bluuebunny/crossref_metadata_2025 huggingface dataset:
Australian Constitutional Law
Authors: Beck Luke
Published: December 2023

An understanding of the Australian Constitution as a framework for government in Australia is critical for any law student interested in ensuring that the rule of law is upheld. Australian Constitutional Law: Concepts and Cases provides an accessible introduction to Australian constitutional law, integrating theory and doctrine. This book provides clear explanations and carefully selected case extracts that are structured conceptually, rather than chronologically, to enable students to understand both the current state of constitutional law doctrine and how to engage in constitutional reasoning. Discussion questions throughout encourage students to consider how the law has evolved and how it can be applied to hypothetical legislation. The second edition has been updated to include commentary on significant recent High Court decisions and a new chapter that examines the scope of the Commonwealth's power to impose taxation. Written by leading constitutional law scholar Luke Beck, Australian Constitutional Law remains an invaluable resource for law students.
Mobilizing for Abortion Rights in Latin America
Authors: Daby Mariela , Moseley Mason W.
Published: December 2023

The past decade has seen sweeping changes in terms of reproductive rights in Latin America. Argentina and Uruguay have fully legalized abortion in the first twelve weeks of pregnancy. Some countries, like Chile, have loosened restrictions; others like El Salvador, Honduras, and the Dominican Republic have maintained or even tightened some of the most punitive abortion laws in the world. Abortion rights even vary within countries—in Mexico, the practice has been fully legal in certain states, and punishable with jail time in others. This Element explains how feminist social movements have transformed the politics of abortion in Latin America.
Field Theory of Multiscale Plasticity
Authors: Hasebe Tadashi
Published: December 2023

This unique book provides a concise and systematic treatment of foundational material on dislocations and metallurgy and an up-to-date discussion of multiscale modeling of materials, which ultimately leads to the field theory of multiscale plasticity (FTMP). Unlike conventional continuum models, this approach addresses the evolving inhomogeneities induced by deformation, typically as dislocation substructures like dislocation cells, as well as their interplay at more than one scale. This is an impressively visual text with many and varied examples and viewgraphs. In particular, the book presents a feasible constitutive model applicable to crystal plasticity-based finite element method (FEM) simulations. It will be an invaluable resource, accessible to undergraduate and graduate students as well as researchers in mechanical engineering, solid mechanics, applied physics, mathematics, materials science, and technology.
Analysis of spatial–temporal validation patterns in Fortaleza’s public transport systems: a data mining approach
Authors: de Almeida Mesquita Kaio G. , de Holanda Barros Luan P. , de Oliveira Neto Francisco Moraes
Published: December 2023

Understanding the spatio-temporal patterns of users’ travel behavior on public transport (PT) systems is essential for more assertive transit planning. With this in mind, the aim of this article is to diagnose the spatial and temporal travel patterns of users of Fortaleza’s PT network, which is a trunk-feeder network whose fares are charged by a tap-on system. To this end, 20 databases were used, including global positioning system, user registration, and PT smart card data from November 2018, prior to the pandemic. The data set was processed and organized into a database with a relational model and an Extraction, Transformation, and Loading process. A data mining approach based on Machine Learning models was applied to evaluate travel patterns. As a result, it was observed that users’ first daily use has a higher percentage of spatial and temporal patterns when compared to their last daily use. In addition, users rarely show spatial and temporal patterns at the same time.
Regulating Parties by Constitutional Rules in Liberal Democracies
Authors: Santos Botelho Catarina , Garoupa Nuno
Published: December 2023

When establishing constitutional rules that regulate political parties, liberal democracies struggle between civil liberties—thus tolerating anti-democratic parties—and potential threats of democratic breakdown, which can be reduced by prosecuting and prohibiting anti-democratic parties. We suggest that liberal democracies must balance false positives and false negatives by combining ex ante and ex post regulatory mechanisms. By making use of a unique dataset of thirty-seven liberal democracies collected by the authors, we find empirical results consistent with our positive theory. An extensive review of the normative debate and case law provides additional qualitative support.
Responses to Critics of Hegel on Being
Authors: Houlgate Stephen
Published: December 2023

I must first express my heartfelt thanks to Susanne Herrmann-Sinai and Christoph Schuringa for convening this debate. I also owe a special debt of gratitude to the four commentators for generously taking the time to read and think about my book, and for their thought-provoking and challenging comments. I have responded to as many of the latter as I could, and I look forward to hearing or reading, on other occasions, further comments on my responses.1
Cyber History: Homespun Historians, Ethnonationalism, and Recasting Yorùbá Oral Traditions in the Age of Social Media
Authors: Anọ́ba ibrahim Bàbátúndé
Published: December 2023

