The Orthopaedic Data Evaluation Panel (ODEP) has recently introduced a listing of knee implant products that comply with the benchmarks set by NICE. Keith Tucker, Martin Pickford and Olga Taylor explain how the system has evolved from a procedure originally designed to evaluate hip implants
About four years ago, the demand for the Orthopaedic Data Evaluation Panel (ODEP) to introduce the ODEP process for knees gathered pace. The drive for change came from many of the knee manufacturers, the British Association for Surgery of the Knee (BASK), the British Orthopaedic Association (BOA) and from other sources.
ODEP now goes back 15 or so years. The panel was initiated and implemented by the Purchasing and Supply Agency (PASA) in response to a request by the National Institute for Health and Care Excellence (NICE) as part of their guidance, following the Capital Hip disaster. This was at about the same time as the National Joint Registry (NJR) was set up. As far as ODEP was concerned, the remit was to formulate a method to ensure that manufacturers would look at the performance of their products in a timely and consistent way, to enable us to inform surgeons about the strength of the evidence presented for a particular hip replacement. ODEP was never specifically set up to be a tool for any procurement process, and we have never had any dealings with price, although ODEP does of course recognise that the implants which survive longer will save money by not needing to be revised.
When we were introducing ODEP for knees we were fortunate in already having the experience of ODEP for hips on which to build. Some of us have also had experience working with the NJR, and particularly the Implant Performance Committee where poorly performing implants are identified.
ODEP for hips has been blessed by having some very experienced and highly respected hip surgeons who work with the core team, and for knees we have again been able to recruit some excellent surgeons, this time from BASK. They have all given freely of their time to put the process together, test it and share the responsibility of assessing the submissions. We would particularly like to thank Tim Wilton (President of BOA and past President of BASK), Richard Parkinson (President of BASK), Colin Esler and Andrew Porteous, as well as several members of ODEP.
When we started with ODEP for hips, there was little data for manufacturers to use in support of their submissions for the various benchmarks. We had to use KM (predictive) to get most of the manufacturers ‘over the line’ unless they were able to use data from one of the Scandinavian registries. Nowadays we have data from multiple sources and with the maturity of most of the world’s registries data is easier to access.
ODEP is not organised around the NJR; when we started there was no NJR and only for the past two years or so has there been NJR data available for 10-year ratings. We take data from multiple sources, including peer-reviewed data; RCTs, papers, presentations, etc. In addition to registry data we accept validated in-house data. These days much of the submitted data does come from NJR supplier feedback.
Supplier feedback
It must be said that one of the many outstanding features of the NJR is Supplier Feedback, which is unique and available to all manufacturers. There are some rules as to how Supplier Feedback data can be used and these include submission to ODEP, dealings with MHRA and internal audits and surveillance. Supplier Feedback is not listed as being available to another benchmarking organisation.
There are some other registries that do produce reports for manufacturers such as the Australian and New Zealand registries and we are very grateful to them.
Independence
There have always been some people who have criticised us and we have to accept that we will never please everybody. We strive to be honest and independent and we are not funded by those manufacturers whose data we have to scrutinise.
ODEP is a not-for-profit organisation and all the surgeons give freely of their time. Our office and expenses are funded by NHS Supply Chain. We think that any other system of funding will always call the quality of the ratings to be in doubt, which i