Few global pharmaceutical companies have been as busy and gone through as much change as AstraZeneca these past couple of years.
Of course the biggest headlines during 2014 concerned the proposed takeover of the UK-based company by US rival Pfizer, which persisted for several months in its pursuit despite several knockbacks, and only putting on the brakes due to new US rules that made ‘tax inversion’ acquisitions less attractive.
AZ was a target for Pfizer for good reason though; ever since Pascal Soriot was installed as CEO in 2012 there has been a sense of optimism about the company, which has reinvigorated its pipelines in long-term conditions with smart acquisitions and agreements and has ambitious plans to launch a new global head office and research centre in the biotech hub of Cambridge in the UK.
In 2014 alone the company completed the acquisition of all diabetes assets from its deal with Bristol-Myers Squibb; boosted its respiratory business with the acquisition of Almirall’s respiratory franchise; and was the pharma company with the most approvals from the US FDA with four last year, including the diabetes drug Farxiga (dapagliflozin) and Lynparza (olaparib) for ovarian cancer.
Such activities have put the company back on the map on a global level but they have also been important in a more localised way for the company’s UK home. AZ certainly faced criticism when it announced plans to move many of its operations from Alderley Park in Macclesfield, but it has also invested heavily in its Cambridge ambitions and supported biotechs taking over its old facilities.
AZ and the UK
The importance of AZ to the UK came to the fore during the saga of Pfizer’s aborted takeover bid when the leaders of the Labour and Conservative parties came to blows on a deal that Labour’s Ed Miliband said “affects one of the UK’s most significant investors in R&D”.
Overseeing all this activity in the UK has been AZ’s president for the UK and Ireland Lisa Anson, who moved to her current role in January 2012, around the same time that Soriot took over as CEO.
“We have undergone quite a transformation under Pascal Soriot,” says Anson, who is based at AZ’s UK headquarters in Luton. “And you can see that all of the moves we have made are in line with our strategy to build scientific leadership, return to growth and make the company a great place to work.”
A key draw to commit to the UK is the country’s impressive scientific heritage and the existing network of academics and biotechs available for AZ to collaborate with.
“We believe that Cambridge can be world competitive in terms of future science,” says Anson, explaining that ground has been broken on its new site in Cambridge and that partnerships with local hospitals are in place.
“In the old days of R&D you could think you could develop new products in your lab, but the science moves so fast and ideas move so fast that an open innovation platform is very much the way of the future. That’s what’s behind the Cambridge philosophy – we will have an ecosystem of bioscience that is a global leader.”
The struggle to gain access
For AZ to continue to invest in the country, however, the UK must be an active partner in developing the life sciences industry, says Anson who notes that 1.8% of the UK’s total exports are provided solely by AZ.
Central to this is access to innovative new drugs, something that Anson says the UK struggles to provide.
“We don’t always lead in the uptake of medicines,” she says. ”Even when you have approval from NICE for a drug it can take a very long time for the NHS to make sure that they actually get to patients.”
The problem, according to Anson, is often down to the localised decision-making of the NHS, leading to a re-evaluation of drugs that goes beyond the NICE procedure.
“The NHS is much more focused on budgetary management of medicines than on making sure the patients gets the right medicine at the right time,” says Anson. “Medicines need to be seen as an investment in improving health outcomes rather than just as an acquisition.”
She gives the example of a drug to prevent a second heart attack that has a positive NICE recommendation, can save people’s lives and reduce further hospital costs. “It sounds like good value and NICE has also said it is,” says Anson. “My belief is that any UK patient that is eligible for this treatment should have access to it but that is not true today.”
AZ and the wider UK industry is working with the NHS to improve the situation, however, and Anson is keen to point out the commitment made by the industry in the 2014 PPRS agreement.
The scheme will see a price freeze on NHS medicine expenditure in England over the next two years and slower than forecast increase in price over the following three years in order to help cut costs.
“It gives the NHS the space over five years to be able to afford new medicines,” says Anson. “I don’t know any other industry that has put together a proposition like that in times of austerity. That’s how serious we are about making sure patients get the right medicines.”
The value of personalised medicines
One growing area of treatment that health technology assessment (HTA) bodies such as NICE will need to evolve to assess effectively is that of personalised medicines.
These medicines are designed to target specific subsets of diseases, such as certain genetic mutations associated with cancers, and therefore tend to have a more limited patient population and a higher price to justify the research efforts.
Despite the growth of these types of medicine, HTA systems across the world are not currently set up to evaluate them in a way that represents their true value, according to Anson.
It is difficult to introduce a specialised medicine for a small population into the UK
It is a particularly pressing matter for AZ considering the company has several personalised medicines on market or in development, including Iressa (gefitinib) to treat lung cancer patients with a mutation in the EGFR-TK gene and Lynparza, which is approved to treat ovarian cancer patients with the BRCA mutation.
“Something like 35% of the industry’s pipeline is in personalised medicines,” says Anson. “But that is an area we are not so good at dealing with.”
She highlights England’s Cancer Drugs Fund – set up in 2010 to pay for cancer medicines not recommended by NICE – as an example of the country’s inability to deal with innovative, targeted drugs. The Fund may have provided thousands of patients access to life-prolonging treatments, but it has been largely deemed an unsustainable political ploy and recently underwent major changes that bring it more in line with NICE’s function of price assessment, removing funding for several treatments in the process.
“We don’t have a long term measure in place where people can get a good understanding of what is the value of a targeted medicine, which makes it difficult to introduce a specialised medicine for a small population into the UK,” says Anson.
She provides the example of Lynparza, which was approved in Europe in December last year to treat BRCA-mutated ovarian cancer and is set to be launched in the region in 2015.
“Lynparza is for a very specific population of platinum sensitive relapse patients,” explains Anson. “So that is the sort of drug we need to make sure has a reimbursement framework behind it so it can get to patients.”
Medicines need to be seen as an investment in improving health outcomes rather than as an acquisition
Working with the NHS
Something that favours AZ when it comes to developing its relationship with the NHS in the UK are the shared priorities of both organisations.
It’s no surprise then to note that the company’s three main areas of focus – diabetes/cardiovascular, oncology and respiratory conditions – are also the three areas of long-term illness that the NHS is most keen to address, considering the UK’s ageing population and the increasing number of people with one or more of these conditions.
“In terms of having a broad relationship with the NHS, we can partner on key areas that are important to it, and we have done something like 30 major partnerships in the past few years,” says Anson. “These partnerships typically look at the care pathway and aim to improve it to get better patient outcomes.”
Anson gives a couple of examples of that form of partnership in practice, including the OneHeart programme, which sees AZ team up with the NHS to provide information on how to live a healthier life following a heart attack.
“After a heart attack people tend to leave the hospital thinking the event is over. But actually it is part of a longer-term disease and there are things the individual needs to manage,” says Anson.
It’s a project that fits with the NHS’ ongoing aim to focus care around patients rather than diseases and Anson says AZ is fully onboard with this ambition.
“We see different examples of how we are able to work with bits of the NHS and put the patient at the centre. And when we do that it works well because we have different skills and expertise that we can bring.”
It may have been a busy and unpredictable couple of years for AZ in the UK but Anson sees the company as one that is now on course for growth and to ultimately improve patient outcomes.
“With the commitment to Cambridge and with the clarity and strategy we have now, it feels like a company that is clear about where it is going. It feels like an exciting journey.”
