eugene salole - value-based access pty ltd

© 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

http://www.gsbme.unsw.edu.au/info-about/our-school


DISCLAIMER

Opinions expressed in this presentation are entirely personal


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

http://www.clockhouse.org/surrey-mri-scanning


‘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


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]

http://archive.treasury.gov.au/igr/igr2010/report/pdf/IGR_2010.pdf



http://www.census.gov/population/international/data/idb/informationGateway.php




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 …”


‘Value-based healthcare’

• Patient outcomes-focussed • Evidence-driven• ‘Value for money’

– Judicious selection and use of new technology

• Good procurement processes are key!


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.


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


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


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


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


Economic evaluation: procurement perspective

Higher

Lower

Less More

COST

EFFECTIVENESS

REJECT !

ACCEPT !

ACCEPTABLE ?

ACCEPTABLE ?


‘Cost-effective’

• Cost-effective ≠ more effective• Cost-effective ≠ cost saving

• Cost-effective = providing additional benefit worth the additional

cost


HTA and national procure-ment of devices and medicines

[http://www.health.gov.au/internet/hta/publishing.nsf/Content/commonwealth-1]


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

http://www.msac.gov.au/

http://www.msac.gov.au/


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

https://www.health.qld.gov.au/healthpact/

https://www.health.qld.gov.au/healthpact/



• 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

http://www.surgeons.org/for-health-professionals/audits-and-surgical-research/asernip-s/






• 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’

https://www.ncbi.nlm.nih.gov/pubmed/

https://www.ncbi.nlm.nih.gov/pubmed/


Procurement, innovative medtech and value for money: concept applicable to all classes

http://www.finermed.com/e_products/?big_id=3&small_id=49

http://www.hollister.com/Products/Ostomy-Care-Products

http://www.acaciamedical.com.au/products/personal-care-and-nursing/continence-care.php

https://bioclinicahoy.wikispaces.com/Diabetes+Mellitus+tipo+II

http://www.clockhouse.org/surrey-mri-scanning


• ‘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


• 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/

http://www.hospitalhealth.com.au/news/shifting-focus-cost-value/

http://www.hospitalhealth.com.au/news/shifting-focus-cost-value/


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