Health Technology Assessment & Innovation

Don Juzwishin, Director

September 21, 2010

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Objectives

• Outline HTAI – what we do• Brief Overview of the HTAI

Programs• How does Health Technology

Assessment differ from Appraisal, Management, and Quality Assurance – terms and example

• Describe the Toolkit that supports HTAI

• Examples of the Toolkit in action

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HTA & Innovation – What We DoHTA & Innovation Branch• Collaborate to lead the development

and implementation of an evidence informed decision support model for managing health technologies

• Identify, prioritize, assess health technologies expected to have significant impact on patient safety, clinical/cost effectiveness, health outcomes, clinical practice, workforce, policy, strategic priorities and system cost

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HTA & Innovation – What We Do

• Review health technology utilization (reassessment/disinvestment) – consider innovative alternatives with improved safety, quality, and/or outcomes

• Guide effective uptake of technologies• Collaborate with AHS stakeholders

(eg. Research) to develop an access through evidence development program (field evaluations, trials and pilot projects) to validate effectiveness of promising health technologies.

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The Health Care Technology Curve In Alberta

Research and Development

Experimental Technology

InnovativeTechnology

General Use Obsolescence/Replacement

Use

Time

HTA

HTA

HTA

Medical Device Licensing

InnovationDisinvestment

Obsolescence

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Health Technology Assessment

Are we doing the right thing?

Health Technology Appraisal

Should we be doing this here?

Health Technology Management

How do we do the right thing?

QualityAssurance

Are we implementing correctly?

Clinical effectivenessCost effectivenessSafety

AppropriatenessAffordability Training/credentialingGuidelines

SpecificationRFPProcurementSelectionCommissioning

Implementation programMonitoring Post-implementation clinical evaluation

Terms & Concepts

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Toolkit - HTAI Forms

• For use by the HTAI Satellite Committees and the HTAI Team to collect information in regard to the safety, efficacy, and organizational impact of requested new technologies – Health Technology Request – Health Technology Request Support – Health Technology Request Contract-Costing Check – Health Technology Request Resource Impact

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Toolkit - HTAI Tools

• Developed as guidelines for making decisions at various steps in the process; includes worksheets for evaluations, reports, and prioritization– STEEPLE Evaluation Guide – HTAI Team Project Charter – Technology Evaluation Worksheet – Technology Recommendation Report Template

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Example 1: AssessmentHysteroscopic Tubal

Sterilization

• Emerging technology (historical open tubal ligation current laparoscopic tubal ligation (standard of care) HTS

• Non-incisional procedure done on an outpatient basis

• HTS takes <20 minutes (laparoscopic surgery takes 30-40 mins)

• Shift out of the OR may in turn improve access and reduce wait times

• Clinical question: Should AHS be providing HTS?

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HTS - Unique Considerations

• Assessment of one technology leading to reassessment of another

• Need to triage to provincial committee (Alberta Advisory Committee for Health Technologies) for provincial review

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Example 2 – Reassessment

Lower Back Pain and MRI • Very little consensus on evaluation and management of low back

pain (LBP)• Patients with LBP experience similar outcomes, despite wide

variation in practice, specialties consulted, and overall cost of care• No evidence to suggest that labeling patients with low back pain by

use of specific anatomical diagnoses improves outcomes

• Operational Question: What is the effectiveness of performing X-ray or MRI compared with no investigation to improve pain, functional disability or psychological distress?

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LBP and MRI – Unique considerations

• How to disseminate results and best practice guidelines to clinicians

• How to encourage compliance to guidelines

• How to involve and educate the public

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Example 3 – Access with Evidence

Development Lymphadema

• The Alberta Lymphedema Association is advocating for access to publicly-funded treatment for both primary and secondary (cancer-related) lymphedema

• There is no standard approach to treatment of both primary and secondary lymphedema in the province

• The Cross Cancer Institute and Tom Baker Cancer Centres provide rehabilitation treatment for people with cancer-related

(secondary) lymphedema and a single consultation

visit for people with primary lymphedema

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Unique considerations

• Patient/public driven review

• Advocacy group will participate on the working group

• Collaboration between AHW and AHS

• Question of access to appropriate service/intervention

• Reassessment of service delivery – investigating the treatment of primary and secondary lymphadema

• Use of health technology assessments completed elsewhere (national or international)

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Example 4 - Innovation Biofilm Testing

• BioFILM PA tests for biofilm cultures in chronic pseudomonas aueriginosa infections (i.e. common in Cystic Fibrosis and Ventilator Acquired Pneumonia) to identify appropriate course of antibiotics

• Potential for improved antibiotic selection, decreased ER visits and hospital admissions, improved patient quality of life

• Operational Question: Should AHS provide BioFILM PA testing for chronic infections?

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Biofilm – Unique Considerations

• How to guide the movement of innovation of a promising health care technology from ‘promising’ to implementation and use

• Encouraging collaboration between internal and external stakeholders (AHW, AHS, IHE, AET, Campus Alberta, and Industry)

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Discussion And Questions