Kenneth Mikkelsen & Jeroen ter Borg describe the work of IQVIA - the world's biggest CRO and life science data services provider - in Denmark, which has served as a testbed for the rollout of the firm's healthcare business. Mikkelsen and ter Borg also highlight some of the key market trends to emerge from the COVID-19 pandemic and how IQVIA is adapting its CRO offering to meet the needs of the biotech industry.
How is IQVIA Denmark organised and what are some of its specificities compared to affiliates in other geographies?
Kenneth Mikkelsen (KM): In addition to IQVIA’s traditional expertise as a CRO and a life science data services provider, IQVIA Denmark is unique in its strong focus on doing business with the government through the Ministry of Health, as well as all the Danish regions and municipalities. IQVIA made a strategic decision to grow its presence and establish a strong footprint in the healthcare space here.
Danish healthcare is quite mature, meaning that Denmark – along with the UK – was a natural choice as one of the frontrunners for growing IQVIA’s healthcare business. Additionally, five years ago we acquired a player with a very strong presence in the market, which feeds into our 20 years of experience and insight into healthcare. IQVIA is now providing its Casemix360 solution, an end-to-end infrastructure to maintain, develop, and improve the patient classification and pricing infrastructure, to all hospitals in Denmark.
When a patient enters the hospital, the cost that is refunded depends on a multitude of factors, including whether they are a smoker or whether they have multiple illnesses. Our solution analyses the patient’s profile and feeds back how much money should be reimbursed to the hospital.
Presumably, this kind of solution can only be utilised in countries like Denmark that has very strong patient data sets. Is there the potential to roll Casemix360 out to other countries without such a data footprint?
KM: One logic is used in Sweden and Norway, while in Denmark, we have another, but all hospitals in the Nordic have some kind of logic where they define a cost to an activity. Globally, 25 countries are using a logic similar to the Danish logic, including Australia. We are also providing the solution to the Middle East and to Eastern Europe. IQVIA is therefore bringing the expertise from Denmark out into the world, catering to the global trend towards value-based healthcare.
What effects has the COVID-19 pandemic had on your business?
KM: At IQVIA Denmark, we saw a growing interest in clinical trials. Even pre-COVID, our CRO organisation was a key provider for the life science industry, but we are now being asked to create an overview of the clinical trials happening in the hospitals and rethink clinical trials to decentralise them. In decentralised clinical trials, the patient does not need to be seen in person and data can be collected digitally, which is a big change. Now, we are not only working in the life sciences, but deep in hospitals’ research departments. The Danish national life science strategy’s stated objective of making Denmark the best country in the world in which to conduct clinical trials also supports this shift.
Decentralisation means that clinical trials are not geographically restricted and patients can be searched for and found more quickly. We are not there yet, but in the future, it will be much easier to utilise AI solutions and recruit a few patients with a very specific illness. Digitalisation is also a key trend and we have seen a lot of funding flowing into AI solutions in healthcare, with public funding into AI projects in the municipalities and hospitals.
We are now working to bring the knowledge and expertise gained in the US, which has been leading the way in virtual/digital trials for the last four to five years, to our sites in Europe. Sponsors also need to see the new opportunities and realise that patients can be drawn from across national borders. National regulation should accommodate for this in the future.
The datasets and registries in Denmark mean that even though the population is relatively small, hybrid studies and smaller trials with smaller cohorts can be conducted. What needs to be done to maintain the country’s strong positioning as a clinical trials hub?
KM: Denmark is also attractive as a clinical trial hub because we have data going back 40 years. In Post-Authorisation Studies, we have 40 years of data where we can go back, follow a patient, know what kind of medicine this patient has had, and see its consequences.
What are the areas in which Denmark is perhaps not so competitive and where do you see room for improvement?
KM: IQVIA Denmark recently hosted a roundtable debate where we discussed the fact that we do not necessarily need new data, but rather need to improve our capabilities to access and use the data we already have. For example, only research projects are currently able to gain access to the data. An AI system which predicts which patient or citizen is likely to get hospitalized could not currently be used in real-world clinical decision making, but only for research. We have a lot of data, knowledge, and solutions, but we are not able to utilise them outside of the research world.
Outside of healthcare, what kinds of clients is IQVIA Nordics servicing in the life sciences space and how have you seen their needs evolving over the past couple of years?
Jeroen Borg (JB): We serve a relatively broad range of clients in the life sciences, ranging from the major pharma companies all the way to emerging biotech players. These biotechs are increasingly important for IQVIA Nordics, especially in Denmark, where we have a lot of interaction and projects. Local IQVIA Teams are involved, but we also work closely with our international teams dedicated to serving companies’ headquarters. It is important to note that Denmark has quite a substantial headquarter base, in terms of pharmaceutical and medtech companies, which generates and attracts a lot of innovation.
How has IQVIA had to adapt to better serve the needs of biotech companies, as opposed to Big Pharma, which tend to have many more capabilities in house?
JB: We have been heavily investing in servicing both large and emerging pharma companies to ensure that their trials are being run faster and more efficiently using the latest techniques. We are also connecting these trials with real world evidence. Digitalisation and virtual trials have long been a key focus, even pre-COVID. Given Denmark’s good data assets, which allow for faster and more relevant data driven patient recruitment, there is still a lot to win.
Some activities always need to be done in person on-site due to regulation, but during COVID all stakeholders had to switch to working virtually, some of which will stick post-pandemic. Even now, the level of non-face to face interactions is still far higher than before the pandemic across the entire clinical trial value chain.
KM: A company changed their approach towards collaboration with the municipalities in which case if there is no impact from a service there is no payment. From this, it is clear that life science companies are also thinking about how to interact more closely with the patient and change their business model.
What makes IQVIA the CRO and consulting partner of choice in Denmark?
KM: In healthcare, we have 40 years of experience designing and executing clinical trials. This experience combined with our deep therapeutic and scientific knowledge is something we can bring into research departments within hospitals. By collaborating with IQVIA, these hospitals also gain deep insight into conducting clinical trials which no other partner to the healthcare space has.
JB: Stakeholders are incredibly more interconnected nowadays, the complexity is so much greater than before, and the healthcare system is producing data at an unbelievable speed. Being able to deal with this vast amount of data and complexity requires partners that understand how things really work and which have the technology and consulting services that can be game changers for the life sciences industry.
There is so much data out there, but not all of it is being used for the benefit of society. So much, including in Denmark, can be improved in terms of accessing and using this data, which is the real challenge and one which IQVIA is helping to solve.
