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Ni M, Borsci S, Walne S, Mclister AP, Buckle P, Barlow JG, Hanna GB. The Lean and Agile Multi-dimensional Process (LAMP) - a new framework for rapid and iterative evidence generation to support health-care technology design and development. Expert Rev Med Devices 2020; 17:277-288. [PMID: 32167800 DOI: 10.1080/17434440.2020.1743174] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Introduction: Health technology assessments (HTA) are tools for policymaking and resource allocation. Early HTAs are increasingly used in design and development of new technologies. Conducting early HTAs is challenging, due to a lack of evidence and significant uncertainties in the technology and the market. A multi-disciplinary approach is considered essential. However, an operational framework that can enable the integration of multi-dimensional evidence into commercialization remains lacking.Areas covered: We developed the Lean and Agile Multi-dimensional Process (LAMP), an early HTA framework, for embedding commercial decision-making in structured evidence generation activities, divided into phases. Diverse evidence in unmet needs, user acceptance, cost-effectiveness, and market competitiveness are being generated in increasing depth. This supports the emergence of design and value propositions that align technology capabilities and clinical and user needs.Expert opinion: We have been applying LAMP to working with medical device and diagnostic industry in the UK. The framework can be adapted to suit different technologies, decision needs, time scales, and resources. LAMP offers a practical solution to the multi-disciplinary approach. Methodologists drive the process by performing evidence generation and synthesis as and by enabling interactions between manufacturers, designers, clinicians, and other key stakeholders.
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Affiliation(s)
- Melody Ni
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Simone Borsci
- Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Cognitive Psychology and Ergonomics, Twente University, Enschede, Netherlands
| | - Simon Walne
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Anna P Mclister
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Peter Buckle
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - James G Barlow
- Imperial Business School, Imperial College London, London, UK
| | - George B Hanna
- Department of Surgery and Cancer, Imperial College London, London, UK
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Strzebonska K, Wasylewski MT, Zaborowska L, Riedel N, Wieschowski S, Strech D, Waligora M. Results dissemination of registered clinical trials across Polish academic institutions: a cross-sectional analysis. BMJ Open 2020; 10:e034666. [PMID: 31974090 PMCID: PMC7044990 DOI: 10.1136/bmjopen-2019-034666] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To establish the rates of publication and reporting of results for interventional clinical trials across Polish academic medical centres (AMCs) completed between 2009 and 2013. We aim also to compare the publication and reporting success between adult and paediatric trials. DESIGN Cross-sectional study. SETTING AMCs in Poland. PARTICIPANTS AMCs with interventional trials registered on ClinicalTrials.gov. MAIN OUTCOME MEASURE Results reporting on ClinicalTrials.gov and publishing via journal publication. RESULTS We identified 305 interventional clinical trials registered on ClinicalTrials.gov, completed between 2009 and 2013 and affiliated with at least one AMC. Overall, 243 of the 305 trials (79.7%) had been published as articles or posted their summary results on ClinicalTrials.gov. Results were posted within a year of study completion and/or published within 2 years of study completion for 131 trials (43.0%). Dissemination by both posting and publishing results in a timely manner was achieved by four trials (1.3%). CONCLUSIONS Our cross-sectional analysis revealed that Polish AMCs fail to meet the expectation for timely disseminating the findings of all interventional clinical trials. Delayed dissemination and non-dissemination of trial results negatively affects decisions in healthcare.
