New this Year – Discussion Groups! Discussion Groups are facilitated conversations between conference attendees and select conference speakers. Held in the new, dynamic Discussion Lounge in the ISPOR Exhibit Hall, these discussions are intended to be highly interactive, collaborative, and promote the exchange of ideas in a peer-to-peer setting.
New this Year – Poster Tours! ISPOR has curated collections of research posters for you within each of the poster sessions. Each tour will feature high impact abstracts within a specific topical area and will include a tour guide as well as the poster authors to share their work and engage in discussions with you. Visit the Learning Formats page for more information.
F. Hoffmann-La Roche Ltd
New this Year – Discussion Groups! Discussion Groups are facilitated conversations between conference attendees and select conference speakers. Held in the new, dynamic Discussion Lounge in the ISPOR Exhibit Hall, these discussions are intended to be highly interactive, collaborative, and promote the exchange of ideas in a peer-to-peer setting.
New this Year – Discussion Groups! Discussion Groups are facilitated conversations between conference attendees and select conference speakers. Held in the new, dynamic Discussion Lounge in the ISPOR Exhibit Hall, these discussions are intended to be highly interactive, collaborative, and promote the exchange of ideas in a peer-to-peer setting.
New this Year – Poster Tours! ISPOR has curated collections of research posters for you within each of the poster sessions. Each tour will feature high impact abstracts within a specific topical area and will include a tour guide as well as the poster authors to share their work and engage in discussions with you. Visit the Learning Formats page for more information.
Welcome Remarks
Jan Hansen, PhD, 2022-2023 ISPOR President
2022 ISPOR Avedis Donabedian Lifetime Achievement Award
AWARDEE: Louis P. Garrison, Jr, PhD
9:30 - 18:30
Exhibit Hall Open
In-person
9:45 - 10:15
Coffee Break
In-person
10:00 - 13:15
In-Person and Virtual Poster Session 3
Live
10:15 - 11:15
Concurrent Breakout Session 4
Personalized Values for Health: Introducing O.P.U.F., the Online Elicitation of Personal Utility Functions
In-person
Level: Intermediate
PURPOSE:
Traditional health valuation methods, such as time trade-off and discrete choice experiments, require data from large samples and are decompositional (‘uncovered’) in nature. Moreover, the values they produce are only valid for the sample average. The recently developed OPUF framework provides a new approach: building on advanced preference elicitation techniques, it enables the creation of adaptive online surveys for the personalised valuation of health. Thereby, OPUF can produce evidence on value for small groups and even on the individual level, being compositional (‘deliberate’) in nature. The framework can be used with existing patient-reported outcome instruments as well as with de novo sets of attributes. This workshop will introduce the OPUF framework and focus on the need and potential for personalised health values. Workshop participants will get a live demonstration of the OPUF method. This workshop will resonate with an audience that is interested in valuation, innovation, patient-centric solutions, individualized medicine, and rare disease.
DESCRIPTION:
In this workshop, we will address the WHY-HOW-WHAT-WHEN of OPUF.
WHY (10 min): Dr. Van Hout will discuss the unmet need that OPUF can fulfil in comparison to existing methods.
HOW (10 min): Dr. Devlin will discuss the theoretical framework to explain what sets OPUF apart from current stated preference methods.
WHAT (15 min): Dr. Schneider will provide a live demonstration based on the EQ-5D-5L with participation of the audience, and show how OPUF can be used to generate aggregate and respondent-level results.
WHEN (10 min): Dr. Heisen will discuss in which cases OPUF should be considered. Closing (15 min): Dr. Devlin will conclude the workshop and chair the Q&A session.
Discussion Leaders
Nancy Devlin, PhD
University of Melbourne, Melbourne, VIC, Australia
Nancy is Professor of Health Economics at the University of Melbourne and Senior Fellow at the Office of Health Economics, London. She is Chair of the Board of the EuroQol Research Foundation and served as President of ISPOR (2019-2020). Her principal areas of research expertise are the measurement and valuation of patient reported health outcomes; the cost effectiveness thresholds used in making judgments about value for money in health care; and priority setting in health care. She is currently leading a large programme of research to improve measurement and valuation of quality of life in children (QUOKKA), funded by the Medical Research Future Fund (Australia). Nancy has published >150 original peer reviewed journal papers on a wide range of empirical and theoretical topics in health economics.
Discussants
Marieke Heisen, PhD
OPEN Health Evidence & Access, Rotterdam, Netherlands
Marieke is the Global Preference Lead and Director in the Patient-Centered Outcomes & Patient Engagement team at OPEN Health. Before focusing on preference research and patient-centered outcomes, Marieke spent 8+ years in health economic modelling. Her all-round experience includes pharmacoeconomic modelling/adaptations, reimbursement submissions, network meta-analysis, survival analysis, expert/patient elicitation, HRQoL evidence strategy, and preference elicitation. Disease areas she has worked in include cardiovascular disease, oncology, hematology, urology, auto-immune diseases, infectious diseases/vaccination, and mental disorders. Marieke joined OPEN Health (Pharmerit) in 2011 and is based in Rotterdam, the Netherlands. She holds a PhD degree in Biomedical Engineering, obtained from the Eindhoven University of Technology, The Netherlands.
Paul Schneider, MD, MSc
University of Sheffield, Sheffield, United Kingdom
Paul Schneider is a PhD student at the Wellcome Trust funded doctoral training centre for public health, economics, and decision science at University of Sheffield, UK.
Paul's research focuses on methodological and normative issues in the valuation of health. He has a keen interest in the use of modern software and interactive user interfaces for health valuation and decision modelling.
https://bitowaqr.github.io/
Ben A Van Hout, PhD
University of Sheffield, Sheffield, United Kingdom
Ben van Hout combines a position of professor of Health Economics with that of Chief Scientific Officer in OPEN Health Evidence & Access. In 2020, he received the Donabedian Lifetime Achievement award for his contributions to the field of economic evaluations in health care. Over the last couple of years, he has taken his research to the next level by first having a myocardial infarction and second having a large motorcycle accident. Since then, he has taken more than 16,000 tablets, still counting, for prevention, pain and itch.
His current position allows him to only be involved in projects he fancies, “personal utility functions” being on the top of the list.
Estimating a Country’s Social Distribution of Health
Virtual
Level: Intermediate
PURPOSE:
The workshop’s objectives are to (1) introduce the rationale for estimating the social distribution of health within a country; and (2) provide examples of how to produce estimates based on research in the United Kingdom (UK), Chile, the United States (US) and Australia. After the workshop, participants will have pragmatic guidance on how to estimate the social distribution of health in their region, as well as recommendations on how to use estimates in equity-informative cost-effectiveness analysis.
DESCRIPTION:
Research to measure and understand the impact of decisions on health inequalities is becoming increasingly important. However, many countries lack baseline information on the social distribution of health, which is needed to apply new equity methods, such as distributional cost-effectiveness analysis. This information can also help decision makers assess the magnitude and importance of health inequalities. The social distribution of health – commonly expressed in terms of life expectancy, disability-free life expectancy and quality adjusted life expectancy across equity-relevant subgroups – measures the current level of inequality in a country. As there are no formal best practices for this research, this workshop will help researchers conduct these studies in their own regions by sharing a step-by-step guide, with information on: (a) how to define equity-relevant subgroups; (b) how to identify measures that capture inequality; (c) how to identify needed data; (d) how to link data or address suppression; and (e) how to interpret and report results. Recommendations will be based on methods and data used to produce estimates of the social distribution of health across four countries (US, UK, AUS, Chile) with different healthcare systems and data availability. The audience will be engaged through polling and interactive discussion on how to use research findings, drawing from real world examples of how information is being used across health technology assessment, government, academic and pharmaceutical stakeholders.
Discussion Leaders
Richard Cookson, DPhil
University of York, York, YOR, United Kingdom
Richard Cookson is a professor at the Centre for Health Economics, University of York. He has helped pioneer “equity-informative” methods of policy analysis, including distributional cost-effectiveness analysis; health equity indicators for healthcare quality assurance; and methods for investigating public concern for reducing health inequality. He has co-chaired international working groups on equity, worked in the UK Prime Minister’s Delivery Unit and served on various NHS advisory committees.
Discussants
Natalie Carvalho, PhD
University of Melbourne, South Yarra, VIC, Australia
Manuel Antonio Espinoza, MD MSc PhD
Pontificia Universidad Catolica de Chile, Santiago, Chile
Manuel Espinoza is Associate Professor in the Department of Public Health and Chief of the Health Technology Assessment Unit, both at Pontificia Universidad Católica de Chile. He is Editor in Chief of Value in Health Regional Issues, Chair of the HTAi Latinamerica Policy Forum and consultant retainer for the Interamerican Bank of Development. Manuel holds a medical doctor degree and Master in Epidemiology both from Pontificia Universidad Católica de Chile; a Master in Biostatistics from Universidad de Chile, and Master and PhD in Health Economics, both from University of York in the UK.
Stacey Kowal, BS, MS, MSc
Genentech, Inc., Alameda, CA, USA
Stacey Kowal currently serves as a principal researcher in Genentech’s Health Policy and Systems Research team where her work focuses on identifying and testing new methods to assess the impact of new healthcare technologies. Her background includes both US and global work to inform health technology assessment and reimbursement as well as design of public health interventions, drawing on disciplines of applied mathematics, economics, and international health policy. Stacey’s current research aims to increase focus on equity effects in health economics and outcomes research (HEOR), including integration of distributional elements into healthcare decision-making. Stacey is a Udall scholar, a Truman scholar and a Marshall scholar. She holds a BS in Mathematics from Alma College, an MSc in public health from the London School of Hygiene and Tropical Medicine and an MSc in International Health Policy and Health Economics from the London School of Economics.
Supplementing Evidence with Expert Beliefs: Within Health Sector Complexities and Considerations
In-person
Level: Intermediate
PURPOSE: Evidence is needed to enable robust and defensible decision making across health care contexts. Different decision making processes rely to a different extent on clinical or subject experts to supplement their evidence requirements. In some contexts, such as public health and for communicable diseases, experimental evidence may be unfeasible to collect within reasonable timescales, necessitating the need for experts' beliefs in order to make allocation, reimbursement and prioritisation decisions.
This session will consider the complexities of different contexts for decision making in healthcare and discuss the considerations for using experts' beliefs within these contexts.
DESCRIPTION: Following on from a brief introduction to the topic, the session will consider two specific contexts in which experts’ beliefs may be considered relevant to help inform decision making: 1) complex interventions/settings, specifically the development of novel therapies with unproven modes of action, 2) evaluation conducted in LMIC settings, used to inform prioritization and planning. A third session will focus on behavioral considerations for the use of experts' beliefs in different contexts.
Moderator (Laura Bojke). Introduction and rationale to use experts’ beliefs in health, different contexts in which elicitation techniques have been applied. Presentation 2 (15 mins): Dina Jankovic. Use of experts’ beliefs to generate prior evidence to inform the evaluation of complex and early stage interventions. Presentation 3 (10 mins): Victoria Shaffer. Cognitive heuristics and their resulting biases in expert judgment, environmental constraints on judgment, learning from experience, and strategies for debiasing judgments. Presentation 4 (15 mins): Abigail Colson. Use of experts’ beliefs in the global health setting, prioritisation and system strengthening. The workshop will use real-time polling to work through considerations for different contexts in which expert beliefs can aid decision making. Audience discussion about the opportunities and challenges of using different methods in these contexts and the agenda for further research.
Discussion Leaders
Laura Bojke, PhD
University of York, York, YOR, United Kingdom
Laura is a Professor of Health Economics from the Centre for Health Economics (CHE), University of York, UK. Laura Bojke has over 20 years experience in economic evaluation. Laura has worked on a wide range of applied and methodological projects, within pharmacoeconomics and public health. She has gained extensive cost-effectiveness modelling experience through her work as part of the evidence review group for NICE and worked on a number of projects involving the use of expert elicited data within decision analytic models.
Discussants
Abigail Colson, MPP
University of Strathclyde, Glasgow, United Kingdom
Abigail Colson is a Senior Lecturer in the Department of Management Science at Strathclyde Business School. Her work focuses on decision and uncertainty analysis, including the structuring, elicitation, and validation of expert judgements. Much of her work is in the field of public health, including program evaluation, cost-effectiveness and benefit-cost analysis, and prioritisation. She is particularly interested in health evaluation in low- and mid-income countries and supporting economic analysis and health technology assessment of new antibiotics.
Dina Jankovic, PhD
University of York, York, United Kingdom
Dina Jankovic is a Research Fellow at the Centre for Health Economics, University of York, UK. Dina has worked on a range of applied cost-effectiveness analyses and methodological research, with special interest in using expert elicitation to support healthcare decision-making.
Victoria Shaffer, PhD
University of Missouri, Columbia, MO, USA
My research focuses on applying decision psychology and behavioral economics to inform practical problems in medical decision making. In particular, my work has applied research about judgment and decision making to the design of patient decision support tools. I am particularly interested in how the inclusion of different elements in patient decision aids either support or bias patients’ decision making processes. Previous research has focused on the impact of patient narratives in decision aids, attitudes towards the use of clinical decision support systems in medicine, and the behavioral economics of noncash incentives.
Clinical Evidence for Health Technology Assessment in Oncology, Are We Going Backwards? Where Are We Going With Single-Arm Trials?
In-person
ISSUE:
Progress in understanding of the underlying biological mechanisms in cancer has led to a paradigm shift in drug development and to many products receiving approval based on single arm trials (SATs). SATs have been favoured over randomized controlled trials (RCTs) to avoid allocating patients to potentially less effective control therapies and address difficulties in enrolling rare subsets of disease. A recent
review reported that the FDA granted 153 new oncology indications based on SATs between 2001 and 2020 (102 accelerated and 51 regular approvals). Absence of RCT evidence presents challenges for health technology assessment (HTA) in evaluating comparative effectiveness of new interventions versus current treatments. Although statistical methods exist, there remains a substantial potential risk of bias from differences in unknown or unmeasured prognostic factors and the definition or ascertainment of endpoints. These issues, as well as small sample sizes, may result in substantial uncertainty in comparative effectiveness estimates. Progress towards higher quality evidence reflecting effectiveness in routine practice (e.g., pragmatic trials) has been very limited. Rather, with increased use of SATs, are we going backwards?
OVERVIEW:
Vishal Bhatnagar will discuss circumstances where an SAT may be appropriate, concerns about and experience with regulatory approvals based on SAT evidence.
Adrian Vickers will describe alternative comparative effectiveness methods based on patient-level and aggregate data; their strengths, limitations, and potential for bias and increased uncertainty that may present challenges for HTA.
Anne-Pierre Pickaert will discuss the importance of efficient research, regulatory, and HTA processes in making new treatments available rapidly whilst ensuring that they truly offer improved outcomes. The panel will debate learnings from regulatory approvals and HTAs and how HTA processes may accommodate uncertainty. Audience polling on key questions and audience questions will be discussed (10 min). Stakeholders interested in issues surrounding SATs including industry, researchers, regulators, and payers may be interested.
Moderators
Sorrel Wolowacz, PhD
RTI Health Solutions, Manchester, United Kingdom
Sorrel Wolowacz, PhD, is Head of European Health Economics at RTI-HS, with 22 years of experience in health economics research and consulting. Her research focuses primarily on economic modelling, health utility estimation, observational studies, and health technology appraisal submissions. Dr. Wolowacz is a member of the editorial board for the Journal of Comparative Effectiveness Research and was co-chair of the ISPOR Good Research Practices Task Force addressing Measurement of Health State Utility Values for Economic Models in Clinical Studies and is a member of the ISPOR Oncology Special Interest Group.
Panelists
Vishal Bhatnagar, MD
Oncology Center of Excellence, U.S. Food and Drug Administration, Silver Spring, USA
Vishal Bhatnagar, MD, is a medical oncologist/hematologist and the Associate Director for Patient Outcomes in the OCE. His interests include patient reported outcomes, patient preference and incorporation of patient experience in oncology trials. His work focuses on the operational management of the OCE’s Patient-Focused Drug Development program. Additionally, Dr. Bhatnagar has a strong clinical interest in multiple myeloma and has previously served as an Office of Hematology and Oncology multiple myeloma scientific liaison. Dr. Bhatnagar received his BA in Political Science and his medical degree at the George Washington University. He completed his internal medicine residency and hematology/oncology fellowship at the University of Maryland.
Anne-Pierre Hubner Pickaert, MSc
Patvocates, VAUCRESSON, 75, France
Anne-Pierre Pickaert has over 20 years of public health and access to medicines experience with a wide range of healthcare stakeholders (charity, patient organisation, governmental agency, consultancy and pharmaceutical industry).
Anne-Pierre holds a MSc in Economic Evaluation of Health Technology Assessment from
the University of York. She most notably worked as cancer prevention specialist through nutrition and
lifestyle (World Cancer Research Fund and the French National Cancer Institute) and
market access director (Kantar Health, Lundbeck, and Sanofi).
Upon her own diagnosis Anne-Pierre realised how much her health care background was of great help to navigate through the complexities of her leukaemia patient journey. In order to have a greater impact on patient access to care, Anne-Pierre founded Care4Access, a consultancy dedicated to patient engagement and advocacy, and has also been collaborating with the think tank and social enterprise Patvocates.
Anne-Pierre is an engaged patient advocate with EGMOS and Association Laurette Fugain, two French patient organisations, to promote bone marrow donor recruitment and improve the management of graft versus host disease GvHD. She is a steering committee member of the Acute Leukemia Advocates Network (ALAN), as well as a board member of the Francophone Society for Bone Marrow Transplant and Cellular Therapies (SFGM-TC), and a campaign committee member of the Hematopoietic stem cell Transplantation Complications (HTC) project.
Adrian Vickers, PhD, MSc, BSc
RTI Health Solutions, Manchester, LAN, United Kingdom
Adrian Vickers is a statistics director at RTI Health Solutions and has been with RTI for 9 years. He specializes in network meta-analysis, survival analysis, and investigatory analyses for health technology assessments. He has previously worked with other agencies performing a wide range of statistical methods including longitudinal models, generalized additive mixed models, and conjoint analysis from patient record data, questionnaire data, and data from clinical trials.
Podium Sessions
The Role of Real-World Data in HTA and Regulatory Decision-Making
In-person
The use of real world data as a tool to inform uncertainty in relation to clinical and comparative effectiveness is a topic of great interest to all decision makers from regulators, payers, evidence based medicines practitioners as well as patients. The robustness of RWE has been questioned in some cases and heralded as the solution to the challenge of products such as ATMPs where full benefits can often be realized much later. This panel explores how real-world evidence has been used and what we can learn from its results.
Moderator
Ramiro Gilardino, MD, MHS, MSc
BMS, Dubendorf, ZH, Switzerland
Dr. Ramiro Gilardino brings 13 years of experience in health economics, outcomes research, and global health policy in pharmaceutical, medical devices companies, and not-for-profit organizations both at the regional and global reach.
He developed customer-centered value propositions, registry studies, claims analysis, among other health economics tactics supporting access to medical technologies. He also was engaged in health policy matters, including health technology assessment policies, patient engagement, and value assessment, where he worked among decision-makers in emerging markets in LATAM and CEMEA.
He is deeply committed to delivering global health innovation for access to technologies while sustaining health systems.
P34: Subclinical Hypothyroidism Influences the Quality of Life During Pregnancy: Results From THYPREQOL2020
10:15AM - 10:30AM
Tužil J1, Pilnackova B2, Watt T3, Jiskra J4, Koudelkova M5, Novotna E6, Doležal T2, Bartakova J7
1First Medical Faculty, Charles University, Prague, 102, Czech Republic, 2Institute of Health Economics and Technology Assessment (iHETA), Prague, Czech Republic, 3Department of Internal Medicine, Endocrinology, Herlev Gentofte Hospital, Copenhagen, Denmark, 4Department of Endocrinology and Metabolism, Third internal clinic, General University Hospital, Prague, Czech Republic, 5Institute of Health Information and Statistics of the Czech Republic, National Screening Centre, Prague, Czech Republic, 6Outpatient gynecology Femcare s.r.o., Odolena Voda, Czech Republic, 7Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
OBJECTIVES:
We are 25 years into an ongoing debate on whether symptoms accompany subclinical hypothyroidism (SHypo); additionally, it is unknown if SHypo influences the quality of life during pregnancy.
METHODS:
In this cross-sectional study (NCT04167423), questionnaires and test results (TSH, FT4, and AntiTPO antibodies) were collected online from pregnant women attending gynecology or endocrinology offices between 2020 and 2022. SHypo during each trimester was defined according to the 2014 ETA guidelines (TSH 0.1-2.5; 0.2-3.0; and 0.3-3.5 mU/L), and using a generic quality of life QoL (EQ-5D-5L) and a specific quality of life (ThyPRO-39). Differences were tested using a t-test and adjusted via multivariate linear regression.
RESULTS:
We collected data from 253 patients at 14 sites (age 31±5 years, 15±6 week of pregnancy, 2.4±2.2 weekly exercises). Seven per cent of conceptions were assisted, 97% of patients reported a satisfactory financial situation, 97% received help from friends, and 99% from family. Sixty-one patients had SHypo (mean TSH=4.1±1.4 mU/L) and were comparable in all characteristics to the 174 patients with normal thyroid function (mean TSH=1.5±0.7 mU/L), except for smoking history (61% vs. 41%, p=0.007) and primiparity (62% vs. 43%, p=0.010). The utility in SHypo (0.89±0.12) was significantly different from healthy patients (0.92±0.11; p=0.028) even after controlling for age, trimester, presence of AntiTPO, primiparity, other health conditions, education level, and smoking history (adjusted difference 0.04, p=0.036). A comparison of ThyPRO-39 domains uncovered pronounced symptoms of hypothyroidism (p=0.023), ocular symptoms (p=0.000), fatigue (p=0.008), cognitive symptoms (p=0.007), anxiety (p=0.000), depression (p=0.011), emotional susceptibility (p=0.011), impaired social life (p=0.048), and overall QoL-impact (ThyPRO-39 composite score) (p=0.001). Differences in ocular and cognitive symptoms, anxiety, and the composite score remained significant after adjustment.
CONCLUSIONS:
This is the first EQ-5D and ThyPRO-39 mapping during pregnancy and the first evidence that SHypo is associated with a small but measurable decrease in the QoL.
P35: Real-World Evidence of Incidence, Initial Treatment, and Survival of Female Breast Cancer in Germany
10:45AM - 11:00AM
Luna J1, Picker N2, Hahn P3, Wilke T3, Maywald U4
1Ingress-Health HWM GmbH, Berlin, Germany, 2Ingress-Health HWM GmbH, Wismar, Germany, 3IPAM, University of Wismar, Wismar, Germany, 4AOK PLUS, Dresden, Germany
OBJECTIVES: To update the knowledge on therapeutic practices and survival of newly diagnosed breast cancer (BC) patients, this study describes the incidence, initial treatment, and survival in German females.
METHODS: Claims data of 1.1 to 1.2 million female members over 18 years in a German statutory health insurance fund (AOK PLUS) from 2010 to 2020 were retrospectively analyzed. Individuals who had at least one inpatient and/or two outpatient diagnoses of BC (ICD-10 code C50) between 2013 and 2019 were identified. A case was considered being incident if there was a diagnosis-free and BC-treatment-free period of at least 36 months. Patients who were not continuously insured during the 36-month pre-diagnosis period were excluded. Treatment data were considered until the end of the study period (31/12/2020). The age-adjusted cumulative incidence was calculated. The time-to-treatment initiation (TTI) and overall survival were estimated by Kaplan-Meier analysis. The first outpatient or inpatient BC treatment after diagnosis, including surgery, radiation, and systemic therapies, was considered the initial therapy.
RESULTS: We identified 17,893 incident cases (median age: 69 years). The yearly age-adjusted cumulative incidence was 0.17%. The survival probability at 5 years after diagnosis was 70.8% (95%-CI: 70.0% - 71.5%). The latter was higher in patients aged below 65 years (90.0%, 95%-CI: 89.2% - 90.8%). The median TTI was 1.14 months (95%-CI: 1.11 – 1.15). Overall, 80.1% of cases received initial treatment within the three months after diagnosis, including surgery (52.5% breast-conserving surgery and 19.0% mastectomy), antineoplastic agents (13.7%), and endocrine therapy (8.5%).
CONCLUSIONS: With a yearly cumulative incidence of 0.17% in females, BC remains a considerable burden in Germany. The median onset age highlighted that the affected population consists of elderly patients having a higher risk of relevant comorbidities, making the treatment management more complex. Nevertheless, a reasonable TTI was observed in this study.
P33: Use of Real-World Evidence in European Medicines Agency Decisions
11:00AM - 11:15AM
Watson C1, Jones G1, Shaw C1, Kuchenbecker U2
1PHMR Ltd., London, UK, 2Xcenda GmbH, London, LON, UK
OBJECTIVES: The use of real-world evidence (RWE) and real-world data (RWD) may play an important role in complementing clinical trial data to support the clinical effectiveness of a medicinal product in regulatory submissions. This review identified the prevalence with which RWE was evaluated in regulatory decisions.
METHODS: European Public Assessment Reports (EPARs) for human drugs published by the European Medicines Agency (EMA) during the last year (20/06/21 - 20/06/22) were identified. Only documents reporting RWE-related terms were included.
RESULTS: During the study period, 76 EPARs were first published or updated by the EMA for authorised drugs, and among these, 43 (57%) included RWE-related terminology. Drug therapeutic areas were most commonly cancer (n=11), followed by neurological conditions (n=8), and infections (n=7). RWD were reported for 27 (36%) drugs, more frequently in the Product Assessment Report (PAR; n=23) than in the Product Information (n=8). A lack of long-term clinical efficacy and/or safety data and small patient numbers, particularly in paediatric and pregnant populations, were referenced as examples of a common evidence need for RWE. However, some concerns were raised by the EMA regarding the interpretation of RWD, due to methodological limitations, such as small sample sizes, risk of bias, and non-randomised study designs. Furthermore, 17 drugs were approved subject to post-authorisation obligations relating to the long-term collection of RWD, most commonly post-authorisation safety studies (PASS; n=10).
CONCLUSIONS: RWE was used to support product labelling claims in more than a third of EMA decisions in the last year. However, these data were mostly reported in the supplementary PAR, not the Product Information, which suggests that the data did not significantly contribute to the regulatory decision-making. The frequency of drugs gaining conditional authorisation indicates that large, long-term observational studies can provide valuable data, particularly in the post-authorisation period.
P36: Can Real-World Evidence (RWE) Drive European, UK, and US Payer Decisions in the Reassessment of Oncology Therapies?
10:30AM - 10:45AM
Bharmal M1, Katsoulis I2, Chang J3, Graham A4, Palencia R5, Stavropoulou A4, Pashos C6
1EMD Serono, Research & Development Institute, Inc., an affiliate of Merck KGaA, Rockland, MA, USA, 2Market Access Transformation, Fleet, HAM, UK, 3Pfizer, New York, NY, USA, 4Market Access Transformation, Fleet, UK, 5Merck Healthcare KGaA, Darmstadt, HE, Germany, 6Genesis Research, Winchester, MA, USA
OBJECTIVES: To understand how health technology assessment (HTA) bodies and payers perceive the use and value of RWE when reassessing oncology therapies, and their perceptions on its most desired attributes. METHODS: A web-based survey was administered via the Rapid Payer Response (RPR) online portal in May 2022, among 30 national and regional payer decision-makers from France, Germany, Spain, the UK, and the US. Responses were collected through RPR in 5 days on the importance of evidence types, use cases of RWE, ranking of RWE attributes, and preference of endpoints, among other considerations. Payer responses were analyzed using descriptive statistics. RESULTS: While clinical trial evidence was confirmed as being of greatest importance during reassessments, decision-makers ranked RWE as the next most important among various payer considerations. Specifically, most responders agreed that confirming the real-world effectiveness (27 of 30 responders, 90%) and safety (80%) of oncology therapies are the primary use cases. Payers also noted that RWE was used to confirm treatment utilization (63%) as well as healthcare resource use and economic benefit (53% each). Demonstrating clinical benefit to subpopulations and comparing with standard of care (SOC) were also highly rated during reassessment. Especially because of the lack of longer-term data at launch and the relatively short duration of registrational trials, payers looked to RWE at reassessment to provide meaningful data on overall survival, incidence of adverse events, and comparative clinical and economic data vs SOC. RWE from prospective observational studies and product/disease registries were considered of higher value, while peer-reviewed published data that are transparently presented as part of industry dossiers were considered to be of highest quality. CONCLUSIONS: RWE can contribute significantly to HTA and payer reassessment decisions on coverage and reimbursement of oncology therapies, especially if meeting certain quality standards.
Advances in Cost-Effectiveness Analysis Methods
In-person
These studies focus on heterogeneity and meta-analysis of utility estimates.
Moderator
Mark Sculpher, PhD, MSc
University of York, York, NYK, United Kingdom
Mark Sculpher is Professor of Health Economics and Director of the Centre for Health Economics, University of York. He is also Co-Director of the Policy Research Unit in Economic Evaluation of Health and Care Interventions, a programme of research for the UK Department of Health and Social Care funded by the National Institute for Health Research (NIHR).
P29: Using Regression to Represent an Economic Model to Support Sensitivity Analyses
10:45AM - 11:00AM
Teljeur C1, Ryan M2
1Health Information and Quality Authority, Dublin, Ireland, 2Trinity College Dublin, Dublin, Ireland
OBJECTIVES: Economic models are frequently complex and the published results are often of limited value in other settings due to differences in parameter values. We explored the potential of using regression to summarise a model as a formula, enabling sensitivity analyses without access to the underlying model.
METHODS: We used a case study of an economic model of mechanical thrombectomy for the management of acute ischaemic stroke, compared with intravenous thrombolysis. The Markov model incorporated 40 parameters to estimate cost-utility. Regression was used to predict the model-generated incremental costs and benefits from the input parameters. We reran the economic model 1,000 times, changing the mean values of between one and ten randomly selected input parameters. The model outputs were compared with those generated using the regression formula with the updated mean parameter values. The simulation was also run using only extreme parameter value changes.
RESULTS: The ICERs estimated using the two approaches were highly correlated: 99% of simulations resulted in the regression formula ICER being within 5% of the model generated ICER. The accuracy of the regression formula estimates reduced when more extreme mean parameter values were used, with only 81% of simulations within 5% of the model-generated ICER. However, accuracy remained high when less than five parameters were set at extreme values at once (96% within 5% of the model-generated ICER).
CONCLUSIONS: Summarising a model using a regression approach can facilitate rapid sensitivity and scenario analyses without rerunning the model. This approach could enable HTA agencies with limited resources to explore the impact of alternative parameter values specific to their setting without access to the original model. The success of this approach may depend on the complexity of the underlying model and whether the alternative parameter values are markedly outside the confidence bounds used in the model.
P30: Incorporating Beliefs on the Relevance of Values Into Meta-Analyses of Health State Utility Values Using the Bayesian Power Prior
10:30AM - 10:45AM
Hatswell A
Delta Hat, Nottingham, UK
OBJECTIVES:
Health state utility values (HSUVs) are pivotal inputs to health-state defined economic models informing most Health Technology Assessments (HTAs), and thus adoption decisions for novel interventions. Where there are multiple potential candidate HSUVs typically a single value is used, implicitly weighting other candidate HSUVs at 0, and occasionally HSUVs meta-analysed.
METHODS:
Using three case studies in lung cancer, liver cirrhosis, and diabetic retinopathy blindness, a Bayesian ‘Power Prior’ (BPP) approach was implemented to incorporate beliefs on study applicability. The BPP is a technique used in clinical research to allow historical data to supplement contemporary control data in clinical studies. In this implementation older studies, non-UK value sets, and vignette studies were downweighted (but not entirely disregarded). Power prior HSUV estimates were compared with using a single preferred value (SPV), fixed effects meta-analysis (FEMA), and random effects meta-analysis (REMA).
RESULTS:
In the lung cancer example (1 contemporary study and 5 historical HSUVs), the BPP reduced uncertainty (HSUV of 0.74 95% Credible Interval, CrI: 0.73-0.75) compared to the use of only contemporary data (0.75, 95% Confidence Interval, CI: 0.72-0.78) without being affected by studies of low relevance. In cirrhosis, synthesizing 9 HSUVs with low relevance, the BPP reflected the uncertainty in the applicability of the evidence base (BPP 0.71, CrI 0.66-0.75). In diabetic retinopathy blindness, the effect of the BPP was to allow inclusion of multiple studies with lower estimates, reducing the estimate (BPP 0.39, SPV 0.61, FEMA 0.40, REMA 0.48).
CONCLUSIONS:
The concept of the BPP can be adapted for meta-analysing HSUVs, leading to and corresponding implications for economic model results. In particular, downweighting shows wider CI/CrIs relative to other meta-analysis methods but more precise estimates than using a SPV. The implementation of BPP provides a practical mechanism to explicitly incorporate perceived relevance to a decision problem.
P31: Estimating Subgroup- And Individual-Level Treatment Effects Using Machine Learning Methods: A Case Study Using the First-ABC Trial
10:15AM - 10:30AM
Hattab Z1, Sadique Z2, O'Neill S3, Ramnarayan P4
1National University of Ireland Galway, Galway, G, Ireland, 2London School of Hygiene and Tropical Medicine, London, UK, 3National University of Ireland, Galway, London, UK, 4Great Ormond Street Hospital For Children NHS Trust, London, UK
OBJECTIVES:
To explore heterogeneity in the effectiveness and cost-effectiveness of high flow nasal cannula therapy (HFNC) compared with continuous positive airway pressure (CPAP) as the first-line mode of noninvasive respiratory support for acute illness in children, using data from the FIRST-ABC Randomized Controlled Trial (RCT) (ISRCTN60048867).
METHODS:
Six hundred acutely ill children aged 0-15 years clinically assessed to require noninvasive respiratory support were randomized 1:1 to start either HFNC (n=301), or CPAP (n=299) in FIRST-ABC step down RCT. The primary outcome of the RCT was time from randomization to liberation from all respiratory support (excluding supplemental oxygen), assessed against a noninferiority margin of an adjusted hazard ratio (HR) of 0.75. Causal Machine Learning (ML) approaches, allow for complex interactions between covariates while avoiding overfitting. We apply causal forests (CF), a causal ML method based on modified decision trees that can estimate subgroup- and individual-level treatment effects, without requiring correct pre-specification of the effect model. We consider CF alongside parametric approaches for estimating heterogeneity in Treatment Effects (HTE). We considered pre-specified subgroups defined by age (<12 months vs >=12 months), co-morbidities (none vs neurological vs other), length of prior Invasive Mechanical Ventilation (IMV) (<5 days vs >=5 days), reason for IMV (cardiac vs non-cardiac), reason for respiratory support post-extubation (planned vs indeterminate vs rescue) and SpO2:FiO2 (SF) ratio at randomisation.
RESULTS:
HFNC was found to be noninferior to CPAP in the aggregate analysis, with a median time to liberation of 52.9 hours (95% CI, 46.0 to 60.9) versus 47.9 hours (95% CI, 40.5 to 55.7). At an individual level, considerable variation was found in the estimated effects of HFNC on median time to liberation and cost-effectiveness endpoints. Less variation was observed at the subgroup level.
CONCLUSIONS:
The ML driven HTE estimates may allow effective and cost-effective targeting of individualised treatments.
P32: The Use of 'Placebo Adjusted Risk Difference Network Meta-Analysis' to Account for Confounding by Heterogeneity in Placebo Response Across Studies
11:00AM - 11:15AM
Hawkins N
University of Glasgow, Glasgow, UK
OBJECTIVES: Variation in placebo response can ‘confound’ indirect comparisons as it effectively acts as a treatment effect modifier. At the placebo response increases it will tend to “crowd” out the response to active treatments reducing relative treatment effects. The potential confounding arising from heterogeneity in placebo response has been addressed by conducting meta-regression with placebo response as a predictor or by using the risk difference scale. However, meta-regression analyses often lack power, and some degree of confounding remains on the risk difference scale. For binary endpoints, based on an assumption regarding the correlation between treatment and placebo response, an explicit adjustment can made for the contribution of the placebo response to the observed response for active treatments. It is them possible to obtain an estimate of the response to active treatments in the absence of any placebo response. These estimates can be compared to estimate relative treatment effects on the risk difference scale that are not confounded by heterogeneity in treatment response.
METHODS: Trial data were simulated for multiple treatment comparisons. Placebo responses were varied across the trials. Network meta-analyses of the simulated data were conducted on the odds ratio, risk difference, and placebo adjusted risk difference scales. Treatment effect estimates and treatment rankings were compared across the analyses. As a case study, the analytic methods were also applied to data from psoriasis trials.
RESULTS: For the simulated data, ordering of treatments based on central estimates of treatment effects and probability rankings varies across the analyses. The simulated treatment effects free of placebo response were accurately recovered in the placebo adjusted risk difference network meta-analysis.
CONCLUSIONS: Placebo adjusted risk difference network meta-analysis may provide useful estimates of treatment effects where there is heterogeneity in placebo response. The analysis also allows treatment response to be predicted for varying levels of placebo response.
Student Network Session
Student Roundtable
In-person
The ISPOR Student Roundtable Event offers opportunities for student attendees to hear from experts on a wide array of subject manner ranging from career advice to scientific topics. In the in-person format, the event welcomes four presenters to each discuss a different topic with attendees rotating from one table to the next. In the virtual format, we would like to explore accomplishing "rotating" between tables by having breakout rooms set up where attendees will be moved from one topic to the next after 10 minutes. At the completion of having attendees visit all 4 speakers there will be 10 minutes at the end of the event for open discussion for all speakers.
This edition of the Student Roundtable will focus on topics in Real-World Data and Information Systems:
- Data Protection, Integrity, & Quality Assurance
- Health & Insurance Records Systems
- Distributed Data & Research Networks
- Reproducibility & Replicability
Moderators
Clara Marquina, M.Sc
Monash University, Melbourne, Australia
Clara is a Postdoctoral Research Fellow in Health Economist at the Centre for Medicine Use and Safety at Monash University, Melbourne. She did her PhD in Health Economics at the School of Public Health and Preventive Medicine at Monash, and has worked as a health economics consultant for governmental agencies and industry partners. Her work focuses on the optimisation of chronic disease care from a health economics standpoint, with particular focus on interventions to improve health system resilience. Prior to her PhD, Clara worked in clinical and biomedical research in top research institutions in Spain, Sweden and Australia.
Speakers
Blythe Adamson, PhD, MPH
Flatiron Health, New York, NY, USA
Blythe Adamson is Principal Scientist in Machine Learning at Flatiron Health and Founder of Infectious Economics. She uses health economics, math, epidemiology, and data science to research and identify high-value medicines in development. Her research includes dynamic transmission modeling of infectious diseases, electronic medical records analysis in oncology, and cost-effectiveness studies to inform policy. Dr. Adamson received her PhD in Pharmacoeconomics and Masters in Public Health in Epidemiology from the University of Washington in Seattle. She served on the White House COVID Task Force in 2020. Prior to Flatiron, she worked on the development of HIV vaccines at Fred Hutchinson Cancer Research Center and informed Gates Foundation investing decisions with the Institute for Disease Modeling at Global Good.
Wim Goettsch, PhD
National Health Care Institute (ZIN); Utrecht University, Division of Pharmacoepidemiology and Clinical Pharmacology, Diemen, Netherlands
Wim Goettsch, PhD is currently Special Advisor HTA at the Dutch National Health Care Institute He was the Director of the EUnetHTA JA3 (2016-2021) Directorate and Chair of the Executive Board of EUnetHTA between June 2016 and March 2018. Since 2019, he also has a position as an Associate Professor at Utrecht University (NL) where he is leading a new H2020 consortium with fifteen partners around Europe, called HTx on new methods for Health Technology Assessment for personalized medicine (2019-2024). He has (co-)authored more than 100 publications in peer-reviewed international journals.
