Does Economic Evaluation lead to

increased uptake of new medical

technologies?

Brenda Dooley March 25th 2015

For consideration today

• What is Economic Evaluation?

• Methodological approaches in current use?

• Impact of evaluation decisions made in one jurisdiction

• Relevance for Ireland

What is an Economic Evaluation?

• Formal assessment of the major health effects a

new technology will have on the patient and the

health care system.

• Purpose is to inform decision making & meet the

needs of the decision maker.

• Assessment methods and practices need to fit

the technologies to be assessed, specific to the

decision to inform.

• Positive outcome should lead to funding and

uptake of new technology.

Differences between health innovations?

• Process of innovation for medical

devices and pharmaceuticals

differs greatly

• Dissimilar mechanism of action

• Product lifecycle

• Provision of robust clinical

evidence – v challenging for

medical devices

• Ready established pathways for

evaluation of pharmaceuticals not

entirely suitable for medical

technologies.

HTA in Practice

Medical Technologies Evaluation Programme (MTEP)

• MTEP provides a single entry point for manufacturers to submit

products for evaluation – then routed to appropriate evaluation

programme

• Overall objectives threefold – to simplify access to, speed up and

increase evaluation capacity for medical devices

• Products must have a CE mark, be new or represent a significant

modification and have clear benefits for patients of NHS

• 1st MTEP guidance published in 2010

• Recommended technologies not subject to mandatory funding

Methodological Approach by MTEP

• Cost Consequence Analysis – no attempt to summarise the benefits into

a single outcome measure.

• Subjective decision making - relative value of each outcome

considered.

• Limitations of the CCA - a medical device is only more beneficial than

current practice if it is resource releasing.

• Approach to evidence synthesis.

• “it (NICE) may discriminate against technologies that would ultimately

provide a net benefit to the NHS” 1

1. Greene W and Hutton J . Health technology assessments in England: an analysis of

the NICE Medical Technologies Evaluation Programme. Eur J Health Econ. 2014 .

Has MTEP been successful to date ?

• Medical Technology Guidance ( MTG ) published for 15 technologies in

initial 3 years of MTEP.

• Target for year 1 = 15 50 in future years

• 4 MTG published in 1st year

Overall

Evaluations

( 2010-2013 )

Recommended ,

some with

specific

circumstances

Further

research

required

Not

Recommended

15 12 2 1

Has MTEP been successful ?

2. Chapman, A.M., Taylor, C.A., & Girling, A.J., 2014. Are the UK Systems of Innovation and

Evaluation of Medical Devices Compatible? The Role of NICE's Medical Technologies Evaluation

Programme (MTEP). Appl Health Econ Health Policy, 12(4), pp.347-357.

Has MTEP been successful to date ?

2.Chapman, A.M., Taylor, C.A., & Girling, A.J., 2014. Are the UK Systems of Innovation and

Evaluation of Medical Devices Compatible? The Role of NICE's Medical Technologies

Evaluation Programme (MTEP). Appl Health Econ Health Policy, 12(4), pp.347-357.

By mid 2014,

nearly 2/3

exceeded

target with avg

of 16.7 mo’s 2

Has MTEP been successful to date ?

• While MTEP provides an accessible entry point for companies wishing to

submit a product for evaluation, barriers exist

• The current process at NICE attracts a small subset of mainly large

device manufacturers.

• Due to current evaluation timelines, high risk of guidance being

outdated prior to uptake.

• No Mandatory uptake of MTEP guidance in England.

NICE efforts to support uptake of new technologies

• Health Technologies Adoption Program (HTAP)

• Develops resources to aid the adoption of NICE guidance

• Topics selected are those identified as having potential adoption

barriers in England

• HTAP teams works with the NHS with a) demonstrator projects or

b) adoption projects

An Example

• Ambu aScope2 system; sterile, single-

patient use endoscope and reusable

monitor for complex intubations.

• During development of NICE guidance -

Ambu aScope3 launched

• HTAP developed a site demonstrator

pack to aid implementation & uptake

of usage : including info on new design

• One major limitation : no metrics on

impact of HTAP

Copyright Ambu Ltd

2013

Copyright Ambu Ltd 2013

Relevance for Ireland

• AdvaMed report recommends “use of value based criteria should be

routine in medical device procurement vs simplistic recourse to

procurement based on lowest price” 3

• IMSTA has called for a multi disciplinary Professional Evaluation Group

to be established to standardise medical technology Evaluation in

Ireland

• Also conducting a piece of work examining the issues associated with

how clinical investigations are currently conducted here

• Objective is a list of recommendations to help standardise how

evidence is collected in clinical investigations

3. IMSTA publication “New Approaches for procuring effective healthcare solutions”

published with permission of AdvaMed 2014

Conclusions

• The MTEP experience would suggest that evaluation of medical

technologies to date has not led to increased uptake

• Partly due to design of the MTEP

• Recent developments indicate willingness to address gaps in uptake

• Key learnings for Ireland if economic evaluation is to be introduced

• Appropriate timelines central coupled with appropriate methodologies

that are fit for purpose of evaluating medical technologies

• NB. A link should be established between guidance and uptake

THANK YOU