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Medical Technology Research Group (MTRG)

A research unit concentrating on interdisciplinary and comparative policy research on medical technologies.

The Medical Technology Research Group conducts research in three main areas: disease management, medical technology financing and health technology assessment.

The group aims to produce high quality research and provide education, training, policy support and advice to key stakeholders, including governments and international organisations. The group and its members:

  • focus on policy analysis and policy evaluation
  • administer the programmes Pharmaceutical Policy Issues (PPPI) and Medical Devices
  • conduct research under the auspices of and participates in the European Medicines Information Network (EMI-net) and the Network on Rare Diseases (BURQOL-RD), the Optimal Expenditure Network
  • is a member of the European Health technology Institute for Socio-Economic Research (EHTI)
  • regularly works with the World Health Organization on projects related to pharmaceutical policy
  • coordinates The Patient Research Network, an initiative between academia, and individual health care stakeholders, including patients, practitioners and hospital managers to promote the diffusion of knowledge to stakeholder groups of health care issues and policies

Research Areas

The Medical Technology Research Group conducts research in three main areas: disease management, medical technology financing and health technology assessment. 

Disease Management

Diabetes

Increasing prevalence of obesity, lack of physical activity, dietary changes are linked with increasing incidence of type-2 diabetes worldwide. This epidemic is disproportionately affecting emerging countries which are in the process of strengthening their healthcare system and working towards universal health coverage. MTRG has contributed to study the impact of diabetes from an epidemiological and economic perspective in a number of countries worldwide. 

Outputs

Potential Research 

Projects evaluating the impact of interventions to improve the quality of diabetes care

People

Federico Grimaccia, Panos Kanavos

Multiple Sclerosis

Multiple-sclerosis (MS) is the most common cause of disability among central-nervous-system (CNS) diseases. The available data provide limited information on the impact and burden of MS as experienced by people living with MS (PwMS) and their caregivers.

If decisions on management strategies and treatment availability are to reflect patient needs, international evidence to capture the full picture of the multiple domains of MS burden is needed.

This ground-breaking study is aimed at:

  • shedding light on the merits of a likely paradigm shift in the management of MS, including the use of better (and more accurate) diagnostic follow up to monitor disease progression and the earlier use of DMTs to achieve better outcomes for individuals
  • assess the socio-economic and personal impact of such a paradigm shift compared to the current status

Ongoing projects

Towards better outcomes in multiple sclerosis by addressing policy change: The IMPrESS (International-MultiPlE-Sclerosis-Study)

Criteria driving values assessments in Multiple Sclerosis medicines.

Outputs

  • Panos Kanavos, Michela Tinelli, Olina Efthymiadou, Erica Visintin, Federico Grimaccia, Jean Mossman. Social impact of MS – the family burden. Romanian Association of Multiple Sclerosis Conference, Bucharest, May 2016
  • Panos Kanavos, Michela Tinelli, Olina Efthymiadou, Erica Visintin, Federico Grimaccia, Jean Mossman. Towards better outcomes in multiple sclerosis by addressing policy change: The International MultiPlE Sclerosis Study (IMPrESS). European multiple Sclerosis Platform Conference, Oslo, May 2016 (link)
  • Panos Kanavos, Michela Tinelli, Olina Efthymiadou, Jean Mossman. Moving towards better outcomes in Multiple Sclerosis by addressing policy change. iHTA conference Tokyo, May 2016 (link)
  • Panos Kanavos, Michela Tinelli, Olina Efthymiadou, Erica Visintin, Federico Grimaccia, Jean Mossman. Towards better outcomes in multiple sclerosis by addressing policy change: The International MultiPlE Sclerosis Study (IMPrESS). Report HTRG LSE March 2016 (link)
  • Social economic costs, quality of life, and experience in multiple sclerosis patients and their caregivers: the IMPrESS (International MultiPlE SclerosiS) survey iHTA conference Oslo, May 2015 (link

Expected Outputs

Project report launch, publications in peer reviewed journals, presentations in conferences and other venues

Expected Impact 

Increase international understanding of the full picture of the multiple domains of MS burden, stimulate change in clinical practice in the use of better (and more accurate) diagnostic follow up to monitor disease progression and the earlier use of DMTs to achieve better outcomes for individuals, stimulate new research collaboration with international stakeholder groups and academic centres towards the generation of new evidence, and promote the use of robust evidence in order to make appropriate decisions about care management in MS strategies.

