EVIDEM
This presentation is the property of its rightful owner.
Sponsored Links
1 / 18

BioMedCom PowerPoint PPT Presentation


  • 57 Views
  • Uploaded on
  • Presentation posted in: General

EVIDEM. BioMedCom. A practical framework to support healthcare decisionmaking, assess quality of evidence, and define explicit data needs. Evidence and Value: Impact on DEcisionMaking - A practical framework applying Multi-Criteria Decision Analysis to support healthcare decisionmaking.

Download Presentation

BioMedCom

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Biomedcom

EVIDEM

BioMedCom

A practical framework to

support healthcare decisionmaking,

assess quality of evidence, and

define explicit data needs

Evidence and Value: Impact on DEcisionMaking -

A practical framework applying Multi-Criteria Decision Analysis to support healthcare decisionmaking

Mireille M Goetghebeur PhD, Monika Wagner PhD, Hanane Khoury PhD, Randy Levitt PhD, Lonny J Erickson PhD, Donna Rindress PhD

BioMedCom Consultants incMontreal, Canada


Biomedcom

Background & Hypotheses

  • Healthcare decisionmaking is a complex process that requires simultaneous integration of numerous disparate types of evidence and value judgments

  • There is a need, nationally and internationally for a transparent access to evidence and values on which decisions are based for coverage/use of healthcare interventions.

  • Ad-hoc assessment of a healthcare intervention without breakdown into components may result in loss of information and possibly biased valuation

  • Healthcare decisionmaking could be facilitated by structuring evidence and value judgments on which it is based into a practical and transparent architecture

  • Transparency will enhance understanding of healthcare decisions


Biomedcom

Objectives

  • Breakdown components of healthcare decisionmaking into practical instruments structuring and quantifying assessment of healthcare interventions to facilitate decisionmaking

  • Build an iceberg architecture to provide multiple layers of transparent access to components of decisionmaking

Ad hoc assessment

Burden of disease Budget impact

Type of medical service Healthcare savings

Improvement of efficacy Equity

Cost-effectiveness Etc…

  • Ultimately, optimize health by best use of healthcare interventions


Conceptual framework components of decisionmaking

Decisionmaking process

Scientific judgment

Value judgment

Intrinsic

value

of product

Extrinsic

value

of product

Quality of

of

evidence

Improvement over existing treatment

None Lower

Major Higher

Validity of efficacy trial

Low Small

High Large

Type of population treated (equity)

Low priority? High priority?

Number of patients

Etc…

Efficacy

Etc…

Vulnerable vs productive

patients

  • Based on international standards

  • Comprehensive analyses can be systematized

  • Not highly dependent on evaluator perspective

  • Similar value system

  • Requires value judgment

  • Dependent on evaluator perspective

  • No shared value system

  • Dependent on region/institution priorities

BioMedCom

BioMedCom

Conceptual frameworkComponents of decisionmaking

1Tunis SR. Reflections on science, judgment and value in evidence-based decision making: a conversation with David Eddy. Health Affairs. 2007 (26): w500-w515;

2Eddy DM. Clinical decision-making: from theory to practice-Anatomy of a decision. JAMA 1990 (263):441-443.

1Tunis SR. Reflections on science, judgment and value in evidence-based decision making: a conversation with David Eddy. Health Affairs. 2007 (26): w500-w515;

2Eddy DM. Clinical decision-making: from theory to practice-Anatomy of a decision. JAMA 1990 (263):441-443.