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Affiliation(s)
- Karolina Strzebonska
- REMEDY, Research Ethics in Medicine Study Group, Department of Philosophy and Bioethics, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz T Wasylewski
- REMEDY, Research Ethics in Medicine Study Group, Department of Philosophy and Bioethics, Jagiellonian University Medical College, Krakow, Poland
| | - Lucja Zaborowska
- REMEDY, Research Ethics in Medicine Study Group, Department of Philosophy and Bioethics, Jagiellonian University Medical College, Krakow, Poland
| | - Nico Riedel
- QUEST Center for Transforming Biomedical Research, Berlin Institute of Health, Berlin, Germany
| | - Susanne Wieschowski
- Institute for Ethics, History and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
| | - Daniel Strech
- QUEST Center for Transforming Biomedical Research, Berlin Institute of Health, Berlin, Germany
- Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Marcin Waligora
- REMEDY, Research Ethics in Medicine Study Group, Department of Philosophy and Bioethics, Jagiellonian University Medical College, Krakow, Poland
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Access to medicines - a systematic review of the literature. Res Social Adm Pharm 2019; 16:1166-1176. [PMID: 31839584 DOI: 10.1016/j.sapharm.2019.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 12/07/2019] [Accepted: 12/08/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Budgetary constraints and the rising cost of new innovative medicines are the key challenges for access to medicines. Multiple research studies explored diverse dimensions of this topic, however, a thorough and detailed review of existing literature on access to medicines in United Kingdom is lacking. Therefore, the objective of this systematic review of literature was to critically review and analyse the literature pertaining to original research on access to medicines issue in the United Kingdom. This review includes two types of studies: (a) UK centric studies (b) studies comparing UK with the other countries. METHODS A systematic search of articles published between Jan 2008 and October 12, 2018 was conducted according to PRISMA guidelines using the following databases: PubMed, Scopus, Science Direct, and specific journals including BMJ, Lancet, Value in Health, Pharmacoeconomics, Pharmacoeconomics Open, Journal of pharmaceutical policy and practice, Health Policy. RESULTS The searches across all databases and journals resulted in 53 relevant articles. The data extracted from the 53 articles generated key themes. These themes included: Access to Medicines, Health technology assessment (HTA), Pricing and Health technology assessment, Risk Sharing Agreements & Stakeholders involvement/views on reimbursement Process. Subthemes were added under the key themes where applicable. CONCLUSIONS This review systematically evaluated the current literature and identified variability in access to medicines across countries in UK &EU and across different categories of medicines. Medicine licensing and reimbursement environment is continuously evolving and there are challenges as well as opportunities for learning and collaboration among countries which are at different stages of advancement in their systems.
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Ehteshami-Afshar S, Zafari Z, Hamidi N, FitzGerald JM, Lynd L, Sadatsafavi M. A Systematic Review of Decision-Analytic Models for Evaluating Cost-Effectiveness of Asthma Interventions. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:1070-1082. [PMID: 31511184 DOI: 10.1016/j.jval.2019.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 01/31/2019] [Accepted: 03/08/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To demonstrate the landscape of model-based economic studies in asthma and highlight where there is room for improvement in the design and reporting of studies. DESIGN A systematic review of the methodologies of model-based, cost-effectiveness analyses of asthma-related interventions was conducted. Models were evaluated for adherence to best-practice modeling and reporting guidelines and assumptions about the natural history of asthma. METHODS A systematic search of English articles was performed in MEDLINE, EMBASE, and citations within reviewed articles. Studies were summarized and evaluated based on their adherence to the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). We also studied the underlying assumptions about disease progression, heterogeneity in disease course, comorbidity, and treatment effects. RESULTS Forty-five models of asthma were included (33 Markov models, 10 decision trees, 2 closed-form equations). Novel biological treatments were evaluated in 12 studies. Some of the CHEERS' reporting recommendations were not satisfied, especially for models published in clinical journals. This was particularly the case for the choice of the modeling framework and reporting on heterogeneity. Only 13 studies considered any subgroups, and 2 explicitly considered the impact of comorbidities. Adherence to CHEERS requirements and the quality of models generally improved over time. CONCLUSION It would be difficult to replicate the findings of contemporary model-based evaluations of asthma-related interventions given that only a minority of studies reported the essential parameters of their studies. Current asthma models generally lack consideration of disease heterogeneity and do not seem to be ready for evaluation of precision medicine technologies.
