Presentation at Second Inter-Country Meeting on Health Technology Assessment EMRO/WHO, Cairo, Egypt, Dec 2, 2014

1. Cairo, Egypt, Dec 2, 2014
Second Inter-Country
Meeting on Health
Technology Assessment
EMRO/WHO
HTA for adding
value to
innovation:
From research
to use in health
systems
Reiner Banken reiner.banken@inesss.qc.ca
Geneviève Plamondon genevieve.plamondon@inesss.qc.ca

2. Reiner Banken reiner.banken@inesss.qc.ca
Geneviève Plamondon genevieve.plamondon@inesss.qc.ca
Cairo, Egypt, Dec 2, 2014
Second Inter-Country
Meeting on Health
Technology Assessment
EMRO/WHO
HTA for adding
value to
innovation:
From research
to use in health
systems

3. Reiner Banken reiner.banken@inesss.qc.ca
Geneviève Plamondon genevieve.plamondon@inesss.qc.ca
Cairo, Egypt, Dec 2, 2014
Second Inter-Country
Meeting on Health
Technology Assessment
EMRO/WHO
HTA for adding
value to
innovation:
From research
to use in health
systems

4. 4
Defining innovation
• “Technological innovation as a device, procedure or organizational support
system that is perceived as new by a proportion of key stakeholders in a
healthcare organization, discontinuous with previous practice and which is
intentionally introduced and directed at improving health outcomes” Robert et
al,2010
• Conceptually new vs. Contextually new Mytton et al,2010
• “Innovation refers not only to the invention of new devices but also to
adjustments to, or incremental improvements of, existing devices and clinical
practices.” WHO,2010
• Incremental innovations vs disruptive innovations Hwang et Christensen,2008
Robert et al., Adopting and assimilating new non-pharmaceutical technologies into health care: a systematic review. Journal of
Health Services Research & Policy,2010,15(4): 243–250.
Mytton et al., Introducing new technology safely .BMJ Quaity and Safety, 2010;19(Suppl 2):i9-i14
WHO. Medical devices: managing the mismatch: an outcome of the priority medical devices project,2010
Hwang J et Christensen CM. Disruptive innovation in health care delivery: a framework for business-model innovation. Health
Affairs 2008;27(5):1329-35.

5. 5
Definition used at INESSS
A definition inspired by the Global Forum for Health Research
Innovation encompasses the entire process from the generation
of new ideas, to their transformation into useful services,
products, methods, management practices and policies in health
and social services.
Invention becomes an innovation when adopted
by the health system
Mobilizing a range of stakeholders
Transforms the context
Global Forum for Health Research (GFHR) (2010). Innovating for the health of all. Genève, Suisse. Disponible à :
bit.ly/1gFuWxJ

6. 6
The role of HTA
• Increased pressure on public funding
• Scarcity of heath resources
• Public pressure: Newest is best!
HTA aims to inform the formulation of safe,
effective, sustainable decision-making in
health systems that is patient-focused and
seeks to achieve best value

7. 7
Technology diffusion is conditionnal to
different levels of decision-making
Decisions
Time
Use
Decision-making
•system
•hospitals
•patients/clinicians
Innovative
Technology
Obsolescence/
Replacement
Experimental
Technology
Research and General Use
development

8. 8
ABSTRACT
Innovation is often regarded as uniformly positive. This paper shows that the
role of innovation in quality improvement is more complicated. The authors
identify three known paradoxes of innovation in healthcare. First, some
innovations diffuse rapidly, yet are of unproven value or limited value, or pose
risks, while other innovations that could potentially deliver benefits to
patients remain slow to achieve uptake. Second, participatory, cooperative
approaches may be the best way of achieving sustainable, positive innovation,
yet relying solely on such approaches may disrupt positive innovation. Third,
improvement clearly depends upon change, but change always generates new
challenges.

9. 9
HTA: A perspective from industry

10. 10
Common objectives for
innovation
• Industry needs profits
• Health Systems need to be sustainable
• Patients want best care regardless of cost
• Economic development wants to favor homemade innovation
• Innovation is necessary for improving
patient care and health systems
performance.
• HTA and other forms of evaluation are
essential for translating the promise of
innovation into reality.

11. 1972 1991
1996
11
INESSS – 40 years of science
advice for decision-making
Conseil d’évaluation des
technologies de la santé
(1988)
Réseau de revue
d’utilisation des
médicaments
January, 19,
Agences d’évaluation
des technologies et
des modes d’intervention
en santé
Comité de revue
de l’utilisation des
médicaments
2000
Conseil consultatif
de pharmacologie
Conseil du
médicament
2003
2003
Institut national
d’excellence
en santé et en
services sociaux
Social Services
Clinical Practice
Guidelines
2009
2011
1988
2011
Medical Biology
Lab tests

12. 12
INESSS advisory committee on HTA
and innovative technologies (CÉTI)
• Created in December 2012
• Advisory to the CEO
Objective: To promote a common understanding of the
challenges of introducing innovative technologies into the health
system, and to identify possible solutions to ensure consistency in
doing so, for the benefit of users
Composition: Representatives from patient and user groups, from the
health technologies industry, from the research and HTA
communities, from the economic development community, and
managers of the health and social services network (local, regional
and national levels)
For more information: http://www.inesss.qc.ca/en/networks-andpartnerships/bridging-mechanisms/
advisory-committee-on-hta-and-innovative-technologies.html

13. 13
CÉTI: current work and next steps
 To optimise the generation of knowledge in real-world settings for
innovative technologies with the greatest potential for positive impacts on
patients and the health system
Objectives:
• To define the concepts related to the production of knowledge in real world
settings;
• To develop a method for generation of knowledge in real-world settings for
innovative technologies, including a method to identify and prioritise the most
promising technologies;
• To identify and discuss the operational and implementation challenges of the
proposed approach;
• To propose a framework for the production of knowledge in real-world settings;
• To promote and facilitate the use of this framework by different groups of
stakeholders

14. Objectives:
•Align the value proposal of an
innovative technology with the needs of
the users
•Integrate the knowledge and the
experience of the partners involved
•Identify optimal conditions and adapt
the use of a technology accordingly
•Collect information about the
effectiveness of a technology, as well as
contextual and organizational elements
relevant to decision makers
14
Progessive field evaluation
Image adapted from the Living Lab Methodology Handbook, Ståhlbröst et Holst, 2012, available at
http://www.ltu.se/cms_fs/1.101555!/file/LivingLabsMethodologyBook_web.pdf

15. 15
Towards a learning health system
Health system

16. 16
Conclusions
• HTA is an important element of the innovation process by
defining the uncertainties and critical conditions for
appropriate use.
• HTA can represent advantages both for the health
system as well as for economic development.
• Certain promising technologies, with a high degree of
plausibility of delivering the promised value, should be
introduced into the health system accompanied by
evaluation.