bluuebunny/crossref_metadata_2025 huggingface dataset:
Differential regulation of TSG-14 expression in murine fibroblasts and peritoneal macrophages
Authors: Goodman Adam R , Levy David E , Reis Luiz F L , Vilçek Jan
Published: January 2018

Tumor necrosis factor (TNF)-stimulated gene 14 (TSG-14, also termed PTX3) encodes a secreted glycoprotein whose carboxyterminal half shares sequence similarity with the pentraxin family of acute phase proteins (C-reactive protein and serum amyloid P component). We compared TSG-14 mRNA expression in cultures of murine BALB/c 3T3 fibroblasts and thioglycollateelicited peritoneal macrophages. TNF and interleukin-1 (IL-1) potently induced TSG-14 expression in 3T3 fibroblasts but not in peritoneal macrophages. Lipopolysaccharide (LPS) elicited TSG-14 expression in both cell types, but induction in 3T3 cells and macrophages showed several distinct characteristics. Whereas in 3T3 fibroblasts TSG-14 mRNA was rapidly up-regulated by LPS, expression in macrophages was substantially delayed. Furthermore, cycloheximide greatly reduced LPS-induced TSG-14 mRNA up-regulation in macrophages but not in 3T3 cells. Finally, interferon-γ (IFN-γ; but not IFN-α/β) inhibited LPS-induced TSG-14 expression in macrophages and not in 3T3 fibroblasts. The antioxidant pyrrolidine dithiocarbamate inhibited LPS-induced nuclear factor-κB (NF-κB) activation and TSG-14 expression in macrophages. In contrast, IFN-γ did not inhibit NF-κB function as measured by IκB-α and IκB-β degradation, IκB-α resynthesis, or electrophoretic mobility shift analysis. Inhibition of LPS-induced TSG-14 mRNA expression by IFN-γ in macrophages was also observed in the presence of cycloheximide and in cells from STAT1 null mice, suggesting that IFN-γ inhibits TSG-14 expression through an unconventional mechanism. J. Leukoc. Biol. 67: 387–395; 2000.
Dexamethasone lowers cytosolic pH in macrophages by altering alkalinizing pH-regulatory mechanisms
Authors: Nauclér Claes , Sundler Roger , Tapper Hans
Published: January 2018

The effect of dexamethasone on cytosolic pH (pHc) in resident mouse peritoneal macrophages was investigated using the fluorescent probe 2′,7′-bis(carboxyethyl)-5(6)-carboxyfluorescein tetra-acetoxymethyl ester (BCECF-AM). Dexamethasone was found to significantly lower pHc and this reduction of pHc evolved gradually with time, was near maximal at 10 nM dexamethasone, and could be prevented by the glucocorticoid receptor antagonist RU-38486. The lower pHc of dexamethasone-treated cells was neither due to a reduction of cellular buffer capacity nor to an altered regulation of pHc by Na+/H+-exchange or by acidifying Na+-independent Cl−/HCO exchange, as assessed by studies of pH recovery after acute acid and alkali loads, respectively. Instead, an impaired pHc recovery by both the H+-ATPase and the alkalinizing Na+-dependent Cl−/HCO exchange was observed. This impairment was most likely not caused by an altered expression or localization of the 39-κDa subunit of the proton pump. Dexamethasone treatment caused a reduction of pHc also in a HCO-containing solution, suggesting that acid extrusion by both the H+-ATPase and Na+-dependent Cl−/HCO exchange is important for maintenance and regulation of macrophage resting pHc. The lowering of macrophage pHc might be one mechanism whereby glucocorticoids exert their anti-inflammatory effects. J. Leukoc. Biol. 67: 876–884; 2000.
Using Self‐Regulated Learning Strategies to Develop Students’ Multicultural Counseling Competency
Authors: Zeleke Waganesh A. , Karayiğit Cebrail , Myers‐Brooks Kaitlyn
Published: January 2018

This study examines the effect of self‐regulated learning strategies on students’ multicultural competency development. Quantitative and qualitative data were collected from 26 students who took a semester‐long multicultural counseling course. Results show statistically significant improvement in students’ multicultural awareness and knowledge and statistical insignificance in multicultural skill development compared to their level of competence before the training. Implications of using this approach to teach multicultural counseling courses and future research are discussed.

Este estudio examina el efecto de las estrategias de aprendizaje autorregulado en el desarrollo de la competencia multicultural de los estudiantes. Se recopilaron datos cuantitativos y cualitativos de 26 estudiantes que atendieron un curso de consejería multicultural de un semestre. Los resultados muestran una mejora estadísticamente significativa en la conciencia y conocimentos multiculturales de los estudiantes y una insignificancia estadística en el desarrollo de las habilidades multiculturales comparadas con su nivel de competencia antes de la capacitación. Se discuten las implicaciones de usar este enfoque didáctico en cursos de consejería multicultural y para investigaciones futuras.
Coronary artery disease in decompensated patients undergoing liver transplantation evaluation
Authors: Patel Samarth S. , Nabi Eiman , Guzman Luis , Abbate Antonio , Bhati Chandra , Stravitz Richard T. , Reichman Trevor , Matherly Scott C. , Driscoll Carolyn , Lee Hannah , Luketic Velimir A. , Sterling Richard K. , Sanyal Arun J. , Patel Vaishali , Levy Marlon , Siddiqui Mohammad Shadab
Published: January 2018

