HTA and CME

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HTA and CME

• Mike Allen
• Dalhousie CME
• SACME
• Rancho Mirage CA
• April 2009

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(No Transcript)
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HTA and CME
Health Technology Assessment and CME

• Mike Allen
• Dalhousie CME
• SACME
• Rancho Mirage CA
• April 2009

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Objectives

• Briefly describe health technology assessment
• Relation to CanMEDS 2005
• Discuss place of health technology assessment in
  CME

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Health Technology

• Drugs
• Devices
• Procedures
• Policies
• used in
• prevention, diagnosis, treatment, or
  rehabilitation
• of health conditions

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Health Technology Assessment

• Multidisciplinary
• It studies the medical, social, ethical, and
  economic implications of the development,
  diffusion, and use of health technologies
• Provides systematic approach to decision- making

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Explanation of health technology assessment

• Randomized controlled trials and systematic
  reviews ? efficacy information
• HTA includes factors such as
• Effectiveness
• Cost and cost-effectiveness
• Safety
• Effects on resources, the health care system, and
  society
• Ethical issues such as access to the health
  technology

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Example

• New surgical procedure
• Effectiveness in real world vs efficacy
• Number of patients using it
• OR time for each procedure, annual OR time
• Operations you wont be able to do
• Procedures you may be able to discontinue
• Training for surgeons and support staff
• Cost of equipment

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Steps in Health Technology Assessment

• Development of health technology assessment
  report
• Application of that report to local situation
• Clinical department
• Hospital
• Health authority
• State/province

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Steps in application of health technology
assessment
Efficacy Evidence
Economic evidence
Step 1 Production of HTA report
Health Technology Assessment Report Efficacy and
cost effectiveness

• Economic considerations
• Existing contracts
• Capital cost
• Maintenance cost
• Engineering cost
• Planning cost

• Administrative considerations
• Location / space
• Training of medical and support staff
• Credentialling
• Patient flow

• Clinical considerations
• Patient population, indications, and access
• Effectiveness in real world
• Safety / level of risk
• Number of patients affected

Step 2 Application of HTA report to local
situation

• Recommendation
• Not recommended
• Approved without restriction
• Restricted approval - audit of limited number of
  cases required
• Restricted approval as a local clinical trial
• Approved in principle pending allocation of
  funding

Step 1 Physicians involved with
multidisciplinary team in reviewing efficacy and
economic evidence to develop health technology
assessment report. Step 2 Physicians involved
with local health technology assessment committee
to apply report to local situation.
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Steps in application of health technology
assessment
Efficacy Evidence
Economic evidence
Step 1 Production of HTA report
Health Technology Assessment Report Efficacy and
cost effectiveness

• Economic considerations
• Existing contracts
• Capital cost
• Maintenance cost
• Engineering cost
• Planning cost

• Administrative considerations
• Location / space
• Training of medical and support staff
• Credentialling
• Patient flow

• Clinical considerations
• Patient population, indications, and access
• Effectiveness in real world
• Safety / level of risk
• Number of patients affected

Step 2 Application of HTA report to local
situation

• Recommendation
• Not recommended
• Approved without restriction
• Restricted approval - audit of limited number of
  cases required
• Restricted approval as a local clinical trial
• Approved in principle pending allocation of
  funding

Poulin P. Local Health Technology Assessment
Tools for Local Decision-Makers, Revision
January 2008. The Department of Surgery and
Surgical Services, Calgary Health Region.
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CanMEDS Roles

• Medical expert
• Professional
• Communicator
• Collaborator
• Scholar
• Manager
• Health advocate

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HTA and CanMEDS

• Manager
• Key competency
• Participate in activities that contribute to the
  effectiveness of healthcare organizations and
  systems
• Participate in systemic quality process
  evaluation and improvement, such as patient
  safety initiatives
• Describe principles of healthcare financing

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HTA and CanMEDS

• Manager
• Key competency
• Allocate finite healthcare resources
  appropriately
• Recognize the importance of just allocation of
  healthcare resources, balancing effectiveness,
  efficiency, and access with optimal patient care
• Apply evidence and management processes for
  cost-appropriate care

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HTA and CanMEDS

• Health advocate
• Key competency
• Respond to the health needs of the communities
  that they serve
• Appreciate the possibility of competing interests
  between the communities served and other
  populations

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HTA and CanMEDS

• Health advocate
• Key competency
• Promote the health of individual patients,
  communities, and populations
• Appreciate the possibility of conflict inherent
  in the role as a health advocate for a patient or
  community with that of manager or gatekeeper

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Why is HTA Important?

