Patient-Centred Decision Making with MCDA:
Should We Be Trying to Quantify the Patient Voice for Use in HTA?
ISPOR 2016, Vienna, 31 October 2016
Prof. Dr. Peter Kolominsky-Rabas, M.D.; M.B.A.
Interdisciplinary Center for Health Technology Assessment (HTA) and Public Health
Friedrich-Alexander-University Erlangen-Nürnberg
Executive Board, National Cluster of Excellence ‚Medical Technologies - Medical Valley EMN’
"Whenever a theory appears to you as the only possible one,
take this as a sign that you have neither understood the theory
nor the problem which it was intended to solve.”
The Logic of Scientific Discovery, 1959
© 2016 Medical Valley EMN I Prof. Kolominsky-Rabas I Patient-Centered Decision Making with MCDA I SPOR 19 th Annual European Congress I Vienna I 31-10-2016
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Sir Karl Popper
born 1902 in Vienna
died 1994 in London
Austrian and British philosopher
Professor at the London School of Economics
He is considered one of the most influential
philosophers of science of the 20th century
© 2016 Medical Valley EMN I Prof. Kolominsky-Rabas I Patient-Centered Decision Making with MCDA I SPOR 19 th Annual European Congress I Vienna I 31-10-2016
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Patient Focused Decision-Making in HTA
Key Questions
■ How are patients involved in the HTA- Sytems?
■ To which extent is MCDA today part of the current HTA processes?
© 2016 Medical Valley EMN I Prof. Kolominsky-Rabas I Patient-Centered Decision Making with MCDA I SPOR 19 th Annual European Congress I Vienna I 31-10-2016
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Patient Focused Decision-Making in HTA
Systematic Review from 2016
Abelson J et al. Public and Patient Involvement in HTA. International Journal of Technology Assessment in Health Care, 32:4 (2016)
© 2016 Medical Valley EMN I Prof. Kolominsky-Rabas I Patient-Centered Decision Making with MCDA I SPOR 19 th Annual European Congress I Vienna I 31-10-2016
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Patient Focused Decision-Making in HTA
Systematic Review - Results
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Broader view
Public AND Patient involvement in HTA
53 HTA agencies, 34 countries
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Research questions
- How are HTA oranizations involving public and patients?
- How are they doing this in terms of approaches, specific mechanism
- With are the results? What are the barriers or facilitators?
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Public and patient involvement approaches ( n = 13)
Goals and rationales for public and patient involvement (n = 5)
Evidence of public and patient involvement effectiveness ( n = 2)
Public and patient involvement feasibility ( n = 0)
Abelson J et al. Public and Patient Involvement in HTA. International Journal of Technology Assessment in Health Care, 32:4 (2016)
© 2016 Medical Valley EMN I Prof. Kolominsky-Rabas I Patient-Centered Decision Making with MCDA I SPOR 19 th Annual European Congress I Vienna I 31-10-2016
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Patient Focused Decision-Making
Canada
■ Patient Involvement
CADTH’s first Call for Patient Input was issued in May 2010
■ CADTH Common Drug Reviews (CDR)
CADTH’s pan-Canadian Oncology Drug Review (pCODR)
■ British Columbia Your Voice Program
■ Ontario Patient Evidence Submission
© 2016 Medical Valley EMN I Prof. Kolominsky-Rabas I Patient-Centered Decision Making with MCDA I SPOR 19 th Annual European Congress I Vienna I 31-10-2016
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Patient Focused Decision-Making in HTA
England & Wales
■ Participation at each strand of NICE‘s work
- Public Board Meetings
- Scoping Process
- Advisory Committees (f.e. Technology Appraisal Committee)
■ NICE’s Public Involvement Programme (PIP)
- developing and supporting opportunities to involve
patients, carers, service users and the public in NICE’s work
■ June 2016
- Myeloma UK has awarded a research grant to NICE
- to fund a two year exploratory study
- Myeloma UK is a registered charity since 1997
■ Project
Methods for patient-centred decision-making on the
availability of new treatments (Lead: Prof Sarah Garner, NICE)
https://www.nice.org.uk/media/default/About/NICE-Communities/Public-involvement/Public-involvement-programme/PIP-process-guide-apr-2015.pdf
© 2016 Medical Valley EMN I Prof. Kolominsky-Rabas I Patient-Centered Decision Making with MCDA I SPOR 19 th Annual European Congress I Vienna I 31-10-2016
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Patient Focused Decision-Making in HTA
Belgium
■ Belgian Healthcare Knowledge Centre
KCE REPORT 195C
Models for Citizen and Patient Involvement in Health Care Policy, Part I: Exploration of their feasibility and acceptability
■ Excellent methodological framework based on concepts
International Association for Public Participation (IAP2)
