Mogens Guldberg, general manager of Novo Nordisk Austria, the Danish global powerhouse focused on innovative diabetic treatments, provides a unique insight into the obstacles associated with launching innovative products in Austria as well as the revolution required in Austria’s diabetic approach. He also highlights how specifically Novo Nordisk assists in inciting a social difference and positively changing the lives of people with diabetes.
You have an impressive 19-year history at the company, what was your mission when you took up the country manager position at Novo Nordisk Austria?
Novo Nordisk has a rich 95-year history in diabetes with therapeutic areas such as haemophilia and human growth hormone coming later. I have worked in all the three therapeutic areas during my time at the company. When I first took up this position I saw it as a clear opportunity for professional career development, but more importantly I was excited with the challenges of inciting a positive difference in diabetes treatment and awareness in Austria. Novo Nordisk Austria endeavours to transfer to the people with diabetes our innovative treatments and in the meantime, support affected people with diabetes along their journey with this life changing condition.
Austria contains 6-700,000 people with diabetes, though this is hard to determine with any real certainty as Austria unfortunately still lacks a national diabetes registry. Only around two thirds of people with diabetes are diagnosed and out of this number a high number are not adequately treated or if receiving treatment are not reaching sufficient outcomes; be it through people not in adherence to scheduled treatment program or not being treated in a timely manner. This is quite shocking considering Austria is perceived as an advanced healthcare system not only throughout Europe, but the entire global healthcare community.
In conclusion, there are two clear challenges we face in the Austrian diabetes ecosystem. Firstly, diagnosing people with diabetes and finding ways to treat them adequately in a timely manner and secondly, giving sufficient information and spreading awareness as a preventive action. Diabetes is also a social problem that affects all facets of people’s lives, but can be better prevented by the general population living a more health-conscious lifestyle. Changing the Austrian mentality is a huge challenge that Novo Nordisk Austria is up to, and I would love to envision in five years that most people with diabetes can be treated adequately, a statement that currently does not hold true under the current healthcare ecosystem.
What impact does diabetes have in the Austrian healthcare ecosystem?
Recently, significant results from outcomes studies have indicated that diabetes goes beyond purely glycaemic control, as cardiovascular risks can be significantly reduced. For example, 85 percent of people with Type II diabetes have a higher risk of cardiovascular disease or have experienced a cardiovascular event. Looking at the overall statistics in Austria there are around 10.000 mortalities directly linked to diabetes with 50-80 percent due to cardiovascular disease and 10-20 percent renal disease. Equally correlated to diabetes are 2500 amputations, 65 percent of all amputations, 200 cases resulting in blindness and 300 patients require renal dialysis.
As you can see diabetes is a diabolical concern for the entire healthcare ecosystem, and the funds being allocated at present are not sufficient considering the overall impact of the condition. Being a general manager of the Austrian branch of a large multinational company, it is easy to demand a larger share of the budget be allocated towards pharmaceuticals – although – as a partner with integrity in the community we must first deliver clear evidence of the economic benefits of our innovative treatments. When delivered then actions should be taken
What strategies are in place to change the Austrian diabetic approach?
Novo Nordisk Austria has a strong patient centric approach, supporting various organizations and programs. In 2013, Novo Nordisk conducted in collaboration with the International Diabetes Federation (IDF), the Steno Diabetes Center, and various national diabetes organisations the DAWN 2 study to deeper understand the psychosocial and unmet needs as experienced by people with diabetes. The study drew conclusions from interviewing 15.000 people (people with diabetes, family members, and HCPs). Though Austria did not participate with interviewees the program allows the Austrian population to better understand the social fight of diabetes and what is being done to better people’s lives, which from our perspective needs to drastically improve in the future.
From a treatment perspective, our strategy is to make it simpler for people with diabetes to use our products, so they are minimally affected in their day to day activities. This is especially important for people with diabetes who are stressed enough with the idea of needing to inject insulin several times a day.
What prevents innovation being properly rewarded?
