mairin ryan presentation
TRANSCRIPT
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Outlining theHealth
TechnologyAssessmentsystems andstructures in
Ireland
Mirn Ryan
Director ofHTA
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Outline of presentation Some background
Establishment of HIQA and its roles Current HTA structures and workplans
Other HTA activity in Ireland
How will HTA progress in Ireland?
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Health Technology Assessment
Health Technology Assessment (HTA) is amultidisciplinary process that summarises informationabout the
Medical
Social Economic
Ethical
Medicolegal Organisational issues
related to use of a health technology in a systematic,transparent, unbiased and robust manner
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Health Technology Assessment
Objective:
To inform safe and effective healthpolicies that are patient focussed and
achieve best value
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Health Information and QualityAuthority: Functions
Setting Standards
Monitoring Quality and Safety inHealthcare
Inspecting Social Services
Health Information
Health Technology Assessment
Driving safer better care
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Health Technology Assessmentfunctions
The functions of the Authority are as follows.
-To evaluate the clinical and cost-effectivenessof health technologies including drugs and provideadvicearising out of the evaluation to the Ministerand the Executive
-To review and make recommendationsas theAuthority thinks fit in respect of the services, toensure the best outcomes for the resourcesavailable
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rationingHTA for consumers/patients
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Clinicans.
..a clinical purist?
..or a financial
realist?
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Cost-effectiveness analysis (CEA)e.g. COST/LYG
Cost-utility analysis (CUA)
e.g. COST/QALY
Economic evaluations are usually in
the form of CEA or CUA.
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Types of HTA Conducted in Ireland
HTAs of national significance by HIQA
Rapid HTA: e.g. single technology assessmentof pharmaceuticals by NCPE under HSE/IPHAagreement and guidelines in development
Mini-HTA: to inform local level decision-making?
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Types of HTA Conducted in Ireland
HTAs of national significance by HIQA broad comprehensive HTA
use of independent economic models
informs national policy (Dept of Health) andnational service (Health Service Executive)
decisions
Rapid HTA: under HSE/IPHA agreement and
guidelines in development
Mini-HTA: to inform local level decision-making
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Vaccination against HPV to preventcervical cancer
National Centre for Pharmacoeconomicscommissioned to conduct HTA
Adaptation of the Danish model
Girls aged 12 years: ICER17,383/LYS
2008 National Immunisation Programmeapproved but then .
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Budget impact matters even when a
technology is deemed cost effective ?
Irish Times November 5th2008
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Health Technology Assessment of
a
Population-Based Colorectal
Cancer Screening Programme in
Ireland
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HTA Findings
Faeco-immunochemical testing (FIT) the optimal strategy
ICER1,696/QALY
Estimated:
15% reduction in incidence (160 cases per annum)
36% reduction in mortality (275 cases per annum)
Significant additional resource requirements - per annum:
12,000 to 15,000 colonoscopies
800 surgeries (but, < pre-programme requirements by year 9)
Ethics: importance of an effective and comprehensive informed consent
process, appropriately trained personnel, and robust quality assurance
procedures in relation to the handling and communication of risks
associated with screening in asymptomatic individuals
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The challenge
Conventional HTA performed; highly cost-effective
Business model developed by NCSS
Further issues of implementation and affordability
needed to be explored to overcome a potential obstacle
to adoption
Could proposed new screening service be delivered
within existing resources and services, without
compromising their quality and safety?
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Evaluation Findings
Use current infrastructure available in 8-12 existing specialistcentres, using extended working day if necessary and increasedcolonoscopist numbers including Advanced Nurse Practitioners
Significant opportunity for developing quality assured process inthis smaller number of centres
Significant opportunity to use existing managerial/administrativecapacity of the National Cancer Screening Service to reduceoverall costs (e.g. in population register maintenance)
Leveraging existing infrastructure versus new build screeningcentres reduced overall costs significantly, with savings from thismodel estimated at:
Capital expenditure: from15m to0Implementation costs: from7.2m to2.2m
Running costs:3m-6m per annum saved
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Colorectal cancer screening and
cervical cancer vaccine to start under
Governments Cancer Control
Programme
Minister for Health announces newdetails
15 January 2010
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Types of HTA Conducted in Ireland
HTAs of national significance by HIQA
Rapid HTA
new pharmaceuticals on Community DrugsSchemes under agreement
May support clinical guidelines in development
Mini-HTA: to inform local level decision-making
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Scarcity means that choices must be made !
www.ncpe.ie
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Expenditure on medicines in Ireland
(Community Drugs Schemes 1991 - 2008)
0
500
1000
1500
2000
2500
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Millions
()
www.ncpe.ie
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Targets to reduce expenditure across all aspects of the drugs
supply chain
Pharmaceutical
industry
Post patent price
reductions & reference
pricing
Wholesalers
Reduced margins
Pharmacists
Changing the
reimbursement
model
PrescribersGeneric prescribing
Awareness of
opportunity cost
Community drugsschemes
Disinvestment
Patients
Co-payments
www.ncpe.ie
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National Clinical Guidelines
National Clinical Effectiveness Committee
National guidelines
Standards set by HIQA
Mandated by the MinisterAudit versus guidelines
Licensing versus standards
Rapid HTA to support evidence base: 2ndHIV test in the third trimester
Antiretroviral therapy to prevent mother to child transmission
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Types of HTA Conducted in Ireland
HTAs of national significance by HIQA
Rapid HTA
Mini-HTA: to inform local level decision-making
non-pharmaceuticals through PCCC, e.g., CF
Physiotherapy Vest technologies including drugs at local hospital
level
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HTA in 2011?
National HTA Policy Framework
Focus on cost containment / disinvestment
Clinical Effectiveness Guidelines
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Role of HIQA
HTAs of national significance
Guideline development
Work with the health system to develop HTA capacity and methods
Finalise prioritisation criteria and procedure
Continue to collaborate with NCPE
Work with NCEC
Information resource and Horizon Scanning
Strategy on stakeholder engagement in HTA
Strategy on availability of cost data
Irelands representative on international collaborations
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International collaboration
EUnetHTA Joint Action 1
Tofacilitate efficient use of resources available for HTA, to create a sustainable
system of HTA knowledge sharing, and to promote good practice in HTA
methods and processes.
Stakeholder Forum
EUnetHTA Joint Action 2
20122014
European Directive on Cross-Border Healthcare (15.1) :
a voluntary network connecting national authorities or bodies responsible for
health technology assessment designated by the Member States
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Thank You