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Finding the right model of health technology assessment for device technologies and diagnostics is an important issue on this year’s agenda at the 2nd annual Health Technology Assessment Conference. In the lead-up to the event in December, we had the chance to speak to Peggy McBride, PhD, Health Economics and Outcomes Manager, Medtronic, ANZ about current assessment methods and the benefits of improving clinician engagement.
IIR Healthcare: What direction do you feel we should be moving in relation to assessment methods in Australia?
Peggy McBride: Despite the widely acknowledged differences between drugs and devices, current HTA methods for medical devices and diagnostics have been developed for the evaluation of pharmaceuticals and therefore impose a disproportionate and potentially inappropriate emphasis on high evidentiary standards. Although this may be an appropriate methodology for some new medical services, it could be argued that this model is over engineered for promising new technologies that represent a relatively low clinical and financial risk – resulting in delayed or denied access to technologies that could deliver substantial clinical benefits, cost savings or efficiency gains to the healthcare system.
By moving towards a flexible HTA model that tailors the method of evaluation to be commensurate to the net risk associated with the emerging technology, evaluation resources could be allocated more efficiently and access to promising technologies could be facilitated. It is envisioned this could be achieved by maintaining the existing MSAC framework, but implementing an additional HTA pathway to facilitate access to low risk emerging medical technologies.
A rapid review process would be consistent with global HTA methodology and has the potential to deliver considerable improvements in process efficiency while maintaining acceptable rigor without compromising patient outcomes.
IIR Healthcare: From an industry perspective, is it important to have hospital based Health Technology Assessment agencies? What effect does increasing clinician engagement have on the HTA process?
Peggy McBride: Whereas HTA has traditionally focussed on assessing the potential impact of new medical technologies and informing policy-making at a macro level, hospitals approach this question from a unique but complementary perspective – with greater emphasis on achieving improved efficiency and effectiveness at the point of service delivery. This is a highly relevant perspective as achieving efficiency gains at the hospital level is an essential precursor to improving the efficiency of the entire healthcare system.
Decisions related to the adoption of health technologies are likely to occur at the hospital level so institutional level HTA should be encouraged to support both managerial and clinical decision-making. The voice of the clinician is particularly valuable in this process as it is reflective of a pragmatic clinical assessment of the technology in the real-world setting and consideration of patient outcomes.
IIR Healthcare: In your opinion, what are the main challenges for industry in Health Technology Assessment in the next 12 months?
Peggy McBride: The topic for the conference is very timely as many in the industry see the current model for HTA as a rate limiting factor in our ability to provide timely access to the latest technological advances which could deliver substantial cost savings or efficiency gains to the healthcare system while improving patient outcomes.
Over the next 12 months, industry must face the challenge of convincing HTA agencies to adopt a more flexible and risk-appropriate approach to the evaluation of new medical technologies and procedures. If successful, there should be sufficient incentives to stimulate innovation and facilitate the timely access to safe, effective and cost-effective medical technologies that represent sustained economic value.
Peggy McBride: Medical technology is evolving rapidly but a cumbersome and time-consuming HTA process can result in delays in updating or implementing new procedure codes to reflect these advances. As a consequence, the MBS tends to lag behind innovation and there are insufficient incentives within the healthcare system to encourage adoption of potentially more efficient and cost-effective delivery of medical services. The result is a continued reliance upon outdated (but funded) technologies and procedures.
I would be interested to hear from conference participants as to whether there is a need to explore innovative approaches to HTA to address this concern, or if there are other ways to reward innovation and encourage uptake of new technologies.