Stirling Bryan PhD Graham Scotland PhD Mohsen Sadatsafavi PhD Overview of session Stirling Bryan In Search of Efficiency Consistency Fairness and Impact in HTA Graham Scotland Modelling screening and treatment pathways for diabetic retinopathy ID: 680743
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Slide1
In Search of Efficiency, Consistency, Fairness, and Impact in HTA: The Case for Clinical Pathway Management and Modelling
Stirling Bryan, PhD
Graham Scotland, PhD
Mohsen Sadatsafavi,
PhDSlide2
Overview of session
Stirling Bryan:
In Search of Efficiency, Consistency, Fairness, and Impact in
HTA
Graham Scotland
Modelling screening and treatment pathways for diabetic retinopathy
Mohsen Sadatsafavi
The
case for
whole disease modelling in
COPDSlide3
Disclosures and Acknowledgements
I am not aware of any actual or potential conflicts of interest in relation to this
presentation.
Some of my relevant current activities:
Chair, CADTH’s Health Technology Expert Review Panel
Member, CADTH’s Economic Evaluation Guidelines Working Group
Member
, BC’s Health Technology Assessment Committee
Director, VCH’s Centre for Clinical Epidemiology & Evaluation
Collaborators on this topic
Graham Scotland, University of Aberdeen
;
Mohsen
Sadatsafavi,
UBC;
Craig Mitton, UBC
; Cam Donaldson, Glasgow Caledonian University; Laurie Goldsmith, SFU; Rick
Sawatzky
, TWU
And many, many more…Slide4
Technology adoption
Technology management
Pathway management
Overview of talkSlide5Slide6
Technology management questions
Assessment
:
Does
the technology, as currently used, deliver value
?
Improvement
:
Can
more cost-effective utilization of the technology be achieved through modification of the clinical protocol?Withdrawal:
Should the technology no longer be in routine use and, hence, a process of withdrawal commenced?Slide7Slide8
Technology management questions
Assessment
:
Does
the technology, as currently used, deliver value
?
Improvement
:
Can
more cost-effective utilization of the technology be achieved through modification of the clinical protocol?Withdrawal: Should
the technology no longer be in routine use and, hence, a process of withdrawal commenced?Slide9
Graham’s talkSlide10
Technology adoption
Technology management
Pathway management
Overview of talkSlide11
Pathway management
Clinical pathway: defined sequence(s) of use of alternative health technologies
Pathway modelling becomes the foundation of HTA activity
Barton et al, 2004Slide12
Chen et al, 2006Slide13
Pathway management and ‘resource stewardship’
‘Resource
stewardship’
A
culture where resource scarcity is openly acknowledged and
recognized as a
shared responsibility
Pathway model development is a collaborative effort
Active engagement of, and ownership by, key stakeholders, including clinical leaders, policy makers, patients and analysts
The reference pathway model defines the resource envelopeConstraints on pathway reconfiguration are transparent
Proposed changes to the clinical pathway evaluated using the reference modelOpportunity cost considered explicitlySlide14
Stewardship facilitated through pathway modelling
Clinical leaders
and care teams
HTA analysts
Policy makers and managers
Patients and
carers
IndustrySlide15
Pathway management and ‘resource stewardship’
‘Resource
stewardship’
A
culture where resource scarcity is openly acknowledged and
recognized as a
shared responsibility
Pathway model development must be a collaborative effort
Active engagement of, and ownership by, key stakeholders, including clinical leaders, policy makers, patients and analysts
The reference pathway model defines the resource envelopeConstraints on pathway reconfiguration are transparent
Proposed changes to the clinical pathway evaluated using the reference modelOpportunity cost considered explicitlySlide16
Pathway management example
In RA, recent
evidence suggests
anti-TNF, biological
treatment
(infliximab) not
superior to conventional
combination therapy (MTX, SSZ, HCQ)
Barton et al, 2004
Eriksson et al, 2013Slide17
Scholz
&
Mittendorf
, 2014Slide18
Model validation…
“Computer models are no different from fashion models…
seductive, unreliable, easily corrupted and they lead sensible people to make fools of themselves.”
Jim
Hacker, ‘
Yes, Prime Minister’Slide19Slide20Slide21
In conclusion
Let’s break
our addiction to
technology adoption
Pathway modelling as a centrepiece of HTA work supports development of a stronger ‘resource
stewardship
’ culture
The mechanism:
Quantification
of resource commitment to a given clinical areaExplicit consideration of opportunity costSimultaneous consideration of investments and disinvestmentsAnalysis of technologies at different points in a clinical pathway, or even across different disease
pathwaysSlide22
mohsen’s talk