Gleb Donin

Medical Device Procurement Tracking System: Concept and Methods

This paper presents the concept of web-based information system for tracking of sophisticated medical equipment procurements in Czech Republic. The three-tiered client-server system architecture was selected for development. The main system components including their functionality and characteristics were suggested. Purchase orders itself, public procurement database and related e-marketplaces, and data from information systems at healthcare facilities were proposed as informational sources. Acquisition data flow was proposed. The significant factors affecting final contract price was proposed for data acquisition. Classification of selected medical equipment types for the purposes of purchases comparison was carried out.

HTA in the Czech Republic: Still Behind

The paper analyses the current state of HTA implementation and organisational initiatives in the Czech Republic. Although there have been some substantial elements of HTA applied in the decision process of pharmaceutical reimbursement since 2008, HTA methods are rather disregarded in other technologies. Since there is practically no demand for HTA studies from payers and state representatives, HTA has been cultivated above all by interested individuals and small academic research groups around them. These groups have succeeded in keeping pace with the global development both in theoretical and practical issues (among others in HTA methods for medical devices), however, the practical production of country specific HTA studies is rather rare. The main problem is non-existence of a national commonly accepted methodology and a legal framework. At least two attempts to establish a regular HTA process initiated by the Ministry of Health were destined to fail due to frequent personal changes in the Ministry. We discuss topical issues to be solved on the way to a national HTA system, and present our vision of a possible solution.

Selection of a PET/CT scanner for the department of nuclear medicine

Selection of capital medical equipment remains unstructured and arduous for hospital managers due its complexity. The aim of this study is to develop a decision support technique that will assist in selection of PET/CT systems using the analytic hierarchy process (AHP) for a department of nuclear medicine in the Czech Republic. The newly build expert group was composed of two physicians, two radiation physicists, and two leading radiology assistants. Selection of the key criteria for alternatives comparison was carried out based on the literature search, technical specifications from completed procurements of PET/CT systems, and preferences of the expert group. Six models of PET/CT systems were included in the study as possible alternatives. The comparison of PET/CT systems was performed using AHP method, where compliance of expert judgements was ensured by Delphi method. Based on the combination of weights assigned to the criteria and results from an evaluation of alternatives, the resulting rank list of PET/CT systems was determined. We have performed a sensitivity analysis to test reliability of the decision. Applied selection procedure and results of this study can serve as an example for the rational selection of medical equipment and could be adjusted according to the needs of specific requirements.

HTA for Medical Devices: Multiple-Criteria Decision Making as an Outcome Evaluation Tool

Health Technology Assessment (HTA), although having been routinely applied in drugs and surgery for a long time, is still quite challenging in medical devices. The reason is that the main objective of HTA studies for devices is not optimization of the cost-effectiveness ratio, but rather decisions about procurement and/or incorporation of the apparatus. The clinical benefit is not expressed in terms of quality of life, but in the rate of diagnostic yield, comfort of the clinician, or the extent to which the technology makes the therapy shorter and/or more patient-friendly. Utilization of multiple-criteria decision-making methods for evaluation of the aggregated clinical, technical and user’s effect (outcome) is recommended as the input to cost-effectiveness analyses. Different methods are derived for strategic and/or operational assessment of new technology.

Economic Evaluation of Robotic Radiosurgery System for Prostate Cancer Treatments in the Czech Republic

The purpose of this study was to carry out the economic evaluation of robotic stereotactic body radiation therapy (rSBRT) in comparison with conventional intensity-modulated radiation therapy (IMRT) for the treatment of localized prostate cancer in the Czech Republic. Cost-utility analysis was used for the economic evaluation of both technologies based on their costs and the number of quality-adjusted life years gained (QALYs). Utilities of both technologies were identified in literature. An estimation of treatment costs was obtained from publicly available secondary sources for the Czech Republic. The cost-utility analysis was conducted from provider’s perspective for three scenarios (optimistic, realistic, and pessimistic). According to the results of cost-utility analysis, in every scenario concerned IMRT was both more effective and less costly than rSBRT. Namely, in realistic scenario, IMRT and rSBRT accrued 9.96 QALY/53,198 CZK and 9.93 QALY/79,956 CZK, respectively. rSBRT reached the same or lower values of the cost-utility ratio than IMRT in situation, when the acquisition price of rSBRT equipment was lower than CZK 58 million in the realistic scenario. Under the conditions of the Czech healthcare system, IMRT was more cost-effective than rSBRT for localized prostate cancer treatment in all the analyzed scenarios.