Coronary artery disease (CAD) is an important contributor to morbidity and mortality in patients undergoing liver transplantation (LT). However, the current literature is limited by sampling bias and nondefinitive assessment of CAD. The current study examines the prevalence of CAD via per protocol coronary angiography and its relationship to etiology of liver disease in patients undergoing liver transplantation evaluation (LTE). Data on 228 patients were prospectively collected who had coronary angiography as part of LTE between 2011 and 2014. Coronary angiography was done in all patients age ≥50 years or with CAD risk factors. CAD was defined as any coronary artery stenosis, whereas stenosis ≥ 70% in distribution of 1 or 3 major coronary arteries was considered as single‐ or triple‐vessel disease. CAD was detected in 36.8% of patients, with the highest prevalence among nonalcoholic steatohepatitis (NASH) patients with cirrhosis (52.8%). Prevalence of single‐vessel disease was higher among patients with NASH compared with hepatitis C virus (HCV) and alcoholic cirrhosis (15.1% versus 4.6% versus 6.6%; P = 0.02). Similarly, patients with NASH were more likely to have triple‐vessel disease when compared with HCV and alcoholic cirrhosis (9.4% versus 0.9% versus 0%; P = 0.001). While adjusting for traditional risk factors for CAD, only NASH as etiology of liver disease remained significantly associated with CAD. Complications from diagnostic coronary angiography or percutaneous coronary intervention were low (2.6%). In conclusion, patients undergoing LTE have a high prevalence of CAD, which varies widely depending on etiology of liver cirrhosis. The procedural complications from coronary angiography are low. Liver Transplantation 24 333–342 2018 AASLD.
Partial Proteome of the Corynetoxin‐Producing Gram‐Positive Bacterium, Rathayibacter toxicus
Authors: Fennessey Christine M. , McMahon Michael B. , Sechler Aaron J. , Kaiser Jaclyn , Garrett Wesley M. , Tancos Matthew A. , Luster Douglas G. , Rogers Elizabeth E. , Schneider William L.
Published: January 2018

Rathayibacter toxicus is a Gram‐positive bacterium that is the causative agent of annual ryegrass toxicity (ARGT), a disease that causes devastating losses in the Australian livestock industry. R. toxicus exhibits a complex life cycle, using the nematode Anguina funesta as a physical vector to carry it up to the seed head of the host plant. ARGT is caused by a tunicamycin‐like corynetoxin that is produced in R. toxicus‐infected seed galls. We analyzed protein expression in R. toxicus under stationary growth phase conditions to obtain a more complete understanding of the biology of this organism and identify potential targets for immunoassay development. A total of 323 unique proteins were identified, including those with putative roles in secondary metabolism and pathogenicity. The proteome analysis for this complex phytopathogenic Gram‐positive bacterium will facilitate in the characterization of proteins necessary for host colonization and toxin production, and assist in the development of diagnostic assays. Data are available via ProteomeXchange with identifier PXD004238.
Effect of long‐term exposure to aluminum and high‐fat diet on NTPDase and 5′‐nucleotidase activities in lymphocytes and platelets of rats
Authors: Kaizer Rosilene Rodrigues , Costa Eduarda , de Andrade Cínthia Melazzo , Schmatz Roberta , Gutierres Jessié Martins , Martins Danieli Brolo , Morsch Vera Maria , Schetinger Maria Rosa Chitolina
Published: January 2018

Aluminum is one of the most abundant metals in the earth's crust. Although it shows no known biological function, it is recognized as an adjuvant in vaccines for human and veterinary uses. This study aims to evaluate the role of lifestyle and environment in the promotion of chronic disease. In it, we associated two factors: chronic exposure to aluminum and high‐fat diets. Thus, we aimed to determine whether the association of long‐term exposure to aluminum and high‐fat diets affects the NTPDase and 5′‐nucleotidase activities in the blood platelets and lymphocytes obtained from the mesenteric lymph nodes of young rats. In fact, the ectonucleotidase activities were shown to be upregulated upon exposure to aluminum plus high‐fat diets. As a result, we can suggest that the progressive upregulation of ectonucleotidase activities that we observed could be controlling the extent of inflammation and immune response.
Assessing the current practice and policy with recommendations for emission control strategy for coal‐fired thermal power plants under Indian regulatory framework emphasizing the roles of R&D
Authors: Bandyopadhyay Amitava
Published: January 2018