People 

Michela Tinelli, Olina Efthymiadou, Erica Visintin, Federico Grimaccia, Panos Kanavos



Medical Technology Financing 

Procurement

This stream of research focuses on different models of strategic purchasing, with a focus on tendering. In a basic tendering system, a health insurer buys generic drugs in bulk from the manufacturers offering the best prices.

Tendering and other drug procurement approaches are increasingly used to stimulate competition between generic drug manufacturers and to control rising drug spending. Procurement is a powerful tool to obtain better value for money when purchasing medicines.

There are different types of procurement strategies available and for countries to choose the most appropriate set of tools, it is important to understand their strengths and weaknesses and system requirement for each strategy to work.

MTRG has been involved over the years on different projects studying procurement tools and their ability to maximise value of public spending.

Outputs                              

  • Sorenson, Corinna and Kanavos, Panos (2011) Medical technology procurement in Europe: a cross-country comparison of current practice and policy Health Policy, 100 (1). 43-50. ISSN 0168-8510
  • Panos Kanavos, Liz Seeley and Sotiri Vandoros, Tender systems for outpatient pharmaceuticals in the European Union: Evidence from the Netherlands, Germany and Belgium, 2009, EMINet  
  • Wouters, OJ, Kanavos PG, McKee M (2017). Comparing generic drug markets in Europe and the United States: Prices, volumes and spending. The Milbank Quarterly (in press).
  • Wouters OJ, Kanavos PG (2017). A comparison of generic drug prices in seven European countries: a methodological analysis. BMC Health Services Research, 17(242). 1-7.

Completed Projects

Health-care reform in Cyprus: In 2014, the Cypriot Ministry of Health sought input from LSE Health researchers on the ongoing health-care reform in the country. Cyprus has one of the longest-running tendering systems for medicines in the world, and the objectives of the research were: (i) to review the current system of pharmaceutical care in the private and public sectors in Cyprus in terms of the availability and affordability of medicines, (ii) to explore how the public and private markets could be efficiently merged in the national health system, which is expected to be implemented in 2017 and (iii) to assess the key barriers to the implementation of the new system.

Funding

World Health Organization Regional Office for Europe; Ministry of Health of the Republic of Cyprus

Outputs

  • Wouters, Olivier J. and Kanavos, Panos G. (2015) “Transitioning to a national health system in Cyprus: a stakeholder analysis of pharmaceutical policy reform.” Bulletin of the World Health Organization, 93 (9). 606-613.
  • Wouters, Olivier J. and Kanavos, Panos G. (2015) “Transitioning to a national health system in Cyprus: a stakeholder analysis of pharmaceutical policy reform.” Presentation, 3rd International PPRI Conference, WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, 13 October 2015, Vienna, Austria.
  • Kanavos, Panos G. and Wouters, Olivier J. (2014). “Pharmaceutical policies in Cyprus: A review of the current system and future options.” Nicosia, Cyprus: Ministry of Health. 65 p.

On-going Projects

1. Strategic procurement, preparation of background paper for WHO EURO consultation (September 2016)        

Expected Outputs: Challenges and opportunities in improving access to medicines through efficient public procurement in WHO European region, World Health Organization Regional Office for Euro

Expected Impact: To inform the next steps in WHO EURO work with Member States in the area of procurement

2. The MTRG is evaluating the impact of tendering in South Africa on drug prices, drug spending, medicines availability, and competition. This research is being conducted in collaboration with the South African National Department of Health.

3.The MTRG is also looking at the effects of tendering on stakeholders, including generic and research-based drug manufacturers, pharmacists, and patients, as well as the operational requirements of tendering systems. This research pertains to both in-patient and out-patient settings.

4. The MTRG is conducting comparative analyes of tendering systems in selected European countries, including Cyprus, Denmark, Germany, the Netherlands, and Sweden.

Potential Research

Evaluating the impact on prices, volume, availability, and appropriateness of care of different procurement methods

People

Olivier Wouters, Alessandra Ferrario and Panos Kanavos

Risk-Sharing and Managed Entry Agreements

Risk-sharing and managed entry agreements are increasingly used to facilitate access to new medicines in a context of uncertainty and high prices. MTRG has been involved since several years in the study of their implementation worldwide and advising countries considering their introduction.

