bluuebunny/crossref_metadata_2025 huggingface dataset:
PP77 Safety, Effectiveness, And Cost Effectiveness Of Telemedicine In Neurological Diseases
Authors: León-Salas Beatriz , Linertová Renata , González-Hernández Yadira , Infante-Ventura Diego , de Armas-Castellano Aythami , Hernández-Yumar Aránzazu , García-García Javier , García-Hernández Miguel , Toledo-Chávarri Ana , Carmona-Rodríguez Montserrat , del Mar Trujillo-Martín María
Published: December 2022

Introduction

Telemedicine has been introduced in health services, but uncertainties about the real value of this strategy in the management of neurological diseases remain.

Methods

A systematic review was undertaken of available scientific literature on the safety, effectiveness, and cost effectiveness of telemedicine combined with in-person visits, compared with usual care, for the treatment and follow-up assessment of patients with neurological diseases. The overall effect size for each neurological disease was estimated using meta-analysis. An economic analysis was performed from the societal and Spanish healthcare system perspectives.

Results

Two economic studies were included for cost effectiveness and 25 randomized controlled trails (n=8,976 patients) were included for the effectiveness and safety assessment (11 on cerebrovascular diseases, four on Parkinson’s disease, three on multiple sclerosis, two on epilepsy, and one each on brain damage, dementia, spina bifida, migraine, and cerebral palsy). The types of telemedicine evaluated included: virtual visits (11 studies); telerehabilitation (seven studies); telephone calls (three studies); smartphone apps (two studies); and online software for computers (two studies). Subgroup analysis by type of telemedicine indicated no discernible effect for telemedicine combined with in-person visits on most of the outcomes analyzed for the various neurological diseases. Given the heterogeneity of diseases, types of telemedicine, and the results observed, a cost-minimization analysis was conducted. Combining telemedicine with in-person visits would cost EUR 2.55 per patient from the perspective of the healthcare system, but it would result in cost savings (EUR 27.34 per patient) from the societal perspective.

Conclusions

The safety and effectiveness of combining in-person visits with telemedicine was similar to that of usual care, but it could be a cost-saving strategy in Spain from a societal perspective.
PP79 Use Of Vagus Nerve Stimulation Therapy In Treatment-Resistant Depression
Authors: Bariyeva Gulzada , Avdeyev Andrey , Benberin Valeriy , Shanazarov Nasrulla , Akhmedullin Ruslan , Akhmetova Makpal , Okesh Makhabbat , Aimanova Tansolpan
Published: December 2022

Introduction

Major depressive disorder (MDD) severely limits a person’s psychosocial functioning and reduces quality of life. According to world statistics, about 3.8 percent of the population, or about 280 million people, suffer from depression. Approximately one-third of patients with MDD have treatment-resistant depression (TRD). Meanwhile, Vagus Nerve Stimulation (VNS) therapy was approved by the US Food and Drug Administration and received CE marking in Europe for the treatment of chronic or recurrent depression in the early 2000s. The aim of this analysis is to determine the impact of VNS use in the treatment of TRD.

Methods

A comprehensive literature search was performed in MEDLINE/PubMed and Google Scholar databases in order to estimate the clinical effectiveness of neurostimulator implantation for treatment of TRD. The main assessment methods were the Hamilton Rating Scale for Depression, the Montgomery-Asberg Depression Rating Scale and the Beck Depression Inventory.

Results

In total, 6 systematic reviews with meta-analyses on the effectiveness of VNS in TRD were studied. The identified meta-analyses did not report any statistically significant differences in treatment outcomes favoring VNS compared to placebo and treatment as usual (TAU). However, the results of two studies demonstrate its positive clinical effect in the form of additional treatment to the TAU with longer follow-up period. An improvement in the clinical response is observed on average after 12 months as a decrease of about 50 percent in the initial estimates of depression.

Conclusions

Despite the lack of clinical evidence of the benefits of treating depression, VNS therapy should be used as a standard adjunct treatment to antidepressants or other treatments for people with TRD. Many studies tend to suggest that the efficacy and safety of VNC in depression is still unclear, and additional further research is still needed to establish clinically significant effects.
PP81 Barriers To Implementation Of Health Technology Assessment
Authors: Kosherbayeva Lyazzat , Askarova Ayganym , Hailey David
Published: December 2022

Introduction

The transition from the budget model of the healthcare system to compulsory social health insurance has created a competitive environment among hospitals in Kazakhstan. Managers are interested in introducing the most effective new technologies. Implementation of the health technology assessment (HTA) process in Kazakhstan began in 2010 but few managers have created a structure for HTA development in their hospitals. Our aim was to identify issues in the implementation of new health technologies in hospitals.

Methods

Structured interviews were held with hospital managers and physicians in June 2020, and September 2021. In the first stage, the needs of hospitals in the implementation of new technologies were considered. In the second stage, the impact of COVID-19 on the introduction of new technologies in the hospital was addressed. Interviews were held on-line by mobile phone or zoom and lasted 25-30 minutes.

