mairin ryan presentation

8/12/2019 Mairin Ryan Presentation

1/29

Outlining theHealth

TechnologyAssessmentsystems andstructures in

Ireland

Mirn Ryan

Director ofHTA


2/29

Outline of presentation Some background

Establishment of HIQA and its roles Current HTA structures and workplans

Other HTA activity in Ireland

How will HTA progress in Ireland?


3/29

Health Technology Assessment

Health Technology Assessment (HTA) is amultidisciplinary process that summarises informationabout the

Medical

Social Economic

Ethical

Medicolegal Organisational issues

related to use of a health technology in a systematic,transparent, unbiased and robust manner


4/29


Objective:

To inform safe and effective healthpolicies that are patient focussed and

achieve best value


5/29

Health Information and QualityAuthority: Functions

Setting Standards

Monitoring Quality and Safety inHealthcare

Inspecting Social Services

Health Information


Driving safer better care


6/29

Health Technology Assessmentfunctions

The functions of the Authority are as follows.

-To evaluate the clinical and cost-effectivenessof health technologies including drugs and provideadvicearising out of the evaluation to the Ministerand the Executive

-To review and make recommendationsas theAuthority thinks fit in respect of the services, toensure the best outcomes for the resourcesavailable


7/29

rationingHTA for consumers/patients


8/29

Clinicans.

..a clinical purist?

..or a financial

realist?


9/29

Cost-effectiveness analysis (CEA)e.g. COST/LYG

Cost-utility analysis (CUA)

e.g. COST/QALY

Economic evaluations are usually in

the form of CEA or CUA.


10/29

Types of HTA Conducted in Ireland

HTAs of national significance by HIQA

Rapid HTA: e.g. single technology assessmentof pharmaceuticals by NCPE under HSE/IPHAagreement and guidelines in development

Mini-HTA: to inform local level decision-making?


11/29


HTAs of national significance by HIQA broad comprehensive HTA

use of independent economic models

informs national policy (Dept of Health) andnational service (Health Service Executive)

decisions

Rapid HTA: under HSE/IPHA agreement and

guidelines in development

Mini-HTA: to inform local level decision-making


12/29

Vaccination against HPV to preventcervical cancer

National Centre for Pharmacoeconomicscommissioned to conduct HTA

Adaptation of the Danish model

Girls aged 12 years: ICER17,383/LYS

2008 National Immunisation Programmeapproved but then .


13/29

Budget impact matters even when a

technology is deemed cost effective ?

Irish Times November 5th2008


14/29

Health Technology Assessment of

a

Population-Based Colorectal

Cancer Screening Programme in

Ireland


15/29


16/29

HTA Findings

Faeco-immunochemical testing (FIT) the optimal strategy

ICER1,696/QALY

Estimated:

15% reduction in incidence (160 cases per annum)

36% reduction in mortality (275 cases per annum)

Significant additional resource requirements - per annum:

12,000 to 15,000 colonoscopies

800 surgeries (but, < pre-programme requirements by year 9)

Ethics: importance of an effective and comprehensive informed consent

process, appropriately trained personnel, and robust quality assurance

procedures in relation to the handling and communication of risks

associated with screening in asymptomatic individuals


17/29

The challenge

Conventional HTA performed; highly cost-effective

Business model developed by NCSS

Further issues of implementation and affordability

needed to be explored to overcome a potential obstacle

to adoption

Could proposed new screening service be delivered

within existing resources and services, without

compromising their quality and safety?


18/29

Evaluation Findings

Use current infrastructure available in 8-12 existing specialistcentres, using extended working day if necessary and increasedcolonoscopist numbers including Advanced Nurse Practitioners

Significant opportunity for developing quality assured process inthis smaller number of centres

Significant opportunity to use existing managerial/administrativecapacity of the National Cancer Screening Service to reduceoverall costs (e.g. in population register maintenance)

Leveraging existing infrastructure versus new build screeningcentres reduced overall costs significantly, with savings from thismodel estimated at:

Capital expenditure: from15m to0Implementation costs: from7.2m to2.2m

Running costs:3m-6m per annum saved


19/29

Colorectal cancer screening and

cervical cancer vaccine to start under

Governments Cancer Control

Programme

Minister for Health announces newdetails

15 January 2010


20/29



Rapid HTA

new pharmaceuticals on Community DrugsSchemes under agreement

May support clinical guidelines in development



21/29

Scarcity means that choices must be made !

www.ncpe.ie


22/29

Expenditure on medicines in Ireland

(Community Drugs Schemes 1991 - 2008)

0

500

1000

1500

2000

2500

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

Millions

()

www.ncpe.ie


23/29

Targets to reduce expenditure across all aspects of the drugs

supply chain

Pharmaceutical

industry

Post patent price

reductions & reference

pricing

Wholesalers

Reduced margins

Pharmacists

Changing the

reimbursement

model

PrescribersGeneric prescribing

Awareness of

opportunity cost

Community drugsschemes

Disinvestment

Patients

Co-payments

www.ncpe.ie


24/29

National Clinical Guidelines

National Clinical Effectiveness Committee

National guidelines

Standards set by HIQA

Mandated by the MinisterAudit versus guidelines

Licensing versus standards

Rapid HTA to support evidence base: 2ndHIV test in the third trimester

Antiretroviral therapy to prevent mother to child transmission


25/29



Rapid HTA


non-pharmaceuticals through PCCC, e.g., CF

Physiotherapy Vest technologies including drugs at local hospital

level


26/29

HTA in 2011?

National HTA Policy Framework

Focus on cost containment / disinvestment

Clinical Effectiveness Guidelines


27/29

Role of HIQA

HTAs of national significance

Guideline development

Work with the health system to develop HTA capacity and methods

Finalise prioritisation criteria and procedure

Continue to collaborate with NCPE

Work with NCEC

Information resource and Horizon Scanning

Strategy on stakeholder engagement in HTA

Strategy on availability of cost data

Irelands representative on international collaborations


28/29

International collaboration

EUnetHTA Joint Action 1

Tofacilitate efficient use of resources available for HTA, to create a sustainable

system of HTA knowledge sharing, and to promote good practice in HTA

methods and processes.

Stakeholder Forum

EUnetHTA Joint Action 2

20122014

European Directive on Cross-Border Healthcare (15.1) :

a voluntary network connecting national authorities or bodies responsible for

health technology assessment designated by the Member States


29/29

Thank You

mairin ryan presentation

Documents