He trained as an electrical engineer and completed his studies in physics at the Royal Institute of Technology in Stockholm, and at the University of Stockholm and Management (IEP) at IMD in Lausanne, Switzerland.
About Elekta
Elekta is a human care company pioneering innovations and clinical solutions for treating cancer and brain disorders. The Stockholm, Sweden-based company develops tools and treatment planning systems for radiation therapy, radiosurgery and brachytherapy, as well as workflow enhancing software systems across the spectrum of cancer care. Elekta employs around 3,800 employees globally, and its solutions in oncology and neurosurgery are used in over 6,000 hospitals worldwide.