2014 12-02 hta emro banken 3

HTA for adding value to innovation: From research to use in health systems

Cairo, Egypt, Dec 2, 2014Second Inter-Country Meeting on Health Technology AssessmentEMRO/WHO

Reiner Banken [email protected]ève Plamondon [email protected]

Reiner Banken [email protected]ève Plamondon [email protected]

HTA for adding value to innovation: From research to use in health systems

Cairo, Egypt, Dec 2, 2014Second Inter-Country Meeting on Health Technology AssessmentEMRO/WHO

Reiner Banken [email protected]ève Plamondon [email protected]

HTA for adding value to innovation: From research to use in health systems

Cairo, Egypt, Dec 2, 2014Second Inter-Country Meeting on Health Technology AssessmentEMRO/WHO

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Defining innovation

• “Technological innovation as a device, procedure or organizational support system that is perceived as new by a proportion of key stakeholders in a healthcare organization, discontinuous with previous practice and which is intentionally introduced and directed at improving health outcomes” Robert et al,2010

• Conceptually new vs. Contextually new Mytton et al,2010

• “Innovation refers not only to the invention of new devices but also to adjustments to, or incremental improvements of, existing devices and clinical practices.” WHO,2010

• Incremental innovations vs disruptive innovations Hwang et Christensen,2008

Robert et al., Adopting and assimilating new non-pharmaceutical technologies into health care: a systematic review. Journal of Health Services Research & Policy,2010,15(4): 243–250.Mytton et al., Introducing new technology safely .BMJ Quaity and Safety, 2010;19(Suppl 2):i9-i14WHO. Medical devices: managing the mismatch: an outcome of the priority medical devices project,2010Hwang J et Christensen CM. Disruptive innovation in health care delivery: a framework for business-model innovation. Health Affairs 2008;27(5):1329-35.

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Definition used at INESSS

A definition inspired by the Global Forum for Health Research

Innovation encompasses the entire process from the generation of new ideas, to their transformation into useful services, products, methods, management practices and policies in health and social services.

Invention becomes an innovation when adopted by the health systemMobilizing a range of stakeholdersTransforms the context

Global Forum for Health Research (GFHR) (2010). Innovating for the health of all. Genève, Suisse. Disponible à : bit.ly/1gFuWxJ

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The role of HTA

• Increased pressure on public funding• Scarcity of heath resources• Public pressure: Newest is best!

HTA aims to inform the formulation of safe, effective, sustainable decision-making in health systems that is patient-focused and seeks to achieve best value

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Decisions

Technology diffusion is conditionnal

to different levels of decision-making

Time

Use

Decision-making•system•hospitals•patients/clinicians

InnovativeTechnolog

y

Obsolescence/Replacement

General UseResearch and development

ExperimentalTechnology

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ABSTRACTInnovation is often regarded as uniformly positive. This paper shows that the role of innovation in quality improvement is more complicated. The authors identify three known paradoxes of innovation in healthcare. First, some innovations diffuse rapidly, yet are of unproven value or limited value, or pose risks, while other innovations that could potentially deliver benefits to patients remain slow to achieve uptake. Second, participatory, cooperative approaches may be the best way of achieving sustainable, positive innovation, yet relying solely on such approaches may disrupt positive innovation. Third, improvement clearly depends upon change, but change always generates new challenges.

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HTA: A perspective from industry

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Common objectives for innovation

• Industry needs profits• Health Systems need to be sustainable• Patients want best care regardless of cost• Economic development wants to favor homemade innovation

• Innovation is necessary for improving patient care and health systems performance.

• HTA and other forms of evaluation are essential for translating the promise of innovation into reality.

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INESSS – 40 years of science advice for decision-making

Conseil d’évaluation des technologies de la santé

(1988)

Agences d’évaluationdes technologies et

des modes d’intervention en santé

Comité de revue de l’utilisation des médicaments

2000

Réseau de revue d’utilisation desmédicaments

Conseil consultatifde pharmacologie

Conseil du médicament

2003

2003

Social ServicesClinical Practice Guidelines

Institut nationald’excellence

en santé et enservices sociaux

2009

January, 19, 2011

1988

1996

1972 1991

2011

Medical BiologyLab tests

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INESSS advisory committee on HTA and innovative technologies (CÉTI)

• Created in December 2012• Advisory to the CEO

Objective: To promote a common understanding of the challenges of introducing innovative technologies into the health

system, and to identify possible solutions to ensure consistency in doing so, for the benefit of users

Composition: Representatives from patient and user groups, from the health technologies industry, from the research and HTA communities, from the economic development community, and managers of the health and social services network (local, regional and national levels)

For more information: http://www.inesss.qc.ca/en/networks-andpartnerships/bridging-mechanisms/advisory-committee-on-hta-and-innovative-technologies.html

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CÉTI: current work and next steps

To optimise the generation of knowledge in real-world settings for innovative technologies with the greatest potential for positive impacts on patients and the health system

Objectives: • To define the concepts related to the production of knowledge in real world

settings;• To develop a method for generation of knowledge in real-world settings for

innovative technologies, including a method to identify and prioritise the most promising technologies;

• To identify and discuss the operational and implementation challenges of the proposed approach;

• To propose a framework for the production of knowledge in real-world settings;• To promote and facilitate the use of this framework by different groups of

stakeholders

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Progessive field evaluation

Image adapted from the Living Lab Methodology Handbook, Ståhlbröst et Holst, 2012, available at http://www.ltu.se/cms_fs/1.101555!/file/LivingLabsMethodologyBook_web.pdf

Objectives:•Align the value proposal of an innovative technology with the needs of the users •Integrate the knowledge and the experience of the partners involved•Identify optimal conditions and adapt the use of a technology accordingly•Collect information about the effectiveness of a technology, as well as contextual and organizational elements relevant to decision makers

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Towards a learning health system

Health system

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Conclusions

• HTA is an important element of the innovation process by defining the uncertainties and critical conditions for appropriate use.

• HTA can represent advantages both for the health system as well as for economic development.

• Certain promising technologies, with a high degree of plausibility of delivering the promised value, should be introduced into the health system accompanied by evaluation.