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Affiliation(s)
- Solmaz Ehteshami-Afshar
- Collaboration for Outcomes Research and Evaluation, The University of British Columbia, Vancouver, Canada; Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Zafar Zafari
- Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Nima Hamidi
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Canada
| | - J Mark FitzGerald
- Division of Respiratory Medicine and Institute for Heart and Lung Health, Vancouver General Hospital, The University of British Columbia, Vancouver, Canada
| | - Larry Lynd
- Collaboration for Outcomes Research and Evaluation, The University of British Columbia, Vancouver, Canada
| | - Mohsen Sadatsafavi
- Collaboration for Outcomes Research and Evaluation, The University of British Columbia, Vancouver, Canada; Division of Respiratory Medicine and Institute for Heart and Lung Health, Vancouver General Hospital, The University of British Columbia, Vancouver, Canada.
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Rejon-Parrilla JC, Jonsson P, Bouvy JC. Key enablers and barriers to implementing adaptive pathways in the European setting. Br J Clin Pharmacol 2019; 85:1427-1433. [PMID: 30849187 DOI: 10.1111/bcp.13916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/25/2019] [Accepted: 03/05/2019] [Indexed: 12/24/2022] Open
Abstract
In 2016, the European Medicines Agency published the conclusions of its pilot on adaptive pathways, with products in early stages of development still building up to their marketing authorisation. Adaptive pathways rests on three principles: iterative development; gathering evidence through real-life use to supplement clinical trial data; and early engagement of patients, payers and health technology assessment bodies in discussions on a medicine's development. While the pilot has now finished, the practical system-wide implications of employing the adaptive pathways approach are not known and further consideration of these three principles is required. In this paper we used the three principles that underpin adaptive pathways to discuss main scientific and European policy developments likely to determine progress on further implementing adaptive pathways in the European setting.
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Affiliation(s)
| | - Pall Jonsson
- National Institute for Health and Care Excellence, UK
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van Boven JFM, van de Hei SJ, Sadatsafavi M. Making sense of cost-effectiveness analyses in respiratory medicine: a practical guide for non-health economists. Eur Respir J 2019; 53:13993003.01816-2018. [PMID: 30578398 DOI: 10.1183/13993003.01816-2018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/09/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Job F M van Boven
- University of Groningen, University Medical Centre Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Dept of General Practice and Elderly Care Medicine, Groningen, The Netherlands.,University of Groningen, University Medical Centre Groningen, Dept of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands
| | - Susanne J van de Hei
- University of Groningen, University Medical Centre Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Dept of General Practice and Elderly Care Medicine, Groningen, The Netherlands
| | - Mohsen Sadatsafavi
- Faculty of Pharmaceutical Sciences, the University of British Columbia, Vancouver, BC, Canada
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Wranik WD, Zielińska DA, Gambold L, Sevgur S. Threats to the value of Health Technology Assessment: Qualitative evidence from Canada and Poland. Health Policy 2019; 123:191-202. [DOI: 10.1016/j.healthpol.2018.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/29/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
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Meessen B. The Role of Digital Strategies in Financing Health Care for Universal Health Coverage in Low- and Middle-Income Countries. GLOBAL HEALTH, SCIENCE AND PRACTICE 2018; 6:S29-S40. [PMID: 30305337 PMCID: PMC6203415 DOI: 10.9745/ghsp-d-18-00271] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 09/12/2018] [Indexed: 11/15/2022]
Abstract
Countries finance health care using a combination of 3 main functions: raising resources for health, pooling resources, and purchasing health services. In this paper, we examine how digital health technologies can be used to enhance these health financing functions in low- and middle-income countries and can thus contribute to progress toward universal health coverage. We illustrate our points by presenting some recent innovations in digital technologies for financing health care, identifying their contributions and their limits. Some examples include a mobile-health wallet application used in Kenya that encourages households to put money aside for future health expenses; an online software platform developed by a startup in Tanzania in partnership with a private insurance provider to give individuals and families the opportunity to choose among different health coverage options; and digital maps by a number of startups that bring together data on health facility locations and capacity, including equipment, staff, and types of services offered. We also sketch an agenda for future research and action for digital strategies for health financing. The development and adoption of effective solutions that align well with the universal health coverage agenda will require strong partnerships between stakeholders and enough proactive stewardship by authorities.
