1. 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

2. Product Pathway to Patients

3. Opportunity cost

4. 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

5. 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 _

6. 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’

7. 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

8. The Benefits of a Positive Medical Technology HTA
PATIENTS
SYSTEM
COMPANY

9. 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

11. 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

12. 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

13. 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).

14. Assessment of Devices, Diagnostics and Digital Technologies: A Review of NICE Medical Technologies Guidance
Crispi et al. Appl Health Econ Health Policy (2018).

15. 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

16. Health Technology Wales
@healthtechwales
Dr Susan Myles Director
Dr Peter Groves Chair
Mr Steve Ham CEO

17. 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

18. 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

19. 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

21. 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

22. 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