bluuebunny/crossref_metadata_2025_split huggingface dataset:
OP147 Educational Costs And Benefits Of Mental Health Interventions
Authors: Pokhilenko Irina , Janssen Luca , Paulus Aggie , Drost Ruben , Evers Silvia 
Published: December 2019

IntroductionThe burden of mental health disorders has a wide societal impact affecting primarily individuals and their significant others. Mental health interventions produce costs and benefits in the health care sector but can also lead to costs and benefits in non-healthcare sectors, also known as inter-sectoral costs and benefits (ICBs). The aim of this study was to develop an internationally applicable list of ICBs in the educational sector resulting from mental health interventions and to facilitate the inclusion of ICBs in economic evaluations across the European Union (EU) by prioritizing important ICBs.MethodsSome ICBs of mental health interventions were identified in earlier research, which were used as a basis for this study. Additional data was collected via a systematic literature search of PubMed and a grey literature search carried out in six EU countries. In order to validate the international applicability of the list and prioritize the ICBs, a survey was conducted with the international group of experts from the educational sector. The outcomes of the expert survey were used to create the condensed list containing the most important ICBs.ResultsThe literature search allowed identifying additional ICBs and creating a comprehensive list of items. In order to improve its usability, a multi-dimensional list was constructed distinguishing between tangible (i.e. special education) and intangible items (i.e. cognitive deficits). Based on the expert survey, the international applicability of the list was validated and the most important ICBs from the economic perspective were determined.ConclusionsMental health interventions can affect a large number of educational facilities. The list of ICBs developed in this study could be used to select relevant educational facilities for economic evaluations of specific mental health disorders. Further research is needed to define, measure, and valuate the identified ICBs in order to facilitate the practical application of the list in economic evaluations.
OP165 Health Technology Assessment And Public Health Priority Setting In China
Authors: Xiao Yue , Qiu Yingpeng , Shi Liwei , Zhao Kun 
Published: December 2019

IntroductionSince 2009, China has initiated a national program on free provision of essential public health services. The national program has expanded both in terms of service categories and funding, showing China's great commitment to universal health coverage. However, with slowdown of public input in the health sector, the government decided to prioritize interventions and optimize reimbursement packages. Researchers in the China National Health Development Research Center (CNHDRC)—the Chinese national health technology assessment (HTA) agency were asked to design the tools to facilitate the decision process.MethodsWith multi-criteria decision analysis (MCDA) method, the researchers analyzed value dimensions in public health issues, and built an evidence matrix for the priority-setting decisions. Supported by HTA tools, they appraised interventions and services through literature review and field studies, and projected budget impact of potential adjustment decisions based on cost analysis results. A deliberative process of key stakeholder groups was taken, and their views were counted in making the final recommendations.ResultsBased on evidence review and scores of stakeholders’ judgment, two public health service interventions were recommended for removal, and another two for adjustment (one for merger, one for optimizing care pathway). Cost estimation and potential budgetary impact were also analyzed to support financial decisions.ConclusionsHTA and MCDA are key tools for defining the value criteria, evidence framework, and deliberative process for the essential public health program. However, lack of cost-effectiveness evidence hinders fine-tuned decisions on resource allocation. Continual health economic evaluation needs to be conducted in the near future.
OP168 The EUnetHTA Quality Management System: Development And Evaluation
Authors: Fathollah-Nejad Reza , Luhnen Miriam , Rehrmann Maike , Nocon Maya , Hutner Heike 
Published: December 2019

