Technology in Care

Andrew MarsdenMedical Advisor, National Procurement

Technology in Care

NationalProcurement

Biomedical TechnologiesBiomedical Technologies

Horizon Scanning & ProcurementHorizon Scanning & Procurement

Health Service Provider

Safety, Efficacy / Value Guidance

Patient Unmet Need

Medical &Surgical Practice

Product Development

Applied Science

Pure

Science

NationalProcurement

Health Service Provider

Safety, Efficacy / Value Guidance

Patient Unmet Need

Medical &Surgical Practice

Product Development

Applied Science

Pure

Science

Wave of Innovation… Wave of Innovation…

Breakthroughs

Biology - Genetics /Proteomics

Chemistry – Molecular / Combinatorial Chemistry

Physics – Biomaterials / Nano-Technologies

Mathematics & Computational

Increase Leads & Targets

Medicine / Biomedical Research

Molecular Engineering

Bioengineering

Biomechanical / Mechanical Engineering

Bio photonics

Bioinformatics

Electronic,/ Electrical Engineering

IT / Computational Engineering

Software Engineering

Etc etc + Convergence & Complexity

Targeted / Wider Indications

Pharmaceuticals – Large Molecule / MABS / RNAi

IV Diagnostics - Lab on a Chip

Imaging –Molecular Diagnistic Contrast, Dual Subtraction

Procedures – MIS , Screening

Biomedical Devices – Convergence

IT & Communications – WIRELESS, DICOM & EPR

Higher

Expectation

NationalProcurement

Health Service Provider

Safety, Efficacy / Value Guidance

Patient Unmet Need

Medical &Surgical Practice

Product Development

Applied Science

Pure

Science

COLLABORATE

•Trial/ In-Line Evidence Development

•Clinical Outcome Registries•Risk Sharing Deals•Strategic / Aligned procurement

Breakthroughs

Biology - Genetics /Proteomics

Chemistry – Molecular / Combinatorial Chemistry

Physics – Biomaterials / Nano-Technologies

Mathematics & Computational

Increase Leads & Targets

Medicine / Biomedical Research

Molecular Engineering

Bioengineering

Biomechanical / Mechanical Engineering

Bio photonics

Bioinformatics

Electronic,/ Electrical Engineering

IT / Computational Engineering

Software Engineering

Etc etc + Convergence & Complexity

Targeted / Wider Indications

Pharmaceuticals – Large Molecule / MABS / RNAi

IV Diagnostics - Lab on a Chip

Imaging –Molecular Diagnostic Contrast, Dual Subtraction

Procedures – MIS , Screening

Biomedical Devices – Convergence

IT & Communications – WIRELESS, DICOM & EPR

TRANSLATIONAL RESEARCH

COLLABORATION / INNOVATION

APPRAISING/ REGULATING

Health Technology Assessment (HTA)

NICE (1999) / SMC (2002)

ANTICIPATE

Horizon Scanning Centre

Higher

Expectation

NationalProcurement

The Scottish Health Technologies The Scottish Health Technologies GroupGroup

• SGHD Patients and Quality Division

• NHSQIS

• Board Chief Executives

• Board Finance Directors

• Board Medical Directors

• Directors Public Health

• Regional Planning Group

• Medicines Management Consultant

• Lay Representative

NationalProcurement

Remit of SHTGRemit of SHTG• To identify existing and new technologies, including devices, which

are likely to have significant implications for patient care in the NHS in Scotland, and areas where there may be evidence to support disinvestment

• To ensure that assessment and appraisal of the effectiveness of technologies is carried out as needed, taking account of assessment and appraisal work being carried out elsewhere, for example, by NICE, by the Centre for Evidence-based Purchasing, and by other Technology Assessment groups

• To facilitate the implementation by the NHS in Scotland of evidence-based recommendations on technologies including NHS QIS Health Technology Assessments and NICE Technology Appraisals

The group is advisory and has no directorial control over Health Boards

NationalProcurementBusiness of SHTGBusiness of SHTG

Scottish Health Technologies Group (SHTG)

•Horizon Scanning

•Appraisal of key topics, to include disinvestment of older technologies

•Supporting Implementation of Recommendations that are a material change to current practice

• Monitoring the take up of such initiatives

Quality Improvement Scotland (QIS) will…

•Prepare and circulate a quarterly horizon scanning report

•Maintain a register of all topics

•Record all decisions and actions

•Prepare and circulate systematic reviews and evidence notes of the clinical and cost effectiveness evidence for topics requested

