Can we build a culture of innovation in healthcare?

Dr Marisa Miraldo, Associate Professor in Health Economics at Imperial College Business School, discusses ways to accelerate innovation in healthcare for the benefit of patients, healthcare providers, and industry

The decline in innovation in research and development (R&D) in the pharmaceutical sector is well documented. Over the past decade, only around a quarter of new drug launches in the UKand a third of new drug approvals in the USA have been truly innovative drugs (using a new approach to fighting disease). This slowdown in innovation particularly affects diseases that are less profitable or more complex. Mental health conditions like dementia and depression, for instance, affect almost 40% of the population but are facing a critical shortage of new treatments.

To make substantial advances in tackling disease and improving public health, we need a new approach to boost innovation in areas of critical need, whilst reducing the complexity and cost of drug development. Currently, fewer than 1 in 10 drugs tested in clinical trials ever makes it to market, and it costs over $1 billion and takes around 12 years to develop a new medicine.

Ultimately, however, the acid-test of an innovation is the impact it has on public health. Ensuring an innovative treatment is widely adopted by the medical community remains a fundamental challenge.

Our research programme at Imperial College Business School aims to tackle these challenges. The main focus has been on understanding the factors that influence innovation success or failure in the R&D process, and on identifying strategies to promote the spread of innovation in clinical practice.

As part of a global study, we are analysing R&D activity data for 62 countries across most disease areas. This has helped us to understand how and why healthcare innovations succeed or fail in the clinical phases from discovery to market launch. For example, we have found that new drugs with considerable competition in the R&D pipeline are more likely to succeed. Conversely, competition pressure from products already established in the market leads to a greater likelihood of failure in the early stages of R&D. What’s more, companies who have forged strong collaborative models appear to do better in phase 1 and 2 clinical trials.

In collaboration with Erasmus University in Rotterdam, we have also been developing a new framework for evaluating and pricing drugs that is meaningful to society and properly rewards innovation. This requires a broader approach to assessing a new drug’s value using factors that go beyond clinical benefit and cost effectiveness to include dynamic efficiency. These additional criteria should reflect both the current and future benefits to society, and the preferences of future generations in tackling different diseases.

An innovation that is not quickly embedded in health systems and clinical practice is essentially a wasted innovation. So another area of our research is to investigate how the uptake and spread of innovations are shaped by factors within healthcare systems, such as collaboration and competition between hospitals, formal and informal networks of clinicians, and attitudes to best practice guidelines.

For example, we are examining the factors that influence the uptake of innovative cancer treatments in UK hospitals. This three-year project, which began in 2015, is analysing 14 years of data from UK hospital records to understand why some patients with colorectal cancer receive best practice laparoscopic surgery while others do not. We have also interviewed senior surgeons to understand the reasons for different practices. We have found that rather than the practices of specific hospitals, it is often the knowledge and attitudes of individual surgeons as well as their networks that affect the uptake of innovative treatments. Most surgeons appear to be resistant to innovation because of a lack of supportive evidence from randomised trials. To increase uptake, they need more information from industry on the availability and use of new treatments.

Overall, our work at Imperial College Business School is providing valuable insights into the drivers and barriers to innovation in healthcare. The key to success is better collaboration between industry, regulators, doctors, and hospital managers. This will drive rapid and widespread uptake of innovative treatments, and ultimately ensure that treatments reflect the latest medical knowledge and that patients with the same condition receive the same standard of care.

Moving forward, with the support of the Health Foundation we are working to develop further practical ways to boost innovation in healthcare—for example, creating R&D incentives for industry in areas of high patient need, and developing initiatives to promote rapid uptake by clinicians. This work will help to bring a step change in the standard of healthcare.