Earlier this year, in a Canadian first, a group of experts came together to identify a list of potentially ‘game-changing’ health technologies that could impact the lives of patients and the delivery of health care.
The Top 10 New and Emerging Health Technology Watch List* for 2014 includes three new cancer treatments, five medical devices, and two medical procedures. Produced by the Canadian Network for Environmental Scanning in Health (CNESH), the list is meant to help health care leaders plan today for what the future may bring.
New health technologies, including devices, procedures, or drugs, may have the potential to reshape many parts of the health system. But as they become available, pressure grows for governments to add new drugs to public formularies and for hospitals to buy new devices or fund new procedures, despite limited evidence of their effectiveness.
“Every day there is more health innovation coming to market, and making decisions about whether to invest in these new technologies is fraught with challenges and uncertainty,” says Rosmin Esmail, Chair of CNESH and Director, SCN Health Technology Assessment and Adoption at Alberta Health Services. “By looking closely at the evidence and creating the Watch List, we hope to help decision makers prioritize their efforts.”
Health technologies were identified through a public call for nominations and the committee followed a rigorous prioritization process to arrive at the final list of 10 technologies.
Developing the list is a key initiative for CNESH and is one way that the committee fulfills its mission to identify and broadly share information on emerging health technologies. The nomination period for the 2015 Watch List just ended and the committee is now in the midst of reviewing and prioritizing the entries.
So, what innovations made the 2014 Watch List*?
Antimicrobial copper surfaces to reduce hospital-acquired infections in the ICU
The penny may be phased out from our pockets, but we could soon be seeing more copper in our hospitals since new research suggests that the metal may be an effective tool in the fight against hospital-acquired infection.
Patients in the intensive care unit are among the most vulnerable to contracting infection. Surfaces touched often like taps and bedrails are typically made of stainless steel or plastic. They are cleaned regularly according to stringent guidelines, but it’s not always enough to stop the spread of germs.
Touch surfaces made or coated with antimicrobial copper seem to be a promising alternative because, in between regular cleanings, they have the natural ability to continuously kill viruses and bacteria that live on surfaces.
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Preserving the lung is key to successful lung transplantation. Typically, after the donor lungs are removed they are flushed with a preservative solution and packed on ice, but the longer the lungs are kept on ice the greater the risk that they will be rejected due to damage.
The original research and successful world first application of ex vivo lung perfusion technology was led by Dr. Shaf Keshavjee and Marcelo Cypel at Toronto General Hospital. The ex-vivo system they developed first allowed surgeons an opportunity to assess and treat injured donor lungs, while outside the body to make them suitable for transplantation.
The newest ex vivo (meaning out of body) lung perfusion device is a portable system that preserves the lungs. Donor lungs are placed in the sterile chamber which maintains a warm temperature and humidity. The system then provides a constant supply of oxygen and a solution that contains packed red blood cells. A wireless monitor lets clinicians continuously assess the function of the lungs to make sure they are still viable.
This new innovative portable perfusion system improves the condition of donor lungs and minimizes the damage that is commonly seen with cold storage methods. By improving the quality of donor lungs, this technology could help increase the number of lungs available to the more than 300 patients on Canada’s waiting list for lung transplant.
In 2013, the University of Alberta’s Mazankowski Alberta Heart Institute established an ex vivo program and became home to the only portable device in Canada. In August 2014 the Federal Drug Administration in the U.S. approved the device, citing its potential to expand the donor organ pool.
Ipilimumab for unresectable or metastatic melanoma
Melanoma is the deadliest form of skin cancer and it’s on the rise among Canadians. When the cancer is diagnosed early, it can be cured by surgery to remove the tumour. But if the cancer has spread locally and cannot be removed completely through surgery (known as unresectable melanoma) or it has spread to other parts of the body (called metastatic melanoma) the disease progresses quickly and has had low survival rates.
Advanced melanoma is an aggressive disease and existing treatments have been largely ineffective in extending life expectancy.
But ipilimumab is a new drug that works by stimulating the body’s immune system to fight the cancer. It is the first drug to show a dramatic impact on survival in advanced melanoma. In some cases, it nearly doubled survival rates at both one year and 18 months, compared with a glycoprotein vaccine.
Since 2012 ipilimumab has been available to Canadian patients who tried but did not respond to other therapies, or who simply cannot tolerate other therapies for advanced melanoma, but in September 2014 Health Canada approved the drug for use as first-line treatment in newly diagnosed patients. The CADTH pan-Canadian Oncology Drug Review is currently reviewing the drug for this new indication.
Mitral valve clip for degenerative mitral regurgitation
For patients with the common heart valve disorder known as mitral regurgitation, symptoms like shortness of breath, fatigue, and chest pains can negatively impact their daily life. The condition causes blood to flow backwards into the upper heart chamber, because a valve on the left side of the heart that separates the upper and lower chamber is ‘leaky’ and does not close properly.
In mild cases medication can help, and in severe cases open heart surgery may be performed to repair or replace the valve. But for older patients who are too sick or frail to survive heart surgery, there are few options.
But a new device called the MitraClip device provides the first non-surgical alternative for some high risk patients with degenerative mitral regurgitation.