IntroductionOne objective of the European Network for Health Technology Assessment (EUnetHTA) Joint Action 3 (JA3) is to set up a quality management system (QMS) for joint work that serves as a standalone infrastructure for a sustainable European HTA-collaboration. Structures of the QMS (quality policy, processes and procedures, and organizational structures) combined with the measures of QM (quality planning, assurance, control and improvement) both ensure achieving the objective of producing high-quality HTAs.MethodsBased on a thorough concept with involvement of a spectrum of EUnetHTA partners, re-evaluation, internal workshops and national expertise, the existing inventory consisting of procedures, templates, methodological guidelines and tools is being refined, complemented and revised. Procedures are gradually being transferred into Standard Operating Procedures (SOPs), seamlessly and chronologically covering all assessment phases. Supplemented by quality-control-checklists and templates these SOPs are linked to relevant guidelines and tools. The so-established QMS is subject to continuous improvement by recurrently applying the Plan-Do-Check-Act (PDCA)-cycle. Members of the assessment teams are surveyed after the publication of each EUnetHTA-report (check-phase). Processed results lead to modification, maintenance and improvement of the inventory (act-phase).ResultsThe majority of content has already been developed or revised and was already made available to the assessment teams to put to practical test. The survey results are systematically collected, processed and compiled. Derived from these results, a comprehensive report and a thorough list of improvement measures have been developed and will serve as a basis for further adaptions.ConclusionsThe establishment of structures of QMS and measures of QM both are supposed to assure high-quality HTA-reports for EUnetHTA and a possible permanent European collaboration on HTA after JA3 as proposed by the EU-commission's regulation proposal 2018/0018 (COD). The installed systematic data collection, processing and compilation mechanisms are a solid basis for the identification of future needs for developments.
PP03 Development Of A Medical Device Maintenance Management System
Authors: Rivas Ronald Alexis , Grossling Benicio , Galvan Pedro 
Published: December 2019

IntroductionHealth technologies are fundamental in an operational health system. Medical devices, in particular, are crucial for disease prevention, diagnosis, treatment and rehabilitation. Recognizing this important role of health technologies, the World Health Assembly adopted, in May 2007, resolution WHA60.29, which addresses issues arising from inadequate installation and use of health technologies, as well as the need to formulate national strategies for the implementation of evaluation, planning, procurement and management systems for health technologies, in collaboration with personnel dedicated to the evaluation of health technologies and biomedical engineering. Maintenance management computer systems and software have evolved to help maintain medical equipment and control associated costs. A Computerized Maintenance Management System contains a database about an organization's maintenance operations.MethodsThe pilot study of observational and descriptive design will include all the medical/laboratory equipment that the Research Institute of Health Sciences (IICS) has that meets the inclusion criteria. The work will be carried out at the IICS, which aims to develop a computerized system for the maintenance of equipment that allows the linking of Quick Response (QR) codes to an application (WebApp) by means of cameras in smartphones, able to relate each QR code (attached to a medical/laboratory equipment) to its corresponding URL, and thus able to access all the technical information of each IICS team and therefore monitor their maintenance (preventive, corrective, predictive), history, spare parts, budgets, and technical specifications.ResultsWe have a database of all medical devices installed in the research center; we look forward to developing the program to include the data. The project focuses on the effective tool for decision making regarding the evaluation of the installed sanitary technology and those that will be installed.ConclusionsThe study proposes an effective solution for maintenance management, using data that supports administrative decisions regarding the acquisition of equipment in the future; that is, the system can contribute when it comes to evaluating installed and acquired sanitary technology.
PP09 Cost-Effectiveness Of Chronic Obstructive Pulmonary Disease Management
Authors: Plunkett Thomas , Carty Paul , O'Neill Michelle , Harrington Patricia , Smith Susan M , Ryan Mairin 
Published: December 2019

