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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