The MitraClip is inserted using a long, flexible, soft plastic tube through a small incision in the groin and delivered to the heart using the femerol vein (found in the leg). Once implanted, it allows the heart to pump blood more efficiently by improving valve closure.
The device is now being used in a just few specialized Canadian centres, including Sunnybrook Health Sciences Centre in Toronto and the University of Ottawa Heart Institute in Ottawa. In April of this year Health Canada formally approved the device.
Obinutuzumab (plus chlorambucil) for patients newly diagnosed with chronic lymphocytic leukemia
Most patients with chronic lymphocytic leukemia (CLL) are seniors over 70 years old and, for many, CLL is not the only medical condition they live with. While healthy patients who are newly diagnosed with CLL are often treated with a cocktail of aggressive chemotherapy and other drugs, the same options aren’t available to patients with coexisting medical conditions.
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But a new anti-cancer drug called obinutuzumab, used in combination with chlorambucil (an older pill that’s been used to treat CLL for many years), shows promise as a better option for newly diagnosed patients who have coexisting medical conditions.
Used together, the combination treatment more than doubles the chance that patients with CLL with live without disease progression and the common adverse events associated with the treatment are reported to be manageable.
Remote ischemic conditioning (RIC) device
Cardiac surgery or a heart attack can sometimes bring about damage to the heart by restricting the blood supply to the heart. When blood flow to cardiac cells is disrupted and then restored, it creates a risk for tissue damage known as ‘reperfusion injury’.
Today no therapies have emerged as the optimal solution to this problem.
But a new non-invasive automated cuff can now be worn on the arm or leg to provide remote ischemic conditioning, which temporarily stops and restarts blood flow through a series of inflations and deflations.
The device, created by two doctors at SickKids, can be used before, during, or after cardiac surgery, or after a heart attack and has shown strong potential to protect the heart from damage.
Retinal implant for patients with retinitis pigmentosa
With so many rapid technological advances in the field of prosthetics, is the ‘bionic patient’ really so far off?
A new prosthetic, likened to a ‘bionic eye’, has been developed to possibly restore some vision in adult patients with severe sight impairment due to retinitis pigmentosa (RP). RP is a group of eye diseases involving the retina that causes slow but progressive loss of vision. It affects almost 11,000 Canadians and half of all cases are linked to family history.
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This prosthetic retina works by being surgically attached to the back of the eye in patients who have some light perception and nerve function left in the eye. The implant electrically stimulates the retina to produce light perception. It is attached externally to a camera and video-processing unit through a cable connected to a pair of glasses worn by the patient.
Studies have shown that patients receiving the implant had improvement in distinguishing motion, recognizing letters, and perceiving colours. However, at $155,000 US, the estimated cost of the device is not insignificant.
Self-expanding, drug-coated stent to treat peripheral arterial disease
Peripheral arterial disease (PAD) in the superficial femoral artery (SFA – the main artery in the thigh that brings blood and oxygen to the leg) is a common circulatory problem where the arteries narrow and reduce the blood flow to the legs. The condition can be debilitating, causing pain in the legs when walking and preventing people from performing daily tasks. It’s more common in the elderly, smokers, and patients with diabetes.
But a new stent, which is coated with a drug called paclitzxel, stays in the artery to help prevent it from narrowing again. The device has proven to be an important advancement for treating patients. It’s the first stent indicated for use in the SFA and its self-expanding material allows it to return to its original shape after external pressures are removed. It’s also the first stent approved in Canada to treat PAD in the SFA.
Trastuzumab emtansine for HER2-positive metastatic breast cancer
A new treatment for advanced breast cancer offers a new option for patients.
Women who are in advanced stages of breast cancer, and who test positive for the human epidermal growth factor receptor 2 gene (HER2) experience a very aggressive form of the disease and have a shorter survival.
Trastuzumab emtansine (T-DM1) is a new drug that incorporates three components: an anti-HER2 agent that attaches to HER2 receptors, a stable linker, and an anti-cancer substance. It allows drug delivery specifically to HER2-cancer cells and minimizes exposing normal cells to the therapy.
When compared to standard treatment, the clinical evidence suggests that T-DM1 alone can improve a patient’s overall survival by 5.8 months and lower adverse events. This targeted approach shows greater efficacy and lowered toxicity, compared with standard treatment.
Tympanostomy tube insertion delivery system for kids with chronic ear infections
Parents hate to see their children suffer the pain of chronic ear infections. Unfortunately, many children between six months and five years of age suffer frequent infections that cause discomfort, loss of sleep, and many trips to the doctor’s office. The infections can also lead to the most common same-day surgery performed on Canadian kids: ear tube insertion (officially known as tympanostomy tube insertion).
But a new, integrated in-office tube-delivery system may offer an alternative to conventional surgery. In a clinic or office setting, the doctor applies local anesthetic and the tube-delivery system makes a quick incision in the eardrum and inserts the tube in the ear in a single, automated motion.
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For more details about each of the health technologies included on the 2014 Top 10 New and Emerging Health Technology Watch List and a description of the methodology used to create the list, visit www.cadth.ca/cnesh. CADTH (Canadian Agency for Drugs and Technologies in Health) serves as the secretariat for CNESH.
*The technologies on the list are in no particular order.