Incorporating patient perspectives in Canadian HTAs · Incorporating patient perspectives in...
Transcript of Incorporating patient perspectives in Canadian HTAs · Incorporating patient perspectives in...
Incorporating patient
perspectives in
Canadian HTAs
Gino De Angelis, MSc Laura Weeks, PhD 3rd WHO Global Forum on Medical Devices May 2017 [email protected]
Disclosures
CADTH is funded by Canadian federal, provincial, and territorial ministries
of health.
Application fees for three programs:
CADTH Common Drug Review (CDR)
CADTH pan-Canadian Oncology Drug Review (pCODR)
CADTH Scientific Advice
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HTA Components
Scientific process with the goal to analyze key properties of
a health technology:
• Comparative clinical effectiveness and safety
• Cost effectiveness
• Patient perspectives and experiences o Templates
o Engaging patients as experts
o Systematic reviews of published literature on PPE
• Organizational and implementation issues
• Ethical issues
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Our Approach
• Systematic review of literature related to patient and
caregiver perspectives and experiences
• Research questions address perspectives and experiences
of those impacted by policy recommendations • Broad, letting issues of importance emerge through review
• Protocol developed in parallel with other HTA sections • External peer review
• Lessons learned • Revisit methods after each project
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Systematic Review Methods
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Peer reviewed, literature
search
MEDLINE, Embase, PsycINFO, CINAHL,
and PubMed
Study selection
Predefined eligibility criteria
Double citation screening
Data extraction
Study and patient characteristics, code verbatim
results, in duplicate
Quality appraisal
Validated tool, in duplicate
Data Analysis
Thematic synthesis
• Following best practices:
• Separate chapter within HTA report
• Presentation to CADTH HTERP
• Inform deliberation and recommendations
Interventions for the Treatment of
Obstructive Sleep Apnea in Adults
What are the experiences and perspectives of adult patients,
their family members, and their caregivers regarding positive
airway pressure (PAP) devices, oral appliances, surgical
interventions, and lifestyle for the treatment of OSA?
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Interventions for OSA require
adaptation to daily routines
and relationships. Some
people are able to integrate
these interventions into their
life and experience benefits,
while others are unable
to do so.
Comfort and Side Effects
Presence of Support
Adaptation and Problem Solving
Impact on Self and Relationships
Information Needs
.
Experienced Benefits
Psychological Impact
Themes and Categories
What do these syntheses add?
• Understanding of how a technology is used, or interacts,
with patients in their daily life
• Provide insight into meaning of clinical results
• Identify when patient choice is important
• Provide insight into an economic model
• For certain technologies, PPE will be more or less important
• Impact on feasibility and acceptance of recommendations
(implementation considerations)
• Rationale to support recommendations
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Lessons Learned
• CADTH and HTERP recognize value
• Methodological rigour
• Parallels to clinical systematic review
• Unique evidence
• Useful to inform deliberations and recommendations
• Flexibility
• CADTH staff adapting to process and methods
• HTERP regarding integration within HTA
• Meeting demand for inclusion of patient perspectives
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Challenges
• Methodological challenges
• Too much or not enough studies
• Relevance to Canada?
• Poor reporting of study attributes and quality criteria
• Ideal methods versus what is feasible (HTA timelines)
• Integrating with other HTA components
• Specialized resources & research skills
• Shift from clinical and economic focus
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Summary
• CADTH is now including a systematic review of patient
preferences and experiences into assessments of medical
devices, procedures, and programs
o Stakeholder demand
o Best practices
o Inform deliberations
• Many challenges and facilitators identified
o Lessons learned Process change, methods
development
• Most important outcome: we are doing it
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