In Search of Efficiency, Consistency, Fairness, and Impact in HTA: The Case for Clinical Pathway...
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In Search of Efficiency, Consistency, Fairness, and Impact in HTA: The Case for Clinical Pathway Management and Modelling Stirling Bryan, PhD Graham Scotland,
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,
PhD
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2 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 COPD
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3 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, CADTHs
Health Technology Expert Review Panel Member, CADTHs Economic
Evaluation Guidelines Working Group Member, BCs Health Technology
Assessment Committee Director, VCHs 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
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4 Technology adoption Technology management Pathway management
Overview of talk
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6 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?
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7
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8 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?
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9 GRAHAMS TALK
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10 Technology adoption Technology management Pathway management
Overview of talk
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11 Pathway management Clinical pathway: defined sequence(s) of
use of alternative health technologies Pathway modelling becomes
the foundation of HTA activity Barton et al, 2004
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12 Chen et al, 2006
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13 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 envelope Constraints on pathway
reconfiguration are transparent Proposed changes to the clinical
pathway evaluated using the reference model Opportunity cost
considered explicitly
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14 Stewardship facilitated through pathway modelling Clinical
leaders and care teams HTA analysts Policy makers and managers
Patients and carers Industry
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15 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 envelope Constraints on pathway
reconfiguration are transparent Proposed changes to the clinical
pathway evaluated using the reference model Opportunity cost
considered explicitly
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16 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, 2013
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17 Scholz & Mittendorf, 2014
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18 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
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21 In conclusion Lets 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 area Explicit consideration of opportunity cost
Simultaneous consideration of investments and disinvestments
Analysis of technologies at different points in a clinical pathway,
or even across different disease pathways