Results

The first interviews involved 8 managers and 14 physicians from 5 hospitals. The needs of HTA for physicians was noted by respondents of both groups. Only a few physicians had been trained in HTA. Hospital staff lacked time and experience in preparing applications for new technologies by a national assessment unit and could not meet deadlines. Managers were interested in use of HTA for hospitals’ technologies in short-term timeframes within existing policies. However, physicians believed that long-term performance of technologies over 5 years or more should also be considered in hospital management. Physicians were aware of the importance of ethical considerations in the HTA of new health technologies. Managers did not consider ethical issues.

At the second stage of the project, 5 managers and 8 physicians were interviewed. COVID-19 had shown the importance and necessity of developing the scientific potential of doctors, and of introducing HTA and training medical personnel in its use.

Conclusions

Positive outcomes from the interviews were the interest of respondents in increasing their knowledge of the HTA process and acceptance of its importance at the hospital level.
PP85 The Cost-Effectiveness Of The Anti-COVID Vaccination Campaign In The Italian Healthcare Setting
Authors: Basile Michele , Di Brino Eugenio , Rumi Filippo , Cicchetti Americo
Published: December 2022

Introduction

Coronavirus disease 2019 (COVID-19) is a contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Symptoms of COVID-19 are variable, but often include fever, cough, headache, fatigue, breathing difficulties, and loss of smell and taste. Symptoms may begin one to fourteen days after exposure to the virus. COVID-19 transmits when people breathe in air contaminated by droplets and small airborne particles containing the virus. The present analysis aims to define the cost-effectiveness profile of the anti-COVID vaccination campaign in the Italian healthcare setting.

Methods

The analysis was based on the collection and analysis of data regarding the number of hospitalizations (ordinary regime and intensive care) and infections recorded by the Italian Ministry of Health in vaccinated and unvaccinated patient cohorts. The acquisition costs of the available vaccine alternatives were considered as well as the cost of the personnel involved in the vaccination campaign. The reduction in hospitalizations was considered as a measure of effectiveness. We have compared the current scenario of campaign vaccination versus a scenario in which the total of the eligible population would be vaccinated. Results are reported in terms of Incremental Cost Effectiveness Ratio (ICER). Deterministic and probabilistic sensitivity analyses were carried out in order to test the robustness of the results.

Results

The vaccination campaign allowed for savings amounting to EUR 9,398,012.10 (EUR 60,499,053.25 vs EUR 69,897,065.35) and 6,647 hospitalizations avoided (715 and 5,932 in the intensive care and ordinary regimen, respectively), thus resulting a dominant strategy as compared with the alternative (no vaccination). As the cost-effectiveness profile of the campaign improves, we should consider the period (May-July 2021), during which the daily threshold of 500,000 doses administered on a national basis was consistently exceeded.

Conclusions

The analysis underlined how the vaccination campaign represents a cost-saving alternative in the Italian healthcare setting.
PP91 Developing A Re-assessment Process For Non-medicine Health Technologies In Wales
Authors: Williams Jessica , Jarrom David
Published: December 2022

Introduction

Updating of health technology assessments (HTAs) is generally more efficient than starting again when new evidence emerges, but there is no clear guidance on how to do this. Health Technology Wales (HTW) has developed a re-assessment process to ensure that HTAs remain current and relevant to best serve the population and health and care providers in Wales.

Methods

HTW developed a standard operating procedure (SOP) to create a consistent approach to HTA re-assessment. HTW keep a record of stakeholders who contribute to a HTA and then send them a questionnaire to ascertain whether the research question is still relevant and if there have been any developments to the evidence since publication of the HTA. The input from these stakeholders is collated and taken to HTW’s Assessment Group to decide whether or not the HTA needs updating. If the Assessment Group decides that re-assessment of a HTA is warranted, HTW perform an updated literature search to inform the re-assessment.

Results

The HTA re-assessment SOP developed by HTW was approved by the organization’s Assessment Group. At the time of writing this abstract, HTW sent questionnaires to stakeholders of three HTAs which had HTW guidance published three years ago, and were therefore due routine consideration for re-assessment as detailed in our SOP. HTW also received a request from a clinician for a more recent HTA to be considered for re-assessment as they believed the evidence-base had changed since original publication. These questionnaires have been collated and will be taken to an upcoming Assessment Group to decide whether HTW should proceed with the re-assessments.