On December 7, 2015, the Ministry of Environment, Forest and Climate Change (MoEFCC), Government of India (GoI), promulgated stack emission standards for sulfur dioxide (SO2), oxides of nitrogen (NOx), and mercury (Hg) from coal‐fired thermal power plants (TPPs). These standards were promulgated in addition to tightening the emission standard for particulate matter. Thus far, the GoI and a non‐governmental organization (NGO) have recommended the use of limestone‐based flue‐gas desulfurization (FGD) technology for removing only SO2 emissions, which would then require the application of additional technologies to remove the other regulated pollutants. A single technology, such as the Multi‐pollutants Control Technology (MPCT), which was recently developed elsewhere in the world and can remove all of the pollutants from the TPP, could be more economical than introducing separate technologies for the removal of each pollutant. Furthermore, unlike the limestone‐based FGD technology, which generates carbon dioxide (CO2) during the desulfurization process, the MPCT does not increase power plant CO2 emissions. Water consumption is also lower in MPCT than with the limestone‐based FGD technology. Thus, MPCT offers a lower carbon footprint as well as a lower water footprint than the limestone‐based FGD technology in accordance with the United Nations Environmental Programme's Sustainable Development Goals. In light of these observations, this article aims to assess current practices and policies and offers policy recommendations for Indian TPPs with the goal of providing a cogent technological solution that also strengthens the Decision Support System for the holistic protection of the Indian environment.
Life cycle assessment of clinker production using refuse‐derived fuel: A case study using refuse‐derived fuel from Tehran municipal solid waste
Authors: Panahandeh Azadeh , Asadollahfardi Gholamreza , Mirmohammadi Mohsen
Published: January 2018

One of the techniques used to dispose of 4,000 tons per day (TPD) of non‐recyclable waste from Tehran is to burn it as an alternative fuel in cement kilns. This practice reduces emissions from landfills, prevents the loss of waste energy, and conserves fossil fuel resources. The aim of our study was to conduct a life cycle assessment (LCA) of clinker production in cement kilns using a combination of natural gas, mazut, a form of heavy, low‐quality fuel oil, and refuse‐derived fuel (RDF) from Tehran. We used SimaPro 7.1 software to perform an LCA of 1 kilogram (kg) of clinker produced using the following fuel combinations: the first scenario involved natural gas consumption alone, the second scenario involved a combination of natural gas and mazut, with the mazut providing 5% to 30% of the heating value needed to produce cement clinker in the kiln, and the third scenario involved a combination of natural gas and RDF (providing 5% to 30% of the heating needed in the kiln). The impact categories in the LCA of global warming, eutrophication, and acidification were assessed by the Center of Environmental Science of Leiden University (Centrum voor Milieukunde Leiden—CML) CML 2000 method. The results indicated that the third scenario, involving natural gas and RDF, reduced acidification by 2.14–11.5% and global warming by 0–1.3% relative to the first scenario involving the use of only natural gas. In addition, we observed a 0.65–3.81% reduction in acidification and a 0.9–3.8% reduction in global warming under the third scenario compared with the second scenario (co‐firing of natural gas and mazut). The amount of nitrogen oxides (NOX) emitted from the combustion of the Tehran RDF was greater than that was emitted when burning mazut. Therefore, reduction of nitrogen from the RDF composition is necessary. This study indicates that the use of Tehran RDF (with reduced nitrogen) in Tehran cement kilns does not increase cement kiln NOX, sulfur dioxide (SO2), and carbon dioxide (CO2) emissions; however, we need to conduct additional investigation into the chemical composition of the Tehran waste before using solid waste in place of fossil fuels.
Effects of halothane on the electroencephalogram of the chicken
Authors: McIlhone Amanda E. , Beausoleil Ngaio J. , Kells Nikki J. , Johnson Craig B. , Mellor David J.
Published: January 2018

Little is known about the effects of inhalant anaesthetics on the avian electroencephalogram (EEG). The effects of halothane on the avian EEG are of interest, as this agent has been widely used to study nociception and analgesia in mammals. The objective of this study was to characterize the effects of halothane anaesthesia on the EEG of the chicken. Twelve female Hyline Brown chickens aged 8–10 weeks were anaesthetized with halothane in oxygen. For each bird, anaesthesia was progressively increased from 1–1.5 to 2 times the Minimum Anesthetic Concentration (MAC), then progressively decreased again. At each concentration, a sample of EEG was recorded after a 10‐min stabilization period. The mean Total Power (PTOT), Median Frequency (F50) and 95% Spectral Edge Frequency (F95) were calculated at each halothane MAC, along with the Burst Suppression Ratio (BSR). Burst suppression was rare and BSR did not differ between halothane concentrations. Increasing halothane concentration from 1 to 2 MAC resulted in a decrease in F50 and increase in PTOT, while F95 increased when MAC was reduced from 1.5 to 1. The results indicate dose‐dependent spectral EEG changes consistent with deepening anaesthesia in response to increasing halothane MAC. As burst suppression was rare, even at 1.5 or 2 times MAC, halothane may be a suitable anaesthetic agent for use in future studies exploring EEG activity in anaesthetized birds.
Transformation from Below in Bangladesh: Decentralization, local governance, and systemic change
Authors: FAGUET JEAN-PAUL
Published: January 2018

I examine decentralization through the lens of the local dynamics it unleashed in Bangladesh. I argue that the national effects of decentralization are largely the sum of its local-level effects. Hence, to understand decentralization, we must first understand how local government works. This implies analysing not only decentralization, but also democracy, from the bottom up. I present a model of local government responsiveness as the product of political openness and substantive competition. The quality of politics, in turn, emerges endogenously as a joint product of the lobbying and political engagement of local firms/interests, and the organizational density and ability of civil society. I then test these ideas using qualitative data from Bangladesh. The evidence shows that civic organizations worked with non-governmental organizations and local governments to effect transformative change from the grass roots upwards—not just to public budgets and outputs, but to the underlying behaviours and ideas that underpin social development. In the aggregate, these effects were powerful. The result, key development indicators show, is Bangladesh leap-frogging past much wealthier India between 1990 and 2015.
Privatization in the Land of Believers: The political economy of privatization in Pakistan
Authors: MUNIR KAMAL , NAQVI NATALYA
Published: January 2018