Ashley Jaksa, MPH
Aetion, Inc., Boston, MA, USA
Concurrent Breakout Session 4
What Does the Future Look Like for Big Data and Precision Medicine?
In-person
Level: Intermediate
Purpose: The objectives of this session are to introduce how use of precision medicine is captured and investigated to support multiple use cases utilizing real-world data (RWD). Description: Advances in precision medicine have led to the development of targeted treatments specific to an individual’s disease, often resulting in improved patient outcomes compared with standard of care. Use of genomic testing to understand disease etiology, inform drug development and impact treatment decisions drive precision medicine. These test results, in connection with clinical records have created robust, longitudinal clinicogenomic datasets with immense potential. This session will review the landscape of genomic RWD focusing on availability of data, utilization practices, hurdles and limitations. This session will start with a quick introduction of the history of precision medicine, from the bench to the bedside to the cloud. The exponential growth and increasing inclusion and limitations of genomic information in a patient journey will be explored (7 minutes, Nguyen). Next, the workshop will examine genomic RWD sources ranging from electronic medical records to laboratory datasets to commercial patient or provider-initiated results. Difficulties in data completeness, types of data (example transcriptome v WGS), and challenges with various data linkages will be discussed (Brenton 17 minutes). The session will then shift to describe how genomic data is being applied to the entirety of the drug discovery and development life cycle. Real world clinicogenomics data is driving drug discovery, improving the probability of technical success for clinical trials, and enabling modern value-based access strategies (Webster, 17 minutes). Finally, best practices and algorithms implemented to generate RWE using independent and linked genomic data will be shared (Nguyen, 7 minutes). The session will conclude with a discussion between audience and panel members (12 minutes). This session may benefit stakeholders who already or intend to utilize, generate, or interpret genomic RWE.
Panelists
Ashley Brenton, PhD
Optum, Eden Prairie, MN, USA
Dr. Ashley Brenton is the Vice President of Real World Evidence and Genomics for Optum Life Sciences. Ashley is responsible for leading the data strategy, development, business development and operations for genomics. In this role, she bridges the gap between clinical genomics and product development to leverage the wealth of Optum data into commercial datasets and strategic alliances.
Prior to joining Optum, Dr. Brenton was the Chief Science Officer at Mycroft Bioanalytics, where she led corporate valuation and sales strategy of the intellectual property portfolio, including the world’s largest clinicogenomic biobank in chronic pain. Previously, Dr. Brenton developed and commercialized a number of precision medicine tests and algorithms while building clinicogenomic datasets. In addition to her product development in the space, she has established herself as a thought leader, publishing a number of manuscripts that provide support for the integration of clinicogenomics in health care.
Before entering industry, Dr. Brenton was a molecular biologist in academia, earning a Bachelor’s in Public Health Studies from Johns Hopkins, a PhD from University California Davis and a viral pathogenesis fellowship from the Scripps Research Institute. Ashley enjoys powerlifting, spending time outside camping, trail running and hiking. She’s an accomplished athlete, completing the Ironman twice and a number of ultramarathons, and competing in CrossFit competitions. She resides in Spokane, WA, with her husband and two daughters.
Jennifer Webster, MS
Pfizer, Lambertville, NJ, USA
Jen Webster has held roles in genomics research, healthcare utilization research and population heath technology before joining Pfizer as the Precision Medicine RWE Lead. Jen leads a team that is responsible for enabling the use of real world precision medicine data across the asset lifecycle.
Discussion Leaders
Amy Nguyen, PhD
Optum, Apple Valley, MN, USA
Towards a Broader Patients' Perspective: The Theory and Practice of Socioeconomic Impact Research
In-person
Level: Intermediate
Purpose: Members of the Task Force on “Socioeconomic Impact Analysis” within the Health Economics Working Group of the Organisation of European Cancer Institutes (OECI) will present and discuss their consented recommendations for future research into the broader social and economic consequences of cancer and cancer care for patients and their relatives. The OECI has a membership of over 110 cancer centers and major (university) hospitals in Europe. Description: The session will begin with an introduction to explicate the rationale and the need for a coherent conceptual basis for research into the socio-economic consequences of cancer from the perspective of patients and their relatives, combining alignment with health economic theory and principles of patient reported outcome (PRO) research. It will conclude with a summary of the OECI Task Force consensus recommendations (MS, 12 minutes). The introduction will be followed by a presentation of major findings from an in-depth analysis of frameworks and terminology, forming the basis for a comprehensive model of socioeconomic impact (JU, 11 minutes). The workshop will continue by elaborating the multiple dimensions of costing from a patients’ perspective and their implications for the validity of research projects (CQL, 11 minutes). The presentations will conclude with the summary findings from the SEC Trial, the first pan-European survey of the socioeconomic consequences of cancer involving over 2,300 patients from at least 10 EU countries, including an outlook towards further research, for example into the validity of instruments used to measure socioeconomic impact (VR, 11 minutes). The session will be concluded by a discussion between audience and panel members (15 minutes). This session may benefit researchers and policymakers interested in a better understanding of the socio-economic consequences of cancer and cancer care for patients and their relatives beyond its impact on purely health-related quality of life.
Panelists
Camila Quirland, PharmD, MSc
Arturo Lopez Perez Foundation, Health Technology Assessment Unit, Santiago, RM, Chile
Head of Health Technology Assessment, Fundación Arturo López Pérez, Chile. Task Force on the Socioeconomic Impact Analysis of Cancer & Cancer Care, Organisation of European Cancer Institutes (OECI). PhD (c) Universitat Autònoma de Barcelona.
Valesca Retel, PhD
Netherlands Cancer Institute, Amsterdam, NH, Netherlands
Valesca Retèl has a PhD degree in Health Economics and a MSc degree in Health Sciences. Currently, she is Head of the HTA division at the division of Psychosocial research and epidemiology at the Netherlands Cancer Institute and professor with special appointment at the Erasmus University of Rotterdam. Her research is focused on early Health Technology Assessments concerning a range of applications in oncology such as Next Generation Sequencing, Immunotherapy, big data, Image Guided Surgery and cancer survivorship. Four of these projects are part of a Coverage with Evidence Development program, which she coordinates within the NKI-AVL. Valesca Retèl uses mathematical modeling to combine information on cost-effectiveness, organizational issues, ethical-legal, and patient related aspects of promising new technologies in early stages of development. In the early stages, broad spectrum scenario drafting is a key element in these early assessments. She currently supervises 8 PhD students. Nationally, Valesca is project leader of the €1,8M “Technology Assessment of Next Generation sequencing of personalized Oncology” (TANGO) project. On an international level, she is coordinator of the Cost-benefit working group of the Organization of European Cancer Institutes (OECI).
Jasper Ubels, MSc
German Cancer Research Center (DKFZ), Heidelberg, Germany
Jasper Ubels is a doctoral researcher, who studies how to apply the capability approach for outcome research for his dissertation. Besides his dissertation, he is also involved in a number of other projects. In one project he participates in a task force that aims to establish how to describe the socioeconomic impact of cancer on patients' lives.
Discussion Leaders
Michael Schlander, MD, PhD, MBA
German Cancer Research Center (DKFZ), Heidelberg, BW, Germany
Professor (Chair) of Health Economics at University of Heidelberg; Head of Division of Health Economics at German Cancer Research Center (DKFZ), Heidelberg; Scientific Director, Institute for Innovation & Valuation in Health Care, Wiesbaden, Germany; prior to professorship (since 2002), 15 years experience in executive positions in the international biopharmaceutical industry; educational background, MD, PhD, MBA.
Use of Real-World Evidence to Support Health Technology Assessment in United States, Europe, and Japan
Virtual
Level: Intermediate
There is a growing interest to utilize real-world evidence (RWE) by various stakeholders across the entire healthcare value chain, including using RWE to guide health technology assessment (HTA). The extent to which it was used in evaluations of pharmaceutical products during HTA processes is not clear. The objectives of this session are 1) to provide an overview of current use of RWE in HTA processes in US, Europe and Japan, 2) to share results from analysis to evaluating the use of RWE in HTA processes globally using HTA accelerator®, 3) to highlight opportunities to increase use of RWE in HTA processes. The first speaker will provide an overview of current use of RWE in HTA processes, including ICER’s clinical evidence assessment, and use of RWE in payer decision making. The speaker will also highlight key challenges. The second speaker will present results from analysis for use of RWE in HTA processes using HTA accelerator®, a database containing submission information for payer assessments. Amongst the 10 largest pharmaceutical markets, the United Kingdom, France, United States, Germany continue to dominate RWE use in HTA. 37% of submissions (n=180/486) included RWE as supporting evidence. Furthermore, RWE use accelerated during this period over tenfold with 45% (n=81/180) documented in Jan-May, 2022 in contrast to 3% (n=5/180) in 2017. Additional results will be presented, including how and what the RWE was submitted in support of comparative safety and/or effectiveness assessment. The third speaker will highlight opportunities to increase use of RWE in HTA processes, particularly updates from ISPOR RWE Transparency Initiative. For RW studies that are meant to test hypotheses about comparative effectiveness or safety, a key aspect of credibility is that they are conducted transparently with tests that follow a prespecified protocol. The session will be concluded by a discussion between audience and speakers.
Speakers
Massoud Toussi, MD, PhD, MBA
IQVIA, Courbevoie, France
Massoud Toussi, MD, PhD, MBA, is the global category lead for evidence generation from secondary data. He has more than 20 years of experience in the design, development and conduct of studies in the field of epidemiology, pharmacoepidemiology and data science. He was involved as principal investigator, epidemiologist or clinician in more than 300 studies, including clinical trials, post authorization safety studies (PASS), and outcomes research (OR) studies using both primary and secondary data.
Dr Toussi is medical doctor with an MD degree in general medicine, a diploma in psychiatry from University of Paris Nord, a master of science (MSc) degree in medical informatics from University of Pierre and Marie Curie (Paris), a PhD in Healthcare Data Analysis and Artificial Intelligence from University of Paris Nord, an MBA from University of Paris-Dauphine and a master’s degree in international management from University of Quebec in Montreal.
He is member of the editorial board of the Methodological Standards Guide of the European Network of Centers of Pharmacoepidemiology and Pharmacovigilance (ENCePP), Chair of the Real World Evidence and Artificial Intelligence interest group (RWE&AI IG) of Health Technology Assessment International (HTAi), member of the Transparency Steering Committee of the International Society of Outcomes Research (ISPOR) and member of the Board of EU2P. He is also the Editor-in-Chief of Epidemiology Open Access Journal and co-author of several articles and book chapters in his field.
Shirley Wang, PhD, MSc
Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
Dr. Wang is an Associate Professor at Brigham and Women’s Hospital, Harvard Medical School. She has led 2 joint task forces between ISPOR and the International Society of Pharmacoepidemiology (ISPE) focused on real-world evidence for healthcare decision-making. Dr. Wang directs the REPEAT Initiative, a non-profit program with projects aimed at improving transparency, reproducibility and robustness of evidence from healthcare databases and co-leads RCT-DUPLICATE, a series of projects designed to inform when and how real-world data analyses can draw causal conclusions.
Eric Yu, MPharm, MSc, LLM
IQVIA Solutions Japan K.K., Tokyo, Japan
Eric Yu, MPharm, MSc, LLM, Principal, Global HEOR & HTA, Real World Evidence Solutions, IQVIA Japan, Tokyo
Eric Yu, MPharm, MSc, LLM, is a Principal in the Global HEOR & HTA function in IQVIA advising on evidence generation within the healthcare and life sciences sector. Originally joining IQVIA in 2013 within the Real World Evidence Practice in London, UK, he has subsequently been based in Tokyo, Japan since 2017 serving clients in Japan and across the globe.
Having obtained his Master of Pharmacy from University College London he qualified as a pharmacist in the UK and subsequently completed his Masters in International Health Management, Imperial College Business School London and Master of Laws from University of London. He has held a variety of roles spanning private healthcare, management consulting as well as within health IT consulting.
Discussion Leaders
Jasmanda H. Wu, PhD, MPH, FISPE
Insmed, Bridgewater, NJ, USA
Dr Jasmanda Wu is a research professional who brings 20 years combined experience in health economics and outcomes research (HEOR), real world evidence (RWE) generation and data analytics, clinical outcomes assessment (COA), and pharmacoepidemiology.
Jasmanda is currently the Head of RWE team, also the HEOR lead for early pipeline products in a Biopharmaceutical company Insmed. Prior to that, she was the Senior Director in Global Pharmacovigilance and Epidemiology Department from 2012-2016, later on in Real-World Evidence and Clinical Outcomes Department from 2017-2020 in Sanofi. Prior to joining Sanofi, she was the Director in Global Pharmacovigilance and Epidemiology Department in Bristol-Myers Squibb. Prior to joining BMS, she was the Associate Director in Ortho-McNeil Janssen Scientific Affairs, L.L.C., part of Johnson & Johnson Pharmaceuticals. She was with US Outcomes Research & Management team at Merck & Co prior to joining J&J.
She obtained her doctoral degree in epidemiology from the University of Michigan Department of Epidemiology and obtained a Master of Public Health degree from the University of Texas-Houston School of Public Health.
Her areas of specialization and interest include rare disease research, natural history studies, disease and drug registries, clinical outcomes assessment (COA) development and validation, advanced analytical research using predictive modeling, network meta-analysis, EU and US regulations related to real-world evidence, health technology assessment (HTA), etc.
11:15 - 13:15
Lunch
In-person
11:30 - 12:30
Educational Symposia
Unlock Real-World Data with Machine Learning
In-person & Virtual
An increasing demand for real-world evidence (RWE) to support regulatory submissions and payer negotiation has accelerated the big-data revolution in health care. Major strides have been made in improving the availability and usability of real-world data (RWD), and the application of machine learning (ML) in RWD is an essential step forward to augment meaningful insights into the care pathway. This symposium will introduce several creative ML approaches to establish consistency across data sources, harness the research value of RWD, and discuss the application of transparent and interpretable ML methods.
First, a case study will illustrate how ML methods are used to improve the consistency, transparency, and traceability of RWD across hospitals in China, where RWE research has traditionally faced many challenges. In a large-scale multi-center hematology study, researchers established a disease model to incorporate both consensus-based decision logic and ML-based data-driven optimization to unify data standards and definitions. This tool was applied to mechanize information integration across top hematology centers in China to enable result synchronization, which is essential in the generation of high-quality evidence to support China’s National Reimbursement Drug List’s negotiation and post-launch activities.
The second presentation will demonstrate how ML tools help to empower data transformation while ensuring relevance and validity. The raw RWD captured by hospital information systems (HIS) are fragmentary and lack an integrated picture of the care pathway. To close this gap, researchers developed and validated progression algorithms, drawn from China’s National Longitudinal Cohort of Hematological Diseases (NICHE), to reconstruct the complex patient journey through a hematologic condition. The progression algorithm was then incorporated into an automated data capture system to obtain, filter, and process traceable data, allowing researchers to supply important information that is not readily available from the HIS, including patients' treatment response by line of therapy.
Lastly, the presenters will demonstrate new transparent and interpretable ML approaches using case studies. Generalized linear models (GLM) are often preferred over ML models because of concerns regarding the lack of interpretability of complex ML algorithms. State-of-the-art interpretable ML methodologies will be discussed, along with their applications to a wide-ranging set of ML models. The objective of these approaches is to describe both general model behavior and the logic behind individual data unit predictions. These methods provide an improved level of interpretability and transparency that is both informative and, to some extent, more granular than GLM.
We hope this symposium can introduce these recent creative examples in the intersection of ML and RWD to the audience and stimulate discussions to further advance RWE research and methodology.
Sponsor
Analysis Group, Inc.
Moderators
Eric Q. Wu, PhD
Analysis Group, Inc., Boston, MA, USA
Dr. Wu is a health economist with expertise in health economics and outcomes research (HEOR), market access, and scientific evidence strategy. He has conducted research in more than 30 countries on behalf of pharmaceutical and medical device companies, payers, providers, and government agencies. Dr. Wu has contributed to over 200 publications across dozens of therapeutic areas, including regenerative therapies (gene and stem cell), rare and ultra-rare diseases, biologics, and immuno-oncology. He spends a significant portion of his practice developing new scientific methods to address challenges in health care research. Dr. Wu has developed client-focused solutions based on the use of artificial intelligence (AI), medical big data, real-world evidence, and innovative comparative-effectiveness research methodologies.
Speakers
Max Leroux, MSc
Analysis Group, Inc., Quebec, QC, Canada
Mr. Leroux specializes in the application of machine learning (ML) and big data technologies to complex problems related to health care, finance, marketing analytics, fraud detection, client engagement, process automation, and credit and market risk. His experience includes developing data-focused strategies and campaign targeting models; developing predictive response event and time-to-event models, analyzing investment and finance portfolios; building predictive, next-best-offer, and behavioral analytics models; leading information technology projects from proof-of-concept stage to enterprise level; and designing, developing, and implementing automated credit scoring and fraud detection systems. Mr. Leroux has also overseen the implementation of ML solutions and big data technologies in numerous domains for both on-premises infrastructure and major cloud platforms.
Jimmy Royer, PhD
Analysis Group, Inc., Montreal, QC, Canada
Dr. Royer, a principal at Analysis Group, has extensive experience applying his skills to health care and pharmacoeconomics. His work includes predicting the potential future onset of rare or undiagnosed conditions with machine learning models applied to large datasets, assessing the socioeconomic impact of a drug, and conducting HEOR data analysis to evaluate the cost effectiveness of disease treatments. Dr. Royer has worked with pharmaceutical companies to assess the competitive impact of generic pharmaceuticals and has assisted with statistical issues associated with clinical drug trials. A previous presenter on artificial intelligence and machine learning topics at ISPOR, he has also published in journals such as Neurology, Current Medical Research and Opinion, Dermatology and Therapy, and eBioMedicine. Dr. Royer serves on the scientific committee for Le Québec Économique, a consortium that strives to broaden the understanding of economic issues in Canada.
Xiaochen Zhang, MS
Beijing Huashu Yihui Technology Co., Ltd., Bejing, China
Ms. Zhang is a biostatistician who applies statistics and big data analysis to research real-world medical health issues. Her medical and statistical background give her rich, interdisciplinary experience in topics such as registered queue research, big data analysis, and data visualization, with a focus on hematology, epidemiology, health economics, and other fields. Ms. Zhang is also proficient in a variety of statistical models and research methods, as well as using statistical modeling and big data analysis to solve practical problems in drug efficacy and safety evaluation and cohort study design. Earlier in her career, she worked as a bioinformatics analyst at a large medical company, where she gained rich project experience in data analysis, algorithm design, big data visualization, consulting reports, medical health knowledge support, and biological information analysis.
Jia Zhong, ScD
Analysis Group, Inc., Boston, MA, USA
Dr. Jia Zhong, a Manager at Analysis Group, is an epidemiologist who specializes in clinical health economics and outcomes research (HEOR), clinical trials, and large-scale epidemiological studies. She has more than 10 years’ research experience in disease areas such as pulmonary diseases, diabetes, cardiovascular diseases, oncology, rare diseases, and immunology. Dr. Zhong’s expertise includes comparative efficacy and safety, individualized medicine, and longitudinal analysis. Her recent work includes leading large-scale prospective cohort studies, evaluating the comparative efficacy of immuno-oncology treatments for regulatory submissions, quantifying direct and indirect resource utilization and costs, and evaluating real-world effectiveness using patient reported outcomes (PROs). Her research has been published in Nature Immunology, Immunity, Proceedings of the National Academy of Sciences, Circulation, Circulation Research, Hypertension, and the International Journal of Epidemiology, among other publications. Prior to joining Analysis Group, Dr. Zhong was a research scientist at the Columbia University Mailman School of Public Health, where she developed data-based therapeutic target identification frameworks.
Gene Therapies: Where High Promise Meets High Uncertainty, How Should HTA Methodologies Appropriately Value and Enable Access?
In-person & Virtual
Gene therapies represent a new era of medicine, offering the potential for truly transformational health gains and further benefits for society and health systems. Health Technology Assessment (HTA) of gene therapies can be challenging for a variety of reasons, including uncertainty regarding long-term outcomes, initial assessment of clinical value, assessment of costs and narrow perspectives. These challenges can result in the potential benefits of these therapies being overlooked and undervalued. This symposium will provide an overview of the challenges faced in the HTA of gene therapies and discuss potential solutions to overcome them. Panelists will provide diverse perspectives and practical examples of solution implementation. The recommendations provided by the panel will demonstrate the practical tools available to address the HTA challenges and work towards unlocking the potentially transformational promise of gene therapy for patients and society.
Sponsor
Pfizer
Moderators
Adrian Towse, MA, MPhil
Office of Health Economics, London, United Kingdom
Professor Adrian Towse is director emeritus and senior research fellow of the Office of Health Economics in the UK. Adrian’s current research includes incentives for new drugs and vaccines to tackle Antimicrobial Resistance, the use of 'risk-sharing' arrangements between healthcare payers and pharmaceutical companies, including value-based pricing approaches; the economics of pharmacogenetics for healthcare payers and the pharmaceutical industry; economic issues that affect both R&D for and access to treatments for diseases prevalent in the developing world; the economics of medical negligence; and measuring productivity in healthcare.
A visiting professor at the London School of Economics and a senior researcher at the Nuffield Department of Population Health at the University of Oxford, Adrian also has been a visiting professor at the University of York. For ten years, he served as the non-executive director of the Oxford Radcliffe Hospitals NHS Trust, one of the UK’s largest hospitals. Adrian was president of ISPOR, for the 2014-15 term.
Adrian joined the OHE in 1993 and served as director for 25 years. He holds an MA (Hons) in Politics, Philosophy and Economics from Keble College, Oxford; an MPhil in Management Studies from Nuffield College, Oxford, and the Oxford Centre for Management Studies; and is a member of the Chartered Institute of Management Accountants.
Speakers
Amanda Cole, PhD
The Office of Health Economics, London, LON, United Kingdom
Amanda is a Senior Principal Economist at the Office of Health Economics. Amanda’s research interests include the economics of innovation, use of real-world evidence to support HTA and product development; novel pricing and reimbursement mechanisms for pharmaceuticals, and the interaction between HTA policy and optimal R&D decisions by industry. Before joining OHE in 2014, Amanda was a research fellow at the University of Birmingham where she focused on the HTA of medical devices and embedding health economic evaluation early in product development. Amanda holds a PhD in health economics from the University of Birmingham.
Josie Godfrey, MA
JG Zebra Consulting, Hammersmith, United Kingdom
Josie has worked in rare diseases and innovative therapies for over 12 years. She currently runs a consultancy business specialising in strategic market access, policy and stakeholder engagement. She is the Strategic Director for Duchenne UK’s Project HERCULES, an award-winning global collaboration developing evidence and tools to support HTAs for new treatments for Duchenne Muscular Dystrophy. Josie is also co-founder and joint CEO of Realise Advocacy, which supports patient involvement in drug development and access processes. She previously led work at NICE to establish the Highly Specialised Technologies programme.
Ruth Kim, PharmD, MPH
Pfizer Inc, New York, NY, USA
Ruth Kim is an intrapreneur in developing unique launch plans for pharmaceutical companies. During her tenure in industry, she successfully led a team launching multiple immuno-oncology assets, with extensive publications in oncology. Ruth established companywide real-world evidence and epidemiology functions at Medivation and Bristol Myers Squibb. Now at Pfizer, she is the Health Economics and Outcomes Research (HEOR) Team Leader for Rare Disease and Internal Medicine.
Ruth is a pharmacist by training with a master’s in public health. She completed her post-doctoral fellowship in HEOR and Epidemiology focusing on Haemophilia and Hepatocellular Carcinoma. Prior to joining industry, she was an adjunct professor in physical chemistry, pharmacoeconomics and pharmacy technics.
Oriol Sola Morales, MD, MSc, PhD
The HiTT Foundation, Barcelona, Spain
I have built a career in the planning, policy and decision-making environment (Regional HTA Agency director (2007-11); Innovation and Strategy Director in several hospitals, member of the Regional Research Advisory Council and policy advisor to 2 Health Ministers). In 2011 I founded HITT, transformed in 2019 into the HiTT Foundation to strive for a sustainable healthcare. I am an assistant professor in Health Economics at Universitat Ramon Llull -IQS, and teach in several courses nationally and internationally and a Research Fellow at the OHE (office for Health Economics). I am an MD specialised in Internal Medicine. I earned an MSc from the London School of Economics and Political Science (LSE) and the London School of Hygiene and Tropical Medicine (LSHTM) and a PhD from Universitat Rovira i Virgili (URV).
11:40 - 12:00
HEOR Theater
How AI Unlocks RWE in Belgium, France, Germany – Use Case in Rare Diseases (hATTR and ATTR-CM)
In-person
Multi-center RWE Hubs are enabling large-scale evidence generation across various therapeutic areas (i.e. cardio, onco, neuro) in Belgium, France, and Germany. Georges De Feu (LynxCare) and Jean-Baptiste Angeloglou (PSIH) will share how these federated clinical data networks create value for patients, clinicians, and researchers. Clara Oeste (LynxCare) will showcase how these insights are being used to identify patients at-risk of rare diseases through A.I. and NLP. LynxCare works with leading hospitals in Europe and the United States, and facilitates scientific research for Life Sciences companies such as AstraZeneca, Pfizer and Novartis within a strict ethical and legal framework.
Sponsor
LynxCare
Speaker
Jean-Baptiste Angeloglou, MSc
PSIH Group, Lyon, France
Jean-Baptiste Angeloglou is the Managing Director of PSIH Group, the leader in Business Intelligence in hospitals in France. After obtaining his MSc in Law and Taxation from the Panthéon-Assas University in Paris, France, he held positions as Deputy Managing Director at CEGEDIM, Head of Sales at CMPMedica, and Commercial Director and member of the ComEx of IQVIA France. PSIH has been supporting healthcare organisations for over 20 years in analyzing their structured data and is active in more than 1,000 hospitals. PSIH also manages databases such as the French hospital discharge database (PMSI) and French nation-wide healthcare data system (SNDS), which is the largest RWD source in Europe.
Georges De Feu, PharmD
LynxCare, Leuven, Belgium
Georges De Feu is a 3x successful start/scale-up founder & exec in HealthTech. Georges is the CEO and founder of LynxCare, the Big Data market leader in healthcare. With an AI-driven data platform, they help hospitals unlock previously unavailable clinical data for better patient care and scientific research. They work with leading hospitals in Europe and the United States, and facilitate scientific research for Life Sciences companies such as AstraZeneca, Pfizer and Novartis within a strict ethical and legal framework.
Clara Oeste, PhD
LynxCare, Lyon, France
Clara L. Oeste obtained her BSc and MSc in Biochemistry and Molecular Biology at the Complutense University in Madrid, Spain. Her PhD at the Spanish National Research Council focused on the dynamics of RAS proteins, and during her 5+ years as a postdoc, she focused on their role in leukaemia and breast cancer. She has co-authored numerous scientific papers, editorials, and book chapters. Recently, as a medical writer and scientific advisor, she has focused on the value of real-world evidence (RWE) in diverse therapeutic areas to foster AI-driven clinical insights and patient outcomes research.
11:45 - 12:45
Discussion Groups
New this Year – Discussion Groups! Discussion Groups are facilitated conversations between conference attendees and select conference speakers. Held in the new, dynamic Discussion Lounge in the ISPOR Exhibit Hall, these discussions are intended to be highly interactive, collaborative, and promote the exchange of ideas in a peer-to-peer setting.
Oncology Discussion Group
In-person
Moderator
Sorrel Wolowacz, PhD
RTI Health Solutions, Manchester, United Kingdom
Sorrel Wolowacz, PhD, is Head of European Health Economics at RTI-HS, with 22 years of experience in health economics research and consulting. Her research focuses primarily on economic modelling, health utility estimation, observational studies, and health technology appraisal submissions. Dr. Wolowacz is a member of the editorial board for the Journal of Comparative Effectiveness Research and was co-chair of the ISPOR Good Research Practices Task Force addressing Measurement of Health State Utility Values for Economic Models in Clinical Studies and is a member of the ISPOR Oncology Special Interest Group.
Member Group Meeting
Open Meeting - Health Preference Research Special Interest Group
In-person
The SIG will present Attribute Selection: More Challenging Than You Thought and will discuss its upcoming key project on individual value clarification. It is also an opportunity to network with SIG leaders and other members interested in this topic.
ISPOR Forums
Economic Evaluation Guidelines in Middle East and North Africa: Development to Implementation
In-person
The World Health Organization (WHO) has emphasized Health Technology Assessment (HTA) as an important tool for achieving Universal Health Coverage (UHC) globally. The growing interest in HTA in low- and middle-income countries has led to more recent developments of Economic Evaluation Guidelines (EEGs) in these countries, including in the Middle East and North Africa (MENA) region. Developing national EEGs is critical to researchers by providing practical steps for conducting economic evaluation to inform health decision-making and priority setting for policy, but it is essential that EEGs are fit-for-purpose at the specific country level. This will require a balance of incorporating international best practice standards while taking into account the local decision-making frameworks and context.
The goal of this forum is to share the experiences within some MENA countries in developing and implementing economic evaluation guidelines. The speakers will discuss the issues and challenges of developing and implementing their guidelines and what impact these guidelines will have on their healthcare systems. Evidence, data, and insights into the development and implementation of these guidelines will be provided in this session.
Moderators
Rita Karam, PharmD, PhD
Lebanese University, BEIRUT, BA, Lebanon
Rita Karam is a Pharmacist graduated from Saint Joseph University of Beirut, Lebanon whose expertise served in various domains.
She holds a Ph.D. in Pharmaceutical Sciences from Claude Bernard University Lyon -France.
She is a Professor at the Faculty of Sciences and Medical Sciences at the Lebanese University
She is the Director of Quality Assurance of Pharmaceutical Products Program and the National Pharmacovigilance Program Coordinator at the Lebanese Ministry of Public Health (MoPH)
She is the Chair of the Professional Society for Health Economics and Outcome Research ISPOR Arabic Network
She technically advises several committees at the Ministry of Public Health.
She has authored numerous articles in the field of Health Technology Assessment, Health Economics and Pharmacovigilance
Speakers
Caroline Daccache, MSc, PhD Candidate
Maastricht University, dbayeh, Lebanon
Caroline Daccache, a biologist, is an expert researcher in the pharmaceutical industry. She has a Master's degree in Market Access for Health Products and is accomplishing her Ph.D. in Health Technology Assessment at Maastricht University - The Netherlands. Caroline is a member of the ISPOR Lebanon Chapter and an affiliate in the Maastricht Health Economics and Technology Assessment Center.
Aiming to develop the Lebanese Economic Evaluation Guidelines, her publications focused on Economic Evaluation Guidelines’ methodological key features and development process, in addition to disease burden.
Randa Eldessouki, MD, PHD, MSc
Fayoum University, Fayoum, Egypt
Randa Eldessouki MBBCH, MSc, MD, Associate Professor of Public Health and Health Economics, and expert member in biostatistics unit, Faculty of Medicine, Fayoum University. Expert member in the pharmacoeconomic committee, Egyptian Drug Authority (EDA) since 2010. Member of MENA health policy forum since 2015. Former Director, Central Administration of Health Technology Management, Egyptian Unified Procurement Authority (UPA). Former Director of Health policy and Scientific initiatives at ISPOR, and member since 2008. Member of ISPOR Egyptian Chapter as well as ISPOR Arabic Network since 2013. An invited Associate professor of pharmacoeconomics, Faculty of political science and economics, Cairo University. Her focus is HTA and the use of real-world evidence and economic evaluation for informed decision making. During her career, she has developed and promoted several HTA, Comparative Effectiveness Initiatives and their use in health care decision making. She has several publications, co-authored books on HTA, health economics and public health. She is a reviewer for several health economics and public health journals. She provides teaching modules and training sessions on outcomes research, HTA, health economics and population health since 2010. She has been an advisor to public, private and national organizations and invited speaker to several countries worldwide.
She obtained her medical degrees form Alexandria University, her Public Health Doctorate from Cairo University. She continued her education and training in Health Economics, Drug development, Clinical Research as well as applied statistical and operational methods in health form ULB, Belgium as well as Temple and Purdue University, USA.
Wadih Mina, PharmD, MSc Pharmaceutical Marketing, MSc Health Economics, MSc Global Health Policy (2024)
Pharma International Roche, Beirut, Lebanon
HTA & Public Procurement of Medtech Solutions: Building a Bridge for Better Decision Making
In-person
The objectives of this panel are threefold: first, to update and inform any stakeholder in the Medical Device and Diagnostic ecosystem on current practices involving the usage of HTA reports by procurement decision makers based on a systematic literature review conducted by MD&D SIG members and gaps in knowledge – how procurement uses (or does not use) HTA, and whether HTA uses procurement for their respective decision-making processes. Second, foster an active discussion of research plans to address these knowledge gaps through survey of stakeholders and offer joining this discussion an opportunity to engage in this future research. Third; to engage the panelists and audience how this interaction should evolve going forward. This forum will leave 20 minutes for open discussion after introductory comments from the speakers. Group discussion will be encouraged.
Background: HTA for MedTech often does not lead to a funding mandate despite being a very robust manner of technology evaluation. When done correctly, HTA considerations include clinical, economic, and societal value to multiple stakeholder groups. There are isolated pockets where funding is attached to HTA, this is far from the norm. Therefore, the role of HTA for MedTech has often been questioned, despite a clear acknowledgement of the value of HTA in health systems. Conversely, estimates suggest that approximately 70% of all medical technologies reach the end user (physicians and patients) through some form of public procurement process. However, most procurement decisions are still predominantly price driven. Initiatives such as value-based procurement, where the procurement decisions are made on clinical improvement and reduced total costs suggest HTA could be a very valuable resource for procurement decision making. We will discuss this paradigm in the context of an ISPOR MD&D SIG working group special project literature review and the future initiative to survey of HTA and procurement stakeholders.
Moderators
Simon Eggington, MSc
Medtronic International Trading Sarl, Tolochenaz, VD, Switzerland
Simon Eggington is a health policy director at Medtronic and has a background in statistics and economic modelling. Prior to joining Medtronic in 2009, he worked for IMS Health and for the School of Health and Related Research at the University of Sheffield. Simon holds a BSc(Hons) in Applied Statistics and an MSc in Operational Research.
Speakers
Richard Charter, MSc
Alira Health, Basel, BS, Switzerland
Sophie Cros, PharmD
Abbott Vascular, Brussels, Belgium
Health Technology Assessment and Reimbursement of Medication Adherence Enhancing Interventions
In-person
The goal of this forum is to describe the value criteria currently employed to assess medication adherence enhancing interventions (MAEIs), to provide an overview of reimbursed MAEIs currently available in European countries and to discuss with forum participants on how to overcome the challenges related to the implementation of MAEIs.
On average, medication adherence to long-term pharmacotherapies is only 50% which has been shown to cause major clinical and economic burden. In the past decade, several MAEIs have been developed which have demonstrated proven benefits in improving patient outcomes. Little is known about the implementation of MAEIs in routine clinical practice. To our knowledge, there is a gap in the scientific literature with regards to the health technology assessment (HTA) and reimbursement of MAEIs.
This forum will present MAEI evaluation criteria identified by the ISPOR Medication Adherence and Persistence Special Interest Group (MAP SIG) through the systematic literature review of 308 studies published between 2018 and 2020 and a comprehensive overview of reimbursed MAEIs available in 39 countries based on a recent survey performed by the European Network to Advance Best practices & technoLogy on medication adherencE (ENABLE). The forum leaders will discuss outcome measures considered for the assessment of MAEIs in clinical trials, and HTA and reimbursement challenges of adherence technologies and programs. Discussion will be followed by an audience participation, which will include polling questions on value criteria, HTA and reimbursement aspects of MAEIs. Participants will be encouraged to share their experiences and recommendations for paving the way for MAEIs to be implemented in the future. The concluding period will allow for wrap up and opportunities for questions and answers.
Moderators
Tamas Agh, MD, PhD
Syreon Research Institute, Budapest, Hungary
Tamás Ágh MD MSc PhD DrHabil is a principal researcher of Syreon Research Institute and a research fellow at the Division of Pharamcoeconomics, University of Pecs. With more than 10 years of experience in health economics and public health research, he developed expertise in the fields of medication adherence, patient reported outcomes, health technology assessment, and evidence synthesis. Dr. Ágh is a core group member of the ISPOR Medication Adherence and Persistence Special Interest Group and the ENABLE Cost Action.
Speakers
Bijan Borah, PhD
Mayo Clinic, Rochester, MN, USA
Mickaël Hiligsmann, PhD
Maastricht University, Maastricht, LI, Netherlands
Dr Mickaël Hiligsmann is Associate Professor in Health Economics and Health Technology Assessment (HTA) at the Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University. As a researcher, he has more than 15 years of experience in health economic evaluation including cost-effectiveness analyses, decision-analytic modelling, valuation of health care (e.g. discrete-choice experiments, best-worst scaling) and medication adherence.
Przemyslaw Kardas, MD, PhD
Medical University of Lodz, Lodz, Poland
Prof. Przemyslaw Kardas, MD, PhD is a founder and Director of Medication Adherence Research Center at the Medical University of Lodz, Poland. He is also Professor of Family Medicine and the Head of the Department of Family Medicine at the Medical University of Lodz, Poland. His professional activities focus on patient adherence to medication, management of chronic conditions, active and healthy ageing, Big Data and eHealth. He is the author of a number of peer-reviewed scientific publications and conference presentations, as well as four monographs. From 2020, he is a Vice-chair of Work Group 3 ‘Sustainable implementation of adherence enhancing technologies’ of the COST Action ENABLE.
Andrew Peterson, PharmD, PhD, FCPP
Saint Joseph's University, Philadelphia, PA, USA
12:30 - 13:15
Poster Session 3 Poster Tours
New this Year – Poster Tours! ISPOR has curated collections of research posters for you within each of the poster sessions. Each tour will feature high impact abstracts within a specific topical area and will include a tour guide as well as the poster authors to share their work and engage in discussions with you. Visit the Learning Formats page for more information.
Poster Tour: Case Studies
In-person
Posters featured in this tour:
HPR125: Real-World External Control Arm to Support Indication for Tisagenlecleucel in Relapsed/Refractory Follicular Lymphoma in the European Union: A Use Case
HTA115: Optimizing HTA Strategies to Improve Assessment Outcomes and Reimbursement for CAR-T Therapies: A German and UK Case Study
OP10: Claims Analysis During Financial Due Diligence of Aficamtem for HCM
OP11: Application of Evidence Generation and Synthesis Strategies to Gain Market Access & Reimbursement, and Deliver Value: Two Case Studies
PCR175: Methods for Elderly Blood Draw Participant Recruitment
PCR176: Methods for Elderly Colonoscopy Naïve Participant Recruitment
Poster Tour: Oncology
In-person
Download the Oncology Poster Tour Guide Packet
Posters featured in this tour:
EE64: Healthcare Resource Utilisation and Medical Costs Among Patients With High-Grade Serous Ovarian Cancer in a Real-Life Setting in Finland: The OCRWE-Finland Study
EE461: Cost-Effectiveness of Nivolumab As an Adjuvant Treatment of Muscle-Invasive Urothelial Carcinoma at High Risk of Recurrence with Tumor Cell Pd-L1 Expression ≥ 1% in Denmark
EE651: Cost-Effectiveness Analysis of Pembrolizumab Plus Chemotherapy in the First-Line Treatment of Patients With Metastatic Triple-Negative Breast Cancer in Greece
EE138: Healthcare Resource Use (HCRU) and Associated Costs Among Patients With Diffuse Large B-Cell Lymphoma (DLBCL) Treated with CAR-T Cells in France – A Real-World Study Using Data From PMSI
HTA232: Indirect Treatment Comparison Methods in NICE Immuno-Oncology Technology Appraisals: Implementation and Critique
SA6: Challenges in Economic Modelling of Adjuvant Cancer Therapy for Health Technology Assessments
12:45 - 13:15
HEOR Theater
Using RWD to Deliver Better Therapies and Outcomes – A Focus on Rare Disease
In-person
Pharma has much to gain if it can work out how to use anonymized RWD to help tackle rare disease. Using RWD can be used to help scope reliable evidence (Real-World Evidence, RWE) to support better decision-making and develop new therapies for rare diseases. RWE can expand on disease epidemiology, progression, and patient pathways, and help gain clarity on the safety and effectiveness of novel therapies both in development and following marketing authorisation.