IntroductionTo inform the development of a national clinical guideline for Chronic Obstructive Pulmonary Disease (COPD), prioritized by the National Clinical Effectiveness Committee in Ireland, a systematic review was conducted to examine the cost-effectiveness of pulmonary rehabilitation programs (PRPs), outreach programs (OPs), and long-term oxygen therapy (LTOT), compared with usual care.MethodsMedline, Embase, the Cochrane Library and grey literature sources were searched up to 19 June 2018. Studies evaluating cost-effectiveness published post-2008 in English were included. Screening, data extraction, and quality assessment using the Consensus Health Economic Criteria and International Society for Pharmacoeconomics questionnaires were conducted independently by two reviewers. Costs were converted to 2017 Irish Euro using consumer price indices for health and purchasing power parity.ResultsFrom 8,661 articles identified, seven studies (one comparing both PRPs and LTOT) were included (PRPs: five; OPs: one; LTOT: two). PRP cost-utility analyses (n = 4) reported conflicting results due to considerable heterogeneity in program and study design, with incremental cost-effectiveness ratios (ICERs) ranging between EUR 12,391 and EUR 509,122 per quality adjusted life-year (QALY) gained. The remaining study investigated hospitalizations avoided and found outpatient and community-based PRPs to be dominant, while home-based PRP produced an ICER of EUR 1,913. OPs were found to be less costly, but also less effective. However, the results of the underpinning trial were neither statistically nor clinically significant. LTOT was found to be cost-effective, with ICERs of EUR 17,603 and EUR 26,936 per QALY gained.ConclusionsApplying a willingness-to-pay threshold of EUR 45,000 per QALY gained, this systematic review found that, compared with usual care, there is inconsistent but generally favorable evidence for PRPs, no clear evidence for the cost-effectiveness of OPs, and that LTOT is likely to be cost-effective. However, there was a lack of methodologically robust studies included in the review and most were not directly transferable to the Irish context.
PP32 Joint Early Dialogs Between Medical Device Regulation and Health Technology Assessment
Authors: Schnell-Inderst Petra , Wild Claudia 
Published: December 2019

IntroductionIn Europe, the new Medical Device Regulation (MDR) and In Vitro Diagnostics Regulation (IVDR) that entered into force 2017 will have to be applied until 2020 and 2022, respectively. Under the old regulation, there was a large gap between evidence requirements for market approval and market access for high risk (class IIb and III) medical devices (MD). The MDR/IVDR will require appropriate clinical investigations for these MD classes. Despite the different purpose of market approval and surveillance and reimbursement decisions, there are possible synergies with regard to evidence generation, for example, design of pivotal trials and post-launch evidence generation with observational data. In the MDR, early scientific advice can be provided by expert panels of the European Commission if requested by MD developers. For medicinal products, the European network for Health Technology Assessment (EUnetHTA) has established joint early dialogs (JED) of HTA agencies with the European Medicines Agency and manufacturers. A similar approach might be possible with the Medical Device Coordination Group (MDCG). The objective was to explore possible synergies for JED with the MDCG and EUnetHTA.MethodsIn 2018, EUnetHTA established a task force for HTA and MDR/IVDR. A workshop, which will explore possible synergies and activities on JED as well as the viewpoints of stakeholders will be held in May 2019. Participants will be Directorate-Generals GROW (Internal Market, Industry, Entrepreneurship and SME) and SANTE (Health and Food Safety), EUnetHTA members assessing MD, representatives of national competent authorities, Team Notified Bodies, MedTech Europe, patient representatives and academia.ResultsA report on the presentations, the results of the discussion, and next steps in a possible collaboration will be presented.ConclusionsJoint early scientific advice to manufacturers on the European level for evidence generation by HTA agencies and the MDCG has the potential to streamline evidence generation in the life cycle of high risk MD.
PP62 Cost-Effectiveness Of Cervical Cancer Screening In Estonia
Authors: Võrno Triin , Laisaar Kaja-Triin , Raud Terje , Jõers Kai , Meigas-Tohver Doris , Kiivet Raul-Allan , Lutsar Katrin 
Published: December 2019