Despite theoretical justifications and empirical evidence that state-owned enterprises have played an important role in late development, as well as over three decades of evidence that privatization programmes since the 1980s have had mixed results at best, international financial institutions continue prescribing privatization as a panacea for developing countries. Pakistan is an interesting case to understand why privatization is still considered desirable, because it is one of a set of developing countries that have whole-heartedly implemented Washington Consensus policies. In this context, we analyse privatization in two key economic sectors in Pakistan: energy and banking. Using qualitative and quantitative data, we describe the motivations behind these privatizations, the process by which they were carried out, and analyse the post-privatization performance of these organizations and sectors. We find that in both cases (a) the privatizations failed not only with respect to their stated aims, leading to a decline in national productive capabilities, but also had adverse distributional consequences, shifting the rewards to the buyers while the risks and costs remained with the public sector, and (b) the suboptimal outcomes of the privatizations went largely unchallenged aided by a prevalent neoliberal view amongst the country's economic policy makers and intelligentsia. Our analysis sheds new light on the process by which privatization in the absence of a state with the capacity to discipline business interests has enabled these interests to obtain state-sponsored rents without bringing any of the associated benefits for economic development.
OP19 Unlocking The Potential Of Established Products: Need For Incentives
Authors: Nayroles Gabrielle , Gabriel Sylvie , Toumi Mondher , Kornfeld Åsa , Jaros Patrycja , Frybourg Sandrine , Antoñanzas Fernando , Espín Jaime , Jommi Claudio , Martini Nello , de Pouvourville Gérard , Tolley Keith , Wasem Jürgen
Published: January 2018

INTRODUCTION:

Re-purposing of established products (EPs) – defined as marketed for 8 years or more – may represent a high value for patients and society. It has been recognized by the European Commission as an important factor contributing to greater access to new therapies. Due to a lower development cost, it could also represent a cost-effective alternative and help to reduce pressure on healthcare budgets. However, it is perceived that no financial incentives exist for the pharmaceutical industry to invest in new indications for EPs. The objective of this research was to review current European regulations and propose strategies stimulating development in this field.

METHODS:

We performed a targeted literature review and held two international expert panel workshops to discuss current policies and their implications, and issue recommendations for changes.

RESULTS:

Within the current regulatory framework EPs face price cuts due to generic competition, reference pricing (RP), price re-negotiations or systematic price cuts, after a period of marketing presence. Extension of indications does not permit to increase or maintain the price. Generic substitution regardless of indication poses another challenge. Limited incentives in the form of an additional year of market protection exists only for new indication(s) registered within the first 8 years following initial approval. The expert panel proposed several strategies to stimulate development in this field, including: (i) extending the period in which registering a new indication results in additional market protection beyond 8 years and extending the duration of additional market protection; (ii) delaying inclusion in RP for EPs with a new value adding indication; (iii) establishing a differential pricing by indication; (iv) preventing temporarily generic substitution when an EP is prescribed for a new indication.

CONCLUSIONS:

Current regulations represent a serious disincentive to develop new indications for EPs. Regulatory and pricing policy changes are needed to stimulate development in this important field.
OP24 A Framework For Improved Systems Of Care In Myocardial Infarction
Authors: Lambert Laurie , Azzi Leila , Boothroyd Lucy , Brière Anabèle , Désy François , Vutcovici Maria , Bogaty Peter , de Guise Michèle
Published: January 2018

INTRODUCTION:

In the past decade numerous efforts have been made to enhance quality of care in the province of Québec for patients with ST-elevation myocardial infarction (STEMI). Despite two prior field evaluations and diffusion of a systematic review as well as recommendations, a third audit revealed persistent gaps in care, specifically excessive treatment delays. Our cardiovascular evaluation unit thus aimed to develop a more comprehensive quality improvement framework that further engaged healthcare professionals.

METHODS:

A literature update identified best practices and ways to reduce treatment delays and improve outcomes. This review, combined with the latest evaluation results, was used to establish structural and process quality standards adapted to the Québec context, via a consensus process with a panel of clinical experts. The standards identified quality-of-care targets and key elements of a governance structure to guide the improvement process. Quality indicators to monitor change were also developed. An implementation plan was then created, likewise based on literature and evaluation results.

RESULTS:

For the first time, the unit publicly disseminated the results of the third evaluation according to region, in addition to standard individual hospital “report cards”. A summit conference was held during which the standards and indicators were presented to clinicians and other stakeholders, in collaboration with the health ministry and a panel of cardiovascular experts. Site visits are planned to facilitate change and establishment of local improvement plans and committees. A “tool kit” was developed containing a treatment algorithm, a drug protocol, five quality indicators each for processes and care networks, and measurement tools for indicators. A 75 percent minimal achievement target was set for treatment times.

