Disruptive Health Technologies:

Implications for HTA

Trisha Hutzul – Global Surgery Group (J&J)

May 7, 2013

Technology Disruption

“You want to look at which ones have a chance of having a

volume impact on many, many people, or large segments

of society.”

Eric Schmidt, Executive Chairman Google

Big “D” or Little “d”

How disruptive a technology is depends on breadth and

scope of impact.

A truly disruptive technology impacts:

• Healthcare delivery system

• Payment mechanisms

• Care pathway

• Patient outcomes

BIG “D” or Little “d”

Delivery Vehicle

Payment Scheme

Site of technology delivery

Patient Outcomes

TECHNOLOGY

IMPACT

WhoHow

Insurance

OR

HCP

Office

Billing

Codes

(DRG/FFS)

Procurement

Recurrence

QOL-

ADLHome

HCP

DeviceDrug

Nurse

Machine

Canada and Innovation

Canada was ranked 13 out of 17 in innovation by McKinsey

and Co in 2008

Conference Board of Canada placed us at 14 of 17th

WHY?

Surgery performed through small incisions or a natural

orifice using video cameras and specialized instrumentation.

This approach is often referred to as laparoscopic.

Minimally Invasive Procedures: Defined

Little “d” - MIP

Delivery Vehicle

Payment Scheme

Patient Outcomes

TECHNOLOGY

IMPACT

How

Billing

Codes

(DRG/FFS)

Procurement

Recurrence

SSI

QOL-

ADL

OpenMIP

Internal data on file: Thomson-Reuters. Estimated Procedure Volumes — 2010

Scope of Procedures

Representing 4.4 Million Patients

GENERAL SURGERYAppendectomy — 474,032

Cholecystectomy — 1,017,342

Reflux Surgery — 60,515

Ventral Hernia Surgery — 384,669

Inguinal Hernia Surgery — 564,160

WOMEN’S HEALTHHysterectomy — 555,574

UROLOGYProstatectomy — 109,040

THORACIC SURGERYWedge Resection — 37,676

Lobectomy — 56,766

BARIATRIC SURGERYGastric Bypass — 167,166

Gastric Banding — 82,105

Sleeve Gastrectomy — 17,718

COLORECTAL SURGERYColectomy — 296,949

Hemorrhoid Surgery — 585,671

Benefits to MIP Adoption

Hospital Length of Stay (LOS)1

Payment System

QOL: Pain, Scarring

Recovery Time

In certain procedures: Nosocomial Infection Rates2

Readmission Rates

Patient Outcomes

page 9

1. Gunnarsson C et al. The effects of laparoscopic surgery and nosocomial infections on the cost of care. Value in Health. 2008 July; Vol 12, Issue 1.

2. Brill A, Ghosh K, Gunnarsson C, Rizzo J, Fullum T, Maxey C, Brossette S. The effects of laparoscopic cholecystectomy, hysterectomy, and appendectomy

on nosocomial infection risks. Surg Endosc. 2008 Apr; 22(4):1112-8.

Hospital Length of Stay (LOS)1

Delivery Vehicle

Barriers to MIP Adoption

Coding

Offset of instrument cost to LOS – silo budgets

Payment System

Healthcare cost analysis concerned with cost management verses measuring health

impact on economic growth (indirect cost drivers)

Patient Outcomes

Delivery Vehicle

MIS Training

page 9

Procedure Rate of MIP

Hemorrhoidectomy – Removal of Hemorrhoids 9%

Colectomy – Partial or Complete Removal of Colon 28%

Hysterectomy – Removal of Uterus 44%

Appendectomy – Removal of Appendix 82%

Reflux Surgery – Surgery of Gastroesophageal Reflex Disease

(GERD)90%

Bariatric Surgery – Weight Loss Surgery 90%

Cholecystectomy – Removal of the Gallblader 95%

VATS – Pulmonary Wedge Resection 35%

VATS – Lobectomy 27%

Inguinal Hernia Surgery – Groin Repair 19%

Ventral Hernia Surgery – Abdominal Repair 35%

MIP Adoption Rates

Internal Data on File: Thomson-Reuters 2010

The BIG “D” - VERV™ Patient Managed

Neuromodulation System

Delivers a pulse envelope

(high + low pulse signals)

to calm nerves - ‘need’

verses ‘urge’

BIG “D” - OAB

Delivery Vehicle

Payment Scheme

Site of technology delivery

Patient Outcomes

TECHNOLOGY

IMPACT

WhoHow

Insurance

OR

HCP

Office

Billing

Codes

(DRG/FFS)

Procurement

Recurrence

QOL-

ADLHome

HCP

DeviceDrug

Nurse

Machine

Benefits of Non Surgical OAB

No DIN – cannot be paid through existing Pharma model

Not surgery – cannot be paid via existing OR budgets

Patient pay?

Patient Outcomes

Payment System

Delivery Vehicle

page 9

Non surgical ,non drug Tx

Non invasive, not implantable

Keeps patients mobile, out of LTC

Move from surgeon to specialist

Can be patient delivered

Barriers to OAB Market Entry

Where does innovation ‘fit’ (not drug or surgery)?

Lack of procedural coding and payment scheme

Patient Outcomes

Importance of chronic verses acute illness

OAB non priority illness

Delivery Vehicle

Move from OR to HCP office to home

page 9

Payment Scheme

Disruptive Technology Barriers

Short lifecycle of medical technologies

Length of time to commercialize disruptive technologies

verses short to medium term ROI

Markets with high evidence requirements and market entry

barriers also with smaller commercial opportunity

Barrier: Innovation Uptake

Disruptive Technology Solutions

Industry

• Develop strategies to minimize market entry barriers

early in product lifecycle

• Allow companies to make „go no go‟ decisions earlier in

innovation cycle by ensuring HTA is part of planning

process

HTA

• HTA moves from policy analysis → advisement →

implementation (Brazil ANS)

• Innovation fund (UK)

Disruptive Technology Solutions

Both

• Health authorities in addition to clinicians need to be

involved earlier in proof of testing

• Idea generation

• Product development phase

• Demonstrate value to the RHA, procurement:

• Better patient outcomes

• Reduction in costs

• Efficiency