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Director of HTA
Outline of presentation
Some background
Establishment of HIQA and its roles
To inform safe and effective health policies that are patient focussed and achieve best value
- To evaluate the clinical and cost-effectiveness of health technologies including drugs and provide advice arising out of the evaluation to the Minister and the Executive
- To review and make recommendations as the Authority thinks fit in respect of the services, to ensure the best outcomes for the resources available
rationing
Clinicans.
HTA Findings
Faeco-immunochemical testing (FIT) the optimal strategy ICER 1,696/QALY Estimated: 15% reduction in incidence (160 cases per annum) 36% reduction in mortality (275 cases per annum) Significant additional resource requirements - per annum: 12,000 to 15,000 colonoscopies 800 surgeries (but, < pre-programme requirements by year 9)
Ethics: importance of an effective and comprehensive informed consent process, appropriately trained personnel, and robust quality assurance procedures in relation to the handling and communication of risks
The challenge
Conventional HTA performed; highly cost-effective Business model developed by NCSS Further issues of implementation and affordability
Evaluation Findings
Use current infrastructure available in 8-12 existing specialist centres, using extended working day if necessary and increased colonoscopist numbers including Advanced Nurse Practitioners Significant opportunity for developing quality assured process in this smaller number of centres
Significant opportunity to use existing managerial/administrative capacity of the National Cancer Screening Service to reduce overall costs (e.g. in population register maintenance)
Leveraging existing infrastructure versus new build screening centres reduced overall costs significantly, with savings from this model estimated at: Capital expenditure: from 15m to 0 Implementation costs: from 7.2m to 2.2m Running costs: 3m-6m per annum saved
Rapid HTA
new pharmaceuticals on Community Drugs Schemes under agreement May support clinical guidelines in development
www.ncpe.ie
Expenditure on medicines in Ireland (Community Drugs Schemes 1991 - 2008) 2500 2000
Millions ()
www.ncpe.ie
Targets to reduce expenditure across all aspects of the drugs supply chain
Pharmaceutical industry Post patent price reductions & reference pricing Community drugs schemes Wholesalers Reduced margins
Disinvestment
Pharmacists
Changing the reimbursement model
Prescribers
Generic prescribing Awareness of opportunity cost
Patients
Co-payments www.ncpe.ie
National guidelines
Standards set by HIQA Mandated by the Minister
Rapid HTA
Mini-HTA: to inform local level decisionmaking
non-pharmaceuticals through PCCC, e.g., CF Physiotherapy Vest
HTA in 2011?
National HTA Policy Framework Focus on cost containment / disinvestment Clinical Effectiveness Guidelines
Role of HIQA
HTAs of national significance
Guideline development
Work with the health system to develop HTA capacity and methods Finalise prioritisation criteria and procedure Continue to collaborate with NCPE
International collaboration
EUnetHTA Joint Action 1
To facilitate efficient use of resources available for HTA, to create a sustainable system of HTA knowledge sharing, and to promote good practice in HTA methods and processes.
Stakeholder Forum
Thank You