Conclusions

HTW has developed a consistent process for HTA re-assessment, which ensures that HTAs done by HTW remain current and relevant to best serve the population and health and care providers in Wales. By utilizing expertise from HTA stakeholders and HTW Assessment Group members, an informed decision can be made as to whether a HTA warrants re-assessment after three years following publication or sooner if requested.
PP95 Health Professionals’ Participation On Health Technology Assessment (HTA) Public Consultation: A Distribution Analysis Of Brazilian HTA In 2021
Authors: Komoda Denis Satoshi , Silveira Correa Carlos Roberto , Visacri Marilia Berlofa , Santos Daniela , Maia Flavia , Barkola Maria
Published: December 2022

Introduction

The Brazilian HTA process includes calls for public consultations, in which society can give its opinion on reports emitted by the National Committee for Health Technology Incorporation (CONITEC). Open and closed queries for public consultation are performed by official formularies and are available online at CONITEC webpage. There are two categories of queries: clinical protocols and guidelines, and incorporation/exclusion demands. Incorporation/exclusion queries are subdivided in two additional categories: opinion and experience, or technical. In this study we analyze health professionals’ technical contributions and their opinion (pro or con) on the inclusion or exclusion of health technologies.

Methods

On November 26th, 2021, formularies concerning concluded public consultations on health technology incorporation/exclusion reports were extracted from CONITEC website for the period, January 1, 2021 to November 26, 2021. Entries on the technical contributions formularies included a close-ended question about the opinion of participants on health technology incorporation/exclusion reports (“favorable”/“against”/“neither”).

Results

A total of 63 health technology incorporation/exclusion queries were carried out during the study period, of which only 4 were exclusions. A total of 7783 contributions were registered. “Patients”, “Family or caregivers”, “Interest on the theme”, and “Health professionals”, accounted for 96.4% (10.9, 15.2, 17.1 and 53% respectively). Health professionals’ participation alone accounted for 4130 entries. Concerning the category “health professionals”, the total number of favorable opinions on the presented documents was 2740 (66.3%), 1306 (31.6%) disagreed, and 84 (2%) had no opinion.

Conclusions

Health professionals can be considered one of the main stakeholders considering HTA for technology incorporation in public health systems. Brazilian HTA reports are submitted to public consultation through queries, which are available open access at the Brazilian National Committee for Health Technology Incorporation website.
PP97 Recommendations For Generating South African Health-Related Quality Of Life Data For Cost-Utility Analyses
Authors: Marsh Sophia Emmarenzia , Truter Ilse
Published: December 2022

Introduction

Health-related quality of life (HRQoL) data are necessary for conducting cost-utility analyses (CUAs) as part of health technology assessments (HTAs), but the lack of robust HRQoL data may delay or even prevent patient access to medicines when National Health Insurance is introduced in South Africa. This study aimed to make recommendations for evidence generation activities to support national HTA in the public health sector, with a focus on creating South African HRQoL data suitable for CUAs.

Methods

A systematic review of HRQoL research in South Africa formed the basis for three analyses. The first analysis quantified and evaluated the suitability of HRQoL studies for CUAs. The second analysis determined the performance indicators of the research output and identified collaborative networks through bibliometric analyses. The third analysis critiqued the translation methodology of the HRQoL instruments retrieved in the systematic review.

Results

Based on the published literature, existing HRQoL data are unlikely to support CUAs because they were derived from observational or cross-sectional studies that lacked the methodological details necessary to determine their scientific merit according to HTA requirements. Overall, there was a lack of research continuity in this field, with numerous isolated research networks. Despite the strong contribution of South African based researchers and organizations in this area, their performance was below that of international counterparts. Since only a few HRQoL instruments suitable for CUAs would be valid in the South African context, HRQoL research output in South Africa could be optimized by using more rigorous study designs and by the expansion of researcher networks to include those working in HTA and related fields. The three-level EQ-5D is the tool best suited for use in South Africa, so its utilization should be encouraged and supported by establishing a South African value set.

Conclusions

Future data generation activities should incorporate the recommendations from this study because existing South African HRQoL data are likely to be inadequate for conducting CUAs in national HTA.
PP107 Scale For Measuring Fatigue In Patients With Parkinson’s Disease: Scientific Technical Report
Authors: Figueiredo Caroline Vieira , De Assis Patroclo Maria Aparecida , Nicaretta Denise Hack
Published: December 2022

Introduction

Fatigue in Parkinson’s Disease (PD) remains poorly understood. The comprovation derives from and is proven by psychometric scales. The objective is to prepare a Technical Scientific Report on the performance of scales in PD.

Methods

Based on the Methodological Guideline for the Preparation of Technical Scientific Report, Brazil 2014, we conducted a search on MEDLINE / PubMed, Virtual Health Library (BVS) and Cochrane, and then a review and critical evaluation of the studies and the quality of the evidence.

Results

Nine studies were analyzed: three systematic reviews, one case-control and five cross-sectional studies. The following were evaluated: Fatigue Severity Scale (FSS), Fatigue Assessment of Chronic Illness Therapy (FACIT-F) and Parkinson’s Fatigue Scale (PFS-16). In Brazil, FSS and PFS-16 were validated. The studies have methodological weaknesses and moderate, low and very low evidence. However, FSS, FACIT-F and PFS-16 show potential for assessing fatigue in PD but further studies are needed.