•Prepare and issue to NHS Scotland implementation advice as requested

NationalProcurement

Sources of Horizon ScanningSources of Horizon Scanning

i. Non drug Technology Briefings issued by the National Horizon Scanning Centre University of Birmingham

ii. New HTAs that have entered the NHS QIS work programme since last horizon scanning Report

iii. Non drug HTAs published by i) NHS QIS ii) the National Coordinating Centre for Health Technology Assessment (includes all undertaken for NICE) and iii) those published by other international agencies

iv. SIGN Guidelines that have been consulted on since last horizon scanning report

v. NICE: Interventional Procedures

vi. Evidence Notes

vii. Topic proposals by Group members

viii. Topic proposals by National Procurement on new technologies and divestment

NationalProcurement

Define Requirement

Research Supply Market

Manage Supplier / Monitor Uptake

Tender / Product Scoring

Supplier Selection

Contract / Implement

P2P (Purchase to Pay

Tactical Procurement

Strategic Procurement

Publish Quantitive Market Data /

Commercial Research

Market Tracking

Actual vs committed

Market Status Update / Product Scoring &

Ranking

Company Pipelines

Targeted / Informed Priorities

Customer Alignment

Role of Procurement ? Role of Procurement ?

Horizon Scanning

Health Technology

Assessment

Monitor Uptake/ Assess Impact

Strategic Collaboration

NationalProcurement

CARDIOLOGY ( VASCULAR)

Current•Drug Eluting Stents •Bare Metal Stents•Catheters & Ballons •Hydrophilic / Hydrophobic Guidaewires•IVUS Imaging

Emerging•Bioactive stents •Bifurcation Stents•PFO Closure Device•Carotid Artery/ Full Body Stenting

Future•Bioresorbable Stents•Vulnerable Plaque•MS CT Angiography•C Reactive Protein Screening

Procurement Scanning opportunity? Procurement Scanning opportunity?

MUSCULOSKELETAL 36,975,000GASTROENTEROLOGY 16,650,000LABS / IV DIAGNOSTICS 15,700,000CARDIOVASCULAR 7,900,000ANEASTHETICS 7,890,000RENAL 7,750,000RADIOLOGY 6,417,631DENTAL 5,700,000OPTHALMOLOGY 4,500,000AUDIOLOGY 4,305,000GYNEACOLOGY 500,000NEUROLOGY ?REHAB & SUPPORTIVE 37,465,000SURGICAL 7,650,000TOTAL 162,322,807

Medical devices & Instruments

• Incremental vs. Disruptive ?

• Changes / Additions to Indications ?

• Rate of Change & momentum ?

• Financial Impact / Commercial Context ?

NationalProcurement

Areas of NP Involvement Areas of NP Involvement

•Input from commodity leads on market research in their areas of special interest

•Information from major suppliers and trade organisations on technology road-mapping

•Proposals for specific Health Technology Assessments on emerging areas

•Contribution on the take-up of new technologies (and the disinvestment of old) through the monitoring of the implementation of new national contracts

•Information on clinical outcomes following the introduction of a new technology

•Events & Reporting

NationalProcurement

"The NP Horizon Scan Report"

Brief Description of the Technology Likely Patient Group/s Current Treatment Alternatives Level and amount of research evidence currently

available (if known) Prediction of clinical and strategic relevance

NationalProcurement

"The NP Implementation Report"

Identify the value added of a strategically sourced contract OR manage the supplier-to-customer processes

Provide information to inform business cases and track implementation activity to monitor take up rates for new technology

OR displacement rates for disinvested products

NationalProcurement

Outputs from NHSQIS

• Evidence-based Assessment Report

• Supervision of Work Programme

• Publication on website

Report of evidence based assessments from Scottish Health Technologies Group

April 2008

HTA Programme: Report no HSRE/2008/001A Health Services Research and Effectiveness Unit

NationalProcurement

Current ExamplesCurrent Examples

• Blood Glucose Monitoring

• Insulin Pumps

• CPAP for Obstructive Sleep Apnoea

• Flexible Endoscopy technologies including nasal intubation and double balloon colonoscopy

• Interventional cardiology technologies including coronary stents and percutaneous valve insertion

•Blood Scavenging

•Digital mammography in breast screening

• Dual Energy Subtraction Radiology

• Tissue Viability Products e.g. Topical Negative Pressure; active micro-stimulation mattresses

• Haemostatic Agents