But while the opportunities are clear, there are many challenges to realising these. This is new territory. Pharma needs to improve skills and capabilities internally in order to realise these opportunities. It also needs robust, well-structured and high-quality data, as well as academic and data partners with whom it can work to derive the insights required from data. Then there is the question of how able HTAs are to accept RWD.
Sponsor
Cegedim Health Data
Speaker
Gilles Paubert, MA, MBA
Cegedim Health Data, Boulogne-Billancourt, France
Gilles Paubert is the Global Head of Cegedim Health Data, which provides Real World Data and Evidence (RWD-E) to drive cutting-edge improvements in patient outcomes, and boasts a data history of over 25 years and millions of anonymized patient records in Europe that are immediately accessible via the THIN®️ (The Health Improvement Network) database. Gilles has a scientific and business school background and nearly two decades experience in life science data analysis and consulting. He provides innovative solutions and advice to help the life science industry manage big data, statistics and analytics.
13:30 - 14:30
Spotlight Session
The Economics of Survival: A Discussion on the Role of Health Policy, Environmental Policy, and Economic Policy in Healthcare Decision Making
In-person
ISSUE:
If healthcare systems were a country, they would collectively be the 5th largest emitter of greenhouse gases globally. Healthcare decision makers are already grappling with increased demand for healthcare, and highly constrained budgets. However, unless we act immediately the climate emergency will quickly supersede both challenges. As with public health policy, environmental policy is highly influenced by economic decision makers. This panel will have a robust discussion on the intersection of health, environmental, and economic policy and how to enable more sustainable healthcare systems.
OVERVIEW:
The IPCC Report 2022 set forth an agenda that highlights the need to reduce Carbon Emissions by 90% by 2050. Unless this happens, the environmental impact will increase the incidence of major public health threats including destructive weather, and increased pandemic situations. This will more frequently place over-stretched healthcare systems on an unmanageable emergency footing. Therefore, health economic dialogue that includes environmental considerations are the economics of survival. The 4 main areas health systems can focus to support sustainability: Prevention, Patient self-care, lean-service delivery, and low-carbon alternatives span each of the Scope 1, 2 & 3 emission reduction plans. This panel will enable the dialogue on the economics of healthcare system sustainability, and initiate discussion on forming an ISPOR SIG: "The Economics of Healthcare System Sustainability".
This structure will be:
(10min - Introduction) The intersection of health, economic and environmental policy: setting the landscape and providing a roadmap to sustainability
(15min - Policy Perspective) An Equilibrium in Care Provision: Balancing individual, population, & planetary outcomes
(15min - Industry Perspective) A Roadmap for Industry Support: How to reduce Carbon-footprint.
(15min - Provider/Hospital Perspective) The role of hospitals: The Economics of Scope 1, 2 & 3 emission reductions.
(20min - Questions and Answers)
Any stakeholder involved in healthcare decision making will benefit, including physicians, providers (hospitals), payers, policy makers, procurement, and patients.
Moderators
Richard Charter, MSc
Alira Health, Basel, BS, Switzerland
Panelists
David Lawson, CIPS
Guys & St Thomas' NHS Foundation Trust, London, United Kingdom
David Lawson MCIPS
Director of Medical Technology - Commercial, Strategy and Policy
Department for Health and Social Care (DHSC)
Newly appointed Med Tech Director for DHSC with responsibility for setting the direction of future UK MedTech policy. Previous Chief Procurement Officer for 21 years at Guy’s and St Thomas’ NHS Foundation Trust. Double winner of the Supply Chain Excellence Award for Supply Chain Innovation (2008) and Urban Logistics (2021) and finalist for City Sustainability Award (2021).
Mark Sculpher, PhD, MSc
University of York, York, NYK, United Kingdom
Mark Sculpher is Professor of Health Economics and Director of the Centre for Health Economics, University of York. He is also Co-Director of the Policy Research Unit in Economic Evaluation of Health and Care Interventions, a programme of research for the UK Department of Health and Social Care funded by the National Institute for Health Research (NIHR).
Michelle Sullivan, MSc
Boston Scientific, Oxted, United Kingdom
Michelle’s career in pharmaceuticals and medical devices started in 1990.
Through roles in sales, management, marketing, and market development, Michelle has followed the needs of the current market by re-training in Health Economics, adding the value ‘spectacles’ and ‘hearing-aids’ necessary in today’s world.
A graduate of the Cambridge Institute of Sustainability Leadership, it is her goal to make this topic simple to understand and execute within the healthcare sector, currently leading the Commercial Environmental Sustainability Workstream within Boston Scientific in Europe.
She sits on the Board of HealthTech Ireland, chairs the ABHI Sustainability working group, and vice-chairs the Commercial policy group for this UK Medical device industry body.
Podium Sessions
Innovative Methods in Indirect Treatment Comparisons
In-person
Measuring the efficacy and effectiveness of new medical technologies is the cornerstone of the decision making on the coverage of new technologies. This session gives an overview of the role of innovative methods in indirect comparisons of medical technologies.
Moderator
Valentin Brodszky, MD, MSc, PhD
Corvinus University of Budapest, Budapest, PE, Hungary
P44: Review of Methods Used to Estimate Treatment Effects Against Relevant Comparators Using Evidence From Single-Arm Studies in NICE Single Technology Appraisals
1:30PM - 1:45PM
Sultana N1, Ren K2
1University of Sheffield, Sheffield, UK, 2University of Sheffield, Sheffield, NYK, UK
OBJECTIVES: The aim of this review of National Institute for Health and Care Excellence (NICE) single technology appraisals (STAs) was to determine how comparisons against relevant comparators have been performed using evidence about new treatments obtained from single-arm studies when individual patient data (IPD) is available only for one study and summary level data were available for the rest of the studies.
METHODS: All the STAs identified within 1st January 2018 to 31 December 2021 in NICE website have been searched to identify relevant STAs involving single-arm studies. Moreover, information was extracted on how prognostic and effect modifier variables have been identified and how survival extrapolation has been conducted in a data extraction form.
RESULTS: A total of 21 TAs were identified where the pivotal study/studies were single-arm study and 16 (76.19%) have used population adjustment methods. All the STAs included in this review were in oncology. Matching Adjusted Indirect Comparison (MAIC) was mostly used population adjustment method (13 out of 21, 61.90%) whereas Simulated Treatment comparison (STC) was the second mostly used method (4 out of 21, 19.04%). More than fifty percent of these appraisals (12 out of 21, 57.14%) have multiple comparisons of treatments with a larger network. The common approach for extrapolation of data beyond the observed period was to fit parametric models with unadjusted IPD of intervention study. Furthermore, identification of variables was mostly done by literature search and clinical expert opinion.
CONCLUSIONS: It is not surprising that adjustment methods like unanchored MAIC and STC were frequently used in NICE STAs with the increase of single-arm studies. These methods make assumptions about the variables included in the analysis which are difficult to satisfy and can produce residual bias.
P41: The Added Value of Joint Modelling of Progression Free and Overall Survival in a Restricted Mean Survival Network Meta-Analysis
1:45PM - 2:00PM
Dietz J1, Claxton L1, Welton N2
1National Institute for Health and Care Excelllence, London, LON, UK, 2University of Bristol, Bristol, UK
OBJECTIVES: Restricted mean survival time (RMST) has been used in network meta-analyses (NMA) when the proportional hazards assumption does not hold. It has been argued that progression free (PFS) and overall survival (OS) should be modelled jointly to capture correlations. This research aims to compare the results for joint versus separate modelling of PFS and OS in RMST NMAs.
METHODS: Using a network of 5 studies of 3 treatments for operable stage IIIA-N2 non-small cell lung cancer, we jointly modelled PFS and OS using both additive and multiplicative fixed effects NMA models. NMA outcomes were treatment differences in restricted mean PFS, post-progression survival (PPS) and OS restricted to 5 years. For comparison, we performed NMAs on PFS and OS data separately to obtain estimates of treatment differences in restricted mean PFS and OS, from which we derived estimates for PPS. We estimated the bias in separate compared with joint modelling by calculating the percentage difference between restricted mean PFS, PPS, and OS.
RESULTS: The percentage difference between joint vs separate modelling of PFS ranged from 3.86%-4.29%, PPS ranged from 25.99%-37.36% and OS ranged from 10.11%-11.03%. Additionally, the direction and scale of these differences varies by treatment.
CONCLUSIONS: Separate modelling of PFS and OS in NMA using restricted means resulted in biased estimates of restricted mean PFS, PPS and OS compared with joint modelling. We recommend the joint synthesis of PFS and OS to capture correlations and ensure that OS is estimated to be greater than PFS when estimating restricted mean survival times. Further work is required to assess the impact of method for NMAs of RMST in health economic models to assess cost-effectiveness, including extrapolation beyond restriction time.
P43: Navigating the Maze of Standard and Novel Population-Adjusted Indirect Comparison (PAIC) Methods
2:15PM - 2:30PM
Kroi F1, Hu Y2, van Beekhuizen S1, Heeg B1
1Cytel Inc., Rotterdam, Netherlands, 2Cytel Inc., Shanghai, China
OBJECTIVES: As suggested by the National Institute for Health and Care Excellence Decision Support Unit (DSU) 18, two methods for population-adjusted indirect treatment comparisons (PAIC) are considered standard when individual patient data are available from at least one trial; matching adjusted indirect treatment comparison (MAIC) and simulated treatment comparison (STC). Recent studies evaluated the performances of these methods or proposed alternative novel PAIC methods. Our study aims to provide a full picture of published PAIC methods and summarize their advantages and disadvantages.
METHODS: A targeted literature review following PICOS eligibility criteria was conducted. Peer-reviewed publications in English that were published after January 2010 (i.e., the year of the first key MAIC publication) which compared or introduced novel PAIC methods were included. Three different databases (i.e., Medline, Cochrane database of systematic reviews, and Cochrane methodology register via Ovid) were searched.
RESULTS: A total of twenty-four studies met the eligibility criteria (i.e., fifteen were identified through the database search and nine through cross-referencing). Fourteen studies assessed the performance of standard PAIC methodologies, four studies explored the potential extensions of the standard MAIC approach, and six studies included novel population adjustment methodologies. The advantages of MAIC/STC over traditional unadjusted indirect treatment comparison (ITC) methods (i.e., Bucher) in the presence of effect modifiers are well confirmed in the literature; however, these approaches also have limitations. Attempts to extend the PAIC approach are mainly related to weight schemes, e.g., weights based on entropy balancing or via a polynomial-based non-linear optimization. Recently proposed novel PAIC methods include multilevel network meta-regression and parametric G-computation.
CONCLUSIONS: The performance of different PAIC methods is still controversial and not clear. Future research should focus on guidelines on PAIC methods selection depending on the target estimand, presence of effect modifiers, covariate overlap, and the size of the treatment network.
P42: Using Bayesian Evidence Synthesis Methods to Incorporate Real-World Evidence in Surrogate Endpoint Evaluation
2:00PM - 2:15PM
Wheaton L1, Papanikos A2, Thomas A1, Bujkiewicz S1
1University of Leicester, Leicester, UK, 2GlaxoSmithKline, Stevenage, UK
OBJECTIVES: In trials, surrogate endpoints are often used instead of final clinical outcomes to more quickly obtain treatment effects, which are used to support regulatory and reimbursement decisions. Before use in decision-making, surrogate endpoints require validation to ensure treatment effects observed on surrogate endpoints can accurately predict treatment effects on final outcomes. Traditionally, validation of surrogate endpoints has only used RCT data. However, RCT data are often too limited for validation. The objective of this study is to investigate approaches for including comparative real world evidence (cRWE) and single-arm RWE (sRWE) alongside RCT data in surrogate endpoint evaluation, accounting for potential differences in treatment effects between sources of data, to improve surrogate endpoint validation and prediction of treatment effects on final outcomes.
METHODS: Bayesian bivariate random-effects meta-analysis (BRMA) is used to evaluate progression-free survival (PFS) as a surrogate endpoint for overall survival (OS) in colorectal cancer. The model is extended to include bias terms to account for differences in treatment effects between RCTs and RWE. Cross-validation is used to assess whether including RWE improves prediction of treatment effects on OS.
RESULTS: Using RCT data alone (7 studies) estimated between-studies correlation of 0.75 (95% CrI: -0.25, 0.99). Adding cRWE and sRWE (7 studies) more precisely estimated correlation at 0.74 (95% CrI: -0.056, 0.98). Inclusion of RWE reduced median absolute discrepancy of predictions of treatment effects on OS from 0.16 to 0.12. Bias adjustment resulted in weaker correlation of 0.71 (95% CrI: -0.25, 0.98) and less accurate predictions of treatment effects on OS with median absolute discrepancy of 0.18.
CONCLUSIONS: Adding RWE to RCTs in BRMA without bias adjustment improves precision of surrogacy parameters and prediction of treatment effects on the final outcome. However, using bias adjustment lowered the correlation, providing weaker evidence for surrogacy. This could be because bias adjustment reduces between-studies heterogeneity.
MedTech
Virtual
Moderator
Ulises Garay, MSc
Roche Diagnostics International, Rotkreuz, LU, Switzerland
P47: Understanding Evidence Requirements for Diagnostic Devices for Reimbursement and Market Access: Insights and Lessons From Review of NICE Diagnostics Assessment Reports (2011-2022)
2:15PM - 2:30PM
Aggarwal S1, Topaloglu J2, Kumar S3, Bela A4, Topaloglu O1
1NOVEL Health Strategies, Bethesda, MD, USA, 2Institute of Global Policy, Washington DC, DC, USA, 3NOVEL HEALTH STRATEGIES, COLUMBIA, MD, USA, 4NOVEL Health Strategies, Chevy Chase, MD, USA
OBJECTIVES: Personalized medicine driven by diagnostics has potential to improve patient outcomes and save costs for payers. However, a significant number of diagnostics are unable to receive reimbursement coverage for market access. The objective of this analysis was to understand the evidence requirements for diagnostics based on review of NICE Health Technology Assessment (HTA) reports.
METHODS: A systematic review of all 2011-2022 NICE diagnostic HTAs was conducted using NOVEL-HTA database. HTA Reports were reviewed for all key reasons for not recommending a diagnostic device. For selected reports, we analyzed the NICE’s final determination and developed insights and lessons learned.
RESULTS: During 2011-2022, there were 41 diagnostics related guidance published by NICE. Twenty (~50%) of the diagnostics were issued a final determination of “not recommended” or “not enough evidence to recommend”. In 8 of these 20 assessments, NICE indicated, there was not enough evidence to determine impact of the diagnostic on treatment decision and patient management. In 7 assessments, uncertainty or lack of cost-effectiveness was cited as the main reason. Interestingly, in 6 assessments, NICE questioned the accuracy of the diagnostics, which is also assessed by regulatory agency, implying need for more collaborative effort between regulatory and HTA agencies. In 5 assessments, NICE indicated it was unclear how the diagnostic improved clinical and patient outcomes. In 2 assessments, NICE strongly criticized the claimed benefits of the diagnostic saying it “lacks face validity”.
CONCLUSIONS: Nearly half of the diagnostics were not recommended by NICE. Insights and lessons from these case studies could help manufacturers design value focused evidence generation strategy.
P48: Evaluating the Clinical, Economic, and Societal Value of Rapid Diagnostic Testing in Emerging Markets: A Systematic Literature Review Assessing Infectious Diseases
1:30PM - 1:45PM
Bourcet A1, Silber A2, Acosta Luis S2, Haas L3, Haddadin W4, Lee M5, Mulrooney M2, O'Hara M2, Sotak M5
1Abbott, Singapore, Singapore, 2Trinity Life Sciences, Waltham, MA, USA, 3Abbott, São Paulo, Brazil, 4Abbott, Dubai, United Arab Emirates, 5Abbott, Abbott Park, IL, USA
OBJECTIVES: Point of care rapid diagnostic tests (RDTs) have demonstrated accurate and timely diagnosis across decentralized settings, broadening patient access in remote locations and improving pathways to diagnosis. This study aimed to synthesize published and other literature on the clinical, societal, and economic value of RDTs for infectious disease across Asia, Africa, and Latin America.
METHODS: A systematic literature review (SLR) was conducted using PubMed and Embase for publications dated 2017 to 2021 in accordance with PRISMA guidelines using RDT and infectious disease search terms. This SLR was supplemented by targeted searches to evaluate guidelines and recommendations for RDTs from non-governmental organizations or other bodies (e.g. WHO).
RESULTS: Of the 616 articles identified in the systematic search, 128 were selected for full-text review, and 63 were included across the targeted and systematic review. Studies spanned 28 countries and 6 infectious diseases. Outcomes were clinical (e.g., patient outcomes), societal (e.g., reduced patient/clinician burden), and economic (e.g., cost savings). Of the 15 studies that reported RDT time to results, 10 reported results in under 1 hour which can lead to testing/treating more patients. Five studies showed that RDTs led to faster time to treatment for multiple disease areas compared to treatment initiated based on centralized laboratory testing, which can reduce the spread of infectious diseases. RDTs can reduce clinical and economic costs for misdiagnosis by reducing unnecessary treatment, including antibiotics that lead to resistance in select populations. Additionally, 11 studies reported high RDT usability for patients and/or clinicians.
CONCLUSIONS: Point of care RDTs with high demonstrated accuracy provide for timely and cost-effective diagnosis across decentralized settings, even in remote areas of emerging markets. This allows for quicker treatment and can improve clinical outcomes. Further work is needed to translate existing evidence into population-level studies/models to determine the holistic impact of RDT implementation.
P46: How Are European Countries Assessing Digital Health Technologies (DHTS)? A Comparison of DHT Health Technology Assessments (HTAS) Across France, Germany and the UK
2:00PM - 2:15PM
Arca` E1, Heldt D2
1OPEN Health Evidence & Access, Rotterdam, ZH, Netherlands, 2OPEN Health, Berlin, BE, Germany
OBJECTIVES: To systematically identify and review HTAs of DHTs across France, Germany, and the UK.
METHODS: A systematic review of grey literature was conducted whereby national-level HTA websites from HAS, BfArM, and NICE were searched. The authors restricted inclusion to stand-alone DHTs falling under Tier C of the NICE assessment framework,1 and/or under BfArM’s definition of digital health apps.2 To improve consistency and minimize variability across assessments, we extracted and analyzed only HTAs of the same DHTs submitted and evaluated for the same indications across multiple agencies.
RESULTS: In total, 54 assessments were identified across the three agencies. Four were identified for France, 30 for Germany, and 20 for the UK. Consistently across the three countries, the disease area with the most submissions was mental/behavioral health, followed by cardiology, diabetes, and oncology. Only two products were assessed by multiple agencies, namely Deprexis and Velibra. Deprexis was first assessed in the UK (January 2018),3 followed by Germany (February 2021),4 and France (December 2021).5 Velibra was assessed in the UK (July 2019)6,7,8 and in Germany (October 2020).9 Despite recognition of the high unmet need, the results of the Deprexis and Velibra assessments varied greatly across France, Germany, and the UK. While Deprexis was not recommended in France, both apps were recommended for reimbursement in Germany. In the UK, Deprexis was recommended for inclusion in the Improving Access to Psychological Therapies program but Velibra was not. The reasons for the divergence were related to the positioning of the products, the submitted evidence, and its quality, and chosen comparator treatments.
CONCLUSIONS: This review provides an overview of the status of HTA frameworks and evidence requirements for DHTs across three major European markets. Although every healthcare system is unique, a common European approach to HTA for DHTs could facilitate innovation and access.
P45: Internal, External, and Cross-Validation of the DEDUCE Model, a Cost-Utility Tool Using Patient-Level Microsimulation to Evaluate Sensor-Based Glucose Monitoring Systems in Type 1 and Type 2 Diabetes
1:45PM - 2:00PM
Coaquira Castro J1, De Pouvourville G2, Greenberg D3, Harris S4, Jendle J5, Shaw JE6, Levrat Guillen F7, Szafranski K8
1Abbott Diabetes Care, Alameda, CA, USA, 2ESSEC Business School, Cergy-Pontoise, France, 3Ben-Gurion University of the Negev, Be'er-Sheva, Israel, 4University of Western Ontario, London, ON, Canada, 5Örebro University, Örebro, Sweden, 6Baker Heart and Diabetes Institute, Melbourne, VIC, Australia, 7Abbott Diabetes Care, London, UK, 8EVERSANA, Burlington, ON, Canada
OBJECTIVES: For health care decision-makers, the use of computer simulation models requires transparency, precision and accuracy. Systematic comparisons of diabetes models, per Mount Hood Challenges, have shown significant variability in results between models. We developed and validated a new cost-effectiveness model (the DEtermination of Diabetes Utilities, Costs, and Effects [DEDUCE] model) in both type 1 and 2 diabetes mellitus (T1DM, T2DM) to evaluate sensor-based glucose monitoring.
METHODS: This Excel-based patient-level microsimulation model used a cost-utility approach to compare sensor-based glucose monitoring systems to self-monitoring of blood glucose (SMBG) testing over a specified time horizon (1 to 100 years) with yearly cycles. The model used the Sheffield risk engine for T1DM and the Risk Equations for Complications Of type 2 Diabetes (RECODe) risk engine for T2DM to predict macro- and microvascular events. Inputs, model architecture, and subsequent validation analyses were reviewed and informed by an advisory board of health economists, endocrinologists and diabetologists.
RESULTS: Internal validation (comparing model predictions to observed outcomes from studies from which the risk equations were derived) and external validation (predictions compared to external datasets) demonstrated high precision (R2 ≥ 0.98) and reasonable accuracy (mean absolute percentage error [MAPE] ranging from 7.64-68%) with regards to macrovascular outcomes for T1DM, and high precision (R2 = 0.94) and high accuracy (MAPE = 19.8%) with regards to all-cause mortality in T2DM. Cross validation (comparing model outcomes between DEDUCE and published results from models participating in previous Mount Hood Challenges) indicated that DEDUCE had the best accuracy (MAPE = 36%) and non-inferior precision (R2 = 0.16) relative to other T1DM models, and second-to-best accuracy (MAPE = 25.03%) and high precision (R2 = 0.95) relative to other T2DM models.
CONCLUSIONS: In both T1DM & T2DM, DEDUCE suitably predicted key outcomes and performed favorably compared with existing models that participated in the Mount Hood Challenges, including the Core Diabetes Model.
Does the Choice of Cost-Effectiveness Model Approach Matter?
In-person
This panel explores the impact of choice of model structures and modelling methods on the cost-effectiveness results.
Moderator
Thor-Henrik Brodtkorb, PhD
RTI Health Solutions, Ljungskile, O, Sweden
P40: An Investigation Into the Relationship Between Choice of Model Structure and How to Adjust for Subsequent Therapies Using a Case Study in Oncology
1:30PM - 1:45PM
Cranmer H1, Shields G2, Bullement A3
1Cranmer Consultancy Ltd, Sheffield, LON, UK, 2Manchester University, Manchester, LIN, UK, 3BresMed Health Solutions, Nottingham, NTT, UK
OBJECTIVES: A common challenge in health technology appraisals (HTAs) of cancer treatments is how subsequent therapy use within the trial follow-up may influence cost-effectiveness model outcomes. Although overall survival (OS) is often a key driver of model results, there are no guidelines to advise how to adjust for potential confounding stemming from subsequent therapies, with different approaches available dependent on the model structure. We compare a partitioned-survival analysis (PartSA) with a semi-Markov multi-state model (MSM) structure, with and without attempts to adjust for the impact of subsequent therapies on OS using a case study describing outcomes for people with relapsed/refractory multiple myeloma.
METHODS: Both model structures included three health states: pre-progression, progressed disease and death. The perspective was that of the UK National Health Service. Three traditional crossover methods were considered within the context of the PartSA, whereas for the MSM the probability of post-progression death was pooled across arms. Impacts on the model incremental cost-effectiveness ratio (ICER) were recorded.
RESULTS: The unadjusted PartSA produced an ICER of £623,563, and after adjustment yielded an ICER range of £381,340-£386,907. The unadjusted MSM produced an ICER of £1,283,780. Adjusting OS in the MSM resulted in an ICER of £345,486.
CONCLUSIONS: The simplicity of the PartSA is lost when the decision problem becomes more complex (for example, when OS data are confounded by subsequent therapies). In this setting, the MSM structure may be considered more flexible, with fewer and less restrictive assumptions required versus the PartSA. Researchers should consider important study design features that may influence the generalisability of data when undertaking model conceptualization.
P38: One Size Does Not Fit All: Calculating the Cost-Effectiveness of Multiple Indications of Pembrolizumab in the Netherlands
2:15PM - 2:30PM
Verbeek F1, van Gils C2, Heine R2, Uyl-De Groot C2
1Erasmus University, Institute of Health Policy & Management, Rotterdam, NH, Netherlands, 2Erasmus University, Institute of Health Policy & Management, Rotterdam, Netherlands
OBJECTIVES:
Tumor-agnostic immunotherapies such as pembrolizumab are known to provide several dozen treatment indications for a single compound. Usually, the first registered indication of a drug shapes reimbursement decisions of all its future indications. However, these later indications are rarely assessed in terms of value for money. Through examination of seven indications of the same compound, this study aims to elucidate the broader cost-effectiveness landscape of pembrolizumab following the automatic reimbursement of these additional indications in The Netherlands.
METHODS:
First, a full cost-effectiveness analysis evaluated the first-line treatment of pembrolizumab in locally advanced non-small cell lung cancer (NSCLC) using a Markov model. Then, these cost and utility inputs, and results of sensitivity analyses guided the overall cost-effectiveness assessment of pembrolizumab for seven other indications, including first- and second-line head and neck cancer, first-line renal cell carcinoma, melanoma, and NSCLC. Estimations of overall survival and progression-free survival, pembrolizumab- and standard-of-care costs, were tailored to each indication. Throughout all indications, utilities per health state, adverse event costs and end-of-life costs were kept constant. All analyses included cost and utility inputs of peer-reviewed studies.
RESULTS:
The first-line treatment of NSCLC generated an ICER of €126,474/QALY. Other indications produced ICERs ranging from approximately €136,000/QALY to €2,6 million/QALY, with two negative ICERs amounting to -€4,3 million/QALY. Upon deeper examination, no correlation existed between the magnitude of the ICER and the line of treatment, the treatment context or the cancer histology.
CONCLUSIONS:
This study found that various indications of the same immunotherapy can yield substantially different cost-effectiveness outcomes, most of which barely approach cost-effectiveness thresholds. Consequently, separate cost-effectiveness calculations per indication are recommended. In The Netherlands, established discounts covering all new indications plausibly prompted unfavourable financial agreements. For new immunotherapies, health authorities should use caution when applying a ‘one compound, one price’ reimbursement system.
P39: Does the Choice of Modelling Approach Matter When Modelling Stroke Prevention Therapy?
2:00PM - 2:15PM
Whitaker J1, Pollit V2, Rinciog C3, Serra-Sastre V4
1Symmetron Limited, London, LON, UK, 2Symmetron Ltd, London, LON, UK, 3Symmetron Limited, London, UK, 4City, University of London, London, UK
OBJECTIVES:
Patient-level discrete event simulation (PL-DES) may capture important nuances of an individual patient’s risk profile and history more robustly than a cohort Markov model. This project assessed whether PL-DES is a preferable approach to assess cost-effectiveness of stroke prevention therapies in an atrial fibrillation population.
METHODS:
To quantify the impact of model choice on cost-effectiveness results, a Markov model (which evaluated direct oral anticoagulants [DOACs] and warfarin) was translated into a DES framework. The results of this cohort-DES model were compared to an updated model incorporating individual patient-level data (IPD) to inform baseline risks for stroke and bleeding events. Additional risk factors (such as hypertension and anaemia), not captured in the Markov model due to design constraints, were added in a secondary PL-DES analysis.
RESULTS:
The cohort-DES and Markov model analyses produced similar results. Following the incorporation of IPD in the PL-DES, the incremental cost-effectiveness ratio (ICER) of all DOACs versus warfarin increased (by up to £8,000). This was driven by PL-DES capture of the left-skew in the distribution of patient age, leading to reduced stroke events in the PL-DES than in the Markov model. Conversely, introducing additional risk factors into the PL-DES decreased the ICER of all DOACs versus warfarin (by up to £6,000). This additional action increased the risk of events, meaning more effective DOACs prevented more events. When considering a subgroup with a lower baseline stroke risk, the combined impact of IPD and additional risk factors led to a more pronounced decrease in the ICER (by up to £15,000).
CONCLUSIONS:
This study demonstrated that the choice of model approach can impact cost-effectiveness results when modelling stroke prevention therapy. PL-DES should be considered when key patient characteristics are asymmetrically distributed within IPD or when the baseline risk of thromboembolic events is low.
P37: Impact of Method for Modelling Distant Recurrence (DR) on Cost-Effectiveness (CE) of Nivolumab (NIVO) as an Adjuvant Treatment of Muscle-Invasive Urothelial Carcinoma (MIUC) Patients With High Risk of Recurrence in France
1:45PM - 2:00PM
Bonastre J1, Négrier S2, Colrat F3, Chamielec C4, Teitsson S5, Knight C6, Ni L6, Chevalier J7, Gaudin AF3, Roupret M8, Branchoux S9
1Gustave Roussy, Villejuif, France, 2Centre Léon Bérard, University of Lyon, Lyon, France, 3Bristol-Myers Squibb SARL, Rueil Malmaison, 92, France, 4VYOO Agency, PARIS, 75, France, 5Bristol Myers Squibb, London, LON, UK, 6RTI Health Solutions, Manchester, LAN, UK, 7VYOO Agency, Paris, 75, France, 8Hopital Pitié Salpêtrière, Paris, France, 9Bristol-Myers Squibb SARL, RUEIL MALMAISON, France
OBJECTIVES: To assess the impact of method for modelling DR (transient or absorbing state) for MIUC patients with high risk of recurrence and tumor cell PD-L1 expression ≥1% on the CE of NIVO versus surveillance in France.
METHODS: A 4-state (disease-free, local recurrence, DR, death) semi-Markov model was developed to conduct an analysis from the French healthcare system perspective, over a 25-year time horizon with weekly cycles. Costs (in 2021 €s) and health outcomes were discounted by 2.5% annually. Patient characteristics, efficacy (for disease-free and local recurrence), safety and utilities (EQ-5D-3L, health-state specific calculated using the French value set) were derived from CheckMate 274 trial. First recurrence events were repartitioned using the trial data within the first year and the largest French prospective cohort with MIUC between years 2 and 5. Disease-free patients at year 5 were considered cured. Post-DR outcomes were assessed by either treating the DR state as a transient state prior to death via tunnel states or as an absorbing state with one-off costs and QALYs. Post-DR survival was informed by parametric survival models fitted to published data in first-line metastatic urothelial carcinoma. Outcomes of interest were life years (LYs), quality-adjusted LYs (QALYs), and incremental cost-utility ratio (ICUR). Probabilistic sensitivity analyses were run for both methods to generate CE acceptability curves.
RESULTS: NIVO was associated with higher total LYs, QALYs and costs (9.3, 5.9, and €126,510, respectively) vs surveillance (6.4, 4.0, and €75,845, respectively) with an estimated ICUR of €26,691/QALY gained with DR as tunnel state. Modelling DR as an absorbing state resulted in an ICUR of €26,083/QALY gained. At a willingness to pay threshold of €50,000/QALY gained, NIVO had 95% probability of being cost-effective for both DR modelling.
CONCLUSIONS: NIVO is estimated to be a life-extending and cost-effective adjuvant treatment in France with minimal sensitivity due to DR modelling approach.
Concurrent Breakout Session 5
Accelerating Adoption and Standardization of R in Health Technology Assessment: The Case of Discrete Event Simulation
In-person
Level: Intermediate
PURPOSE: To examine enablers for the adoption and standardization of using R for health economic modeling, by bringing together the experience of a working group of authors on an R textbook with that of a health technology assessment agency and the shared experiences of the audience.
DESCRIPTION: There has been growing interest in the use of R for health economic modeling. Compared to proprietary software, R is considered more transparent because it is open-source and code-based, and more efficient because all data analyses, modeling, and reporting can be performed in the same environment. However, there may be a steep learning curve for those new to R and there are often multiple ways to do the same task, which both pose challenges for the development and appraisal of economic models in R. This workshop will examine enablers for adopting and standardizing health economic modeling in R, by bringing together the experience of a working group of authors on an R textbook with that of a health technology assessment agency and the shared experiences of the audience. Prof Koffijberg will start the session by providing the background and polling the audience’s experience with R (9 minutes). Dr Degeling will provide a technical perspective through demonstrating code for alternative discrete event simulation (DES) implementations and discussing techniques for reducing runtimes (12 minutes). Dr O’Mahony will discuss trade-offs between coding convenience, transparency, control, runtime, and the validation, stability and reliability of R packages (12 minutes). Dr Vreman will provide the perspective of a health technology assessment agency, presenting on the R initiative within the Dutch National Health Care Institute (ZIN)(12 minutes). Finally, the audience will be solicited on their preferred DES implementation, the relevance of the trade-off criteria, and suggested training materials for the adoption and standardization of modeling in R (15 minutes).
Discussion Leaders
Erik Koffijberg, PhD, MSc
University of Twente, Enschede, OV, Netherlands
Prof.Dr. H. (Erik) Koffijberg is full Professor Technology Assessment of Digital Health Innovations at the University of Twente in the Netherlands, and chair of the section Health Technology & Services Research. He has an MSc in Technical Computer Science and a PhD in Decision-Analytic Modelling. He has published >125 peer-reviewed scientific papers on methods and on applications in the field of HTA/health economic modeling, focusing on methods development for optimizing testing and screening strategies, and for identifying patient heterogeneity to tailor interventions to subgroups. He teaches MSc and postgraduate external courses on early HTA, regular HTA, Advanced Health Economic Modelling, and Discrete Event Simulation in Healthcare, and coordinates the Healthcare Technology & Management track of the master program Industrial Engineering & Management. He is PI in multiple large (international) research consortia focusing on the optimal use of biomarkers, imaging technologies, and AI, for early disease detection.
Discussants
Koen Degeling, PhD, MSc, BSc
University of Melbourne, Melbourne, VIC, Australia
Dr Koen Degeling is Scientific Director and the Economic Modelling & Innovation Lead at Lumen Value & Access, a Healthcare Consultancy Group company. He was trained as an Industrial Engineer specializing in Healthcare Technology and Management and holds a PhD in Advanced Health Economic Modelling from the University of Twente in the Netherlands. Prior to joining Lumen Value & Access, Koen worked on real-world data-driven health economic and health services research projects at the Cancer Health Services Research department of the University of Melbourne in Australia, where he continues to be involved as an honorary fellow. He is an active ISPOR member and currently serves on the Editorial Advisory Board for Values & Outcomes Spotlight and ISPOR New Professionals Steering Committee, is involved in several short courses and workshops, and has served as global chair of the ISPOR Student Network.
Amarens Geuzinge, PhD
Zorginstituut Nederland, Diemen, NH, Netherlands
James F O'Mahony, PhD
Trinity College Dublin, Dublin, D, Ireland
Advanced Forecasting: Incorporating External Data Within Survival Extrapolations
Virtual
Level: Experienced
PURPOSE: To demonstrate new methods of using external data to improve survival extrapolations, using case studies as examples.
DESCRIPTION:
In a landscape of accelerated approvals, increasingly immature trial data, and the dedication of considerable resources to improve the quality and availability of supplementary trial and observational data, it has never been more important to apply robust new methods in extrapolations to inform healthcare decision-making. In the past, external data has generally been used to validate models fit only to observed trial data. This is an inefficient use of such information and potentially misleading. Advances in other fields, such as the forecasting models used by large companies like Uber, show external data can be used to strengthen inferences and facilitate the choice of model, thus improving our ability to forecast. Given this upcoming change, we will demonstrate how to use different types of external evidence to improve survival extrapolation. Dawn Lee will provide a general and historical introduction to advanced extrapolation methods and the methods currently used within NICE submissions (10 minutes). Using a case study based on trials evaluating treatments for previously untreated advanced BRAF-mutated melanoma, Ben Kearns will demonstrate how Bayesian hierarchical modeling can be used to simultaneously synthesize evidence from multiple sources (15 minutes). Using a case-study of multiple myeloma, Mario Ouwens will demonstrate how historical trial data can be used as informative Bayesian priors to improve extrapolations (10 minutes). JS will discuss how data from structured expert elicitation can then be used to supplement extrapolations within a Bayesian framework where no alternative datasets exist (10 minutes). Polls will be used to seek input. A Question and Answer session will follow, plus discussion on application of these new methods (15 minutes).
Discussion Leaders
Dawn Lee, MMath, MSc
Lumanity, Sheffield, DBY, United Kingdom
Dawn joined Exeter University / PenTAG ERG as an Associate Professor in September 2022 following nearly 12 years at Lumanity (previously known as BresMed) where she was their Chief Scientific Officer for HEOR. Dawn has experience in a number of disease areas and project types, and currently specializes in oncology modelling (in immuno-oncology in particular), early product assessment, health technology assessment (HTA), complex decision problems, models with complex statistical needs, end-to-end modelling solutions using R/R-SHINY and anything else “a bit weird and wonderful”. Dawn is currently determining where her long-term research focus will be and is open to collaborations.
Discussants
Shannon Cope, MSc
PRECISIONheor, Vancouver, BC, Canada
Benjamin Kearns, PhD
University of Sheffield, School of Health and Related Research, Sheffield, United Kingdom
I am a Principal Health Economist at Lumanity. I was previously the deputy director for the NICE Decision Support Unit and an invited health economic expert for the NICE scientific advice service. My PhD focused on the use of Bayesian dynamic survival models for the analysis and extrapolation of survival data.
I have substantial experience of health technology assessments, and the use of statistical methods to support appraisals. This includes several rare disease and oncology appraisals, and leading projects such as the first UK options-appraisal of screening for ovarian cancer, evaluating pathway (service) re-design options.
Mario Ouwens, PhD
AstraZeneca, Mölndal, O, Sweden
Mario Ouwens, PhD in biostatistics, is a senior statistical science director in AZ. He is group director of the medical and payer evidence statistics group and has many years worked in statistical innovation for health economics and real world evidence.
Approaches to Algorithm Development for the Estimation of Lines of Therapy in Oncology Using Real-World Data
In-person
Level: Intermediate
PURPOSE: Cancer treatment is complex, involving the sequential use of different treatment regimens as disease progresses. This workshop will discuss the challenges of identifying distinct lines of therapy (LOT) in real-world oncology studies and present best practices to generate reliable LOT algorithms. The workshop will provide practical examples of cancer treatment pattern analysis using retrospective, observational, real-world data (RWD).
DESCRIPTION: The accurate quantification of LOTs is critical for the identification of distinct points of care for comparative research, treatment decision-making at disease progression, and for the accurate evaluation of treatment pathways. There is no standard method to define LOTs for solid or hematologic malignancies, in part due to disease heterogeneity and the rapid pace of treatment innovation.
The learning objectives of this workshop are:
- To understand the importance of accurately defining LOTs
- To identify the necessary components of a LOT algorithm
- To distinguish the variables that can impact algorithm development from different databases
- To assess the differences in algorithms by tumor type
- To critically evaluate research using LOT algorithms
- To share a case study using administrative claims and clinical data
The content will include:
- LOT background and key considerations (Chi Nguyen, 10 minutes);
- Step-by-step best practices to develop and validate LOT algorithms (Lisa Hess, 15 minutes)
- Case study example of LOT analysis using large administrative claims data integrated with clinical data (Bal Nepal, 15 minutes).
- Challenges with data sources; algorithms for solid vs. hematologic malignancies (Julia Slejko, 10 minutes).
