CNESH Horizon Scanning:

Challenges and Alternative Approaches.

John Soloninka, PEng MBAPresident and CEO, HTX

jsoloninka@htx.ca

• Private non-profit corporation.

• Leading Canadian supporter of medtech.– Project financing – Support, ecosystem information broker and network.

Connectivity.

• De-risking  technologies and business plans.

• Multiple foreign market access initiatives.

• $21.4M HTCP fund – 38 financings – $86M total project value

• NEW REACH Innovation Procurement Fund

33 Portfolio Companies

Thoughts…

• Quick observations on Horizon Scanning• Value Proposition?• How HTX-led Initiatives might support

CNESH– National RISE Medtech Ecosystem Registry– REACH Innovative Technology Registry

23 International Scanning Organizations:Are there complementarities or collaboration potentials?

• EuroScan (20 government-funded members) • AHRQ• U.S. Centers for Medicare & Medicaid Services (CMS) • U.S. Food and Drug Administration (FDA)• U.S. Center for Disease Control and Prevention (CDC)• Private organizations: ECRI Institute, Frost and

Sullivan, Hayes, Ingenix, and Thomson Reuters.

EuroScan includes the following: • Agencia de Evaluación de Tecnologías Sanitarias

(AETS). Instituto de Salud Carlos III, Spain • Agencia de Evaluación de Tecnologías Sanitarias de

Andalucía, Spain (AETSA) • Agenzia nationale per i servizi sanitari regionali, Italy

(Age.na.s) • Australia and New Zealand Horizon Scanning

Network, Australia and New Zealand (ANZHSN, including Adelaide Health Technology Assessment [AHTA])

• Basque Office for Health Technology Assessment, Basque Country (OSTEBA)

• Canadian Agency for Drugs and Technologies in Health, Canada (CADTH)

EuroScan - continued: • Committee for Evaluation & Diffusion of Innovative

Technologies, France (CEDIT) • Council of the Netherlands, The Netherlands (GR) • Danish Centre for Evaluation and Health Technology

Assessment, Denmark (DACEHTA) • Division of Medical Technology Policy, Ministry of

Health, Israel (DMTP) • German Institute for Medical Documentation and

Information, Germany (DIMDI) • Haute Autorité de Santé, France (HAS) • Health Information & Quality Authority, Ireland

(HIQA) • Italian Horizon Scanning Project, Servizio

Farmaceutico Territoriale, Italy (IHSP) • Ludwig Boltzmann Institute for Health Technology

Assessment, Austria (LBI-HTA) • Managed Uptake of Medical Methods programme,

Finnish Office for Health Technology Assessment, Finland (Finohta [MUMM])

• National Horizon Scanning Centre, England (NHSC) • Norwegian Knowledge Centre for the Health

Services, Norway (NOKC) • Swedish Council on Technology Assessment in Health

Care, Sweden (SBU) • Swiss Federal Office of Public Health, Switzerland

(SFOPH)

Horizon Scanning Examples Show Wide DivergenceHealth System Priorities and Local Innovation Sector Influences Results

All of the lists are unique….no overlap?!Could be due to criteria, health systems, local technologies…

NHSC Evaluation:

Sensitivity, specificity, and predictive values of NHSC’s prediction methods.Estimated wrt expert opinion of the impact 3 to 5 years after prediction.

• Sensitivity 71% (95% CI, 0.36–0.92), • Specificity 73% (95% CI, 0.64–0.8), • NPV 98% (95% CI, 0.92–0.99), and • PPV 14% (95% CI, 0.06–0.3).

The authors concluded that NHSC methods were ..“reasonably good at identifying lower priority developments, but tended to assign significance to more topics than the experts considered significant in their later practice.”

Challenges…

• Increasing relevance?• Getting more nominations?• HTX-led Initiatives might support CNESH

– National RISE Medtech Ecosystem Registry– REACH Innovative Technology Registry

Possible Directions…• For Regulators

– Focus on new science discoveries and capabilities introducing new risks or requiring new reg. science.

• Eg. BYOD mobile diagnostics; radical material properties; new imaging modalities; implantable sensors; closed loop artificial organs; self appendectomy iPhone apps.

– Focus less on cool devices that are not new from a regulatory science or clinical trial perspective.

• For HTA bodies– Focus on “cross silo” or “lean” technologies that show dramatic

potentially to increase quality at reduced cost.– Focus on technologies that could fundamentally alter existing

treatment pathways for dramatic effect.

• For Procurement and Providers– Focus on technologies showing realized value, not potential.– Focus on 10x, 5x, 2x benefits actually achieved!– Allow industry to self report…based on demonstrated evidence.

RISE – Medtech Ecosystem DatabaseRegistry of Innovators, Suppliers and Exporters

Vancouver

Toronto Montreal

Alberta6%

British Columbia

11%Manitoba

4%New

Brunswick1%

Newfound-land0%

Nova Scotia2%

Nunavut0%

Ontario56%

PEI0%

Quebec19%

Saskatchewan1%

Yukon0%

Total Provincial Aggregate

MedTech RISERegistry of Canadian Medtech Innovators, Suppliers and Exporters

WHAT IS RISE?

A SUSTAINABLE ONLINE REGISTRY OF

MEDTECH ENTITIES2,700+MEDTECH RISE PLAYERS

MANUFACTURERS

GOVERNMENT ORGANIZATIONS/NPO

DISTRIBUTORS

INVESTORS

SERVICE PROVIDERS/CONSULTANTS

MEDIA

R&D SERVICES 20863

929594

382545

16

BENEFITS TO REGISTERING?

Improves LOCAL &INTERNATIONAL VISIBLITY for your

COMPANY

IDENTIFIEScompetition and relevant players in Medtech space enable

s

opportunitiesADVANTAGEOUS

partnership

COST-FREE & EASY REGISTRATION!

~3,000

Our Collaborators

Biotechgate Partners

REACH: A New Innovation Procurement Program.(Highlighted in the “Evidence is Not Enough” Panel)

Technology/Product Development/

Validation

Maturing/ Evidence

Generation

Scale: Diffusion/ Export - Local,

Global

Intake(Pipeline)

OntarioSales

$ MNEs

SMEs

AcademicSpinoffs

USEU

ROCChina

Ont

US

EU

Rest of Canada

China

Ontario

HTX REACHTraditional InnovationSupport

Pre-MarketDevelopment Post-Market Evaluation

and AdoptionForeign Market Access

REACH Planned Registries• Innovative Technology Registry

– To support procurement and providers– “What innovative technologies are out there?”– ‘What has worked well?”– Pre/Post market technologies – so less speculative– Can be linked to the Problem Registry below.

• Health System Problem Registry– To inform innovators of H/S Needs & Priorities– Three possible classes

• Generic (e.g. Deskilling, setting of care change, lean etc.)• Reform driven e.g. (5% focus, QBPs, etc.)• Clinical Priorities (eg. Re-admits on CHF, Dx Apnea, ALCs, etc.)