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Building Bridges Not Walls: Can
We Develop Sustainable and
Sharable Cost-Effectiveness
Models?
Chair: Tammy Clifford (CADT...
Introduction and Overview
Deborah Marshall
University of Calgary, Canada
The Context
• Health technology management is the new HTA…
• Efficiency in use of analytic resources
• avoiding unnecessar...
Description of Models for Rheumatoid Arthritis
by Modeling Technique
Decision TreesMarkov Models Discrete Event
Simulation...
Evolution Diagram of Simulation
Models of Chronic Obstructive
Pulmonary Disease (COPD)
n = 49 publications
To August 2015
...
Examples – Depends on Objective and Setting
• Mount Hood Diabetes Challenge Network: Dedicated to promoting an exchange of...
Potential Barriers and Criteria/Characteristics
that make Models ‘Transferable and Sustainable’
1) Personal – intellectual...
Stirling Bryan
University of British Columbia, Canada
Building Bridges Not Walls…
A Canadian Perspective
Stirling Bryan, PhD
Scientific Director, BC SUPPORT Unit
Senior Scienti...
10
Disclosures
I am not aware of any actual or potential
conflicts of interest in relation to this
presentation.
Personal ...
11
Pathway model: COPD
Lead: Dr. Mohsen Sadatsafavi
12
Two personal worries…
Quality
Waste
13
Zafari et al,
2017
14
“Where there are well-constructed, validated
models that appropriately capture the clinical or
care pathway and reflect...
15
16
CADTH’s 2018–2021 Strategic Plan
17
Chris Sampson
Office of Health Economics, United Kingdom
Building bridges not walls in Europe
Chris Sampson
The Office of Health Economics, UK
HTAi 2018 | Building Bridges Not Walls
The burden of scaling walls
HTAi 2018 | Building Bridges Not Walls
Manufacturer
Academic
modellers
Consultants
NICE-funded
modellers
ABPI / EFPIA
DSU
...
HTAi 2018 | Building Bridges Not Walls
Organisational structures
Processes
Accountability
Methodology
Legislation
30 count...
Rick Chapman
Institute for Clinical and Economic Review (ICER), USA
Building Bridges Not Walls:
Can We Develop
Sustainable and Sharable
Cost-Effectiveness
Models?
US Experience
Rick Chapman,...
Practical Requirements & Logistics in US
• Fragmented system with multiple payers
• Private sector with IP concerns
• No H...
ICER Pilot
Transparency
Project
What Does ICER Mean by Transparency?
• Always shared information about economic model structure and
inputs with manufactur...
Description of Transparency Pilot Project
• Models involved
• Migraine (UIC)
• Endometriosis (U CO)
• Contracting/Fees
• M...
Transparency Pilot: Results/Lessons Learned
• Feedback received from manufacturers and other stakeholders will help
determ...
Summary and Discussion
Deborah Marshall
University of Calgary, Canada
Possible Considerations for Discussion
• What do we mean by “transparent, transferable and
sustainable model”?
• How can w...
Issues to Consider
• Intellectual Property
• Ownership
• Control
• Security
• Training program to learn model
• Access to ...
Discussion
Tammy Clifford
Canadian Agency for Drugs and Technologies in Health, Canada
