Transcript Slide 1

Implementation of new
technologies
Dr Keith Cooper
Southampton Health Technology
Assessments Centre
University of Southampton
Structure of talk
• Introduction
• Background to evidence based decision
making for implementing new
technologies
• Example: Machine perfusion preservation
vs. cold storage in kidney transplantation
Introduction
• Within health care systems there is
limited resources and increasing demand
on services
• Choices need to be made in a fair and
equitable manner
Choice A
Choice B
HTA modelling
• Health Technology Assessment aims to evaluate
health technologies by investigating:
–
–
–
–
whether the technology works
for whom
at what cost
how it compares with the alternatives
• A health technology can be any intervention that
improves health and includes
– medications, devices, hospital procedures, health promotion
activities and diagnostic tests
• Health Technology Assessment in the UK is
overseen by the NIHR HTA programme
– Provides Technology Assessment Reports for NICE
NICE (National Institute for
Health and Clinical Excellence)
• Provides guidance to NHS on new technologies, promote
clinical excellence and the effective use of resources within
the NHS.
• Recommendations are based upon
– Clinical evidence: systematic review, meta analyses
– Economic evidence: cost effectiveness models
• Bases decision-making on Technology Assessment Reports
(TARs) and manufacturer submissions
• TARs produced by university departments, such as
Southampton Health Technology Assessments Centre (SHTAC)
• New technologies are most often more effective and more
costly – is it good value for money to adopt?
NICE decision making – Cost
effectiveness
• Costs and health benefits are estimated for
patients on alternative treatments
• Health benefits are in term of Quality Adjusted
Life Years
– Life expectancy + Quality of life
• Compare new treatment with existing
treatment(s)
• NICE is more likely to recommend a treatment if
its cost effectiveness is lower than CE threshold
(£30,000 per QALY)
Machine perfusion systems and cold static
storage of kidneys from deceased donors
• NICE technology
appraisal guidance
[TA165] Published date:
January 2009
• Assessment group report
by PenTAG, university of
Exeter
– (Bond, Pitt, Akoh,
Moxham, Hoyle,
Anderson)
What is the best method of preservation
for kidneys for transplantation?
• Cold storage solutions
– the kidney is flushed through with a
sterile preservation solution and is kept
on ice in a box before transplantation
– Marshall's hypertonic citrate (Soltran,
Baxter Healthcare) and Belzer UW
(Viaspan, Bristol Myers Squibb)
• Machine perfusion systems
– Machine perfusion systems continuously
pump cold preservation solution through
the kidney
– The LifePortTM kidney transporter
(Organ Recovery Systems), RM3 renal
preservation system (Waters Medical
Systems)
Clinical evidence
Machine Preservation
Trial (Moers, 2008)
PPART study (Watson
2010)
Cold
storage
(Viaspan)
N= 336
Machine
perfusion
(Lifeport)
N = 336
Cold
storage
N = 45
Machine
perfusion
(Lifeport)
N = 45
Proportion of delayed
graft function following
transplant
26.5%
20.8%
56%
58%
Proportion of primary non
function
4.8%
2.1%
0%
2%
Graft survival at 1 year
90%
94%
98%
93.3%
Cost effectiveness model
Other model parameters
(costs)
Parameter
Storage cost per Kidney:
Cold storage (ViaSpan)
Value
£262.33
Machine perfusion (LifePort)
£736.55
Other costs
Transplant cost
Dialysis cost (per month)
Post transplant cost (month 1-3)
£16,413
£2052
£2463
Post transplant cost (month 4-12)
£1385
Other model parameters
(QALY)
• Quality of life values (age 50 years)
• Transplant state: 0.75
• Dialysis state: 0.63
Cost effectiveness results
Results using MPT data
(Moers 2008)
Costs per
patient
Health benefits
(QALYs)
Cold storage (ViaSpan)
£142,805
9.58
Machine perfusion (LifePort) £139,110
9.79
Difference
£-3695
0.22
Results using PPART data
(Watson 2010)
Costs per
patient
Health
benefits
(QALYs)
Cold storage (ViaSpan)
£139,205
9.19
Machine perfusion (LifePort)
£141,319
9.13
Difference
£2114
-0.06
Preferred
technology
Machine
perfusion
Preferred
technology
Cold storage
NICE recommendations
• The overall costs and benefits associated with
kidney transplantation using either machine
perfusion or cold static storage were similar.
• The Committee recommended that the LifePort
kidney transporter be considered as an
alternative to cold static storage solutions.
• The choice of which to use would depend on
clinical and logistical factors within both the
retrieval team and transplant centres.
NICE – recommendations further
research
• The Committee considered that it was
important for transplant centres to
collect standardised and comprehensive
data that follow up the outcomes for
kidneys stored using different methods.
Conclusions
• Unclear from current data (2009), whether
machine perfusion preferable to cold storage
– Depends upon trial data used
• Difficult to show difference in clinical outcomes
– Large RCT is needed which may not be practical
• Other more recent studies have come to
different conclusions
• Gomez et al 2012 – MP is cost effective
• Groen et al 2012 – MP cost saving
• Jochmans 2015 (Transplant International)
provides excellent overview of current evidence
Thank you!