Where Ambitions Meet





Fons van Mieghem – Field Market Access Manager – Amgen

Niels Kok – Surgical Oncologist – The Netherlands Cancer Institute (Antoni van Leeuwenhoek, AVL)

Martijn van Schaik – Care Pathway Manager – The Netherlands Cancer Institute (Antoni van Leeuwenhoek, AVL)


Two organisations, each with a firm ambition: The Netherlands Cancer Institute (Antoni van Leeuwenhoek, AVL) wants to offer patients the best possible treatment at acceptable costs. By 2022 biopharmaceutical company Amgen wants to be rewarded for their contribution to the result of the treatment and the value for patients, and not only for selling the medicines. Martijn van Schaik (Care Pathway Manager AVL): “Our government wants to limit the growth of healthcare costs, health insurance companies want to measure outcomes and we want to be the best healthcare provider. We can achieve these goals if we do what Harvard professor Michael Porter stated: if you want to improve your quality, but cannot allow costs to rise, you must add value to what you do. This is exactly what we aim for with the value-based healthcare approach we took in collaboration with Amgen. And Amgen proved to be the right partner.”

Four years ago, Amgen changed its business approach to a model that does justice to the value that their medicines represent. “It was our way of taking responsibility, not only for our medicines but for what they do for the patient”, says Field Market Access manager Fons van Mieghem. “In this, value-based healthcare is the key. It gives us the means to improve the quality of care, learn from what we achieve and pave the way for outcome-based payment models. When AVL asked us to collaborate in their value-based healthcare projects, we already had experience with this approach in partnerships with other hospitals. Especially for this purpose, we established a value driven care team with Health Care Consultants, making value-based healthcare a focus point in our strategy. It was this team that prepared and guided the workshops that led to the outcome sets that AVL needed. That the number one oncology centre in the Netherlands asked Amgen to collaborate, means a lot to us.”

Looking beyond survival rates

The outcome sets that AVL wanted, were for HIPEC-treatment for colorectal carcinoma, breast cancer and cancer patients in the last stage of their life. Surgical Oncologist Niels Kok played a leading role in the first one of these three. “I immediately said yes when I was asked to participate”, he tells. “My wife, who is also a Surgical Oncologist, had often told me about her own experience with value-based healthcare projects, therefore I was enthusiastic of what can be achieved. As doctors, we are primarily focused on the success of cancer treatment in terms of overall survival and progression free survival. But for patients and their family and loved ones, other things can be just as important when they are faced with the consequences of cancer and cancer treatment.”

The HIPEC-treatment for colorectal carcinoma is used for patients in whom the cancer has already metastasized. “This means you are working in a grey zone”, he says. “For the patient the treatment has a great impact on the quality of life; we also know that, despite the treatment, in about fifty percent of the patients the cancer has returned after twelve months. Knowing this, you realise how important it is to fully inform the patient, so that they can make an informed choice.”

The patients’ perspective

One of Kok’s patients had already undergone the HIPEC-treatment twice. When she and her partner agreed to participate in developing the HIPEC outcome set, they had other concerns than just survival. She had questions about the cancer and treatment induced fatigue, about sexual disfunction and its impact on the relationship with her husband, and about the impact of the scar on her abdomen that resulted from the treatment. Her husband wanted to know if the radiation burden could further harm her health. “Things that are normally not – or at best marginally – discussed in the doctor’s consulting room”, Kok says. “It’s usually the oncology nurse who talks about such matters with patients. Now, I find myself saying “Choosing not to be treated is also an option” more often than I used to. I don’t know if this is a direct result from the project we did with Amgen, but I do know that even if we will not take further steps in value based healthcare from here on, the analysis of this entire care path made me think differently, and therefore brought me a lot.”

Making the patient benefit

Where to go from here? For Kok this is not an easy question to answer. He says: “The restriction that our government puts on the growth of healthcare costs requires choices to be made. A process, such as the one we just went through, is very supportive in making them. The next challenge is to convert a project into something that you can use in the consulting room, in such a way that the patient really benefits. I cannot do this alone, I need a policy officer to help me and commitment from our board of directors.” Van Schaik agrees that implementing outcome sets is not an easy task. “It needs to be fitted into existing structures”, he says. “The key to all such projects is to keep them as small-scale as possible at the start. For our next project – finding out what we can learn from what we offered patients in the last ninety days of their lives – we look forward to further collaboration with Amgen.”

That feeling is mutual, states Van Mieghem: “Not only will we help to implement the HIPEC outcome sets and develop new sets, but also to stimulate the acceptance and implementation of value-based healthcare. Our government has the ambition to have outcome data transparent for fifty percent of the disease burden in 2022. We want to support that as much as possible.”