【艾昆緯】IQVIACAR-T細(xì)胞療法衛(wèi)生系統(tǒng)就緒度評估報告障礙與機遇

AchievingCART-cell

TherapyHealthSystemReadiness

ANASSESSMENTOFBARRIERSANDOPPORTUNITIES

MARCH

2025

Introduction·

CART-celltherapieshaveshownsubstantialefficacyinseveralhematological

conditionsandholdthepotentialfortransformativebenefitsinotherdifficulttotreatdiseases;however,thecomplexjourneytodeliverCART-celltherapiestopatientsandassociatedoperationalandcapacityneedscanleadtosuboptimalaccesstoanduseofthesetherapies.Despitethesetherapiesfirstlaunching

globallyin2017,barrierstopatientaccessremain.

Inthisreport,thecurrenthealthsystemcapacity

fordeliveringCART-celltherapiestopatientswas

assessedinsevencountries(Australia,Canada,France,

Germany,Italy,Spain,theUnitedKingdom).This

includesreimbursementandfunding,patientreferral,

treatment,andlong-termfollow-up.ThisreportprovidesbackgroundonthecomplexCART-celltherapypatientjourneyfrompatientidentificationandreferralto

long-termmonitoring,andestimatesCART-celltherapyutilizationinasubsetofcountries.

Thecurrentstateofhealthsystemreadinessisassessedindetailforeachofthesevencountries,including

nationalorregionalstrategies,patientidentification

andreferral,andtreatmentinitiation,administration,andmonitoring.Keybarriersandbestpracticesfor

enhancingthedeliveryofCART-celltherapiesare

alsohighlightedforeachcountry.Basedonthis

assessmentandlearningfrombestpractices,potentialsolutionsareprovidedtoimprovepatientaccessto

CART-celltherapies.Thisreportisintendedtoprovideafoundationfordiscussionsaroundkeybarriersand

actionsorpoliciesthatcouldbetailoredtospecific

countryorregionalneedstoensurethefullpotentialofCART-celltherapiesisrealized.

ThestudywasproducedindependentlybytheIQVIA

InstituteforHumanDataScience.Fundingforthe

researchwasprovidedbyGileadandKite,whichhad

theopportunitytoreviewthefindings,buthadno

editorialcontroloverthefinalcontent.ThecontributionstothisreportofKateBennet,CarolinaRicarteIniesta,

ErikaSzewkies,andBenedettaSpadaroaregratefullyacknowledged.

FindOutMore

IfyouwishtoreceivefuturereportsfromtheIQVIA

InstituteforHumanDataScienceorjoinourmailinglist,visit.

MURRAYAITKEN

ExecutiveDirector

IQVIAInstituteforHumanDataScience

REFERENCINGTHISREPORT

Pleaseusethisformatwhenreferencingcontentfromthisreport:

Source:IQVIAInstituteforHumanDataScience.AchievingCART-celltherapyHealthSystemReadiness:AnAssessmentofBarriersandOpportunities.March,2025.Availablefrom

?2025IQVIAanditsaffiliates.Allreproductionrights,quotations,broadcasting,publicationsreserved.Nopartofthispublicationmaybereproducedor

transmittedinanyformorbyanymeans,electronicormechanical,includingphotocopy,recording,oranyinformationstorageandretrievalsystem,withoutexpresswrittenconsentofIQVIAandtheIQVIAInstitute.

AchievingCART-cellTherapyHealthSystemReadiness:AnAssessmentofBarriersandOpportunities

TableofContents

Overview2

Background6

CountryreadinessforoptimalCART-celltherapyadministration6

Australia11

Canada16

France20

Germany24

Italy27

Spain31

UK36

Crosscountrysummary39

OvercomingbarrierstoCART-celltherapyuseacrosscountries43

Methodologies45

Notesonsources47

References48

Abouttheauthors52

AbouttheInstitute53

2|AchievingCART-cellTherapyHealthSystemReadiness:AnAssessmentofBarriersandOpportunities

Overview

Cancerremainsamajorsocietal,publichealth,and

economicproblem,responsibleforalmostoneinsix

deaths(16.8%)andforoneinfourdeaths(22.8%)from

noncommunicablediseases(NCDs)worldwide.Globally,therewere20millionnewcasesofcancerin2022,with

thisnumberexpectedtoriseto35millionby2050.

