proms in reimbursement and real-world assessments of ... · proms in reimbursement and real-world...
TRANSCRIPT
PROMs in reimbursement and real-world assessments of clinical
interventions
Stirling Bryan, PhD
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Disclosures
• Some of my relevant current activities: – Director, Centre for Clinical Epidemiology & Evaluation,
Vancouver Coastal Health Research Institute
– Chair, CADTH’s Health Technology Expert Review Panel
– Member, BC’s Health Technology Assessment Committee
– Member, EuroQol Group
• My Centre has a contract to conduct HTA projects for the BC Ministry of Health.
• I am not aware of any other actual or potential conflicts of interest in relation to this presentation.
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Overview of talk
• Example PROMs
• PROMs in support of HTA
• Moving from HTA to health technology management (HTM)
• PROMs in support of HTM
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Generic utility-based PROMs
Short Form Health Survey instruments
EQ-5D
5 Whitehead S J , Ali S Br Med Bull 2010;96:5-21
PROMs give us Quality-Adjusted Life Years (QALYs)
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Example Markov model
State 1 Mild
State 2 Moderate
State 3 Severe
State 4 Terminal
State 5 Death
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CEA / CUA results
“Riluzole is recommended for the treatment of
individuals with amyotrophic lateral sclerosis (ALS)
form of Motor Neurone Disease (MND).”
Results
Life-years gained 0.13 QALYs gained 0.09 Increase in costs $9,100 Incremental cost-effectiveness ratio Cost per life-year gained
$70,000
Cost per quality-adjusted life-year gained
$100,000
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Cost-effectiveness plane
Drummond, et al. 2005. Methods for the economic evaluation of health care programmes:
Oxford University Press
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MOVING FROM HTA TO HEALTH TECHNOLOGY MANAGEMENT
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Areas of concern
Primary concern: The ‘performance’ of health technologies in routine use
(1) Model validation questions: How good are our models? Are the predicted benefits and costs really delivered?
(2) Improvement questions: Can we get better value from existing technologies?
(3) Appropriateness questions: Do we see indication creep? (e.g., Statins for primary prevention in low-risk patients)
(4) Withdrawal questions: Are technologies nearing the end of their useful life?
14 Copyright ©2005 BMJ Publishing Group Ltd.
Miners, A H et al. BMJ 2005;330:65
Logged pairwise comparison of incremental cost effectiveness ratios
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Michael Fish and the Great Storm of 1987
www.youtube.com/watch?v=uqs1YXfdtGE
“The Great Storm of 1987
occurred on the night of 15–16
October 1987, when an
unusually strong weather
system caused winds to hit
much of southern England and
northern France. It was the
worst storm to hit England
since the Great Storm of 1703
(284 years earlier) and was
responsible for the deaths of at
least 22 people in England and
France.”
But what did the BBC weather forecaster say?
Wikipedia
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Areas of concern
Primary concern: The ‘performance’ of health technologies in routine use
(1) Model validation questions: How good are our models? Are the predicted benefits and costs really delivered?
(2) Improvement questions: Can we get better value from existing technologies?
(3) Appropriateness questions: Do we see indication creep?
(4) Withdrawal questions: Are technologies nearing the end of their useful life?
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Technology management
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Technology management examples
• Knee arthroplasty: – 20% of patients ‘dissatisfied’, many
with ongoing poor outcomes
• Asthma: – we have highly effective low cost
therapies that people don’t use
• Rheumatoid Arthritis: – recent evidence suggests high cost
biological treatment not superior to conventional therapy
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HTA and HTM
• Life-cycle evaluation of health technologies
– Data systems (including PROMs) to facilitate monitoring of technologies in use
– In part to validate analysis predictions made at the time of coverage/reimbursement
Early HTA Adoption Ongoing
assessment
Disinvestment Appropriate
Use
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A pan-Canadian HTM Strategy?
• CADTH leading this work
• Pan-Canadian HTM agenda (input from all jurisdictions)
• Consideration of overall system impact (including clinical guidelines, health human resources, fee codes)
• Common processes for new and in-use technologies
• Post-market surveillance programs (incorporating real world evidence)
• Enhanced knowledge mobilization
