New Zealand Respiratory Conference 2014 NHC 2014 Marty de Boer

DISCLOSURES NHC 2014

NATIONAL HEALTH COMMITTEE Section 11 Advisory Committee responsible for providing the Minister of Health with independent, evidence based recommendations on:  Which technologies should be publicly funded in New Zealand  To what level and where technology should be provided  How new technology should be introduced and old technology removed NHC 2014

WHAT ARE WE TRYING TO ACHIEVE?  High quality health, wellbeing and independence outcomes for individual patients and populations  Evidence based value for money  Sustainability  Enhanced health contribution to GDP growth Sustainability: Continuing to provide the range and types of services (outcomes) currently available, or better, without incurring excessive levels of taxes and / or debt VfM = measurable health outcomes / $ value resources invested NHC 2014

NHC APPROACH … Evidence based, management of non-drug technologies with a focus on models of care Four domains  Clinical safety and effectiveness  Societal and ethical  Economic  Feasibility of adoption 11 decision making criteria A4R framework NHC 2014

MODEL OF CARE Components  Pathway of care for 80% of target patient population  Business model that supports and manages the resource critical nodes in the pathway of care NHC 2014

Proactive Reactive Pull model Sector Programme Budget Tiered business cases Notional Budget Sector annual referral round Innovation fund, HRC &CI Streams Tools NHC 2014 Technology management streams and tools

THEN AND NOW EGFR Catheter Ablation Learning Projects 26 Referrals Cardiac Cluster Sector Referrals COPD IHD Tiered Approach NHC 2014

PROGRAMME BUDGET 2013 NHC ANALYSIS OF 2010–2013 NMDS Source: NHC Strategic Business Plan 2014/15–17/18 NHC 2014 Mean % Price % ($1000s) Individuals % (n, thousands)

Proactive 14/15 Musculoskeletal and Eye 15/16 Neoplastics and Endocrine 16/17 Hepatobiliary and Kidney and Urinary 17/18 Digestive and Mental Health Reactive referrals Age Related Macular Degeneration Chronic Lower Back Pain Intra Operative Radio Therapy Pull model Diagnostics, genetic testing for bladder cancer Four year Strategic Work Programme NHC 2014

NHC Tiered Business Approach to Work Plans Sector Engagement and Participation Source; NHC Strategic Business Plan 2014/15-17/18 NHC 2014

National Prioritisation Network ‘working together for patients and communities’ Purpose to provide the NHC with direction, data, support and a regional perspective that enables wise and effective prioritisation implementation monitoring

NHC NOTIONAL BUDGET MANAGEMENT 1.Direct (Vote: Health) vs Indirect (Whole of Govt) 2.Cost avoided (‘notional’ savings) 3.Released value (‘real’ savings) cost effectiveness efficiencies reprioritisation 4.Evidence based investment (expenditure) 5.Movement of funds between spends NHC 2014

Example of a notional budget Source: NHC Executive Notional Budget paper 2014 NHC 2014

$265m public casemix hospital discharges 10 disease states Assess prevalence, incidence, health outcomes, health utilisation and cost Identify the disease state for Tier 2 assessment with the aim of improving health outcomes whilst maintaining or reducing costs through the prioritisation and application of the most cost effective new and existing health technologies across a model of care TIER 1 STRATEGIC OVERVIEW RESPIRATORY DISEASE IN NEW ZEALAND NHC 2014

Advisory Group Respiratory Physician DHB P & FDHB COO Respiratory Nurse Specialist PhysiotherapistPsychologist General Practitioner PHO Representative Patient Representative AmbulancePharmacist Thoracic Surgeon NHC 2014 Respiratory Working Group

Source: NHC Executive analysis 2013 NHC 2014 Source: 2013 NHC Executive Analysis of 2009/10–2011/2012 NMDS

Burden of Respiratory Disease Source: NZBDS 2013 DALY Breakdown by PercentageDeath Breakdown by Percentage NHC 2014

Source: 2013 NHC Executive analysis of 2010–2011/12 NMDS and 2010 National Mortality Collection Burden of Respiratory Disease NHC 2014

Incident Diseases Efficiency Gains Required to Reach $5 million 2013 NHC Executive Analysis of 2011/12 NMDS NHC 2014

Source; NCH Decision Making Paper 2013 NHC 2014

Tier 2 COPD: A Pathway to Prioritisation Source: OECD Data 2011 NHC 2014

Patient numbers and costs along the pathway NHC 2014 Source: National Health Committee Executive analysis (2013) of 2010/11 New Zealand Health Tracker

Source: National Health Committee Executive analysis (2013) of 2010/11 New Zealand Health Tracker data NHC 2014 Deprivation and Ethnicity

DHB non admitted ED rate and hospital discharge variation per 100 for Maori high-deprivation COPD patients Source :2013 NHC analysis of 2010/11 New Zealand Health Tracker data NHC 2014

NHC Model of Care for COPD 2013 NHC 2014 Tier 3 Assessments Improved diagnosis / case finding Pulmonary rehabilitation Long term oxygen therapy Non invasive ventilation Advanced care planning Strategies to reduce ED presentations, admissions and inpatient costs

NHC 2014 HIP ‘bottom up’ research $1.4m NHC Innovation Fund

LTOTPulmonary RehabNIVSpirometryACP NHC 2014

Source: NHC Executive Analysis of Garrett J, Chen B, Taylor DR. A Survey of Respiratory and Sleep Services in New Zealand Undertaken by the Thoracic Society of Australia and New Zealand (TSANZ). The New Zealand Medical Journal. 2009;122(1289). Long Term Oxygen Therapy

NHC 2014 Source: NHC Executive Analysis of DHB Oxygen Questionnaire Data, 2014

NHC 2014

Further Questions What does an appropriate LTOT rate look like? What is the possible health gain? What about portable oxygen? Less overall variation Most DHBs follow TSANZ or MoH guidelines Data kept inconsistent across DHBs X

NHC 2014 Thank you