Like other oral sources of history, oral traditions constantly respond to political incentives. In the social media world, demographics relegated to the peripheries of modern state-making projects are using oral traditions as a genre of political activism to negotiate belonging. Following this trajectory, Yorùbá homespun historians on social media are refining Yorùbá oral traditions with ethnonationalism contaminants to galvanize netizens in opposition to the ethnicity’s marginalization in Nigeria and to demand a sovereign Yorùbá nation. This article interrogates the methods and approaches that Yorùbá homespun historians employ in recasting oral traditions. Consequently, it considers potential ramifications on oral traditions as a tool for historical inquiry.
A New Heuristic for Climate Adaptation
Authors: Hoffman Kate Nicole , Kovaka Karen
Published: December 2023

An influential heuristic for thinking about climate adaptation asserts that “natural” adaptation strategies are the best ones. This heuristic has been roundly criticized but is difficult to dislodge in the absence of an alternative. We introduce a new heuristic that assesses adaptation strategies by looking at their maturity, power, and commitment. Maturity is the extent to which we understand an adaptation strategy’s effects. Power is the size of the effect an adaptation strategy will have. Commitment is the degree to which an adaptation strategy is difficult to test or reverse.
Don’t Look Back in Anger: Cooperation Despite Conflicting Historical Narratives
Authors: HERRERA YOSHIKO M. , KYDD ANDREW H.
Published: December 2023

States in conflict often have divergent interpretations of the past. They blame each other for starting the conflict and view their own actions as justified retaliation, which makes them reluctant to cooperate. This phenomenon, while common in international relations, is not well understood by existing formal theories of cooperation. In the context of the Repeated Prisoner’s Dilemma framework, we show that strategies that demand atonement for past misdeeds are outperformed by strategies that do not. The latter are able to get out of retaliatory cycles and return to cooperation more quickly when there are divergent perceptions of the past. We conclude with a case study of Chinese and U.S. responses to the Tiananmen protests of 1989. China and the United States strongly disagree about the cause of the Tiananmen uprising and the legitimacy of the Chinese response, but nevertheless returned to cooperation after a limited period of mutual punishment.
THE TERRITORIAL REACH OF EUROPEAN UNION LAW: A PRIVATE INTERNATIONAL LAW ENQUIRY INTO THE EUROPEAN UNION'S SPATIAL IDENTITY
Authors: Marzal Toni
Published: December 2023

This article offers a reconstruction of how the Court of Justice of the European Union (EU) justifies the territorial scope of application of EU law. Scholarship on this issue tends to advocate for an expansive projection of EU norms in the pursuit of global values, subject to the external limits of public international law. This article will develop a critique of this approach by pointing to its underlying assumptions as to the territorial dimension of the EU's rule, the insoluble practical issues that it leads to, and the need to consider differently the EU's spatial identity and relation to the wider world. It will also be argued that, in fact, other case law sometimes already reflects an alternative vision, by imagining the EU implicitly, not as a ‘global actor’ promoting universal values, but as a concretely situated and spatially bounded community. It will be shown that this is so with the methodological help of private international law, and in particular three doctrines that are traditional to this discipline—the localisation of cross-border relations, international imperativeness, and the public policy exception. This will ultimately allow for a more sophisticated understanding of the EU's territory to emerge—irreducible to the physical coordinates of its acts of intervention, or the mere sum of the physical spaces under Member State sovereignty, but as a distinct space of social relations, informed and delineated by the particular axiology and structure of the EU legal system.
OP11 Cost-Effectiveness Of Atezolizumab Plus Chemotherapy As A First-Line Treatment For Metastatic Non-Squamous Non-Small Cell Lung Cancer
Authors: Liu Liu , Yang Yi , Xiao Dunming , Chen Yingyao
Published: December 2023

Introduction

Treatment with atezolizumab plus standard chemotherapy can prolong the overall survival of patients with metastatic non-squamous non-small cell lung cancer (NSCLC). However, the economic value of this treatment regimen is unknown. This study aimed to estimate the cost effectiveness of atezolizumab plus chemotherapy in the first-line treatment of metastatic non-squamous NSCLC from a healthcare system perspective in China.

Methods

A partitioned survival model consisting of three discrete health states was developed to estimate the cost and effectiveness of atezolizumab plus carboplatin or cisplatin plus pemetrexed (APP) versus carboplatin or cisplatin plus pemetrexed (PP) in the first-line treatment of metastatic non-squamous NSCLC over a 12-year lifetime horizon. Key clinical data were generated from the IMpower132 trial. Local direct medical and non-medical costs were used and health preference data were collected from patients with NSCLC in 13 tertiary hospitals across five provinces in China. Costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were measured. One-way and probabilistic sensitivity analyses were performed to assess the robustness of the model.

Results

Compared with the PP regimen, APP therapy yielded a gain of 0.21 QALYs at an increased cost of CNY145,602 (USD22,574), resulting in an ICER of CNY684,894 (USD106,185) per QALY gained. The ICER was significantly higher than three times the gross domestic product per capita for China in 2021 (USD37,663). One-way sensitivity analyses revealed that one of the most influential factors in this model was the cost of atezolizumab. Probabilistic sensitivity analysis showed that there was 14.7% probability that atezolizumab plus chemotherapy was cost effective at a willingness-to-pay value of CNY242,928 (USD37,663) per QALY gained.