Conclusions

Consensus on fatigue are recommended for Brazilian studies comparing FSS and FACIT-F with PFS-16 and longitudinal monitoring of patients.
PP114 The Influence Of Implicit Factors On The Health Technology Assessment Deliberative Process: A Survey In Five European Countries
Authors: Monleon Clara , Toumi Mondher , Späth Hans-Martin , Dussart Claude , Crespo Carlos
Published: December 2022

Introduction

Implicit factors can be defined as any criteria that play a role in the health technology assessment (HTA) deliberative process but are not part of the HTA framework. To date, very few studies have explored the influence of implicit factors on this process. This survey of HTA experts in five European countries aimed to analyze the influence of implicit factors on the HTA deliberative process.

Methods

Semi-structured interviews with 20 HTA experts from five European countries (France, Germany, Italy, Spain, and the United Kingdom) were conducted from February to May 2021. The main topics of the interviews were: the HTA deliberative process; the degree of influence on the HTA deliberative process of a set of factors previously identified in a systematic literature review performed by the authors; and recommendations for improving the deliberative process.

Results

All but two of the experts concurred that implicit factors played a role in the deliberative process. German experts considered that the factors explored had a low influence on the process. Burden of disease and unmet need scored highest, followed by the professional experience of the people involved in the HTA deliberative process. To improve the deliberative process, experts suggested expanding the external stakeholder perspective (i.e., including patients, the pharmaceutical industry, and the public), increasing transparency when revealing implicit factors, and implementing a methodology to mitigate the influence of implicit factors.

Conclusions

Our survey indicates a need to increase external involvement in the process and to develop a methodology for unmasking the implicit factors in the deliberative process. This may be achieved by either updating the current frameworks to include these implicit factors or by developing new methods to address them. Further research may explore approaches to acknowledge the implicit factors in the HTA deliberative process in a systematic manner.
PP115 Analysis Of Previous Joint Clinical Assessment And Potential Transferability To Four European Countries: Case Study And Conceptual Approach
Authors: Kern Jeanne , Pascha Victoria Malek
Published: December 2022

Introduction

The European Network for Health Technology Assessment (EUnetHTA) has led together, with member states, several joint actions, including Joint Clinical Assessments (JCA), under the form of project-based voluntary cooperation, which outputs and transferability of those projects in other European countries remains somehow limited. In June 2021, the European Council has reached an agreement on the European Health Technology Assessment (HTA) regulation, which is entering into force gradually. Initially limited to oncology products, then extended to orphan/advanced therapy, and after a five to eight-year additional period, it will apply to all centrally approved products. The JCA will consist of a focused scientific analysis on relative effectiveness assessment, including the health condition, technology description, clinical effectiveness, and safety. These analyses will also include information relating to the degree of certainty. We consider that the evidence appraisal might have limitations, and transferability would not be generalizable. We aim to determine the potential drivers and barriers for HTA transferability in EU4, employing the analysis of a case example where JCA was conducted.

Methods

Employing an oncology JCA, we will compare an HTA analysis conducted in EU4 countries (Germany, France, Italy, and Spain). Overview and background information on countries involved in the JCA, and EU4 HTA system will be provided, followed by HTA outcome and main evidence requirements, reimbursement outcome, and pricing agreements.

Results

Study results supporting HTA outcomes may focus on the population assessed, the comparator considered, and uncertainty management. A conceptual adaptation about the scope of the EU JCA regulation will be discussed, to understand its potential advantages to individual HTAs in Europe and remaining gaps to effectively inform HTA or decision-making process.

Conclusions

The analysis of pricing and reimbursement outcomes can further help understand potential barriers and drivers for JCA transferability and potential areas of evidence generation requirements.
PP117 Larger Impact Of An Appropriate Care Program By Involving Healthcare Professionals: A Case Report On Cervical Pre-malignancy
Authors: Böcker Koen , de Bruijn Thom , Vink Maarten
Published: December 2022

Introduction

Appropriate care programs differ in the way and the extent to which they involve or collaborate with stakeholders. Here we describe the collaboration of two national appropriate care programs with gynecologists to improve the curative care of women with cervical intraepithelial neoplasia (CIN), a cervical pre-malignancy.

Methods

The present case report describes the collaboration based on project documentation.

Results

The Appropriate Care program from the Dutch National Health Care Institute performs a systematic cyclic health technology assessment to examine the degree to which care in the insured package is provided to patients. The full cycle consists of four phases: screening, in-depth analysis, implementation, and evaluation. The results of the in-depth analysis are discussed with the stakeholders. This is followed by written agreements on multiple actions to improve healthcare from the patient perspective. For CIN these actions encompass improvements in a top-down fashion; for example, by updating guidelines to eliminate unwanted practice variation and creating tools for shared decision-making. These actions were supplemented by the development of audit and feedback information on a national and local level. The development was supported by a second national appropriate care program, Healthcare Evaluation and Appropriate Use. The results of the first production run of the audit and feedback information were disseminated by the Dutch Society of Obstetrics and Gynaecology and more than 50 healthcare institutions. This information was used to prioritize modular guideline updates and helped pinpoint the main areas of improvement of individual healthcare institutions. A future production run of audit and feedback information will facilitate the Plan-Do-Check-Act cycle on a local and national level.