IntroductionIn Estonia, organized cervical cancer screening program is targeted at women aged 30–55(59) years and Pap-tests are taken every five years. Since cervical cancer is associated with human papillomavirus (HPV), a number of countries have introduced the HPV-test as the primary method of screening. The objective of this study was to evaluate the cost-effectiveness of organized cervical cancer screening program in Estonia by comparing HPV- and Pap-test based strategies.MethodsFor the cost-effectiveness analysis, a Markov cohort model was developed. The model was used to estimate costs and quality-adjusted life-years (QALYs) of eight screening strategies, varying the primary screening test and triage scenarios, upper age limit of screening, and testing interval. Incremental cost-effectiveness ratios (ICERs) were calculated in comparison to current screening practice as well as to the next best option. Sensitivity analysis was performed by varying one or more similar parameter(s) at a time, while holding others at their base case value. The analysis was performed from the healthcare payer perspective adopting a five percent annual discount rate for both costs and utilities.ResultsIn the base-case scenario, ICER for HPV-test based strategies in comparison to the current screening practice was estimated at EUR 8,596–9,786 per QALY. For alternative Pap-test based strategies ICER was estimated at EUR 2,332–2,425 per QALY. In comparison to the next best option, HPV-test based strategies were dominated by Pap-test based strategies. At the cost-effectiveness threshold of EUR 10,000 per QALY Pap-testing every three years would be the cost-effective strategy for women participating in the screening program from age 30 to 63 (ICER being EUR 3,112 per QALY).ConclusionsDecreasing Pap-test based screening interval or changing to HPV-test based screening can both improve the effectiveness of cervical cancer screening program in Estonia, but based on the current cost-effectiveness study Pap-test based screening every three years should be preferred.
PP64 Economic Evaluation For Esophageal Cancer Screening In China
Authors: Li Yuanyuan , Du Lingbin , Hu Xiaoqian , Gu Shuyan , Zhen Xuemei , Gu Yuxuan , Dong Hengjin 
Published: December 2019

IntroductionThe aim of the study was to estimate the cost-effectiveness of esophageal cancer (EC) screening compared to non-screening in China.MethodsA Markov model was conducted that followed the history of EC. Screening strategies targeted a population aged 40-69 years, classified into six age groups. Each age group had three cohorts: screening without follow-up, screening with yearly follow-up for low-grade intraepithelial neoplasia (LGIN), and non-screening. Life years (LYs) and quality-adjusted life years (QALYs) presented the effectiveness and utility. The incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR) were evaluating indicators. Eighteen cohorts from 100,000 hypothetical individuals were used to run the model, until aged 79 years or death. Costs were changed into USD using the purchasing power parity of 3.506 in 2017. The willingness-to-pay was set as three times the gross domestic product per capita (USD 51,340.6) in 2017. A sensitivity analysis was introduced to assess model robustness.ResultsScreening with follow-up compared to non-screening, ages 40-44, 45-49, and 50-54 years, showed cost-effectiveness, with one LY gained costing USD 6,875.0, USD 9,204.6, and USD 25,278.6, respectively. Ages 40-44 and 45-49 years explained cost-utility, with ICURs of USD 6,709.4/QALY and USD 13,991.4/QALY, respectively. Screening without follow-up compared to non-screening, ages 40-54 years, addressed cost-effectiveness, with one LY gained costing USD 6,934.8, USD 9,760.0, and USD 35,126.0 in ages 40-44, 45-49, and 50-54 years, respectively; the 40-44 years age group demonstrated cost-utility with an ICUR of USD 8,512.3/QALY. Screening with follow-up compared to screening without follow-up, all ages, explained cost-effectiveness and cost-utility. The probabilistic sensitivity analysis supported the outcome of the base cohort analysis.ConclusionsCompared to non-screening, screening with follow-up targeting ages 40-54 years was highly recommended with the ICER as the evaluated indicator, whereas it targeting ages 40-49 years was suggested with the ICUR as indicator.
PP69 Potential Gains In Health-Adjusted Life Expectancy From Reducing Four Non-Communicable Diseases Among Chinese Elderly
Authors: Gu Shuyan , Zhen Xuemei , Sun Xueshan , Gu Yuxuan , Dong Hengjin , Hu Xiaoqian 
Published: December 2019

IntroductionWith the fast speed of aging, burden from non-communicable diseases (NCDs) is increasing in China, and will continue to increase to 2020 and beyond. This study aims to estimate the potential gains in health-adjusted life expectancy (HALE) after hypothetical elimination of four NCDs among Chinese elderly from 1990 to 2016, including cardiovascular diseases (CVD), cancers, chronic respiratory diseases (CRD) and diabetes mellitus (DM).MethodsBased on data from Global Burden of Disease 2016, we generated life table by gender using Sullivan method to calculate HALE. Disease-deleted method was used to calculate cause-elimination HALE, after hypothetical elimination of specific diseases. This method could combine the impact of mortality and morbidity, which are particularly useful for estimating the impact of the disease and setting priorities for health planning to get ready for the new challenges in upcoming decade.ResultsFrom 1990 to 2016, HALE increased for all age groups. After hypothetically eliminating the four main NCDs, potential gain in HALE by CVD, DM and cancers increased, while CRD decreased from 1990 to 2016 for both genders. Among four main NCDs, potential gain in HALE after eliminating CVD was largest and increased most for both genders. Although elimination of DM led to the smallest gain in HALE, the increasing speed of gain in HALE by DM was faster than that by CVD and cancers from 1990 to 2016.ConclusionsThis study highlights the potential gains in HALE of NCDs among Chinese elderly from 1990 to 2016. HALE of Chinese elderly could further increase from the reduction of NCDs. Control measures and targeted prevention should be carried out to get ready for the new decade.
PP98 Educating Medical Students Toward Quality-Targeted Leadership
Authors: Tal Orna , Tal Inbal 
Published: December 2019

