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Aligning, Foreseeing, and Optimizing HTA in Canada 2016 CADTH Symposium

April 12, 2016

Dr. Gabriela PradaDirector, Health Innovation Policy The Conference Board of Canadaprada@conferenceboard.ca

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Objective. Independent.Evidence-based.

Three principles guide us: insights, understanding, impact.

What we do: research, convening, education, and dialogue.

About The Conference Board of Canada

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Policy Question

“What is the experience, both within Canada and internationally, of HTA as a tool to provide knowledge for informing decisions on the adoption and appropriate use of pharmaceutical products and medical devices that benefit patients and/or wider health system, as well as the disinvestment and displacement of pharmaceutical products and medical devices currently used?”

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• Literature review

• Thirty-four, one-hour key informant interviews conducted over a three-month period (June to August, 2015)

• Three international case studies (UK, Germany, Italy – ongoing)

• Online survey of HTA organizations in Canada

Methodology

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• Number: 31 HTA producers in Canada were invited to participate. 42 percent (13) replied.

• Mandate: generate HTA reports to support decision making (11 of 13); support public policy and resource allocation (6 of 13); train professionals in HTA methods (2 of 13).

• Team: In most organizations staff involved in HTA work have at least a masters degree as their highest qualification. Multidisciplinary teams include medical librarian/information specialists, clinicians, epidemiologists, health economists, statisticians.

Understanding HTA Producers

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• Funding: Less than $500k (8); $1 million or more (5). Governments, grants, and hospital are the main source of these funds.

• What do they look at? Processes of care was the most common, followed by medical devices, medical procedures, combination technologies, pharmaceutical products, modes of intervention/organization of services, and laboratory testing/screening. Most respondents indicated their HTA work is used to provide evidence for technology adoption, displacement, or both.

Understanding HTA Producers (2)

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Methods Used for Assessments

Benchmark-testing

Group judgement

Clinical trials

Post-marketing surveillance

Epidemiological/observational

Modelling

Cost or economic

Expert opinion

Meta-analysis

Systematic review

0 2 4 6 8 10 12 14

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Perception of Functioning of the Process

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• Canada’s approach is more fragmented, especially for its size

• Separation of the HTA producer and policy-maker functions is desirable to avoid political influence

• Disinvestment/Re-assessment is a challenge in all jurisdictions

• The use of Decision Analytical Modelling (DAM) as well as other qualitative evidence that focus on the patient and caregiver perspectives allow HTA assessments to be more flexible

Learnings from other Jurisdictions

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• The mandate for HTA producers is evolving and this sometimes leads to a disconnect between the evidence needed for decision making and the information provided by HTA assessments

• Inventory management system of ‘first-in-first-out’ for priority does not work well. Options: horizon/environmental scanning? Focus on areas with worse mortality?

• Public and patient involvement in HTA is still very limited

• Real-world data and adaptive pathways are more often needed

• Limited sharing across HTA producers due to use of different frameworks, lack of databases

Challenges

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The Alzira Model in Spain: increased patient satisfaction by 20%, while costs decreased by 25%

Increasing Value of Health Care Delivery

Outcome

Cost

HC Value =

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What is Value?

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• Support value-based healthcare systems: define outcomes, performance measures, and value and design HTA to support the measurement of these.

• Harmonization of language, framework, and products –EUnetHTA for Canada? facilitate efficient use of resources

available for HTA, create a sustainable system of HTA knowledge sharing, promote good practice in HTA methods and processes.

• Develop robust priority setting process (e.g., include criteria such as impact of health outcomes and potential costs).

• Synchronization with regulation and procurement processes.

Opportunities

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• Develop better metrics (e.g., modeling care pathways and options of care within these pathways).

• Invest in disease registries, unique identifiers, improve information systems, and broaden access to data outside of the health system.

• Develop frameworks to support better technology management (e.g., systematic disinvestment/reassessment).

Opportunities

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Closing Remarks •Canada is a world leader in health technology assessment.

•Value within health care is being redefined. HTA needs to adapt to the changing needs of health care.

•Need to clearly define the role of HTA within VBHC and VBP.

•Patchwork system for non-drug technologies in Canada needs to be addressed.

•Greater collaboration with key stakeholders is required to measure value.

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