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Building Bridges Not Walls: Can We Develop Sustainable and Sharable Cost-Effectiveness Models? Slide 1 Building Bridges Not Walls: Can We Develop Sustainable and Sharable Cost-Effectiveness Models? Slide 2 Building Bridges Not Walls: Can We Develop Sustainable and Sharable Cost-Effectiveness Models? Slide 3 Building Bridges Not Walls: Can We Develop Sustainable and Sharable Cost-Effectiveness Models? Slide 4 Building Bridges Not Walls: Can We Develop Sustainable and Sharable Cost-Effectiveness Models? Slide 5 Building Bridges Not Walls: Can We Develop Sustainable and Sharable Cost-Effectiveness Models? Slide 6 Building Bridges Not Walls: Can We Develop Sustainable and Sharable Cost-Effectiveness Models? Slide 7 Building Bridges Not Walls: Can We Develop Sustainable and Sharable Cost-Effectiveness Models? Slide 8 Building Bridges Not Walls: Can We Develop Sustainable and Sharable Cost-Effectiveness Models? Slide 9 Building Bridges Not Walls: Can We Develop Sustainable and Sharable Cost-Effectiveness Models? Slide 10 Building Bridges Not Walls: Can We Develop Sustainable and Sharable Cost-Effectiveness Models? Slide 11 Building Bridges Not Walls: Can We Develop Sustainable and Sharable Cost-Effectiveness Models? Slide 12 Building Bridges Not Walls: Can We Develop Sustainable and Sharable Cost-Effectiveness Models? Slide 13 Building Bridges Not Walls: Can We Develop Sustainable and Sharable Cost-Effectiveness Models? Slide 14 Building Bridges Not Walls: Can We Develop Sustainable and Sharable Cost-Effectiveness Models? Slide 15 Building Bridges Not Walls: Can We Develop Sustainable and Sharable Cost-Effectiveness Models? Slide 16 Building Bridges Not Walls: Can We Develop Sustainable and Sharable Cost-Effectiveness Models? Slide 17 Building Bridges Not Walls: Can We Develop Sustainable and Sharable Cost-Effectiveness Models? Slide 18 Building Bridges Not Walls: Can We Develop Sustainable and Sharable Cost-Effectiveness Models? Slide 19 Building Bridges Not Walls: Can We Develop Sustainable and Sharable Cost-Effectiveness Models? Slide 20 Building Bridges Not Walls: Can We Develop Sustainable and Sharable Cost-Effectiveness Models? Slide 21 Building Bridges Not Walls: Can We Develop Sustainable and Sharable Cost-Effectiveness Models? Slide 22 Building Bridges Not Walls: Can We Develop Sustainable and Sharable Cost-Effectiveness Models? Slide 23 Building Bridges Not Walls: Can We Develop Sustainable and Sharable Cost-Effectiveness Models? Slide 24 Building Bridges Not Walls: Can We Develop Sustainable and Sharable Cost-Effectiveness Models? Slide 25 Building Bridges Not Walls: Can We Develop Sustainable and Sharable Cost-Effectiveness Models? Slide 26 Building Bridges Not Walls: Can We Develop Sustainable and Sharable Cost-Effectiveness Models? Slide 27 Building Bridges Not Walls: Can We Develop Sustainable and Sharable Cost-Effectiveness Models? Slide 28 Building Bridges Not Walls: Can We Develop Sustainable and Sharable Cost-Effectiveness Models? Slide 29 Building Bridges Not Walls: Can We Develop Sustainable and Sharable Cost-Effectiveness Models? Slide 30 Building Bridges Not Walls: Can We Develop Sustainable and Sharable Cost-Effectiveness Models? Slide 31 Building Bridges Not Walls: Can We Develop Sustainable and Sharable Cost-Effectiveness Models? Slide 32 Building Bridges Not Walls: Can We Develop Sustainable and Sharable Cost-Effectiveness Models? Slide 33
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In this session, we discussed the potential to create an environment in which analysts develop robust and sustainable cost-effectiveness models, which can be continually developed to support health technology management. We explored and identified opportunities, barriers, and future strategies for developing and implementing key infrastructure to support collaborative and transparent cost-effectiveness models.

