CADTH 2015 Symposium

1. CNESH Horizon Scanning:
Challenges and
Alternative Approaches.
John Soloninka, PEng MBA
President and CEO, HTX
jsoloninka@htx.ca

2. • Private non-profit corporation.
• Leading Canadian supporter of medtech.
– Project financing
– Support, ecosystem information broker and network.
Connectivity.
• De-risking technologies and business plans.
• Multiple foreign market access initiatives.
• $21.4M HTCP fund
– 38 financings
– $86M total project value
• NEW REACH Innovation Procurement Fund
33 Portfolio Companies

3. Thoughts…
• Quick observations on Horizon Scanning
• Value Proposition?
• How HTX-led Initiatives might support
CNESH
–National RISE Medtech Ecosystem Registry
–REACH Innovative Technology Registry

4. 23 International Scanning Organizations:
Are there complementarities or collaboration potentials?
• EuroScan (20 government-funded members)
• AHRQ
• U.S. Centers for Medicare & Medicaid Services (CMS)
• U.S. Food and Drug Administration (FDA)
• U.S. Center for Disease Control and Prevention (CDC)
• Private organizations: ECRI Institute, Frost and
Sullivan, Hayes, Ingenix, and Thomson Reuters.
EuroScan includes the following:
• Agencia de Evaluación de Tecnologías Sanitarias
(AETS). Instituto de Salud Carlos III, Spain
• Agencia de Evaluación de Tecnologías Sanitarias de
Andalucía, Spain (AETSA)
• Agenzia nationale per i servizi sanitari regionali, Italy
(Age.na.s)
• Australia and New Zealand Horizon Scanning
Network, Australia and New Zealand (ANZHSN,
including Adelaide Health Technology Assessment
[AHTA])
• Basque Office for Health Technology Assessment,
Basque Country (OSTEBA)
• Canadian Agency for Drugs and Technologies in
Health, Canada (CADTH)
EuroScan - continued:
• Committee for Evaluation & Diffusion of Innovative
Technologies, France (CEDIT)
• Council of the Netherlands, The Netherlands (GR)
• Danish Centre for Evaluation and Health Technology
Assessment, Denmark (DACEHTA)
• Division of Medical Technology Policy, Ministry of
Health, Israel (DMTP)
• German Institute for Medical Documentation and
Information, Germany (DIMDI)
• Haute Autorité de Santé, France (HAS)
• Health Information & Quality Authority, Ireland
(HIQA)
• Italian Horizon Scanning Project, Servizio
Farmaceutico Territoriale, Italy (IHSP)
• Ludwig Boltzmann Institute for Health Technology
Assessment, Austria (LBI-HTA)
• Managed Uptake of Medical Methods programme,
Finnish Office for Health Technology Assessment,
Finland (Finohta [MUMM])
• National Horizon Scanning Centre, England (NHSC)
• Norwegian Knowledge Centre for the Health
Services, Norway (NOKC)
• Swedish Council on Technology Assessment in Health
Care, Sweden (SBU)
• Swiss Federal Office of Public Health, Switzerland
(SFOPH)

5. Horizon Scanning Examples Show Wide Divergence
Health System Priorities and Local Innovation Sector Influences Results
All of the lists are unique….no overlap?!
Could be due to criteria, health systems, local technologies…

6. NHSC Evaluation:
Sensitivity, specificity, and predictive values of NHSC’s prediction methods.
Estimated wrt expert opinion of the impact 3 to 5 years after prediction.
• Sensitivity 71% (95% CI, 0.36–0.92),
• Specificity 73% (95% CI, 0.64–0.8),
• NPV 98% (95% CI, 0.92–0.99), and
• PPV 14% (95% CI, 0.06–0.3).
The authors concluded that NHSC methods were ..
“reasonably good at identifying lower priority developments, but tended
to assign significance to more topics than the experts considered
significant in their later practice.”

7. Challenges…
• Increasing relevance?
• Getting more nominations?
• HTX-led Initiatives might support CNESH
–National RISE Medtech Ecosystem Registry
–REACH Innovative Technology Registry

8. Possible Directions…
• For Regulators
– Focus on new science discoveries and capabilities introducing new
risks or requiring new reg. science.
• Eg. BYOD mobile diagnostics; radical material properties; new imaging modalities;
implantable sensors; closed loop artificial organs; self appendectomy iPhone apps.
– Focus less on cool devices that are not new from a regulatory science
or clinical trial perspective.
• For HTA bodies
– Focus on “cross silo” or “lean” technologies that show dramatic
potentially to increase quality at reduced cost.
– Focus on technologies that could fundamentally alter existing
treatment pathways for dramatic effect.
• For Procurement and Providers
– Focus on technologies showing realized value, not potential.
– Focus on 10x, 5x, 2x benefits actually achieved!
– Allow industry to self report…based on demonstrated evidence.

9. RISE – Medtech Ecosystem Database
Registry of Innovators, Suppliers and Exporters
Vancouver
Toronto Montreal
Alberta
6%
British
Columbia
11%
Manitoba
4%
New Brunswick
1%
Newfoundland
0%
Nova
Scotia
2%
Nunavut
0%
Ontario
56%
PEI
0%
Quebec
19%
Saskatchewan
1%
Yukon
0%
Total Provincial Aggregate

10. Registry of Canadian Medtech Innovators, Suppliers and Exporters
WHAT IS RISE?
A SUSTAINABLE ONLINE REGISTRY
OF
MEDTECH ENTITIES
2,700+
MEDTECH RISE
PLAYERS
MANUFACTURERS
GOVERNMENT
ORGANIZATIONS/NPO
DISTRIBUTORS
INVESTORS
SERVICE
PROVIDERS/CONSULTANTS
MEDIA
R&D SERVICES 208
63
929
594
382
545
16
BENEFITS TO REGISTERING?
Improves LOCAL &
INTERNATIONAL
VISIBLITY for your
COMPANY
IDENTIFIES
competition and
relevant players in Medtech space
enables
opportunities
ADVANTAGEOUS
partnership
COST-FREE & EASY
REGISTRATION!
~3,000

11. Our Collaborators
Biotechgate Partners

12. REACH: A New Innovation Procurement Program.
(Highlighted in the “Evidence is Not Enough” Panel)
Technology/Product
Development/
Validation
Maturing/
Evidence
Generation
Scale: Diffusion/
Export - Local,
Global
Intake
(Pipeline)
Ontario
Sales
$ MNEs
SMEs
Academic
Spinoffs
US
EU
ROC
China
Ont
US
EU
Rest of
Canada
China
Ontario
HTX REACH
Traditional Innovation
Support
Pre-Market
Development Post-Market Evaluation
and Adoption
Foreign Market Access

13. REACH Planned Registries
• Innovative Technology Registry
– To support procurement and providers
– “What innovative technologies are out there?”
– ‘What has worked well?”
– Pre/Post market technologies – so less speculative
– Can be linked to the Problem Registry below.
• Health System Problem Registry
– To inform innovators of H/S Needs & Priorities
– Three possible classes
• Generic (e.g. Deskilling, setting of care change, lean etc.)
• Reform driven e.g. (5% focus, QBPs, etc.)
• Clinical Priorities (eg. Re-admits on CHF, Dx Apnea, ALCs, etc.)