Conclusions

The APP regimen could prolong survival and improve health benefits over standard chemotherapy in the first-line treatment of patients with metastatic non-squamous NSCLC, but it is unlikely to be a cost-effective treatment option in China.
OP24 Preferences Of Depressed And Depression-Prone Groups With Regard To Antidepressants In China: A Best-Worst Scaling Survey
Authors: Liu Shimeng , Ren Yanfeng , Liu Jing , Wei Yan , Chen Yingyao
Published: December 2023

Introduction

Antidepressants are one of the main treatment approaches for depression, and previous evidence suggests that consideration of patient preferences can improve their adherence to medication regimens. The objective was, therefore, to evaluate the preferences of depressed and depression-prone groups in China with respect to antidepressant medications.

Methods

An online survey with best-worst scaling choices was administered in depressed and depression-prone patients. The balanced independent block design generated 13 choice task profiles for each participant to answer, with each choice set consisting of four alternatives out of 13 antidepressant-specific attributes. Count analysis and a conditional logit model were used to estimate the relative importance of the 13 attributes and preference heterogeneity.

Results

The analytical sample included 210 participants, comprising 49 individuals who had previous experience with depression and 161 who were depression prone. Participants in both groups preferred medications with a low risk of liver or kidney damage, headache or dizziness, and recurrence. There were significant differences in both groups regarding out-of-pocket costs and duration of medication. The K-means clustering further proved preference heterogeneity among the patients.

Conclusions

Our study revealed patient preferences for antidepressant medication choices in China. Healthcare decision makers should consider and discuss patient preferences in the treatment decision-making process to improve patient adherence to and satisfaction with medications, and to ultimately improve patient outcomes.
OP29 Impact Of New Drug Indications After Initial Registration By The Agência Nacional de Vigilância Sanitária (ANVISA) in Brazil
Authors: Kelles Silvana , Pereira Camila , Martins Carina , Reis Daniel , Azevedo Ernesto , Ribeiro Geraldo , Zocrato Karina , Carvalho Lélia , Freitas Marcela , Horta Maria , Barbosa Mariana , Talim Mariza , Borin Marcus Carvalho
Published: December 2023

Introduction

Most drugs have data only from clinical trials focused on a specific population at the time of first registration, so their indications for use are restricted to this population. In Brazil, the prices of new drugs for clinical conditions with no therapeutic alternatives are relatively high. When these drugs expand to other indications their prices are not reviewed, which can have a major financial impact. This study aimed to evaluate the financial impact of expanding the indication for trastuzumab deruxtecan.

Methods

We calculated the annual cost to treat all Brazilian patients with the indications listed for trastuzumab deruxtecan at first registration, and then all additional indications. Populations were estimated from epidemiological data from National Committee for Health Technology Incorporation reimbursement documents and a clinical trial comparing trastuzumab deruxtecan with trastuzumab emtansine. Costs were calculated using the ANVISA Câmara de Regulação do Mercado de Medicamentos price value and a patient weight of 70 kg.

Results

In January 2022, trastuzumab deruxtecan was introduced in Brazil for patients with human epidermal growth factor receptor (HER2) positive metastatic or unresectable breast cancer who had received two or more anti-HER2 treatment regimens. In June 2022, the indication was expanded to patients with HER2-positive metastatic or unresectable breast cancer who had received one anti-HER2 treatment regimen. In November 2022, the indication was further expanded to patients with metastatic or unresectable low-expression HER2 breast cancer who had received prior systemic therapy. The number of patients estimated to be eligible for the drug increased from 383 to 23,000, with an increased total cost from BRL467,970,786 (USD90,621,763) to BRL26,048,234,160 (USD5,044,197,164).

Conclusions

The expansion of indications for trastuzumab deruxtecan may substantially increase its financial impact and compromise the sustainability of health systems. In Brazil, the lack of monitoring of drug prices means that the only change in prices occurs due to regulated annual inflation adjustments. Regulation is needed to reduce drug prices according to new indications, changes in therapeutic options for the same condition, and obsolescence.
OP39 Real-World Evidence Of Post-Incorporation Use Of Monoclonal Antibodies For Psoriasis In The Brazilian Public Health System
Authors: Neiva Pantuzza Laís Lessa , Lyrio Amanda Oliveira , Ferré Felipe , Mega Tacila Pire , de Freitas Lopes Ana Carolina , Canuto Santos Vania Cristina , Borges Stéfani Sousa
Published: December 2023

Introduction

Psoriasis is an immune-mediated chronic inflammatory disease that can affect the skin, joints, and nails. The treatment of the disease is offered by the Brazilian Public Health System (SUS) in accordance with the guidelines of the Ministry of Health. The aim of this study was to analyze real-world data (RWD) on the implementation and use of monoclonal antibodies (mAbs) for the treatment of psoriasis in the SUS.