Conclusions

In the case we present, the collaboration between appropriate care programs and healthcare professionals led to a synergy between top-down (updating and disseminating guidelines and tools for shared decision-making) and bottom-up (learning from audit and feedback information) activities to improve curative care for women with CIN.
PP128 Development And Piloting Of An Online Training Course On Health Technology Assessment For Patients
Authors: Vicente-Edo María José , Triñanes Yolanda , Toledo-Chávarri Ana , Bono-Vega María , Gavín-Benavent Patricia , Prieto-Remón Lucía , Suñe Begoña , Segovia Margarita , Novella-Arribas Blanca , Pilar Loeches-Belinchón , Cantero-Muñoz Paula , Perestelo-Pérez Lilisbeth , Jayo Nerea Arias , Reviriego-Rodrigo Eva
Published: December 2022

Introduction

Patients have knowledge, perspectives and experiences that are unique and can make an essential contribution to Health Technology Assessment (HTA). However, in order for their participation to be effective, they need to be able to understand how HTA reports are generated and the decision-making processes that they inform. The aim is to describe the development and virtualization of training materials for patients, as well as to their implementation in a pilot study.

Methods

A working group from Spanish Network of Agencies for Assessing National Health System Technologies and Performance (RedETS) agencies was created to develop educational materials in collaboration with patients. The content was based on international initiatives and feedback from the working group. The project was initiated in November 2020. The team consisted of HTA researchers, technicians with experience in training and virtualization and patients. The final version was obtained after an iterative process and refinement of the content and design.

Results

The materials were published in complete and summary versions, and they were translated into Catalan, Basque and Galician. The online course was designed in an e-learning platform (Moodle) with the aim of being implemented by each of the agencies. The materials include relevant and summarized information on HTA processes, current framework at national and European level, and the role of patients in HTA. Health research and the importance of qualitative and quantitative methods are also addressed. The course also includes a module of practical aspects of patient and citizen participation for achieving an effective contribution to HTA. The course is being piloted with patients in different regions in Spain. The objective of the pilot is to evaluate the usefulness and satisfaction with the course, and it has been designed with the purpose of incorporating the pertinent modifications in the course.

Conclusions

The online training course is intended to facilitate the acquisition of knowledge related to the processes and tools of HTA for patients, as well as to inform them in what phases and in what way they can participate. The pilot will provide relevant information on its use in practice. It is expected that the course will favor capacity building and patient involvement.
PP140 Economic Evaluation Of Several Vaccination Strategies Against Rotavirus In Spain
Authors: Imaz-Iglesia Inaki , Carmona Montserrat , García-Carpintero Esther E. , Martínez-Portillo Alejandro , Alcalde-Cabero Enrique , García-Pérez Lidia , Linertová Renata
Published: December 2022

Introduction

The Spanish Ministry of Health asked us about the efficiency of extending the current rotavirus vaccination strategy to all newborns. The current strategy is to vaccinate only to high-risk newborns (premature and those qualified as high-risk by a pediatrician). The objective of this research was to compare three strategies: no-vaccination, vaccination of high-risk newborns and universal vaccination, considering the two vaccines available in Spain: RotaTeq® and Rotarix®.

Methods

A cost-utility analysis, based on a de novo Markov model, was carried out both from a societal and a healthcare system perspective. The model follows a cohort of newborns during their life-course. The cycle length is annual and a half-cycle correction was applied. A discount rate of 3 percent was applied in the base case both to costs and utilities. Most of the incidence, probabilities and costs data were Spanish. The Quality Adjusted Life Year (QALY) data were taken from international literature. We assumed a willingness to pay threshold of EUR 25,000 per QALY gained. We performed deterministic one-way sensitivity analysis.

Results

Compared to no-vaccination, the high-risk vaccination strategy is cost-effective assuming the above- mentioned threshold only with Rotarix® from a societal perspective (RotaTeq® EUR 32,008 per QALY; Rotarix® EUR 23,368 per QALY). Universal vaccination is not cost-effective either compared to no-vaccination or compared to the high-risk vaccination strategy and with both perspectives. Vaccine prices and efficacy data are highly sensitive variables. We find that universal vaccination would be cost-effective with a discount of 44.6 and 36.9 percent of the current price of RotaTeq® and Rotarix®, respectively.