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Katkade VB, Sanders KN, Zou KH. Real world data: an opportunity to supplement existing evidence for the use of long-established medicines in health care decision making. J Multidiscip Healthc 2018; 11:295-304. [PMID: 29997436 PMCID: PMC6033114 DOI: 10.2147/jmdh.s160029] [Citation(s) in RCA: 150] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Evidence from medication use in the real world setting can help to extrapolate and/or augment data obtained in randomized controlled trials and establishes a broad picture of a medication’s place in everyday clinical practice. By supplementing and complementing safety and efficacy data obtained in a narrowly defined (and often optimized) patient population in the clinical trial setting, real world evidence (RWE) may provide stakeholders with valuable information about the safety and effectiveness of a medication in large, heterogeneous populations. RWE is emerging as a credible information source; however, there is scope for enhancements to real world data (RWD) sources by understanding their complexities and applying the most appropriate analytical tools in order to extract relevant information. In addition to providing information for clinicians, RWE has the potential to meet the burden of evidence for regulatory considerations and may be used in approval of new indications for medications. Further understanding of RWD collection and analysis is needed if RWE is to achieve its full potential.
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Bouvy JC, Jonsson P, O’Rourke D, Chadha AS, Hedberg N, Makady A, Xoxi E, Wied CGD, Schiel A, Long R, Gallacher J. Regulatory and Health Technology Assessment Considerations for Disease-Modifying Drugs in Alzheimer's Disease. CNS Drugs 2018; 32:1085-1090. [PMID: 30467744 PMCID: PMC6280845 DOI: 10.1007/s40263-018-0581-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Although there are a growing number of well-reported, late-stage clinical trial failures in Alzheimer's disease, the introduction of a disease-modifying therapy within the next 5 years may be anticipated. These treatments are likely to target Alzheimer's disease in the earlier disease stages, unlike drugs that are currently available that treat symptoms of moderate-to-severe dementia. Therefore, there is a need to establish a consensus on regulatory and health technology assessment requirements for Alzheimer's disease, as a new drug will need to undergo regulatory and health technology assessments before it becomes available to patients. This article reports the discussions and activities of the regulatory and health technology assessment expert advisory group of the 2-year ROADMAP (real-world outcomes across the Alzheimer's disease spectrum: a multimodal data access platform) project. The expert advisory group discussions identified a lack of consensus on validated outcomes in the earliest Alzheimer's disease stages, the need for filling gaps between outcomes used across clinical trials and real-world settings, and the role that real-world evidence might have in characterising the impact of a possible disease-modifying therapy on caregivers, resource use and long-term outcomes.
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Affiliation(s)
- Jacoline C. Bouvy
- Science, Policy and Research Programme, National Institute for Health and Care Excellence, 10 Spring Gardens, London, SW1A 2BU UK
| | - Pall Jonsson
- Science, Policy and Research Programme, National Institute for Health and Care Excellence, 10 Spring Gardens, London, SW1A 2BU UK
| | - Diana O’Rourke
- Science, Policy and Research Programme, National Institute for Health and Care Excellence, 10 Spring Gardens, London, SW1A 2BU UK
| | | | - Niklas Hedberg
- The Dental and Pharmaceutical Benefits Agency (TLV), Stockholm, Sweden
| | - Amr Makady
- Zorginstituut Nederland (ZIN), Diemen, The Netherlands
| | - Entela Xoxi
- Faculty of Economics, Catholic University of the Sacred Heart and Graduate School of Health Economics and Management (ALTEMS), Rome, Italy
| | | | - Anja Schiel
- Unit for Health Technology Assessment and Reimbursement, Department for Pharmacoeconomics, Norwegian Medicines Agency, Oslo, Norway
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