Participants will have the opportunity to interact and share experiences and challenges working with oncology LOT algorithms using RWD via real-time polling and interactive discussion. This workshop is designed for both academic and industry scientists interested in using RWD for oncology-related research.
Discussion Leaders
Chi Nguyen, PhD
HealthCore, Inc., Wilmington, DE, USA
Dr. Chi Nguyen is a senior researcher at HealthCore, an independent subsidiary of Elevance Health Inc. in the United States. She has experience conducting health economics and outcomes research using a variety of study designs, statistical methods, and data sources. At HealthCore, she focuses on real-world treatment patterns, comparative effectiveness, and costs of care of medical oncology treatments. She earned her PhD in Epidemiology from the University of Texas Health Science Center at Houston.
Discussants
Lisa Hess, PhD
Eli Lilly and Company, Indianapolis, IN, USA
Lisa M Hess, PhD (https://www.linkedin.com/in/lisa-m-hess-phd-88ab0218/)
Lisa Hess is Executive Director of Value, Evidence and Outcomes research at Eli Lilly and Company and Adjunct Professor of Public Health and Medicine at Indiana University (IU), Indianapolis USA. After a more than 20-year career in academia, she joined Eli Lilly and Company where her work focuses on observational research methods in oncology. She continues to teach meta-analysis courses at IU and UMIT TIROL- University for Health Sciences and Technology. Her research interests involve multidisciplinary and collaborative efforts to improve cancer care and patient outcomes through the use of retrospective, prospective, and clinical trial data.
Bal Nepal, PhD
HealthCore, Inc., Bear, DE, USA
Bal Nepal obtained doctorate degree in Public Health from The University of Texas Health Science Center at Houston in 2017. He then joined HealthCore, a wholly owned subsidiary of Elevance Health as a Researcher. In this role, he involves in health economics and outcomes research. His research primarily focuses on oncology, diabetes, respiratory diseases, and autoimmune diseases.
Julia F. Slejko, PhD
University of Maryland School of Pharmacy, Baltimore, MD, USA
Julia F. Slejko, PhD is an Associate Professor of Pharmaceutical Health Services Research at the University of Maryland School of Pharmacy and is Co-Director of the Patient-Driven Values in Healthcare Evaluation (PAVE) Center. Dr Slejko’s research is focused on innovative approaches for decision-analytic modeling for economic and health outcomes assessments. She holds a BA in Molecular, Cellular, and Developmental Biology from the University of Colorado Boulder. During her PhD training, she focused on pharmacoeconomics at the University of Colorado School of Pharmacy Center for Pharmaceutical Outcomes Research (CePOR). Her postdoctoral training was completed at the Pharmaceutical Outcomes Research and Policy Program in the University of Washington School of Pharmacy. Prior to her PhD training, she had a 7-year career in drug discovery at Array BioPharma. Dr Slejko serves as co-lead of ISPOR’s Women in HEOR initiative, Co-Chair Elect of the ISPOR Faculty Advisor Council and is a member of ISPOR’s Health Science Policy Council.
Using Target Trial Emulation for Estimation of Treatment Effects Using Real-World Data
In-person
Level: Intermediate
PURPOSE: Health technology assessment (HTA) bodies are increasingly considering real-world data (RWD) for informing decision-making. The target trial emulation (TTE) framework has emerged as a promising approach to estimate treatment effects whilst minimizing common biases and methodological pitfalls in non-randomized studies. By applying design principles from randomised controlled trials, TTE explicitly ties the design and analysis of the non-randomised study to the target trial, facilitating the interpretation and communication of its underlying assumptions and study findings. In addition, TTE provides a structured approach for identifying potential limitations of RWD and the extent to which these affect the HTA decision.
The purpose of this workshop is to illustrate how the use of TTE can estimate per-protocol treatment effects when evidence comes primarily from a single-arm trial and an external (real-world) control arm. We will use three advanced non-small-cell lung cancer (aNSCLC) trials for illustrating the advantages of the TTE framework as well as major challenges.
DESCRIPTION:
Participants will be introduced to a broad overview of the target trial framework and the adoption of TTE for HTA. The workshop then will review design considerations and an application in a subset of aNSCLC trials. Grace Hsu will chair the session. Manuel Gomes will provide a general introduction to TTE (10 min.). Sreeram Ramagopalan will illustrate how these methods have been applied to aNSCLC (10 min.). Stephen Duffield will outline the potential value of TTE from a HTA perspective (10 min.). Audience participation will include engaging in a poll-driven question-and-answer period to identify potential issues and solutions for TTE scenarios (20 min.). This workshop would be valuable to researchers, industry analysts, and HTA representatives who are interested in trial emulation and analysis of RWD.
Discussion Leaders
Sreeram Ramagopalan, PhD
F. Hoffmann-La Roche Ltd, Basel, BS, Switzerland
Sreeram (Ram) Ramagopalan is the Global Head for Real World Evidence for Market Access at Roche. Dr Ramagopalan’s team strategically plans and executes real world research studies to obtain and maintain access for Roche medicines. Dr Ramagopalan holds a PhD in Epidemiology from the University of Oxford, as well as an MSc in Health Economics from the London School of Economics. Prior to Roche, Dr Ramagopalan led European Real World Evidence teams at Bristol Myers Squibb and the life-sciences consultancy Evidera. He is an international expert in real world evidence with over 295 peer reviewed publications.
Discussants
Stephen Duffield, PhD, MD
NICE, Liverpool, United Kingdom
Stephen’s role involves the continuing development of NICE’s real-world evidence (RWE) framework, collaboration on RWE demonstration projects, and helping to transform NICE’s use of real-world data across guidance products. He is also involved with upskilling individuals within and externally to the organisation, contributing to training workshops and technical forums. Stephen has a degree in medicine and a PhD in public health. Previously, he worked as a clinical doctor and a guideline developer in NICE Centre for Guidelines
Manuel Gomes, PhD
University College London, London, United Kingdom
Grace Hsu, MSc
Cytel Canada Health Inc, Waltham, MA, USA
Are Existing Measures of Pediatric Health-Related Quality of Life Fit for Purpose for Use in Health Technology Assessment?
In-person
ISSUE:
The issue to be presented and debated is the current status of existing generic preference-accompanied measures of HRQoL for use in the self and proxy report of paediatric HRQoL, and the extent to which they are fit for purpose for HTA. This includes discussion of current evidence about the instruments and where further evidence is required to guide the use of the instruments in decision making.
OVERVIEW:
Measuring HRQoL in paediatric populations is challenging, resulting in substantial gaps in evidence submitted to HTA bodies around the world. There are a range of generic measures of HRQoL, including the EQ-5D-Y, EQ-5D-Y-5L, CHU-9D, PedsQL and HUI-3. Key features of these instruments that impact on the assessment of HRQoL include the age range in which the instrument can be used, the ability for self and proxy report, and the availability and validity of value sets. These features, as well as data on measurement characteristics, including the suitability for use in certain ages and childhood conditions, differs across the instruments. This led the National Institute of Health and Care Excellence (NICE) to recently conclude that the evidence was not currently strong enough to enable the recommendation of specific instruments for paediatric populations. However, ongoing research is generating substantial evidence to further understand the measurement performance and characteristics of the instruments. In this panel, an overview of the instruments will be provided, along with detailed description of ongoing research. This will focus on work in Australia collecting HRQoL data from more than 6,000 children across diverse health conditions (the Paediatric-Multi Instrument Comparison [P-MIC] study, which is the largest international comparison of paediatric measures conducted to date). The perspectives of HTA and industry on the measurement of paediatric HRQoL and the usefulness of the instruments in the HTA process will be discussed.
Moderators
Michael Herdman, MSc
Insight Consulting & Research, Mataró, Spain
Mike has worked in the field of health technology assessment and outcomes research for over 25 years. He currently runs his own consulting and research company in Spain and is Honorary Visiting Associate Professor at the Saw Swee Hock School of Public Health at the National University of Singapore.
His main areas of interest are the development, validation, application, and interpretation of patient reported outcome (PRO) measures. He has led or collaborated on numerous national and international projects involving the use and development of PRO instruments and in recent years has focused on the measurement and valuation of health and quality of life in younger populations. He was part of the development team that produced the most widely used generic preference-weighted measure of health status, the EQ-5D-5L, and its equivalent for use in younger populations, the EQ-5D-Y.
He has been a member of the EuroQol Group for 25 years, is Chair of that Group’s Younger Populations Working Group, and currently serves on its Executive Committee. He has published over 100 original peer-reviewed journal articles on a range of topics, from the use of utilities in health economic assessments in areas such as vaccines and cancer to widely-cited papers on the cross-cultural measurement of health-related quality of life.
Panelists
Sophie Cooper, BSc
National Institute for Health and Care Excellence (NICE), Manchester, United Kingdom
Sophie Cooper is a Senior Scientific Adviser in the Science Policy and Research Programme at NICE, with several years’ experience in NICE's Technology Appraisals Programme. Her current role involves developing NICE’s responses to science policy issues and undertaking and commissioning research to improve methods for health technology assessment and guideline development.
Kim Dalziel, PhD
The University of Melbourne, Carlton, VIC, Australia
Professor Kim Dalziel is Head of the Health Economics Group at the University of Melbourne. She is also a Group Leader of Health Services and Economics within the Health Services Group at Murdoch Children's Research Institute (MCRI) and collaborates with the Royal Children's Hospital, The Women's Hospital and the Peter MacCallum Cancer Centre.
She leads a program of research in child health and has specialist expertise in economic evaluation and modelling, health-related quality of life measurement and valuation, child health policy, vulnerability/equity and use of health services and economic evaluation alongside clinical trials. She actively supervises Masters of Public Health, clinical advanced trainee research projects and PhD students.
James Shaw, PhD, PharmD, MPH
Bristol-Myers Squibb, Princeton, NJ, USA
Dr Shaw leads the Patient-Reported Outcomes Assessment (PROA) Center of Excellence in Worldwide Health Economics and Outcomes Research at Bristol-Myers Squibb. PROA consists of scientists responsible for driving clinical outcome assessment (COA) data generation strategies across development programs to support regulatory, market access, and commercial needs. As PROA Lead, Dr. Shaw ensures that endpoint strategies are aligned with product strategic plans from matrix teams to achieve BMS’ vision of patient centricity. He also provides strategic leadership to therapeutic area teams regarding the development of COA strategies, fitness of assessment measures for intended uses, and regulatory efforts to maximize labeling opportunities. Dr Shaw is a seasoned leader with demonstrated expertise in regulatory and health technology assessment applications of COA data, measure development and validation, health preference assessment, and statistics.
How Should the EU Pull Their Weight? Designing and Implementing an Effective Delinked Pull Incentive for Antibiotics in the EU
In-person
ISSUE: In the last decade the scientific community, health economists, policymakers and industry have come together to propose a ‘delinked’ pull incentive as the most appropriate tool to stimulate an antibiotic pipeline sufficient to fight the threat of Anti-Microbial Resistance (AMR). The UK has assumed global leadership with a pilot implementation of a delinked subscription model published in March 2022. Using a subscription model the UK will purchase the two evaluated antibiotics through a subscription model that reflects the UK’s ‘fair share’ of the minimum global incentive needed to stimulate development of one antibiotic. For a global pull incentive to work, other key contributors to global R&D funding need to do their part, or else the UK’s effort may be wasted. The US, a crucial actor, has already made important progress with the PASTEUR act. This panel will discuss what steps the EU, on the heels of the UK and likely the US, should take to play its vital role in solving the AMR crisis. What is the most appropriate mechanism for an EU pull incentive? Which member states should be in- or excluded from payment? How much should each member state pay? How could the EU streamline value assessment methods?
OVERVIEW: This panel will discuss the role of the EU in contributing to a global delinked pull incentive for AMR, approaches for its design, and implementation. The moderator will briefly introduce the issue (5 mins). Panellists will each speak for 12 minutes, providing their perspectives on the key areas for learning from the AMR pilot and closing their presentation with a summary of 2-3 take-aways on a delinked pull incentive from their singular perspective. 20 minutes will be reserved for audience discussion. The moderator will enable the discussion by facilitating participation or discussion through interactive polling and questions.
Moderators
Adrian Towse, MA, MPhil
Office of Health Economics, London, United Kingdom
Professor Adrian Towse is director emeritus and senior research fellow of the Office of Health Economics in the UK. Adrian’s current research includes incentives for new drugs and vaccines to tackle Antimicrobial Resistance, the use of 'risk-sharing' arrangements between healthcare payers and pharmaceutical companies, including value-based pricing approaches; the economics of pharmacogenetics for healthcare payers and the pharmaceutical industry; economic issues that affect both R&D for and access to treatments for diseases prevalent in the developing world; the economics of medical negligence; and measuring productivity in healthcare.
A visiting professor at the London School of Economics and a senior researcher at the Nuffield Department of Population Health at the University of Oxford, Adrian also has been a visiting professor at the University of York. For ten years, he served as the non-executive director of the Oxford Radcliffe Hospitals NHS Trust, one of the UK’s largest hospitals. Adrian was president of ISPOR, for the 2014-15 term.
Adrian joined the OHE in 1993 and served as director for 25 years. He holds an MA (Hons) in Politics, Philosophy and Economics from Keble College, Oxford; an MPhil in Management Studies from Nuffield College, Oxford, and the Oxford Centre for Management Studies; and is a member of the Chartered Institute of Management Accountants.
Panelists
James Anderson, MSc MBA
IFPMA, Maidenhead, United Kingdom
James joined the IFPMA as Executive Director of Global Health in January 2021, where he is responsible for leading the work on priorities in global health. This includes industry’s policy and advocacy on pandemic preparedness, antimicrobial resistance (AMR) and global access to medicines and vaccines. In his previous role as Head of Corporate Government Affairs at GSK, James led GSK’s strategic engagement with the UK Government and was a member of the Life Science Strategy Board and Vice-Chair of Business at OECD’s Healthcare Committee. He led GSK’s work on AMR and advised on AMR policy development at the WHO, UN, EU Commission and National Governments. He was also in the Founding team of the AMR Action Fund and led the development of the Davos Declaration and UNGA Industry AMR Roadmap.
Christine Årdal, MBA, PhD
Norway Institute of Public Health, Oslo, Norway
Christine Årdal MBA PhD has worked for over 20 years on access to medicines through different sectors. At the Norwegian Institute of Public Health, her research focuses on the policy aspects of antimicrobial access and innovation. Årdal was the co-lead of the research and innovation work package for the European Union’s Joint Action on Antimicrobial Resistance and Healthcare-Associated Infections (EU-JAMRAI), detailing European strategies to implement mechanisms to increase antibiotic access and innovation. She was also a co-lead in the DRIVE-AB research project, with a focus to stimulate innovation, the sustainable use, and the equitable availability of novel antibiotics to meet unmet public health needs.
Kevin Outterson, LLM
University of Boston, Boston, MA, USA
Kevin Outterson is a global thought leader on business models for antibiotic development and use. He is Professor of Law and N. Neil Pike Scholar of Health and Disability Law at Boston University School of Law, where he leads multi-disciplinary teams to solve global health issues. Professor Outterson is the Executive Director and Principal Investigator of CARB-X and a partner in DRIVE-AB.
14:30 - 15:15
Coffee Break
In-person
14:45 - 15:15
HEOR Theater
Generating Payer Insights and Evidence: Meeting the Challenges of the New Evidence Paradigm
In-person
Overview
A new evidence paradigm is emerging with the availability of additional real-world data sources facilitated by technological innovation and the evolving adoption of real-world evidence (RWE) in regulatory, reimbursement and other health care decisions. The intent of this presentation is to describe the new evidence paradigm and why generating payer insights and relevant, impactful evidence is now a ‘must have’. The presentation will describe opportunities, including tech-enabled solutions, which can add speed, agility, and scientific rigor to the generation of payer insights and evidence generation.
Description
In an evolving healthcare environment with continuous economic pressures, clinical innovation alone is not enough to achieve optimal reimbursement and patient access. Payers, regulator, and health technology assessment (HTA) agencies prioritize products that demonstrate the most compelling clinical and economic value, including improvements in patient outcomes.
Timely payer insights can inform a relevant evidence package and development strategy by defining the data required to support an optimal place in therapy/treatment pathways and by describing the value of the product in populations of unmet need. However, heterogeneous evidence requirements from different HTA agencies make it challenging to use the same evidence package across markets. HTA policies and stringent data requirements mean payer insights are critical throughout the product life cycle to understand what is most meaningful to them. When products come to market with a limited evidence package, HTA agencies and payers are likely to turn to credible and robust RWE to assess the value of a product post-launch. This adds complexity because companies have a need to gather payer insights and customize each evidence package to support the value assessments at launch and then update evidence for post-launch reviews.
In demonstrating the full value of a product and customizing evidence packages, consideration should be given to emerging RWE data sources to capture the data elements required to differentiate products in competitive disease areas. Many if these emerging data sources include supplementary elements such as patient outcomes, genomics, biomarkers, etc., which may allow companies to address research questions with greater precision. Opportunities also exist to integrate data across sources; however, this requires complex analytical RWE expertise. Clearly defining the analytical approaches using reliable scientific methods is critical for gaining acceptance among regulatory and HTA agencies, especially when RWE is being considered as confirmatory evidence.
In summary, the dynamic global healthcare environment elevates the need for scientifically rigorous and fit-for-purpose evidence generation, informed by payer insights, throughout the product development life cycle and continually updated following product launch. This iterative process of insight collection and evidence generation is critical to build an evidence package that is relevant and informative for decision-makers.
Sponsor
Genesis Research
Speaker
Tijana Ignjatovic, PhD
Market Access Transformation, Short Hills, NJ, USA
Tijana Ignjatovic has over 15-years of consultancy experience within market access, having conducted over 100 pieces of research across a range of therapy areas during her time at MAT. This experience has given Tijana in-depth knowledge on how to optimize research methodologies to meet the strategic intent of payer research and provide actionable recommendations.
Priti Jhingran, PhD
Genesis Research, Hoboken, NJ, USA
With over two decades in the pharma industry, Priti Jhingran has focused on understanding evidence needs and delivering tools/solutions for access decision makers/HTAs. She has led multiple enterprise level initiatives; launched 15+ products; and developed diverse teams of scientists dedicated to the generation, dissemination, and communication of evidence.
15:00 - 16:00
ISPOR Forums
Nutrition Economics – a New Approach for the Future: Opportunities to Advance the Science
In-person
The Nutrition Economics Special Interest Group is dedicated to characterizing the economic and health outcomes of nutrition and advancing the scientific methodologies and approaches for studying nutrition economics more broadly. Over the past several years, the SIG has completed two collaborative papers: the first was a scoping review of MN terminology and regulations in Europe and the United States, which found extensive inconsistencies across countries in terminology used and a dearth of economic evaluations to inform the adoption of FSMP. The second paper took a broad look at coverage and reimbursement policies for FSMP across 14 countries in four continents. Despite the importance of medical nutrition (MN) for the management of malnutrition and nutrition-related disorders and conditions, little is known about regulatory policies governing reimbursement and coverage of Food for Special Medical Purposes (FSMP) across the world. A number of issues were identified, including (1) limited reimbursement in the outpatient and community settings; (2) variation in the conditions eligible for reimbursement across countries; (3) lack of health technology assessment to inform coverage and reimbursement decisions; and (4) a disconnect between clinical guidelines and coverage.
This Forum session will highlight the key findings from the most recent report, delve into the coverage and reimbursement issues identified in the review, and highlight opportunities for future collaborations related to the economics of MN and non-MN to improve societal health. Specifically, Mark Nuijten will discuss the need for future research in regulatory issues - aligning reimbursement with the clinical value of nutritional care and Tânia Maria Beume will discuss the need for research to improve equity in reimbursement across settings. The session will wrap up with a discussion about key SIG initiatives for the coming year.
Moderators
Tricia Johnson, PhD
Rush University, Oak Park, IL, USA
Tricia Johnson is Professor and Economist in the Department of Health Systems Management and co-leads the Health Equity Research Group at Rush University in Chicago, USA. She is one of the few human milk economists in the world, and her current research evaluates the short and long-term economic consequences of breastmilk and nutrition strategies for premature infants. She is Multiple Principal Investigator of a randomized controlled trial that tests an economic intervention aimed at reducing racial and ethnic gaps in the provision of mother’s own milk for very preterm infants in the neonatal intensive care unit. Dr. Johnson is Chairperson of ISPOR’s Nutrition Economics Special Interest Group.
Speakers
Aditi Aggarwal, M.Pharm
IQVIA, Gurugram, HR, India
Aditi had done Master’s in pharmacology from prestigious University in India. She has 13 years of experience in health economic and outcome research (HEOR), currently working as a Senior Consultant in IQVIA. She has worked with multiple HEOR consultancies in the past and domain expertise is in literature reviews, associated analysis, and dossiers/other reports for regulatory, commercial, strategy purposes. She has also done few online HEOR courses, has ~15 scientific publications, participated in leading national and international conferences and has been speaker in webinars for reputed organizations/ academic institutes such as OPPI, BITS, IIPH NIPER, India. Presently, member of ISPOR international society, active participant of SIGs, and supports as a reviewer.
Tania Maria Beume, MBA, MSc, Lic
Independent Consultant, Schleife - Rohne, SN, Germany
Tania is a Healthcare manager and Consultant, with experience in managing health institutions with different payer profiles, including government and private agents. She is a Health Economist, Public Health Analyst, and Professor of Health Economics for healthcare professionals. Tania has Experience with Public Health Policies in Oncology, Health Technology Assessment, and Cost Management in Healthcare. Member ISPOR, American Economic Association, International Health Economics Association.
Mark Nuijten, MBA, PhD, MD
cell medica, Amsterdam, NH, Netherlands
Quo Vadis? Evolving the ISPOR Digital Health SIG for 2023 and Beyond
In-person
ISPOR’s mission is to improve health care decisions, and core to achieving this is furthering the methods and applications of health economics and outcomes research (HEOR). Increasingly, with the burgeoning of digital technology in healthcare, this mission can only be carried out by recognizing the impact of digital health on our strategic interests. The aim of this Forum is to provide an update on ISPOR’s Digital Health Strategy, with focus on the Digital Health Special Interest Group (SIG). We will also elicit feedback on the priorities for the SIG business plan activities for 2023 relative to the context and speed with which digital health is evolving. A review of changes in the health policy landscape with respect to the growing adoption of digital health will be presented. The panel will also provide current and new SIG members with an overview of the SIG’s book of work including the key project. This project, a scoping review on the usefulness of the umbrella terms for outcomes research, has led to a manuscript in Value in Health. A further manuscript evaluating the secondary terms is in development. Engagement activities such as presentations made to ISPOR Chicago Chapter and the ISPOR Patient Representatives Roundtable – North America, posters presented at scientific conferences including ISPOR, HTAi and DIA, as well as webinars held on topics such as data privacy in digital health over the past two years will be reviewed. The proposed format is presentations on the topics above followed by a group discussion/Q&A period for the attendees. Polling will be used to elicit rankings on planned and potential activities.
Moderators
Vlad Zah, MS, MBA, PhD
ZRx Outcomes Research Inc., Toronto, ON, Canada
Speakers
Katarzyna Kolasa, PhD
PAREXEL and Kozminski University, Warsaw, MZ, Poland
Driven with the passion to health economics, I have more than 20 years of academic and industry experience in the field of healthcare. Holding various Regional and Global leader-ship positions, I have worked with the pricing & reimbursement challenges in the pharma and medtech industry.
Since 2018 I am a Professor at the Kozminski University leading Health Economics & Healthcare Management Division (HeM). My PhD was titled “The principle of equity and social justice with respect to financing of health service in Poland and Sweden”. My habilita-tion book „Optimal allocation of healthcare resources” was published in 2017.
My extensive knowledge in the field of health economics was acquired at the University of York, University of Lund, and University of Bergen as well as during the International Doc-toral Courses in the Health Economics and Policy organized by the Swiss School of Public Health.
At the Kozminski University, I am the leader of the International Master Program Health Economics & Big Data (HEBDA) financed by the EU research grant of the National Center for Research and Development which was listed as the best project in the POWER 2018 call. I collaborate closely with the health economics partners from the University of Lund, the University of Athens, University of Illinois, University of York and the University of Ap-plied Science in Berlin as well.
My first practical skills in the field of health economics were developed during six years employment contract at the Kalmar County Council in Sweden. After that, I worked in both global and regional Health Economics & Outcomes Research (HEOR) functions at different pharmaceutical companies for ten years in total. At AstraZeneca and BiogenIdec. I held Global and European positions respectively. At Bristol Myers Squibb and Lundbeck I lead Market Access teams in Central Eastern European (CEE) and Nordic Region. In the last four years, I gained experience with the pricing &reimbursement challenges in the field of medi-cal devices. Since 2017, I have supported Straub Medical as Global Market Access Lead. Before that, I was employed as a Senior Sales Director responsible for HEOR at GE Healthcare.
In October 2020, I was nominated to ISPOR’s Health Sciences Policy Council (HSPC). I am chair elect of ISPOR Special Interest Group Digital Health as well.
Guest Editor of Special Issue "Quest for Value Drivers of Digital Health Solutions in the Post COVID-19 Era" at International Journal of Environmental Research and Public Health (ISSN 1660-4601) (IF 3.2)
Currently I am leading the project of the optimal allocation of CT scanners for the Polish Ministry of Health. It is the adaption of evolutionary algorithms to analyze more than 120 mln of historical CT procedures. In addition, my research agenda relates to the value frame-works of medical devices and digital health interventions. I am leading the project of the development of integrated healthcare model for oncological care based on patients’ prefer-ence for the Polish HTA agency.
Laura Pizzi, PharmD, MPH, RPh
ISPOR, Lawrence Township, NJ, USA
Dr. Laura Pizzi is Associate Chief Science Officer for ISPOR and Professor at Rutgers University in the schools of pharmacy and public health. For the past 25 years, she has led interdisciplinary teams of methodologists, statisticians, and clinicians to design and conduct economic analyses on healthcare interventions and is a frequent author, speaker, and mentor on the topic.
At ISPOR, she provides leadership to the organization’s scientific strategy and initiatives, including content planning and oversight of the Special Interest Groups, Patient Council and roundtables, the ISPOR Competency Framework workgroup, Publications Council, Institutional Council, and Digital Health Strategy. She also liaises with the Student Network and Faculty Advisor Council to support their scientific needs.
Zsombor Zrubka, MD, MBA, PhD
Óbuda University, Budapest, Hungary
Zsombor is an associate professor and the head of the Health Economics Research Center at the University Research and Innovation Center at Óbuda University, Budapest, Hungary
Structured Expert Elicitation for Healthcare Decision Making Emerging Good Practices Task Force Preliminary Findings
In-person
Evidence is needed to enable robust and defensible decision making, but it can often be insufficient or unsuitable. Different decision-making processes across the health sector rely to a different extent on clinical or subject experts to support allocation, reimbursement and funding decisions.
There are a number of ways in which experts’ beliefs can be elicited but there is little or no guidance on the applicability and appropriateness of alternative methods for particular health care decision making contexts. Examples of relevant contexts are reimbursement decisions on complex interventions/complex settings or novel therapies with unproven modes of action, requests for off-formulary use of medicines (US) or individual funding requests (UK), or evaluations conducted in low- or middle-income settings used to inform prioritization and planning.
We will use polling to engage with the range of stakeholders in the audience to identify barriers and facilitators to the use of elicitation methodology in support of decision making across a range of decision-making contexts.
The session will include:
- General introduction and content of the task force (Bojke,5 min)
- Rationale for the use of expert elicitation, description of different ways in which it has been used to support healthcare decision making (IJzerman,10 min).
- Methods available to elicit experts’ judgements (Colson,10 min)
- Structured discussion (40min, Soares will present the task force’s considerations on each topic and Bojke will chair the polling and audience discussion)
- Topic 1: (10 min) Alternative decision-making contexts/settings over which elicitation may be applied in, and requirements for elicitation.
- Topic 2: (10 min) Applicability of existing protocols/guidance: barriers to implementation.
- Topic 3: (10 min) Potential facilitators for elicitation.
- Open discussion (10 min)
Moderators
Laura Bojke, PhD
University of York, York, YOR, United Kingdom
Laura is a Professor of Health Economics from the Centre for Health Economics (CHE), University of York, UK. Laura Bojke has over 20 years experience in economic evaluation. Laura has worked on a wide range of applied and methodological projects, within pharmacoeconomics and public health. She has gained extensive cost-effectiveness modelling experience through her work as part of the evidence review group for NICE and worked on a number of projects involving the use of expert elicited data within decision analytic models.
Speakers
Abigail Colson, MPP
University of Strathclyde, Glasgow, United Kingdom
Abigail Colson is a Senior Lecturer in the Department of Management Science at Strathclyde Business School. Her work focuses on decision and uncertainty analysis, including the structuring, elicitation, and validation of expert judgements. Much of her work is in the field of public health, including program evaluation, cost-effectiveness and benefit-cost analysis, and prioritisation. She is particularly interested in health evaluation in low- and mid-income countries and supporting economic analysis and health technology assessment of new antibiotics.
Maarten IJzerman, PhD
University of Melbourne, Melbourne, VIC, Australia
Maarten J. IJzerman is Professor of Cancer Health Services Research and Dean of Erasmus School of Health Policy and Management in Rotterdam, the Netherlands. He is a part-time Professor of Cancer Health Services Research in the Faculty of Medicine, Dentristry and Health Sciences of the University of Melbourne in Australia.
He leads a data-driven research program focussing on the implementation of genomics enabled precision oncology.
Marta Soares, MSc, PhD
University of York, York, YOR, Great Britain
Marta Soares joined the Team for Economic Evaluation and Health Technology Assessment (TEEHTA) in 2009. She holds an MSc in Biostatistics awarded by the University of Lisbon in 2008 and a PhD on “Making best use of evidence for explicit decisions in health care” awarded by the University of York in 2017.
Marta's research interests are related to the development and application of statistical, econometric and decision analysis methods in all components of health technology assessment, including statistical analysis of primary data, evidence synthesis, elicitation of expert opinion, decision modelling methods and value of further research analysis.
Marta served as a member of the National Institute for Health and Care Excellence (NICE) Technology Appraisal Committee between 2011 and 2017 and since 2017 she acts as a pharmacoeconomic expert for INFARMED in Portugal. In 2020, Marta joined the General HTA Programme Funding Committee.
In 2014, Marta won the ISPOR Award for Excellence in Application of Pharmacoeconomics and Health Outcomes Research. The award was given for the research paper: Methods to assess cost-effectiveness and value of further research when data are sparse: Negative-pressure wound therapy for severe pressure ulcers. Med Decis Making April 1 2013;33(3):415-436.
Discussion Groups
New this Year – Discussion Groups! Discussion Groups are facilitated conversations between conference attendees and select conference speakers. Held in the new, dynamic Discussion Lounge in the ISPOR Exhibit Hall, these discussions are intended to be highly interactive, collaborative, and promote the exchange of ideas in a peer-to-peer setting.
Environmental Policy Discussion Group
In-person
Moderator
Richard Charter, MSc
Alira Health, Basel, BS, Switzerland
Real-World Data Discussion Group
In-person
Moderator
Sreeram Ramagopalan, PhD
F. Hoffmann-La Roche Ltd, Basel, BS, Switzerland
Sreeram (Ram) Ramagopalan is the Global Head for Real World Evidence for Market Access at Roche. Dr Ramagopalan’s team strategically plans and executes real world research studies to obtain and maintain access for Roche medicines. Dr Ramagopalan holds a PhD in Epidemiology from the University of Oxford, as well as an MSc in Health Economics from the London School of Economics. Prior to Roche, Dr Ramagopalan led European Real World Evidence teams at Bristol Myers Squibb and the life-sciences consultancy Evidera. He is an international expert in real world evidence with over 295 peer reviewed publications.
Member Group Meeting
Open Meeting - Clinical Outcomes Assessment (COA) Special Interest Group
In-person
The goal of the meeting is to provide members with the opportunity to meet SIG leadership, discuss potential project ideas, and network with Special Interest Group Members. The leadership will provide a brief overview of the SIG accomplishments and the current projects.
Educational Symposia
New Pan-EU HTA: How Can Biopharma Navigate the Joint Clinical Assessment?
In-person & Virtual
The EU Joint HTA regulation was enacted in January 2022 with the primary objective of streamlining the clinical assessment process for EU member states’ HTA bodies. Given the newness of the assessment process and lack of precedent on which to draw conclusions, health technology developers such as biopharma are seeking guidance on clinical development and market access processes in this uncharted environment.
In this educational symposium, we will discuss the components of the EU joint HTA regulation, share anticipated impacts at the level of the joint and individual EU member HTA body, and provide key considerations for health technology developers as they prepare for market authorisation and HTA submission in this new and evolving process.
Sponsor
AmerisourceBergen
Moderators
Tommy Bramley, PhD
AmerisourceBergen, London, United Kingdom
Thomas J. Bramley, PhD, is Senior Vice President of Global Consulting at AmerisourceBergen where he is responsible for delivery and expansion of global market access, real-world evidence (RWE), and health economics and outcomes (HEOR) research activities across international markets. Prior to his current role, Tommy was President of Lash Group and served as President of Xcenda, both business units at AB, where he has dedicated his 20+ year career to enhancing the delivery and efficiency of healthcare to improve patient outcomes. Tommy has been an invited speaker at many international conferences and has authored numerous peer-reviewed articles. He serves on the Board of Directors for valued charities, including The AmerisourceBergen Foundation and Claire’s Army.
Speakers
Michael Drummond, PhD
University of York, York, YOR, United Kingdom
Michael Drummond, BSc, MCom, DPhil is professor of Health Economics and former Director of the Centre for Health Economics at the University of York. His particular field of interest is in the economic evaluation of health care treatments and programmes. He has undertaken evaluations in a wide range of medical fields including care of the elderly, neonatal intensive care, immunization programmes, services for people with AIDS, eye health care and pharmaceuticals. He is the author of two major textbooks and more than 700 scientific papers, and has acted as a consultant to the World Health Organization and the European Union. He has been President of the International Society of Technology Assessment in Health Care, and the International Society for Pharmacoeconomics and Outcomes Research. In October 2010 he was made a member of the National Academy of Medicine in the USA. He has advised several governments on the assessment of health technologies and chaired one of the Guideline Review Panels for the National Institute for Health and Care Excellence (NICE) in the UK. He is currently Co-Editor-in-Chief of Value in Health and has been awarded 3 honorary doctorates, from City University (London), Erasmus University (Rotterdam) and the University of Lisbon.
Mihai Rotaru, MSc
European Federation of Pharmaceutical Industries and Associations, Brussels, Belgium
Mihai Rotaru works as a Senior Manager Market Access at EFPIA (European Federation of Pharmaceutical Industries and Associations) where he is currently responsible for overall industry engagement in the implementation of the HTA Regulation at EU level. In addition, Mihai is also responsible for oncology policy working with the EFPIA Oncology Platform to drive industry engagement at EU and national levels, biotherapeutics as well as various supply chain issues (Falsified Medicines Directive, shortages and anticounterfeiting efforts).
Alberto Rubio, MBA
PharmaLex, Madrid, Spain
Alberto Rubio is a Senior Director at PharmaLex and Head of International Market Access. He has over 15 years of experience in the life sciences industry where he has held increasingly senior roles in market access and government affairs. Alberto’s expertise is in healthcare innovation projects, with focuses on eHealth, value-based healthcare, innovative contracting schemes and public-private collaborations. Previously, Alberto held managerial roles in other industries, including legal and financial services. He holds a BS in Economics from Texas Christian University and an MBA from the University of Phoenix.
Are We Turning a Blind Eye? Challenges in Value Assessment of Gene Therapies for Inherited Retinal Disease
In-person & Virtual
Gene therapies have the potential to deliver transformative improvement in patient outcomes but challenge the status quo of value assessment by HTA bodies and affordability for health care systems.
In the value assessment of gene therapies, which typically target severe diseases, various challenges are uniquely combined. For example, for diseases with early-onset and a slow progression such as inherited retinal disease (IRD) X-linked retinitis pigmentosa, multiple issues exist in measuring and quantifying the quality of life over a long time horizon. Furthermore, while some gene therapies may have relatively large upfront costs, their potentially large long-term benefits for patients, informal carers, and families are uncertain. Their expected value is also affected significantly by the various discounting approaches used internationally. Understanding and, where possible, overcoming these and other value assessment challenges for gene therapies like IRD X-linked retinitis pigmentosa is critical for all concerned with value-driven innovation, payment, and access models.
This educational session will be focused primarily on those within the HEOR community that aim to expand their knowledge base regarding the challenges faced by gene therapies. It will provide an introductory overview of how traditional value assessment is challenged when evaluating gene therapies, using IRD X-linked retinitis pigmentosa as one example, and what solutions may exist based on learnings from various countries and/or other technologies. These challenges and solutions will be discussed by representatives from a patient organisation, an HTA-organisation, and industry. A moderated debate between the speakers and the audience will conclude the session.
Sponsor
Office of Health Economics
Moderators
Lotte Steuten, PhD, MSc
Office of Health Economics, London, LON, United Kingdom
Lotte Steuten, PhD, is Deputy Chief Executive at the Office of Health Economics and Honorary Visiting Professor at City, University of London, UK. After graduating cum laude with her PhD from Maastricht University, the Netherlands, Lotte has been active in the HEOR field for over 15 years in various academic roles and executive functions (non-profit and for-profit).
To inform better decisions based on independent research and analysis, Lotte worked effectively with pharmaceutical industry, technology assessors, payers and policy makers, (academic) researchers, clinical and patient representatives as well as capital investors. Notably, her international career-path, including the UK, the US and the Netherlands, has provided her with deep insights in the fundamental differences as well as commonalities between the role of HEOR in different healthcare systems, cultural and societal values.
Over the past decade, Lotte has been leading diverse teams; developing strategies and delivering on program or company missions, values and objectives; acquiring funding and managing budgets; and been responsible for executive decision-making as well as legal and fiduciary matters. In her current role at the Office of Health Economics she is responsible for the research-led consulting program, making sure to maintaining OHE's stellar reputation for objective, innovative and high-quality research and analysis globally, as well as meeting its charitable objectives. In addition, she is a professor at City, University of London, contributing to their Master and PhD programs. Before joining OHE, Lotte worked as an Associate Member at the Fred Hutch Cancer Research Institute and Associate Professor at the University of Washington, Seattle (US), where she currently holds affiliate appointments.
Speakers
Simon Brassel, MSc, Dipl.Ing
Office of Health Economics, London, LON, United Kingdom
Simon is a Health Economist and Electrical Engineer and works as a Principal Economist at the Office of Health Economics in London. He has over eight years of professional experience in international healthcare markets covering the whole spectrum of health technologies, from pharmaceuticals to digital health technologies.
Before joining the OHE, Simon worked at the EMEA headquarters of Fresenius Medical Care, the world’s largest provider of products and services for patients suffering from chronic kidney disease. There, he held various roles within the field of therapy marketing and product management and in the field of Health Economics, Market Access and Policy Affairs.
Before Fresenius, Simon worked as a technology consultant at the VDI Technologiezentrum in Berlin. As part of a small team, he worked on the National Strategy Process on Innovations in Medical Technology, which three German Federal Ministries initiated. He also served as a grants officer and helped fund a range of collaborative research projects in the health-tech field with support from the German Federal Ministry of Research and Education.
Simon also holds an MSc in Health Policy (Health Economics) from the London School of Economics and Political Sciences (LSE), a Dipl.-Ing. in Electrical Engineering from the Technische Universität München (TUM), and a joint Diploma in General Management from the University of Rochester and the University of Bern.
Caroline Bregman, PharmD, MSc
NICE, Manchester, LAN, United Kingdom
Caroline is a Senior Scientific Adviser in the NICE Scientific Advice team. Caroline is involved in a range of scientific advice projects and parallel scientific advice procedures with other health technology assessment and regulatory agencies, as well as delivery of educational seminars.