Conclusions

Universal vaccination would not be a cost-effective strategy for Spain with either of the two vaccines at current prices. Vaccination of high-risk newborns would be cost-effective at current prices and from a societal perspective only with Rotarix®. Substantial vaccines price reductions could make the universal vaccination a cost-effective option in Spain.
PP142 Time-Driven Activity-Based Costing (TDABC) Of Brazilian Public Healthcare System (SUS): Preliminary Results For Osteogenesis Imperfecta (OI)
Authors: Azevedo Camila , Souza Juliana , Gargano Ludmila , Salvador Bianca , Santana-da-Silva Luiz Carlos , Ogata Gabriel , Nita Marcelo , Félix Têmis
Published: December 2022

Introduction

Improving the value of healthcare delivered requires accurate cost information, which can be challenging for rare diseases. We report direct costs of patients with OI using the TDABC methodology.

Methods

This research is part of a nationwide observational study to assess the “Value of Healthcare Journey for Patients With Rare Diseases” in SUS. Patient journey and economic data was collected for the actual clinical practice in each medical center enrolled in the project. We set the starting point of disease and map a patient’s path in the healthcare journey, including treatment, exams, procedures and appointments needed. Unit cost, time and amount of resources to perform each activity, such as human resources, materials and medicines, was assessed, disregarding indirect costs. Here we present preliminary results for OI. We considered medical centers from different regions of Brazil. The results are presented in terms of percentage and/or mean and its standard deviation (SD).

Results

Three medical centers completed the data collection. The average [SD] cost of a one year journey of a patient diagnosed with OI is BRL 16,308.07 [11,005.21] (USD 2,886.91 [1,948.36]) per center. Activities with greater cost are medicines, with an average cost of BRL 11,919.47 [12,629.45] (USD 2,109.76 [2,235.52]), followed by materials and human resources, with an average cost of BRL 2,881.91 [3,311.57] (USD 509.92 [585.84]) and BRL 1,506.70 [1,300.46] (USD 266.54 [230.24]), respectively. When assessing the moment of a patient’s journey, the percentage of appointments, diagnosis, treatments and follow-up were 11.2, 25.8, 32.5 and 30.5, respectively. Only 3.3 percent of consumed resources were external to the center (out-of-pocket or private insurance).

Conclusions

The TDABC can efficiently draw the processes and costs associated with it. Medicines are the main driver of annual costs for OI patients in the SUS. This study was funded by the National Council for Scientific and Technological Development – CNPq and the Ministry of Health of Brazil – MoH.
PP146 The Use Of Indirect Comparisons For Reimbursement Decision Making In The Netherlands And England
Authors: Kalf Rachel , Dawoud Dalia , Bregman Caroline , Leckenby Emily , de Vries Marijke J.S. , Delnoij Diana M.J. , Bouvy Marcel L. , Goettsch Wim G.
Published: December 2022

Introduction

Reimbursement decision making is based on a relative effectiveness assessment (REA), which may be combined with a cost-effectiveness assessment, by national Health Technology Assessment (HTA) agencies. These assessments are based on clinical data where new interventions are compared to the current standard of care, which may differ between countries. Since most pivotal trials only include a limited number of interventions, indirect treatment comparisons (ITCs) can be used to compare multiple interventions. The aim of this study was to evaluate the use of ITCs in HTA decision making in the Netherlands and England.

Methods

All pharmaceutical assessments published between 2015 and 2019 by the National Health Care Institute (ZIN) and the National Institute for Health and Care Excellence (NICE) were reviewed to determine whether an ITC had been used. For detailed analysis we included all assessments of ZIN using an ITC, and a random sample of assessments of NICE using an ITC (10 assessments per publication year).

Results

Between 2015 and 2019 a total of 106 and 265 assessments were conducted by ZIN and NICE, respectively. Of these assessments 48 from ZIN and 150 from NICE included an ITC. The detailed analysis showed that pharmaceutical assessments including indirect comparative evidence led to the REA conclusion of similar therapeutic evidence in 57 percent of 48 assessments by ZIN and in 52 percent of 50 assessments by NICE. Reimbursement recommendations including indirect comparative evidence most often resulted in positive recommendations by ZIN (57% assessments), and in restricted recommendations by NICE (50% assessments). Different methods were employed to incorporate indirect comparative evidence, such as naïve ITCs and network meta-analysis.

Conclusions

Our results showed a significant variability in the use of ITCs between NICE and ZIN, which may contribute to differences in their recommendations. Further analysis will provide deeper insight in these differences and may provide suggestions for a clearer international guidance on the use of ITCs for HTA.
PP150 The Role Of Expert Consensus In UK Guidance: Patient Selection For Hydrogel Spacer Use During Prostate Cancer Radiotherapy
Authors: Saunders Rhodri , Payne Heather Ann , Jain Suneil , Peedell Clive , Edwards Albert , Thomas Andrew , Das Prantik , Hedblom Amanda Hansson , Woodward Emily , Bahl Amit
Published: December 2022

Introduction

In UK males, prostate cancer is the most common cancer, with over 47,500 diagnosed annually. Radiotherapy is a highly effective curative treatment but can be limited by dose to surrounding normal-tissues such as the rectum. Radiation to the rectum can be reduced by increasing the distance between prostate and rectum with a hydrogel spacer. Despite National Institute of Health and Care Excellence guidance, spacers are not widely funded in the UK. Limited funding has necessitated patient prioritization, without any existing consensus on method.