Methods

This is a descriptive study that used national administrative data on drug dispensing from the Open Room for Health Intelligence Situation (SABEIS-SUS) from October 2019 to December 2021. Adult individuals (≥18 years) with vulgar (L40.0), generalized pustular (L40.1), gutata (L40.4) and other (L40.8) psoriasis who used the mAbs adalimumab, etanercept, risankizumab, secukinumab and ustekinumab were included.

Results

The year of implementation of mAbs for the treatment of psoriasis in the SUS was October 2019 (adalimumab, etanercept and secukinumab) and May 2020 (ustekinumab). Risankizumab was implemented in April 2022. The number of individuals using mAb grew from 366 in 2019 to 10,146 in 2021. In 2019, 2020 and 2021, the proportion of individuals using each mAbs was 62.3 percent, 46.2 percent and 35.4 percent (adalimumab), 7.9 percent, 3.3 percent and 2.7 percent (etanercept), 29.8 percent, 33.8 percent and 30.5 percent (secukinumab), 0 percent, 16.7 percent and 31.4 percent (ustekinumab), respectively.

Conclusions

The number of mAbs users has greatly increased from 2019 to 2021, which may indicate a successful implementation of the psoriasis treatment in SUS. Most individuals used adalimumab in the year of the first implementation. However, the proportion of users of this mAb has greatly decreased after the implementation of ustekinumab. This reduction should not be so expressive since adalimumab and ustekinumab are recommended in different lines of treatment. The low proportion of etanercept use may be due the fact the medication is indicated for individuals up 18 years of age. This study provides important real-word evidence for monitoring the implementation of mAbs for psoriasis treatment in Brazil.
OP40 An Initiative To Identify The Long-Term Effects Of COVID-19: Turkish Ministry Of Health (MoH) COVID-19 Follow-Up Centers
Authors: Şener Olgun , Ayar Banu , Ogras Sultan
Published: December 2023

Introduction

During COVID-19 pandemic Follow-up Centers were established by Turkish Ministry of Health (MoH) to detect possible complications in recovered COVID-19 patients at an early stage and make necessary interventions on time. It was aimed to reveal the short, medium and long-term effects of the disease by monitoring regularly. The Follow-up Center algorithms were designed by 10 clinicians of different branches with the support from United Nations Development Programme (UNDP). The follow-ups were made for one year in two pilot centers by using the health information systems infrastructure. In the dissemination process, Follow-Up centers were established initially in 24 and subsequently in 81 provinces.

Methods

In this study, the establishment, dissemination, operation and patient follow-up process of the COVID-19 Follow-up Centers were examined. The one-year (between 1 December 2021 and 1 December 2022) data obtained were analyzed. The patient follow-up;

•

was made at 0, 1, 3, 6 and 12 months for the first year,

•

planned to be made twice in the second year and the following years if needed.

In the first year, people who received 3 follow-ups by using the forms and scales in the integrated information system modules were assumed to be followed up regularly.

Results

Among the one-year data obtained from the COVID-19 follow-up centers, the total number of follow-ups, the distribution of follow-ups by date, gender and age groups and symptoms according to time were examined. In the first year; 11,288 people were included in the follow-ups and 18,328 follow-ups were made; 2,462 people were followed-up regularly. The followed up people consisted of 51.8% women; 48.3% of them were men. The incidence of symptoms decreased from 1,198 people in the first follow-up and to 180 people in the third follow-up.

Conclusions

The establishment of Follow-up Centers is considered to be an important initiative to generate systematic data on the long-term effects of COVID-19. It was concluded that conducting studies using two-year data obtained from the follow-up centers, especially for complications, would be beneficial for management of the COVID-19 pandemic and in preparation for similar pandemics.
OP44 Exploring The Disconnect In Relevant Outcomes For Health Technology Assessment-Related Economic Evaluation Relative To Care Commissioning: Implications For Resource Allocation
Authors: Franklin Matthew , Hinde Sebastian , Hunter Rachael , Richardson Gerry , Whittaker William
Published: December 2023

Introduction

Outcome-based commissioning – a set of arrangements to define and pay for a service based on pre-agreed outcomes – has been operationalized in some regional care settings (e.g., adult social care). However, it remains largely aspirational due to operational considerations and challenges. Outcomes-based commissioning shares a common goal with economic evaluation alongside health technology appraisal (HTA): to achieve value for money for outcomes from a finite budget.

Methods

We explored the considerations, implications, and challenges regarding the practical role of relevant outcomes in economic evaluation, relative to care commissioning, using England as a case study. Our exploration bridges a gap between economic evaluation evidence and practical resource allocation decision-making, focusing on conceptual (e.g., what are ‘relevant’ outcomes), practical considerations (e.g., quantifying and using relevant endpoints or surrogate outcomes alongside costs), and pertinent issues when linking these to commissioning based payment mechanisms.