Previously, Caroline worked in the Technology Appraisals Programme at NICE. Before joining NICE, Caroline worked in a consultancy within the life science sector where she led on the development of health technology assessment dossiers for submissions in the UK and in France.
Caroline holds a Doctorate in Pharmacy from Paris Descartes University and an MSc in Health Economics from Paris Dauphine University.
Avril Daly, BSc
Retina International, Zürich, Switzerland
Avril Daly is CEO of the patient-led global umbrella organisation, Retina International, which represents the voice of charities and foundations concerned with the promotion of retina research and related health policy in 43 countries.
Avril has worked in health policy for rare and common eye disease since 2000 and was CEO of the Irish NGO, Fighting Blindness for eight years. She was Chairperson of Rare Disease Ireland from 2006-2019. In 2009 she was elected to the Board of Directors of Rare Disease Europe – EURORDIS, and has been the organisations Vice-President since 2012.
In 2011 Avril was appointed by the Irish Minister for Health to a steering committee working towards the development of the Irish National Plan for Rare Diseases. The plan was published in 2014. She was appointed to the Irish Clinical Programme for Rare Diseases at the Health Service Executive (HSE) in Ireland in 2014 and was recently appointed to the Rare Disease Technology Review Committee and the National Centre of Pharmacoeconomics (NCPE) to review orphan therapies that fail initial Health Technologies Assessment (HTA) for statutory reimbursement.
Avril has held board positions with the European Patient Forum, The European Platform for Patient Organisation Science and Industry (EPPOSI), the HRCI (formerly Medical Research Charities Group) in Ireland and IPPOSI, the Irish Platform for Patients Organisation Science and industry. She believes that patients have a critical role to play in aiding the development of appropriate interventions from concept to delivery.
Avril holds a Bachelors Degree in Business and International relations, she is affected by Retinitis Pigmentosa.
Jennifer M Lee, MBA, BSc
Janssen-Cilag Denmark, Birkerod, 84, Denmark
Jennifer is a trained health economist and biochemist. She completed her BSc in Biology/Biochemistry at the University of British Columbia, her MBA at the University of Calgary in Canada and her Postgraduate in Pharmacoeconomics in Melbourne, Australia. She began her career as a health economist in consulting in 2004 in Sydney, Australia, before moving onto a senior health economist role at Sanofi in Australia. She then moved to a regional market access role based in Singapore with Sanofi, prior to moving to the UK and joining Janssen in 2012. She led the Janssen UK Operating Company team responsible for market access, government affairs, policy and patient engagement as the Director of HEMAR and Advocacy until December 2019. She is currently the EMEA Therapy Area Market Access Leader for Immunology, Retina, CVM and VOT based in Copenhagen, Denmark.
15:00 - 18:15
In-Person and Virtual Poster Session 4
Live
15:15 - 16:15
Member Group Meeting
Open Meeting - HEOR Workforce Diversity Initiative
In-person
The goal of this discussion is to generate feedback and interest on the ISPOR HEOR Workforce Diversity Cross Council Workgroup’s activities to date and plans for 2023.
15:45 - 16:15
HEOR Theater
LiveHTA; Concept and Implementation Tools for the Future of Health Technology Assessments
In-person
In response to the recent changes (COVID-19 pandemic, precision medicine, increased healthcare expenditure, expanded use of real-world data), healthcare decision-making bodies searched for new ways to implement more responsive, innovative processes for the technologies’ assessment. These changes along the increased recognition of current HTA challenges (evidence availability and quickly out of date evidence reviews, health care system sustainability, budgetary constraints) have opened a window of opportunity for decision makers to consider moving towards a fully, “living” approach to health technology assessment (HTA). Furthermore, these challenges are even magnified in the context of a general drive for faster patient access to effective health technologies.
This theatre will discuss how the traditional methods for synthesizing comparative clinical and economic evidence for the assessment of new health technologies may be problematic and how the exploration of more reactive and flexible “liveHTA” approaches can mitigate these challenges. The speakers will also discuss implementation tools to make liveHTA a reality for health care decision-makers.
Sponsor
Cytel
Moderators
Bart Heeg, MSc, PhD
Cytel, Rotterdam, ZH, Netherlands
Bart has more than 20 years of experience in leading and conducting health economic and outcomes research consulting projects for pharmaceutical industry, such as trial analyses, economic modelling, and indirect treatment comparisons for HTA submissions. Prior to merging with Cytel Bart co-founded Ingress-health in 2015. Bart is passionate about developing or extending methodologies such as Bayesian survival network meta-analyses, developing tumor agnostic models and models for early/adjuvant oncology therapies. Bart has a PhD in health economics from the University of Groningen.
Speakers
Anna Forsythe, PharmD, MSc, MBA
Cytel, Waltham, MA, USA
Prior to joining Cytel, Anna Forsythe cofounded PSE with the vision of providing curated evidence and economic modeling to support global HTA. In addition to her PharmD and MBA, Anna earned a MS in Health Economics and Public Policy from the University of Birmingham.
Grammati Sarri, PhD, MSc, DiDS
Cytel, London, United Kingdom
Grammati worked in private consultancies leading HEOR projects and providing strategic guidance on evidence synthesis and clinical effectiveness analyses for early product value demonstration and HTA submissions. Grammati has also a strong experience in understanding the payer perspective and requirements through her senior leadership role in the development of NICE Guidelines and closely working with clinicians, patient's and NICE executives.
Andre Verhoek, MSc
Cytel, Rotterdam, ZH, Netherlands
Using his background in econometrics, Andre focuses on advanced analytics in HEOR. He has a wealth of experience in developing global cost-effectiveness models, Bayesian network meta-analyses and working with innovative HEOR technology products within Cytel’s LiveHTA suite.
16:30 - 17:30
Concurrent Breakout Session 6
Treating the Family and Not the Individual - How Can We Capture Burden and Quality of Life for Familial Carers of Those with Life Limiting Illness?
In-person
ISSUE: It is clear that some diseases significantly affect more than just the patients and may have profound effects on carers and other family members. This is particularly the case for familial carers of people with life limiting illness, though not exclusive to them. There is no consensus on whether HTA should seek to incorporate these carer effects or, if so, how. HTA bodies take different perspectives on measuring carer QoL and burden. There are significant challenges in measuring carer QoL in life limiting progressive conditions and disagreement on whether such measures should be routinely included, particularly for life transforming treatments that can change the course of disease progression.
OVERVIEW: The panel will discuss whether there is any case to include wider carer considerations in HTA and, if they are included, the appropriate ways in which it might be done. Ron Akehurst, will moderate the session and pose questions to the panel.
- Can standard methodologies preferred by HTA bodies for assessing effects on patients adequately capture the burden on carers? Can we reflect what is most important to carers?
- Can we account for the inevitable adjustments made by carers over a lifetime?
- Should we seek to incorporate anticipatory grief, the value of hope for untreatable life limiting conditions and the long term impact of bereavement?
The panellists will represent different stakeholder and geographical perspectives.
Fleur Chandler will present a carer perspective arguing for more pragmatic and sensitive approaches to measuring QoL in those caring for people with lifelong progressive and life limiting conditions and recommend greater collaboration between patient groups, academics, manufacturers and agencies. Jill Carlton, an academic researching carer HRQoL and burden, will argue that current approaches do not always capture what is important to carers. Peter Neumann will show how the approach reflected in the ISPOR "Value Flower" has relevance.
Moderators
Ron Akehurst, DSc, Hon MFPHM
Lumanity, Sheffield, United Kingdom
Ron is Chairman of Lumanity HEOR and an Emeritus Professor at the School of Health and Related Research (ScHARR), University of Sheffield, where he served as founder and Dean for 17 years.
He was a member of the first NICE Technology Appraisal Committee, and has continuously served on multiple NICE decision making committees since. He remains on the HST Committee at NICE and RDAG at NHS England, working in the Rare Disease space.
Ron has worked with governmental policy bodies and pharmaceutical companies over many years and various jurisdictions.
Panelists
Jill Carlton, BMedSci MMedSci PhD
University of Sheffield, Sheffield, United Kingdom
Jill Carlton, PhD is a senior research fellow in Health Economics and Decision Science at ScHARR and a member of the ScHARR Outcomes team. She has an interest in developing and refining quality of life and patient outcome measures (PROMs). She has experience in developing a number of condition-specific instruments. She has expertise in mixed methods research, and research with children, mental health and rare diseases, including Duchenne muscular dystrophy (DMD). Jill has been involved in a number of projects using COSMIN to review the validity of PROMs for use in conditions such as DMD, carer quality of life, autoimmune hepatitis, and hypoglycaemia.
Fleur Chandler, MSc
Sanofi and Patient Advisory Board Lead, Duchenne UK, Reading, United Kingdom
Fleur is a health economist with a wealth of outcomes research and health technology assessment experience, with over 30 years leading both global and local teams in the pharmaceutical industry. Her current role is Head of Market Access UK at Sanofi. Fleur is especially driven by rare disease, a parent of a teenager with Duchenne, she is on the advisory board of patient organisation Duchenne UK. Bringing her professional and personal experience together, she conceptualised and leads Project HERCULES, a global collaboration generating gold standard disease level evidence for HTA in Duchenne.
Peter I Neumann, ScD
Tufts Medical Center, Boston, MA, USA
Peter J. Neumann, Sc.D., is Director of the Center for the Evaluation of Value and Risk in Health (CEVR) at the Institute for Clinical Research and Health Policy Studies at Tufts Medical Center, and Professor of Medicine at Tufts University School of Medicine. He is the founder and director of the Cost-Effectiveness Registry, a comprehensive database of cost-effectiveness analyses in health care. Dr. Neumann has written widely on the role of clinical and economic evidence in pharmaceutical decision making and on regulatory and reimbursement issues in health care.
Walking a Tightrope: How to Balance Real-World Data Quality Versus Locality in Supporting Single-Arm HTA Submissions?
In-person
ISSUE: Innovative health technologies, precision medicine and the increasing recognition of real-world evidence (RWE) have transformed the healthcare decision-making process. To follow these trends and to meet a high need for earlier patient access to promising technologies, the clinical trial landscape is rapidly evolving with the rise of single-arm trials. To establish comparative effectiveness of new technologies, decision makers have shown preference for national data to construct external control (EC) arm reflecting local treatment pathways with an emphasis on patient representativeness. However, this preference is not always realistic depending on data availability, sample size and quality that may affect confidence in results and, ultimately, in decision-making. Can the advance in RWE methodological approaches overturn the HTA over-dependency on local data?
OVERVIEW:
Unquestionably, the selection of EC arms to support the comparative effectiveness analyses for health technologies evaluated in single-arm trials has been a major area of criticism during HTA submissions. The moderator will begin by framing the topic, conflicting issues around quality and locality in the selection of the most reliable source for RWE EC, and the impact of under-development HTA guidance. Then, the moderator will present three case-studies in different disease areas (rare diseases, oncology, chronic conditions) to the panel, who will debate, from an industry, academic and HTA perspective (12 min each presentation) the main drivers for RWE EC acceptance and challenges when decision makers are urged to select the least biased RWE source to support reimbursement submissions. How challenging is it to walk the line between RWE quality and locality when selecting the “most appropriate” EC arm? Which factors may shift the decision from one side (quality) to the other (locality) and is this disease-dependent? A 12-minute interactive discussion using online polling system with the audience will be encouraged. Industry, researchers, and payers will benefit.
Moderators
Grammati Sarri, PhD
Cytel, London, United Kingdom
Chair-Elect ISPE Comparative Effectiveness Special Interest Group
Active Member of ISPOR RWE SIG
Moderator in previous Issue Panels
US ISPOR 2022_Is the Global Real-World Data Supply-Chain Broken? Choosing Between RWD Quality Versus Locality in Supporting Single Arm Submissions [Issue Panel IP16, May 18]
HTAi 2019_Integrating Patient Experience In Complex Pharmacological Solutions: Are The HTA Bodies Ready?
selected Webinars
ISPE Sponsored_ "Building Trust in Reliably Synthesizing Evidence from Non-Randomized Studies and RCTs in Healthcare Decision Making; a proposed ISPE Framework" October 2021
HTAi issue panel 2021 (panelist)_ Bridging Evidence Gaps in HTA: Building Confidence In Analytical Methods for Combining Results from Randomized and Non-Randomized Studies
HTAi issue panel 2020
Expert Workshop (2021): New RWE frameworks, new analytical methods but not yet much HTA acceptance; what is next?
Relevant Publications
sarri et al (2022) ISPE-Endorsed Guidance in Using Electronic Health Records for Comparative Effectiveness Research in COVID-19: Opportunities and Trade-Offs
3. Kongnakorn T, Sarri G, Freitag A, Marczell K, Kazmierska P, Masters E, Pawar V, Zhang X. Modeling Challenges in Cost-Effectiveness Analysis of First-Line Immuno-Oncology Therapies in Non-small Cell Lung Cancer: A Systematic Literature Review. Pharmacoeconomics. 2022 Feb;40(2):183-201. doi: 10.1007/s40273-021-01089-4.
Sarri G et al. The Role of Patient Experience in the Value Assessment of Complex Technologies – Do HTA Bodies Need to Reconsider How Value is Assessed? Health Policy 2021.
Sarri G et al. Framework for the synthesis of non-randomised studies and randomised controlled trials: a guidance on conducting a systematic review and meta-analysis for healthcare decision making. BMJ Evid Based Med. 2020 Dec 9:bmjebm-2020-111493.
D'Andrea E, ... Sarri G. How well can we assess the validity of non-randomised studies of medications? A systematic review of assessment tools. BMJ Open. 2021 Mar 24;11(3):e043961. doi: 10.1136/bmjopen-2020-043961.
11. Sarri G et al. PNS221 Healthcare Decision-Making Using Real-World Evidence: Many Opportunities, Little Guidance. Results from a Systematic Review of Guidance. Value in Health 2020.
13. Freitag A and Sarri G. PNS156 Are Surrogate Outcomes Enough for the Reimbursement of Health Technologies? An Umbrella Literature Review. Value in Health 2020.
Real World Evidence in Network Meta-analysis: Is it Now a “Must Have” in Technology Appraisals?, July 2018
New EU HTA Directive Set to Revolutionize HTA in Europe – How Will it Affect You?, May 2018
Panelists
Luis G. Hernandez, PhD MPH MSc
Takeda Pharmaceuticals America, Inc., Lexington, MA, USA
Luis Hernandez, PhD MPH MSc, is the Head of Global Health Economics, in the Global Oncology Patient Value, Policy, and Access, at Takeda. His team is responsible for developing the health economics strategy and evidence to demonstrate the value of Takeda innovative and transformative oncology medicines for patients, payers and society. Also, to develop valuable partnerships across Industry, and with patient organizations, payers, and academia, to shape the environment in relevant health economics and outcomes research topics.
Dr. Hernandez has extensive experience in health economics and outcomes research, evidence generation planning, market access, and cross functional team leadership and management.
Prior to joining Takeda, Dr. Hernandez spent 13 years at Evidera (a business within Pharmaceutical Product Development, LLC, [PPD] a leading global contract research organization [CRO]) where he spearheaded health economics evidence generation and dissemination to support the optimal value proposition for pipeline, launch, and lifecycle assets. During his tenure, Dr. Hernandez held several leadership roles including Senior Director and Senior Scientist heading Evidera’s health economics modeling and simulation in Waltham, Massachusetts, USA.
Between 2009 and 2010, Dr. Hernandez was a full time professor of Probability, Statistics, Discrete Event Simulation, and Decision Analysis for undergraduate and graduate students at Universidad de los Andes (Bogota, Colombia) for the Industrial Engineering Department and the Executive MBA program.
Dr. Hernandez holds a PhD in Health Economics from the University of Groningen (the Netherlands), a Master’s in Public Health from Tufts University (Boston, Massachusetts, USA), and Master’s and Bachelor’s degrees in Industrial Engineering from Universidad de los Andes (Bogota, Colombia).
Seamus Kent, PhD
National Institute for Health and Care Excellence (NICE), London, LON, United Kingdom
Seamus is a Senior Adviser in Data & Analytics at NICE. He is leading the development of a framework for the use of data and analytics in the development of NICE guidance and has participated in several conferences discussing the role of RWE tools in delivering value to patients and health systems.
Kristian Thorlund, MSc, PhD
McMaster University, Hamilton, ON, Canada
Kristian Thorlund, PhD, is a trained statistician with specialization in Bayesian statistics and complex models for evidence synthesis and health care decision-making. He has published extensively and led the development of several statistical methodologies that are now being used widely
A Possibility of Administering Selected Domains of Existing Patient-Reported Outcome Questionnaires to Reduce Patient Burden and Increase Clinical Relevance
In-person
ISSUE:
FDA has been a proponent of the idea of administering selected domains of Patient-reported outcome questionnaires, while other stakeholders insist on using only the validated measures as they were originally developed. Sponsors are caught in the middle needing to satisfy stakeholder desires while also being incentivized to reduce respondent and operational burden and optimize the study costs.
OVERVIEW:
Patient-reported outcomes (PROs) are used for a variety of purposes including to describe the course of disease or condition, inform treatment decisions, and understand treatment tolerability and benefit in clinical research. Some frequently used PRO assessments have limitations, however, and are often critiqued as, among other things, too long and burdensome (or too short and not comprehensive) or too generic and not relevant for a patient population (or too restrictive and not relevant for a patient population). For these reasons, outcomes researchers are interested in selecting and administering only the relevant “core domains” from existing validated assessments to patients participating in clinicals trials. This is to minimize redundancy (and potentially bad or inconsistent data because of it) as well as burden and costs while still collecting sufficient information on which treatment tolerability and efficacy conclusions can be drawn. Such a “modular approach” to assessment has appeal, although some stakeholders posit that there is an unknown consequence to content validity, psychometric performance, and score interpretation when administering only selected domains from an existing tool. In other words, the goal of this panel is to discuss whether a subset of domains from an existing instrument may be considered “fit for purpose” and to gain a deeper understanding of the impact this modular approach may have in clinical trial research particularly in the context of selecting, implementing, and using these assessments in pivotal studies as key endpoints to support product approval and labeling objectives.
Moderators
Julia Braverman, PhD
BMS, Needham, MA, USA
Dr. Braverman is a Director, WW HEOR in the Patient Reported Outcome Assessment (PROA) group in BMS. As a PROA lead, Julia is responsible for driving clinical outcomes assessment (COA) data generation strategies across development programs to support regulatory, market access, and commercial needs. Julia is an expert in developing COA data generation plans for trials, conducting research to support the development and validation of COA measures; guiding the interpretation of results; and supporting medical communications, regulatory submissions, and health technology assessment body submissions based on trial COA data.
Prior to joining Celgene (acquired by BMS in 2019) in 2017, Julia worked in consultancy providing HEOR support to pharmaceutical companies for incorporating patients’ voice into the drug development process. Prior to that, Julia held an academic position in Harvard Medical School. Her experience while in academia involved research in health communication and addiction, including the analysis of online gambling data. Julia holds Ph.D. in Social & Experimental Psychology from Northeastern University and M.S. in Biomedical Informatics from Harvard-MIT.
Panelists
Paul Kluetz, MD
Oncology Center of Excellence, U.S. Food and Drug Administration, Silver Spring, MD, USA
Dr. Paul Kluetz is a medical oncologist and the Deputy Director of the Oncology Center of Excellence at the U.S. FDA. In addition to his broader role in OCE’s strategic oversight and management, Dr. Kluetz founded the OCE’s PFDD program and continues to support its strategic mission. He has engaged the global cancer drug development and health outcomes community in leading a sustained effort to advance patient reported outcomes (PRO) data, wearable technologies, and other methods to obtain rigorous patient experience data in both the clinical trial and “real-world” settings
Andrew Lloyd, DPhil
Acaster Lloyd Consulting Ltd, London, United Kingdom
Andrew Lloyd is a Director of Acaster Lloyd Consulting Ltd. His background is in patient reported outcomes research, with a focus on patient preferences / utilities. Andrew was the VP of the PRO Group at ICON PLC. He previously held research posts at several universities within the UK. Andrew is an Honorary Professor at the London School of Hygiene and Tropical Medicine. He is a former co-editor of Value in Health. He is a board member of the EuroQol Group.
Lauren Podger, MSc
OPEN Health Group, London, United Kingdom
Lauren is a Senior Scientist at OPEN Health Group. She has over 5 years experience within PRO research and consulting; specifically focused on psychometric analysis and interpretation, trial efficacy analysis of COA endpoints, and regulatory strategy. Lauren holds a Master's Degree focused in MSc Neuropsychology from University of Bristol.
Innovation of HTA Methods. How Can the IHTAM Framework, Developed By HTx Project, Support the Introduction, Development, and Implementation of New HTA Methods in HTA Practice?
In-person
ISSUE: Can the Innovation of Health Technologies Assessment Methods (IHTAM) framework, as developed by the H2020 HTx project, help to improve the development and implementation of new HTA methods in HTA practice?
OVERVIEW:
Adequate methods are urgently needed to guarantee the good practice of health technology assessment (HTA) for technologies with novel properties. As part of the H2020 HTx project we constructed a conceptual framework to improve the innovation of HTA methods (IHTAM)1. The framework was constructed based on twenty documents on innovating HTA frameworks and fourteen guidelines from three scientific disciplines and includes a generic innovation process consisting of three phases ("Identification," "Development," and "Implementation") and nine subphases. In the framework, three roles that HTA stakeholders can play in innovation ("Developers," "Practitioners," and "Beneficiaries") are defined, and a process on how the stakeholders innovate HTA methods is included. The IHTAM framework visualizes systematically which elements and stakeholders are important to the development and implementation of novel HTA methods. In this panel, we want to discuss with academy, HTA bodies and practitioners and industry whether this IHTAM framework could provide an important tool for improving and implementing HTA methods and which roles they can take in the innovation process. We will use several examples of innovative HTA methods (for instance evidence synthesis based on RCT and RWD or machine learning/artificial a intelligence methods) and assess how this fits the IHTAM framework and benefit the different stakeholder groups in different settings around Europe. 1Jiu L, Hogervorst MA, Vreman RA, Mantel-Teeuwisse AK, Goettsch WG (2022). Understanding innovation of health technology assessment methods: the IHTAM framework. International Journal of Technology Assessment in Health Care 38, e16, 1-10.
Moderators
Wim Goettsch, PhD
National Health Care Institute (ZIN); Utrecht University, Division of Pharmacoepidemiology and Clinical Pharmacology, Diemen, Netherlands
Wim Goettsch, PhD is currently Special Advisor HTA at the Dutch National Health Care Institute He was the Director of the EUnetHTA JA3 (2016-2021) Directorate and Chair of the Executive Board of EUnetHTA between June 2016 and March 2018. Since 2019, he also has a position as an Associate Professor at Utrecht University (NL) where he is leading a new H2020 consortium with fifteen partners around Europe, called HTx on new methods for Health Technology Assessment for personalized medicine (2019-2024). He has (co-)authored more than 100 publications in peer-reviewed international journals.
Panelists
Gracy Crane, PhD
Roche Pharmaceuticals UK, Camberley, United Kingdom
Gracy Crane is a cancer biologist by training with a Master in Biomedical Research and a Ph.D. in Cancer Biology. She has also completed post-doctoral training fellowships at Oxford University (UK) and Massachusetts Institute of Technology (USA).
She has over 12 years of years of experience in the pharmaceutical industry, in varying roles including medical and scientific affairs, clinical development, health outcomes research and real world data. For the past 5 years, she has worked on leading the real world evidence strategy for molecules within the rare cancer space as part of the global Data Science team of the personalized health care department at Roche. Currently, she is the RWD policy and chapter leader within the Regulatory Policy team at Roche.
Gracy is also part of a number of external steering/working groups including the ISPOR RWD transparency Initiative (https://www.ispor.org/strategic-initiatives/real-world-evidence/real-world-evidence-transparency-initiative), the CIOMs working group on RWD/E guidelines, and the Duke Margolis RWE Collaborative.
This is her LinkedIn Profile: https://www.linkedin.com/in/gracy-crane-374ba120/
Oresta Piniazhko, PhD
State Expert Center of the Ministry of Health of Ukraine, Kyiv, Ukraine
Oresta Piniazhko, PhD, Director of HTA Department at State Expert Centre of Ministry of Health, Ukraine.
Oresta is an experienced expert in HTA, pharmaceutical policy and implementation practitioner. She holds a PhD degree in Pharmacoeconomics and is currently holding a position of Director of HTA Department at the State Expert Center of the Ministry of Health of Ukraine, ensuring management and implementation of the best international practices of HTA into health care system of Ukraine since February 2019. Being a dynamic communicator she is also a President of Ukraine ISPOR Chapter since 2017 and before ISPOR Ukraine Students Network (2015-2017). Oresta is visiting lecturer at The Institute of Business Education of Vadym Hetman Kyiv National Economics University and senior lecturer at Danylo Halytskyi Lviv National Medical University.
Junfeng Wang, PhD
Utrecht University, Bilthoven, Netherlands
Dr. Junfeng Wang is currently working as the coordinator of the HTx project in Utrecht University. After getting his PhD in Clinical Epidemiology and Biostatistics at University of Amsterdam in 2017, he started as a statistician at EBMT and LUMC. From October 2019, he was appointed as Assistant Professor in Julius Center, UMC Utrecht. His research interests include: (comparative and individual patient data) meta-analysis, development, validation and evaluation of clinical prediction models, analysis of registry/EMR data, survival analysis, HTA and health economics, and medical insurance.
The Value of “New”: Attitudes to and Consideration of Treatment Novelty in Health Technology Assessment
Virtual
ISSUE: Many HTA bodies consider novel aspects of new treatments important to society in their deliberations, over and above quantified clinical and economic benefits. However, approaches to do so vary, and questions remain as to how (and how consistently) novelty is defined and considered in technology appraisals. Dan Ollendorf will moderate the session and present results from new research on documented policies for treatment novelty across diverse organizations as well as case studies on the application of these policies in practice. Dr. Kanavos will describe variation in the use and application of novelty concepts by HTA bodies internationally. Ms. Strammiello will represent the patient perspective, including efforts to integrate patient views on what aspects of novelty are important to the community. Dr. Crabb will represent the HTA agency perspective, and will discuss the challenges and benefits of considering novel aspects of treatment in analysis and deliberation.
OVERVIEW: Novel aspects of new technologies, including method of action; changes to route, setting, and/or frequency of administration; modifications to clinical practice; and unique approaches to addressing unmet need, are often stated considerations in HTA policy outside of traditional quantification of clinical and economic benefit. However, consideration of these aspects varies substantially by organization; for example, new methods of action are considered a benefit in some settings and an uncertainty in others. In addition, how these aspects are integrated into actual deliberations, whether there are stated policies for doing so, and how they affect decisions or recommendations remain open questions. This session will review current practice at representative HTA bodies, identify additional elements important to patients and other stakeholders that may be under-appreciated, discuss the challenges inherent in considering novel elements outside of a quantitative analytic framework, and develop potential guidance for the field on novel elements to be considered and potential approaches for doing so.
Moderators
Daniel Ollendorf, PhD
Tufts Medical Center, Boston, MA, USA
Dan Ollendorf, PhD, MPH is Director of Value Measurement and Global Health Initiatives at the Tufts Center for the Evaluation of Value and Risk in Health (CEVR) and Assistant Professor of Medicine. Dr. Ollendorf’s research interests include expanding the use of health technology assessment (HTA) in low- and middle-income countries, as well as refinement and use of value assessment tools in the US and other high-income settings. Prior to joining CEVR, Dr. Ollendorf was Chief Scientific Officer for the Institute for Clinical and Economic Review (ICER) for over 10 years.
Panelists
Nick Crabb, PhD
NICE, Manchester, United Kingdom
Nick Crabb is Programme Director, Scientific Affairs at the National Institute for Health and Care Excellence (NICE). Prior to joining NICE in 2010 as the associate director responsible for establishing and managing the Diagnostics Assessment programme, Nick had a 20-year career in analytical science, process technology and general management in the chemical, pharmaceutical and contract laboratory industries. In 2014 he was appointed to his current role where he oversees the Science Policy and Research programme. Nick has broad scientific and policy interests relating to the evaluation of technologies and interventions to support the development of clinical, public health and social care guidance. His experience includes consideration of HTA issues arising from the availability of novel new products such as cell and gene therapies and work on methods issues relating to the evaluation of antimicrobials.
Panos Kanavos, PhD
London School of Economics and Political Science, London, United Kingdom
Dr Panos Kanavos is Associate Professor in International Health Policy in the Department of Health Policy at London School of Economics and Political Science, Deputy Director at LSE Health and Programme Director of the Medical Technology Research Group (MTRG).He has acted as an advisor to a number of international governmental and non-governmental organizations, including the European Commission, the European Parliament, the World Bank, the World Health Organization, the Organization for Economic Co-operation and Development (OECD), and Ministries of Health of over 28 transition, emerging and developing countries.
Valentina Strammiello, MA
European Patients’ Forum, Brussels, Belgium
Valentina Strammiello works as Head of Programmes and oversees the EPF project portfolio and Youth Strategy. She represents EPF in HTA-related activities and in the European Health Parliament initiative.
Before joining EPF, Valentina has had a long collaboration with the CIPI Network and has worked as freelance OSINT analyst on Security and Energy issues. Self-trained in website management and web 2.0 applications, she is among the founders of ecpa2.0 (European Center for Public Affairs 2.0), a forum of young professionals. She holds a BA in International Relations and a Master’s Degree in European Studies.
Podium Sessions
Patient Heterogeneity and Equity in Stated Preference Studies
Virtual
This panel features examples of how stated preference studies explore and inform equity considerations.
Moderator
Caitlin Thomas, MSc
Evidera, London, United Kingdom
Caitlin Thomas, MSc, is a Senior Research Associate within the Patient-Centered Research group at Evidera, with a background in Health Economics. Ms. Thomas is experienced at designing and conducing qualitative and quantitative preference research across multiple disease areas to support regulatory and reimbursement decisions. More recently Ms. Thomas has been applying preference research to understand the impact that study design has on patients’ willingness to participate in clinical trials and how this varies between patients. Ms. Thomas is also an active member of Evidera’s Patient Engagement Special Interest Group.
P52: Patient Preferences for Diagnostic Imaging Services Among Underserved and Rural Populations: Blueprint for Value-Based Incentives Incorporating Individual Preference Heterogeneity
5:15PM - 5:30PM
Van Den Broek-Altenburg E1, Benson J1, DeStigter KK1, Atherly A2
1University of Vermont, Burlington, VT, USA, 2Virginia Commonwealth University, Richmond, VA, USA
OBJECTIVES:
As diagnostic imaging demands and costs escalate, there are significant negative impacts on patient satisfaction. The objective of this study was to identify patient preferences for diagnostic imaging services and analyze how patients make trade-offs between attributes of services and compare patient preferences to value and volume-based approaches.
METHODS:
In this mixed methods study, focus groups were performed in semi-structured manner with patients in a rural health network. This preliminary work helped define key attributes and levels for a discrete choice experiment (DCE). Attributes and levels included interpreting physician specialty, primary care recommendation, cost, clinic wait time, travel time, appointment scheduling wait time, patient-rated service quality, government-rated quality score, and online scheduling availability. Two DCE's were designed to assess different aspects of the choice scenario: acute (injured ankle X-Ray), and general imaging (MRI for chronic back pain). Stated preferences data have been analyzed using random parameter mixed logit models and interaction models including participant demographics have also been constructed.
RESULTS:
We found increased cost resulted in lower probability of selection of an imaging center, while all other attributes assessed either increased or had little effect on the probability of selection. Participants placed high value on Radiologist expertise, including that of subspecialty Radiologists as well as recommendation of imaging centers by PCPs. These factors are not captured by existing quality metrics for Radiology. Participants demonstrated a strong preference for reviewing results and discussing next steps in their care with their ordering providers, while preferences for interaction with Radiologists were more heterogeneous.
CONCLUSIONS:
Patient preferences are not well aligned with value-based priorities. Value based systems will only be able to succeed if they can generate sufficient cost savings to patients to offset undesirable practice characteristics. The findings of this study are relevant to decision makers interested including patient value assessment in their healthcare reforms.
P49: Public Preferences in Organ Allocation: A Discrete Choice Experiment Regarding Principles of Distributive Justice
5:00PM - 5:15PM
Oedingen C1, Bartling T1, Schrem H2, Mühlbacher AC3, Krauth C1
1Hannover Medical School, Hannover, NI, Germany, 2Medical University Graz, Graz, Austria, 3Hochschule Neubrandenburg, Neubrandenburg, Germany
OBJECTIVES: There has been a persistent organ shortage, which forces priority setting to potential recipients. Because organ allocation is a highly normative decision task, it can be only legitimate if the general public is also involved in the decision-making. Therefore, public preferences for the allocation of deceased donor organs in Germany focusing on ethical principles of distributive justice were assessed.
METHODS: A discrete choice experiment (DCE) using a self-completed online questionnaire was performed. Based on a systematic review and focus group discussions, six attributes each with two-four levels were selected: life years gained after transplantation, quality of life after transplantation, chance for a further donor organ offer, age, registered donor and individual role in causing organ failure. A fractional factorial design with a total of 104 choice sets (13 blocks with 8 choice sets) without opt-out was conducted. Data were analyzed using conditional logit, mixed logit and latent class.
RESULTS: The final sample comprised 1,028 respondents. Choice decisions were significantly influenced by all attributes except chance for a further donor organ offer. The conditional logit demonstrates that a good quality of life after transplantation (Coef: 0.59; p<0.001), 25 year-old age (Coef: 0.32; p<0.001) and no individual role in causing organ failure (Coef: 0.37; p<0.001) had the greatest impact on choice decisions. Life years gained after transplantation and being a registered donor were less important. The latent class model identified four classes with preference heterogeneities.
CONCLUSIONS: The DCE reveals that the probability of success in terms of a good quality of life after transplantation and a younger patients’ age are most important in organ allocation for the public. Public preferences can help to inform policy to warrant socially responsible allocation systems and thus improve organ donation rates.
P51: A Discrete Choice Experiment to Understand the Value of Equity
4:30PM - 4:45PM
Spackman E1, Steele D2, Wagner D1, Nathoo AN2, Hazlewood G1
1University of Calgary, Calgary, AB, Canada, 2Alberta Health Services, Calgary, AB, Canada
OBJECTIVES: To understand trade-offs between health and equity and provide a framework to incorporate equity in funding decisions.
METHODS: We developed a discrete choice experiment using attributes and levels of importance to the local decision maker. Attributes were based on health provided, life-expectancy and quality-of-life, whether the treatment had the potential for conflict with patients’ beliefs, population characteristics, the average time with disease, whether the population had experienced unfair treatment by society, and whether it was a rare disease.
We contacted 1,445 respondents between May and July 2021 using probability sampling of adults in Alberta, Canada. The main survey consisted of 10 questions. The specific levels shown to each respondent were determined by a balanced overlap fractional factorial experimental design. Validity was tested, and a multinomial logit model was used.
RESULTS: Of those contacted, 891 (62%) opened the survey, and of those 574 (64%) completed it. Straight lining and attribute dominance did not appear to be a concern. 539 (94%) of respondents chose the dominant warm-up scenario. Baseline life-expectancy or quality-of-life, time with disease and whether the disease was rare did not have a statistically significant effect on utility. Gain in life-expectancy increased utility by 0.21 per year gained, utility increased by 0.05 for each 0.01 improvement in quality-of-life, treatments for patients that had been treated unfairly by society increased utility by 0.09 and treatments that respected all patients’ beliefs increased utility by 0.17. These preferences were used to develop a calculator to combine the health, cost and equity impacts of interventions and compare them to an opportunity cost threshold.
CONCLUSIONS: This research demonstrates the willingness of respondents to trade-off health maximization for treatments that respect all patients’ beliefs and populations that have been treated unfairly by society and allows decision makers to incorporate equity impacts into their decision making.
P50: Methods to Acknowledge Patient Heterogeneity in Economic Evaluation: A Review of the Methods Literature
4:45PM - 5:00PM
Shields G1, Bullement A2, Clarkson P3, Wilberforce M4, Farragher T5, Verma A5, Davies L1
1Manchester Centre for Health Economics, The University of Manchester, Manchester, UK, 2Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Nottingham, NTT, UK, 3Social Care and Society, Division of Population Health, Health Services Research, and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK, 4Social Policy Research Unit, Department of Social Policy & Social Work, University of York, York, UK, 5The Epidemiology and Public Health Group (EPHG), Division of Population Health, Health Services Research, and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
OBJECTIVES:
Cost-effectiveness analyses commonly use population averages, which can mask key differences across subgroups, potentially resulting in suboptimal resource allocation. This study sought to identify recent advances in methods for acknowledging patient heterogeneity in economic evaluations and to provide an overview of these methods.
METHODS:
A literature search was conducted in April 2022, using Econlit, Embase and MEDLINE databases, to identify literature published since 2011 (date of a previous review on this topic). Eligible studies needed to have an explicit methodological focus, related to acknowledging patient heterogeneity within a full economic evaluation. Citation pearl growing supplemented the database searches. Two stages of screening were applied and author consensus was used to determine the studies to be included. Extracted data captured relevant study design (model or trial), phase of the economic evaluation, methods, case studies presented, and strengths and limitations.
RESULTS:
Database searches identified 1,403 records after duplicate removal, with 14 studies included in the review. Four studies were added following citation pearl growing. Included methodologies were varied and included regression techniques, model design and value of information analysis. Recent publications have applied methodologies more commonly used in other fields (e.g., machine learning and causal forests). Commonly noted challenges associated with acknowledging heterogeneity included data availability (e.g., sample size), statistical issues (e.g., risk of false positives) and practical factors (e.g., computation time). Studies also discussed a need to consider ethical issues and feasibility of implementation.
CONCLUSIONS:
There is a growing range of methods available to acknowledge patient heterogeneity in economic evaluation. Relevant methods differ according to disease area, scope of the economic evaluation and data availability. Researchers need to be aware of the challenges associated with acknowledging patient heterogeneity to ensure findings are meaningful and robust. Future research is needed to assess whether and how methods are being applied in practice.
Real-World Evidence to Inform Healthcare Decision Making
In-person
This panel explores the use of real-world evidence to investigate health outcomes and to target healthcare interventions.
Moderator
Ashley Jaksa, MPH
Aetion, Inc., Boston, MA, USA
P54: Antimicrobial Resistance Associated With Worse Outcomes in Hospitalized Adults With Pneumococcal Disease
5:00PM - 5:15PM
Mohanty S1, Johnson KD2, Watts J3, Yu K3, Gupta V3
1Merck & Co., Inc., Holland, PA, USA, 2Merck & Co., Inc., Rahway, NJ, USA, 3Becton, Dickinson & Company, Franklin Lakes, NJ, USA
OBJECTIVES: Antimicrobial-resistant (AMR) Streptococcus pneumoniae (SP) is considered a serious threat. This study assessed patient outcomes for hospitalized adults with invasive (IPD) and non-invasive pneumococcal disease (non-IPD).
METHODS: From October 2015 to December 2020, microbiology, general laboratory, antimicrobial orders, and administrative data were analyzed from 92 hospitals (BD Insights, Franklin Lakes, NJ USA). IPD and non-IPD were categorized using ICD10 code data and positive urine antigen or cultures for SP. Risk factors for SP infection including chronic/immunocompromising conditions were categorized using ICD10 code data. For each admission we evaluated hospital mortality, length of stay (LOS), and hospital cost/margin by infection status using generalized linear models adjusting for patient demographics, severity of illness, pneumococcal resistance, and hospital demographics.
RESULTS: There were 157,005 admissions with pneumococcal disease (50.1% IPD and 49.9% non-IPD). Antimicrobial resistance was identified in 40.0% (732/1832) of admissions with a positive culture for SP and was higher in admissions with non-IPD. Observed hospital mortality was higher in admissions with IPD (11.9%) compared to non-IPD (5.7%). Hospital mortality was higher in the multivariate analysis (odds ratio (OR)) for admission with IPD (1.78), culture positive SP admissions with ≥ 1 AMR event (OR: 1.67), increasing age (OR: 1.44 [65-75 years], 1.51 [>75 years]), admissions with all-cause pneumonia (OR: 1.41), and admissions with chronic/immunocompromising conditions (OR: 1.04). Admissions for adults aged 50-64 represented the largest proportion of culture positive SP admissions (34.2 %), and had significantly higher LOS, and hospital costs than adults aged 65 years and older.
