Integrated product development for ATMPs

By: Claes Buxfeldt and Dr Paula Salminkangas

In this article, published in the September issue of MedNous, Claes and Paula discuss why an integrated product development strategy for ATMPs is essential to meet both regulatory and HTA requirements.

Advanced Therapy Medicinal Products (ATMPs), which include cell and gene therapies and tissue engineered products, are a group of innovative products targeting diseases and conditions for which there are few, if any, effective treatments. The success of the first CD19 chimeric antigen receptor T cell (CAR T) products Kymriah and Yescarta against B-cell malignancies has raised the awareness of the high potential of ATMPs, but also shown the several challenges relating to their clinical use1. One of these challenges is the high prices asked by the manufacturers of these products, which are not always supported by national pricing and reimbursement bodies2.

In such cases, the discrepancy between a regulatory approval and a negative decision from a health technology assessment (HTA) body has raised concerns and questions from industry about how to ensure that an approved product also gets to the market and to patients. Many jurisdictions have created early access schemes and ways to communicate with regulatory and HTA bodies early on to ensure successful outcomes of both reviews3. However, the ATMP industry is facing challenges in both aspects.

The development of ATMPs has substantially increased with a focus on clinical trials in recent years. Several cell and gene therapy products have been authorised worldwide, most recently the CAR T product Tecartus from Kite Pharma Inc.4 in the US and Zolgensma for spinal muscular atrophy (SMA)5 in the EU.

Today there are more than 980 developers globally, the majority (78%) of whom are in North America and Europe.6 Over 1,000 clinical trials were underway worldwide at the end of 2019, two-thirds of which (64%) were in Phases 2 and 3. There has been a clear shift from early to late phase trials, as only four years earlier the majority of trials (> 90%) were in Phases 1 and 27. Since beginning of 2015, the overall number of ATMP clinical trials and ATMPs in Phase 3 has doubled, suggesting multiple new ATMPs will be approaching the marketing authorisation application stage in the next few years.

Today, the focus of ATMP development is heavily in gene therapy and genetically modified cells which constitute three-quarters of products in clinical trials. This is most probably due to the fast development of novel vectors and technologies, including genome editing. In addition, a lot of safety data has accumulated for certain gene therapy approaches (e.g. adeno associated virus vectors, AAV and lentivirus vectors, LVV), which reduces the regulatory burden before first clinical trials.

From an indication perspective, the majority of ATMP clinical trials (657/1066, 62%) 6 are in oncology, including leukaemia, lymphoma, and solid tumors, which may be explained by the great interest towards novel immunotherapies using genetically modified cells. In 2019, genome edited cells using the CRISPR/Cas9 approach proceeded to clinical trials both in the US and the EU8 and the first results from a trial studying an induced pluripotent stem (iPS) cell-derived product were reported in the EU 9.

Click to the full article

Contact us to learn more about how our integrated team can provide advice and support into your drug development plan.


References :

  1. Mohty M., Gautier J., Malard F., et al. CD19 chimeric antigen receptor-T cells in B-cell leukemia and lymphoma: current status and perspectives. Leukemia 2019, 33: 2767–2778
  2. Jönsson, B., Hampson, G., Michaels, J., Towse, A., Graf von der Schulenburg, JM. and Wong, O. Advanced therapy medicinal products and health technology assessment principles and practices for value-based and sustainable healthcare. Eur. J. Health Econ. 2019, 20(3): 427–438
  3. Jörgensen, J. and Kefalas, P. Reimbursement of licensed cell and gene therapies across the major European healthcare markets. J Mark Access Health Policy 2015, 3: 10.3402/jmahp.v3.29321.
  4. FDA approved Cellular and Gene Therapy Products,
  5. EU public assessment report for Zolgensma
  6. Alliance for Regenerative Medicine: 2019 Regenerative Medicine Sector Report, available from
  7. 7.Alliance for Regenerative Medicine: Q1/2015 Regenerative Medicine Sector Report, available from
  8. CRISPR Therapeutics and Vertex Announce Progress in Clinical Development Programs for the Investigational CRISPR/Cas9 Gene-Editing Therapy CTX001, available from
  9.  Cynata Completes Clinical Study Report for Phase 1 Trial of CYP-001 in GvHD, available from



Market access for immune-oncology products in the EU

By: Claes Buxfeldt, HTA Director at NDA Group

In this article, published in Volume 22 September 2020 of Pharmafocus, Claes Buxfeldt discusses key considerations in early development to succeed with market access for immune-oncology products in the EU.