Hematologicalcancerincidenceisalsoprojectedto

increaseby55%inthesametimeperiod,from1.3millionto2.0million.

Therapiesforadvancedcancersutilizinghighly

innovativescience,suchascell-basedimmunotherapies,celltherapies,genetherapies,andtissue-engineered

products,areunderdevelopmentorhavebeenlaunchedinthelastdecade.Cancertherapiesrepresentthe

largestcurrentareaofresearchandthehighestoverallareaofdrugspending.

Despitesignificantadvancesintreatment,theglobal

oncologycommunityandpatientscontinueto

experiencedisparitiesinaccessandcare.Infrastructureneedsandthecomplexitiesofthejourneyinvolved

inpatientsreceivingadvancedinnovativetherapiesposesignificantbarrierstotimely,optimaltreatment.ChimericantigenreceptorT-celltherapies(CART-celltherapies)havebeenassessedasacasestudyto

understandthesebarriers.

CART-celltherapies

belongtothecategoryofadvancedtherapymedicineproducts(ATMPs).

CART-CELLTHERAPYBACKGROUND

CART-celltherapiesbelongtothecategoryofadvancedtherapymedicineproducts(ATMPs).Thesetherapies

havesignificantlyexpandedtreatmentoptionsfor

hematologicalmalignanciessuchasacutelymphoblasticleukemia(ALL),diffuselargeB-celllymphoma(DLBCL),highgradeB-celllymphoma(HGBCL),follicular

lymphoma(FL),primarymediastinallargeB-celllymphoma(PMBCL),mantlecelllymphoma(MCL),andmultiplemyeloma(MM).

CART-celltherapiesinvolvemodifyingT-cells,which

arewhitebloodcellsthatplayacrucialroleinthe

immunesystem.ScientistscanprogramT-cellsto

identifyspecificproteins,suchastheCD19orB-cell

maturationantigen(BCMA),presentonthesurface

ofcancercells.Thisisachievedbyaddinganewpieceofgeneticcodetocreateachimericantigenreceptor

(CAR).CART-cellscanthenrecognizecancercellsand

attackthemmoreeffectively.CART-celltherapiesareconsideredtobehighlysuccessfulimmunotherapies.

Theydemonstratenotableefficacyincertainrelapsedorrefractory(R/R)hematologicalmalignanciesandarebeingstudiedinseveralotherhematologicalindicationsandsolidtumors,aswellasinnon-cancerindications

suchasimmunology.

TreatmentwithCART-celltherapyrequiresthe

coordinationofamulti-disciplinaryteamincluding

referringandtreatingphysicians,nurses,and

pharmacists,alongwithotherstakeholdersthatcanvarybycountry,region,orhospital.Investmentintreatmentcenterinfrastructureisoftenneeded,including

expansionofintensivecareunit(ICU)capacitytotreatanyseveretreatment-relatedadverseevents,aswell

asspendingtomeetotherorganizationalandtrainingrequirements.Policymakersarealsokeystakeholdersastheyshapetheoverallenvironment,including

helpingtofundthetherapeutics,andcandirectfocusandinvestmentstowardsenhancingoverallprocesses.ThecomplexityofCART-celltherapyreimbursement,administrationandpatientjourneycanresultin

suboptimalprovisionofthesetherapiestopatients,withpotentiallyadverseimpactsonpatientoutcomes.

AnanalysisoftheCART-celltherapyclassutilization

shareforItaly,France,Germany,Spain,andtheUnitedKingdomwasundertakenusingaproprietaryIQVIA

methodology,basedonIQVIAandexternalsources.

Allstudiedcountrieshadanincreasingtrendinthe

shareofpatientstreatedwithCART-celltherapies

amongdrugtreatedLBCLsecondline(2L)+R/RCAR

T-celltherapyna?vepatientsin2022and2023.However,theoverallsharevariesacrosscountries.Francehad

thehighestsharein2023with30%,followedbySpain

(18%),Germany(17%),theUK(15%),andItaly(11%).ThedifferencesinCART-celltherapyshareuptakeamong

thecountriescanbedrivenbyseveralfactors,suchasthenumberoftreatmentcenters,theprocessesfor

referralsandtreatmentinitiation/administration,and

reimbursementdynamics.Thevaryinglevelsofclass

utilizationacrosscountrieshighlightstheneedtoreviewthesefactorsandtounderstandkeybarrierstoefficientuseandpotentialsolutions.