Author(s) and affiliation(s): Chair: Tammy Clifford, CADTH, Canada Panelists: Deborah Marshall, University of Calgary, Canada Stirling Bryan, University of British Columbia, Canada Chris Sampson, Office of Health Economics, UK Rick Chapman, Institute for Clinical and Economic Review, USA

Conference/meeting: Health Technology Assessment International (HTAi) 2018

Location: Vancouver, Canada

Date: 04/06/2018

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Building Bridges Not Walls: Can We Develop Sustainable and Sharable Cost-Effectiveness Models?

  1. 1. Building Bridges Not Walls: Can We Develop Sustainable and Sharable Cost-Effectiveness Models? Chair: Tammy Clifford (CADTH, Canada) Panelists: Deborah Marshall (U Calgary, Canada), Stirling Bryan (UBC, Canada), Chris Sampson (OHE, UK), Rick Chapman(ICER, US) Monday, June 4, 3:30 pm to 4:45 pm
  2. 2. Introduction and Overview Deborah Marshall University of Calgary, Canada
  3. 3. The Context • Health technology management is the new HTA… • Efficiency in use of analytic resources • avoiding unnecessary duplication • Quality of cost-effectiveness modelling (Bell C et al, BMJ, 2016) • Minimizing error and bias; supporting model validation • Recent guideline statements • CADTH: modelers should build upon existing high quality modeling work • US Panel: emphasis on model transparency and ‘open source’ modelling
  4. 4. Description of Models for Rheumatoid Arthritis by Modeling Technique Decision TreesMarkov Models Discrete Event Simulation Individual Sample Methods n = 58 publications Between 1996 to 2012 Decision tree, n=13 Markov , n=25 Individual sampling, n=13 DES, n=7 Bold letters represent the original model within a tree of references - Scholz S and Mittendorf T, Health Econ Rev, 2014
  5. 5. Evolution Diagram of Simulation Models of Chronic Obstructive Pulmonary Disease (COPD) n = 49 publications To August 2015 Decision tree, n=2 Markov , n=41 Time in State, n=1 Individual sampling model, n=2 Discrete Event Simulation, n=1 System dynamics Model, n=2 - Zafari Z et al. Value in Health, 2017
  6. 6. Examples – Depends on Objective and Setting • Mount Hood Diabetes Challenge Network: Dedicated to promoting an exchange of ideas and information between those developing and using health economic diabetes simulation models since 1999. Conferences focus on comparisons of health economic diabetes models both in terms of their structure and performance. • Cancer Intervention and Surveillance Modeling Network (CISNET): Consortium of NCI-sponsored investigators who use statistical modeling to improve understanding of cancer control interventions in prevention, screening, and treatment and their effects on population trends in incidence and mortality. Breast, cervical, colorectal, esophageal, lung, prostate cancer. • Population Health Model (POHEM): Health microsimulation model developed at Statistics Canada in the early 1990s. POHEM simulates the lifecycle of the Canadian population, specifically focusing on aspects of health. Dynamically simulates individuals’ disease states, risk factors, and health determinants, to describe and project health outcomes, including disease incidence, prevalence, life expectancy, health-adjusted life expectancy, quality of life, and healthcare costs. Applications in cardiovascular disease, physical activity, cancer, osteoarthritis, and neurological diseases. • Canadian Partnership Against Cancer (CPAC) OncoSim Model: Web-based microsimulation tool that evaluates cancer control strategies for prevention, screening and treatment of common cancers. OncoSim creates and compares projections of cancer rates, deaths, resource needs, direct health-care costs and other economic impacts.
  7. 7. Potential Barriers and Criteria/Characteristics that make Models ‘Transferable and Sustainable’ 1) Personal – intellectual property, fear, lack of direct benefit, more work 2) Institutional - intellectual property, accountability, who should pay for additional work 3) Conceptual – defining the scope, accountability 4) Practical – proprietary software, privacy of patient data, infrastructure, long term commitment • Platform / software • Model Structure • Consistent data sources • Testing and validation of the models • Standardized and transparent documentation • Application of guidelines for good modeling e.g. ISPOR • Criteria that are critical to make a model sustainable • Others… - Sampson C, Washington, DC, November 2017 - ISPOR-SMDM Modeling Good Research Practices Task Forces, https://www.ispor.org/workpaper/Modeling-Good-Research-Practices-Overview.asp
  8. 8. Stirling Bryan University of British Columbia, Canada
  9. 9. Building Bridges Not Walls… A Canadian Perspective Stirling Bryan, PhD Scientific Director, BC SUPPORT Unit Senior Scientist, C2E2, VCHRI Professor, School of Population & Public Health, UBC
  10. 10. 10 Disclosures I am not aware of any actual or potential conflicts of interest in relation to this presentation. Personal salary/funding support: Vancouver Coastal Health; UBC; CIHR; BC Ministry of Health; Genome Canada/BC; CADTH
  11. 11. 11 Pathway model: COPD Lead: Dr. Mohsen Sadatsafavi
  12. 12. 12 Two personal worries… Quality Waste
  13. 13. 13 Zafari et al, 2017