CONCLUSIONS:

A comprehensive framework aimed at improving quality of care for STEMI patients and monitoring change was created by combining evidence from the literature and “real world” data and mobilizing key stakeholders.
OP35 Involving Members Of The Public In A National Screening Programme Health Technology Assessment
Authors: Cockcroft Emma , Long Linda , Hyde Christopher , Liabo Kristin
Published: January 2018

INTRODUCTION:

Involving members of the public in the development of Health Technology Assessments (HTAs) has scientific and public value (1) but the most common form of involvement in HTA remains collection of people's views in the form of data (2). Involving members of the public in shaping the research is rare due to perceived time or resource constraints (3). Our research aimed to; (i) develop tailored meeting formats for public involvement in a lung cancer screening HTA, (ii) capture views on lung cancer screening using a community drop in format (iii) explore how different groups of public contributors, with various prior experience of involvement, participated in the HTA consultation process.

METHODS:

The involvement included three separate public meetings and a drop-in session at a community centre. Meeting formats were specifically tailored to meet the needs of the lung cancer screening HTA while drawing on previous patient and public involvement (PPI) work in relevant disciplines. All meetings were audio recorded and observed using a structured form. This data is currently being analysed using a combination of inductive and thematic analysis.

RESULTS:

The qualitative research data on PPI processes was collected in November 2016. The paper will present results from our full analysis. At present, we note that while limited time was available to explain HTA to participants, this did not hamper the discussions’ relevance to the HTA work. Participants shared personal stories irrespective of whether they knew each other from before. People drew on own and others’ experiences when discussing outcomes of importance to this HTA.

CONCLUSIONS:

Prior involvement in research or specific research methods training may not be necessary for public involvement in HTA. This has implications for involving diverse or “hard to reach” groups, without high levels of associated cost.
OP49 Restrictive Versus Non-Restrictive Drug Reimbursement Systems
Authors: Maynou Laia
Published: January 2018

INTRODUCTION:

Existing literature shows evidence on the differences in drug reimbursement decisions across countries. These differences are the reason for this study. The main aim of this research is to model the impact of drug reimbursement decisions on health outcomes (that is, life expectancy, healthy life years and mortality rates). In particular, this study is looking at countries that have different acceptance, restriction and rejection rates for drug reimbursement decisions.

METHODS:

The current study is based on a longitudinal dataset with data from nine European countries from 2002 to 2014. This dataset is formed of primary data on drug reimbursement decisions (that is, cancer drugs) collected in the Advancing and strengthening the methodological tools and practices relating to the application and implementation of Health Technology Assessment (ADVANCE-HTA) project and secondary data on life tables and indicators of health and socioeconomic status (from Eurostat and World Bank). Following the longevity model defined by Lichtenberg (1), a panel data model with country and year fixed-effects is run on this dataset in order to model the impact of the level of access to drugs on health outcomes.

RESULTS:

The results show that the rate of adoption of new drugs into a national health system does not have any significant effect on life expectancy. However, more restrictive systems are positively and significantly related with healthy life years. Finally, for mortality rates, higher rejection rates are associated with lower deaths.

CONCLUSIONS:

To conclude, contrary to the public opinion, results show that a more restrictive drug reimbursement system is not related with a worse health outcome, it is either associated with a positive outcome or it is not related.
OP64 Economic Impact Of Cardiac Device Remote Monitoring In South Korea
Authors: Ahn Jeonghoon , Ju Kim Eung , Yoo Justin , Colangelo Irene , Morichelli Loredana , Ricci Renato Pietro
Published: January 2018

INTRODUCTION:

The reduction of healthcare costs and societal cost due to remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) has been demonstrated in several countries; however, to the best of our knowledge it does not exist for South Korea. This work aims at providing an estimation of the potential benefit of RM versus standard care (SC) of CIEDs in term of healthcare costs in South Korea, in order to provide additional substance to the currently ongoing societal debate about the value of telemedicine.

METHODS:

Healthcare resource consumption was taken from the results of the TARIFF study, a prospective, non-randomized, multicenter clinical trial designed in Italy to assess the economic benefits of RM follow-up in comparison with standard follow-up in 209 patients (107 SC, 102 RM). The main results demonstrated that RM reduced healthcare resource consumption by 54 percent from a healthcare services perspective (SC: EUR1,044.89±1,990.47 versus RM: EUR482.87±2488.10, p<.0001 (1).

In order to perform a cost analysis from the perspective of the South Korean healthcare payer, the following unit costs were assigned to resources collected in TARIFF (hospitalizations, visits, examinations): fee-for-service tariffs, emergency tariffs and outpatient tariffs. Remote follow-up costs were considered as zero.

RESULTS:

From the perspective of the South Korean healthcare payer, the overall mean annual cost/patient in the RM group is 53 percent lower than in SC group (SC: EUR405,439±40,135 versus RM: EUR189,96±725,52, p<.0001) (SC: KRW 497,145±49,2137 versus RM: KRW 232,936±890,181, p<.0001). This is mainly due to a significant cost reduction in device-related hospitalizations, examination tests and visits in the follow-up period.

