HERDING CATS: CORRALLING THE SUBJECTIVITY IN HTA Integration of a - - PowerPoint PPT Presentation
HERDING CATS: CORRALLING THE SUBJECTIVITY IN HTA Integration of a simple framework for translating evidence into policy at a hospital-based health technology assessment unit Nisha Almeida, PhD Epidemiologist, Technology Assessment Unit of the
Nisha Almeida, PhD Epidemiologist, Technology Assessment Unit of the MUHC April 16th, 2019
presentation.
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the developing of recommendations
inherent in HTA decision-making?
making process by consulting relevant stakeholders
making process by recording value judgements of different stakeholders
into an objective scoring system
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(Epidemiologist, Health economist)
(physicians, nurses, allied health professionals, administration, and patients)
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Background
Evidence Recommendation RCTs Observational studies Effectiveness Safety Cost Local data Decision- Making Process
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Background
1 2 3 4 5 6 7 8 APPROVED APPROVED FOR EVALUATION NOT APPROVED Frequency Recommendation type Weak Moderate Strong
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Background
Domain Comment Balance between desirable and undesirable effects
The larger the difference between the desirable and undesirable effects, the higher the likelihood that a strong recommendation is warranted. The narrower the gradient, the higher the likelihood that a weak recommendation is warranted
Quality of evidence
The higher the quality of evidence, the higher the likelihood that a strong recommendation is warranted
Values and preferences
The more values and preferences vary, or the greater the uncertainty in values and preferences, the higher the likelihood that a weak recommendation is warranted
Costs (resource allocation)
The higher the costs of an intervention—that is, the greater the resources consumed—the lower the likelihood that a strong recommendation is warranted
Domain Sub-domain Overall clinical benefit Effectiveness Safety Burden of illness Need Feasibility of adoption Economic feasibility Organizational feasibility Value for money Economic evaluations Consistency with expected societal and ethical values Expected societal values Expected ethical values
1 Grading of Recommendations Assessment, Development
and Evaluation, McMaster University
2 Ontario Health Technology Appraisal Committee
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Background
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Goal
1.
2.
3.
4.
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Objectives
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Objectives
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Objective 1: Results
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Objective 2
Respondent representation % MUHC member 73 HTA member 31 Administrator 23 Patient perspective 8
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Clinical Benefit
Value for money
Feasibility
Impact on patient
Impact on health system
Strategic concerns
Ethical considerations
Clinical Benefit
Value for money
setting
Feasibility
Ethics and Values
patients and/or health professionals
and external collaborations
new alternative treatment
centres
Strategic concerns Old version New version
After HTA completed
research staff
favourability of each domain Before committee meeting
committee members
importance of each domain At committee meeting
committee members
results from tool and make recommendati
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Objective 3
To evaluate the use of a hydrogel spacer as part
in patients with localized prostrate cancer at the MUHC
Policy Question
Patients with localized prostrate cancer receiving radiotherapy
Population
External beam radiotherapy (EBRT) + spacer gel
Intervention
EBRT alone
Comparator
Acute and late QoL (using EPIC), and adverse events (using RTOG or CTCAE)
Outcome
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Objective 4
complete the HTA and record their findings for each criterion
the findings are favourable:
GOAL: To ensure a systematic
approach to considering different factors relevant to the decision-making process.
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Objective 3
a link to the decision-aid tool to be completed online, along with the technology assessment report
rate the importance of each criterion based on their values and preferences and within the context of the technology
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Objective 3
3120373/?sguid=19Jk34IBN7VJczN0rk
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GOAL:
results of the health technology assessment.
important should also have received favourable findings.
made anonymously through our online tool ahead of the committee meeting.
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Objective 3
importance ratings and recommendations across the committee will be presented (see illustration).
justify extenuating reasons, until a consensus on the final recommendation is reached.
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69% 23% 8% A P P ROVE D A P P ROVE D F OR E VA LUA T ION NOT A P P ROVE D
DISTRIBUTION OF RECOMMENDATION TYPES AMONG COMMITTEE MEMBERS
GOAL: To create a structured and transparent decision-making process.
Objective 3
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Objective 4
DOMAINS CRITERIA FAVOURS APPROVAL? % CONSIDERING CRITERION Very Important Somewhat Not at all
Clinical benefit
Magnitude of effectiveness
No 73 18 9
Quality of the evidence
No 55 45
Safety of the technology
Maybe 55 36 9
Impact on Patient
Patient preference
No data 18 46 36
Impact on patient convenience
Maybe 18 64 18
Patient-reported outcomes
No 82 18
Value for money
Net cost
No 46 54
Costs avoided (increased hospital efficiency)
Maybe 27 64 9
Impact on budget of other departments
Maybe 36 55 9
Cost-effectiveness
No 64 27 9
Feasibility
Availability of local expertise
Yes 36 36 28
Disruptiveness
Yes 36 55 9
Need to generate local evidence
Maybe 27 64 9
Impact on cross-institution collaboration
No data 27 73
Satisfaction of personnel
No data 27 73
Impact of innovativeness of the technology
No 27 27 46
Impact on healthcare system /society
Benefit of the technology to society
No 55 45
Burden on other healthcare centres/services
Maybe 28 36 36
Need for the technology
Maybe 45 55
Ethical considerations
Ethical considerations
Yes 46 36 18
Strategic considerations
Stakeholder pressure
No 9 36 55
Availability of external funding
No 18 55 27
Number of patients affected by technology
Maybe 18 64 18
final recommendation
stakeholders to address the underlying nuances in a methodical fashion
stakeholders to acknowledge the lack of evidence for domains they consider important, thus tempering their championing of an unproven technology.
an anonymous fashion before the meeting, free of group pressure and the impact
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stakeholders
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Conclusion
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