CONCLUSIONS: Hospital admissions with any SP resistance, IPD, chronic/immunocompromised conditions, and older age were associated with significantly higher mortality. The burden of AMR among adults aged 50-64 represented a large proportion of hospital admissions and had higher financial burden than those 65 years and older.
P53: Prevalence and Cancer Burden of Individuals With Modifiable Risk Factors for Cancer, Alone and in Combination, in the US
4:30PM - 4:45PM
Kim A1, Cong Z1, Jazieh AR2
1GRAIL, LLC, a subsidiary of Illumina, Inc., is currently held separate from Illumina, Inc. under the terms of the Interim Measures Order of the European Commission dated 29 October 2021, Menlo Park, CA, USA, 2Cincinnati Cancer Advisors, Cincinnati, OH, USA
OBJECTIVES: To estimate population-level prevalence of, and cancer incidence rates (IR) among, individuals with modifiable risk factors for cancer (e.g., obesity, smoking), alone and in combination, in the US.
METHODS: A retrospective cohort study was conducted using IBM MarketScan Treatment Pathways to estimate the prevalence of obese individuals, smokers, and obese smokers in 2019, and to identify incident cancer patients aged 18-79 years among those with ≥1 claim for obesity and/or tobacco use (i.e., dependence, cessation) in 2016, with the date of first claim as the index date, from which they were continuously enrolled for 1 or 3 years. Cancer IR and incidence rate ratios (IRR), using the general population as reference, were calculated. Subgroup analyses by age were conducted.
RESULTS: In total, 212,701 obese individuals, 120,166 smokers, 23,979 obese smokers, and 2,439,526 individuals in the general population were identified in 2016. The 1- and 3-year cancer incidence rates were 1.0% and 2.3% for obese individuals, respectively, 1.3% and 2.7% for smokers, 1.5% and 3.1% for obese smokers, and 0.7% and 1.8% for the general population. Thus, the IRR at 1 and 3 years were 1.41 (95% CI, 1.35, 1.48) and 1.28 (1.22, 1.33) for obese individuals, 1.94 (1.84, 2.05) and 1.56 (1.47, 1.65) for smokers, and 2.26 (2.04, 2.51) and 1.73 (1.54, 1.94) for obese smokers, respectively. The IRR were generally consistent among different age groups. The prevalence of obese individuals, smokers, and obese smokers in 2019 was estimated to be 19.9%, 9.7%, and 2.4%, respectively.
CONCLUSIONS: A substantially increased risk of cancer was observed among individuals with risk factors. Compared to those with a single risk factor, individuals with multiple risk factors have an even higher risk of cancer when compared to the general population. Identifying these higher-risk individuals can help inform early cancer detection strategies.
P56: Impact of Comorbidities on the Over-Mortality of People Living With Human Immunodeficiency Viruses (PLHIV)
4:45PM - 5:00PM
Bouee S1, Majerholc C2, Livrozet JM3, Prevoteau du Clary F4, Guigui B5, Vallee A2, Laurendeau C6, Zucman D2
1CEMKA, Bourg-La-Reine, France, 2Hôpital Foch, Suresnes, France, 3Hospices Civils de Lyon, Lyon, France, 4CHU Toulouse, Toulouse cedex 9, France, 5Université Paris Cité, Paris, France, 6CEMKA, Bourg La Reine, France
OBJECTIVES: Efficacious treatments prevent the immunodeficiency and opportunist infection in PLHIV. However, PLHIV have more frequent other chronic conditions such as cardiovascular diseases, cancer, due to the infection itself or to side effects of antiviral treatments. Moreover, some patients remain untreated because of unknown reasons. The objectives of this study were to estimate the over-mortality of PLHIV and the impact of other conditions on the over-mortality.
METHODS: A French cohort of PLHIV and age and gender matched controls was extracted from the SNDS French claim and hospitalization database between. PLHIV were identified between 2006 and 2019 and followed up until 2019. The incidence of deaths was estimated and compared between both groups. Comorbidities were identified through classical algorithms used in this database (ICD-10 codes, specific drugs or procedures etc.). A cox model was used to estimate the increased risk of deaths. Impact of comorbidities was estimated by adjusting on them.
RESULTS: 173,712 PLHIV and controls were followed up 8 years on average. Mean age at inception was 42 years and 66% were males. Significant increase of death rates was found in PLHIV with a HR of 2.1 (CI95%=[2.0;2.2]). This HR was 1.961 (CI95%=[1.898;2.027]) for men and 2.966 (CI95%=[2.767;3.180]) for women. The HR was higher in young PLHIV: 3.5 [18-30[ years old subjects, 3.7 [30-40[, 2.9 [40-50[, 1.7 [50-60[, 1.5 [60-70[, 1.4 [70-80[. Infectious diseases had the higher impact on the over-mortality: the HR decreased from 2.1 to 1.6 after adjusting on infectious diseases, hence a attributable risk (AR) of 50%). The other conditions were: hepatitis C (AR=30%), psychiatric diseases (AR=16%), hepatitis B (AR=6%), coronary diseases (4%), and phlebitis/pulmonary embolism (4%). Other studied diseases had ARs below 3%.
CONCLUSIONS: HIV infection doubles the risk of deaths and infections explains half of this over-mortality. The over-mortality is higher among women and young patients.
Concurrent Breakout Session 6
Leveraging the Win Ratio Method to Better Assess the Value of Interventions in Rare Disease
In-person
Level: Intermediate
PURPOSE: To introduce win ratio analysis for quantifying benefits of an intervention, particularly in the rare disease, and illustrate how the outputs can be used to derive the intervention’s value.
DESCRIPTION: Designing and analyzing rare disease clinical trials is challenging, not only due to limited small sample sizes, but also the multisystemic and heterogenous nature of their manifestations. This necessitates assessments on multiple end points to capture fully the disease impacts and treatment benefits. Treatment developers, regulators and health technology assessors are, thus, faced with how best to address these multiple endpoints, particularly if using standard statistical approaches. Traditional approaches force selecting a primary endpoint, “putting all the eggs in that basket”, thereby relegating other, potentially important endpoints, to secondary testing. These standard methods can fail to achieve statistical significance because of small sample sizes and multiple testing. This impairs translating clinical trial results to value and may lead to important innovations being withheld from patients with few other options.
In this workshop, we will outline the challenges and introduce an innovative solution. The recently proposed win ratio method will be detailed and its application in rare disease discussed. A case study will be used to illustrate the considerations involved in setting up win ratio analyses, including selection of endpoints, definitions for wins and losses, capturing uncertainty in estimates and interpreting results. Outcomes of traditional analysis and win ratio will be compared. The difficulties for valuation posed by the newer approach will also be addressed. Participants will be asked to pose and discuss issues with the method, particularly in terms of value assessment. How would they handle win ratio results? Would these be acceptable as the core efficacy input to a health technology assessment? Given the “comingling” of endpoints of different nature, how will valuations be done? Are new modeling approaches required?
Discussion Leaders
J. Jaime Caro, MDCM, FACP, FRCPC
Evidera, Waltham, MA, USA and University McGill, Canada, Waltham, MA, USA
Jaime Caro, Chief Scientist at Evidera and Professor of Epidemiology and of Medicine at McGill University and Professor in Practice at London School of Economics. He pioneered the use of DES, developed the Simulated Treatment Comparison approach and proposed the efficiency frontier as an alternative to cost/QALY. Recently, he has developed a new modelling technique, DICE simulation, tailored to problems in Health Technology Assessment.
Discussants
Alicia Granados, MD
Sanofi, Barcelona, Spain
Dr. Alicia Granados is serving at Sanofi Genzyme as Head of Global Rare disease Medical Scientific Advocacy & Insights. She joined Genzyme in 2011 as Global Head of HTA scientific strategy with special focus in providing strategic direction in evidence generation, with the aim of contributing to optimize both effectiveness and efficiency of integrate evidence generation plans.
Dr. Granados was responsible for the creation and direction of Catalan Agency for Health Technology Assessment and Research (CAHTAR) in 1991. She was a founding member of INAHTA, the first international HTA network; as well as the first HTA joint initiative in Europe, EUR-ASSESS, predecessor of EUnetHTA. She is also former President of the International Society for Technology Assessment in Health Care (ISTAHC) and the Chair of the Committee for the Creation of a new HTA Society: HTAi, becoming the first HTAi president in 2003. Since January 2022 she is Chair of HTAi Policy Forum Advisory Committee .
Dr. Granados has been temporary advisor of several UN agencies on Evidence Based Health Care, and Acting Regional Advisor of WHO European Office, leading the Health Evidence Network. She has been an Associate Professor of Medicine at the University of Barcelona and has more than 60 scientific and policy articles published. Dr. Granados is former President of Autonomous University of Barcelona’s Board of Trustees.
Alicia Granados MD, PhD PH. Universidad de Barcelona, Catalunya España
K. Jack Ishak, PhD
Evidera, St-Laurent, QC, Canada
K. Jack Ishak, PhD, is Vice President, Statistical Methodology and Strategy at Evidera, a PPD business. Dr. Ishak is responsible for ensuring Evidera remains the scientific leader in statistics, ensuring the application of best practices, developing novel methodologies, fostering flexible and integrated responses to client priorities, and promoting best-in-class capabilities and training internally. Working from Evidera’s office in Montreal, Canada, Dr. Ishak specializes in predictive analyses to model disease processes that serve as the core of economic evaluations, treatment comparisons, and simulations of clinical trials. This involves capturing the dynamic relationships between various disease markers with statistical models for time-to-event or longitudinal data, possibly with time-dependent variables to capture correlated change patterns over time. Dr. Ishak also works extensively in the analysis of outcomes in oncology trials; more specifically, relating progression and survival, dealing with crossover using novel techniques (e.g., rank-preserving structural failure time models, inverse-probability weighted models), projection of incomplete survival curves, and sequential modeling of treatment lines. Other areas of expertise include exploratory analyses, methods for measuring the effect of compliance or persistence with chronic treatments, and the design and analysis of observational studies.
Dr. Ishak is also engaged in methodological research and teaching of statistics in the context of economic evaluations and related areas. He has been involved in methodological developments in indirect treatment comparison (simulated treatment comparisons), complex method for modeling time-to-event curves, crossover adjustment methods in oncology, and novel study designs (e.g., evaluating the benefits of Bayesian adaptive designs in the context of comparative effectiveness research). His methodological and substantive papers have been published in peer-reviewed journals.
Dr. Ishak received his undergraduate degree in statistics from Concordia University and obtained his master’s and doctoral degrees in biostatistics and epidemiology from McGill University.
Women in HEOR: Achievements, Lessons Learned and Future Ambitions
In-person
Level: Introductory
PURPOSE: To highlight a 5-year lookback of the Women in HEOR initiative and showcase ways the initiative has brought attention to gender diversity, elevating diversity in the HEOR workforce, and discussion of future directions of the initiative. DESCRIPTION: The vision of the Women in HEOR initiative is to support the contribution of women in our field by serving as a catalyst for leadership and a platform for mentorship, collaboration, and networking. In 2017, this initiative formed in response to evidence from numerous studies that show supporting diversity leads to better performance for organizations. Gender diversity is one of the dimensions of diversity that ISPOR is committed to. Over the past five years, through a range of activities and the support of the ISPOR community, Women in HEOR has been successful at delivering on their objectives. We will describe progress that the Society has made in terms of growth in the proportion of gender diverse panels and conference program committee members. Ensuring diversity in our conference speakers helps support diversity in science, because these speakers not only represent our field and their individual sectors but inspire others to follow their path. Olivia Wu will describe the history of the Women in HEOR initiative, highlighting past sessions and activities. A diverse panel will be invited to reflect on their involvement in the initiative and perceived outcomes of the initiative. Julia Slejko will moderate discussion among the panelists and audience about the future of the initiative including ongoing research projects and membership feedback related to identifying mentors and leadership development. Speakers will elicit discussion from the audience through polling and live discussion on topics including needs of ISPOR members and discussion of diversity within ISPOR. The session is designed to benefit a broad audience and open to all ISPOR Europe 2022 registrants.
Moderators
Julia F. Slejko, PhD
University of Maryland School of Pharmacy, Baltimore, MD, USA
Julia F. Slejko, PhD is an Associate Professor of Pharmaceutical Health Services Research at the University of Maryland School of Pharmacy and is Co-Director of the Patient-Driven Values in Healthcare Evaluation (PAVE) Center. Dr Slejko’s research is focused on innovative approaches for decision-analytic modeling for economic and health outcomes assessments. She holds a BA in Molecular, Cellular, and Developmental Biology from the University of Colorado Boulder. During her PhD training, she focused on pharmacoeconomics at the University of Colorado School of Pharmacy Center for Pharmaceutical Outcomes Research (CePOR). Her postdoctoral training was completed at the Pharmaceutical Outcomes Research and Policy Program in the University of Washington School of Pharmacy. Prior to her PhD training, she had a 7-year career in drug discovery at Array BioPharma. Dr Slejko serves as co-lead of ISPOR’s Women in HEOR initiative, Co-Chair Elect of the ISPOR Faculty Advisor Council and is a member of ISPOR’s Health Science Policy Council.
Speakers
Lotte Steuten, PhD, MSc
Office of Health Economics, London, LON, United Kingdom
Lotte Steuten, PhD, is Deputy Chief Executive at the Office of Health Economics and Honorary Visiting Professor at City, University of London, UK. After graduating cum laude with her PhD from Maastricht University, the Netherlands, Lotte has been active in the HEOR field for over 15 years in various academic roles and executive functions (non-profit and for-profit).
To inform better decisions based on independent research and analysis, Lotte worked effectively with pharmaceutical industry, technology assessors, payers and policy makers, (academic) researchers, clinical and patient representatives as well as capital investors. Notably, her international career-path, including the UK, the US and the Netherlands, has provided her with deep insights in the fundamental differences as well as commonalities between the role of HEOR in different healthcare systems, cultural and societal values.
Over the past decade, Lotte has been leading diverse teams; developing strategies and delivering on program or company missions, values and objectives; acquiring funding and managing budgets; and been responsible for executive decision-making as well as legal and fiduciary matters. In her current role at the Office of Health Economics she is responsible for the research-led consulting program, making sure to maintaining OHE's stellar reputation for objective, innovative and high-quality research and analysis globally, as well as meeting its charitable objectives. In addition, she is a professor at City, University of London, contributing to their Master and PhD programs. Before joining OHE, Lotte worked as an Associate Member at the Fred Hutch Cancer Research Institute and Associate Professor at the University of Washington, Seattle (US), where she currently holds affiliate appointments.
Discussion Leaders
Olivia Wu, PhD
University of Glasgow, Glasgow, United Kingdom
Olivia Wu, PhD is Director of the Health Economics and Health Technology Assessment (HEHTA) Research Unit and William R Lindsay Chair of Health Economics, at the University of Glasgow. She is also Director of the Complex Reviews Support Unit, a national methods support unit for evidence synthesis funded by the UK National Institute for Health Research (NIHR). Olivia has expertise in a broad range of health technology assessment (HTA) methodologies and is interested in adapting and applying HTA methodologies in context. She has a particular interest in evidence synthesis and economic evaluations. Her research spans across a wide range of clinical areas and different types of health technologies (eg, pharmacological treatments, medical devices and diagnostic tests). Her work has informed clinical guidelines and health policy decisions, both at national and international levels. In addition to her research, Olivia had been a long-standing member of the NICE Technology Appraisal Committee. Currently, she is advisor to HTA agencies in Scotland, the Philippines, Taiwan and Thailand.
Do Advanced Methods Mean More Uncertainty? Quantifying Uncertainty Induced by Using Advanced Modelling Methods
In-person
Level: Intermediate
Purpose: This breakout session will create awareness of the different sources of uncertainty in health economic models that utilize advanced methods such as advanced survival models, individual-level simulations, and prediction models, and provide guidance on how that uncertainty can be quantified and propagated appropriately in analyses to ensure appropriate reflection of uncertainty in outcomes. Description: Increasingly sophisticated methods are used to populate and analyze health economic models to appropriately represent clinical pathways and outcomes. Appropriately quantifying the uncertainty in these analyses is essential to inform decision making, however this is not as straightforward as it is for more conventional modeling methods. Dr Degeling will introduce the session and provide a refresher on the different types of uncertainty and their importance in health economic modeling through an interactive example (8 minutes). Dr Fenwick will discuss challenges around quantifying uncertainty in advanced survival models, such as mixture cure models (15 minutes). Dr Degeling will discuss how the different types of uncertainty apply to individual-level simulation models and provide guidance on approaches for dealing with stochastic and parameter uncertainty (15 minutes). Prof Koffijberg will discuss challenges regarding the use of prediction models in economic evaluations and the different sources of uncertainty they introduce (15 minutes). The audience will be able to ask questions after each presentation (included in presentation time), and the session will end with another interactive example along with voting questions for the audience, to evaluate whether their understanding on the topic has improved (7 minutes). Those who (aim to) develop or appraise health economic models will benefit from attending this session.
Speakers
Elisabeth Fenwick, PhD
OPEN Health Evidence & Access, Oxford, OXF, United Kingdom
Elisabeth Fenwick is Deputy Chief Scientific Officer in Evidence & Access at Open Health, based in Oxford in the UK.
Liz provides scientific and strategic support to HE projects globally. She has extensive experience in economic evaluation and health economic modeling having worked in the field for over 20 years. She has worked on a variety of projects in a wide range of disease areas including oncology, respiratory, infectious diseases, cardiology, ophthalmology, and orphan diseases.
Liz has also contributed to methods in the field, in particular relating to decision analytic modeling and simulation methods, probabilistic decision analytic modeling and value of information analysis. Liz was a member of the ISPOR joint task force on good research practices in modeling and a co-author on the joint taskforce paper on uncertainty and co-chaired/co-authored the recent ISPOR task force assessing emerging good practice in value of information analysis for research decisions.
Liz has a PhD and MSc in Health Economics as well as an MSc in Operations Research and joined Open Health from ICON plc where she led the modeling team for the global HE group. Prior to her consultancy career, Liz spent over 15 years as an academic working at University of York, McMaster University, and most recently University of Glasgow.
Erik Koffijberg, PhD, MSc
University of Twente, Enschede, OV, Netherlands
Prof.Dr. H. (Erik) Koffijberg is full Professor Technology Assessment of Digital Health Innovations at the University of Twente in the Netherlands, and chair of the section Health Technology & Services Research. He has an MSc in Technical Computer Science and a PhD in Decision-Analytic Modelling. He has published >125 peer-reviewed scientific papers on methods and on applications in the field of HTA/health economic modeling, focusing on methods development for optimizing testing and screening strategies, and for identifying patient heterogeneity to tailor interventions to subgroups. He teaches MSc and postgraduate external courses on early HTA, regular HTA, Advanced Health Economic Modelling, and Discrete Event Simulation in Healthcare, and coordinates the Healthcare Technology & Management track of the master program Industrial Engineering & Management. He is PI in multiple large (international) research consortia focusing on the optimal use of biomarkers, imaging technologies, and AI, for early disease detection.
Discussion Leaders
Koen Degeling, PhD, MSc, BSc
University of Melbourne, Melbourne, VIC, Australia
Dr Koen Degeling is Scientific Director and the Economic Modelling & Innovation Lead at Lumen Value & Access, a Healthcare Consultancy Group company. He was trained as an Industrial Engineer specializing in Healthcare Technology and Management and holds a PhD in Advanced Health Economic Modelling from the University of Twente in the Netherlands. Prior to joining Lumen Value & Access, Koen worked on real-world data-driven health economic and health services research projects at the Cancer Health Services Research department of the University of Melbourne in Australia, where he continues to be involved as an honorary fellow. He is an active ISPOR member and currently serves on the Editorial Advisory Board for Values & Outcomes Spotlight and ISPOR New Professionals Steering Committee, is involved in several short courses and workshops, and has served as global chair of the ISPOR Student Network.
17:30 - 18:30
Networking Social
In-person
17:45 - 18:30
Discussion Groups
ISPOR's Digital Health Strategy Discussion Group
In-person
This discussion will be focused on obtaining member feedback on ISPOR’s digital health activities, including the organization’s digital health strategy and digital health SIG activities.
Moderators
Laura Pizzi, PharmD, MPH, RPh
ISPOR, Lawrence Township, NJ, USA
Dr. Laura Pizzi is Associate Chief Science Officer for ISPOR and Professor at Rutgers University in the schools of pharmacy and public health. For the past 25 years, she has led interdisciplinary teams of methodologists, statisticians, and clinicians to design and conduct economic analyses on healthcare interventions and is a frequent author, speaker, and mentor on the topic.
At ISPOR, she provides leadership to the organization’s scientific strategy and initiatives, including content planning and oversight of the Special Interest Groups, Patient Council and roundtables, the ISPOR Competency Framework workgroup, Publications Council, Institutional Council, and Digital Health Strategy. She also liaises with the Student Network and Faculty Advisor Council to support their scientific needs.
Speakers
Anita Burrell, BA, MA, MBA
Anita Burrell Consulting LLC, Flemington, NJ, USA
Vlad Zah, MS, MBA, PhD
ZRx Outcomes Research Inc., Toronto, ON, Canada
Personalized Values for Health Discussion Group
In-person
Moderators
Nancy Devlin, PhD
University of Melbourne, Melbourne, VIC, Australia
Nancy is Professor of Health Economics at the University of Melbourne and Senior Fellow at the Office of Health Economics, London. She is Chair of the Board of the EuroQol Research Foundation and served as President of ISPOR (2019-2020). Her principal areas of research expertise are the measurement and valuation of patient reported health outcomes; the cost effectiveness thresholds used in making judgments about value for money in health care; and priority setting in health care. She is currently leading a large programme of research to improve measurement and valuation of quality of life in children (QUOKKA), funded by the Medical Research Future Fund (Australia). Nancy has published >150 original peer reviewed journal papers on a wide range of empirical and theoretical topics in health economics.
Speakers
Marieke Heisen, PhD
OPEN Health Evidence & Access, Rotterdam, Netherlands
Marieke is the Global Preference Lead and Director in the Patient-Centered Outcomes & Patient Engagement team at OPEN Health. Before focusing on preference research and patient-centered outcomes, Marieke spent 8+ years in health economic modelling. Her all-round experience includes pharmacoeconomic modelling/adaptations, reimbursement submissions, network meta-analysis, survival analysis, expert/patient elicitation, HRQoL evidence strategy, and preference elicitation. Disease areas she has worked in include cardiovascular disease, oncology, hematology, urology, auto-immune diseases, infectious diseases/vaccination, and mental disorders. Marieke joined OPEN Health (Pharmerit) in 2011 and is based in Rotterdam, the Netherlands. She holds a PhD degree in Biomedical Engineering, obtained from the Eindhoven University of Technology, The Netherlands.
Poster Session 4 Poster Tours
New this Year – Poster Tours! ISPOR has curated collections of research posters for you within each of the poster sessions. Each tour will feature high impact abstracts within a specific topical area and will include a tour guide as well as the poster authors to share their work and engage in discussions with you. Visit the Learning Formats page for more information.
Poster Tour: Cardiovascular & Diabetes/Endocrine/Metabolic Disorders
In-person
Download the Cardiovascular & Diabetes/Endocrine/Metabolic Disorders Poster Tour Guide Packet
Posters featured in this tour:
EE111: Cost-Effectiveness of Sodium-Glucose Cotransporter-2 Inhibitors in Patients With Chronic Heart Failure Irrespective of Left-Ventricle Ejection Fraction in the Netherlands
EE577: Cost-Consequence Analysis of EPTFE Vascular Grafts With Heparin End Point Covalent Bond Compared to Standard EPTFE Vascular Grafts in Below-Knee Surgical Bypass for Critical Limb Ischaemia Pad Patients in Portugal
EE668: Empagliflozin for the Treatment of Adult Patients With Symptomatic Chronic Heart Failure With Reduced Ejection Fraction (HFREF): A Cost-Effectiveness Analysis From the Italian NHS Perspective
EE224: Cost-Effectiveness Analysis of Real-Time Continuous Glucose Monitoring (RTCGM) vs Self-Monitoring of Blood Glucose (SMBG) in Patients With Type 1 Diabetes in the Netherlands
HTA131: An Early Health Technology Assessment of Non-Invasive Fractional Flow Reserve Versus Standard Diagnostics in Patients with Stable Chest Pain in the Netherlands
PCR265: Preferences and Needs of Heart Failure Patients Regarding Their Treatment and Care
Poster Tour: Rare and Orphan Diseases
In-person
Download the Rare and Orphan Diseases Poster Tour Guide Packet
Posters featured in this tour:
CO15: A Matching-Adjusted Indirect Comparison of Efgartigimod Versus Ravulizumab for Generalized Myasthenia Gravis
EE382: Cost-Utility Analysis of Avacopan for the Treatment of Anca-Associated Vasculitis (AAV) Patients in the UK
EE274: Orphan Drug Pricing Comparisons in Low-, Middle- and High-Income Countries
EE147: Estimating the Causal Effect of Early Use of Erythropoietic Stimulating Agents in Intermediate-1 to Low-Risk MDS Patients: An Application of the Longitudinal Targeted Maximum Likelihood Estimation
HPR17: Changing Landscape of Orphan Drug Reimbursement - Evidence From EU-4 and England
SA73: Addressing Unmet Needs of Patients With Neuronopathic Gaucher Disease Type 2 and Type 3: Creation of the GARDIAN Patient Registry
Wed 9 Nov
7:00 - 8:00
Morning Coffee Service
In-person
7:00 - 13:00
ISPOR Europe 2022 Registration Hours
In-person
The ISPOR Registration Desk will be open for in-person participants.
8:00 - 9:00
Concurrent Breakout Session 7
A Value-Based Negotiation Framework for Improved Managed Entry Agreement Negotiations and Faster Access to Innovative Therapies
In-person
Level: Intermediate
PURPOSE:
To interactively engage with a proposed value-based negotiation framework (VBNF) tool to facilitate more structured, transparent and faster negotiations of managed entry agreements (MEAs) for innovative therapies.
DESCRIPTION:
Innovative therapies hold substantial potential for diseases with unmet need, but simultaneously often raise concerns around affordability and/or evidential uncertainties. MEAs represent a method that can address these concerns, in order to accelerate access for patients to promising innovative therapies. To support more structured, transparent and faster MEA negotiations, the VBNF concept has been developed based on current scientific literature and real-world expertise. It uses a stepwise approach with corresponding tools to systematically identify and prioritize manufacturer and payer perspectives and concerns about a product, and select a mutually acceptable combination of MEA terms that can best address these priority concerns. The concept has been published as a peer reviewed article and has been presented at various conferences and workshops, including ISPOR Europe 2021; the goal of this workshop is to now move beyond the conceptual phase and host a mini-negotiation with more active audience engagement. Discussion leaders will use 10 minutes to introduce the background and framework; further detail will be provided throughout the interactive experience. Regulators, payers, manufacturers and NGOs will benefit from this workshop. AUDIENCE INTERACTIVE ELEMENT: 10 minutes will be used to introduce a simplified case example of a fictitious disease and product. The audience will be tasked with taking the ‘payer’ or ‘manufacturer’ perspective, and engaging for 30 minutes with a digital tool based on the framework concept to identify priority concerns and possible MEA terms. In the last 10 minutes, discussion leaders will comment on the results of the experience and the MEA agreed by the audience. The audience will discuss their experiences with the framework and if and how it could be applied in practice.
Discussion Leaders
Amanda Whittal, PhD
Dolon Ltd., Breisach, BW, Germany
Amanda Whittal is health psychologist by training and a Senior Consultant at Dolon Ltd. She has been involved in a wide range of research and consulting projects with a focus on rare disease policy. Amanda worked on the orphan medicinal products workstream of the Horizon 2020 project ‘IMPACT-HTA: Improved methods and actionable tools for enhancing HTA.’
Discussants
Claudio Jommi, M.Sc.
SDA Bocconi School of Management, Bocconi University, Milano, MI, Italy
Claudio Jommi is Professor of Practice of Health Policy and Director of the Master of International Health Care Management Economics and Policy of Health Policy at SDA Bocconi University. His research activity is focused on Market Access for Medicines, Pharmaceutical Economics, Policy and Management, Health Technology Assessment and Decision Making in Health Care. He published in international journals, including BMJ Open, Frontiers in Pharmacology, European Journal of Health Economics, Health Policy, Pharmacoeconomics, PLOS, Social Science and Medicine, and Value in Health.
Enriching Real-World Data Sets With Insights from Online Communities for a Robust Understanding of the Patient Experience
In-person
Level: Introductory
This session will explore online patient communities as a research methodology to supplement data from traditional real-world sources, such as registries, EMR, and claims data. Online patient communities are a trusted source of information and support for patients living with health conditions. They also provide a rich source of patient-reported data, which can be used to enrich the data available from other real-word sources. In this session, we will explore research methodologies that can be utilized within communities, and how this data can be analyzed to create a robust picture of the patient lived experience, QoL, and healthcare behaviors. The session will begin with an overview of the use of community data to enrich other RWD. Then, 3 experts with deep experience in the use of online health communities will share their knowledge, experiences, and viewpoints. First, the Chief Patient Officer of an organization that hosts online patient health communities will share practical aspects of conducting this innovative research and how organizations have applied the results. An executive at a biopharmaceutical company will join us; his company is utilizing an online patient community for insights to guide its R&D program in mental health. Finally, a representative of a Patient organisation that moderates a community will discuss the benefit to both researchers and patients. These specialists will share their viewpoints on the value of online patient community data and how its use can supplement traditional real-world data collection methods to provide a complete picture of the patient experience. The session will be highly interactive. Audience members will participate by completing a worksheet to design their own community interaction/research event, as well as hold partner discussions and debates on the utility of this type of data. We will complete the session with open Q&A with audience members and our panelists.
Discussion Leaders
Valerie Powell, MS
CorEvitas, LLC, Waltham, MA, USA
Ms. Powell has 30 years of experience in the pharmaceutical industry and an advanced degree in Instructional and Performance Technology.
At CorEvitas, Ms. Powell serves as Chief Patient Officer, ensuring the voice of the patient is considered in all company initiatives. She is also the Vice President of CorEvitas' Patient Experience business, where she leads both the Delivery and Client Solutions teams. She is focused on marrying client needs with patient characteristics to select the optimal research methodology for each project, and on delving deeply into the patient experience to bring forth revealing and meaningful insights.
Ms. Powell previously worked at Mapi/ICON where, as Senior Director of Patient Insights & Engagement, she conducted research to influence trial protocols and patient recruitment and retention plans. Prior to this, she served as Vice President of Learning Strategy for a health communications agency. She conducted qualitative research to design patient messaging, oversaw the development of effective patient educational materials, and led the initiative to improve patient literacy across platforms.
Discussants
Clare Jacklin, n/a
National Rheumatoid Arthritis Society, Maidenhead, United Kingdom
Clare Jacklin is the CEO of the National Rheumatoid Arthritis Society (NRAS), where she is leading the charity into a new and challenging era through and post COVID-19 pandemic. In her previous role as Director of External Affairs at NRAS, her main responsibilities were the society's helpline, publications, volunteer network and external projects.
Ms. Jacklin has represented NRAS and the voice of those living with RA or JIA as a guest speaker on a great many national and international platforms as well as being a contributing author on a number of publications. Speaking engagements have ranged from the British Society for Rheumatology conferences to the EMA and TV, radio, and podcasts. Among her many publications is "Blood Matters", a valuable NRAS resource published in 2022.
Lucinda Orsini, DPM, MPH
COMPASS Pathways, Skillman, NY, USA
It’s Not a Sprint, It’s a Datathon: Bridging Clinical and Real-World Data to Generate New Insights and Data-Driven Innovations in Healthcare
In-person
Level: Introductory
PURPOSE: The objectives of this session are to share learnings and insights from a data-driven hackathon. DESCRIPTION: Provision of real-world-evidence (RWE) is of great interest for all stakeholders within the health care sector. Where randomized controlled trials (RCTs) provide the unique ability to evaluate efficacy, the use of real-world-data (RWD), i.e. claims data, enable analyses of real-world clinical practice. However, neither data source is in itself without limitations with regard to internal and external validity, time horizon and collected parameters. We experimented with an innovative approach – a “Datathon” (data-driven Hackathon) - to bridge this gap. In our Datathon we had the ambition, by combining data and knowledge from both perspectives (RCT/real-world) with machine learning in an unconventional and intensive working event over 2,5 days to tackle different medical challenges within the healthcare sector. These challenges in the area of asthma and chronic lymphocytic leukemia were assigned to competing teams, resulting in innovative solutions and comprehensive insights for participants and stakeholders alike. This breakout session starts with a background on the challenge of data driven healthcare projects and an outline of the Datathon approach. Insights from the conceptualizing phase, challenges and solutions from the perspective of data protection, data linkage, data science and general collaboration set-up are presented (20 min, Kümpel/Unger). Next, one of the winning teams of the Datathon will present its results for the prediction and identification of asthma patients with high risk of developing OCS related adverse events (20 min, Alig/Grotenrath). After a summary of learnings from the event (10 min), a discussion with the audience concludes the session (10 min). This session may benefit any healthcare stakeholder with an interest in exploring an innovative, multi-disciplinary approach for RCT and RWD linkage and machine learning approaches in order to solve medical research questions and develop innovative care models.
Panelists
Jacqueline Alig, Dr.
AstraZeneca GmbH, Hamburg, HH, Germany
Dr. Alig studied biochemistry and molecular biology at the universities of Bielefeld, Salamanca and Hamburg. She has a PhD in Neurobiology. Since 2009 she has been working as a Medical Affairs Manager in pharmaceutical industry with a current focus on the treatment of severe asthma patients.
Lea Grotenrath, Master
GWQ, Düsseldorf, NW, Germany
As a data scientist working with real world data from German statutory healthcare insurances contributing to data-driven decision making in terms of optimizing provision of care to patients.
Michael Huemer, PhD
AstraZeneca Oncology, Medical Department, Hamburg, Germany
Discussion Leaders
Alexander Unger, Dr. Phil.
AstraZeneca GmbH, Hamburg, HH, Germany
Dr. Unger is currently Director Data Insights & Business Intelligence at AstraZeneca GmbH spearheading the team with the mission to leverage the power of data (insights), data science & AI to help generate value in healthcare by enabling digital healthcare, real-world evidence (RWE), value-/outcome-based reimbursement, and omnichannel solutions.
Before joining AstraZeneca in 2020, he was Vice Chairman of the Board
at OptiMedis AG, a health science-based management company facilitating integrated care systems throughout Germany and other European countries. During this time he also served as CEO of Gesundes Kinzigtal, a leading Accountable Care Organization, as well as General Manager of Gesundheit für Billstedt-Horn, an innovative care model to improve health outcomes in a socially-deprived area in Hamburg.
Dr. Unger holds a PhD in health care management and health economics from the Institute for Healthcare Management and Health Economics, within the University for Health Sciences, Medical Informatics and Technology in Austria. He is a 2015/16 Commonwealth Fund Harkness Fellow in Health Care Policy and Practice. His research interests include data-science & data-driven healthcare, digital health, value-based purchasing, and health economic evaluations of complex care interventions.
LinkedIn Profile: https://www.linkedin.com/in/apimperl/
Development, Evaluation and Adoption of Digital Health Technologies: How Stakeholders Need to Interact to Make This Work?
In-person
ISSUE: The digital health context is chaotic and vast, with innovation progressing at pace and healthcare systems increasingly demanding digital solutions to contribute to patients benefits and optimise resources. This complex environment requires a whole system approach. This panel will showcase the experiences from 2 HTA agencies in developing tools to support the development, evaluation and adoption of digital health technologies in their jurisdictions. These will be contrasted with the perspective from the developer on how these tools can accelerate adoption of digital health technologies. How do stakeholders need to interact to make this works?
OVERVIEW:
Pilar will provide an overview of the digital health landscape and the identification of stakeholders that are likely to be involved in the development, evaluation and adoption of digital health technologies. The session will be interactive, with questions posed to the audience on relevant stakeholders and their needs from each other. Anyone interested in the evaluation and adoption of digital healthcare technologies should attend. Farhan will present how NICE (UK) is aiming to establish its role in the evaluation of the value of digital health technologies, providing best practice guidance on evidence and evaluation methods for digital health technologies and collaborating with system partners. Rosa will share the experience from AQuAS (Spain), as the HTA agency developing a framework for evaluating digital health technologies nationally and regionally. Both will share how interactions with system partners have been crucial. Felip will provide an overview of paradigmatic developments of digital health from the perspective of Eurecat’s digital health unit, which promotes transformation of health with support from innovative digital technologies. Highlights regarding how evidence standards frameworks can be useful to developers to accelerate adoption of digital health solutions in clinical practice will be discussed. There will be Q&A and the audience will be invited to present their views.
Moderators
Pilar Pinilla, MSc
National Institute for Health and Care Excellence, London, United Kingdom
Pilar is the Associate Director of the NICE International team. She is responsible for the strategic objectives and direction of the NICE International services, oversees all the international services provided by the team and contributes to the delivery of different international engagements through workshops, educational seminars, and international consultancy projects. She has extensive experience in delivering these services at a national and international scale and represents NICE in a series of NHS International groups.
Pilar also works in scientific advice projects in the NICE Scientific Advice team, where she contributes to the standard service providing advice on behalf of NICE and also collaborates in parallel scientific advice with other Health Technology Assessment (HTA) and regulatory agencies. She joined NICE in 2012 and worked in the Technology Appraisals and the Highly Specialised Technologies programme until 2016, when she became part of the Scientific Advice team.
Pilar holds a University degree in Business Administration and Management from University of La Laguna (Spain), and an MSc in Health Economics, Policy and Law with specialisation in Health Economics from the Erasmus University of Rotterdam (The Netherlands). She is currently conducting a PhD at University of Las Palmas de Gran Canaria (Spain) focusing on HTA. Before joining NICE, Pilar worked as a Researcher in one of the Spanish regional HTA units (SESCS, Canary Islands) conducting systematic reviews and economic evaluations for the Spanish Healthcare System. She is currently on the Board of Directors for the Spanish Health Economics Association (AES).
Panelists
Felip Miralles, PhD
Technology Centre of Catalonia (Eurecat), Barcelona, Spain
I am a Computer Science Engineer by Universitat Politècnica de València, hold a MSc in Information Systems by New Jersey Institute of Technology and a PhD in Engineering and Advanced Technologies by Universitat de Barcelona.
I have been leading ICT projects both in the public sector and the private enterprise. I am entrepreneur, professor and principal investigator in many digital health initiatives. My research interests span modelling and representation of healthcare knowledge, multimodal interfaces, telemonitoring, mobile health, predictive and prescriptive models, clinical decision support systems and interoperability to progress beyond the State of Art in digital health domains such as integrated care, personalized medicine and biomechanics.
In the last years I have been leading private and public funded international R&D projects such as CONNECARE, BackHome, Synergy-COPD, SAAPHO and BrainAble. I am currently director of the Digital Health Unit at Eurecat technology centre, specializing in service oriented architectures, mobility, internet of things, big data analytics, machine learning and assistive technologies to design, build and deploy innovative products and services for a personalized, preventive, predictive, participative, precision and value-based healthcare.
Mark Salmon, BSc, MBA
National Institute for Health and Care Excellence, Manchester, United Kingdom
Rosa Vivanco-Hidalgo, MD, PhD, MPH
Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain
Rosa Maria Vivanco Hidalgo, MD PhD MPH, is the Head of the Health Technology and Quality Assessment Department at the Agency for Health Quality and Assessment of Catalonia (AQuAS). She is a member of the Spanish Network of Health Technology Assessment Agencies and provides evidence-based support to the Spanish and Catalan Ministry of Health about the introduction of medical innovations to the National Health Service, including digital health technologies.
