 So my name is Neil Bertelsen and I presented at the recent MPE masterclass talking about patient involvement in HTA. So I'm just going to give you a really quick summary here. And I really started by going back to the basics and really explaining what HTA is and particularly the relationship between HTA health technology assessment and politics. So I think one of the key first points I made was that it's politicians who decide how much resources going to healthcare, and it's politicians who decide how health technology assessment works. And what rules apply in your country around health technology assessment. And so that means that you have to be aware of the political system, as well as the mechanics of health technology assessment because it's in the politics that you can actually increase healthcare spending on a particular disease area, for example. I'll talk a little bit about that but then really focused on what is it around HTA that we need patients for. So what are the key questions that occur when a health technology assessment body is looking at a new medicine and deciding whether they want to invest in that new medicine for patients in their country. And there are a lot of gaps in evidence that health technology assessment bodies really have difficulty understanding. We need to know exactly why a new treatment brings benefits to patients, specifically what is it that patients can do on this new treatment that they perhaps couldn't do on the old treatments that exist already within the healthcare system. So looking to the patient community to give them some context to help them understand what it's like to live with this condition. What are some of those key things that specific things that patients have difficulty with with this particular condition, in this case, myeloma, you know, and really understand how that affects the day to day life of people with myeloma. And from there they're trying to understand, okay, so if that's the problem with the disease, what's the problem with the current way the disease is treated. So the current treatments, the current ways that patients are managed with myeloma. So they want to understand what's good about the current treatments and the current ways they are used, but also what is bad, what still is a gap that needs to be filled from the patient perspective. So you can see already that they're looking to the patient community to give them evidence around how patients experience not just the disease, but the current treatments of the disease. And they're wanting to find out what's meaningful and important about any aspects of the new treatment that they're assessing. So not all of these questions are answered in the clinical trials. So sometimes there are big gaps in evidence that actually the patient community can help to fulfill some of those gaps and give context to them. Which is why many health technology assessment bodies now have processes for including patients in their decision making. And the way that works is different from country to country. But one common method is asking patients to write in with some evidence and the evidence can be from interviews, it could be from patient surveys, it could be patient stories, it can be quotes. But really building a package of evidence that says from the patient perspective, this is what we think you need to know when you're making a decision about this upcoming treatment. So I explained all of that in the master class, but I also raised some really important points that it's worth keeping in mind that cause some frustration between patient communities and health technology assessment bodies. Now, HTA bodies were never set up to grant the wishes of patients, they weren't. They were set up to protect healthcare systems and make them sustainable for all citizens, not for one particular group of patients. And that creates a conflict or sort of a tension within HTA, where actually it's set up to make decisions based on the health of the, or the strength of the healthcare system itself for all patients. It's wanting to protect resources within the healthcare system so that the healthcare system can meet the needs of the widest population of patients possible. And sometimes that means that they can't invest in every new medicine that comes to their door. And it's making that decision, it's really a hard decision. So when health technology assessment bodies say no to a particular medicine, it's actually really difficult decision for them to get to that no, it means that they have serious questions that have not been answered about whether this will really deliver on its promise when it's used in real life. And there's lots of mechanisms now in place to try and improve that process. And one of the important ones that I mentioned in the masterclass is things like they're called managed entry agreements. And so that's a way that a health technology assessment body can say, we're not convinced with the evidence, but you know what will give you the benefit of the doubt. We will let this medicine be available to some patients, but as long as you collect evidence to show that it's actually working. And once we start to see that in real life, it is actually working, then perhaps we can expand access to more people. So that's one way that they try to overcome some of those challenges. Another key point that I make is health technology assessment is based on input from multiple stakeholders from the industry from economists, from clinicians, and often from the patient community. And sometimes I've seen that it's patient groups can feel as though the whole decision rests on their shoulders that they need to say the right things in the committee meeting or in their submission in order to secure access to the medicine for patients. And I really want to stress that sometimes the patient involvement is not going to be able to address the questions that health technology assessment body has. So it's important as patient groups that we understand that our role is really to make sure that the patient perspective is considered within that decision making process. But it's not our role to always secure access. Sometimes there are gaps in evidence that are just too big to turn that no into a yes. And then it's up to the company to go back and collect more evidence or provide more evidence to answer some of those concerns. So I don't want anybody in the patient community to ever walk into a committee meeting, feeling that it's their responsibility and only their responsibility to secure access to that medicine. It requires all of the stakeholders to work together and provide the right evidence to do that. But I think that that we're going to a future now where we're seeing patient involvement more accepted within health technology assessment bodies. We're seeing the quality of evidence that patient groups provide getting stronger and stronger. And so we're seeing that patient groups do have an influence. They are able in some cases to say hey you're looking at the wrong thing. You need to be looking at this kind of evidence over here because that's what really matters to us. And we have examples now where we can say without patient groups being in the room that medicine probably wouldn't have been approved reimbursement. So it's a long journey. I'm not saying it's always easy, but it's really worth doing. It's really worth finding how your system works in your country and making sure that the health technology assessment body knows you exist. Knows you're there to call upon to answer questions and to be invited to take part into these processes. So do look and see how your system works and find ways of making the HTA bodies aware that you're there to help them. You're there to give them advice and support and answer their questions whenever they're looking at treatments for myeloma. Thank you very much.