Integrating market access considerations early into your development program saves money and the chances that your product will reach the market, or a premium at exit.

At NDA we work closely with development teams covering many disease areas. Reflective of the global pipeline, a large part of our time is spent helping clients with immune-oncology portfolios. Here we cover what activities should be considered in early development of new immune-oncology (IO) drugs to ultimately secure reimbursement or optimise the asset’s value. We also explore how IO treatments are different compared to other treatment options and important attributes to consider.


Achieving regulatory approval by demonstrating your product’s appropriate benefit/risk profile is only one step to reach and treat patients. In many countries pricing and reimbursement bodies have additional requirements to be fulfilled. This includes demonstrating comparative effectiveness and value for money.

Immune-oncology (IO) therapies

Instead of targeting tumours directly, IO therapies engage the patient’s own immune system to stop them. This approach may offer a more effective treatment for some patients. Important characteristics of IO therapy include full tumour regression, often a more sustainable clinical outcome and improved health-related quality of life compared to standard chemotherapy. IO therapy often has a different side-effect profile and durability of response.

The development of targeted immune checkpoint inhibitors resulted in the first FDA approval in 2011 of Yervoy (ipilimumab – CTLA4 antibody) for melanoma. Additional studies of PD1/PDL1 antibodies have led to regulatory approval both as single agents and in combination with other agents. IO therapies are now approved by EMA and FDA in treating melanoma, lung, kidney, bladder, head and neck cancer.

Key distinctive features of IO therapies:
  • Immune-mediated mechanisms of action,
  • Significant and increased durability of response,
  • Unique kinetics enabling delayed response,
  • Potential for shorter treatment period,
  • Possibility of being “cured”,
  • Different, often more manageable, side-effect profiles,
  • Sometimes severe and systemic adverse effects,
  • Better health-related quality of life,
  • Flattening of the Kaplan Meier survival curve suggesting durable responses,
  • Administrated often in unique combinations of IO drugs.

Critical questions in developing IO therapies include targeting of those patients most likely to respond, combining IO therapies with other treatment options, mitigating related side-effects and reducing the resistance to therapies. How to practically use these therapies in an evolving health care environment and when to stop treatment are also important.

Click to the full article

Contact us to learn more about how our integrated team can provide advice and support into your drug development plan.




Webinar – Opportunities to Enhance Pharmacovigilance in Oncology

On Thursday 23 April 2020, 15:00 BST, 16:00 CEST & 10:00 EDT,  Dr Brian Edwards Principal Consultant, Pharmacovigilance & Drug Safety, NDA Group, will discuss current best practices and opportunities for future improvement in oncology safety processes.

Oncology has seen tremendous advances in treatments with impressive results for some previously incurable solid cancers. This is best illustrated by immunotherapies such as immune checkpoint inhibitors. In addition, the use of predictive biomarkers helps identify patients who may truly benefit from treatment.

To maximise benefit of these therapies, we need to enhance pharmacovigilance. We are all keen to ensure pharmacovigilance work transforms from volume-based operations to value-based work through effective use of technology to allow automation and machine learning without comprising quality and early risk detection.

The use of accelerated procedures for regulatory approval means more and more that real world evidence gathering and assessment is deferred to the post-authorisation phase, putting more responsibility on pharmacovigilance professionals.

The webinar will focus on:

  • How best to increase operational efficiency using technology and the consistency of data quality when processing ICSRs, including applying severity grading and collecting patient reported outcomes
  • Novel approaches to signal detection when faced with large amounts of data
  • How best to manage off label use and medication errors
  • Planning for risk management of immunotherapy-related toxicity, which can be variable, occurring at any time throughout treatment or even after completion of treatment

To learn more about NDA’s Pharmacovigilance specialists and services click here

Click here to book your place today!

About the Speaker

Brian has a BSc (Hons), M. B. B.S., MRCP, MD.  and is a GMC registered physician with previous experience in hospital, renal medicine and clinical research, as a pharmacovigilance assessor in the UK regulatory authority (MHRA), clinical trials and post-marketing pharmacovigilance in a global CRO, deputy QP for pharmacovigilance at Johnson & Johnson. He joined NDA in 2007 and specialises in PV quality management and all aspects of safety compliance, risk management, QP for pharmacovigilance services, clinical trial safety.

In addition, Brian is Director of ISoP Secretariat Ltd and co-chairs the ISOP Medication Error Special Interest Group, Vice President Pharmacovigilance & Drug Safety in the Alliance Clinical Research Excellence and Safety (ACRES) and Chair of the UK Pharmaceutical Human Factors group.



