Health Technology Assessment & Innovation Don Juzwishin, Director September 21, 2010

2 Objectives Outline HTAI – what we do Brief Overview of the HTAI Programs How does Health Technology Assessment differ from Appraisal, Management, and Quality Assurance – terms and example Describe the Toolkit that supports HTAI Examples of the Toolkit in action

3 HTA & Innovation – What We Do HTA & Innovation Branch Collaborate to lead the development and implementation of an evidence informed decision support model for managing health technologies Identify, prioritize, assess health technologies expected to have significant impact on patient safety, clinical/cost effectiveness, health outcomes, clinical practice, workforce, policy, strategic priorities and system cost

4 HTA & Innovation – What We Do Review health technology utilization (reassessment/disinvestment) – consider innovative alternatives with improved safety, quality, and/or outcomes Guide effective uptake of technologies Collaborate with AHS stakeholders (eg. Research) to develop an access through evidence development program (field evaluations, trials and pilot projects) to validate effectiveness of promising health technologies.

5 The Health Care Technology Curve In Alberta Research and Development Experimental Technology Innovative Technology General UseObsolescence/ Replacement Use Time HTA Medical Device Licensing Innovation Disinvestment Obsolescence

6 Health Technology Assessment Are we doing the right thing? Health Technology Appraisal Should we be doing this here? Health Technology Management How do we do the right thing? Quality Assurance Are we implementing correctly?  Clinical effectiveness  Cost effectiveness  Safety  Appropriateness  Affordability  Training/  credentialing  Guidelines  Specification  RFP  Procurement  Selection  Commissioning  Implementation program  Monitoring Post- implementation clinical evaluation Terms & Concepts

7 Toolkit - HTAI Forms For use by the HTAI Satellite Committees and the HTAI Team to collect information in regard to the safety, efficacy, and organizational impact of requested new technologies –Health Technology Request –Health Technology Request Support –Health Technology Request Contract-Costing Check –Health Technology Request Resource Impact

8 Toolkit - HTAI Tools Developed as guidelines for making decisions at various steps in the process; includes worksheets for evaluations, reports, and prioritization –STEEPLE Evaluation Guide –HTAI Team Project Charter –Technology Evaluation Worksheet –Technology Recommendation Report Template

9 Example 1: Assessment Hysteroscopic Tubal Sterilization Emerging technology (historical open tubal ligation  current laparoscopic tubal ligation (standard of care)  HTS Non-incisional procedure done on an outpatient basis HTS takes <20 minutes (laparoscopic surgery takes mins) Shift out of the OR may in turn improve access and reduce wait times Clinical question: Should AHS be providing HTS?

10 HTS - Unique Considerations Assessment of one technology leading to reassessment of another Need to triage to provincial committee (Alberta Advisory Committee for Health Technologies) for provincial review

11 Example 2 – Reassessment Lower Back Pain and MRI Very little consensus on evaluation and management of low back pain (LBP) Patients with LBP experience similar outcomes, despite wide variation in practice, specialties consulted, and overall cost of care No evidence to suggest that labeling patients with low back pain by use of specific anatomical diagnoses improves outcomes Operational Question: What is the effectiveness of performing X-ray or MRI compared with no investigation to improve pain, functional disability or psychological distress?

12 LBP and MRI – Unique considerations How to disseminate results and best practice guidelines to clinicians How to encourage compliance to guidelines How to involve and educate the public

13 Example 3 – Access with Evidence Development Lymphadema The Alberta Lymphedema Association is advocating for access to publicly-funded treatment for both primary and secondary (cancer- related) lymphedema There is no standard approach to treatment of both primary and secondary lymphedema in the province The Cross Cancer Institute and Tom Baker Cancer Centres provide rehabilitation treatment for people with cancer-related (secondary) lymphedema and a single consultation visit for people with primary lymphedema

14 Unique considerations Patient/public driven review Advocacy group will participate on the working group Collaboration between AHW and AHS Question of access to appropriate service/intervention Reassessment of service delivery – investigating the treatment of primary and secondary lymphadema Use of health technology assessments completed elsewhere (national or international)

15 Example 4 - Innovation Biofilm Testing BioFILM PA tests for biofilm cultures in chronic pseudomonas aueriginosa infections (i.e. common in Cystic Fibrosis and Ventilator Acquired Pneumonia) to identify appropriate course of antibiotics Potential for improved antibiotic selection, decreased ER visits and hospital admissions, improved patient quality of life Operational Question: Should AHS provide BioFILM PA testing for chronic infections?

16 Biofilm – Unique Considerations How to guide the movement of innovation of a promising health care technology from ‘promising’ to implementation and use Encouraging collaboration between internal and external stakeholders (AHW, AHS, IHE, AET, Campus Alberta, and Industry)

17 Discussion And Questions