Evidem what practical iceberg architecture to support decisionmaking

Extrinsic value

Intrinsic value of treatment

Value Matrix

Multi Criteria Decision Analysis (MCDA)

Synthesized evidence

Key info for each component of

Value Matrix

Fully referenced

Quality of evidence

Quality Matrix

Criteria of quality

International standards

Decisionmaking body requirements

BioMedCom

BioMedCom

EVIDEM – What?Practical iceberg architecture to support decisionmaking

Decision

Evidence

Full text source documents (published, registries, proprietary)


Evidem who communication tool to connect stakeholders

T

r

a

n

s

p

a

r

e

n

t

c

o

m

m

u

n

i

c

a

t

i

o

n

t

o

o

l

BioMedCom

EVIDEM – Who?Communication tool to connect stakeholders

Decisionmakers

EVIDEM investigators

& experts

Data producers


Evidem why sharing of value judgments and structured multilevel access to data

BioMedCom

EVIDEM - Why?Sharing of value judgments and structured multilevel access to data

More transparent and understandable

Can be explored more easily

Limit obstruction of

thinking process

by large amount of data

Focus on value

Sharing of weights & scores

Transparent

access

to quality of data

and methods

Transparent multilayer

access to

evidence


Evidem how integrated process example improvement of efficacy

Quality Matrix: quality of clinical evidence

Synthesized clinical evidence

References

Evidence - Full text sources/links

BioMedCom

Proprietary

data

Meta-

Analyses

(Cochrane)

Registries

Published

trials

EVIDEM – How?Integrated process – example “Improvement of efficacy”

Decision

Extrinsic value

Value Matrix (MCDA)

Value Matrix component T3: Improvement of medical service - efficacy

2


Evidem tools mcda value matrix 15 components defining intrinsic value of treatment

EVIDEM tools – MCDA Value Matrix 15 components defining intrinsic value of treatment

Quality Matrix

Components identified from literature review and current decisionmaking processes, and selected to fulfill MCDA guidelines on clustering, completeness, redundancy, operationality & mutual independence (Baltussen R, Niessen L. Priority setting of health interventions: the need for multi-criteria decision analysis. Cost Eff Resour Alloc. 2006;4:14.; National Economic Research Associated. Multi-criteria analysis manual 2005. http://www.communities.gov.uk/pub/252/MulticriteriaanalysismanualPDF1380Kb_id1142252.pdf Accessed Jan2007)


Evidem tools quality matrix 12 types of evidence 3 criteria of quality

EVIDEM tools - Quality Matrix12 types of evidence, 3 criteria of quality

  • Structured based on criteria defining quality and on requirements from more than 20 decisionmaking bodies worldwide (INTERFACE database. 2000-2008. www.biomedcom.org); Assessment for each component based on instruments derived from quality standards (e.g., CONSORT, CHEC, STROBE, Siegel et al,

  • Mauskopf et al) as well as guidelines and processes from decisionmaking bodies


Pilot study in canadian context proof of concept using historical cases

Pilot study in Canadian contextProof of concept using historical cases

  • Historical cases: 10 medicines (cardiovascular diseases, endocrinology, infectious diseases neurology, oncology, ophthalmology,) using data from literature review and manufacturer dossiers submitted to the Canadian Common Drug Review (CDR) and Québec Conseil du Médicament (CM)

  • QM scores: EVIDEM investigators;

  • VM weights and scores, and feedback on process: Canadian Value Panel composed of representative stakeholders across Canada (decisionmakers, specialists, generalists, nurses, pharmacists, health economists/epidemiologists)

  • Feasibility: Algorithm developed to operationalize each cell of the matrices; applicable to any therapeutic areas and jurisdiction

  • Practicality: 30 min on average to apply VM by stakeholders; about 250 hrs to build the structured package of fully traceable information (quality, synthesized format and full text access) and value scores

  • Feedback from panelist: Value of EVIDEMin structuring evidence, assessing strengths and weaknesses systematically, and sharing values and value scores

  • Limitations of pilot: limited access for panelists to underlying source data (electronic interface to be developed); extrinsic components not covered (to be explored)


Pilot study value matrix value assessment example for clusters 1 2

Pilot study - Value MatrixValue assessment example for clusters 1 & 2

  • Anchors defined from a societal perspective, i.e., optimizing health at the societal level

