Transcript Health Technology Assessment

Health Technology Assessment
A helicopter view
Jean Mossman
European Federation of
Neurological Associations
Working for people living with brain disorders
What is a health technology?
Prevention: childhood
vaccination
A diagnostic test: CT scan
A device: cochlear
implants
A procedure:
laparoscopy
A drug: insulin for diabetes
Health Technology Assessment
(HTA)
• HTA is a multidisciplinary process that
summarises information about the medical,
social, economic and ethical issues related
to the use of a health technology in a
systematic, transparent, unbiased, robust
manner
Why is HTA important for patients?
HTA can provide information to support a range of decisions, for
example:
• Health authorities thinking of putting in place primary or secondary
prevention programmes, such as screening programmes;
• Health care payers deciding which technologies (e.g., operations,
drugs) should be paid for;
• Health care organisations deciding whether to exclude or implement
new technologies such as modern types of radiotherapy;
• Health care companies producing new products that may need to
demonstrate a level of benefit for the product to justify the cost.
HTA can also be used by individuals, including:
• Patients and carers deciding which of the available treatment
options best meets their needs;
• Members of the public thinking of taking part in a screening
programme.
Treatment costs for infusional vs oral 5FU
Drug cost
Infusional
£
563
Oral
£
464
Administration
1500
113
Adverse events
22
131
One-off costs
12
7
6255
2132
Total
Patient costs for infusional vs oral 5Fu
Infusional
• 3 days in hospital
each fortnight
• Adverse events
• Discomfort
• Shortage of veins
• Loss of dignity
• Boredom
• Frustration
• Little time for real life
Oral
• One outpatient visit
every three weeks
• Adverse events
• Pills to take
Benefit of oral
treatment
Only patients and their caregivers know precisely
how a disease impacts on daily life and how
specific treatments or management strategies
can influence its quality
Treatments need to be assessed in the light of real
world use:
– At least 50% of patients don’t take their medication as
prescribed
– About 30% of patients interrupted treatment for at least
30 consecutive days in their first year on Glivec
‘Experiential’ evidence shows what an
illness and a treatment mean in real life
• Saying you were sick five times each day is less
meaningful than explaining that this means you cannot
manage to go to work, or that it happens so quickly that
you cannot make it to the toilet and have to clean up after
yourself.
• Recording that the fatigue caused by existing treatments is
so severe that it means you have to lie down all day and
so cannot look after your children.
• Explaining that a pill is more acceptable than an
intravenous treatment not just because it means less trips
to hospital but because it allows you to continue living a
more normal life.
• Describing the effect a treatment has on your daily life –
such as, ‘it makes it impossible to stand on my feet all day,
which means I cannot work’.
What do patients want from HTA?
• That the impact considered is broader than the health
service
– Staying in the workplace
– Staying independent
– Staying active and mobile
• That the impact of an illness and its treatment on the
patient and family is understood
• That illness is given a priority to reflect its burden
• That a true reflection of a drug’s value is assessed
• That the assessors accept that all evidence has been
generated with a particular view in mind
Where can patient groups have input?
• Scope
– Defines what will be addressed by the HTA
• Assessment
– Reviews the available evidence and develops
models where there is none
• Appraisal
– Makes decisions based on the assessment
– E.g. NICE decides whether a technology
should be made available in England
Collecting patient evidence
• Collect information on the experience of
an illness from a range of sources, for
example:
– Enquiries to your organisation
– Surveys
– Focus groups
– Discussions at self-help and support groups,
or hospital clinics
– Public presentations at official meetings, on
websites or in the media
Checklist for patient evidence
• Details of the benefits and risks of the technology:
what specific benefits does it provide and at what
‘cost’ to patients and carers?
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What benefits does it bring?
How do the benefits impact on patients’ daily life?
How do the benefits compare with those of existing treatments?
What unwanted effects does the technology cause?
How tolerable are they?
How do they impact on the patient’s daily life?
How do the unwanted effects compare with those of other
treatments?
– What would happen to patients if there was limited access to the
technology?
Checklist for patient evidence (2)
• How easily does the technology fit into patients’
daily life?
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Do they have to go to hospital to receive it?
Do they have to take extra time from work?
Does the technology prevent them from doing anything routine?
Is anyone else affected, such as a family member accompanying
the patient?
• How the illness and the technology being tested
impact on:
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The ability to work
Self management of the illness
Home life
Social life and relationships
‘It was deeply frustrating. I didn’t feel
as though they were listening. The
chairman moved on every time I
drew breath and they kept going on
about deafness, which is completely
irrelevant.’
Patient representative at NICE, March 2010
Presenting patient evidence in person
• Below are some general assertiveness methods that you
can use to make you more comfortable in the meeting:
– Try to sit in the line of the Chairman’s eye
– Have a notepad so you can write down what you want to say in
response to anything said in the discussion
– If you are anxious, rehearse in your head how you will say
something
– Acknowledge that you have understood the points being made
but, if you do not agree, explain that you do not
– Be polite but persistent if you want to make a point
– Use brief statements that are to the point
– Avoid using expressions such as ‘you must’ but introduce your
comments in a non-threatening way, e.g. ‘people with this illness
would prefer ….’
– If you feel that your comments have been misunderstood, make
the same point but in a different way
HTA Summer School for patient
groups
Collaboration
between EFNA
and London
School of
Economics
Sponsored by 16
companies
Working for people living with brain disorders
Participants
• 27 participants from
11 countries
– National organisations
• Neurology and
oncology
– Chief Executive or
Policy Lead
– Good ability in English
– Organisation has
resources to
participate in HTA
Conclusion
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HTA is here to stay
‘Nothing about us without us’
Find ways to contribute
Remember ‘distress is not enough’
Patient involvement means a two way
process
“What is the point of patients and patient
groups trying to contribute to health
technology assessment if there is absolutely
no evidence that their perspective is taken
into account?”
Need transparency about where and
how the patient evidence influences the
decision making in HTA if we want
patient groups to participate
• Health Technology Assessment
International
– Patient/citizen interest group
– www.htai.org
– LSE training course 2 – 4 June 2010, London
– Contact [email protected]