Cost-Effectiveness Analysis of Intrabeam System Introduction to the Czech Healthcare System Environment

Backround: Intrabeam system is a technology used in oncology for intraoperative radiotherapy (IORT), a technique of partial delivery of radiation therapy to the tumour bed during surgery. The aim of this study is to evaluate cost effectiveness of the Intrabeam system compared to the standard treatment with external beam radiotherapy (EBRT) in early stage breast cancer treatment in order to reach a decision on a possible introduction of the technology to the Czech healthcare system. Methods: In order to determine the clinical effects, a worldwide literature review was conducted. The cost of the Intrabeam system was estimated based on available information about acquisitions of the system worldwide in the last 5 years. The cost of treatment was calculated from the perspective of a healthcare payer, and all the information gathered was summarized in a Markov model to finalize the cost-effectiveness calculation. A sensitivity analysis was performed. Results: The input of the model was based on the TARGIT-A pragmatic randomized controlled trial—the largest and most comprehensive study among 26 selected studies from the literature review. The estimated purchase cost of the system for the Czech Republic was determined in the range of CZK 16–20 million without VAT. Based on the findings, three versions (baseline, optimistic, pessimistic) of the calculation for IORT interventions using Intrabeam were determined. In the baseline scenario, the cost of the Intrabeam system intervention was CZK 38 559, the ICER value was CZK 53 483 saved per 1 QALY lost. The results of the sensitivity analysis are consistent with the results of the baseline scenario. The ICER value is not above the cost-effectiveness threshold (currently a little above CZK 1.2 million), which is required to consider the technology cost effective. Conclusion: According to the results of the cost-effectiveness analysis, we do not currently recommend the Intrabeam system to be introduced into the Czech healthcare system.

Estimation of medical equipment prices – a case study of tomotherapy equipment in the Czech Republic

Medical equipment (ME) is often considered to be an important factor in the growth of healthcare expenditures. In the Czech Republic (CR) validated approach does not yet exist for hospitals to use to assess commercial offers, nor is there a generally accepted methodology for regulatory bodies to allow for the evaluation of the effectiveness of prior purchases. This study intends to present a methodological approach that will allow for assessing the effectiveness of the procurement of capital ME based on international prices. The case of the purchase of tomotherapy system in the CR was used to demonstrate the developed approach. We performed a multiway search for international estimated and exact prices for tomotherapy unit using public-procurement databases, scientific papers, health technology assessment studies, professional reports, and Internet searches. All of the data that was gathered on prices was subjected to critical assessment vis-a-vis the reliability of the information. This research lays new methodology that may provide general background of international comparison studies focused on ME. The results provide support for decision making about the acquisitions of ME.

Novel Medical Device Procurement Tracking Approach

This paper presents approaches implemented in the medical device procurement tracking system in the Czech Republic. The System was created to enable the monitoring and assessment of procurement efficiency and to provide valid information to different stakeholders during future medical equipment purchases planning. Data collection process was proposed and implemented into practice. Several reports run on the grounds of a multi-criteria comparison based on comprehensive data model, which enable to analyse the procurement data and to formulate hypotheses relative to procurement efficiency. The multi-criteria approach is based on the valuation of the medical equipment procurements upon the set of criteria specified by the user, such as procurement terms and conditions, medical equipment price and technical specifications. The System developed allows users to compare purchase contracts with the purpose of identifying their weaknesses and planning future purchases.