Webinar – Demonstrate, Communicate and Negotiate Successfully with Payers

Join us on Thursday 12th of December 15:00 GMT, 16:00 CET, 10:00 EST for this engaging webinar presented by Claes Buxfeldt, HTA Director NDA Advisory Board and Lisa Peluso, Director of Coaching and Client Engagement, PharmApprove.

Advanced medical treatments, including cell and gene therapies, are on the cusp of changing medical care around the globe. Developing and communicating cutting-edge science demands rigorous planning to mitigate challenges and set up your product for successful market access.

New treatments are complicated and competition is fierce. Are you planning appropriately to demonstrate the data you need, communicate effectively and be in a position to negotiate successfully with payers? Join this informative webinar to hear from HTA and Value Communications experts Claes Buxfeldt and Lisa Peluso on how to:

  • Steer development teams to demonstrate value, manage uncertainty in data and leverage external advice
  • Educate stakeholders early – from your internal team to payers – to ensure alignment and clarity around value and positioning
  • Create and deliver the clinical narrative of the data
  • Communicate complex data and science effectively and handle objections with confidence
  • Negotiate successfully with decision-makers

Waiting until submission time to align and prepare to communicate value is a mistake your team can’t afford to make. Sign up for this webinar to hear how to communicate impactfully to clear a path for a successful value journey to patients.

Click here to book your place today!


Claes joined pharma-industry in 1992, have close to 20 years’ experience working in local and global market access and health economics positions, in a variety of disease areas. Prior to joining NDA he spent 10 years at AstraZeneca starting as a Value Demonstration Leader in Global Health Economics & Outcomes Research, and most recently as the Global Price & Reimbursement Director in Respiratory & Inflammation, in addition to CNS/Pain.
He has supported more than 30 molecules/brands in development in a global position. He has represented the payer voice in many development programs, including the development of payer evidence strategies, pricing and market access strategy, economic models, PROs, RWE and clinical program input. Claes has a MSc from University of Karlstad and more recently a postgraduate diploma in health economics from University of York.

Lisa helps development teams, doctors, patients and advocates to create and deliver clear, consistent, and convincing messages to regulators in the US and Europe. Lisa has coached hundreds of individuals and provided presentation/Q&A training and workshops to teams in pharma and biotech, and has helped over 45 clinical development teams prepare to present at FDA Advisory Committee meetings and EMA Oral Explanations. Her experience and familiarity with high-stakes regulatory meetings allows her to get to the heart of the challenge, and she excels at giving presenters and responders clear and actionable feedback, to instill confidence and help them communicate with clarity and impact. Prior to joining PharmApprove, Lisa worked at Kyowa Pharmaceuticals, where she supported both commercial and clinical teams and served as the principal liaison between the Tokyo, UK and US offices. Lisa spent 12 years in Japan, where she worked in communications in the legal, financial and hospitality industries.

Webinar – Integrated Product Development for ATMPs to Meet Regulatory and HTA Requirements

Join us on Thursday 3rd October 15:00 BST, 16:00 CEST, 10:00 EDT for this engaging webinar where Dr Paula Salmikangas, Director for Biopharmaceuticals and ATMPS, NDA Advisory Board and Claes Buxfeldt, HTA Director NDA Advisory Board will describe an integrated product development process for ATMPs, which will take key aspects of both reviews into account from the beginning, thus ensuring a positive path from clinical trials up to pricing and reimbursement.

Advanced Therapy Medicinal Products (ATMPs, or cell and gene therapy and tissue engineering products) is an increasing group of innovative products, often targeting diseases and conditions with high unmet medical need.

The success of first CD 19 CAR T products against B-cell malignancies has raised awareness of the high potential of these new products, but also shown the several challenges relating to their manufacturing and regulatory approval. The prices of the first approved ATMPs have been high and not always supported by the national pricing and reimbursement bodies.

In such cases, the discrepancy between regulatory approval and negative result of a health technology assessment (HTA) has raised concerns and questions within the industry, as to how to ensure an approved product also gets to the market and patients. Many jurisdictions have created early access schemes and ways to communicate with regulatory and HTA bodies early on to ensure successful outcomes of both reviews. However, the ATMP industry is facing challenges in both aspects.

Why you should attend:

  • See how the regulatory and HTA expectations differ
  • Learn how to build an Integrated Regulatory / HTA Product Development for ATMPs
  • Identify the need for interactions with regulatory and HTA authorities

Click here to book your place today!


