1. society
2. welfare
3. healthcare
4. hospital

a pilot project of innovative public
procurement (IPP)
in biomedical technologies
WHY WE NEED A NEW SYSTEM OF
PUBLIC PROCUREMENT
January 2013
The Bellvitge Biomedical Research Institute (IDIBELL) center manages research carried out by professionals of the Bellvitge University Hospital, The Duran i Reynals Hospital (ICO), and the Bellvitge Campus of the University of Barcelona. IDIBELL is located in Biopol’H, the scientific and health business park of L’Hospitalet de Llobregat. solid organ transplantation index
40
35
30
25
20
15
10
5
0
Spain is world leader in surgical interventions of high complexity
solid organ transplantations per million
only main European countries
Source ONT, 2007
relative contribution to the European sectorial NAV
40
35
30
25
20
15
10
5
0
españa
belgica
francia
irlanda
italia
finlandia
austria
alemania
suecia regne unit holanda dinamarca
NAV (net added value): industry‐wide contribution
to the European GDP
expressed in percentages over total sectorial NAV Source: Panorama de la Industria Europea, 2000 • we have been doing something wrong for
decades
• we are not utilizing our medical knowledge to
generate our own industrial sector
pilot project for innovative public procurement
• an experimental approach
• small is beautiful – and useful
• governments keep moving on with their policies
• this is a parallel initiative and seeks to obtain firsthand experience and hard data.
goals
1. test the implementation of this tool in the field, in a hospital setting of high complexity.
2. document the economic impact of its application.
scope
• geographical
– limited to our Bellvitge campus and the two
large hospitals: ICO y HUB
• technical
– pharmaceuticals, medical devices, instrumentation, equipment, information technologies, organisational tools, or others.
proposals
products or services that bring about cost savings to the public health system by introducing technical improvements, by replacing former costs, or through different pricing strategies, among others.
products or services in the precompetitive stage, that need to prove efficacy and cost efficiency. This should allow promoters to enter the market successfully, and should allow the hospitals to capitalise the demonstration effect they contribute to.
expected benefits
• reduce health care spending.
• improve the competitiveness of companies that participate.
• improve health care.
• generate employment.
• pave the road for the adoption of a IPPP policy by the government.
plan of action
1. proposal‐collection phase
2. evaluation and selection
3. call definition
4. call issuing
5. final evaluation and report (summer 2013)
first case: PCR based endometrial cancer test
MPM
Rama Control
BE (Cornier)
Positiva
(Cáncer/Hiperpla
sia)
Protocolo
Cáncer
Endometrio
Negativa
No concluyente
ECOTV
LE <4 mm
No más
síntomas
(sangrado)
Persistencia de
síntomas
ALTA
HISTEROSCOPIA
ECOTV
LE>4 mm
HISTEROSCOPIA
MPM
Rama Control
BE (Cornier)
Positiva
(Cáncer/Hiperpl
asia)
Protocolo
Cáncer
Endometrio
the system could
reduce the need
for
histeroscopies
Negativa
No concluyente
ECOTV
LE <4 mm
No más
síntomas
(sangrado)
Persistencia de
síntomas
ALTA
HISTEROSCOPIA
ECOTV
LE>4 mm
HISTEROSCOPIA
stalemate?
• cost advantages were difficult to estimate
• also, they vary considerably in different hospitals
this could have been the end of it!
MPM
Rama Control
BE (Cornier)
Positiva
(Cáncer/Hiperpl
asia)
Protocolo
Cáncer
Endometrio
Negativa
No concluyente
ECOTV
LE <4 mm
No más
síntomas
(sangrado)
Persistencia de
síntomas
ALTA
HISTEROSCOPIA
ECOTV
LE>4 mm
HISTEROSCOPIA
MPM
Rama Control
BE (Cornier)
Positiva
(Cáncer/Hiper
plasia)
Protocolo
Cáncer
Endometrio
HOSPITAL
Negativa
No
concluyente
ECOTV
LE <4 mm
No más
síntomas
(sangrado)
Persistencia
de síntomas
ALTA
HISTEROSCOPIA
PRIMARY
ECOTV
LE>4 mm
HISTEROSCOPIA
MPM
Rama estudio
BE (Cornier)
GX (Gynec Dx)
BE Positiva
GX Positivo
BE Positiva
GX Negativo
Protocolo
Cáncer
Endometrio
BE Negativa
GX Positivo
Histeroscopia *
BE Negativa
GX Negativo
ALTA
ALTA
HOSPITAL
MPM
Rama estudio
PRIMARY
BE (Cornier)
GX (Gynec Dx)
BE Positiva
GX Positivo
BE Positiva
GX Negativo
Protocolo
Cáncer
Endometrio
BE Negativa
GX Positivo
Histeroscopia *
BE Negativa
GX Negativo
ALTA
ALTA
• we were all looking at a possible alternative test in the hospital,
• but the real savings seem to be in sending the test away from the hospital and into the primary care units
• this is expected to dramatically reduce the number of hospital interventions
– why didn’t anybody think of that before?
showcasing the technology
• randomized pharmacoeconomic study
– 30 + 30 cases
– three to six months
– to validate the circuits and to measure the
number of patients that reach the hospital from
both lines (old protocol, new protocol)
– 1% royalty on sales within catalonia for 5 years
•
link
what have we learned so far?
• there are less opportunities than we thought
– and they take longer to mature
• even the best offers need a lot of work
– think outside the box (or the hospital)
– a climate of confidence and collaboration is
essential
food for thought
• why is this so?
– an innovative costumer creates an innovative system
– but the opposite is also true!
• no huge structural changes are needed
– ...why is not everybody doing this?
take‐home message
you can trust the administration to do the right thing...
after having exhausted all the other possibilities!
thanks for your attention!
epola@idibell.cat