  14. 14. 14 “Where there are well-constructed, validated models that appropriately capture the clinical or care pathway and reflect all of the components of the decision problem, researchers should consider these models when trying to conceptualize their own model structure.” “This could involve contacting and potentially collaborating with researchers who have developed previous models…” “…to avoid duplication of efforts to address the same decision problem, and may provide a basis for model validation…”
  15. 15. 15
  16. 16. 16 CADTH’s 2018–2021 Strategic Plan
  17. 17. 17
  18. 18. Chris Sampson Office of Health Economics, United Kingdom
  19. 19. Building bridges not walls in Europe Chris Sampson The Office of Health Economics, UK
  20. 20. HTAi 2018 | Building Bridges Not Walls The burden of scaling walls
  21. 21. HTAi 2018 | Building Bridges Not Walls Manufacturer Academic modellers Consultants NICE-funded modellers ABPI / EFPIA DSU NHS EUnetHTA National agencies Industry National government Funders Public
  22. 22. HTAi 2018 | Building Bridges Not Walls Organisational structures Processes Accountability Methodology Legislation 30 countries 80+ organisations
  23. 23. Rick Chapman Institute for Clinical and Economic Review (ICER), USA
  24. 24. Building Bridges Not Walls: Can We Develop Sustainable and Sharable Cost-Effectiveness Models? US Experience Rick Chapman, PhD │Director of Health Economics rchapman@icer-review.org June 4, 2018
  25. 25. Practical Requirements & Logistics in US • Fragmented system with multiple payers • Private sector with IP concerns • No HTA authority • Skepticism toward CEA • Sustainability: Create value for stakeholders • Other initiatives (e.g., IVI)
  26. 26. ICER Pilot Transparency Project
  27. 27. What Does ICER Mean by Transparency? • Always shared information about economic model structure and inputs with manufacturers during our review • To understand and critique models during development • To develop/modify parallel model analyses • Pilot attempts to balance IP rights of our collaborators with goal of even greater model transparency • Provide opportunity for manufacturers to gain even greater insights into draft models • Ultimately patient groups and other qualified stakeholders • Goal: Feedback can enhance accuracy and relevance of final model versions
  28. 28. Description of Transparency Pilot Project • Models involved • Migraine (UIC) • Endometriosis (U CO) • Contracting/Fees • Manufacturers contract & pay fee to ICER’s academic collaborators to cover time needed to produce sharable executable files and all supporting documentation • Ownership/Use requirements • To protect IP of researchers and institutions, models shared under confidentiality or licensing agreements • Unable to keep or alter model for their own purposes • Security/NDA • Signed non-disclosure/confidentiality agreements • Secured access (e.g., Dropbox) • Access/Support infrastructure • Access for limited timeframe, with no saving or retention of materials • Confined to team of individuals responsible for review • Support via initial orientation, follow-up email/phone contacts (limited), ?in-person workshops • Expectation is that reviews will inform written public comments on our draft reports
  29. 29. Transparency Pilot: Results/Lessons Learned • Feedback received from manufacturers and other stakeholders will help determine ICER’s future approach to sharing economic models associated with other evidence reviews • Bridges • Model access provided to manufacturers/consultants • Technical support processes developed • Contracting, sharing infrastructure developing • Walls • Timing for contracting, review, etc. (e.g., none for endometriosis) • Level of support expected (e.g., level & number of interactions), model changes over time • Financial barriers to access for non-manufacturer stakeholders • Confidential/redacted data
  30. 30. Summary and Discussion Deborah Marshall University of Calgary, Canada
  31. 31. Possible Considerations for Discussion • What do we mean by “transparent, transferable and sustainable model”? • How can we promote efficiency and quality in Canadian cost-effectiveness modelling? • Is this an attractive direction in a Canadian context? • Should we be trying to facilitate transparent, transferable and sustainable models, and if so how? • If yes, how might this be operationalized in a Canadian context to support health care decision-making?
  32. 32. Issues to Consider • Intellectual Property • Ownership • Control • Security • Training program to learn model • Access to the model • Funding for development and maintenance • Others?
  33. 33. Discussion Tammy Clifford Canadian Agency for Drugs and Technologies in Health, Canada
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In this session, we discussed the potential to create an environment in which analysts develop robust and sustainable cost-effectiveness models, which can be continually developed to support health technology management. We explored and identified opportunities, barriers, and future strategies for developing and implementing key infrastructure to support collaborative and transparent cost-effectiveness models. Author(s) and affiliation(s): Chair: Tammy Clifford, CADTH, Canada Panelists: Deborah Marshall, University of Calgary, Canada Stirling Bryan, University of British Columbia, Canada Chris Sampson, Office of Health Economics, UK Rick Chapman, Institute for Clinical and Economic Review, USA Conference/meeting: Health Technology Assessment International (HTAi) 2018 Location: Vancouver, Canada Date: 04/06/2018

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