  • Score options translate to 0% (score of 0), 33% (score of 1), 66% (score of 2) and 100% (score of 3)


Biomedcom

Pilot study - Value MatrixValue assessment example for cluster 3


Biomedcom

Pilot study - Value MatrixValue assessment example for cluster 4


Potential applications transparent access to evidence and values

OTHER HEALTHCARE DECISIONS

Healthcare intervention reimbursement decisions

Collaboration axis

Explicit data needs

  • Define explicit needs of decisionmakers

  • Establish reasonable requirements

Application axis

Retrospective

Application axis

Prospective

EVIDEM

framework

  • Validate process in various jurisdictions

  • Explore context of past decisions

  • Generate data on quality of evidence

  • Adapt framework to existing decisionmaking processes

  • Basis to develop extrinsic value components

Collaboration axis

Research planning

  • Planning tool for researchers and intervention developers to meet explicit needs

  • Develop methodology to generate data tailored to critical data needs

BioMedCom

BioMedCom

Potential applicationsTransparent access to evidence and values


Future developments

Future developments

  • Collaborative studies and iterative processes to explore the value of EVIDEM in context

  • Interactive web based architecture integrating evidence and value for various healthcare interventions

  • Expected outcome of a systematized and shareable approach for data access and value assessment is to optimize resources, decisions and health


Acknowledgments

Acknowledgments

  • EVIDEM Canadian Value panel:

  • Jean-Francois Bussières BPharm MSc MBA FCSHP, Director, Pharmaceutical Practice Research Unit, Dept of Pharmacy, CHU Sainte-Justine Research Center; Clinical Associate Professor, Faculty of Pharmacy, University of Montréal.

  • Benoit Cossette BPharm MSc, Pharmacist, Coordinator, Drug Disease Management Program, Fleurimont Hospital, Sherbrooke University Hospital Centre.

  • Doug Coyle PhD, Associate Professor, Faculty of Medicine, Epidemiology and Community Medicine, University of Ottawa.

  • Cheri Deal MD PhD FRCPC, Associate Professor and Program Director, Endocrine Service, CHU Sainte-Justine Research Center, University of Montréal.

  • RolandGrad MD CM MSc CCFP FCFP, Associate Professor, Department of Family Medicine, McGill University.

  • Christine Lee MD, FRCPC Assistant Professor, Director of the Microbiology Residency Program, Department of Pathology and Molecular Medicine, McMaster University.

  • Mitchell Levine MD FRCPC FISPE, Professor, Director of Centre for Evaluation of Medicines Department of Clinical Epidemiology & Biostatistics, Department of Medicine, McMaster University

  • Diane Lowden RN MSc, Clinical Nurse Specialist, Montreal Neurological Institute & Hospital, McGill University.

  • John Mancini MD FRCP, Professor/Program Director Continuing Medical Education, Department of Cardiology, University of British Columbia.

  • Paul Oh MD FRCPC, Medical Director of the Cardiac Rehab and Secondary Prevention Program, Department of Medicine, Clinical Pharmacology and Toxicology, University of Toronto.

  • Genevieve Tousignant N MScN, Clinical Nurse Specialist, Montreal Neurological Institute & Hospital, McGill University.

  • Wendy Ungar PhD, Senior Scientist, Child Health Evaluative Sciences, The Hospital for Sick Children; Associate Professor, Health Policy, Management, and Evaluation, University of Toronto.

  • Marie-Claude Vanier BPharm MSc, Clinical Associate Professor, Faculty of Pharmacy, University of Montréal; Pharmacist UMF-GMF Cité de la Santé de Laval.

  • Funded by an unrestricted research grant from Pfizer Canada


Biomedcom

EVIDEM

  • Thank you

EVIDEM tools are open access

We welcome input and collaborations

Please contact the EVIDEM Group @

www.evidem.org

[email protected]


  • Login