1. Clinical evaluation of UHC for cancer
HOW CAN WE MOBILISE ACTION TO REALISE UHC IN ASIA?
Clinical evaluation of UHC for cancer
Shigeo Horie, M.D., Ph. D.
Department of Urology
Juntendo University Graduate School of Medicine

2. 3 objectives of UHC Equity in access to health services
those who need the services should get them, not only those who can pay for them
Quality of health services
Being good enough to improve the health of those receiving services
Financial-risk protection
ensuring that the cost of using care does not put people at risk of financial hardship.

3. How UHC for cancer can be achieved in Asia
UHC is conceptually appealing but its application will vary from one country to another given the diversity of country levels of economic development, health system resources and epidemiological challenges.
It is important to identify ways of measuring UHC across countries that are comparable but adaptable to local contexts.
MEASUREMENT AND MONITORING OF UNIVERSAL HEALTH COVERAGE
WHO summary report 2013

4. Breast cancer survival is a key indicator for UHC in cancer control
How countries are covering prevention, care, and treatment of cancers.
a focus on women
the need for well-trained health workers and functioning infrastructure
including laboratory capacity, an adequate stock of medicines, and radiation equipment.

11. Fundamental barriers to UHC of cancer care
Primary prevention
Survivorship
Palliation
Eligibility
financial barriers
Accessibility
linkage barriers between services with referral networks

12. screening
palliation
diagnosis
treatment
treatment
rehabilitation

13. UHC and clinical guidelines
Clinical guidelines should be stratified according to the resource availability.
Resource-stratified guidelines can be utilized for bench-marking.

14. Treatment of clinically localized prostate cancer according to level of health-care resources
Health care resource category
Basic level
Limited level
Enhanced level
Maximum level
General
Patients education
Infrastructure to diagnosis and treatment
Multidisciplinary team management
Survivorship programmes
Treatment
Surgical castration
Radical prostatectomy
Curative –aim therapy
PADT
Laparoscopic surgery
Radiation w/wo hormone
Active surveillance
PSA monitoring
Side-effect management
Access to clinical trials
Lancet Oncol 2013；14:e524-34

15. [CONFIDENTIAL: Working Draft 150622]
ACS #6a
ACS #6b
[CONFIDENTIAL: Working Draft ]

16. Kaplan–Meier estimates of OS in Swedish patients diagnosed with mRCC by year of diagnosis
2012
2002
M Lindskog　et al. ASCO-GU 2015

17. More access to drugs, longer life span
International mRCC Database Consortium database 
Overall survival of patients who received 1, 2, or 3+ lines of target therapy were 14.9, 21.0, and months, respectively
On multivariable analysis, 2 lines and 3+ lines of therapy were each associated with better OS (HR=0.738 and 0.626, P<0.0001).
British Journal of Cancer (2014) 110, 1917–1922.

18. Sustainable UHC
Lancet oncology 2015

19. PD-1 ab costs $1.9 million/month

20. Precision Medicine in Cancer treatment
Precision medicine in oncology is focused on identifying
which therapies will be most beneficial for each patient
based on genetic characterization of their cancer.

21. Evaluate predictive biomarkers by “Liquid biopsy”
Circulating tumor cells
Cell-free DNA
Hegemann M et al. BJU Int 2015
Exosome
exosomal protein, miRNA

22. AR-V7 Status matters for “precision” drug choice
Docetaxel (generic)
AR-V7 (-)
AR target medicine
Antonarakis ES, et al. ;N Engl J Med Sep 3 (e-pub)

23. Achieving UHC in Cancer treatment
Increase survival
Maintain quality of life and Reduce the disease burden

24. Shared decision making
Localized prostate cancer
What matters most?
choice
option
preference
value
surgery
radiation
Active surveillance 責任

26. UHC for cancer in Asia Diversity Resource stratification
Public awareness, prevention
Evaluation and appraisal
Precision Medicine
Select appropriate population
Shared decision making
Respect value