Current Trends in Clinical Endpoint Evaluation Used for Relative Effectiveness Assessments of Pharmaceuticals in Context with EUnetHTA
In-person
ISSUE:
A multistakeholder discussion of the new EUnetHTA 2022 requirements on endpoints used for relative effectiveness assessment (clinical, composite, and surrogate endpoints; safety, HRQoL and utility measures)
OVERVIEW: Clinical and patient relevant outcomes assessments are crucial in the development of new products. Novel and surrogate endpoints are more frequently used, but there is a risk that they will be disregarded in HTA, which may hinder patient access. The EUnetHTA guidelines on endpoints will be open for stakeholder review in October 2022 (
EUnetHTA endpoint guidance). We believe that this guideline will inform an important discussion for ISPOR members involved in evidence submission for HTA submissions across Europe. Dr. Rudell will moderate the session and the audience questions following the presentations. M. Schlichting (Merck KGaA, Darmstadt, Germany) will provide an overview of clinical outcome assessment (COA), in the context of HTA assessments, eg, issues related to clinical relevance, surrogate endpoints, composite endpoints, and PRO endpoints (10 minutes). Dr. Wieseler (IQWIG) will summarize the outcomes relevant for HTA (10 min). Dr. Ryll (Melanoma Patient Network Europe) will discuss the patient/carer perspective on clinical and surrogate endpoints (10 minutes). We believe ISPOR members would like the opportunity to directly discuss this topic with experts as well as to review whether it would address the patient needs regarding access to medication.
Moderators
Katja Rudell, PhD, MSc
Parexel International, Chittering, CAM, United Kingdom
Katja Rudell cofounded the ISPOR Special Working Group in COA at ISPOR in 2019 and is a Senior Director of COA Science at Parexel. She holds a PhD from University of London, and has been working in Clinical Outcomes Research for 20 + years.
Panelists
Bettina Ryll, MD, PhD
Melanoma Patient Network Europe, and Past Chair of the Patient Advocates Working Group, European Society for Medical Oncology, Uppsala, Sweden
Dr. Ryll holds a medical degree from the Free University of Berlin, Germany, and a PhD in Biomedical Sciences from University College London, UK. After losing her husband to Melanoma, she founded the Melanoma Patient Network Europe and developed a special interest in patient-centric clinical research and innovation, innovative trial designs and novel drug development concepts. Between 2019 and 2021, she was member of the first EU Cancer Mission Board where her particular interest has been how to best leverage the potential of personalized medicine for patients and society through novel forms of collaboration and the support of health policy and governance. Currently, she works as subject matter expert for personalised medicine and patient-centric innovation at SIR, Stockholm School of Economics' Research Institute for Mission Zero Cancer and TestBed Sweden.
Michael Schlichting, MSc
Merck KGaA, Darmstadt, HE, Germany
Michael Schlichting is currently the global biostatistical HTA lead at Merck KGaA, Darmstadt, Germany. He worked in the pharmaceutical industry for more than 30 years with special interest in patient-reported outcomes (PRO). He is co-leading the methodological workstream for RCTs at SISAQOL-IMI (Setting International Standards in Analysing PRO and QOL Endpoints in Cancer Clinical Trials – IMI) consortium. Recently published work includes the ISPOR COA report on the applicability on IQWiG's 15% PRO threshold (https://doi.org/10.1016/j.jval.2022.07.010) and HTA insights on the ITT approach in context of the estimand framework (https://doi.org/10.1016/j.jval.2022.08.008).
Beate Wieseler, Dr.rer.nat
Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany
Beate Wieseler is Head of the Department of Drug Assessment at the German Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG). At IQWiG she is responsible for the scientific assessment of pharmaceuticals, the development of assessment methods as well as the Institute’s collaboration with German and international external parties. Prior to joining IQWiG in 2005, Beate Wieseler worked in clinical research and regulatory affairs for about 10 years.
How to Assess and Implement Patient Preferences in Decision-Making Along the Medical Product Life Cycle?
Virtual
ISSUE: Patient preference studies (PPS) yield evidence about unmet needs and treatment outcomes that matter most to patients, which can inform pharmaceutical companies, health technology assessment bodies, payers, researchers, physicians, and patient organizations in understanding whether a product answers an unmet need and provides benefits that are meaningful to patients. While the potential is clear, there is lack of case examples and understanding on how the implementation and integration of PPS in decision-making along the medical product life cycle (clinical trial endpoint determination, regulatory/HTA assessment) can occur in practice.
OVERVIEW: Drawing upon experiences and results from PPS’ in diverse disease domains (e.g. multiple myeloma, Duchenne muscular dystrophy, inflammatory bowel diseases), speakers from different stakeholder organisations (European Medicines Agency, KU Leuven, Patvocates) will share their views (regulatory, methodological, patient) on how PPS can be robustly designed to provide evidence-based information regarding the unmet needs and treatment outcomes that matter most to patients how much, and how these results could be integrated to inform healthcare decision-making. The session will cover both qualitative (interviews, focus group discussions) and quantitative preference elicitation methodologies (Discrete Choice Experiment, Swing Weighting, threshold technique). Next, the presenters will illustrate how PPS attributes of importance to patients (such as life expectancy and quality of life-related attributes) can be implemented in medical product decision-making and regulatory evaluation. Finally, the session will discuss how patients and patient organizations should be engaged as active research partners throughout the PPS development and dissemination.
Panellists will have 10 min presentation time. 25 minutes are foreseen for audience discussion during which attendees’ opinions towards the discussed topics will be probed using an interactive tool (such as PollEverywhere), employing open and closed questions. Multiple stakeholder groups will benefit from attending this issue panel including policymakers, HTA assessors, payers, regulators, patient representatives, academics, clinicians, pharmaceutical industry, market access representatives.
Moderators
Liese Barbier, PhD, PharmD
Department of Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, VBR, Belgium
Liese Barbier, PharmD, PhD, is a post-doctoral researcher at the KU Leuven in Belgium, in the Regulatory Sciences & Pharmaco-Economics research unit. Her research interests and activities focus on regulatory, clinical and policy aspects of medicinal products, including clinical drug development, regulatory evaluation, market access policies, and clinical product implementation. She has a particular interest in optimizing regulatory and decision-making frameworks for complex medicines and in areas with high unmet medical need. Her PhD research focused on regulatory, clinical and policy challenges related to biosimilar market entry in Europe, through which multi-stakeholder informed recommendations were generated to foster sustainable off-patent biological market dynamics. In 2019, Liese was seconded to the European Medicines Agency as National Expert. Here, she was part of the Oncology, Haematology and Diagnostics office of the Human Medicines Evaluation Division and focused as Product Lead on the evaluation of biosimilar candidates in oncology. Further, she provided scientific input to biosimilar related initiatives across the Agency and coordinated as Scientific Lead the Biosimilar Medicinal Products Working Party.
Panelists
Rosanne Janssens, PhD
KU Leuven, Leuven, VBR, Belgium
Rosanne Janssens is a post-doctoral researcher at the KU Leuven in Belgium, in the Regulatory Sciences & Pharmaco-Economics research unit. She is one of the IMI-PREFER project academic researchers where she conducted patient preference studies (qualitative + quantitative survey- based research) that directly informed the PREFER recommendations. She has applied hands-on experience with qualitative and quantitative (survey-based) research methods used in patient preference studies – including: qualitative research design and conduct of interviews and focus group discussions with patients in different disease areas; analysing qualitative research to derive attributes and levels and using appropriate softwares (NVivo) towards attribute development; hands-on expertise with preference survey development and discrete choice experiment in appropriate softwares (Sawtooth); hand-on experience with statistical analysis techniques for preference surveys – including how to assess and interpret relative attribute importances, preference heterogeneity for the closed survey preference questions and qualitative thematic analyses for the open preference survey questions; writing-up and publishing preference study protocols and findings in multiple therapeutic domains + communicating the results to various audiences in both scientifically/medically (conferences), and more lay language formats (webinars on youtube).
Francesco Pignatti, MD
European Medicines Agency, Amsterdam, Netherlands
Ananda Plate, MSc
Patvocates Research, Hohenbrunn, Germany
To Adjust or Not to Adjust for Effect Modifiers in HTA Submissions; Considerations in Population-Adjusted Indirect Treatment Comparisons
Virtual
ISSUE:
In HTA submissions, obtaining reliable relative treatment effect estimates (RTEs) for the technology under appraisal is critical for decision-making. Standard indirect treatment comparisons (ITCs) and network meta-analyses for estimating RTEs are based on aggregated data and assume that effect modifiers (EMs) are balanced between trials. When there are differences in the distribution of EMs across the trials, effect modification results in biased RTEs, and population-adjusted indirect comparison methods may be considered. The panel will provide case-studies and debate on the considerations for selecting population adjustment methods, the circumstances when their assumptions can be justified and what to do when these are not met. The panel will also debate when EMs should not be adjusted for.
OVERVIEW:
Population adjustment methods such as matching-adjusted indirect comparison [MAIC] and simulated treatment comparisons [STC] use available individual patient data to adjust for differences in EMs through reweighting or regression adjustment. Recently, the NICE Decision Support Unit advocated a preference for the use of multilevel network meta-regression [ML-NMR] in HTA submissions, whereas MAIC should be avoided. Others have advocated that for time-to-event data, MAIC may result in less biased estimates than STC. The debate on preferred population adjustment methods to inform RTEs is still ongoing. The moderator will introduce the topic by discussing how to identify if a covariate is a true EM for a decision problem; and how to ensure that the relationship between EMs and outcomes in ITCs are relatively unbiased (5min). Following, each panellist will present from a different background (research, consultancy, industry) the opportunities and challenges applying these ITC methods in decision-making and considerations on the way EMs are accounted for (15 min each). The session will conclude with an interactive discussion with the audience and the use of online polling questions. Stakeholders from industry, HTA bodies and researcher bodies will benefit.
Moderators
Matthew Bryan, PhD
CADTH, Gatineau, QC, Canada
Matthew Bryan is a Manager at Scientific Affairs at CADTH for over 3 years with a long experience as a biostatistician in HTAs. Matthew previously hold a position as an Assistant Professor at the University of Pennsylvania.
Panelists
Bart Heeg, MSc, PhD
Cytel, Rotterdam, ZH, Netherlands
Bart has more than 20 years of experience in leading and conducting health economic and outcomes research consulting projects for pharmaceutical industry, such as trial analyses, economic modelling, and indirect treatment comparisons for HTA submissions. Prior to merging with Cytel Bart co-founded Ingress-health in 2015. Bart is passionate about developing or extending methodologies such as Bayesian survival network meta-analyses, developing tumor agnostic models and models for early/adjuvant oncology therapies. Bart has a PhD in health economics from the University of Groningen.
Kirsty Rhodes, MSc
AstraZeneca, Cambridge, CAM, United Kingdom
Kirsty Rhodes is an Associate Director at AstraZeneca. She is a statistician with interests in methods for analysis of clinical trial and observational study data and their application to decision making. Of particular interest are methods for meta-analysis, indirect treatment comparisons, external controls, surrogate endpoint validation and multi-state modelling.
Prior to joining AstraZeneca, Kirsty carried out PhD and post-doctoral research at the MRC Biostatistics Unit, University of Cambridge. Her research focussed on the development of methodology for dealing with heterogeneity and within-trial biases in meta-analysis. She also contributed to a number of real-world evidence studies, examining long-term outcomes and health service utilisation of patients.
Nicky Welton, PhD
University of Bristol, Bristol, United Kingdom
Nicky Welton is Professor in Statistical and Health Economic Modelling at the University of Bristol where she leads the Multi-Parameter Evidence Synthesis (MPES) research group, is Director of the NICE Guidelines Technical Support Unit, Co-Director of the Bristol Technology Assessment Group (TAG), and is a member of a NICE technology appraisals committee. Nicky's research concerns methods for evidence synthesis in health technology assessment and health care decision-making. This includes network meta-analysis, extrapolating survival curves, bias adjustment, and value of information analysis.
Data for Sale: The Future of Pharma?
In-person
ISSUE: The current business model of pharma is broken. The costs of drug development are too high, and the real-world effects of medicine are often too low. Only 50 new drugs make it through the needle’s eye of FDA approval every year. This panel explores another valuable resource pharma produces and utilizes, both in relation to trials and in combination with RWE: Data.
This data, when repurposed, can be of great use in the development of personalized medicine as well as approximating more knowledge on specific patient groups to improve prediction of effect or even prevention of disease. But how do we evaluate the quality and validity of data? Is it ethically acceptable to re-use health data? And doable in practice? And if it is time for pharma to embrace health data as a new commodity, then how do we price it, as data is a commodity that can be copied, shared
OVERVIEW: This panel discusses the possibilities of repurposing health data from clinical trials and proposes a way to evaluate the value of data as a commodity that acts different from all others. Tove Holm-Larsen will provide an overview of where and why the current business model in pharma is broken (5 minutes). Claus Rehfeld will present his theory on the value of data and what the future can hold (5 minutes). Anne will present the current status of data use in pharma, where data repurposing is already used, and where it seems too risky (5 minutes). Ulrik Lassen will explain how it is only possible to improve personalized medicine if we reuse health data (5 minutes). Next will be a 20 minute debate. The panel will end with 15 minutes for audience questions.
Moderators
Tove Holm-Larsen, M.Sc, PhD
Ghent University, Farum, Denmark
Tove Holm-Larsen, M.Sc., Ph.D., is guest professor of health economic evidence at University of Ghent, Belgium. She has +25 years of hands-on experience from working in and for the Pharma industry, where she has specialized in tailoring of clinical trials to provide core data for HTA and market access.
Lately, Tove’s main focus has been on the possibilities of using AI and Big Data in clinical research. She has therefore co-founded ‘DataFair’, a company combining different types of Real World Data via block-chain, and founded ‘Silvi.ai’, a company developing an AI platform to speed up the process of Systematic Literature Review and Meta-Analysis.
Tove has written several books and many articles on health economics, AI in drug development, pricing and assessment of clinical benefit. She frequently presents her views on megatrends in Pharma at Scientific conferences.
Panelists
Ulrik Niels Lassen, MD, PhD
Rigshospitalet, Copenhagen, Denmark
Trine Pilgaard, M.Sc.
Pfizer ApS, Ballerup, 84, Denmark
As Health and Value Director for Pfizer Denmark and Iceland, Trine Pilgaard is responsible for the Market Access department, ensuring access and approval of Pfizer’s products.
Trine’s department consists of experts within Health Technology Assessments, Health Economics, Market Access, Outcomes Research, Real-World Evidence, Regional Market Access and Pricing & Tenders.
Trine has +15 years of experience from the pharmaceutical industry, among others from working with Market Access and Public Affairs at Novo Nordisk and as Head of Global Public Affairs at Lundbeck.
In her early career, she worked for the World Health Organization as Pharmaceutical Policy Analyst.
Trine has a M.Sc. of Health Services Management from London School of Economics and London School of Hygiene and Tropical Medicines and a M.Sc. in Public Health from the University of Copenhagen.
When Trine is not at Pfizer, she spends her time with her family and kids. She is inspired by nature and culture is what gets her out and about.
Claus Rehfeld, M.Sc.
Datafair, Copenhagen, Denmark
9:00 - 10:00
Coffee with Exhibitors
In-person
Join us in the Poster-Exhibit Hall to network with exhibitors over a light breakfast and coffee.
9:00 - 12:30
In-Person and Virtual Poster Session 5
Live
9:00 - 12:45
Exhibit Hall Open
In-person
10:00 - 11:00
Concurrent Breakout Session 8
Sharing-of-Information in Evidence Synthesis to Strengthen HTA Decisions
In-person
Level: Foundational
PURPOSE: The evidence supporting decision-making is often restricted to studies that fully conform to the decision problem PICOS: i.e. on the specific population(P), intervention(I), comparators(C), and outcomes(O) of interest, and using robust study designs(S, e.g. RCTs). There are, however, many cases where extending the evidence base can strengthen decision-making. These include cases where the existing ‘direct’ evidence is limited (e.g. disconnected networks), complex (e.g. surrogate outcomes), or sparse (e.g. indications in children). Or may be motivated on the fact that the extended evidence plausibly retains relevance (e.g. the effectiveness of chemotherapy is judged similar across different types of solid tumors). Under such circumstances, evidence synthesis methods, potentially complemented with expert elicitation, can facilitate the sharing of information. These methods are already used in HTA, but haphazardly and with insufficient consideration for the impact that the methodology can have on the strength of sharing imposed. This workshop aims to introduce information-sharing methods and discuss with the audience opportunities and challenges of using these methods for decision making from a range of stakeholders’ perspectives.
DESCRIPTION:
This workshop will: . introduce sharing-of-information methods in evidence synthesis and present a taxonomy of methods(Soares, 4 minutes) . present exemplar applications: -- sharing using structural dose-response models: case study on triptans for migraine(Pedder, 12 minutes) -- sharing across study designs (RCTs and real world evidence) using bivariate NMA: case study on biologic therapies in rheumatoid arthritis(Bujkiewicz, 12 minutes) . present an exploration of how alternative sharing-of-information methods compare using a case study on IVIG for sepsis(Nikolaidis, 12 minutes) . structured audience discussion (with polling) on the expected opportunities and challenges of introducing information-sharing in decision-making(Soares, 20 minutes) This workshop is aimed at all that those that participate in HTA, including decision makers and analysts. The panellists have extensive experience as decision makers and have authored technical methods guidance for HTA.
Discussion Leaders
Marta Soares, MSc, PhD
University of York, York, YOR, Great Britain
Marta Soares joined the Team for Economic Evaluation and Health Technology Assessment (TEEHTA) in 2009. She holds an MSc in Biostatistics awarded by the University of Lisbon in 2008 and a PhD on “Making best use of evidence for explicit decisions in health care” awarded by the University of York in 2017.
Marta's research interests are related to the development and application of statistical, econometric and decision analysis methods in all components of health technology assessment, including statistical analysis of primary data, evidence synthesis, elicitation of expert opinion, decision modelling methods and value of further research analysis.
Marta served as a member of the National Institute for Health and Care Excellence (NICE) Technology Appraisal Committee between 2011 and 2017 and since 2017 she acts as a pharmacoeconomic expert for INFARMED in Portugal. In 2020, Marta joined the General HTA Programme Funding Committee.
In 2014, Marta won the ISPOR Award for Excellence in Application of Pharmacoeconomics and Health Outcomes Research. The award was given for the research paper: Methods to assess cost-effectiveness and value of further research when data are sparse: Negative-pressure wound therapy for severe pressure ulcers. Med Decis Making April 1 2013;33(3):415-436.
Discussants
Sylwia Bujkiewicz, PhD, MSc
University of Leicester, Leicester, United Kingdom
Sylwia Bujkiewicz is Professor of Biostatistics in the Biostatistics Research Group at the University of Leicester. She leads a research team working in the area of methods development of Bayesian multi-parameter evidence synthesis for combining data from diverse sources of evidence, including multivariate meta-analysis (of multiple outcomes including surrogate endpoints), network meta-analysis and meta-analysis of data from mixture of study designs. Sylwia is a member of NICE Decision Support Unit and Associate Editor for the Journal of the Royal Statistical Society A.
Georgios Nikolaidis, PhD
IQVIA, London, United Kingdom
George is a Senior Consultant in Health Economics and Evidence Synthesis at IQVIA. He has worked in academia, consulting, and in the appraisal of manufacturers submissions to NICE. His areas of interest include Bayesian evidence synthesis methods, the development of economic models, and the use of real-world evidence in HTA.
Hugo Pedder, MSc, BSc
University of Bristol, Bristol, United Kingdom
Hugo is a statistician at the University of Bristol, primarily developing methods for evidence synthesis, with a focus on incorporating dose and time information into Network Meta-Analysis using Bayesian methods. He sits on a NICE HTA Committee and is a member of the NICE Technical Support Unit, providing technical expertise to support clinical guideline development. He previously worked at the National Guideline Alliance, contributing to several guidelines. Hugo is a Statistical Ambassador for the Royal Statistical Society and is passionate about communicating research and data literacy.
Should Payers Increase Reimbursement for Treatments for Severe Diseases? Empirical Approaches for Estimating Risk Preferences with Applications to Grace and Insurance Value
In-person
Level: Experienced
PURPOSE:
To present a variety of empirical approaches for estimating risk preferences in the context of health, describe the benefits and limitations of these approaches, and discuss the implications of how risk preference estimates could inform payer decisions on reimbursement for treatments for severe disease.
DESCRIPTION:
Many novel approaches to value measurement for severe diseases rely on incorporating risk preferences. These include not only various petals of the ISPOR value flower (e.g., value of hope, insurance value) but also Generalized Risk Adjusted Cost Effectiveness (GRACE). This workshop will provide an overview of different empirical methods for estimating risk preferences through stated preference surveys, as well as a discussion of possible applications. The workshop will begin with Dr. Snider providing an overview of the economic theory of the value of health gains starting from a state of severe disease, possible implications for willingness to pay for treatments for severe disease, and some previous attempts to measure risk preferences. Next, Dr. Skedgel will provide a practical example of how to measure risk aversion based on generic quality-of-life values and how the result could inform operationalization of the GRACE model. Dr. Shafrin will extend this approach by describing how to estimate patient risk preferences while incorporating heterogeneity in patient valuations of specific health states within a disease. Dr. Shafrin will then discuss how the multiple random staircase approach could be used to quantify patient willingness to pay for generous insurance coverage of treatments for more vs. less severe disease. Finally, Dr. Snider will lead discussion with the discussants about the benefits and challenges of applying these risk-based estimates to value assessment for severe disease. Audience participation will include real-time survey to insure participants internalize the key steps for applying these risk measurement approaches empirically.
Discussion Leaders
Julia Snider, PhD
Kite, A Gilead Company, Santa Monica, CA, USA
Julia Thornton Snider, PhD is head of the health economics & outcomes research (HEOR) team at Kite, a Gilead company. In this role she leads the team in designing and executing a rigorous research portfolio to demonstrate product value, including burden of illness, comparative effectiveness, cost-effectiveness and budget impact, and patient experience. Prior to Kite, she led a team of researchers at Precision HEOR supporting various clients and indications. She has taught health economics at UC Berkeley and served as an economist at the UCLA Anderson School of Management. She has a BA in economics from Stanford and an MA and PhD in economics from the University of Minnesota.
Discussants
Jason Shafrin, PhD
FTI Consulting, Los Angeles, CA, USA
Jason Shafrin, Ph.D. is a Senior Managing Director at FTI Consulting's Center for Healthcare Economics and Policy. Dr. Shafrin has over 15 years of health economics research experience serving as trusted advisor and expert to a wide variety of healthcare and life sciences companies, governments and non-governmental organizations (NGOs). Dr. Shafrin is a guest lecturer at the University of Southern California, the former Director of Research at the Innovation and Value Initiative and the Founder and Editor of the Healthcare Economist blog.
Chris Skedgel, PhD
Office of Health Economics, London, United Kingdom
Chris has over 20 years of applied health economics experience in consulting and academia. His interests centre on the use of health economics to maximise the societal value of scarce healthcare resources, including the use of cost-effectiveness and cost-utility frameworks to evaluate value-for-money, and stated preference methods to elicit patient and public values.
External Control Arms, Is It the Way to Go?
In-person
ISSUE:
The growing implementation of Single Arm Trials (SAT) with External-Control Arms (ECA) has been the subject of heated debate with some advocating its use when traditional RCTs are unfeasible, while others fear that it is a means to accelerate timelines and limit costs at the expense of robust quality of evidence.
Contrasting perspectives on the different uses and applications of ECA will be discussed. OVERVIEW:
While RCTs remain the gold standard to demonstrate the efficacy and safety of technologies, with the growing number of targeted therapies and innovative technologies (e.g., cell and gene therapies), SAT are becoming increasingly common, especially in rare diseases where it may be unethical or unfeasible to implement a traditional control arm. Leveraging RWE with carefully designed ECA, can address evidence gaps of SATs and inform decision-making for regulators (EMA, FDA), and Health Technology Assessment (HTAs) bodies. However, criteria evaluating ECAs vary and several technologies receiving EMA/FDA approval with SATs supported by ECAs, face different outcomes when undergoing country-level HTA. Additionally, ECA extracted from RWD can also enrich RCTs by extending the results of a controlled environment to a broader real-world population, which can bring additional value for HTAs. Dr. Proenca
will provide an overview (approximately 15 min) on the regulatory and HTA use of ECA, supported by case studies and inputs from patient-representatives about their perspective on usage of ECA. Dr. Olsen brings an industry perspective discussing the rationale and engagement process with Regulatory agencies and HTAs and some of the strategies considered when designing RCTs with ECA. Dr. Dietrich, will draws on her HTA/payer perspective to challenge the uses and design of ECA with SAT, reinforcing the benefits of RCTs. Finally, Dr. Mukherjee leverages his background in biostatistics and EMA submissions, proposing high-level methodological considerations that should be respected for the successful design of ECA.
Moderators
Catia Proenca, PhD, PGDip
Alira Health, Basel, BS, Switzerland
Catia Proenca has over 11 years of experience in fundamental Research, RWE, and Market Access, across the pharmaceutical industry, consulting, and academia. Catia has expertise in designing and executing fit-for-purpose RWE strategies to meet key stakeholder needs (e.g., Payers/HTAs, KOLs, patients), closing evidence gaps to support the development of value propositions, and preparing a positive environment to enable access to technologies.
Catia holds a Ph.D. in Neuroscience from the Weill Cornell Graduate School of Medical Sciences, and a post-graduate diploma in epidemiology from the London School of Hygiene and Tropical Medicine. She has authored and co-authored several peered-reviewed publications. She has studied, worked and lived in Portugal, Germany, US and Switzerland.
Panelists
Eva Susanne Dietrich, MSc, PharmD
Institute for Evidence-based Positioning in the Healthcare Sector, Bonn, Germany
Professor Eva Susanne Dietrich is a pharmacist with more than 20 years professional experience in reimbursement, health politics, and drug evaluation.
She graduated at the University of Heidelberg, obtained her PhD in the field of pharmacoeconomic methodology from the University of Tuebingen and received a Master’s degree on Health Technology Assessment and Management from the University of Barcelona.
Professor Dietrich served as a deputy member of the Federal Joint Committee (G-BA) which specifies for almost 90 percent of the German population the services in medical care that are reimbursed. In parallel, she led the Department of Drugs, Remedies and Aids at the German National Association of Statutory Health Insurance Physicians (KBV) which concludes contracts with health insurance funds and other parties of the health care sector on the part of the 140,000 office-based physicians and psychotherapists in Germany. In the following years, she organized a scientific institute for Techniker Krankenkasse, one of the largest health insurance funds in Germany, and was responsible for the Management Division Health Sciences. Thereafter, she managed a scientific consulting firm in Basel for eight years and founded the Institute of Evidence-based Positioning in the Healthcare Sector in 2018.
An important emphasis of her professional and academic activities is the critical review of the evidence of new drugs, their classification in the existing care context and, more specifically, early benefit assessments and the German AMNOG process as well as the compilation of AMNOG dossiers.
Since 2000, Eva Susanne has been teaching at the department of clinical pharmacy at the University of Bonn, where she holds a honorary professorship and also leads a module in the drug regulatory affairs degree programme. Apart from this she taught pharmacoeconomics, evidence based medicine, and benefit legislation e.g. at the universities of Hamburg, Berlin and Marburg.
Rajat Mukherjee, PhD
Alira Health, Barcelona, Spain
Rajat has over 25 years of experience in Biostatistics in the pharmaceutical industry and public health.
Rajat joined Alira Health in April 2022 as VP Advanced Statistics and Data Sciences. In his current role Rajat’s main responsibilities include definition and implementation of long-term business strategies in collaboration with Alira Health leaders from various practices such as Market Access, RWE, Regulatory and Management consulting and to provide strategic statistical consulting for clinical pipelines and clinical trials. His main areas of expertise include Bayesian and Adaptive trial designs, application of Machine Learning and AI for diagnostics and biomarker discovery and statistical computation to facilitate the incorporation of complex endpoints in clinical trials. Rajat is also keen in developing statistical software to empower statisticians and clinical trialists.
In his previous position Rajat acted as a Senior Research Fellow/Consultant for Cytel, leading innovative clinical trials design activities including trials under the CID (FDA) program. In addition, his responsibilities included consulting in areas of Bayesian adaptive designs, big-data, biomarker discovery and machine learning. He was a part of the executive team for developing consulting business strategies, thought leadership activities (research publication, conferences, etc.) and mentoring fellow consultants.
Rajat holds a PhD degree in Mathematical Statistics from the University of Wisconsin-Madison, an MSc degree in Applied Statistics from Bowling Green State University, Ohio and a BSc degree in Statistics from the Presidency College, Calcutta.
Melvin "Skip" Olson, PhD
Novartis Pharma AG, Basel, BS, Switzerland
Melvin "Skip" Olson is currently the Global Head of Integrated Evidence Strategy and Innovation at Novartis. As such, he is responsible for promoting the very best in research methodology and applications of Real World and other Evidence across all therapeutic areas and around the globe to drive better decision making. He comes from a background in HE&OR where he has led the use of RWE to transform the generation of patient insights and value for money assessments. He earned a ScD in Biostatistics from Harvard University and has worked in the pharmaceutical industry for nearly 30 years.
Addressing Equity Challenges in Genome Sequencing: What Can Health Economics Contribute?
In-person
ISSUE: There is growing interest in going beyond conventional approaches to economic evaluation to understand whether costs and effects are distributed fairly, and to what extent trade-offs exist between efficiency and equity objectives. One clinical context in which inequities may impact on value is genome sequencing. Sequencing is being implemented in clinical practice at the population level globally, but initial analyses have highlighted unequal test access (impacting data diversity) and outcomes. These inequalities may be inequities, and could lead to bias in studies evaluating the cost-effectiveness of population sequencing programmes. This panel session will identify key challenges for health economic analysis related to diverse datasets (data sources, type, access, population coverage) and inequalities in a genomic testing context. The session will begin with an overview, then engage panellists with backgrounds in multiple jurisdictions in a structured discussion to consider evidence challenges and debate potential approaches and solutions. Audience input will complement the panel discussion.
OVERVIEW: Genome sequencing – the process of determining an individual’s entire DNA sequence – could transform care for people with cancer or rare diseases worldwide, improving diagnosis, prognosis and clinical management. Population sequencing initiatives (e.g. 100,000 Genomes Project (England), All of Us Program (USA), 1+Million Genomes initiative (EU)) have generated valuable evidence on the potential clinical benefits of implementing sequencing in routine care. Evidence on cost-effectiveness is more elusive, and equity issues may impact the value case; evidence suggests inequalities exist in both access to sequencing (impacting data diversity), and the health and cost outcomes arising from sequencing. Approaches such as distributional cost-effectiveness analysis could help quantify key trade-offs between improving total health and reducing inequality in outcomes. However, evidence gaps may challenge the implementation of such an approach. Alternatively, health systems modelling – underpinned by population-level data – could help to quantify issues around access and utilisation.
Moderators
James Buchanan, DPhil
University of Oxford, Oxford, United Kingdom
Dr James Buchanan joined the Health Economics Research Centre in 2005 and he primarily works on health economics projects in the area of genomic testing, including economic evaluations and stated preference studies. This work spans multiple clinical specialties, including cancer (chronic lymphocytic leukaemia, bowel cancer), rare diseases, infection control practice, screening and inflammatory bowel disease. His DPhil (PhD) work investigated issues related to the economic analysis of genomic diagnostic technologies for multifactorial genetic diseases in the UK NHS, based on a study evaluating genomic testing in haematological cancers. Alongside this academic work, James curates the Health Economics and Genomics blog (https://healtheconomicsandgenomics.com/). In addition to his genomics research, James contributes to multiple projects at HERC related to the economics of antibiotic prescribing and antimicrobial resistance.
Panelists
Maarten IJzerman, PhD
University of Melbourne, Melbourne, VIC, Australia
Maarten J. IJzerman is Professor of Cancer Health Services Research and Dean of Erasmus School of Health Policy and Management in Rotterdam, the Netherlands. He is a part-time Professor of Cancer Health Services Research in the Faculty of Medicine, Dentristry and Health Sciences of the University of Melbourne in Australia.
He leads a data-driven research program focussing on the implementation of genomics enabled precision oncology.
Jeroen Jansen, PhD
University of California – San Francisco, San Francisco, CA, USA
Deborah Marshall, PhD, BSc
University of Calgary, Calgary, AB, Canada
Deborah is a professor at Cumming School of Medicine, University of Calgary. Her research program focuses on the measurement of preferences, cost-effectiveness analysis, and simulation modeling of health services and interventions. Deborah has over 20 years of research experience in health technology assessment agencies, academic institutions, and industry settings in Canada, US, and Europe. She is a founding co-investigator of the Patient and Community Engagement Research (PaCER) Program and co-leads the economics and stated preferences research platforms for the Genome Canada/ Candian Institutes for Health Research funded programmes: Canada-Netherlands Personalized Medicine Network in Childhood Arthritis and Rheumatic Disease (UCAN CANDU) and the SOLVE on rare diseases.
Deborah is an active member of the ISPOR as the past-president of the Board of Directors, and co-author on four ISPOR Task Force Reports for Good Research Practice in Preferences, and Chaired the Simulation modeling Task Forces.
Innovate or Continuously be Outdated: The Need for a “Living” Approach to HTAs
In-person
ISSUE:
The recent COVID pandemic not only created the necessity, but an opportunity to implement a responsive, innovative “living” approach to health technology assessment (HTA). The need for change is not unique to the pandemic. With the increased pressure to provide patients with early access to new health technologies, the demand for continual data collection from both trials and real-world studies is rising. These pressures opened a discussion on whether HTA bodies need to evolve from the traditional approach of systematic reviews, which become instantaneously outdated, to a “living” approach using technological tools and methods capturing the constant stream of new evidence underpinning a living economic analysis and facilitates data sharing between organisations. So far, HTA bodies have been slow in adopting such innovation.
OVERVIEW:
HTA bodies face significant challenges on how to obtain rapidly generated evidence on promising technologies efficiently and rigorously, paralleled with a demand to consider a wider evidence base, whilst still maintaining the same methodological standards under constrained time and resources. This panel will debate, from a research, industry, and automation perspective (15 min each presentation) if a new paradigm of “Living HTAs” is the only real viable solution to efficiently respond to the rapidly evolving and complex treatment and evidence landscape. How can automated software companies and industry facilitate transparency and acceptance in the use of technology in the “Living HTA” approach as a viable, and only means to efficiently inform decision-making? What are the main methodological and operational challenges if moving towards a “living” standardized approach for all types of assessment? How can we establish a set of standards to minimise analytical time to process data, while optimizing certainty in decision-making? 10min interactive discussion will follow including using real time polling questions. Stakeholders (industry, researchers, payers) will benefit from this panel.
Moderators
Grammati Sarri, PhD
Cytel, London, United Kingdom
Chair-Elect ISPE Comparative Effectiveness Special Interest Group
Active Member of ISPOR RWE SIG
Moderator in previous Issue Panels
US ISPOR 2022_Is the Global Real-World Data Supply-Chain Broken? Choosing Between RWD Quality Versus Locality in Supporting Single Arm Submissions [Issue Panel IP16, May 18]
HTAi 2019_Integrating Patient Experience In Complex Pharmacological Solutions: Are The HTA Bodies Ready?
selected Webinars
ISPE Sponsored_ "Building Trust in Reliably Synthesizing Evidence from Non-Randomized Studies and RCTs in Healthcare Decision Making; a proposed ISPE Framework" October 2021
HTAi issue panel 2021 (panelist)_ Bridging Evidence Gaps in HTA: Building Confidence In Analytical Methods for Combining Results from Randomized and Non-Randomized Studies
HTAi issue panel 2020
Expert Workshop (2021): New RWE frameworks, new analytical methods but not yet much HTA acceptance; what is next?
Relevant Publications
sarri et al (2022) ISPE-Endorsed Guidance in Using Electronic Health Records for Comparative Effectiveness Research in COVID-19: Opportunities and Trade-Offs
3. Kongnakorn T, Sarri G, Freitag A, Marczell K, Kazmierska P, Masters E, Pawar V, Zhang X. Modeling Challenges in Cost-Effectiveness Analysis of First-Line Immuno-Oncology Therapies in Non-small Cell Lung Cancer: A Systematic Literature Review. Pharmacoeconomics. 2022 Feb;40(2):183-201. doi: 10.1007/s40273-021-01089-4.
Sarri G et al. The Role of Patient Experience in the Value Assessment of Complex Technologies – Do HTA Bodies Need to Reconsider How Value is Assessed? Health Policy 2021.
Sarri G et al. Framework for the synthesis of non-randomised studies and randomised controlled trials: a guidance on conducting a systematic review and meta-analysis for healthcare decision making. BMJ Evid Based Med. 2020 Dec 9:bmjebm-2020-111493.
D'Andrea E, ... Sarri G. How well can we assess the validity of non-randomised studies of medications? A systematic review of assessment tools. BMJ Open. 2021 Mar 24;11(3):e043961. doi: 10.1136/bmjopen-2020-043961.
11. Sarri G et al. PNS221 Healthcare Decision-Making Using Real-World Evidence: Many Opportunities, Little Guidance. Results from a Systematic Review of Guidance. Value in Health 2020.
13. Freitag A and Sarri G. PNS156 Are Surrogate Outcomes Enough for the Reimbursement of Health Technologies? An Umbrella Literature Review. Value in Health 2020.
Real World Evidence in Network Meta-analysis: Is it Now a “Must Have” in Technology Appraisals?, July 2018
New EU HTA Directive Set to Revolutionize HTA in Europe – How Will it Affect You?, May 2018
Panelists
Seye Abogunrin, MBBS, MPH, MSc
F. Hoffmann-La Roche, Basel, BS, Switzerland
Dr. Seye Abogunrin, MB BS, MPH, MSc, is a Global Access Evidence Leader and a health economics methods expert at F. Hoffmann-La Roche, Switzerland. Dr. Abogunrin has twenty years of combined research, clinical, public health and consulting experience, including more than ten years of conducting health economics and outcomes research. Before joining Roche, he worked with pharmaceutical, biotechnology, and medical device companies in a consulting capacity. His work has been presented at key scientific conferences of societies such as the American Society of Clinical Oncology, European Society for Medical Oncology, International Society for Pharmacoeconomics and Outcomes Research, joint European Neonatal Societies, and International Parkinson and Movement Disorder Society. Previously, Dr. Abogunrin also worked as a hospital doctor, project coordinator and in various managerial roles in Nigeria for private- and third-sector organisations. He is an advocate, enthusiast and strategist for disruptive healthcare technologies.
Dr. Abogunrin holds an MSc in Health Policy, Planning, and Financing jointly from the London School of Hygiene and Tropical Medicine and the London School of Economics and Political Science. He also has a Master’s degree in Public Health (MPH) and a medical degree (MB BS) from the University of Lagos.
Saskia Cheyne, MSc, BSc
University of Sydney, Arncliffe, NSW, Australia
Saskia Cheyne is a Research Fellow in Living Evidence Methods at Cochrane Australia and the Australian Living Evidence Consortium, and a Consultant in Living Guideline Methods for the World Health Organization. She leads research developing methods for living guidelines and evidence-based decision-making. Saskia has worked extensively on evidence reviews for the last decade, including intervention, prognostic, diagnostic, qualitative, overviews, living, and surveillance reviews, of RCT and observational evidence. She previously worked as a Senior Evidence Officer and Methods Co-Chair for the National COVID-19 Clinical Evidence Taskforce. Prior to joining Monash University Saskia undertook evidence reviews for Health Technology Assessments (HTA) and guidelines at the NHMRC Clinical Trials Centre at the University of Sydney, where she continues as a PhD candidate. Saskia also worked for the National Institute of Health and Care Excellence (NICE) in the UK as a Research Fellow and Project Manager conducting evidence reviews for guidelines
Gaugarin Oliver, MSc
CapeStart, Cambridge, MA, USA
Gaugarin "G" is the CEO of CapeStart, which helps life sciences enterprises scale their AI innovation through data annotation, machine learning, and software development. CapeStart's expertise includes using AI to solve complex problems in Systematic Literature Review, HEOR, Pharmacovigilance, and Clinical Trials.
