Health technology assessments alongside the translational pathway of innovations in oncology - Providing guidance towards implementation
Due to the COVID-19 crisis measures the PhD defense of Melanie Lindenberg will take place (partly) online in the presence of an invited audience.
The PhD defence can be followed by a live stream.
Melanie Lindenberg is a PhD student in the research group Health Technology & Services Research (HTSR). Her supervisor is prof.dr. W.H. van Harten from the Faculty of Behavioural, Management and Social Sciences (BMS).
Healthcare budgets are under pressure because of increasing healthcare costs, resulting in an increased awareness that money has to be spent wisely. Therefore, health innovations need to prove their value for money before they will be implemented in the hospital. Health technology assessments (HTA) can be used to systematically assess the effects, among others the cost-effectiveness, of a new technology of interest.
Generally, these analyses are performed in the end of the development process, but when introduced earlier in the process (“early HTA”) they may be effective to guide and steer further development and/or inform adoption decisions. This could prevent unnecessary delays for patients, prevent investing valuable time in an innovation that would not succeed, and increase or accelerate the implementation of a technology. In this dissertation we evaluate the use of HTA methods alongside the full translational pathway from basic research to clinical adoption of multiple innovations in oncology. As the optimal HTA method to guide a technology varies per technology and its stage of development, various HTA methods were used (e.g. (early) cost-effectiveness modelling, stakeholder interviews, scenario drafting).
The innovations evaluated in this dissertation are tumour-infiltrating lymphocytes in treating advanced melanoma, tools for image-guided surgery (e.g. navigated surgery) in several oncologic surgeries, robot-assisted surgery for radical removal of the prostate, and the use of imaging technologies to evaluate response on neoadjuvant chemotherapy in breast cancer treatment.
With this dissertation we informed and guided multiple stakeholders of the innovations in decisions related to research and development, clinical study set-up, potential implementation barriers, and reimbursement decisions by applying HTA alongside the development process. We encountered multiple challenges which were translated in recommendations for policy, and areas for future research categorised into three general concepts: “definition of value”, “variability in cost data”, and “duration of translational pathway”.
Based on our experiences we conclude that application of HTA alongside the translational process could improve effective innovation and could therefore improve patient outcomes on the long run. Therefore, we encourage clinical research groups, medical device companies, and pharmaceutical companies to include HTA, or HTA experts, alongside their development process.
A detailed summary and the content of this thesis is publicly available at: https://doi.org/10.3990/1.9789036550697.