ASSESSMENTOFCOUNTRYREADINESSFORCART-CELLTHERAPYADMINISTRATION

TounderstandthelevelofcountryreadinessandcurrentbarrierstooptimaladministrationofCART-celltherapy,severaldimensionsoftheCART-celltherapyjourney

wereassessedforAustralia,Canada,France,Germany,Italy,Spain,andtheUnitedKingdom,utilizingtheIQVIACART-CellMonitor,secondaryresearch,government

documentsandexpertinterviewstoidentify:

?NationalorregionalpolicystrategiesforCART-celltherapies,cellandgenetherapies,andadvancedtherapeutics

?CART-celltherapytreatmentsites

?Patientidentificationandreferralprocesses

?ReimbursementandfundingofCART-celltherapyadministrationandassociatedprocedures

?Practicesfortreatmentinitiationandadministration

?Typicalshort-termandlong-termmonitoringanddatacollection

AUSTRALIA

WhileincreasingnumbersofCART-celltherapiesare

reachingthemarketinAustraliaandpatientaccessis

expanding,severalissuesstillremain.AustraliaonlyhassevenCART-celltherapytreatmentcenters;fourstatesandterritorieshavenotreatmentcenters,includingthepopulouscityofAdelaideinSouthAustralia.Limited

accessinthesestatesandinruralAustraliarequires

somepatientstotravellongdistancesfromhome

fortreatmentandpotentiallycreatesdisparitiesin

treatmentaccess.FundingofCART-celltherapyand

associatedprocedurecostsvariesacrossstatesandcanbeinsufficientincertainscenarios.Thedistancefrom

CART-cellmanufacturingsitescanpresentachallengefortimelydeliveryofthetreatment.Capacityissues

inhospitals,includinglimitednumbersofapheresis

machinesandbeds,putanadditionalburdenonthe

highlyskilledstaffneededtoprovidetreatmentto

themaximalnumberofpatients.Theabsenceofcarecoordinatorstakesawayfromproviderandclinicalstafftimetreatingpatients.

CANADA

CART-celltherapiesarebecomingmoreestablished

asstandardofcareforcertainpatientsinCanada,

howeverthereareseveralbarriersthatrequirefurtherconsideration.Forexample,accesstoCART-celltherapytreatmentcentersinsomesmallerprovincesand

moreruralpartsofCanadaislimited.Duetothelargegeographicsizeofthecountry,somepatientsmay

havetotravelsignificantdistancestoreceivetreatmentandmaychosetoforegotreatmentduetolimited

supportnetworksthroughouttheextendedstaynearatreatmentcenter.

|3

4|AchievingCART-cellTherapyHealthSystemReadiness:AnAssessmentofBarriersandOpportunities

WhileCanadahasauniveralpubliclyfundedhealthcaresystem,eachprovinceandterritorymanagesaseparatepublicinsuranceplanandthemajorityofCanadiansarealsocoveredunderprivateinsuranceplansforservicesnotcoveredbypublicplans.Thiscreatesafragmentedpayersystemwhichcanresultindelaysanddisparitiesinaccesstohigh-costtherapies.Finally,capacityissuesinhospitalsincludinginancillaryservicessuchas

imaging,apheresis,andinterventionalradiology,as

wellasworkforcecapacitylimitationslimitthenumberofpatientsthatcanbetreatedwithCART-celltherapiesandwillbefurtherexacerbatedasthesetherapies

becomeavailableforadditionalindicationsexpandingtheeligilblepatientpopulationsignificantly.

FRANCE

Overall,Francehassetupefficientsystemsforthe

deliveryofCART-celltherapiestoeligiblepatients

byusingpre-existinghematopoieticstemcell

transplantationnetworksandthroughwell-organized

processesforapprovalsandtreatmentinitiation/

delivery.Asthenumberofpatientsbeingtreatedwith

CART-celltherapiesincreases,itwillbeimportantto

ensurethatcapacityistracked,andprocedurecostsaresufficientlycovered.Assessingcurrentstaffinglevelsanddevelopingfundingpathwaysforanyadditionalrequiredstaffwillalsobeimportant.

