Abstract
Early stage evaluation of medical device innovations is important for healthcare decision-makers as much as for manufacturers, meaning that a wider application of a basic cost-effectiveness analysis is becoming necessary outside the usual expert base of health technology assessment specialists. Resulting from an academic-industry-healthcare professional collaboration, a spreadsheet tool is described that was designed to be accessible both to professionals in healthcare delivery organisations and to innovators in the healthcare technology industry who are non-experts in the field of health economics. The tool enables a basic cost-effectiveness analysis to be carried out, using a simplified decision-tree model to compare costs and patient benefit for a new device-related procedure with that of standard care employing an incumbent device or other alternative. Such a tool is useful to healthcare professionals because it enables them to rapidly elucidate the cost-effectiveness of heterogeneous innovations by means of the standard quality adjusted life year (QALY) measure of clinical outcome, which is intended to be broadly comparable across treatments. For the innovator or manufacturer it helps them focus on what is required for future stages of development, in order to fill gaps in the input data and so further strengthen their case from a health economics perspective. Results are presented of first experiences from deploying the tool on three medical device exemplars, in face-to-face meetings of the NHS National Innovation Centre (NIC) along with the innovator or clinical champion. The results show that mapping of device-related innovations to the tool is achievable in a short meeting between the NIC and the innovator using expected costs, outcomes data from the literature and estimates of ranges for unknown input data. Whilst the result of a simplified analysis is not expected to be definitive, the process of reasoning is found to be illuminating for the parties involved, enabling innovators to articulate the benefits of their innovations and for all parties to highlight gaps in data and evidence that will be required to take the innovation forward. The partnership model of the authors’ organisation supports the kind of cooperative design approach that is necessary to produce the kind of tool described.---------------------------7dd39101208fa Content-Disposition: form-data; name=c14_creators_1_name_family Craven
Highlights
Economic evaluation is commonplace in the assessment of therapies involving drugs and medical devices
In producing its early stage tool for use by medical device companies and the National Innovation Centre, MATCH needed to ask: o What features of the National Institute for Health and Clinical Excellence (NICE) reference case are important for an early stage analysis? o What kind of tool is most readily accessible to businesses and healthcare professionals who may have little prior knowledge of health economics? o What features of a tool are required to map the range of innovations presented to the NIC? o Will the tool enable an initial assessment to be made in a short time period? o Will the results of the analysis focus the innovators in the right direction?
By running the Solver component of the Excel spreadsheet for appropriate input ranges of costs, probabilities and utilities, it was revealed that overall cost differences between Saturation Driven Oxygen Therapy (SDOT) and conventional oxygen therapy vary to the extent that in the very worst case, the Incremental Cost Effectiveness Ratio (ICER) could possibly go over a willingness-to-pay threshold (WTP) threshold of £30,000 per quality adjusted life year (QALY)
Summary
Economic evaluation is commonplace in the assessment of therapies involving drugs and medical devices. As a measure of the take-up of such tools, in August 2008 the NHS National Innovation Centre had received 151 submissions of an idea to its Scorecard tool and 500 out of the 939 registered individuals had used it for their own use without submitting it to NIC Resulting from this focus on accelerating the adoption of innovations into the NHS, technology businesses that are developing new medical devices for sale in the NHS are being encouraged to think about cost-effectiveness analysis at an ever earlier stage in the innovation process. As MATCH grew its relationship with the UK National Health Service, it became clear that translation of HTA methodology of NICE into a decision aid for estimating cost-effectiveness of specific medical device innovations would be useful Out of these relationships emerged the idea for a software tool which is introduced . It is worth noting that another way of considering the cost-effectiveness from the manufacturer perspective is to see whether there is enough headroom between the price of the device and the WTP threshold to ensure that the innovation is profitable[8]
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