Studies have shown generally homogenous results in reduction of rectal toxicity across assessed subgroups, but the requirement to prioritize remains. One way of addressing the appropriate use of beneficial health technologies is the inclusion of end-user experts in decision-making. The study aim was to identify consensus among radiation oncologists on patient prioritization for rectal hydrogel spacers.

Methods

We conducted a Delphi study where six leading clinical oncologists and one urologist from across the UK experienced in using rectal hydrogel spacers participated in two rounds of online questionnaires and two virtual advisory board meetings.

Results

The experts estimated that 83 percent of patients who could potentially benefit from a spacer were denied access. Overall, ten points of consensus were reached. Key ones concerning patient-access were:

•

Spacer use in eligible patients significantly reduces radiation dose to the rectum and toxicity-related adverse events.

•

Increased benefit is expected in patients on anticoagulation, with diabetes and with inflammatory bowel disease.

•

Increased benefit can be expected with ultra-hypofractionated radiotherapy, but radiotherapy modality is not a key consideration for patient selection.

•

Patients should have the opportunity to actively participate in the discussion regarding the use of a spacer.

Conclusions

Currently, not all patients who would benefit can access funding for hydrogel spacers. Consensus in this study indicates that appropriate health policy and funding mechanisms are warranted for patients, to provide equitable access to technologies improving quality of life.
PP151 VALIDATE Methodology On A Medication-Related Clinical Decision Support System: Holistic Assessment For Optimal Technology Adoption
Authors: Barcelo Carla Fernandez , Calvo-Cidoncha Elena , Sampietro-colom Laura
Published: December 2022

Introduction

In the past decade, health technology assessment (HTA) has narrowed its scope to analyses of mainly clinical and economic benefits. Technology challenges in the 21st century emphasize the need for holistic assessments to obtain accurate recommendations for decision-making, as in HTA’s foundations. Using the VALues In Doing Assessments of health TEchnologies (VALIDATE) methodology for complex technologies provides a deeper understanding of problems through analysis of stakeholders’ views, allowing for more comprehensive HTAs. This study aimed to assess a pharmaceutical clinical decision support system (CDSS) using VALIDATE.

Methods

Semi-structured interviews with different stakeholders were conducted in the following domains: problem definition (medication error [ME] occurrence and prevention); judgement of solution (existing preventive methods and previous experiences of the CDSS); background theories (future impact and personal beliefs); and barriers to and facilitators of implementation. The following individuals were interviewed: medical informatic specialists (n=3), pharmacists (n=2), nurses (n=2), physicians (n=2), CDSS company representatives (n=1), electronic health record developer (n=1), and health consultancy firm representatives (n=1). Content analysis was used to integrate and analyze the data.

Results

The multistakeholder interviews identified various barriers to the acceptance and implementation of a pharmaceutical CDSS that were different from those reported in the literature. These included: (i) occurrence of ME (no traceability of medication taken or poor patient medication empowerment); (ii) perception of current level of MEs (huge improvement from ten years ago); (iii) perception of technology as a tool to prevent ME (not enough if only implemented at one point of care); (iv) previous experiences with a CDSS (low rates of development of CDSSs are due to medication prescriptions being digitalized last in hospitals); (v) CDSS metrics (input data should be measured to control CDSS performance); and (vi) other barriers.

Conclusions

Including facts and stakeholders’ values in problem definition and the scoping of health technologies is essential for the proper conduct of HTAs. Incorporating views from multiple stakeholders when scoping the assessment of health technologies brings additional values to literature findings, resulting in a more holistic evaluation. The lack of multistakeholder scoping can lead to inaccurate information and result in wrong decisions about if, when, and how to adopt a CDSS.
PD03 Uptake Of Health Technology Assessment In Hospitals: A Scoping Review
Authors: da Silva Galdino Johnathan Portela , Camargo Erika Barbosa , Elias Flávia Tavares Silva
Published: December 2022

Introduction

The use of Health Technology Assessment (HTA) in hospitals contributes to decision-making, professional training, greater interaction with technical to scientific knowledge, resource-saving, and partnerships. Hospitals are strategic for the field of clinical management and quality of care and are open to partnerships with national and international agencies and groups. Despite the hospital-based (HB)-HTA movement, the incipient application of HTA to the hospital decision-making process is related to incipient planning, and there is still much room for progress worldwide. The aim of this study was to analyze the uptake level of HB-HTA in diverse contexts.

Methods

A scoping review was conducted according to the methodology of the Joanna Briggs Institute, whose data analysis model consisted of the combination of Donabedian’s structure, process, and outcome categories and the dimensions of the project Adopting Hospital Based Health Technology Assessment in European Union (AdHopHTA).

