TWO BY TWO: A METHODOLOGICAL PERSPECTIVE ON THE USE OF EVIDENCE TO SUPPORT THE VALUE OF A HEALTH TECHNOLOGY A/Prof Tracy Merlin Adelaide Health Technology Assessment (AHTA) School of Population Health University of Adelaide
HEALTH TECHNOLOGY
INDUSTRY PERCEPTION OF TECHNOLOGY VALUE (2X2) Cash cow hold & milk the technology Stars harvest technology s success Question mark invest? or divest? Dog divest from technology The Boston Consulting Group (BCG) Portfolio Matrix
DETERMINING TECHNOLOGY VALUE TO THE HEALTH SYSTEM Health Technology Assessment (HTA) is a form of policy research that systematically examines the short- and long-term consequences, in terms of health and resource use, of the application of a health technology, a set of related technologies or a technology related issue. Henshall et al. (1997)
Source: http://lillypad.eu/entry.php?e=51
METHODS OF EVIDENCE GENERATION. I. Strategic development of primary research (studies) on the technology fit-for-purpose (should address both regulatory and reimbursement requirements) more certainty in policy outcome but resource intensive
GREEN PARK COLLABORATIVE http://www.greenparkcollaborative.org/ AHTA, University of Adelaide 8
DECIDE NETWORK Dr Scott Smith, AHRQ Center for Outcomes & Evidence 2009
WHAT DOES DECIDE PRIMARILY DO? A. Analyse existing health care databases to compare the effectiveness & outcomes of treatment. B. Analyse existing disease, device, and other registries. C. Conduct methodological studies to improve research on clinical effectiveness of treatments.
POINTS FOR PRIMARY EVIDENCE GENERATION Target is: local market focus evidence generation to regional requirements global market broadly applicable evidence generation but tailoring to regional HTA requirements (studies with multiple comparators, multiple patient indications, different relevant health outcomes) Engage with policy/hta sector: to determine areas of clinical need prior to technology development prior to commencing human studies (research design advice RCTs are not always needed) possibilities of coverage with evidence development in areas of high need Tap existing resources academia and clinicians in the field, existing trial networks and administrative datasets / registers
METHODS OF EVIDENCE GENERATION. II. Collate or adapt published evidence from other sources in a manner that supports the value proposition and addresses the policy question less certainty in policy outcome (applicability of evidence may be poor) but less resource intensive
SCIENTIFIC EVIDENCE Source: http://www.flickr.com/photos/rosefirerising/3008488545/
SYSTEMATIC VS. NARRATIVE LITERATURE REVIEWS Scientific approach Comprehensive search for all relevant primary research Study selection criteria determined at outset Explicit pre-defined methods of appraisal and synthesis Meta-analysis may be used Review is replicable Approach depends on authors inclination Search any databases Author gets to select studies using any criteria (bias) Methods not usually specified Vote count or narrative summary Cannot replicate review
ECONOMIC MODELLING http://www.scielo.br/img/revistas/abc/v90n2/en_a05fig01.gif
POINTS FOR SECONDARY EVIDENCE GENERATION What is the clinical need for the technology? What are the patientrelevant benefits and harms of the technology? Define the clinical pathway: how will the technology be used in clinical practice in the targeted health system? in what setting will it be used? in what patient groups? what existing technologies will it replace or supplement? Are there any other interventions associated with use of the technology? Who will deliver the technology? Is additional training required? Systematically review the available clinical evidence. Does it address all of the points above? Can it be extrapolated from elsewhere? Model clinical effects and costs of delivering technology as described above.
POLICY PERCEPTION OF TECHNOLOGY VALUE (2X2) SW trade-off between costs/benefits NW reject technology NE trade-off between costs/benefits SE accept technology Petrou S, and Gray A BMJ 2011;342:bmj.d1548 2011 by British Medical Journal Publishing Group The cost effectiveness plane
QUESTIONS? tracy.merlin@adelaide.edu.au