CONCLUSIONS:

RM of CIED patients is cost-saving from the perspective of the South Korean healthcare system. Introducing appropriate reimbursement for remote monitoring of CIED is not likely to change this result and should make RM sustainable for the provider and encourage widespread adoption of RM.
OP86 Identifying Surgical Procedures Of Low Or No-Added Value In Spain
Authors: Ibargoyen-Roteta Nora , Varela-Lema Leonor , Gutiérrez-Ibarluzea Iñaki , Benguria-Arrate Gaizka , Baños Elena , Atienza-Merino Gerardo , Martin Iñaki , Valentin Beatriz , Gavin Patricia , Kotzeva Anna , Garcia-Armesto Sandra
Published: January 2018

INTRODUCTION:

There is an increasing interest in divesting activities, giving rise to several initiatives both academic and governmental to identify and address one of the problems of health systems. In 2013 the Spanish Atlas of Variability in Clinical Practice (VPM) in collaboration with the Spanish Network of Health Technology Assessment (HTA) Agencies started a project with the purpose of providing elements to support a national strategy aimed at minimizing the use of doubtful procedures in the Spanish National Health System (1).

METHODS:

The identification, selection and definition of low added value procedures and the determination of the most cost-effective alternatives were carried out jointly between the AtlasVPM group and the HTA agencies of Andalusia (AETSA), Catalonia (AQUAS), Galicia (Avalia-t), Basque Country (Osteba), Madrid (UETS) and Aragon (IACS). The process consisted of the following phases: (i) Literature review; (ii) Preliminary list of procedures of dubious value; (iii) Analysis of feasibility and construction of the indicators (variability); and (iv) Empirical validation of the defined indicators. Different lists and sources of evidence were used to identify the procedures and evidence that support their low-value.

RESULTS:

The synthesis of the evidence gave rise to an initial list of fifty-nine procedures of doubtful value that could be classified as: obsolete or outdated procedures in comparison to more effective / cost-effective alternatives (n = 31), procedures of doubtful value when used outside their main indication (n = 17) and procedures for which the evidence around effectiveness was still insufficient (n = 11). With the advice of clinical experts and coders, the original list was reduced to seventeen procedures and after some adjustments to thirteen.

CONCLUSIONS:

Identifying procedures of low-added value is a complex task and is context dependent. Literature could be useful to identify a preliminary list but the analysis of the clinical practice, its variability and reasons that justify it are required to determine which procedures are good candidates for disinvestment.
OP125 A New Collaborative Approach To Assess Innovative Health Technologies
Authors: de Guise Michèle , Plamondon Geneviève , Simoncelli Mariève
Published: January 2018

INTRODUCTION:

Decision makers worldwide face the challenge of offering the best health care within a context of scarce resources. Technological developments have multiplied in the past decades, with the lifecycle of technologies becoming shorter. As a result, the traditional Health Technology Assessment (HTA) model is often caught in a too early, too late syndrome. In the province of Québec (Canada), there is no standardized process for assessing non-pharmaceutical technologies for reimbursement purposes, and technologies are therefore introduced via multiple sources. There are concerns that the introduction of some of the most promising technologies is delayed, and on the contrary, that others are introduced without providing a real added value to patients and the health system.

METHODS:

INESSS (Institut national d'excellence en santé et services sociaux), collectively with stakeholders of the Québec innovation field, has developed a dynamic process for assessing the added value of innovative technologies. POETIS (Processus optimisé d'évaluation des technologies innovantes en santé) aims to identify the technologies with the highest potential for positive impact on patients and the health system, in order to accelerate their implementation and promote their optimal use.

RESULTS:

POETIS comprises four phases aligned with the lifecycle of technologies: research and development, pre-implementation, limited implementation, and diffusion. It allows a continuum of assessment, from the promise of a technology to its real-world benefit. It differs from other approaches because of the sustained involvement of key stakeholders, including patients, and because it assesses technologies iteratively, therefore fostering their adaptation to better suit patients needs. It is hoped for the first technologies to be assessed in 2017.

CONCLUSIONS:

HTA has to adapt to the challenges of innovation, and this could be done with a lifecycle approach and an enhanced collaboration with end-users. Developed in Canada, the goals behind POETIS are common to many countries and the process could be adapted by other HTA agencies.
OP134 Predictors Of Public Health Outcomes: A Case Study From Turkey
Authors: Cinaroglu Songul , Baser Onur
Published: January 2018

INTRODUCTION:

In Turkey, there is a scarcity of knowledge about the predictors of health outcomes at a national level, and it is well known that there is a gap between rural and urban parts of developing countries in terms of the level of health outcomes. This study aims to find out predictor factors of the public health outcomes at a province level in Turkey.

METHODS:

Life expectancy at birth and mortality are used as public health outcome indicators. Logistic regression and Random Forest classification generated by using 50, 100, and 150 trees were used to compare prediction performance of health outcomes. The results of different prediction methods were recorded changing the “k” parameter from 3 to 20 in k-fold cross validation. The Area Under the ROC Curve (AUC) was used as a measure of prediction accuracy. Prediction performance differences were tested using Kruskall-Wallis analysis and visualized on a heatmap. Finally, predictor variables of public health outcomes were shown on a decision tree.

