Health Technology Assessment A helicopter view

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Health Technology AssessmentA helicopter view

• Jean Mossman
• European Federation of Neurological Associations

Working for people living with brain disorders
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What is a health technology?
Prevention childhood vaccination
A procedure laparoscopy
A diagnostic test CT scan
A device cochlear implants
A drug insulin for diabetes
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Health Technology Assessment (HTA)

• HTA is a multidisciplinary process that
  summarises information about the medical, social,
  economic and ethical issues related to the use of
  a health technology in a systematic, transparent,
  unbiased, robust manner

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Why is HTA important for patients?

• HTA can provide information to support a range of
  decisions, for example
• Health authorities thinking of putting in place
  primary or secondary prevention programmes, such
  as screening programmes
• Health care payers deciding which technologies
  (e.g., operations, drugs) should be paid for
• Health care organisations deciding whether to
  exclude or implement new technologies such as
  modern types of radiotherapy
• Health care companies producing new products that
  may need to demonstrate a level of benefit for
  the product to justify the cost.
• HTA can also be used by individuals, including
• Patients and carers deciding which of the
  available treatment options best meets their
  needs
• Members of the public thinking of taking part in
  a screening programme.

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Treatment costs for infusional vs oral 5FU
Infusional Oral
Drug cost 563 464
Administration 1500 113
Adverse events 22 131
One-off costs 12 7
Total 6255 2132
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Patient costs for infusional vs oral 5Fu

• Infusional
• 3 days in hospital each fortnight
• Adverse events
• Discomfort
• Shortage of veins
• Loss of dignity
• Boredom
• Frustration
• Little time for real life

• Oral
• One outpatient visit every three weeks
• Adverse events
• Pills to take

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Benefit of oral treatment
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• Only patients and their caregivers know precisely
  how a disease impacts on daily life and how
  specific treatments or management strategies can
  influence its quality
• Treatments need to be assessed in the light of
  real world use
• At least 50 of patients dont take their
  medication as prescribed
• About 30 of patients interrupted treatment for
  at least 30 consecutive days in their first year
  on Glivec

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Experiential evidence shows what an illness and
a treatment mean in real life

• Saying you were sick five times each day is less
  meaningful than explaining that this means you
  cannot manage to go to work, or that it happens
  so quickly that you cannot make it to the toilet
  and have to clean up after yourself.
• Recording that the fatigue caused by existing
  treatments is so severe that it means you have to
  lie down all day and so cannot look after your
  children.
• Explaining that a pill is more acceptable than an
  intravenous treatment not just because it means
  less trips to hospital but because it allows you
  to continue living a more normal life.
• Describing the effect a treatment has on your
  daily life such as, it makes it impossible to
  stand on my feet all day, which means I cannot
  work.

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What do patients want from HTA?

• That the impact considered is broader than the
  health service
• Staying in the workplace
• Staying independent
• Staying active and mobile
• That the impact of an illness and its treatment
  on the patient and family is understood
• That illness is given a priority to reflect its
  burden
• That a true reflection of a drugs value is
  assessed
• That the assessors accept that all evidence has
  been generated with a particular view in mind

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Where can patient groups have input?

• Scope
• Defines what will be addressed by the HTA
• Assessment
• Reviews the available evidence and develops
  models where there is none
• Appraisal
• Makes decisions based on the assessment
• E.g. NICE decides whether a technology should be
  made available in England

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Collecting patient evidence

• Collect information on the experience of an
  illness from a range of sources, for example
• Enquiries to your organisation
• Surveys
• Focus groups
• Discussions at self-help and support groups, or
  hospital clinics
• Public presentations at official meetings, on
  websites or in the media

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Checklist for patient evidence

• Details of the benefits and risks of the
  technology what specific benefits does it
  provide and at what cost to patients and
  carers?
• What benefits does it bring?
• How do the benefits impact on patients daily
  life?
• How do the benefits compare with those of
  existing treatments?
• What unwanted effects does the technology cause?
• How tolerable are they?
• How do they impact on the patients daily life?
• How do the unwanted effects compare with those of
  other treatments?
• What would happen to patients if there was
  limited access to the technology?

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Checklist for patient evidence (2)

• How easily does the technology fit into patients
  daily life?
• Do they have to go to hospital to receive it?
• Do they have to take extra time from work?
• Does the technology prevent them from doing
  anything routine?
• Is anyone else affected, such as a family member
  accompanying the patient?
• How the illness and the technology being tested
  impact on
• The ability to work
• Self management of the illness
• Home life
• Social life and relationships

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It was deeply frustrating. I didnt feel as
though they were listening. The chairman moved
on every time I drew breath and they kept going
on about deafness, which is completely
irrelevant.

• Patient representative at NICE, March 2010

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Presenting patient evidence in person

• Below are some general assertiveness methods that
  you can use to make you more comfortable in the
  meeting
• Try to sit in the line of the Chairmans eye
• Have a notepad so you can write down what you
  want to say in response to anything said in the
  discussion
• If you are anxious, rehearse in your head how you
  will say something
• Acknowledge that you have understood the points
  being made but, if you do not agree, explain that
  you do not
• Be polite but persistent if you want to make a
  point
• Use brief statements that are to the point
• Avoid using expressions such as you must but
  introduce your comments in a non-threatening way,
  e.g. people with this illness would prefer .
• If you feel that your comments have been
  misunderstood, make the same point but in a
  different way

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HTA Summer School for patient groups

• Collaboration between EFNA and London School of
  Economics
• Sponsored by 16 companies

Working for people living with brain disorders
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Participants

• 27 participants from 11 countries
• National organisations
• Neurology and oncology
• Chief Executive or Policy Lead
• Good ability in English
• Organisation has resources to participate in HTA

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Conclusion

• HTA is here to stay
• Nothing about us without us
• Find ways to contribute
• Remember distress is not enough
• Patient involvement means a two way process

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• What is the point of patients and patient groups
  trying to contribute to health technology
  assessment if there is absolutely no evidence
  that their perspective is taken into account?
• Need transparency about where and how the patient
  evidence influences the decision making in HTA if
  we want patient groups to participate

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• Health Technology Assessment International
• Patient/citizen interest group
• www.htai.org
• LSE training course 2 4 June 2010, London
• Contact jean.mossman_at_btinternet.com