GERMANY

WhileGermanyhasrelativelyhighernumberof

authorizedcenters,thelackofstandardizedreferral

networksalongwithvaryinglevelsofeducation

andawarenessamongreferringphysicianscanbea

challengeandcanleadtodelaysinreferrals.Further

delayscanbecausedbythelackoftimelinessof

reimbursementapprovalsbysomeGermansickness

fundsandassociatedbureaucraticburdens.Finally,

capacityissuessuchasthelackofsufficientICUbedsinsomecentersalongwithanassessmentofothercapacityneeds(e.g.hospitalapheresisslots,staffingavailability,etc.)needtobetackled.

ITALY

WhiletheuseofCART-celltherapieshasbeenrisinginItaly,severalissuesrequirediscussionsfromapolicy

perspective.CART-celltherapycentersaregenerally

concentratedinthenorthernregion.Basedonthe

bestavailableinformation,fiveoutof20regionsof

ItalydonothaveaCART-celltherapycenter.Thiscan

requirepatientstotravellongdistances,increasethe

challengesofreferralsandawarenessofthisoption

amongreferringphysicians,andleadtocomplexities

infundingoftreatments.EnsuringtimelyandsufficientfundingforhospitalsadministeringCART-celltherapiesiscriticalforoptimalpatienttreatment.Thiscanbe

particularlychallenginginItalyduetocomplexities

involvedwithfundingtreatmentforpatientsfromotherregions,leadingtodelaysintreatmentandassociatedpooroutcomes.ThereisalackofintegrationofregionalreferralandcarenetworksforCART-celltherapies,

alongwithcapacityissuesintermsofhospitalapheresisslots,ICUbedsandtrainedstaff.Inaddition,early

planningandfundingfortheseelementsareinadequateatsomecenters.

SPAIN

Overall,theuseofCART-celltherapiesforeligible

patientsisincreasinginSpain,withthedevelopment

andregularassessmentofthenationalplanallowing

foreffectivepolicychanges.Spainhasestablished

networksforreferrals.However,ensuringthatreferringphysicianeducationandawarenessregardingCART-celltherapiesisequitableacrossregionswillbeimportant.ThereremainsvariabilityinCART-celltherapytreatmentadministrationandtimelinesacrossregionswith

delaysinapprovalsataregionallevelinsomeparts

ofSpain.Capacityissuesexistforhospitalapheresisslots,ICUbeds,andtrainedstaff,thereisalsoalackofearlyplanningandfundingforcapacity.Addingstafftomanagecaseprocessesanddatacollectioncan

potentiallyhelpreducetheburdenoncliniciansandallowforfastertreatmentadministration.

|5

THEUNITEDKINGDOM

ThedeliveryofCART-celltherapiesintheUKhas

beenimprovingwithadvancesinreferralprocessesandutilizationofexistingnetworksforallograft

centers.However,notallsiteshadaccesstoaCAR-T

Multi-DisciplinaryTeam(MDT)meetingonalocalor

regionallevel.Additionally,communicationandguidanceonreferralswasinplacebutwasnotconsistentoruniform.Fromaninfrastructureperspective,thereisaparticular

needtoensuresufficientcapacityforhospitalapheresisslotsandICUbedstoenableequitableaccessforpatients.Patientconcernsaroundtravelcosts,particularlyin

vulnerablepopulations,needtobeconsidered.Finally,ensuringthatsufficientnumbersofappropriatelytrainedstaffareavailableandcanbefundedwillbeimportant.AssessmentofthecurrentstateofCART-celltherapy-

relatedcareandplanningwillbecrucialtoensurethatadministrationcontinuestobesmoothasdemandforthesetherapiesincreasesovertime.

POTENTIALSOLUTIONSANDCALLSTOACTION

ThereviewoftheCART-celltherapyjourneyineach

countryhasalsohighlightedbestpracticesandpilot

studieswhichcanhelpovercomesomeoftheidentifiedbarriers.Basedontheselearningsandotherexpert

input,severalpolicyandoperationalsolutionshave

beenidentifiedthatcanhelpaddresstheidentified

barriers.Thesesolutionsareimportantforensuring

thatthehealthcaresystemaddressescurrentbarrierstoaccessingCART-celltherapiesandplansinadvanceforthefuturedemandtoachieveoptimalutilizationofthesetherapiesforeligiblepatientsinatimelymanner.Thesolutionswillneedtobeevaluatedbycountries

andregionsforpotentialbenefitsinspecificcontexts.Possiblesolutionsinclude:

