Priority Setting for Systematic Reviews Drug Effectiveness Review Project US Cochrane Center Conference Baltimore, Maryland Presented by: Alison Little, MD, MPH Date: July 11, 2008

Drug Effectiveness Review Project State of Oregon Medicaid had 60% increase in drug spending in the year 2000 PDL Legislation (Senate Bill 30) Consider effectiveness/safety first Consider cost if effectiveness/safety equal Collaboration with OHSU EPC – 4 Reviews Washington and Idaho join – 8 more Reviews HISTORY

State of Oregon Medicaid had 60% increase in drug spending in the year 2000

PDL Legislation (Senate Bill 30)

Consider effectiveness/safety first

Consider cost if effectiveness/safety equal

Collaboration with OHSU EPC – 4 Reviews

Washington and Idaho join – 8 more Reviews

Drug Effectiveness Review Project HISTORY Broader base desirable to increase number of reviews and provide for updating DERP officially begins in 2003 with 3 year contract Ultimately includes 15 states and 2 other organizations Phase 2 of project runs from 2006 to 2009

Drug Effectiveness Review Project Arkansas Missouri Canadian Agency for Drugs/ Montana Technologies in Health New York Colorado North Carolina Idaho Oregon Kansas Washington Michigan Wisconsin Minnesota Wyoming CURRENT DERP MEMBERS

Arkansas Missouri

Canadian Agency for Drugs/ Montana

Technologies in Health New York

Colorado North Carolina

Idaho Oregon

Kansas Washington

Michigan Wisconsin

Minnesota Wyoming

Drug Effectiveness Review Project To obtain and synthesize global evidence on the comparative effectiveness, safety and effects on subpopulations of drugs within classes, and to support policy makers in using that evidence to inform policy in local decision making MISSION

To obtain and synthesize global evidence on the comparative effectiveness, safety and effects on subpopulations of drugs within classes, and to support policy makers in using that evidence to inform policy in local decision making

Drug Effectiveness Review Project Full systematic reviews with explanation by report authors Ability to choose those reviews Translational products (executive summaries, power point slides, P&T Committee briefs, P&T presentations) Proprietary electronic report library Monthly teleconferences Biennial face to face conferences BENEFITS OF MEMBERSHIP

Full systematic reviews with explanation by report authors

Ability to choose those reviews

Translational products (executive summaries, power point slides, P&T Committee briefs, P&T presentations)

Proprietary electronic report library

Monthly teleconferences

Biennial face to face conferences

Drug Effectiveness Review Project Center for Evidence-based Policy responsible for contracting, communication, meetings Oregon Evidence-based Practice Center either completes or oversees review work Total of 34 reviews to date Total of 60 updates of those reviews BENEFITS OF MEMBERSHIP

Center for Evidence-based Policy responsible for contracting, communication, meetings

Oregon Evidence-based Practice Center either completes or oversees review work

Total of 34 reviews to date

Total of 60 updates of those reviews

Drug Effectiveness Review Project Considerations Dollar and Prescription Volume Variation of Cost within a Class Timing of New Releases and Changes to Generic/OTC Status Likelihood of Good Quality Evidence Expected Workload of the Review Drugs in the Class TOPIC SELECTION - ORIGINAL

Considerations

Dollar and Prescription Volume

Variation of Cost within a Class

Timing of New Releases and Changes to Generic/OTC Status

Likelihood of Good Quality Evidence

Expected Workload of the Review

Drugs in the Class

Drug Effectiveness Review Project 3 months before Governance conference: Solicit the 5 most pressing topics from each participating organization. 2 months before Governance conference: Center collates and distributes list to all participants List discussed at Governance call and narrowed to 10 topics Participants analyze their data to determine answers to selected prioritization criteria and submit to Center TOPIC SELECTION – SECOND PHASE

3 months before Governance conference:

Solicit the 5 most pressing topics from each participating organization.

2 months before Governance conference:

Center collates and distributes list to all participants

List discussed at Governance call and narrowed to 10 topics

Participants analyze their data to determine answers to selected prioritization criteria and submit to Center

Drug Effectiveness Review Project 1 month before Governance conference: Center collates participant’s answers to criteria as well as additional information on the topic to create a briefing paper. EPC provides review of evidence for each potential topic. At Governance conference: Final discussion and vote for new topics Post Governance conference: Summary of the decision added to briefing paper, Re-confirm relevancy of topic prior to onset of work TOPIC SELECTION – SECOND PHASE

1 month before Governance conference:

Center collates participant’s answers to criteria as well as additional information on the topic to create a briefing paper. EPC provides review of evidence for each potential topic.

At Governance conference: Final discussion and vote for new topics

Post Governance conference:

Summary of the decision added to briefing paper,

Re-confirm relevancy of topic prior to onset of work

Drug Effectiveness Review Project Briefing Paper Elements Disease Burden Alternatives Clinical Impact Budget Impact Economic Impact Evidence Marketing Benefit/ Policy Considerations TOPIC SELECTION – SECOND PHASE

Briefing Paper Elements

Disease Burden

Alternatives

Clinical Impact

Budget Impact

Economic Impact

Evidence

Marketing

Benefit/ Policy Considerations

Drug Effectiveness Review Project Revisions to the Process Number of topics solicited varies based on number of reports to choose List of solicited topics varies based on number of reports to choose More elements of briefing paper to be completed by Center TOPIC SELECTION – REVISION

Revisions to the Process

Number of topics solicited varies based on number of reports to choose

List of solicited topics varies based on number of reports to choose

More elements of briefing paper to be completed by Center

Drug Effectiveness Review Project Revisions to the Process Economic Impact eliminated Budget Impact reporting standardized Evidence limited to last 3 years Pros and Cons added TOPIC SELECTION – REVISION

Revisions to the Process

Economic Impact eliminated

Budget Impact reporting standardized

Evidence limited to last 3 years

Pros and Cons added

Drug Effectiveness Review Project Originally, all reports updated continually or annually In reality, some not updated for years Second phase of DERP brings more formalized process – Annual Scanning TOPIC SELECTION – UPDATING

Originally, all reports updated continually or annually

In reality, some not updated for years

Second phase of DERP brings more formalized process – Annual Scanning

Drug Effectiveness Review Project Literature search of MEDLINE since date of last search Include abstracts New Drugs New Indications New Safety Alerts TOPIC SELECTION – SCANNING

Literature search of MEDLINE since date of last search

Include abstracts

New Drugs

New Indications

New Safety Alerts

Drug Effectiveness Review Project DERP Topic Selection has evolved over time in response to: Increased project size More limited resources Need for fairness SUMMARY

DERP Topic Selection has evolved over time in response to:

Increased project size

More limited resources

Need for fairness

Drug Effectiveness Review Project Alison Little, MD, MPH, Medical Director Drug Effectiveness Review Project Center for Evidence-based Policy Oregon Health and Science University 503-494-7239 [email_address] www.ohsu.edu/policycenter www.ohsu.edu/drugeffectiveness CONTACT INFORMATION

Alison Little, MD, MPH, Medical Director

Drug Effectiveness Review Project

Center for Evidence-based Policy

Oregon Health and Science University

503-494-7239

[email_address]

www.ohsu.edu/policycenter

www.ohsu.edu/drugeffectiveness