1 / 28

Evidence, HTA and Comparative Effectiveness in the U.S. Presentation at AMCP

Evidence, HTA and Comparative Effectiveness in the U.S. Presentation at AMCP. March 28, 2007 Peter J. Neumann Tufts-New England Medical Center. Overview. HTA around the world American exceptionalism? A new U.S. Center for Comparative Effectiveness? Looking ahead (implications for VA).

samuru
Download Presentation

Evidence, HTA and Comparative Effectiveness in the U.S. Presentation at AMCP

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. Evidence, HTA and Comparative Effectiveness in the U.S. Presentation at AMCP March 28, 2007 Peter J. Neumann Tufts-New England Medical Center

  2. Overview • HTA around the world • American exceptionalism? • A new U.S. Center for Comparative Effectiveness? • Looking ahead (implications for VA)

  3. HTA Around the World

  4. ISPOR MEMBERSHIP BY REGION 2006

  5. ISPOR Chapters

  6. American Exceptionalism?

  7. Explaining American exceptionalism in health care • The values argument • The “system” argument • The political obstructionist argument

  8. The U.S. Landscape • Medicare • AHRQ • Medicaid (the DERP) • Regional efforts • Other (VA!)

  9. Medicare spending trends Medicare Spending Per Beneficiary Total Part A Part B Part D Source: 2006 Medicare Trustees Report

  10. A New Center for Comparative Effectiveness?

  11. Activities of a Comparative Effectiveness Center • Conducting and/or sponsoring research • Setting research priorities • Providing a forum for methodological and other issues

  12. Placement Options • Within CMS • Within AHRQ • Within NIH • Within FDA • Creation of a new government agency • Creation of a quasi-public organization

  13. Governance, Oversight, and Funding • Institutional independence • Separation of assessment from decision making • Funding

  14. Substantive Issues • Methodological rigor • Analytic perspective • Objectivity and independence • Transparency • Stakeholder input • Appeals process • Identifying research priorities • Updating conclusions over time

  15. Implications • For the collection of evidence • For patient access • For innovation • For patient health

  16. Key issues • Level of evidence required • Tradeoff between rigor and timeliness • The process for evaluation and decision making • Role of CEA in HTA

  17. Will there be a role for cost-effectiveness?

  18. NICE in America?

  19. NICE Decisions by Cost-Effectiveness Threshold (1999-2003) >30 >30 20-30 >30 20-30 20-30 < 20 < 20 < 20

  20. Selected cost-effectiveness ratios for technologies covered by Medicare • Implantable cardioverter defibrillators: $30,000-$85,000/QALY • Lung-volume reduction surgery: $98,000-$330,000/QALY • Left-ventricular assist devices: $500,000-$1.4 million/QALY • PET for Alzheimer’s disease (Over $500,000) Source: Neumann et al., 2005

  21. Why don’t Americans use CEA? • Conflicting/weak incentives • Quality of evidence is problematic • Regulatory/legal barriers • Ethical concerns • Lack of infrastructure • Lack of cultural acceptance

  22. The role of the AMCP Format

  23. An audit of 115 dossier, 2002-2005

  24. Audit (page 2)

  25. Six trends to watch… • Rise of HTA organizations and evidence requirements • Increasing parsing of clinical evidence • Coverage with evidence development • Cost-effectiveness requirements • Flexible evidentiary standards • Quantification of risks/benefits • Adaptive clinical trials • Linking evidence to payment

More Related