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Implementation Considerations
in a HTA of Dialysis
Gino De Angelis, MSc
Eftyhia Helis, MSc
Janet Crain, MSc
Kristen Moulton, MSc
Laura Weeks, PhD
3RD WHO GLOBAL FORUM ON MEDICAL DEVICES
MAY 2017
ginod@cadth.ca
Disclosures CADTH is funded by Canadian federal, provincial, and territorial ministries
of health.
Application fees for three programs:
CADTH Common Drug Review (CDR)
CADTH pan-Canadian Oncology Drug Review (pCODR)
CADTH Scientific Advice
Presentation based on: Dialysis Modalities for the Treatment of End-Stage Kidney Disease: A Health
Technology Assessment. Ottawa: CADTH; 2017. (CADTH Optimal Use Report;
vol. 6,no. 2b).
Purpose of Implementation Reviews
(separate chapter in the HTA)
1. To inform HTERP deliberations by bringing attention to
issues that may impact on the implementation of a
recommendation
2. To help CADTH customers to implement recommendations
developed by HTERP
• To inform dissemination and implementation
support strategy for all customers (policy,
clinicians, patients)
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CADTH Dialysis Health Technology
Assessment (HTA)
• To inform policy questions regarding the optimal treatment
for eligible patients and effective methods of implementation
support for the various dialysis options for the treatment of
ESKD.
• Reviewed through an assessment of:
• clinical effectiveness
• cost-effectiveness
• patient experiences and perspectives
• ethical issues
• implementation issues
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Dialysis in Canada
• Several options for dialysis treatment are available to
patients with end-stage kidney disease (ESKD).
• Hemodialysis offered in a clinical setting remains the
most frequently used modality.
• Hemodialysis (HD) and peritoneal dialysis (PD) offered
in the home are less frequently used.
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Policy Questions • What is the optimal use, including patient selection and methods of
implementation, of self-care or assisted home dialysis (HD or PD) and
self-care in-centre HD?
• What strategies could effectively be used to enhance
implementation of self-care or assisted home dialysis (HD or PD)
and self-care in-centre HD among eligible patients?
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Implementation Review Research Questions • What strategies and processes have been used to implement home-
based and self-care in-centre dialysis programs for eligible patients with
ESKD?
• What contextual factors contribute to the implementation of home-based
and self-care dialysis programs for eligible patients with ESKD?
Methods – review
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• Stakeholder Survey
• Dialysis program professionals
• Nephrologists
• Nesrallah et al (2013)
• Targeted Literature Search
• Searched and included Canadian literature only (2000-present)
• Consultations with experts
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What we learned:
• Availability of treatment options in Canada is not uniform
• Infrastructure requirements must be in place to support
home-based and self-care modalities
• Facilitators and challenges for remote dialysis (as
reported by dialysis stakeholders)
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Key Messages & Implementation
Focus • For patients diagnosed with end-stage kidney disease (ESKD) deemed eligible
for home therapies by their care provider, self-care home-based dialysis
either with home hemodialysis (HHD) or peritoneal dialysis (PD) is
recommended.
• Patient eligibility, available capacity, reimbursement, patient preference,
awareness and education about dialysis modalities and quality of life
considerations should be considered prior to treatment assignment.
• Education to appropriately address existing knowledge gaps at various levels
of health care decision-making (policy, health administration, medical staff,
patients, caregivers)
• Facilitate sharing of successful strategies already underway across Canada.
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Summary and considerations
• A review of implementation considerations added a much
needed “context” aspect to the HTA and complemented all
other HTA review sections.
o HTERP recommendation; KM strategy for implementation
support
• Consultation; literature review; surveys and interviews (as
required)
• Do we know what to ask of our experts? What do we want
to know?
• Are other methods appropriate?
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