?Developingnationaland/orregionalplanstoassesstheuseofCART-celltherapiesforeligiblepatientsinatimelymannerandregularlymonitoringprogress

?EnsuringsustainablefundingforCART-celltherapyateverystageofthepatientjourney,includingfor

proceduresandcapacity-relatedcosts,toenhanceoptimaluseforalleligiblepatients

?Establishingstandardizedgovernancesystemsforreferralsandregional/nationalhubstocoordinatecarebetweenreferringcentersandtreatingcenterswherepossible

?EnsuringregularandcoordinatedscrutinyofCAR

T-celltherapyneeds,inparticularthelocationandnumberofqualifiedhospitalsandcurrentandfuturecapacityneedsbyregional/nationalstakeholders

?EvaluatingalternativemodelsfortheCART-cell

therapyjourney,includingthoseassociatedwith

pre-treatmentsteps,post-treatmentfollow-up

andoutpatientmonitoringpostadministrationto

freeupICUbedcapacityandpotentiallyeasepatienttravelrequirements

ConsideringthesignificantclinicalbenefitsthatCART-celltherapies

currentlyofferandthepotential

showcasedbyongoingCART-cell

therapyclinicaltrials,itiscrucialtocontinuouslyimprovethehealthcaresystemforoptimalpatientcare.

Consideringthesignificantclinicalbenefitsthat

CART-celltherapiescurrentlyofferandthe

potentialshowcasedbyongoingCART-celltherapyclinicaltrials,itiscrucialtocontinuouslyimprovethehealthcaresystemforoptimalpatientcare.AllhealthcaresystemstakeholdersshouldcollaborateeffectivelytoensurethatCART-celltherapiesare

deliveredpromptlyandefficiently,therebyfacilitatingthebestpossibleoutcomesforpatientsreceivingtheseinnovativetreatments.

6|AchievingCART-CellTherapyHealthSystemReadiness:AnAssessmentofBarriersandOpportunities

——Background

IMPORTANCEOFADDRESSINGBARRIERSTOADVANCEDINNOVATIVETREATMENTS

Cancerremainsamajorsocietal,publichealth,andeconomicproblem,responsibleforalmostoneinsixdeaths(16.8%)andoneinfourdeaths(22.8%)fromnoncommunicablediseases(NCDs)worldwide.1

Globally,therewere20millionnewcasesofcancerin

2022,withthisnumberexpectedtoriseto35millionby2050.2Hematologicalcancerincidenceisalsoprojectedtoincreaseby55%inthesametimeperiod,from1.3

millionto2.0million.2Whilesolidtumorsareamongthemostdiagnosedmalignancies,hematologicalcancersaccountfor9%ofallcancersindevelopedand

developingcountries.3

Newtreatmentsinoncologyareincreasinglybecominghighlytargeted,providingprecisionmedicinefor

subpopulationsofpatientsthatmaynothavebenefittedfromthetraditionalstandardofcare.4Advanced

therapiesforcancersutilizinginnovativemodalities,

suchascell-basedimmunotherapies,celltherapies,andgenetherapies,areunderdevelopmentorhavebeenlaunchedinthelastdecade.5

Despitesignificantadvancesintreatment,theglobal

oncologycommunityandpatientscontinuetostrugglewithdisparitiesinaccessandcare.Infrastructureneedsandthecomplexitiesofthejourneyoftenrequired

bypatientstoreceivecellandgenetherapiespose

significantbarrierstotreatment.5Giventhehighandgrowingburdenofcancer,thereispressingneedto

ensurethatthesebarriersareidentifiedandaddressedsothatthesenoveltreatmentsareavailabletoeligiblepatientsinatimelymanner.

Tounderstandthebarrierstotimelyandoptimal

treatmentwithanadvancedtherapeuticmodality,

chimericantigenreceptorCART-celltherapieshavebeenassessedasacasestudy.Thisresearchisintendedto

offerlearningsacrossarangeofcellandgenetherapies.

CART-celltherapybackground

CART-celltherapiesbelongtothecategoryof

advancedtherapymedicineproducts(ATMPs).6

ForcurrentcommerciallyavailableCARTs,apatient’sown(autologous)Tcells—whicharewhiteblood

cellsthatplayacrucialroleintheimmunesystem

andfightingcancer7—arecollectedbyapheresisandgeneticallyengineeredtoexpressaCARconstruct.