Paula is a clinical biochemist by original training, with a Ph.D. in muscle cell biology. Her main research work career has been in cell and molecular biology of various inherited diseases. Since 2006, she has been an Adjunct Professor of Biochemistry for the University of Helsinki. Paula joined NDA in 2017 from her position as a Research Professor at the Finnish Medicines Agency (2003-2017). She has served as a member of the EMA Committee for Advanced Therapies (CAT) from 2009 to 2017 and as the Chair of the CAT 2014-2017. She has also been the Chair of EMA CPWP and a member of the BWP. Her main areas of expertise are biological medicinal products, especially advanced therapy medicinal products and CMC aspects of biopharmaceuticals.


Claes joined pharma-industry in 1992, have close to 20 years’ experience working in local and global market access and health economics positions, in a variety of disease areas. Prior to joining NDA he spent 10 years at AstraZeneca starting as a Value Demonstration Leader in Global Health Economics & Outcomes Research, and most recently as the Global Price & Reimbursement Director in Respiratory & Inflammation, in addition to CNS/Pain.
He has supported more than 30 molecules/brands in development in a global position. He has represented the payer voice in many development programs, including the development of payer evidence strategies, pricing and market access strategy, economic models, PROs, RWE and clinical program input. Claes has a MSc from University of Karlstad and more recently a postgraduate diploma in health economics from University of York.


Why should you engage early with regulators and HTA bodies?

By: Dr Mira Pavlovic-Ganascia & Claes Buxfeldt, NDA Group

In this white paper NDA’s Dr Mira Pavlovic-Ganascia and Claes Buxfeldt provide insight into the reasons to seek scientific advice and elaborate on what the expected outcomes of constructively engaging with regulators and HTA bodies could be.

Dr Mira Pavlovic-Ganascia
Claes Buxfeldt

In Europe there are many routes to gain scientific advice directly from official authorities. National regulatory advice is a routine practice of most regulatory agencies, as well as of the European Medicines Agency (EMA).

Scientific advice in the HTA arena is more recent. In this context, national HTA advice is provided against the backdrop of country or region-specific policies and legal requirements. Early dialogue involving multiple HTA bodies is also rather recent, provisioned in the context of the European Network of Health Technology Assessment (EUnetHTA) Joint Action 2 as well as specific actions financed by the European Commission (SEED)(ref) and involving both EMA and EUnetHTA. Indeed, in recent years, EMA and EUnetHTA have led several combined regulatory-HTA pilots to get experience both on the process and the content of such an exercise (1,2,3).

Since the creation of our NDA Joint Advice service offering in 2011, the NDA Advisory Board has also conducted numerous such projects for clients, focusing on ensuring a thorough understanding of the varying regulatory and HTA requirements and bridging the relative efficacy – relative effectiveness gap.

The means to gain scientific advice are many and diverse, but so are the reasons companies strive to get it.

Why seek scientific advice?

The combined scientific advice/early dialogue processes allow a company to engage relatively early in discussions with regulators and HTA bodies. The label on the tin indicates that the main interest of such an engagement would be to gain scientific input into the development program of a product to be able to steer it away from regulator, HTA and payer pitfalls and towards rapid patient access.

The scientific input usually covers the proposed study design(s), comparators, endpoints, target study population and inclusion criteria’s, study length and other key aspects important both for regulatory and HTA bodies. More in general, this early discussion will allow a company to check if the evidence to be generated for EMA is relevant for HTA submissions.

Asking for a combined regulatory and HTA advice is even more important in cases where treatment guidelines are weak or inexistent and/or there is no relevant HTA decision available in the field of interest.

Reality, however, is even more diverse than this and the reasons and rationales for companies to go for scientific advice therefore vary greatly.

1. Stake holder engagement

Engaging early with regulators and HTA bodies can be a crucial motivation for engaging in the scientific advice process, as it provides a unique opportunity to introduce these two key stake holders to the science and circumstances behind the company’s product. This can benefit the process in two ways:

  1. In any future engagements the regulators and HTA bodies will know the product/technology and targeted patient population better. This will potentially enhance future interactions and remove communication hurdles.
  2. By engaging with the right individuals in the right agencies, interest in the product can be sparked which can lead to constructive and positive input along the product’s development path. Building rapport with assessors are again an important vehicle to friction less communication.


2. Demonstrating progress

Engaging with external experts in a structured manner is also an excellent way to demonstrate to boards and stake holders that the product is progressing through the development process. Constructive feedback from regulators and HTA bodies can help steer the product development but can also be a value driver for the company.

