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Ontario Health Technology Advisory Committee OHTACMedical Advisory Secretariat MAS

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Title: Ontario Health Technology Advisory Committee OHTACMedical Advisory Secretariat MAS


1
Ontario Health Technology Advisory Committee
(OHTAC)/Medical Advisory Secretariat (MAS)
  • OHA Health Achieve 2006
  • Dr. Les Levin
  • Senior Medical Advisor
  • Head Medical Advisory Secretariat,
    MOHLTCNovember 7, 2006

2
Ontarios Health Care System (Pre-LHINs)

Drugs Over 2,800 Pharmacies Over 3,600 Drug
Products on Formulary
Groups Associations 400 Health Interest Groups
and Professional Associations.
Independent Health Facilities 944 IHFs
Community Services 732 Community Service
Agencies 67,441 beds in Long-Term Care
Facilities 55 Community Health Centres operating
at over 68 sites 18 Childrens Treatment
Centres 275 hospital, community (private) and
public health laboratories 1,100 assistive device
and home oxygen vendors 42 community care access
centres 70 HIV/AIDs education and support
programs 67 land ambulance operators 134 diabetes
education centres
Mental Health Services 3 Provincial Psychiatric
Hospitals 4 Specialty Psychiatric Hospitals 4,353
Community Programs 159 homes for special
care 3,600 homeless supportive Units 6,900
dedicated supportive housing units 160 agencies
for drug and alcohol treatment services 47
problem gambling treatment agencies
MOHLTC
Technologies (including all treatment
interventions) can enter the health system at any
of these points
Health Care Providers More than 21,000
physicians Over 139,000 Nurses 2270 Midwives 223
regulated professions 321 regulatory colleges
Hospitals 154 Corporations on 228 sites
3
Diffusion Curve
Steady State
U
Diffusion
R D
Point of Inflection -OHTAC
TIME
4
Ontario Health Technology Advisory Committee
OHTAC
  • Consultation with 29 hospital CEOs in 2003 -
    overwhelming support for a single portal for
    uptake and diffusion for health technologies
  • Since October 2003, OHTAC has developed a
    credible, transparent process that advises
    MOHLTC and the health system re - uptake,
    diffusion and distribution of new, and existing
    health technologies
  • Based on evidence of effectiveness, economic,
    safety, regulatory and societal/ethical
    considerations in the context of Ontarios health
    system.
  • MAS provides secretariat function and health
    technology policy analyses (HTPA)
  • Key programs have been developed to deal with
    OHTAC recommendations.

5
OHTAC Membership
6
Health Technology Assessment in
Ontario MAS/OHTAC and its associated Structures
and Linkages
Joint Policy Planning Committee (JPPC)
Provincial Guidelines Committee
(Dissemination) OMA OHA CPSO CNO OCFP
MOHLTC
Ontario Health System
OMA/ Physicians OHIP Schedule of Benefits
Diagnostic Services Committee
Health Technology Utilization Guidelines of
Ontario (HEALTH TUGO)
Recommendation
Professional Feedback Loop
Accountability Agreements
Health System Requests
Ontario Health Technology Advisory Committee
(OHTAC)
OHTAC guideline development recommendation
Hospitals, Community Agencies, LHINs
(Implementation)
UHN Usability Lab safety and human factors
analysis
Further analysis required
OHTAC safety and training recommendation
- Urinary Incontinence - Cardiac arrhythmia -
Cardiac imaging - Arthritis -
PET - Genetic screening - Diabetes (pre-OHTAC)
Outcomes Tracked by Health Results Team, ICES,
etc. Utilization and patient outcomes
Medical Advisory Secretariat (Evidence-based
Platforms) Experts, industry inform process
Expert Panels to integrate technologies around
disease states
OHTAC field evaluation recommendation
Health Quality Council, MOHLTC, LHINs
E-Base (ICES, PATH, UofT)
Field Evaluation Studies PATH, experts,
Institutions
Cancer remains under CCO
7
MAS Interactions with Interprovincial
International Agencies
Meet bi-annually
Member of
QuebecAETMIS Agency DEvaluation des
technologies and des modes dintervention en
santé
INAHTA International Network of Agencies for
Health Technology Assessment
Acknowledged in 2004 2005 OECD reports as
innovative bottom up
Alberta AHFMR Alberta Heritage Foundation for
Medical Research
OECD Organization for Economic Cooperation and
Development
MAS
British Columbia CHSPR Centre for Health
Services and Policy Research
Will form part of a 2005 WHO international review
of HTA
WHO World Health Organization
Interprovincial Contacts
Canadian Agency for Drugs and Technologies in
Health Scientific Advisory Committee
Using Grade Approach
Grade Working Group
United StatesCMS - Centres for Medicare and
Medicaid Services - Washington State
AustraliaMSAC Centre for Health Economics
Research and Evaluation
United Kingdom National Cancer Research Institute
8
OHTAC PRIORITISATION PROCESS
  • Requests for analyses from
  • Potential payers in the health system (insured
    service)
  • Minister or Deputy Minister
  • Program areas in MOHLTC
  • OHTAC
  • Requests handled by MAS with preparation of
    vignette and score sheet, circulated one week
    ahead of meeting
  • OHTAC does not consider applications from
    industry or private health services

