Incorporating patient

perspectives in

Canadian HTAs

Gino De Angelis, MSc Laura Weeks, PhD 3rd WHO Global Forum on Medical Devices May 2017 ginod@cadth.ca

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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