If this is a main driver for expert engagement or seeking scientific advice, other reasons should also be carefully considered to optimize the value of the interaction. Seeking endorsement for the sake of it is rarely the optimal use of the time spent by external experts or regulatory agencies and HTA bodies.


3. Compliance

Many multi-product pipeline companies have highly controlled processes for how to progress products through the development process. This may well include the consideration and execution of a formal scientific advice procedure.

As this reason is not a value driver in itself, the reasons that the company put this requirement in place in the first instance should be carefully considered when running through the motions. Teams following a check list risk missing the underlying strategic reasons for why the process is necessary and may therefore not consider alternatives or options that might fit better or add more value.


4. Internal alignment

Although not its primary purpose, internal alignment is an incredibly valuable potential outcome of any scientific advice/early dialogue process. Teams working towards a clear goal along a clear timeline tend to glue together and more easily visualize the ultimate outcome. At NDA Group we’ve seen many occasions where the formal process has created strong composite teams. These teams are primed to progress the product through development with a determination and shared purpose that would not have been possible without the structure and clear goal that the scientific advice process offers.

Achieving internal alignment should therefore always be considered a potential beneficial outcome and should be planned for accordingly.


Read the full white paper

Don’t miss the opportunity to hear to Dr Mira Pavlovic-Ganascia and Claes Buxfeldt speak about HTA and Europe at our complimentary seminar:  Optimizing Value – Regulatory and Market Access Considerations in Stockholm on the 21st May.

Read more and register

Optimizing Value – Regulatory and Market Access Considerations

Welcome to NDA’s seminar on 21st May 08:30-13:00 on Optimizing Value – Regulatory and Market Access Considerations.

NDA would like to invite you to join Professor Steffen Thirstrup and Professor Mira Pavlovich-Ganascia share their experiences and provide their insights and considerations to optimize the value of your development program.

The market access environment is getting increasingly challenging. The ability to develop plans and strategies for access, for today as well as tomorrow, is critical to bring new medicines to patients.

08:30 Registration and light breakfast
09:00 Welcome – Claes Buxfeldt, Director NDA HTA Advisory Board
09:30 Session one: Challenges on development programs for new drugs – Professor Steffen Thirstrup
10:00 Coffee and mingle
10:30 Session 2: HTA and Europe – where are we heading? – Professor Mira Pavlovich – Ganascia
11:00 Question and answer session
11:30 Concluding remarks and take home messages

12:00 – 13:00 Ask the Experts – Book a 20 min slot to speak directly with our experts, email:

About the speakers

Professor Steffen Thirstrup,
Director NDA Advisory Board, Former Head of Division, Medicines Assessment and Clinical Trials, Danish Health and Medicines Authority, and CHMP member. Steffen is an expert in clinical development and regulatory strategies.


Professor Mira Pavlovich-Ganascia,
NDA HTA Advisory Board member, practicing physician and former Deputy Director for Health Technology Assessment at the Hauté Autorité de Santé (HAS), France. Mira is an expert in HTA activities related to early dialogues with developers, disease-specific guidelines and methodology of assessment for reimbursement purposes.

Claes Buxfeldt,
HTA Director at NDA Group, former Global Price & Reimbursement Director in Respiratory & Inflammation at AstraZeneca. Claes has 20 years’ experience in the market access and health economic areas and has extensive experience in developing the market access strategy/payer strategy/payer evidence generation for drug development programs from pre-                                            clinical to launch phase.

Learning aspects

  • How to secure value in your development program considering both regulatory and market access requirements
  • Learn about how, when and why it is critical to consider HTA and market access requirements in your development program
  • Understand how to mitigate differences in demands/requirements between regulatory and HTA bodies

When: Tuesday 21st May 2019

Time: 08:30 – 13:00 (opportunity to book 1-1 meetings from 12:00)

Venue: SciLifelabs, Tomtebodavägen 23a, 171 65 Solna, Sweden

The seminar will be an open and interactive workshop with the opportunity to ask our presenters questions.

Specific questions can also be sent in advance to Indicate if you would like to discuss them openly during the meeting; otherwise we can book separate meetings to discuss them after the seminar.

Registration: RSVP by Friday 17th May 2019 to

Contact: Denise Strömquist, Marketing and Management Coordinator, +46 (0)8 590 778 00, or email

The seminar is free however if you are unable to attend, please advise us no later than two days before the seminar.


We look forward to seeing you there!