Austria has a defined political structure with a long history based around the nine federal states being each individually given a health care budget. This can create a lack of fund allocation transparency in the system, not allowing us to fully understand how innovative drugs can help establish a more cost-efficient system. Furthermore, each individual sector in the healthcare industry has its own targets and is trying hard to achieve these. Nevertheless, we all need to take a step back and take a holistic view and have a courageous, uniform, and innovative approach around how the entire healthcare system can spend budgets efficiently with the overriding aim to provide patients with better care.
In relation to diabetes, as previously mentioned, we lack a national diabetes registry; therefore, there is no way clear way of correctly identifying if a treatment is being used at its optimal level and if innovative treatments are positive from an economic standpoint. This is incredibly important as the condition is rising in prominence not just in Austria, but the entire world. By working in partnership with other stakeholders in the Austrian health care system we can influence a change towards higher acceptance of innovative drugs that are clearly aimed at making a difference in the lives of people with chronic disease.
On the other hand, the system requires leaders who have courage and might be willing to break down the walls of Austrian healthcare by employing an atmosphere of transparency and trust. I am very optimistic this can happen, but only time will tell.
Despites the difficulties to drive the launch of innovative products in Austria, efforts are geared to promote innovation via clinical trials. Novo Nordisk has realised this potential and 80 percent of the value we transfer to Health Care Professionals and Health Care Organisations are going to R&D, hereby leveraging the world class Austrian environment of highly qualified personnel, excellent standards and a population willing to participate.
How is the Novo Nordisk portfolio present in Austria and how does this translate to the company’s global plans?
The overriding objective of Novo Nordisk Austria´s portfolio is to positively impact the lives of people with chronic diseases from a health perspective as well as from a society perspective. A key example is Victoza®, which should change standard of care in Type II treatment moving beyond purely glycaemic control. Our innovations in diabetes are also directed towards significantly reduce hypoglycaemia, which is a driver in diabetes related costs in the healthcare system.
In haemophilia, we are striving to be a leader, despite competitors at present having a larger Austrian footprint. Nevertheless, it is a challenge my team are up for and we believe NovoEight®, the recombinant factor VIII product with the longest post-reconstitution storage time, is a game-changer. It allows freedom for people with haemophilia to go about their daily activities without requiring a cold storage facility to be ever-present. This represents a social life changer for the effected persons.
Overall, we are slightly under Novo Nordisk´s 2016 global growth rate of six percent, hampered by the restrictive innovation environment in Austria and the high solidarity pay-back as a result of the agreement between the industry and the national sick fund. Nevertheless, I believe we have huge potential in Austria to improve patient outcomes and with the introduction of a national diabetes registry we could have a further understanding of which treatment we must bring here to more effectively treat people with diabetes and be a partner in more cost-efficiently spend health care budget.
How does Novo Nordisk have an active voice in Austria and leverage its expertise?
We directly support the national diabetes association and patient organizations as well as participating in various awareness campaigns. Equally, we need patients to have an active voice in understanding their disease and making demands when needed due to increased general health literacy.
We actively support the bigger picture of promoting pharmaceutical innovation as members of PHARMIG and FOPI. Equally, we back the reimbursement authorities’ vision of ensuring all Austrians from every corner of the nation having the same access to reimbursement of drugs regardless of personal sick fund.
As a company Novo Nordisk Austria must continue to have the same mindset at all times and with every launched product; the patient always comes first. Drugs that excite me do not only have financial benefits but significantly improve patient outcomes. It could be as little as patients injecting once rather than three times a day; a small change but a huge social upside as stress has a strong influence on adherence and overall health costs
How do you translate your competitive spirit as a former Olympic athlete into your managerial approach, and furthermore, what continues to make you tick day in day out at Novo Nordisk?
My years as an athlete set me up in many aspects for my ensuing professional life. Firstly, I view stress is a motivating factor that stimulates me to deliver solutions. Secondly, I am extremely ambitious and competitive and portray this vision onto my team by driving them to always strive to achieve their best.
Novo Nordisk as a company encompasses a culture that spurs me on daily. We strive to achieve our targets year on year and invest heavily to ensure people with chronic disease have access to innovative drugs. Though above all, it is a great team atmosphere that promotes an engaged environment where we all strive toward the common goal; to incite a tangible positive impact on people’s lives making a real difference.