Results

Firstly, there is a disconnect between existing economic evaluation approaches and commissioning processes. For example, using a single quality-adjusted life-year (QALY) maximum and limited consideration of affordability relative to cost effectiveness. Secondly, service-focused outcomes (e.g., seeing a specialist team) rather than person-focused outcomes (e.g., QALYs) are often desirable from a practical commissioning and service provider perspective as they make it easier to measure key performance indicators. Thirdly, both person- and service-focused payment structures could lead to market inefficiencies when activity is focused on only people for whom a prespecified outcome can be achieved or service delivered; these approaches require additional efficiency-equity tradeoff considerations (e.g., using distributional cost-effectiveness analyses).

Conclusions

We highlight payment structures as a major and complex consideration for commissioning, for which economic evaluation provides little to no consideration. Service-related outcomes and payments can be used as surrogate outcomes within economic modeling frameworks, while monitoring and evaluation can still be based on economic outcomes (e.g., QALYs and aggregated costs). Accounting for and explaining direct links from payment structures to economic outcomes is a major step to bridging a gap between economic evaluation evidence and practical resource allocation.
OP45 HTA And Gender Medicine: Time To Take Action!
Authors: Ragusa Rosalia , Guardabasso Vincenzo , Bellia Maria Alessandra , Piana Filippo , Quattrocchi Rosalba
Published: December 2023

Introduction

Gender medicine responds to the need for a reassessment of the medical-scientific approach in a gender perspective, to increase knowledge of the different aspects underlying gender differences and the appropriateness/ effectiveness of health interventions.

Methods

A policy review of documents prepared by the Italian Ministry of Health on gender medicine was carried out, to investigate the possible areas of intervention of health technology assessment in the development of this interdisciplinary dimension. The areas of highest priority for action have been identified.

Results

In Italy, the Ministry of Health, with the support of the National Institute of Health, issued a Plan for Application and Dissemination of Gender Medicine in June 2019. Our review shows that for the development of research on the mechanisms of pathogenesis the Italian Plan gives indications on the identification of diagnostic markers, prognostic and predictive response in a gender perspective, but there are no formalized rules that constitute a constraint or an obligation to do so. In Horizon Europe calls, for example, “Pragmatic trials on minimally invasive diagnostics” (HORIZON-MISS-2023-CANCER-01-03) on the other hand, it is required that gender and gender issues should be taken into account in all projects and all data should be disaggregated by gender, socio-economic status and ethnicity. Separating subjects into two groups in the analysis leads to greater complexity. This is even more true when considering the different types of gender. The total number of subjects to be included must likely increase to maintain statistical power in evaluating effects in subgroups. This increase leads to an increase in time and cost, if one needs to provide separate data by sex and even more so by gender. Different statistical tests to be used, according to the type of variables of the primary endpoint, should be considered in the study protocols.

Conclusions

It seems appropriate to suggest reviewing upcoming health technology assessments with an eye to gender medicine. Gender medicine should become a strategic goal of prevention in public health and will strengthen the concept of the patient centrality until the personalization of therapies is achieved.
OP47 The Risk-Based Price: Incorporating Uncertainty And Risk Attitudes In Health Technology Pricing
Authors: Kirwin Erin , Paulden Mike , McCabe Chris , Round Jeff , Sutton Matt , Meacock Rachel
Published: December 2023

Introduction

Decision makers often use value-based decision rules to determine whether technologies offer good value for money and should therefore be adopted, comparing cost-effectiveness analysis results with a threshold value. This assumes that decision makers are indifferent to interventions with the same expected value but different levels of underlying uncertainty. Such indifference is unlikely to hold in practice. We propose a risk-based price and accompanying decision rules to address this limitation.

Methods

We characterized risk using the per-patient expected value of perfect independent information (EVPII), a modification of a standard output from value of information analysis. The EVPII estimates the expected value of net benefit losses caused by uncertainty related to a technology, independent of the uncertainty related to alternative treatments. ‘Payer risk tolerance’ is then defined as the maximum per-patient risk of making wrong decisions that payers are willing to accept, expressed in monetary terms. The risk-based price is the price at which the EVPII is equal to the payer risk tolerance.

Results

The risk-based pricing decision rules are as follows: (i) a technology is acceptable for adoption at the submitted price if the incremental net benefit of the technology is greater than or equal to zero and the EVPII is less than or equal to the payer risk tolerance; and (ii) the optimal technology has the greatest expected net benefit at the lowest of the sponsor submitted, value-based, or risk-based price at a given cost-effectiveness threshold value.