4 ways that HTA will change under the new European regulation

By: Johan Strömquist, CEO, NDA Group

In this white paper NDA’s CEO, Johan Strömquist, discusses four ways that Health Technology Assessments will change under the new proposed European regulation.

Johan Strömquist, CEO

Over many years the European Network for Health Technology Assessment (EUnetHTA) has been working to HTA bodies into the same room to harmonise and develop thinking around the assessment of medicines from a societal point of view. The approaches to HTA assessment across Europe vary significantly across member states causing confusion, challenges and increased costs for drug development so the work of this voluntary network has been greatly appreciated by industry, payers and politicians alike.

However, the network’s voluntary nature and a lack of a formalized framework for the continuation of the activities have caused issues to progress and harmonization throughout its existence. To stabilise the situation and institutionalise the continued efforts, the European Commission (EC) has therefore presented a new HTA regulation back in January 2018 that will be up for decision in the European Parliament in spring 2019.

The regulation does not put any restrictions on how health economic decisions should made or how pricing of products should be carried out

Should this new regulation be endorsed as it is it will have important impact on drug developing companies and the way that drugs will and should be developed if drug developers want to optimise their path to market.

The regulation addresses four things that every biotech CEO and industry leader should be aware of.

1.   Joint Clinical Assessments

Years of experience and significant respect for the subsidiarity principle enshrined in the Maastricht Treaty has enabled a pragmatic approach in the draft regulation. The regulation does not put any restrictions on how health economic decisions should made or how pricing of products should be carried out. Instead it focuses on the area of commonality that has been agreed and pushed with EUnetHTA (with varying support from different member states). This area is clinical assessment or the assessment of relative effectiveness of the product.

Should the regulation pass as it is this means that all novel products (defined as any medicinal product passing through the centralised procedure or any medical device or IVD that receives an opinion under the new Medical Device Regulation) will be assessed under a new centralised clinical assessment scheme. This would in theory replace national clinical assessments and could straighten a product’s road to market.

Once a product has been assessed for its clinical benefits, national authorities would still have to assess its value in the local market but one crucial step in this process would have been eliminated and the outcome would be harmonised across the EU.

At NDA we will be ready to support clients managing this process when / if the regulation kicks in. Through our extensive experience in the market access area and by support of collaboration partners   we are ideally placed to work with companies pulling their HTA dossier together.


2. Joint Scientific Consultations

The practice of scientific consultations has become increasingly well-established yet is a relatively under-utilised mechanism for companies to improve their understanding of the different stake holder requirements. One reason why this is the case is because the process is time consuming. Another is because the procedure is under resourced and to a great extent based on voluntary contributions from the member agencies.

Under the new regulation all scientific consultations would be managed centrally, including the parallel consultations with the EMA.

This is most likely going to have relatively little impact on the use and performance of consultations to begin with, but by establishing a long-term platform for these activities there will be greater room to expand resources, improve the process and harmonise the contributions from the member states.

NDA’s Joint Advice services addresses several of the weaknesses of parallel consultations. By relying on the experts that built the European regulatory systems we deliver high quality, high speed advice. This is used by many companies as a proxy for formal consultation when time is tight, or as a way to prepare for the formal process to maximise the value that can be attained from engaging early with HTA bodies.


3. Identification of emerging health technology

Horizon scanning as it’s popularly called is a resource intensive activity when it is performed at the member state level. Consolidation of this to a central European function will allow more efficient use of resources, but it will also result in an overall higher quality of the output and material that will be used for training and intelligence at the member state level.

In the long run biotechs and pharma companies can expect their HTA counterparts to be more up to speed with emerging health technologies and that the playing field will become gradually more level across countries thanks to this.


4. Voluntary Cooperation

A clause that is easy to dismiss in the new regulation is where it speaks of voluntary cooperation. However, this means that the current cooperation, which has been moving slowly but has left important marks in the way assessments are carried out, has a formal home. This is important as it gives legitimacy and encourages the continuation of EUnetHTA’s activities in a new and more official format.

Expect this to lead to increased cooperation between HTA bodies in Europe and an increased exchange of scientific and methodological ideas across the member states.

NDA continually monitors the regulatory development to cover any relevant regulatory changes. As many changes are not publicised through regulation, but are a matter of practice in the agencies, our exposure to on-going procedures and 25% of our staff having experience working at a regulatory body are essential in staying on top of the change. Over the last five years NDA has been involved in more than 40% of the new medicinal products approved in the EU.


Will it lead to harmonisation?

