How can the Healthcare System Deliver Innovative Medical Technologies to Patients Most Effectively? Dr Peter Groves MD FRCP Consultant Cardiologist Chair Medical Technologies Advisory Committee NICE Chair Health Technology Wales Chair Devices Expert Advisory Committee MHRA

Product Pathway to Patients

Opportunity cost

Health Technology Assessment Scarce resources DIFFICULT CHOICES FOR DECISION MAKERS Health Technology Assessment Evidence-based methods to guide the optimal allocation of health care resources

Assessing Clinical and Cost Effectiveness Comparison of two alternative treatment strategies Cost + More effective and more costly _ + Effect Less effective and less costly More effective and less costly _

NICE Medical Technology Evaluation Programme Selects medical device and diagnostic technologies for evaluation Produces evidence-based guidance that identifies clinical and cost benefits Promotes the adoption of worthy technologies Promotes ‘collaborative research’

MTEP recommendations Case for adoption Recommendation Fully supported Use Partially supported Use in specific circumstances Partially supported and potential to provide significant benefits Use in specific circumstances and develop further evidence Not supported but potential to provide significant benefit Use in a research context Not supported and no potential Negative

The Benefits of a Positive Medical Technology HTA PATIENTS SYSTEM COMPANY

Challenges for Generating Medtech Guidance Limited published evidence Resource constraints of industry Confounding factors - operator skills, learning curve Blinding bias; recruitment; drop-out Short product lifecycle and multiple iterations ‘Equivalent’ technologies

Evidence to Support Technology Selection by MTAC Between Dec 2009 and Nov 2015, 169 technologies were considered by MTAC 44% were selected for evaluation 702 studies of various types were presented to the committee in support of the claims Technologies that were selected had significantly greater total numbers of studies to support the claims than those that were not selected Campbell et al. International Journal of Technology Assessment in Health Care, 34:4 (2018), 419–424

Evidence to Support Technology Selection by MTAC Types of studies significantly associated with selection decisions cohort studies (p< 0.05) surveys (p < 0.05) cost analyses (p< 0.05) Types of studies significantly associated with technologies not being selected pilot studies (p< 0.05) unpublished studies submitted in confidence (p< 0.05) marketing claims with no substantiating evidence (p< 0.001) Types of studies that were represented equally in selected and non- selected groups RCTs p=NS Observational studies p=NS Campbell et al. International Journal of Technology Assessment in Health Care, 34:4 (2018), 419–424

Assessment of Devices, Diagnostics and Digital Technologies: A Review of NICE Medical Technologies Guidance Between Dec 2009 and Feb 2017, 31 Medical Technology Guidance (MTG) documents were published Of the 31 MTGs 14 were fully supportive 11 were partially supportive 6 were not supportive 58% had no RCT evidence All supportive MTGs had evidence of cost savings Crispi et al. Appl Health Econ Health Policy (2018). https://doi.org/10.1007/s40258-018-0438-y

Assessment of Devices, Diagnostics and Digital Technologies: A Review of NICE Medical Technologies Guidance Crispi et al. Appl Health Econ Health Policy (2018). https://doi.org/10.1007/s40258-018-0438-y

NICE MTEP Support for Medical Technology Selection and Guidance Consider the value proposition carefully Generate a small number of claims around clinical and cost benefits Develop evidence to support the claimed benefits Interact with NICE Scientific Advice

Health Technology Wales healthtechnology@wales.nhs.uk @healthtechwales www.healthtechnology.wales Dr Susan Myles Director Dr Peter Groves Chair Mr Steve Ham CEO

Origins of HTW Access to medical technologies in Wales (Dec 2014) recommended: ensure … a strategic approach to medical technology development and adoption develop options for an all-Wales medical technologies appraisal mechanism develop and establish a more strategic approach to the commissioning of new medical technologies in Wales which must be linked to a robust appraisal and evaluation process Velindre NHS Trust chosen to host Health Technology Wales/Technoleg Iechyd Cymru

Purpose of HTW To deliver a strategic and national approach to the identification, appraisal and adoption of new technologies into health and social care settings ‘Health technologies’ devices diagnostics procedures clinical interventions organisational interventions pharmaceuticals public health interventions HTW covers ‘non-medicines’ health technologies

HTW First Year Achievements 3 multi-disciplinary groups established Steering Group Assessment Group Appraisal Panel 15 staff recruited 57 topic referrals received from stakeholder groups 16 Topic Exploration Reports completed 4 pieces of Guidance published

www.healthtechnology.wales

Criteria for evaluating potential appraisal topics ALL OF: Current potential for quality improvement Likely impact on NHS resources Focused appraisal questions can be asked Sufficient published research findings No recent relevant NICE guidance ONE OF: Clear benefits to patients or NHS Uncertainty about clinical or cost- effectiveness Variation in provision or outcome across Wales Supports prudent healthcare

HTW Plans for the Future Topic selection Methodical and proactive approach Engagement with professional stakeholders Collaboration with NICE Healthtech connect Implementation and Adoption ‘Adopt or justify why not’ Work with Health Board MDs and CEOs to audit adoption of HTW guidance Increase Guidance output