Sept 24 SEMPER Prévention

Prevent to become

The Luxembourg Ministry of Health has made it its number one priority: prevention and early detection of diseases are at the heart of the government's health project.

Screening and vaccination campaigns, events organized in the name of the fight against diseases, investments in R&D, preventive medicine services... The Grand Duchy has chosen to deploy significant resources to curb the statistics of the onset or worsening of diseases. All these measures, added to those carried out by health professionals, private companies and initiatives of the pharmaceutical industry, act so that patients remain, above all, healthy people.

The most recent example? Based on new recommendations from the European Commission, the Health Directorate announced that since 1 July 2024, breast cancer and colorectal cancer screening programs will be accessible from the age of 45 (compared to 50 previously) in Luxembourg.

This choice was validated by the Scientific Council of Luxembourg based on medical data and scientific studies that assess the risks and benefits of screening at different ages. It appears that these diseases affect increasingly younger patients. According to the World Cancer Observatory, 40% of cancers in Europe are preventable. Prevention and lifestyle are thus directly involved in the fight against this disease, which represents the second leading cause of death in Europe, after cardiovascular diseases.

While disease prevention finds its legitimacy in the analysis of epidemiological data and risk factors in society, it cannot do anything about risky behaviors that are a matter of personal choice (smoking, hygiene, physical activity, sexual behavior, etc.). Drawing attention to illness or health risks can sometimes seem inappropriate or intrusive to a healthy person. Any preventive or awareness-raising action necessarily involves a variable failure rate, because apart from the mandatory vaccines at birth, it suggests adherence to good practices without ever imposing them. Like any long-term enterprise, disease prevention is effective if it is integrated into people's daily lives from a very young age. It is then experienced not as a constraint, but as a real way of life. Sporting and cultural events aimed at raising funds for patient associations, or for research and development in the fight against certain diseases also act as awareness-raising. From awareness to prevention, there is only one step.

IML, as the spokesperson for the activities of the pharmaceutical industry, supports these initiatives. Indeed, the innovation for which our industries work finds its way into the benefit of patients, that is to say, the extension of their life expectancy and the improvement of their quality of life. Before becoming a patient, we want people to stay healthy for as long as possible.

A comprehensive and holistic approach

For the pharmaceutical industry, preventing diseases means acting with patients, but also with healthcare professionals. Significant investments are devoted to this aspect in laboratories each year based on impact analyses. Prevention, like the research and development of innovative drugs, requires a cost/efficiency ratio that goes far beyond the framework of the pharmaceutical industry and actually concerns the entire healthcare ecosystem.

A brief historical and medical reminder of prevention with Stéphane Soulard, Head of Market Access and Public Affairs at Boehringer Ingelheim.

Historically, when did the first preventive measures date back to?

Already in antiquity, the construction of infrastructures (aqueducts, public baths or wastewater drainage) can be considered as a preventive measure, by improving the health conditions of populations and hygiene in cities. During the Middle Ages, people considered to be plague-stricken were kept away to prevent the spread of the disease. As for vaccination, in the 10th century, the Chinese used dried smallpox scabs that they insufflated into the nostrils as a form of vaccination. It was then Edward Jenner who developed a first vaccine against smallpox at the end of the 18th century, based on cowpox, a benign disease of cows.

Do you have examples of diseases for which medications have shown significant benefits in terms of prevention?

Type 2 diabetes, heart failure and kidney failure are conditions that are progressive by nature and are interrelated. Diabetic patients can suffer from complications that develop silently if they are not anticipated. It has been estimated that 30 to 40% of them develop chronic kidney failure. The presence of one of these conditions can amplify the risk and accelerate the progression of other conditions. SGLT2 inhibitors were first developed for the treatment of diabetes, but clinical trials have shown that this class of molecule can also reduce cardiovascular risks (mortality or hospitalizations related to heart failure) in diabetic or even non-diabetic patients by more than 20%. SGLT2 inhibitors also slow the progression of kidney failure by half, which could ultimately delay the start of dialysis.

How does the pharmaceutical industry justify the costs associated with prevention? What are their limits?

First, let us note the clinical aspect and the concrete benefits for patients. Hospitalizations, mortality, dialysis, portable oxygen, etc., are fundamental aspects for the quality of life of patients, but also of their caregivers.
Prevention actions have a cost. To take into account the economic impact of prevention on firms, there are two main types of pharmacoeconomic studies. The budgetary impact analysis answers the question "how much does it cost?", by comparing the current scenario and a scenario considering the inclusion of a new treatment. To the pharmacological budgetary impact, it is possible to incorporate data from clinical trials, to deduce the savings for example due to the reduction in the number of hospitalizations from the cost of the treatment. The cost-effectiveness analysis answers the question "is it efficient?". Here, we model the disease and compare clinical costs and benefits, measured for example in quality-adjusted life years (QALYs). These cost-effectiveness analyses are much more complex and it is important to test the robustness of the model used by different sensitivity analyses.
The pharmaceutical industry has a fundamental role in prevention, not only in the development of innovative treatments impacting the lives of patients, but also in raising awareness and educating healthcare professionals, generating evidence or more generally in creating projects. However, prevention actions cannot have a real impact without collaboration with other stakeholders (healthcare professionals, patient and medical associations, public authorities). Together, a comprehensive and holistic approach will ultimately strengthen the ability to prevent diseases, their associated risks and promote the well-being of individuals.

What are the effective ways to support prevention in Luxembourg?

On the one hand, promoting screening activities in at-risk populations or establishing systematic care protocols with IT support would make it possible to detect diseases at earlier stages. The E-health platform is an existing IT architecture that can help in this regard. In addition, techniques using artificial intelligence are being developed to facilitate, for example, the differential diagnosis of respiratory diseases by examining spirometry or medical imaging. On the other hand, when the disease is diagnosed, both health professionals (doctors, nurses) and patients must be well aware of the risks and recognize the complications of the diseases. Another condition is that a quality conversation is established between patients and health professionals to detect new symptoms as early as possible.
Prevention must be a priority for the new government. It represents savings in the medium and long term, with a better quality of life for the citizens of the Grand Duchy. n The references from which the information in this article is taken are available on request.

 Semper Luxembourg - septembre 2024