RESULTS:

Study results revealed that Logistic regression outperformed Random Forest classification. The difference between all prediction methods to predict public health outcome indicators was statistically significant (p<.000). The heatmap shows that AUC values to predict mortality have superior performance when compared with life expectancy at birth. Decision tree graphs present that the most important predictor variables were total number of beds for mortality and percentage of higher education graduates for life expectancy at birth.

CONCLUSIONS:

The results of this study represent a preliminary attempt to determine public health outcome indicators. It is hoped that the results of this study serve as a basis to understand the determinants of health care outcomes at province level with focus on a developing country. This study illustrates that there is a need to spend extra effort for future studies to analyze public health outcomes to improve social welfare functions in health systems.
PP039 Health Utility Values In Renal Cell Carcinoma: A Systematic Review
Authors: Lister Johanna , Stanisic Sanja , Neumann Monika , Dinet Jerome , Gabriel Sylvie
Published: January 2018

INTRODUCTION:

Advanced or metastatic renal cell-carcinoma (RCC) is associated with poor health outcomes; in particular in those whose disease progressed after first line treatment. A literature review was conducted to elucidate evidence on health-related utility associated with advanced and metastatic RCC.

METHODS:

A systematic literature search from 2006 onwards (date of search: July 2016) was conducted for studies evaluating health-related quality of life (QoL) and utility outcomes. Searches included Medline, Embase, National Health Service (NHS) Economic Evaluation Database and HTA Database and were supplemented by free internet search for key European Health Technology Assessment reports. Publications were limited to 2006 onwards as previous research (1) revealed no prior relevant evidence.

RESULTS:

The search yielded 4,178 records. The selection process revealed seventy-eight relevant publications. Generic EuroQol (EQ)-5D scale was most commonly used. Health-state utilities were assessed for specific treatments and at different time points. Mean reported value for patients after failure of one prior systemic therapy ranged from .79 - .62. For patients without progression (on and off-treatment) reported utility values were in range from .80 – .63. Utility in stable patients with adverse events ranged from .71 - .47. For patients with progressive diseases, utility was reported from .71 - .36. Utility for interventions due to skeletal-related events in patients with bone metastasis was reported to range between .46 and .15.

CONCLUSIONS:

Identified evidence confirms advanced or metastatic RCC leads to significant detriment to patients health-related utility. Further research efforts are warranted to assess health-state utility beyond clinical trial assessment.
PP041 Universal Coverage Through Innovative Telediagnosis Technology
Authors: Galvan Pedro , Velazquez Miguel , Rivas Ronald , Barrios Antonio , Hilario Enrique , Benitez Gualberto
Published: January 2018

INTRODUCTION:

Through technological innovations based information and communication technologies (ICT), advantageous telediagnostic systems can be developed to improve the health care of remote populations (1). In the context of universal coverage and the efficient use of available resources, there is a favorable opportunity to develop telemedicine towards an integrated ecosystem to improve health care in remote locations without access to specialists. This study, performed by the Telemedicine Unit (MoH) in collaboration with the Biomedical Engineering Dept (IICS-UNA) and the Basque Country University (UPV/EHU) evaluated a telediagnostic system implemented in 2014 in public health. The results of a cost utility analysis for this telediagnosis project in remote, regional and district hospitals in Paraguay are presented.

METHODS:

This is a prospective study, where the results of using telediagnosis implemented in remote hospitals over three years 2014–16 were evaulated. For these purposes, a utility analysis was carried out by comparing the cost of performing telediagnosis versus performing it “face to face” in a diagnosis center in the capital city.

RESULTS:

During the study 182,406 remote diagnoses were performed in the fifty-four remote hospitals using the telediagnosis tool. Of the total, 37.3 percent (68,085) corresponded to tomography (CT), 62.0 percent (113,059) to electrocardiography (ECG), 0.68 percent (1,243) to electroencephalography (EEG) and 0.01 percent (19) to ultrasound studies. The average cost of a tele-tomography, tele-ECG and tele-ultrasound was USD2.6, and USD8.6 for tele-EEG, respectively. The cost reduction through the telediagnosis was 26.4 times for tomography, 4.5 times for ECG, 8.0 times for EEG and 8.3 times for ultrasound. The cost utility analysis performed demonstrates an economic benefit of USD12.9 million to the citizens of the fifty-four communities included in this project.

CONCLUSIONS:

Despite the potential benefit of the telediagnosis (2) to facilitate the universal coverage, and optimize the use of scarce human and health financial resources shown in this study, other important aspects such as acceptance of the technology, patient satisfaction and a widespread use-assessment should be analyzed (3) before a large diffusion.
PP072 Applying Sensitivity Analysis For Robust Choice Of Health Technologies
Authors: Andellini Martina , Faggiano Francesco , Sabusco Francesca , Derrico Pietro , Ritrovato Matteo
Published: January 2018

INTRODUCTION:

The aim of this work is to evaluate the stability and robustness of the solution obtained at the end of the Health Technology Assessment (HTA) process by conducting a sensitivity analysis. Sensitivity analysis allows identification of the elements representing the source of uncertainty and to determine the impact of this variability on the stability of the assessment results, in order to provide more adequate and objective support to decision-making process.