Conclusions

The risk-based price incorporates uncertainty and risk attitudes into decision-making. We demonstrate that both risk-averse and risk-neutral payers prefer the outcomes of risk-based pricing. Risk-based decision rules incentivize sponsors to develop evidence. Implementation of the risk-based price improves outcomes for patients by increasing health system net benefits under constrained resources, with better alignment to decision maker risk attitudes.
OP61 Value Of Disinvestment: The Journey From Possibility To Reality
Authors: Abd Rahim Ku Nurhasni Ku , Kamaruzaman Hanin Farhana , Abdullah Mohamed Hirman , Mohamed Ghazali Izzuna Mudla
Published: December 2023

Introduction

In recent years, most countries have struggled to meet the annual demand for increases in healthcare resources. This scenario poses a significant challenge for those who pay for or manage healthcare services, namely the clinicians and hospital managers Thus, value-based implementation for resource allocation may include disinvestment initiatives to maximize benefits to patients and the population. The purpose of this study was to explore the feasibility of incorporating a systematic and explicit value assessment in hospital-based decision-making for the prioritization of resource allocation.

Methods

An evidence-informed stakeholder engagement workshop was held with approximately 50 hospital directors and utilized a scenario analysis of making decisions for hospital procurement. The key question discussed was what should be considered when making decisions about resource allocation and disinvestment in health services at the hospital level. The participants were divided into five groups with a mix of multilevel institutional categories. Each group was given a similar resource allocation scenario, a wish list, and a shift list. The participants were involved in a facilitated discussion on the process, criteria for prioritization, and the justification of their final selections. Subsequently, a deliberative discussion was held at the end of the workshop to explore the feasibility of this prioritization method.

Results

Prioritization criteria that were identified and unanimously agreed upon included effectiveness, safety, burden of disease, suitability of services, human resources and facilities, and economic considerations. The deliberative discussion also highlighted the impact of the disinvestment of services, managing the expectation of patients and clinicians, and monitoring and audit mechanisms.

Conclusions

The value of disinvestment should not compromise access to services and quality of care. There is a huge potential for implementing a systematic and explicit value assessment in hospital-based decision-making for prioritization of resource allocation. Further refinement of the process and mitigation of challenges will enable its use.
OP62 Development Of The Oral Health Risk Adjustment Model To Predict The Outpatient Dental Expenditure In Children With Autism
Authors: Lai Mei-chi , Chang Ruei-Yi , Huang Li-Ying (Grace) , Hsu Shu-Mei , Chen Ying-Li , Wang Perng-Haur
Published: December 2023

Introduction

National health insurance (NHI) Taiwan has provided additional markups on dental service fees for people with specific disabilities, and the expenditure has increased significantly from TWD473 million (USD15 million) in 2016 to TWD722 million (USD24 million) in 2022. The purpose of this study was to determine oral health risk and to develop a risk assessment model for capitation outpatient dental payments in children with Autism.

Methods

Based on the literature and expert opinion, we developed a level of oral health risk model from the claim records of 2019. The model uses oral outpatient claim data to analyze: (i) the degree of caries disease; (ii) the level of dental fear or cooperation; and (iii) the level of tooth structure. Each factor was given a score from zero to four and a total score was calculated. Low-, medium-, and high-risk groups were formed based on the total points. The oral health risk capitation models are estimated by ordinary least squares using an individual’s annual outpatient dental expenditure in 2019 as the dependent variable. For subgroups based on age group and level of disability, expenditures predicted by the models are compared with actual outpatient dental expenditures. Predictive R-squared and predictive ratios were used to evaluate the model’s predictability.

Results

The demographic variables, level of oral health risk, preventive dental care, and the type of dental health care predicted 30 percent of subsequent outpatient dental expenditure in children with autism. For subgroups (age group and disability level) of high-risk patients, the model substantially overpredicted the expenditure, whereas underprediction occurred in the low-risk group.

Conclusions

The risk-adjusted model based on principal oral health was more accurate in predicting an individual’s future expenditure than the relevant study in Taiwan. The finding provides insight into the important risk factor in the outpatient dental expenditure of children with autism and the fund planning of dental services for people with specific disabilities.
OP66 Adoption Of The World Health Organization Algorithm For Essential Medicines In The Philippine National Formulary Listing Process
Authors: Samonte Sheena Jasley , Mondala Princess Allyza , Liban Lara Alyssa , Reyes Patrick Wincy , Marfori Anne Julienne , Guerrero Anna Melissa , Castro Bu , Sia Isidro , Calimag Maria Minerva , Maramba-Lazarte Cecilia , Peña Imelda
Published: December 2023

Introduction

The Philippine National Formulary (PNF) System preceded the health technology assessment (HTA) process in the Philippines, which was institutionalized in 2019. The transition led to previously prioritized topics of expert bodies overseeing the PNF System being endorsed to the HTA Council. However, the advent of COVID-19 forced the HTA Philippines to focus on emergency assessment needs and financing recommendations for the national government, resulting in limited capacity to assess non-public health emergency topics. To address this and improve patient access to medicines, we adopted the World Health Organization (WHO) process for evaluating and selecting medicines in the National Essential Medicines List (NEML).

Methods

In assessing the pre-pandemic topics, we matched the population, intervention, comparator, and outcomes of the WHO clinical evidence reviews with those scoped with relevant stakeholders and performed local costing analyses to ensure applicability of findings to the Philippine setting. When needed, we subjected the topics to price negotiation or conducted qualitative assessments.