He is a successful serial entrepreneur (4 startups and 2 new business initiatives) and investor / mentor to over 30 early-stage companies. He has a BS in Electrical Engineering from Government College of Technology in India, MS in Industrial Engineering from the University of Oklahoma and executive education from Harvard Business School.
Podium Sessions
Exploring the Impact of Cancer Treatment on Patients' Quality of Life
In-person
This session will explore the impact of cancer treatments on patients' quality of life using direct and indirect comparisons and systematic literature reviews. It shows that monitoring patients' quality of life from patients' reported outcomes measures provides important information to determine the benefits of treatments, in addition to survival.
Moderator
Bill Byrom, B.Sc., Ph.D.
Signant Health, Nottingham, NTT, United Kingdom
Bill serves as Vice President at Signant Health (www.signanthealth.com/company/leadership/), a global company providing technology solutions for pharmaceutical clinical trials. He has worked in the Pharmaceutical industry for 30+ years and is a recognised industry leader in eClinical product strategy, electronic clinical outcome assessments (eCOA), and decentralized clinical trials. Bill is an experienced scientific expert and the author of over 70 publications, and two industry textbooks on electronic patient-reported outcomes (ePRO). His recent scientific work includes the use of wearable and sensor technology, and bring-your-own-device (BYOD) eCOA in clinical trials. Bill serves on two industry expert task forces within the International Society for Pharmacoeconomics and Outcomes Research (ISPOR), is a member of the scientific leadership board of the Digital Medicine Society (DiMe), and a core contributor to the US Critical Path Institute’s eCOA Consortium. Bill is a senior visiting professor within Nottingham Trent University's Medical Engineering Design Research Group.
P61: Health State Utility Values and Quality of Life in Patients Receiving Ripretinib in the Phase 3 Invictus Trial and a Real-World Evidence Study in China
10:30AM - 10:45AM
Jones RL1, Blay JY2, Chi P3, Bauer S4, Gelderblom H5, Shen L6, He YL7, Heinrich MC8, Schöffski P9, Zalcberg JR10, Harrow B11, Sherman ML11, Ruiz-Soto R11, Becker C12, von Mehren M13
1Royal Marsden Hospital and Institute of Cancer Research, London, UK, 2Centre Léon Bérard, Lyon, France, 3Memorial Sloan Kettering Cancer Center, New York, NY, USA, 4Universitaetsklinikum Essen, Essen, Germany, 5Leids Universitair Medisch Centrum, Leiden, Netherlands, 6Peking University Cancer Hospital and Institute, Beijing, China, 7Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China, 8Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA, 9University Hospitals Leuven, Leuven, Belgium, 10The Alfred Hospital, Melbourne, Australia, 11Deciphera Pharmaceuticals, LLC, Waltham, MA, USA, 12Deciphera Pharmaceuticals, LLC, belmont, MA, USA, 13Fox Chase Cancer Center, Philadelphia, PA, USA
OBJECTIVES: Ripretinib is a switch-control tyrosine kinase inhibitor (TKI) approved for fourth-line (4L) treatment of patients with advanced gastrointestinal stromal tumor (GIST). In the INVICTUS study (NCT03353753) ripretinib demonstrated clinically meaningful benefit and a well-tolerated safety profile; patients reported stable or improved health-related quality of life (HRQoL) vs. placebo.1 We present health state utility values (HSUV) derived from EuroQol-5-Dimension (EQ-5D) questionnaires collected during both INVICTUS and a post-approval real-world evidence (RWE) study conducted in China.
METHODS: In INVICTUS, ≥4L GIST patients received ripretinib 150 mg (n=85) or placebo (n=44) once daily (QD).1 HRQoL was assessed using EQ-5D 5-Level (5L) at Day 1 of each cycle and end of treatment. Data were mapped using UK value sets to EQ-5D 3-Level (3L) utilities.2
In the RWE study, ≥4L GIST patients received ripretinib 150 mg QD (N=241). HRQoL was assessed monthly using EQ-5D-3L over 13 months. Data were mapped using Chinese value sets to EQ-5D-3L utilities.
3 For both studies, mean HSUV were estimated for progression-free (PF) and progressed disease (PD) states.
RESULTS: In INVICTUS, EQ-5D completion was >99%. HSUV for ripretinib vs. placebo were 0.75 vs. 0.73 for PF patients and 0.75 vs. 0.71 for PD patients. In the RWE study, EQ-5D completion was 65%. HSUV were 0.81 for PF patients and 0.67 for PD patients.
CONCLUSIONS: HSUV calculated from the INVICTUS study were higher for patients receiving ripretinib vs. placebo. HSUV calculated from the RWE survey were similar, indicating high HRQoL for patients receiving ripretinib both within a clinical trial and under real-world conditions. These HSUV may be used to inform economic evaluations of novel therapies for patients with advanced GIST.
REFERENCES:
1Blay JY et al. Lancet Oncol. 2020;21(7):923–34;
2van Hout B et al. Value Health. 2012;15(5):708–15;
3Liu GG et al. Value Health. 2014;17(5):597–604.
FUNDING: Deciphera Pharmaceuticals, LLC. Medical writing by Costello Medical.
P64: Health-Related Quality of Life in HER2-Positive Early Breast Cancer Woman Using Trastuzumab: A Systematic Review and Meta-Analysis
10:15AM - 10:30AM
Khoirunnisa S1, Suryanegara FDA1, Setiawan D2, Postma MJ1
1University Medical Center Groningen, Groningen, GR, Netherlands, 2Universitas Muhammadiyah Purwokerto, Banyumas, JT, Indonesia
OBJECTIVES: This study explored the effects of early trastuzumab treatment on health-related quality of life (HRQoL), including pooled meta-analysis, in an effort to provide an integrated assessment of HRQoL for Her2-positive early breast cancer patients.
METHODS: A literature review was performed using three databases, focusing on treatment using trastuzumab during the early stage. The mean changes from baseline during and after treatment were extracted from the included RCT papers and cross-sectional HRQoL scores were obtained from observational studies included. Mean difference (MD) and 95% confidence intervals were assessed by a random effect or fixed effect model based on heterogeneity (I2).
RESULTS: A total of seven studies were identified and reviewed, consisting of 5 randomized control trials and 2 cross-sectional studies. The pooled analysis of the mean change from baseline during treatment resulted in an MD of 1.92 (95% CI = 1.59 to 2.25, P < 0.05, I2 = 0%), favouring the trastuzumab group. A non-significant result of the mean change from baseline after treatment appeared in the analysis of 12-month follow-up. In the observational studies, pooled analyses of HRQoL showed that trastuzumab meaningfully demonstrated an improved HRQoL profile (MD = 9.29, 95% CI =1.31 to 17.27, P = 0.02, I2 = 0%).
CONCLUSIONS: Trastuzumab as a targeted therapy resulted in a favourable effect on HRQoL in the early stages of Her2-positive breast cancer. The findings of significant improvements in patients’ HRQoL and less clinically important deterioration in side effects of trastuzumab-containing regimen during treatment were supported by prolonged survival.
Keywords: trastuzumab, HRQoL, breast cancer, meta-analysis
P63: Patient-Reported Outcomes Following Treatment with Vimseltinib for Tenosynovial Giant Cell Tumour in a Phase 2 Expansion Study
10:00AM - 10:15AM
Blay JY1, Gelderblom H2, Rutkowski P3, Wagner AJ4, van de Sande M5, Stacchiotti S6, Le Cesne A7, Palmerini E8, Vallee M9, Harrow B10, Becker C11, Jarecha R9, Sharma M9, Tap WD12
1Centre Léon Bérard, Lyon, France, 2Leids Universitair Medisch Centrum, Leiden, Netherlands, 3Maria Skodowska-Curie National Research Institute of Oncology, Warszawa, Poland, 4Dana-Farber Cancer Institute, Boston, MA, USA, 5Leiden University Medical Centre, Leiden, Netherlands, 6Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy, 7Gustave Roussy, Villejuif, France, 8IRCCS Instituto Ortopedico RIzzoli, Bologna, Italy, 9Deciphera Pharmaceuticals, LLC, Waltham, MA, USA, 10Deciphera Pharmaceuticals, LLC, Burlington, MA, USA, 11Deciphera Pharmaceuticals, LLC, belmont, MA, USA, 12Memorial Sloan Kettering Cancer Center, New York, NY, USA
OBJECTIVES: Tenosynovial giant cell tumour (TGCT) is a rare, locally aggressive neoplasm caused by upregulation of the colony-stimulating factor 1 (CSF1) gene. Vimseltinib is an oral switch-control tyrosine kinase inhibitor specifically designed to selectively and potently inhibit CSF1 receptor (CSF1R) and was well tolerated by patients in a phase 1/2 study. Here, we evaluate patient-reported outcome measures for patients with TGCT treated with the recommended phase 2 dose (RP2D) of vimseltinib (30 mg twice weekly; NCT03069469).
METHODS: Patients with TGCT not amenable to surgery were treated in 2 cohorts: A (no prior anti-CSF1/CSF1R therapy except imatinib and/or nilotinib) and B (prior anti-CSF1/CSF1R therapy). Pain was evaluated using the brief pain inventory; swelling and stiffness at the site of the tumour were assessed with symptom-specific questions on the numeric rating scale (scale from 0–10 with 0 being none and 10 being worst imaginable). Results at Week 25 are reported.
RESULTS: As of Feb 18, 2022, 57 patients were enrolled: 46 in A (enrollment complete) and 11 in B (enrollment ongoing). In cohort A, 22/46 (48%) and 24/46 (52%) patients had ≥30% improvement in worst and average pain, respectively. In cohort B, 6/9 (67%) patients had ≥30% improvement in both worst and average pain. At baseline, the average score was 5.1 for both swelling and stiffness in cohort A; swelling decreased by 2.5 points and stiffness decreased by 2.0 points. In cohort B, the average baseline scores for swelling and stiffness were 4.0 and 5.0, respectively; swelling decreased by 2.4 points and stiffness decreased by 2.7 points.
CONCLUSIONS: At the RP2D of vimseltinib, patients in both cohorts reported improvement in worst and average pain and joint swelling and stiffness at Week 25. Results support continued evaluation of vimseltinib at this dose level in the ongoing phase 3 MOTION trial (NCT05059262).
P62: Parametric Survival Extrapolations of Larotrectinib and Entrectinib for NTRK Fusion Cancers
10:45AM - 11:00AM
Sullivan S1, Suh K2, Williamson T3, Carlson JJ1
1University of Washington, Seattle, WA, USA, 2University of Pittsburgh, Pittsburgh, PA, USA, 3Bayer U.S. LLC, Whippany, NJ, USA
OBJECTIVES: Larotrectinib and entrectinib are tumor-agnostic tropomyosin receptor kinase (TRK) inhibitors for the treatment of advanced or metastatic solid tumor cancers with neurotrophic tyrosine receptor kinase (NTRK) gene fusions. Regulatory approval of both agents was based on data from single-arm Phase 1/2 studies, including tumor-agnostic basket trials. In the absence of randomized controlled trials, there remains a paucity of data to demonstrate the comparative effectiveness of these agents. The objective was to extrapolate clinical trial results to compare estimated progression-free and overall life-years (LYs) and quality-adjusted LYs (QALYs) for larotrectinib and entrectinib in patients with colorectal cancer (CRC), soft tissue sarcoma (STS), and brain metastases (BM) at baseline.
METHODS: We performed a naïve direct comparison of larotrectinib versus entrectinib using a partitioned survival model to project long-term progression free and overall survival. Larotrectinib survival data were from a July 2020 analysis of adult patients (≥18 years of age) with NTRK fusion CRC, STS, and BM prior to starting TRK inhibitor treatment. Survival inputs for entrectinib were derived from published literature and conference abstracts. Exponential curve fitting methods were used to extrapolate progression-free (PFS) and overall survival (OS) for both treatments and across all three tumor types.
RESULTS: Larotrectinib resulted in an additional 1.58 LYs (1.17 QALYs), 5.81 LYs (2.02 QALYs), and 1.01 LYs in CRC, STS, and BM, respectively as compared to entrectinib. These analyses that included more patients and more mature data from the pivotal Phase 1/2 studies showed consistent results for patients treated with larotrectinib as compared to entrectinib.
CONCLUSIONS: In patients with NTRK gene fusion CRC, STS, and BM, larotrectinib provided life expectancy and QALY gains compared to entrectinib. Additional studies would be beneficial as more patients are treated and survival data develops to better inform comparative effectiveness and economic models.
Public Health
Virtual
Moderator
Laura Mccullagh, PhD
National Centre for Pharmacoeconomics, Dublin, Ireland & Discipline of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, D, Ireland
Dr Laura McCullagh is Head of Research, a Chief I Pharmacist and a member of the Senior Management Team within the National Centre for Pharmacoeconomics (NCPE), Ireland. Dr McCullagh is a lead health technology assessor within the NCPE. The NCPE is affiliated with Trinity College Dublin; roles here include various teaching and research commitments. Previous roles have included Associate Professor of Pharmacoeconomics & Health Technology Assessment, Trinity College Dublin, Senior Medicines Information Pharmacist (Oxford Radcliffe Trust, UK). Dr McCullagh holds a PhD (Trinity College Dublin) for research which focused on HTA within the Irish Healthcare Setting.
P65: Impact of COVID-19 on Hospital Screening, Diagnosis and Treatment Activities Among Prostate and Colorectal Cancer Patients in Canada
10:00AM - 10:15AM
Lee FSH1, Halat M1, Bleibdrey N2, Zhang S1, Chalmers R1, Zimskind D1
1ZS Associates, Toronto, ON, Canada, 2ZS Associates, Hampton, NJ, USA
OBJECTIVES: Suspension of cancer screening and treatment programs were instituted to preserve medical resources and protect vulnerable populations. This research aims to investigate the implications of COVID-19 on cancer management and clinical outcomes for patients with prostate and colorectal cancer, two of the most prevalent cancers in Canada.
METHODS: Hospital cancer screening, diagnosis, treatment, length of stay, and mortality data among prostate and colorectal cancer patients between April 2017 and March 2021 were obtained from the Canadian Institute for Health Information. Baseline trends were established with data between April 2017 and March 2020 for comparison with data collected during the pandemic between April 2020 and March 2021 using Student’s t-tests. Scenario analyses were performed to assess the incremental capacity requirements needed to restore hospital cancer care capacities to the pre-pandemic levels in Canada.
RESULTS: For prostate cancer, A 12% decrease in hospital diagnoses and a 5.3% decrease in treatment activities were observed during COVID-19 between April 2020 and March 2021. Similarly, a 43% reduction in hospital colonoscopies, 11% decrease in hospital diagnoses and 10% decrease in treatment activities were observed for colorectal cancers. Additionally, a marked reduction in hospital prostate cancer (12%) and colorectal cancer (21%) mortality was observed over the same period. Overall, an estimated 1,438 prostate and 2,494 colorectal cancer cases were undiagnosed, resulting in a total of 620 and 1,487 unperformed treatment activities for prostate and colorectal cancers, respectively, across the nine provinces included in the study in Canada. To clear the backlogs of unperformed treatment procedures in will require an estimated 3%-6% monthly capacity increase over the next 6 months.
CONCLUSIONS: A concerted effort from all stakeholders is required to immediately ameliorate the backlogs of cancer detection and treatment activities. Mitigation measures should be implemented to reduce the impact of future interruptions to regular practice.
P68: Investing in the Prevention of Infectious Disease Outbreaks: Fiscal Health Modelling for Assessing the Public Investment Case
10:45AM - 11:00AM
Schöttler M1, van der Schans S2, Connolly M3, Van der Schans J4, Boersma C5, Postma M6
1Health-Ecore B.V., Zeist, UT, Netherlands, 2University Medical Center Groningen, University of Groningen, Groningen, GR, Netherlands, 3Global Market Access Solutions LLC, Mooresville, NC, USA, 4University of Groningen, Faculty of Economics and Business, Unit of Economics, Econometrics and Finance, Groningen, Netherlands, 5University of Groningen, University Medical Center Groningen, Zeist, UT, Netherlands, 6Health-Ecore, Zeist, UT, Netherlands
OBJECTIVES:
National strategies for preparedness on future outbreaks of COVID-19 often include the timely preparedness with available vaccines. Fiscal health modelling (FHM) has recently been brought forward as an additional analysis by defining the fiscal impact of a health condition from a governmental perspective. As governments are the main decision-makers on preparedness, this study assesses a FHM framework for a communicable disease.
METHODS:
Using data of the Dutch COVID-19 pandemic, two approaches for identifying the fiscal impact of COVID-19 were assessed: 1. modelling of future fiscal impact based on publicly available population counts; and 2. assessment of the extrapolated tax and benefit income and gross domestic product (GDP) in a particular time period with the respective realized values. The appropriateness of different modelling approaches was in line with the ISPOR FHM guidelines and extensively validated in an expert meeting.
RESULTS:
Dutch publicly available data was the basis for the analysis performed, showing total counts of 2.36 million infections, 52,678 hospitalisations, 9,805 ICU admissions and 9,493 deaths in a period of 24 months following the start of COVID-19 in 2020. Consequences which can be causally linked to these counts influencing income tax collected and social benefits paid (approach 1) amounted to a fiscal loss of €158 million over 2 years. The total losses in terms of the fiscal income and GDP (approach 2), were estimated at respectively €13,582 million and €96.3 billion over 24 months.
CONCLUSIONS:
This study is a full integrated fiscal macro-economic orientation to analyse different aspects of an infectious disease outbreak and its influence on government public accounts. The suitability of the two presented approaches depends on the perspective of the analysis, time horizon of the analysis and availability of data. The consequence-linking approach is more suited to a prospective estimation and the extrapolating approach more to a retrospective one.
P67: Cumulative Effect of Depression on Health Worsening During The COVID-19 Lockdown Among Diabetic Patients in Europe
10:15AM - 10:30AM
Laurent T1, Bonnal L2, Favard P3
1Université de Tours, Versailles, France, 2Université de Poitiers, Poitiers, France, 3Université de Tours, Tours, France
OBJECTIVES: A greater burden of depressive symptoms in those with diabetes was observed during COVID-19 pandemic. Here, we investigated the cumulative effect of depression before the pandemic on health worsening during the COVID-19 lockdown in Europe.
METHODS: Individuals aged 65 years or more who responded to the fifth wave (in 2013) from 29 European countries, and reporting treated diabetic condition within the Survey of Health, Aging and Retirement in Europe (SHARE) study were identified. These individuals were followed through the sixth (in 2015) and eighth (2019) waves. The cumulative effect of depression, as the cumulated number of times that depression was declared across multiple waves, was evaluated after identifying health worsening during the COVID-19 pandemic based on a single question in the questionnaire survey conducted within SHARE in the period June-September 2020. The effect of depression was estimated using a marginal structural model accounting for baseline characteristics and time-dependent confounding.
RESULTS: In the fifth, six and eighth waves, 5062, 3622 and 1579 patients were identified, respectively, and among the latter, 1140 patients participated in the COVID-19 questionnaire. A logistic regression using baseline covariates yielded an increasing odds ratio of depression on health worsening (OR=3.24; 95%CI=3.17-3.31) during the lockdown. For the marginal structural model, the effect of depression was significant but reduced (OR=1.12; 95%CI=1.01-1.23), suggesting overestimation when accounting for baseline characteristics only.
CONCLUSIONS: In our study, a significant effect of depression before the pandemic on health worsening during lockdown was revealed. This study highlights the importance of taking control measures on isolated depressive diabetic patients from multiple stakeholder perspectives, including health professionals and health policy makers.
P66: Understanding of Post-COVID Conditions (PCC) and Related Burden of Illness
10:30AM - 10:45AM
Guisinger A1, Misra Y2, Czworka D3, Pham S2, Rousculp M4
1AESARA, Fort Myers, FL, USA, 2AESARA, Chapel Hill, NC, USA, 3Novavax, Inc., Gaithersburg, MD, USA, 4Novavax, Inc., Cary, NC, USA
OBJECTIVES: Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pathogen, is a multi-organ disease with a broad spectrum of manifestations.1-2 Long-term complications following SARS-CoV-2 infection, known as post-COVID conditions (PCC) or ‘long COVID’, are important to understand due to their significant burden on healthcare systems and patients.3 PCC may affect individuals differently, manifesting as a sequela of symptoms that can vary in duration and severity.4-5 Additionally, little is known about the risk factors of PCC, making it difficult to describe those more likely to develop PCC. A targeted literature review was conducted to elucidate understanding of PCC and impact on patient health-related quality of life (HRQoL) from a global perspective.
METHODS: PubMed was searched using terms describing PCC for global, English-language studies (2020-2022). Included studies reported any relationship between patient HRQoL and PCC. Single-case reports were excluded.
RESULTS: From 349 identified publications, 37 underwent full-text review; 20 met inclusion criteria1-3,6-22 (17 excluded). Median follow-up time was 15 weeks, with most studies (85%) including follow-up of at least 12 weeks. Most studies attributed the symptoms of PCC to a decrease in HRQoL. Fatigue was the most reported symptom, followed by other neurological and psychological symptoms (e.g., headache, sleep disturbances, cognitive impairment, loss of taste and smell, vision and hearing changes, impaired mobility, anxiety/depression). Cardiopulmonary and digestive symptoms were also reported in all studies. Almost all studies stated the need to understand risk factors causing symptoms of PCC to better characterize HRQoL.
CONCLUSIONS: This study revealed the diverse symptomatic burden and negative impact on HRQoL in patients with PCC. More research is needed to understand the risk factors and evolving complexity and long-term impact of PCC to ultimately guide global prevention and treatment of COVID-19.
*Note: references are available upon request and will be included with the ISPOR presentation.
Applications of Machine Learning and Artificial Intelligence in Real-World Studies
In-person
Machine learning and artificial intelligence has an increasingly important role in health care sector and medical sciences. This session gives an overview of the state of art application of ML and AI in clinical practice.
Moderator
Imre Boncz, MD, MSc, PhD, Habil
University of Pécs, Pécs, Hungary
Current positions:
- professor & director, Institute for Health Insurance, Faculty of Health Sciences, University of Pécs, Hungary
- vice-dean, Faculty of Health Sciences, University of Pécs
- vice-president for strategic affairs, Clinical Center, University of Pécs
- president, Health-Economics and Health Care Management Section, Medical Advisory Board of the Ministry of Human Resources, Hungary
- secretary, Committee on Preventive Medicine, V. Section of Medical Sciences, Hungarian Academy of Sciences
Education:
2021. Postgraduate Diploma in Health Research, University of Oxford, UK
2010. habilitation (Dr. Habil) University of Pécs, Hungary
2008. „Leaders to Leaders (L2L)” Project Hope, The University of Sheffield, UK
2007. doctoral degree (Ph.D) University of Pécs, Hungary
2005. Diploma in „Health Outcome Research“ Vienna School of Clinical Research, Austria
1997. Master of Science (M.Sc.) Erasmus University Rotterdam, The Netherlands
1996. Diploma in Health Services Management, Faculty of Economics, Janus Pannonius University, Pécs, Hungary
1993. medical doctor (M.D.) University Medical School of Pécs, Hungary
Former positions:
2006-2008. Director for strategic affairs (Coordinative Center for Medical and Health Sciences, University of Pécs, Hungary)
2001-2006. department head, Department of Health Policy, National Health Insurance Fund Administration (OEP), Budapest
1999-2001. director, County Vas Health Insurance Fund, Szombathely, Hungary
1993-1999. assistant professor, University Medical School of Pécs, Hungary
Research interest:
- health policy analysis
- health care financing
- health insurance
- health services research
- health-economics
- health technology assessment
- organized public health screening programmes
- real world data and big data analysis
P58: Predicting the Risk of Stroke Using Machine Learning on a Large Administrative Health Database
10:30AM - 10:45AM
Ghiani M1, Maywald U2, Wilke T1
1IPAM, University of Wismar, Wismar, Germany, 2AOK PLUS, Dresden, Germany
OBJECTIVES: Stroke is a leading cause of death worldwide and understanding its risk factors is key for prevention. This study investigates the predictive performance of several machine learning classifiers using a large administrative database to predict individual stroke risk.
METHODS: We used data from AOK PLUS, a German sickness fund covering 3.6 million patients in Saxony and Thuringia. We identified all adult patients continuously insured between 01/01/2016-31/12/2017. The outcome variable was an indicator of whether the patient was hospitalized with a stroke diagnosis between 01/01/2017 (index date) and 31/12/2017. We collected 28 baseline characteristics over the period 01/01/2016-31/12/2016, including age, sex, prior stroke/TIA hospitalizations, comorbidities (including myocardial infarctions, hypertension, diabetes, and venous thromboembolism), prior treatments and procedures. The sample was split in 80% training and 20% testing and we evaluated the predictive performance of logistic model, lasso, ridge, and XGBoost. Measures of performance included sensitivity (true positive rate), specificity (true negative rate) and the area under the ROC curve (AUROC). We used random under-sampling to adjust for the high unbalance of the outcome across classes.
RESULTS: We included 2,543,965 adult patients continuously insured between 01/01/2016-31/12/2017 (53% females, mean age 54.1 years). In 2017, 0.75% of the population had a stroke hospitalization. The AUROC was 0.813 for logistic, lasso and ridge, and 0.814 for XGBoost. Sensitivity and specificity where, respectively, 0.784 and 0.707 for the logistic model and lasso, 0.791 and 0.698 for ridge, 0.795 and 0.698 for XGBoost. Features with highest importance included prior stroke or TIA, smoking and history of diabetes and hypertension.
CONCLUSIONS: Different algorithms displayed similar performance and our proposed logistic regression approach was on par with state-of-the-art ML algorithms for tabular data. The fitted logistic model could be deployed on new claims data to predict the risk of stroke, correctly identifying 78% of stroke patients and 71% of non-stroke patients.
P57: Machine Learning-Accelerated Outcomes Research: A Real-World Case Study of Biomarker-Associated Overall Survival in Oncology
10:00AM - 10:15AM
Benedum C, Adamson B, Cohen AB, Estevez M, Sondhi A, Fidyk E, Nemeth S, Bozkurt S
Flatiron Health, New York, NY, USA
OBJECTIVES: Meaningful outcomes research requires unstructured data found in electronic health records (EHRs) which are often missing from administrative claims. Historically, clinical experts manually review charts, a resource intensive process. Researchers have developed machine learning (ML) models to recognize patterns in language documenting characteristics of interest and extract clinically relevant information. We explored the impact of data curation method (expert-abstraction vs ML-extraction) on the association between real-world overall survival (rwOS) and ROS1 rearrangement status in advanced non-small cell lung cancer (aNSCLC).
METHODS: Using a sample of 159,000 patients with a lung cancer ICD code from Flatiron Health’s nationwide (US-based) EHR-derived de-identified database, we extracted diagnosis dates, stage, histology, ROS1/ALK/EGFR/BRAF/PD-L1 status, and oral therapies from text documents using ML-models trained on expert-abstracted data. Two populations with an aNSCLC diagnosis (2011-May2021), ever-tested for ROS1 were defined using: 1) expert-abstracted variables 2) ML-extracted variables. Structured variables were used for both populations (e.g., age). Patients ever-positive for ROS1 were compared with ROS1-negative and ALK/BRAF/EGFR never-positive. We compared patient characteristics by data curation method using standardized mean differences (SMD). We evaluated the association between ROS1 status and rwOS using matched analysis and adjusted Cox regression.
RESULTS: Population selected using multiple ML-extracted variables achieved sensitivity and PPV of: 83% and 86% (ROS1-positive) and 82% and 90% (ROS1-negative). Abstracted (N=21,362) and ML-extracted (N=23,660) populations had similar ROS1 prevalence (1.2% and 1.1%) and didn’t differ (SMD<0.1) by gender, practice type, race, age, advanced diagnosis year, histology, ECOG Performance Status and PD-L1 status, but differed by stage and therapies received (SMDs=0.11-0.13). No association was found between ROS1 status and rwOS in expert-abstracted and ML-extracted populations (Hazard Ratio [95%CI]: 0.98[0.83-1.12] and 0.95[0.82-1.12], respectively).
CONCLUSIONS: When using multiple, high-performance ML-extracted variables trained on expert-abstracted oncology data, similar results can be achieved as when using abstracted data, unlocking the ability to perform outcomes research at scale.
P60: Use Cases for Artificial Intelligence and Machine Learning Methods to Support Health Technology Assessment
10:15AM - 10:30AM
Pitcher A1, Halmos T2, Poole L3, Richards C3, Shankar R4, Sharma Y3, Guerra I3
1IQVIA, Copenhagen, Denmark, 2IQVIA, Brighton, WSX, UK, 3IQVIA, London, UK, 4IQVIA, Kenilworth, WAR, Great Britain
OBJECTIVES: Data from healthcare and life sciences are typically high dimensional; in other words, there is a high ratio of potential variables to data points. Artificial intelligence (AI) and machine learning (ML) methods are particularly adept at handling such datasets without overfitting, and recent advances in causal ML and explainable AI enable these methodologies to address some of the challenges with Health Technology Assessment (HTA) and the preparation, generation and planning of payer evidence. The objective of this research is to provide an overview of the use cases for AI/ML to support HTA.
METHODS: The IQVIA HTA Accelerator database was used to determine whether AI/ML (or related terms) had been mentioned in global English language HTA documents for single or multiple drug assessments between January 2016 and June 2020. Additionally, relevant publications from the last five years were reviewed and experts were consulted to determine the potential use cases for AI/ML to support HTA submissions.
RESULTS: Two HTAs were found to have made use of AI/ML: one to identify predictors of glycaemic control in diabetes, and the other an Evidence Review Group request to use LASSO for variable selection in a Cox Proportional Hazards model for a Multiple Myeloma treatment.
Potential and future applications of AI/ML to support HTA fell broadly into three categories: generating evidence and understanding disease (including efficacy/effectiveness, safety, disease burden and natural history), informing HTA strategy and planning (including identifying the right target population and understanding predictors of HTA success), and supporting operational aspects of HTA submission preparation (increasing automation and efficiency).
CONCLUSIONS: AI/ML is not currently commonly used to support HTA; however, there are a number of potential applications that may help manufacturers to strengthen their evidence and support their submissions. Some of these applications of AI/ML may become essential for successful submissions in the future.
P59: Automated Literature Screening Using Artificial Intelligence: A Meta-Analysis of Different Algorithm Results
10:45AM - 11:00AM
Witzmann A1, Queiros L2, Abogunrin S3
1F. Hoffmann La Roche, Kaiseraugst, AG, Switzerland, 2F. Hoffmann-La Roche, Basel, Switzerland, 3F. Hoffmann-La Roche, Basel, BS, Switzerland
OBJECTIVES:
Systematic literature reviews (SLR) are the preferred method for evidence synthesis. They are, however, associated with significant resource consumption. As a result, artificial intelligence (AI) methods have been studied to automate literature screening processes. In this context, we have explored the usage of different AI algorithms for title and abstract screening. The focus of this analysis was to summarize the experiments conducted so far using a meta-analytic technique and identify potential advantages of the investigated AI algorithms.
METHODS:
We identified data from 12 retrospective human-led SLRs and developed three AI approaches (neural network, support vector machines, and natural language processing). Metrics including recall, specificity, and the summary receiver operating characteristic curve (SROC) were used to express diagnostic accuracy. A bivariate diagnostic meta-analysis was performed summarizing the results from the different experiments. The statistical analysis was executed in R using the “mada” package.
RESULTS:
We included results from 50 experiments in the meta-analysis. Eleven experiments each were available for data synthesis with maximized recall values and maximized precision values, respectively. The remaining 28 experiments were used to a subgroup analysis according to different AI approaches. The combined recall and specificity were 0.973 [95% confidence interval (CI), 0.947–0.986] and 0.289 (95% CI, 0.220–0.369 for maximized recall compared to 0.657 (95% CI, 0.576–0.730) and 0.91 (95% CI, 0.881–0.932) for maximized specificity in the AI models. No significant difference was found in recall and specificity among a subgroup analysis for different AI algorithms.
CONCLUSIONS:
Literature screening is an imbalanced classification task. We observed (negatively) correlated sensitivities and specificities. Depending on the automation approach, either high recall/low specificity causes many irrelevant literatures identified as relevant or lower recall/high specificity causes relevant literature is missed. Currently available AI algorithms should be complemented by human screening.
10:00 - 11:15
Spotlight Session
Developments in the Use of Health Economics and Outcomes Research to Improve Enrollment and Retention in Clinical Trials
In-person
Purpose: This session will summarize and illustrate how the health economics and outcomes research (HEOR) community is supporting the design and implementation of clinical studies and how this is improving enrolment and retention.
Outline: Engaging patients in the design of clinical trials has been demonstrated to improve enrollment and retention. To date this has often been limited to engagement with small, non-representative samples of patients. However, recent efforts have enabled the insights of HEOR to be applied to the design of clinical studies. After summarizing the state of the art in engaging patients in clinical study design, the session will illustrate how HEOR is enabling study design optimization. The development of a patient study experience instrument will be covered as well as recent applications of preference methods to understand how study design impacts patients’ willingness to participate in studies. The use of both experience instruments and preference data to improve study design will be described.
Moderators
Maureen Rutten-van Mölken, PhD
Erasmus University Rotterdam, Rotterdam, ZH, Netherlands
Maureen Rutten-van Mölken is full professor of Economic Evaluation of Innovations for Health at the Erasmus School of Health Policy & Management, where she is head of the Health Technology Assessment department. She is also scientific director of the Institute for Medical Technology Assessment, a company fully owned by the Erasmus University Holding. She holds an MSc in health sciences and a PhD in health economics, both from the University of Maastricht. She teaches Health Technology Assessment and Pharmaceutical Pricing and Market Access in the Master-program Health Economics Policy and Law and in the European Master in Health Economics and Management.Her expertise includes cost-effectiveness analysis alongside clinical trials and observational studies, probabilistic decision analytic modeling, health economic outcomes research and innovative payment models. She worked in many disease areas, including respiratory diseases (COPD, asthma), rheumatology, diabetes, cardiovascular disease, and Pompe disease. She has a special interest in the cost-effectiveness, and financing and payment of complex multi-faceted interventions that involve system-level changes (e.g., integrated care programs, disease management programs, hospital at home programs, outpatient rehabilitation programs, remote patient monitoring). She also has an interest in the health economics of personalized and precision medicine. She was the coordinator of SELFIE, a Horizon2020 project on multi-criteria decision analysis of integrated care programmes for patients with multi-morbidity. She was a principal investigator in Horizon2020 project HEcoPerMed that developed guidance on health economic modelling of personalised medicine and applied this guidance to various pharmacogenetic interventions. She also coordinates the Medical Delta program From Prototype to Payment.
Speakers
Kevin Marsh, PhD
Evidera, London, LON, United Kingdom
Kevin Marsh, PhD, is Vice President at Evidera in London, UK. He specializes in the use of preference data and decision analysis to inform health decisions, including pipeline optimisation, authorisation, reimbursement, and prescription decisions.
Dr Marsh’s research interests include stated and revealed preference methods, decision modelling, and MCDA. He has applied these and other research techniques for a range of organisations, including both regulatory and industry clients. He actively contributes to the methodological development of these techniques. He is currently co-Chairing ISPOR Health Preference SIG and is a member of the ISPOR Task Force on qBRA. He has previously chaired the ISPOR Task Force on the Use of MCDA in Health Care Decision-Making and an ISPOR working group on the use of preference data in Europe.
Zachary Smith
Tufts University School of Medicine, Henderson, NV, USA
Zak Smith works on a variety of Tufts CSDD studies focusing on drug development performance, efficiency, economics and innovation adoption. Many of these projects involve creating, compiling, and analyzing very large datasets. Zak completed his BS at Florida Southern College and received his MA from Brandeis University, and has worked at Tufts CSDD for 6 years.
Discussants
Kimberley Kallsen, PhD
Boehringer Ingelheim, 55218 Schwabenheim, Germany
Kimberley Kallsen is a cell biologist by training and holds a PhD and a master in public health. She joined Boehringer Ingelheim in 2013, worked in different global strategic and operational roles including medical writing, scientific publications, patient engagement, and is currently Head of Global Clinical Development & Operations Patient & Site Engagement. She is passionate about early partnerships with patient representatives and healthcare professionals to ensure patient- and site-centric clinical trials.
11:00 - 11:30
Break
In-person
Coffee service, Lunch on own
11:30 - 12:45
Plenary Session 3
ISPOR Welcome Remarks
Welcome Remarks
Nancy Berg, ISPOR CEO & Executive Director
Innovative Methods for Integrating Data Across Outcomes and Borders
The volume, granularity and heterogeneity of real-world evidence have been growing exponentially as technology and electronic platforms have provided new opportunities to access, link and integrate these data and use them for outcomes research and regulatory purposes. While clinical trial evidence remains the gold standard for causal evaluation of treatment efficacy, there is increasing interest and potential for using innovative study designs to derive comparative effectiveness when RCTS cannot be performed and for integrating evidence in decision-analytic models to estimate long-term benefits, harms, costs and other aspects as well as the related tradeoffs between these different outcomes. In the era of joint health technology assessments an important topic is which approaches and methods could be used to enable cross-border collaboration, evidence generation, data analysis and interpretation.
As speakers are confirmed, they will be added to the session description.
Moderators
Uwe Siebert, MD, MPH, MSc, ScD
UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, 7, Austria
Uwe Siebert, MD, MPH, MSc, ScD is Professor of Public Health, Medical Decision Making & HTA, Chair of the Dept. of Public Health, Health Services Research and HTA, and Director of HTADS Continuing Education (www.htads.org) at UMIT TIROL, and Adj. Professor of Epidemiology and Health Policy & Mgmt at the Harvard Chan School of Public Health. He is Past-President of the Society for Medical Decision Making (SMDM), member of several Boards of Directors, and he advices several HTA/government agencies. He has authored more than 400 publications and is Editor of the European Journal of Epidemiology.
Speakers
Peter Arlett, MBBS (MD)
European Medicines Agency, Amsterdam, Netherlands
Twenty-six years of experience in delivering programmes of major change, in leadership of health and product innovation, in regulation and legislation, and in medicine and academia. This experience has been gained through employment in, and management of organisations at national, European and international level.
Shahid Hanif, PhD
GetReal Institute, Utrecht, Netherlands
Shahid Hanif is the Managing Director of the GetReal Institute, responsible for leading, developing and executing GetReal’s strategies to achieve its mission and objectives. He founded Avenzoar Consulting, a life science consultancy, is a Senior Research Fellow at RAND Europe and is an Affiliate Member of the Usher Institute at the University of Edinburgh.
The GetReal Institute is an independent member-led not-for-profit whose mission is to facilitate the adoption and implementation of real world evidence in health care decision-making in Europe.
Shahid holds a B.Sc. and PhD. in Biochemistry and Molecular Biology, and a M.Sc. in Information Technology from the University of Glasgow in Scotland.
Beate Jahn, Dipl.Math. oec. Dr.rer.soc.oec
UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
Beate Jahn, Dipl.-Math. oec., Dr.rer.soc.oec., is an Associate Professor of Public Health and Data & Decision Science, the Coordinator of the Program on Personalized and Precision Medicine and Director of the Practical Hands-on Workshop 'Modeling Approaches for HTA' at the Institute of Public Health, Medical Decision Making and Health Technology Assessment at UMIT TIROL, Austria. She is Past President of the Austrian Regional ISPOR Chapter, a member of the ISPOR-SMDM Modeling Good Research Practices Task Force, a member of the COVID-19 Future Operations Platform (FUOP) and serves as expert in the European Commission Initiative on Colorectal Cancer (ECICC).