There are still big differences in the legal traditions, pricing and reimbursement systems and the socio-economic circumstances across the member states of the EU. We will not see these things change overnight, hence it will take substantial time for these collaborative efforts to bear fruits across the range of the spectrum. Since health care systems and financing is a country matter, appraisals of value and decisions if a new medicine should be granted access is still a country matter. This includes all decisions around pricing as well.

We have however already seen how collaboration, exchange of ideas and development of joint therapeutic area specific methodologies are spreading. This does lead to harmonisation in a few crucial areas around clinical assessment and this is not just progress, but also important for drug developers across the world, as it has the potential to make HTA more transparent and therefore predictable.

The new HTA regulation builds on these important steps to increase the transparency and predictability even further. Despite the challenges that remain, this is progress.

As a partner NDA is ideally placed to support drug development companies navigate through the changes that this new regulation entails. By tracking and reflecting the current thinking and practices of the agencies and by providing tailor made, actionable advice and the help to operationalise this we are looking forward to seeing how this new regulation can help increase predictability and improve the speed with which important therapies reach patients in need, all across the EU.


Observations of a market access expert

An insightful interview with NDA’s Claes Buxfeldt, HTA Director, entitled “Observations of a market access expert” featured in Aprils edition of Pharmafocus.

Reimbursement is the fourth hurdle of pharmaceutical development. Payers and Health Technology Assessment (HTA) bodies demand compelling evidence of how new interventions improve the standard of care and public health.

In the article Claes reflects on his experiences, challenges & opportunities and highlights the key trends and drivers for changes that will affect the Life Science industry in the HTA and market access space.





Free Webinar – How to demonstrate value in drug development programs to improve chances of reimbursement

Being able to demonstrate the expected value for health care systems and society for a new pharmaceutical is critical for market access including chances of reimbursement. Having a clear strategy for value demonstration as an integrated part of your drug development program can improve your chances of reimbursement leading to a faster market access. Knowing different payer’s expectations in terms of endpoints and supportive data as well as having an understanding of Health Technology Assessment (HTA) and how this is applied is critical to success.

Join us on Thursday 29th November, at 15:00 GMT, 16:00 CET, 10:00 EST for this engaging webinar where Claes Buxfeldt, HTA Director, will cover the following:

  • The needs/requirements of the HTA bodies and payers in all countries
  • How strategy could be implemented in TPP, value proposition and messages to secure value and reimbursement
  • What activities are needed to investigate and at what stage in development
  • How to:
    • design and improve a clinical development program to satisfy HTA bodies and deliver value for payers
    • design and improve programs to strengthen unmet need and the economic story
    • prepare and improve the ability to communicate the value story and improve payer negotiations skills
    • validate your strategy and plans using the NDA Advisory Board, both regulatory and HTA / payer

The webinar will be followed by a Q&A session for you to get direct feedback on key areas of uncertainty.

Click here to book your place today.


Claes Buxfeldt, joined pharma-industry in 1992 and has close to 20 years’ experience working in local and global market access and health economics positions, in a variety of disease areas. Prior to joining NDA Claes spent 10 years at AstraZeneca starting as a Value Demonstration Leader in Global Health Economics & Outcomes Research, and most recently as the Global Price & Reimbursement Director in Respiratory & Inflammation, in addition to CNS/Pain. He has supported more than 30 molecules/brands in development in a global position. He has represented the payer voice in many development programs, including the development of payer evidence strategies, pricing and market access strategy, economic models, PROs, RWE and clinical program input. Claes have a MSc from University of Karlstad and more recently a postgraduate diploma in health economics from University of York.



The future of Health Technology Assessment in Europe

On 24th October, Carole Longson, Dr Steffen Thirstrup & Claes Buxfeldt, NDA Advisory Services Ltd, will be holding a complimentary seminar on market access/Health Economics and Outcomes Research (HEOR), discussing the future of HTA.

The market access environment is getting increasingly challenging. The ability to develop plans and strategies for access, for today as well as tomorrow, is critical to bring new medicines to patients.

This seminar will discuss the past, present and future of HTA and market access.

Click here for more details.



NDA Group welcomes proposal for new HTA regulation in Europe

Stockholm 2018-02-07 – NDA Group, the world’s leading drug development consultancy, signals their appreciation of the EU Commission’s proposal for a new HTA regulation in EU. The particular focus on Relative Effectiveness Assessment, the establishment of a new Coordination Group of clinical experts from the Member States and the continuation of the practices established by the voluntary European HTA network were all cited as reasons for a promising future for the regulation.