Results

We found the method efficient in expediting the decision-making process of the HTA Council. However, given the limited internal capacity of the HTA Philippines to conduct assessments for all ongoing HTA tracks, some of the topics responsive to Universal Health Care will be outsourced to the HTA Research Network, which is yet to be established. There is also a need to improve alignment among the topics being assessed, since the priorities of the proponents, national health program, and national payer have already evolved.

Conclusions

It is important to identify the priority areas for stakeholders as part of the topic nomination process, account for analytic capacity when setting the number of topics for HTA, establish mechanisms to allow proponents to conduct HTAs based on the HTA Council’s methodological standards, and proactively work with the national regulatory agency on horizon scanning and early HTA. We also recommend efficient monitoring, evaluation, and updating of the Philippine HTA guidelines so that they are more responsive to the needs of the healthcare system and the Filipino people.
OP72 Innovating To Decrease Mortality And Resource Use In Surgical Inpatients: The ZERO Project
Authors: Fernández-Barceló Carla , Abbas Ismail , Muñoz Guido , Sanchez Joan , Mellado-Artigas Ricard , Ferrando Carlos , Sampietro-Colom Laura
Published: December 2023

Introduction

Interest in early detection of complications in hospitals has increased recently. Complications after elective or urgent surgery are frequent and are associated with higher mortality rates, longer hospital stays, and more resource utilization. The ZERO project implemented an educational nursing program and developed an innovative algorithm that assesses a patient’s complication risk based on clinical parameters to prevent complications and reduce hospital burden. Our aim was to present the results from one year of implementing ZERO at the Clinic Barcelona University Hospital.

Methods

A comparative effectiveness and cost study was conducted. Data from patients admitted after elective or urgent surgery were collected for one year retrospectively (n=8,844 from January 2019 to December 2019) and prospectively (ZERO) (n=8,163 from October 2021 to October 2022). Effectiveness was measured in terms of mortality, complications, and life-years gained (LYG). Length of stay (LoS) at conventional, intermediate, and intensive care units and rates of readmissions were collected for resource use. The chi-square test was used to compare categorical variables. The t-test and Wilcoxon test were used for normally and non-normally distributed continuous variables, respectively.

Results

There was a significant decrease in the rate of complications (7.8%, 95% confidence interval [CI]: -8.46, -7.19; p<0.001) with ZERO. Moreover, there were statistically significant reductions in mean LoS for readmissions to conventional wards (-5.04 days, 95%CI: -9.9, -0.18; p=0.04) and to the intensive care ward within the same episode (-4.68 days, 95%CI: -9.26, -0.14; p=0.02). The mean cost per patient was EUR2,772.92 and EUR2,591.57 before and after ZERO implementation, respectively. After accounting for the cost of implementing ZERO, there was a cost saving of EUR147.76 per patient (p=0.048), which yielded a yearly impact of EUR1,206,165 for the hospital budget.

Conclusions

This one-year analysis of the effect of ZERO on surgical patients shows that it decreases complication rates and all types of LoS, leading to overall cost savings for the hospital.
OP85 Cost Effectiveness Of Prednisolone To Treat Bell’s Palsy In Children: An Economic Evaluation Alongside A Randomized Controlled Trial
Authors: Xiong Xiuqin , Huang Li , Herd David , Borland Meredith , Davidson Andrew , Hearps Stephen , Mackay Mark , Lee Katherine , Dalziel Stuart , Dalziel Kim , Cheek John , Babl Franz
Published: December 2023

Introduction

The cost effectiveness of treating Bell’s palsy with prednisolone in children is unknown. This study aimed to assess the cost effectiveness of prednisolone, compared with placebo, in treating Bell’s Palsy in children from a healthcare sector perspective.

Methods

This economic evaluation was a prospectively planned secondary analysis of a triple-blind randomized superiority trial conducted from 2015 to 2020 that compared prednisolone with placebo. The time horizon was six months after randomization. The 180 participants were aged from six months to 17 years and presented within 72 hours of onset of clinician diagnosed Bell’s palsy. Interventions were oral prednisolone (1 mg per kg daily) or taste-matched placebo administered for ten days. Incremental cost-effectiveness ratios comparing prednisolone with placebo were estimated. Costs included medication costs, doctor visits, and medical tests over the six-month study period. Effectiveness was measured using quality-adjusted life-years (QALYs) derived from the Child Health Utility 9D instrument. Nonparametric bootstrapping was performed to capture uncertainties. Prespecified subgroup analyses by age (12 to 17 years versus <12 years) were performed.

Results

The mean cost per patient was USD188 in the prednisolone group and USD121 in the placebo group over the six-month period (difference USD66, 95% confidence interval [CI]: 47, 179). The mean QALYs gained over six months were 0.45 in the prednisolone group and 0.44 in the placebo group (difference 0.01, 95%CI: -0.01, 0.03). Prednisolone was very likely cost effective given a conventional willingness-to-pay threshold of USD 50,000 per QALY gained (the cost per additional QALY gained was USD6,625 using prednisolone compared with placebo). Subgroup analysis suggested that this was primarily driven by the high probability of prednisolone being cost effective in children aged 12 to 17 years (98%), compared with those younger than 12 years (51%).