■ Different levels of involvement according to different decisions
- for priority setting in the allocation of scarce health care resources: citizen representation
- for reimbursement decisions of new treatments: patient representation
https://kce.fgov.be/sites/default/files/page_documents/KCE_195C_citizen_and_patient_participation.pdf
http://c.ymcdn.com/sites/www.iap2.org/resource/resmgr/imported/IAP2%20Spectrum_vertical.pdf
© 2016 Medical Valley EMN I Prof. Kolominsky-Rabas I Patient-Centered Decision Making with MCDA I SPOR 19 th Annual European Congress I Vienna I 31-10-2016
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Patient Focused Decision-Making in HTA
Germany
■ G-BA Coordination Committee of Patients Representatives
- in total 220 patient representatives involved in G-BA subcommittees
■ Institute for Quality and Efficiency in Health Care (IQWiG)
- Written comments to benefit assessments (direct)
- Hearings (PRO) (via Coordination Committee of Patients Representatives)
- Patient‘s perspective in benefit assessements (via questionnaire)
© 2016 Medical Valley EMN I Prof. Kolominsky-Rabas I Patient-Centered Decision Making with MCDA I SPOR 19 th Annual European Congress I Vienna I 31-10-2016
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Patient Focused Decision-Making in HTA
MCDA in Germany‘s HTA
2010
IQWiG initiated a study on Analytic Hierarchy Process (AHP)
Integrating patients ‘ views into HTA
Topic
Diagnosis of major depression
Rating of preferences with respect to the importance
of different endpoints of antidepressant treatment
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Recommendations:
AHP useful in HTA to give a quantitative dimension
to patients’ preferences for treatment endpoints
Danner M et al. Integrating patients’ views into health technology assessment: Analytic hierarchy process (AHP) as a method to elicit patient preferences.
Int J Tech Assess Health Care, 27:4 (2011), 369–375.
Hummel MJ et al. Using the analytic hierarchy process to elicit patient preferences: prioritizing multiple outcome measures of antidepressant drug treatment. Patient. 2012;5(4):225-3
© 2016 Medical Valley EMN I Prof. Kolominsky-Rabas I Patient-Centered Decision Making with MCDA I SPOR 19 th Annual European Congress I Vienna I 31-10-2016
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Patient Focused Decision-Making
USA
■ Patient Preference Initiative
“While patient representatives participate in many of the
FDA's advisory committees, […] the FDA has never had
a committee that was wholly focused on patients.”
■ Center for Biologics Evaluation and Research (CDER)
- working on integrating qualitative data into review processes
■ Center for Devices and Radiological Health (CDRH)
- working on quantitative approach
- Pilot project on medical devices (weight-loss device)
Ref: Surg Endosc (2015) 29:2984–2993
■ Final Guidance in effect October 23, 2016
“FDA encourages medical device manufacturers
to voluntarily include in their premarket submissions information
on Patient Preference Information (PPI)”
http://www.fda.gov/AboutFDA/CentersOffices/OfficeofMedicalProductsandTobacco/CDRH/CDRHPatientEngagement/ucm462830.htm
Ho et al. Incorporating patient-preference evidence into regulatory decision making. Surg Endosc (2015) 29:2984–2993
http://www.fda.gov/downloads/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/UCM446680.pdf
© 2016 Medical Valley EMN I Prof. Kolominsky-Rabas I Patient-Centered Decision Making with MCDA I SPOR 19 th Annual European Congress I Vienna I 31-10-2016
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Patient Focused Decision-Making in HTA
Conclusion
Patients‘ perspectives
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Considering patients‘ perspectives is increasingly essential as healthcare systems move toward
more patient-centred approach
■ This trend is part of broader political context of consumer protection
■ However the majority of HTA agencies lack systematic evaluation on
- structures
- impact
- facilliators and barriers of patient involvement
© 2016 Medical Valley EMN I Prof. Kolominsky-Rabas I Patient-Centered Decision Making with MCDA I SPOR 19 th Annual European Congress I Vienna I 31-10-2016
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Patient Focused Decision-Making in HTA
Conclusion
MCDA in HTA
■ Technical
MCDA techniques can support a broad variety of decision problems in HTA
■ Political
- transparency of the preference-elicitation process
- involvement of ALL stakeholders into the value-assessment process
- increasing the legitimacy of decision process
■ Lack of familiarity with the deversity of MCDA techniques
■ No sufficient methodological guidance how to
- design
- conduct and
- implement MCDA a spart of HTA
© 2016 Medical Valley EMN I Prof. Kolominsky-Rabas I Patient-Centered Decision Making with MCDA I SPOR 19 th Annual European Congress I Vienna I 31-10-2016
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