Completed Projects

EU process on corporate responsibility in the field of pharmaceuticals, platform on access to medicines, European Medicines Information Network (EMINet)          

Outputs

  • Ferrario A and Kanavos P, Managed Entry Agreements for Pharmaceuticals: The European Experience, European Commission, DG-Enterprise, April 2013            

On-going Projects

The MTRG is maintaining a database of risk-sharing and managed entry agreements                      

Outputs

  • Ferrario A & Kanavos P, Dealing with uncertainty and high prices of new medicines: A comparative analysis of the use of managed entry agreements in Belgium, England, the Netherlands and Sweden, Social Science and Medicine, 124C: 39-47

Potential Research 

Projects of interest include the evaluating the impact of health-outcome based agreements using patient level data

People

Alessandra Ferrario, Olivier Wouters and Panos Kanavos

Regulation Database

The aim of this project is to outline -- based on primary and secondary evidence -- the pricing, reimbursement, supply chain and demand-side policies used in 59 high- and middle-income countries (2000-today). The countries are located in Europe, Latin America, the Middle East, East/Southeast Asia, and sub-Saharan/North Africa.

On-going Projects

The database is being populated with information on which policies have been implemented in each country over the last 16 years, as well as the key features of those policies. This information is based on peer-reviewed studies, grey literature, and key informant interviews. The database will be used to investigate policy changes occurring in different countries/regions since 2000 and their impact on health policy goals.

People

Anna-Maria Fontrier, Olivier Wouters, Olina Efthymiadou, Erica Visintin

External Reference Pricing (ERP)

The aim of this project is to study the evolution of ERP systems in different geographical jurisdictions and analyse the way ERP interlinks with developments in other regulatory approaches. In addition, we tried to gain a clearer understanding of the impact of ERP systems on health system goals and to highlight trends and consequences related to ERP.

On-going Projects

Two reports are being finalised for publication. The first report examines the implementation of ERP across countries and the second report studies the impact of ERP across and within countries.

People

Anna-Maria Fontrier, Jennifer Gill and Olina Efthymiadou



Health Technology Assessment 

HTA

This stream of research focuses on Health Technological Assessment (HTA) process across different countries. As resources are limited, priority setting is required to allocate efficiently health budgets and European Health systems have increasingly implemented models of value-based pricing to evaluate the efficacy related to the cost of innovative medicines.

In particular, HTA has played a key role in informing public payers’ coverage and policy decisions. However, the systematic nature of the process and the conventional HTA principles pose several challenges for reimbursement decision-making. Besides, countries make different decisions about which drugs to provide through their national health systems to all citizens.

As a result, the reimbursement decision may vary across countries and could be recommended, not recommended or recommended with restrictions, and consequently has implications on access to these drugs.

Previous Projects

ADVANCE-HTA was a research project funded by the European Commission's Research Framework Programme (FP7). It comprised several complementary streams of research that aimed to advance and strengthen the methodological tools and practices relating to the application and implementation of Health Technology Assessment (HTA). It was a partnership of 13 Consortium members led by LSE Health.                                                                      

ADVANCE-HTA aimed to broaden the spectrum, complement and address areas of intense methodological debate in the application, use and implementation of HTA across settings. It also aimed to improve HTA methods, which can be taken further by competent authorities nationally whilst supplementing the work of supra-national bodies (e.g. EUnetHTA) towards a common understanding of choices in health care decision-making. 

Outputs

  • Nicod E, Kanavos P. 2012. "Commonalities and differences in HTA outcomes: A comparative analysis of five countries and implications for coverage decisions". Health policy (Amsterdam) (0168-8510) (accepted for publication September 2012, online)
  • Kanavos P, Nicod E. 2012. "What Is Wrong with Orphan Drug Policies? Suggestions for Ways Forward". Value in health (1098-3015) (accepted for publication September 2012, online)
  • Nicod E, 2010. "Harmonizing the outcomes of HTA: An application to Central Nervous System treatments". EuroObserver. Winter 2010. Volume 12, Number 4.
  • Kanavos P, Nicod E, Van den Aardweg S, Pomedli S, 2010. "The impact of health technology assessments: An international comparison". EuroObserver. Winter 2010. Volume 12, Number 4
  • Angelis A, Lange A, Kanavos P. Measuring the value of new medicines in health technology assessment: a systematic review and expert consultation in Europe. Under peer review

On-going Projects

Study on impact analysis of policy options for strengthened EU cooperation on HTA

People

Aris Angelis, Erica Visintin, Anna-Maria Fontrier and Panos Kanavos

Value Based Assessment/MCDA

 Multiple criteria decision analysis (MCDA) has emerged as a likely alternative approach to economic evaluation in the context of health technology assessment (HTA). However, there is no sufficient methodological guidance on how to design, conduct and implement MCDA as part of HTA, including how to select criteria appropriately.