• Technology accounts for 50 to 60 of the health
  care cost inflation
• 50 of all diagnostic and treatment methods used
  today did not exist 10 years ago
• More than 20,000 drugs in Canada an estimated
  490,000 medical devices

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PMPRB Drug Categories

• Patented drug products reviewed by the Patented
  Medicines Review Board (PMPRB), 2003-2007

• New class of drug or substantial improvement
  over existing drugs for a specific disease
• Usually a new strength of an existing drug
• New version or dosage of an existing medicine

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Discussion

• Should we be involved in health technology
  assessment?
• At what stage?
• How?

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Steps in application of health technology
assessment
Efficacy Evidence
Economic evidence
Step 1 Production of HTA report
Health Technology Assessment Report Efficacy and
cost effectiveness

• Economic considerations
• Existing contracts
• Capital cost
• Maintenance cost
• Engineering cost
• Planning cost

• Administrative considerations
• Location / space
• Training of medical and support staff
• Credentialling
• Patient flow

• Clinical considerations
• Patient population, indications, and access
• Effectiveness in real world
• Safety / level of risk
• Number of patients affected

Step 2 Application of HTA report to local
situation

• Recommendation
• Not recommended
• Approved without restriction
• Restricted approval - audit of limited number of
  cases required
• Restricted approval as a local clinical trial
• Approved in principle pending allocation of
  funding

Poulin P. Local Health Technology Assessment
Tools for Local Decision-Makers, Revision
January 2008. The Department of Surgery and
Surgical Services, Calgary Health Region.
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Where HTA Can Be Used

• Macro level
• (health policy/funding)
• Meso level
• (health region or hospital/requestor)
• Micro level
• (users of technology)

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Example from University of Calgary (Calgary
Health Region)

• Department of Surgery (all divisions)
• Structure to assess new technologies
• Local needs (vary from national and international
  reports)
• staffing, priorities, populations,funding
  options, infrastructure
• Local HTA Research team developed decision
  support process and tools to assist in evaluation
  of new technologies

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Calgary Local HTA

• Workshops to get input on process and learn about
  HTA
• Incorporated input and changed tools to suit the
  departments
• Education sessions on using the process
• Formed local HTA advisory committee

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Calgary Local HTA Committee

• Involves
• Clinicians with training in epidemiology or
  public health
• Contract/costing expert
• Researcher
• Nurse
• Patient care manager

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Calgary Local HTA step 1

• 1. Technology request
• Device, process of care, medication
• Manufacturer
• Category
• New - innovative/experimental
• New - proven
• Replacement of existing technology
• Upgrade of existing technology
• Discard old technology
• Benefits and safety

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Calgary Local HTA step 1 (Cont)

• 1. Technology request
• Location for use
• Number of patients or devices
• Test limited number / permanent use
• Change from current practice
• Minor ? expedited review
• Significant uncertainties about safety,
  effectiveness, cost, or resources ? Local HTA

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Calgary Local HTA step 2

• 2. Local health technology assessment
• Patient population and indications
• Needs, benefits, advantages
• Potential to establish new standard of care
• Staff training
• Nursing care
• Physician/surgeon training
• Credentialing

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Calgary Local HTA step 2 (Cont)

• 2. Local health technology assessment
• Safety/level of risk
• Evidence source, level of evidence
• Outcome measures
• Effects on infrastructure and costs
• Capital cost
• Maintenance cost
• Engineering cost
• Planning cost

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Calgary Local HTA step 3

• 3. Local health technology assessment
• Recommendation
• Not recommended
• Approved
• Restricted approval audit
• Restricted approval clinical trial
• Approved in principal but more funding required
• Request HTA reports

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Next Steps

• Health technology assessment workshop
• Residents?
• HTA Committee?
• CADTH