1 / 41

Laboratory Medicine Grand Rounds

Laboratory Medicine Grand Rounds. Health Technology Assessment for developers Janet Bouttell 15 November 2017. Health Economics and Health Technology Assessment (HEHTA). What I am going to talk about Who HEHTA are What health economics is NICE style health economics vs what we are doing

etimmons
Download Presentation

Laboratory Medicine Grand Rounds

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Laboratory Medicine Grand Rounds Health Technology Assessment for developers Janet Bouttell 15 November 2017 Health Economics and Health Technology Assessment (HEHTA)

  2. What I am going to talk about • Who HEHTA are • What health economics is • NICE style health economics • vs what we are doing • Health economics and precision medicine • Current projects Health Economics and Health Technology Assessment (HEHTA)

  3. Who we are and where we come from Health Economics and Health Technology Assessment (HEHTA)

  4. What is economics? Health Economics and Health Technology Assessment (HEHTA)

  5. What is health economics? Child Mental Health services Health budget Cancer drugs Health Economics and Health Technology Assessment (HEHTA)

  6. 1 Health profile with intervention Quality of life scale (0-1) Quality adjusted life years gained Health profile without intervention 0 8 Time (Years)

  7. Steps in the economic analysis • Define the ‘status quo’ in terms of expected cost and expected health outcomes (QALYs) • Specify how intervention could lead to different health outcomes (extension or improvement in QoL) • Translate clinical utility into QALY gains • Balance costs to give the expected value of the intervention • Incremental Cost Effectiveness Ratio (ICER) = cost/QALY gain

  8. The QALY • Visual Analogue scale • EQ5D3L/5L – EuroQol 5 dimensions, 3/5 levels (mobility, self-care, usual activities, pain/discomfort and anxiety/depression) - patients • Discrete Choice Experiments and Time Trade Off used to ‘value’ each health state – general population

  9. Visual analogue scale (VAS)

  10. NICE-style health economics? • Review some/all new medicines – value for money • NICE multiple technology appraisals compare existing drugs in one category (often as part of guideline development) • Mandatory/advisory • Devices (including diagnostics) different pathway but same idea Health Economics and Health Technology Assessment (HEHTA)

  11. The cost-effectiveness plane COST EFFECTIVENESS Health Economics and Health Technology Assessment (HEHTA)

  12. The cost-effectiveness plane COST EFFECTIVENESS Cheaper and more effective – no brainer! Health Economics and Health Technology Assessment (HEHTA)

  13. The cost-effectiveness plane COST More expensive and less effective – no way! EFFECTIVENESS Health Economics and Health Technology Assessment (HEHTA)

  14. The cost-effectiveness plane COST EFFECTIVENESS Cheaper and less effective – interesting! Health Economics and Health Technology Assessment (HEHTA)

  15. The cost-effectiveness plane COST More expensive and more effective – most usual EFFECTIVENESS Health Economics and Health Technology Assessment (HEHTA)

  16. The cost-effectiveness plane COST ICER for Drug B Threshold value for ICER EFFECTIVENESS Health Economics and Health Technology Assessment (HEHTA)

  17. NICE-style health economics (AKA HTA) Health Economics and Health Technology Assessment (HEHTA)

  18. NICE-style health economics (AKA HTA) Source of model diagrams – Buisman et al. Arthritis Research & Therapy (2016) 18:135 DOI 10.1186/s13075-016-1020-3 Health Economics and Health Technology Assessment (HEHTA)

  19. Probabilistic sensitivity analysis Threshold of £20,000 - £30,000 per QALY Source of model diagram – adapted from Advanced Decision Analytic Modelling Course Materials - HEHTA Health Economics and Health Technology Assessment (HEHTA)

  20. Some major controversies in NICE style health technology assessment • The amount of the threshold • End of life/orphan disease provisions • The QALY – is it sensitive enough? • The QALY – does it capture all aspects of value? • The QALY - should it distinguish between ages/working status?

  21. But NICE style health economics (or Health Technology Assessment) not really appropriate for us here because….. Health Economics and Health Technology Assessment (HEHTA)

  22. Steps for economic assessment in early stage of development process Health Economics and Health Technology Assessment (HEHTA)

  23. Value Wheel for biomarker-based tests Drugomics Drugomics

  24. Drugs don’t work in patients who don’t take them. — C. Everett Koop, M.D.[1]

  25. Drugomics - Stage 1 of the early HTA framework: Understand disease and treatment pathway: • Chronic treatment for asymptomatic disease • Associated with high levels of non-adherence • Worse health outcomes and increased resource use

  26. Drugomics - Stage 2 of the early HTA framework: Define the decision problem: • What is the value of a routine test of drug adherence in hypertension? • How would we demonstrate the value of the test? • Should we invest in development of the test?

  27. Stage 3 – Develop qualitative causal value model

  28. Drugomics Early HTA value added – from qualitative discussion • Focus at on what the value proposition is and be able to communicate it in a simple way • Identification of potential barriers/evidence requirements at an early stage • Can identify disease context factors which will add value – e.g. treatment escalation

  29. Value Wheel for biomarker-based tests Drugomics ORBIT

  30. Potential biomarkers in inflammatory disease

  31. Biomarker test to predict treatment response

  32. Stage 3 – qualitative causal value model Prescribe Ritux and increase responders

  33. Stage 3 – qualitative causal value model Save cost by not treating non- responders

  34. Stage 3 – qualitative causal value model Save cost by giving cheaper treatment

  35. Stage 4 – develop quantitative model Base case – no testing Test for TNFi response only Test for Ritux response only

  36. Other discussions/projects • Extension of KRAS/NRAS/BRAF testing in colorectal cancer • Potential for hormonal treatment of ovarian cancer (‘what if’ analysis) • Potential value of panel in Chronic Myeloid Leukemia • Potential health economics input to trial of pancreatic cancer panel • Cardiochip – point of care test for the simultaneous measurement of cardiac biomakers

  37. References 1) Health Economics 2017:1-16, 23-06-2017 Valuing health‐related quality of life: An EQ‐5D‐5L value set for England Devlin N, Shah K, Feng Y, Mulhern B, van Hout B. 2) 1] Adherence to Medication Lars Osterberg, M.D., and Terrence Blaschke, M.D. n engl j med 353;5 www.nejm.org august 4, 2005

More Related