Completed Projects

ADVANCE-HTA was a research project funded by the European Commission's Research Framework Programme (FP7). It comprised several complementary streams of research that aimed to advance and strengthen the methodological tools and practices relating to the application and implementation of Health Technology Assessment (HTA). It was a partnership of 13 Consortium members led by LSE Health.                                                                      

ADVANCE-HTA aimed to broaden the spectrum, complement and address areas of intense methodological debate in the application, use and implementation of HTA across settings. It also aimed to improve HTA methods, which can be taken further by competent authorities nationally whilst supplementing the work of supra-national bodies (e.g. EUnetHTA) towards a common understanding of choices in health care decision-making. 

Outputs

  • Kanavos P, Angelis A. Multiple criteria decision analysis for value based assessment of new medical technologies: a conceptual framework. The LSE Health Working Paper Series in Health Policy and Economics London. London: London School of Economics and Political Science; 2013.
  • Angelis A, Kanavos P. Using MCDA to assess value of new medical technologies. LSE Health Working Paper Series in Health Policy and Economics London. London: London School of Economics and Political Science; 2013.
  • Angelis, A., Kanavos, P.: Value-Based Assessment of New Medical Technologies: Towards a Robust Methodological Framework for the Application of Multiple Criteria Decision Analysis in the Context of Health Technology Assessment. Pharmacoeconomics 34(5), 435-446 (2016)
  • Angelis, A., Kanavos, P.: Critique of the American Society of Clinical Oncology Value Assessment Framework for Cancer Treatments: Putting Methodologic Robustness First. Journal Of Clinical Oncology: Official Journal Of The American Society Of Clinical Oncology (2016).

On-going Projects

Case studies of decision conference workshops with various HTA agencies and payers across EU countries.

People

Aris Angelis and Panos Kanavos

HTA and Quality of Life Measurement

This study, part of the EU funded project “Advance HTA” aimed to provide an updated framework on Health Related Quality of Life (HRQoL) measurement based on health state utility datasets derived from groups of patients rather than the general population.  It was specifically aimed at identifying differences in Quality of Life (QoL) preferences between the general population and defined groups of patients, analyse the causes and discuss the policy implications of such differences. Furthermore, in order to provide a broader perspective on QoL research, it aimed to generate and discuss evidence on whether the EQ-5D questionnaire accurately represents the aspects that are important for patients’ QoL    

Outputs

  • “HTA and QoL measurement; Newly defined value sets and their policy implications”: Final report submitted in collaboration with the Institute of Economic Research (IER) to the European Commission as the final deliverable of Work Package 4 (WP4) under the Advance HTA project.
  • Research outputs presented at: Advance HTA final conference, London, UK (add hyperlink: http://www.advance-hta.eu/PDF/FinalConference/presentations/9-QoL_Measurement_Online_surveys_LSE_ECB.pdf), LSE Summit 2016 (add hyperlink with presentation from Jean) 
  • “Health related quality of life aspects not captured by EQ-5D-5L: Results from an international survey of patients”: Manuscript under review.
  • “Beyond EQ-5D;what patients say is important”: Abstract presented at HTAi 2016, Tokyo, Japan (add link: https://issuu.com/htai/docs/tokyo-htai_abstracts_20160512-may13)
  • “Measuring caregiver QoL; which aspects really matter?”: Abstract presented at  HTAi 2016, Tokyo, japan (add link  https://issuu.com/htai/docs/tokyo-htai_abstracts_20160512-may13 and maybe add the actual poster as a hyperlink?). Manuscript to be submitted for peer-review by end September ’16.
  • “Differentiation of HRQoL outcomes between patient populations; results from patients with Breast Cancer, Rheumatoid Arthritis, Multiple Sclerosis, Rare Cancers and Rare Diseases”: Manuscript to be submitted for peer-review by end July ’16

Policy Implications

Re-consider the content and utilisation of generic instruments for HRQoL measurement in chronically ill individuals and their caregivers, in the context of improving HTA methodologies

Potential Research

Further research could potentially focus on clarifying how patients’ disease-specific and caregivers’ utilities map against a generic tool such as the EQ-5D to better reflect the experiences of these individuals.

People

Olina Efthymiadou and Panos Kanavos

 

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