Results

We identified 270 studies, and after removing duplicates and reading full texts, 36 references met the eligibility criteria. Thirty-six hospitals were identified, of which there were 24 largescale hospitals with extra bed capacity. Twenty-three hospitals were affiliated with universities. Canada stood out with five university hospitals, four of which with public funding. Half of the identified hospitals had HB-HTA units (18/36). Hospitals with full uptake level of HTA corresponded to 75 percent of the sample (27/36), and the remainder had partially uptake level of HTA, or 25 percent of the hospitals in the review (9/36). There were no hospitals with incipient uptake level of HTA.

Conclusions

Measuring the uptake level of HTA in hospitals contributed to understanding how their participation has occurred in the field of HB-HTA. This study revealed the importance of identifying factors such as sustainability, growth, and evolution of HB-HTA in countries with and without a tradition in this field.
PD09 Comparing Long-term Costs Associated With Intraocular Lens Selection And Nd:YAG Laser Capsulotomy In The UK: A Cost-Consequence Analysis
Authors: O’Boyle Derek , North James , Payton Emily
Published: December 2022

Introduction

Cataract surgery is the most frequently performed surgical procedure in the UK and posterior capsule opacification (PCO) is the most common complication post-surgery. Nd:YAG capsulotomy is the standard of care for treating PCO, although it bears a cost and is also associated with complications. The objective of this research was to estimate costs from a budget holders perspective associated with PCO related, post-cataract surgery resource use, comparing different single-piece intraocular lenses (IOLs) and utilizing results from a recently published audit of PCO incidence in the UK (n=601,084).

Methods

This research adapts the findings of the aforementioned audit to develop a cost-consequence analysis. The model is underpinned by the Nd:YAG rates of the included single-piece acrylic IOLs at 5 years. Nd:YAG related additional consultations and reported complications of the procedure were also included as variables of efficiency in the model. Estimates are presented from the perspective of a hospital setting in the UK, performing 3,000 cataract surgeries annually and extrapolated out to the broader cataract population (n=472,000). Costs were sourced from NHS Tariff documentation.

Results

AcrySof IQ was associated with lower Nd:YAG procedures and additional consultations at 5 years post-cataract surgery compared to all other single-piece monofocal acrylic lenses included in UK Audit Report. Assuming 3,000 cataract surgeries carried out annually, this translated into potential cost savings for the AcrySof IQ lens ranging from GBP 7,993 (EUR 9,379) (versus Eyecee One) to GBP 194,502 (EUR 228,243) (versus Akreos Adapt). Extrapolating to the broader population cataract patients in the UK would provide for a cost-saving estimates in the region of GBP 1.25 to GBP 30.6 million (EUR 1.47 to EUR 35.91 million).

Conclusions

This economic analysis highlights that the appropriate choice of IOL for cataract surgery, as a direct consequence of lower ND:YAG capsulotomy rates may translate into significant savings both for UK hospitals and the national healthcare system.
PD12 Quality Assessment Of Health Economic Evaluation On Screening Programs From China
Authors: Xia Yu , Lian Dai , Chen Yingyao
Published: December 2022

Introduction

With the increasing use of health economic evaluation (HEE) in decision-making and health resource allocation and management policy design has seen an increase in HEE studies on screening programs in China l. In addition to the quantity of HEE, the quality may be of particular concern as it influences the reliability of HEE evidence adopted in policy formulation. This study sought to assess the reporting quality of HEE on screening programs over the last 20 years in China and identify potential predictors and relevant recommendations to improve the quality of study reporting.

Methods

A search of HEE studies published in PubMed, Embase, CNKI and WANFANG from 2000 to 2021 was performed. Two reviewers independently extracted data and assessed the quality if reporting using the 24 item Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. The CHEERS score for each study was converted into standardized 0-1 point scale. General liner regression was used to identify predictors associated with the reporting quality.

Results

One hundred and thirty-three studies met the inclusion criteria. The mean standardized score for the included studies was 0.56 (title), 0.64 (abstract), 0.74 (introduction), 0.58 (methods), 0.40 (results), 0.70 (discussion), and 0.54 (other section). The number and reporting quality of articles published each year showed an overall upward trend. A greater proportion of studies were published in Chinese journal (69.2%), modelling-based (54.9%), conducted by universities/research institutions (45.9%), focused on non-infectious disease (84.2%), using cost-effectiveness analysis method (50.4%), published in non-specialty journal (60.2%), and declaring the funding support (76.7%). Items related to study perspective, discount rate, measurement of effectiveness, currency and price, analytical methods, uncertainty, heterogeneity and conflicts were under-reported. Published year, journal type, first author affiliation and economic evaluation type predicted higher score in regression analyses (p<0.05).

Conclusions

Overall, the quantity and quality of HEE on screening programs in China is improving, although there is a need to improve the use of on specific reporting items in the CHEERS criteria. The use of suitable evaluation guidelines will make the decision-making process more scientific.