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© Value-Based Access Pty Ltd
Assessing the value of innovative medical technologies in procurement decision-makingEugene Salole PhD MPHPrincipalValue-Based Access Pty Ltd, Sydney, AustraliaConjoint Professor, Faculty of Medicine, UNSW, Australia
7th Annual National Hospital Procurement Conference, Sydney, 25th-26th October 2016
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DISCLAIMER
Opinions expressed in this presentation are entirely personal
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Medical technology - medical device - medtech• Products intended for diagnosis, prevention,
monitoring, alleviation, compensation or treatment of injury, disease or deficiency in anatomical or physiological processes – which do not achieve their intended action by pharmacological or physiological means
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‘Universal coverage’ healthcare systems: key concerns
• Quality of care and service delivery• Equity of access• Continuous availability of new
(often expensive) technologies• Rising professional expectations• Increasing consumer demands
– Expectation of immediate access to new technology
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Australian healthcare: key issue – financial sustainability
Intergenerational Report 2010: Australia to 2050 – Future Challenges[http://archive.treasury.gov.au/igr/igr2010/report/pdf/IGR_2010.pdf]
Australia population projections: 2016 & 2050 [US Census Bureau. International Data Base. http://www.census.gov/population/international/data/idb/informationGateway.php]
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National Commission of Audit report, 1st May 2014
• “…health care spending…the Federal Government’s single largest long-term fiscal challenge…”
• “Putting health care on a sustainable footing will require fundamental changes to all the components …”
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‘Value-based healthcare’
• Patient outcomes-focussed • Evidence-driven• ‘Value for money’
– Judicious selection and use of new technology
• Good procurement processes are key!
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Procurement• Complex exercise
– Impacted by many and varied factors • Traditional focus on:
– Delivering financial outcomes Optimising acquisition costs Minimising life-cycle expenditure Mitigating risk
– Ensuring good practice: fair and transparent processes, etc.
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Procurement & value for money
• ‘Value for money’: foundation principle of good procurement practice
• Value of innovative medical technologies to healthcare at risk of being overlooked
• Incorporating HTA principles in procurement practice allows evidence-driven assessment of overall product value
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Health technology assessment (HTA)• Multidisciplinary process of assessment by
systematic review of the evidence• Focus on:
– Health benefit - patient outcomes– Quality of evidence– Economic evaluation
• Identifies product value by comparative analysis of both benefit and cost
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Cohort studiesCase Control studies
Case SeriesCase Reports
Animal researchIn vitro research
Professional opinion
Randomised, controlled, double-blind trials (RCTs)
Systematic reviews and meta-analyses of RCTs
HTA: hierarchy of evidence quality
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HTA: economic evaluation• Data-driven framework for assessing value:
– Identify the alternative options – Assess the outcomes they provide– Determine their costs– Compare alternative outcomes and costs
COSTSHEALTH BENEFITS
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Economic evaluation: procurement perspective
Higher
Lower
Less More
COST
EFFECTIVENESS
REJECT !
ACCEPT !
ACCEPTABLE ?
ACCEPTABLE ?
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‘Cost-effective’
• Cost-effective ≠ more effective• Cost-effective ≠ cost saving
• Cost-effective = providing additional benefit worth the additional
cost
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HTA and national procure-ment of devices and medicines
[http://www.health.gov.au/internet/hta/publishing.nsf/Content/commonwealth-1]
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HTA for procurement: sources• Vendors
– Best placed to substantiate value of their product!! • National HTA agencies
– Medical Services Advisory Committee (MSAC)http://www.msac.gov.au/ Assessments of applications for government
subsidy of new services and their inclusion in the Medicare Benefits Schedule
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HTA for procurement: sources (contd.)
• National HTA agencies (contd.)– Health Policy Advisory Committee on Technology
(HealthPACT)https://www.health.qld.gov.au/healthpact/ Assessments of emerging technologies for
Australian Department and New Zealand Ministry of Health
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HTA for procurement: sources (contd.)
• National HTA agencies (contd.)– Australian Safety and Efficacy Register of New
Interventional Procedures - Surgical (ASERNIP-S)http://www.surgeons.org/for-health-professionals/audits-and-surgical-research/asernip-s/ Assessments of new and emerging surgical
technologies and procedures
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HTA for procurement: sources (contd.)
• Clinical literature – PubMed: full-text archive of 26 million biomedical
citations held at the US National Library of Medicine – online and free accesshttps://www.ncbi.nlm.nih.gov/pubmed/
• ‘Dr Google’
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Procurement, innovative medtech and value for money: concept applicable to all classes
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• ‘Technological imperative’ will ensure new medical technologies continue to become available…and clinicians will want to use them
• ‘Value imperative’ and HTA also fixtures – as long as effectiveness, efficiency and equity of healthcare service provision remain concerns – and control of expenditure a priority
Procurement, innovative medtech and value for money
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• What patient-relevant outcomes does the product offer? • Where is the supporting evidence?• How does the new compare with current practice?• Are any differences in patient outcomes worth it?
Procurement, innovative medtech and value for money: key questions
Salole E. Device technology procurement: shifting focus from cost to value. Australian Hospital and Healthcare Bulletin 2016; Summer: 68-70. http://www.hospitalhealth.com.au/news/shifting-focus-cost-value/
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