TheseCARconstructsallowscientiststoprogramT-cellstoidentifyspecificproteinspresentonthesurfaceof

cancercells,suchasCD19orB-cellmaturationantigen(BCMA).CART-cellscanrecognizecancercellsandattackthemmoreeffectively.8

CART-celltherapyisconsideredahighlysuccessful

immunotherapy,demonstratingnotableefficacyin

relapsedorrefractory(R/R)hematologicalmalignancies.9CARTscanbeusedtotreatlife-threateningdiseases

withlargesocietalcosts,andcanoffersustaineddiseaseremissionandevencureforsomepatientswithrelapsedorrefractorydisease,whohavehistoricallyhadlimitedoptionsandpoorprognosis.

In2017,tisagenlecleucel(Kymriah)andaxicabtagene

ciloleucel(Yescarta)becamethefirstCARTsapprovedglobally.TTisagenlecleucelisapprovedbytheEuropeanMedicinesAgency(EMA)forB-cellacutelymphoblasticleukaemia(ALL),inchildrenandyoungadultsupto25yearsofagewhosecancerdidnotrespondtoprevioustreatment,hascomebacktwoormoretimes,orhas

comebackafteratransplantofstemcellsandDiffuselargeB-celllymphoma(DLBCL)andfollicularlymphoma(FL)inadultswhosecancerhascomebackordid

notrespondaftertwoormoreprevioustreatments.AxicabtageneciloleucelisapprovedbytheEMAfor

treatmentofadultpatientswithDLBCLandHGBL

thatrelapseswithin12monthsfromcompletionof,orisrefractoryto,first-linechemoimmunotherapy,thetreatmentofadultpatientswithrelapsedorrefractoryDLBCLandPMBCL,aftertwoormorelinesofsystemictherapy,andthetreatmentofadultpatientswith

relapsedorrefractoryFLafterthreeormorelinesof

|7

Exhibit1:Cellandgenetherapytrialstartsbytherapyareaandcompanysize,2020–2024

ModalitybysponsorsizeModalitybytherapyarea

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

387

188

4%

4%

483

1,176

12%

3%

2,234

3%

11%

8%

17%

5%

7%

88%

88%

83%

82%

73%

CART/

cell-based

immuno-

therapy

StemOtherGeneAll

therapytherapy

cellcelltherapytypes

100%

90%

80%

Large

70%

Mid

60%

Small

50%

EBP

40%

30%

commercial

EBPpre-

commercial

20%

10%

0%

1,1763871884832,234

CART/

cell-based

immuno-

therapy

StemOtherGeneAll

therapytherapy

cellcelltherapytypes

Allothers

Otherinfectiousdisease

Cardiovascular

Ophthalmology

COVID-19

Metabolic/

EndocrinologyNeurology

Immunology

Hematologicalcancers

Solidtumour

Source:CitelineTrialtrove,Jan2025;IQVIAInstitute,Feb2025.

systemictherapy.10SincetheinitialCARTapprovals,thesefirsttwoCARTsandfouradditionalCARTshavebeen

approvedbyregulatorybodiesintheEU,UK,Australia,

andCanadaacrossadditionalindicationsandasearlier

linesoftherapy.Additionally,CART-celltherapycanalsobehospitalexemptwhichallowshospitalstodevelop

anduseadvancedtherapymedicinalproducts(ATMPs),

includingCAR-Tcelltherapies,forindividualpatients

underspecificconditions.Alongwiththeapproved

indications,CARTsandothercell-basedimmunotherapiesarebeingstudiedinseveralotherhematologicaland

solidtumorsaswellasinnon-cancerindicationssuchas

autoimmunediseases(Exhibit1).GiventhebroadinterestinCART-celltherapydevelopment,thedemandforthesetreatmentsislikelytoincreasesoon.

CART-celltherapypatientjourney

TreatmentwithCART-celltherapyrequiresthe

coordinationofamulti-disciplinaryteamincluding

referringandtreatingphysicians,nurses,pharmacists,alongwiththepatientsandtheircaregivers.Policy

leadersarealsokeystakeholdersastheyshapethe

overallenvironment,fundtheseoften-ex