On Wednesday January 31st the EU Commission released its proposal for a new regulation on HTA for all Member States of the EU. The new regulation builds on the long-standing activities of the Member States HTA agencies, and particularly the voluntary network and joint action programs hosted by the EUnetHTA network.

Based on the EUnetHTA recommendation and the Impact assessment report (1) that provides an in-depth analysis of four policy options, the Commission has chosen to propose the option 4, advocating permanent cooperation on common tools, procedures, early dialogues and joint HT assessments. In the proposed regulation, the use of joint assessment of clinical aspects of technology evaluation becomes mandatory; all other aspects, such as cost-effectiveness and economic assessment, legal, ethical and societal aspects, are left for the Member States to continue to manage.

While specifying that regulatory and HTA process will remain well separated, the regulation focuses on three particular areas of interest to the drug developing industry:

  • Joint clinical assessments limited to innovative technologies,
  • Provision of scientific advice and guidance to developers, and
  • Identification of emerging health technologies.

The execution of these activities will primarily be carried out via a new Coordination Group of Member State experts, helped by specific sub-groups for each area of interest, and a new Commission Secretariat supporting the processes.

The regulation can be expected to be adopted in 2019, if successfully negotiated and approved by European Parliament and Council of Ministers, after which two subsequent three-year transition periods would kick in before it is fully adopted by the Member States.

The NDA Group has supported drug developing companies with joint regulatory and HTA assessment since 2011. Many of the experts employed by the company in this process have been involved in setting up the systems in place today, and the new regulation is no exception.

NDA’s Dr. Mira Pavlovic-Ganascia, who formerly coordinated the work on several EUnetHTA guidelines and work packages as well as the SEED (Shaping European Early Dialogues) sponsored by the Commission, commented:

“It is reassuring to see that the Commission has taken so much of the work of the [EUnetHTA] network on-board. I truly believe that a new Coordination Group will continue to profit from the actions achieved and structures already put in place, such as Early Dialogues Working Party and ED secretariat. As joint clinical assessments are the Commission’s key measure to promote market access for innovative technologies, Option 4 became the natural default position and with some minor modification this is what the Commission has chosen to go for.”

NDA’s Dr Thomas Lönngren, former Executive Director of the European Medicines Agency added:

“The work that was started over 20 years ago has now finally reached the legislative phase. This is a breakthrough, but the legislative process in Europe is difficult to navigate and it will take time before we eventually see this proposal adopted and implemented.”

When NDA established its Joint Advice service, it was to reduce the uncertainties inherent in drug development, particularly in gaining approval from regulators and efficiently ensuring that the product could be reimbursed by the national payers. One of the challenges has been the fragmentation and varying degrees of maturity across the Member States and an evolution towards the Commission’s proposal has been a favorite discussion topic in the consultancy over the last few years.

Johan Strömquist, CEO of NDA Group, commented:
“It’s quite incredible to see what we’ve expected, for such a long time, presented as a clear legislative proposal. Our experts predicted this development several years ago and the new regulation will certainly make the lives of hundreds of developers easier and more predictable.”

Strömquist continued:
“As the leading experts in the field we welcome the Commission’s proposal. We stand at our clients’ disposal to support in the creation of the necessary submissions and preparation for engaging with the new Coordination Group to attain the best possible advice for their product.”




Common failures in drug development

Dr. Thomas Lönngren, Strategic Advisor NDA Group and former head of the EMA, has been invited by BioMelbourne Network to present at the CEO lunch forum entitled “A CEOs nightmare – Regulatory and Market access failure, How to get a good sleep?”

This exclusive forum is being held on 2nd February at Norton Rose Fulbright, Melbourne.

Dr. Lönngren will present and discuss the common failures in drug development from a regulatory and market access perspective and how to avoid these failures; best practices for regulatory and market access strategies and discuss with the audience the latest pharma sector hot topics including the Brexit.



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Dr. Smaldone Alsup has over 25 years of global leadership experience in the pharmaceutical and biotechnology industries in drug development, regulatory strategy and regulatory approvals across all major therapeutic areas. She has led the development and commercialization of drugs for oncology, HIV/AIDS, cardiovascular, metabolics, immunology, infectious diseases, neuroscience, dermatology, inflammatory and immune-based diseases. She has led numerous multidisciplinary teams in over 50 US FDA and European EMA proceedings, including preparations for numerous key FDA meetings, Advisory Committee hearings and EU Scientific Advice and Oral Arguments.