9
Point of Inflection Portal of Recommendation
OHTAC Prioritization
Evidence-based analysis (GRADE) on effectiveness
related to patient outcomes and system
efficiencies
Active engagement of provincial experts industry
Ontario specific info on practice patterns,
trends utilization for current other
technologies around the disease state.
MAS HTPA
Economic analysis (MOHLTC budget impact,
comprehensive lit review, Ontario based
cost-effectiveness, downstream costs and savings,
sensitivity analysis, Bayesian and Markov
modeling)
MAS/OHTAC
Ethical, legal, regulatory, societal and human
resource issues
Recommendation to DM 60 days later Disseminate
on Website E-Bulletin Appeals process
OHTAC Critical Review Determining the strength
of recommendation based on weighing risks
benefits
10
GRADE
Recommendations Quality of evidence trade off
between benefits, risks, burdens
GRADE Recommendation Decision Process
Quality of the Evidence High, moderate, low,
very low
GRADE Quality Assessment
11
Consistency of OHTAC Recommendation Decisions
BgtRB
BRB
Trade offs
Very Low
Low
Moderate
High
BltRB
Uncertain
Quality of Evidence
Blue Accept Black Reject Green Field
Study Red No Recommendation
12
OHTAC Decision and Technology Trajectories
Approval with no restrictions
Approval with restrictions
Health TUGO
UHN Usability Lab
PATH
Opportunity for Revision
Guideline Development
Safety Human Factors Analysis
Integration of Technologies
Field Evaluation
Professional Feedback Loop
Hospitals Community
Expert Panels
Specialists, experts, academic institutions
Rejected
MAS/OHTAC
13
Ontario Field Evaluation Studies
  • (Ontario has International Lead)
  • COMPLETED
  • Drug eluting stents (20,000 patients)
  • Endovascular repair of abdominal aortic aneurysms
    (160 patients)
  • Diabetes economic model
  • HPV as an adjunct to cytopathology in cervical
    cancer screening
  • ONGOING
  • 64-slice CT angiography versus coronary
    angiography (1,000 patients)
  • PET scanning
  • 5 cancer clinical trials (2,000 patients)
  • 4 cancer registries (600 patients)
  • Extracorporeal photopheresis (120 patients)
  • Implantable Cardiac Defibrillator (1,000 patients
    per year)
  • FORMATIVE

14
Safety Issues Addressed through the UHN Usability
Laboratory
  • CT Safety with field evaluation
  • MRI safety with field evaluation
  • Automated external defibrillators
  • Use of in-room air cleaners in hospitals
  • Smart infusion pumps

15
Implementation of OHTAC Recommendations
IMPLEMENTATION PATHWAYS
Implementation or Enhanced Access 30
Technology recommended for Field Evaluation 12
Specific Safety Overviews Recommended 5
Uptake of Technology not Recommended 14
(MAS)
12 MOHLTC decisions to increase uptake or
diffusion
18 communicated to hospitals via
e-bulletins/website to encourage increased access
PATH/ OCOG/ etc
OHTAC
Communicated to Health System (e-bulletins, OHTAC
website)
6 Guideline Developments
Experts, AHSCs etc
UHN Usability Lab
HEALTH TU-GO
16
Diffusion Curve - Diffusion Phase
Information Management (Health Results Team)
Tracking
ICES
Volume of new and competing
technologies
Health Quality Council
Concurrence with guidelines/OHTAC recommendations
Performance (e.g. patient outcomes, accuracy and
system efficiencies)
17
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21
Implementation of OHTAC Recommendations
  • Adjustments to OHIP fee schedules through OMA
  • Appropriate funding of the health system
  • Existing and projected hospital operating and
    infrastructure costs
  • Device costs
  • Each technology presents unique issues regarding
    implementation
  • Preferred route is to develop business cases for
    each technology
  • Currently under development through JPPC

22
Heath Technologies Reviewed by OHTAC 2005/06
Based on MAS Analyses
23
Heath Technologies Reviewed by OHTAC 2004/05
Based on MAS Analyses
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