METHODS:

A new method for health technologies evaluation, Decision-oriented HTA (1), which integrates the Analytic Hierarchy Process (AHP) (2) in the model Core Model® of the European Network for HTA (EUnetHTA) was taken into account. In this context, a mathematical model was implemented to conduct a sensitivity analysis on weights and on performance values of the technology alternatives evaluated. The objective is to evaluate the effects on AHP results induced by a change on initial values of each criterion of the decision-making model. Sensitivity analysis was carried out by calculating the minimum changes of the weights and performances needed to reverse the current ranking of alternatives technologies (3).

RESULTS:

This approach was applied to some technology assessment studies such as video-laparoscopy, femtosecond laser, da Vinci robot, to test their efficacy and reliability. It is very important to perform a sensitivity analysis and assure the stability of the solution when the performance values associated to the technology alternatives are close because, in this case, a small change of performance values reversed the ranking of alternatives technologies.

CONCLUSIONS:

Applying sensitivity analysis to such decision-making processes is essential to ensure the consistency of final decisions. This evidence has shown that this method allows for a more rapid interpretation of results, thus facilitating the choice of decision-makers about the decision to invest or not in new technology.
PP079 The Construction Of Database Using Japanese National Claims Database
Authors: Sato Daisuke , Shiroiwa Takeru , Fukuda Takashi
Published: January 2018

INTRODUCTION:

In 2014, the Ministry of Health, Labor and Welfare (MHLW) in Japan began to assume a cost-effectiveness perspective. Some expensive pharmaceutical and medical devices have been regulated, which resulted in a drastic change of the healthcare system.

The Japanese National Insurance Claims Database (NDB) is an administrative database based on claims data from Medical Insurance Claims since 2008. The government enacted the Act on Assurance of Medical Care for Elderly People during health care reform in 2008. In 2006, the MHLW commenced discussions on a framework for the optimization of the healthcare expenses, which aimed to evaluate the structure of the increase in healthcare expenditure.

The NDB was developed as a tool for investigation and analysis by the MHLW in the context of the Healthcare reform. In addition, the NDB was used for the development of academic research in order to contribute to the implementation and evaluation of healthcare policy management.

A major strength of the NDB is its exhaustiveness or completeness of insurance claims. The NDB collects data from all insured people nationwide and covers all medical institutions in Japan.

METHODS:

We applied to the Expert Meeting on Provision of Medical Insurance Claims to examine the research plan, items extracted, and data management. Inpatient and Outpatient information was extracted on medical procedures and payment. Diagnoses for both inpatients and outpatients are coded according to the International Classification of Diseases Tenth Edition (ICD-10). The coding of treatments and surgeries follow Japan's local procedure and surgical coding, which was specifically developed for insurance claims.

RESULTS:

We generated any personally traceable patient ID from the “hash ID” generated by patient name, sex, date of birth, and insurer number with the aim of protecting personal identifying information in the NDB. The disease of stroke was defined to analyze the database for cost-effectiveness analysis, and to connect disease information to. The prescription claims information described pharmaceutical names, prescription date, total dose, and number of days.

CONCLUSIONS:

Our study showed the new standard way of analysis for cost-effectiveness analysis using the Japanese National Insurance Claims Database.
PP109 Horizon Scanning For Information Providing In Brazil
Authors: Gomes Pollyanna , Vidal Avila , de Souza Andrea Brígida , Canuto Vania , Petramale Clarice
Published: January 2018

INTRODUCTION:

The last five years represented an advanced season for the establishment and reinforcement of the Brazilian Ministry of Health's Horizon Scanning System. The recognition of Horizon Scanning (HS) as a tool for evidence- based decision making has been reflected in the requests for information directed to the Horizon Scanning's team. These requests for information about new and emerging technologies come from cabinets offices and thematic departments of the Ministry of Health. The methodology of Horizon Scanning assessments described in EuroScan's toolkit1 has been applied to guarantee that the information reach stakeholders at the right time. The National Committee for Health Technology Incorporation (CONITEC) was accepted as a member of EuroScan (1) in 2016, and this represented another important step of Brazil's HS System.

METHODS:

In order to provide the specific information requested, the assessments of the technologies are done. So, databases on ongoing clinical trials, commercial pharmaceutical database, registration and licensing sites, proceedings and abstracts of scientific conferences and scientific databases are checked to collect the information. The extent and depth of the assessments depends on the stakeholders needs and time available to complete them. However, information as how the technology works, the clinical burden of disease, if there are available technologies in the Brazilian Public Health System to treat the disease, safety and effectiveness data, the regulatory status in the world as well costs, social, ethical and legal concerns are commonly given.

RESULTS:

The information provided using the HS methodology is used by stakeholders for several purposes as to defend the Ministry of Health in the Courts in the typical Latin American phenomena called “judicialization of health;” in assistance of the decision making of incorporation of technologies by the Brazilian Public Health and to support the definition of which medicines would be more strategic for establishment of Public-private partnerships for development of medicines, the named “Productive Development Partnerships (PDPs)”.

CONCLUSIONS:

The assessment of the technologies and the prediction of its potential for impact has helped the health policy making process in Brazil.