Conclusions

This study provides new evidence to stakeholders and policy makers who are considering whether to make prednisolone available for treating Bell’s palsy in children aged 12 to 17 years.
OP88 Translating Patient Reported Measure Score Into Specific Outcomes From The Patient Perspective–Example Using Health Assessment Questionnaire-Disability Index
Authors: Han Chenglong , Strauss Marcie , Hassan Fareen , Alulis Sarah , Adejoro Oluwakayode , Griffin Adrian
Published: December 2023

Introduction

To facilitate communication of clinical study results among patients, clinicians, and payers, this post-hoc analysis examined the association between achieving the Health Assessment Questionnaire-Disability Index (HAQ-DI) clinical meaningful improvement (CMI) and normalization of individual daily activities using pooled clinical trial data of patients with moderate-severe psoriatic arthritis (PsA).

Methods

Patients with active PsA (n=1,120) who participated in two Phase III trials were administered the HAQ-DI at baseline and weeks (W) 24 and 52. The HAQ-DI is a patient-reported instrument measuring functional status that is validated for rheumatological diseases including PsA. It contains 20-items assessing activities of daily living using a 0-3 Likert scale [0=able to perform activity without difficulty (normalization) through to 3=unable to perform activity]; 0.35 or more improvement in total HAQ-DI represents the CMI in PsA patients. Study participants with baseline item-specific scores more than zero (indicating some level of impairment) who experienced both 0.35 or more improvement in total HAQ-DI and item-specific score equal to zero, were compared over time.

Results

The proportion of patients with compromised ability to perform individual activities at baseline ranged from 42.3 percent (Difficulty Turning Faucet) to 84.1 percent (Difficulty Doing Chores). Fourteen of 20 activities with 60 percent or more of patients reporting impairment at baseline decreased to one of 20 activities in patients reaching the CMI at W24. Fourteen of 20 activities with 50 percent or more of patients reporting no impairment at W24 increased to 18 of 20 activities at W52. Notably, the proportion of patients reporting impairment for the two outlier activities at W52 (Reach-Get Down 5lb Item/Doing Chores) decreased during the follow-up period by 28 percent and 30 percent, respectively, despite presenting as very challenging at baseline.

Conclusions

PsA patients achieving a clinically meaningful change in total HAQ-DI over time were more likely to achieve normalization of individual daily activities. Translating changes in patient-reported outcome scores to specific symptom or functional improvements are meaningful to help patients understand clinical trial results, as well as to communicate with payers the value of accessing treatment for specific health conditions.
OP95 A Systematic Review Of The Cost And Cost Effectiveness Of Immunoglobulin Treatment In Patients With Hematological Malignancies
Authors: De Albornoz Sara Carrillo , Chai Khai Li , Higgins Alisa M. , Petrie Dennis , Wood Erica M. , McQuilten Zoe K.
Published: December 2023

Introduction

Patients with hematological malignancies are likely to develop hypogammaglobulinemia (HGG) and subsequent infections. Immunoglobulin (Ig) replacement is commonly given to prevent infections, but the total costs and cost effectiveness of its use are unknown.

Methods

A systematic review was conducted following PRISMA guidelines to assess evidence on the costs and cost effectiveness of Ig replacement, administered intravenously (IVIg) or subcutaneously (SCIg), in adult patients with hematological malignancies. This review was registered with PROSPERO (CRD42022321908).

Results

Six studies were included out of a total of 3,612 citations. A narrative synthesis was conducted because of the high level of heterogeneity across the included studies. Two economic evaluations were identified: one cost-utility analysis (CUA) of IVIg versus no Ig and one comparing IVIg with SCIg. The quality of the evidence was low, with most studies having small patient numbers and a high risk of bias. Compared with no treatment, Ig replacement reduced the hospitalization rate in patients with hematological malignancies.

One study reported no change in hospitalization rates following a program to reduce IVIg use, and an observational study comparing IVIg with SCIg found more hospitalizations with SCIg but lower total costs per patient. The CUA comparing IVIg with no IVIg suggested that IVIg treatment was not cost effective, but this study was published in 1991 and had significant limitations. The other CUA found that home-based SCIg was more cost effective than IVIg, but model inputs were derived from unpublished data in a very small patient cohort with HGG and different malignancies.

Conclusions

Our review highlights key gaps in the literature. The cost effectiveness of Ig replacement in patients with hematological malignancies is still very uncertain. Despite the increasing use of Ig replacement there are limited data regarding its direct and indirect costs, and its optimal use and implications for healthcare resources remain unclear. Given the paucity of data on the cost and cost effectiveness of Ig treatment in this population, further health economic research is warranted.