IntroductionClassic health technology assessment (HTA) is based on safety, efficacy, and costs. However, in the dynamic world of medicine, “real-world” experience is used to improve HTA. Aggregating evidence is a constant challenge. Physicians are traditionally trained in professionalism (knowledge and skills) and compassion, concentrating on the patient and disease rather than the technology. Currently, medical education also emphasizes quality of care by promoting standardization, and reducing mistakes by root cause analysis. We aimed to integrate the key parameters of safety, effectiveness, quality measures, economic aspects, and assessment guidelines for real-world experience in medical education.MethodsA group of medical students participated in a targeted HTA-orientated education program, which focused on the identification of challenges and barriers in the adoption of health technologies, and then completed a structured survey.ResultsThe program included 243 students. They raised four major emerging challenges: (i) to initiate a culture of quality and HTA-targeted perception for individual physicians; (ii) to better understand the role of different stakeholders in the health system; (iii) to be exposed to considerations of budget allocation; and (iv) to incorporate patient preferences, expectations, and engagement so that patient-centered care becomes a critical part of HTA.ConclusionsIncorporating values of HTA-targeted quality at an early stage of medical education, while future physicians are developing their professional identity, may create a professional, quality-focused leadership group in health care. The understanding and implementation of these “new” dimensions may serve as a platform for building smart capability to ensure better decision making processes among caregivers and medical managers.
PP99 Hospital-Based Health Technology Assessment Units In Brazil: Present And Future
Authors: Cohen Mírian , Lima Ana Flávia , Miguel Sandro , Aziz Marina , Cardoso Ricardo Bertoglio , Cruz Luciane 
Published: December 2019

IntroductionSince 2007, 23 Núcleos de Avaliação de Tecnologias em Saúde or hospital-based health technology assessment (HB-HTA) units have been established in teaching hospitals across Brazil. These units aim to promote the development of health technology assessment in hospitals, assisting the decision-making process for implementing new technologies and evaluating and promoting the rational use of widespread technologies.MethodsAn online questionnaire was sent by e-mail to all HB-HTA units registered in the Brazilian Network for Evaluation of Health Technologies. Information was acquired to comprehensively assess the activity of the units.ResultsAll 23 HB-HTA units answered the questionnaire. Of these, 65 percent had a technology prioritization process. The technologies assessed included drug therapies (73%), equipment (64%), medical devices (64%), clinical protocols (46%), and emerging technologies (27%). The dimensions of health technology assessment (HTA) evaluated by these organizations were: efficacy (76%); effectiveness (67%); safety (67%); costs (52%); cost effectiveness or cost utility (52%); and budget impact (43%). The hospital departments that required more HTA studies were: cardiology (50%); infectious diseases (45%); hospital management (45%); oncology (40%); surgery (40%); and endocrinology (20%). HTA studies supported: incorporation of new technologies (81%); protocol or guideline development (57%); new indications for already approved technologies (38%); and withdrawal of obsolete technologies (29%). Half of the institutions also conducted educational or training activities. The main difficulties reported were a lack of trained professionals (78%), funding (70%), and material resources (48%).ConclusionsFor low- and middle-income countries, the process of implementing HB-HTA units remains a challenge. Even though human resources and funding are scarce, HB-HTA units continue to develop. Given their importance in the decision-making process, it is imperative that every effort is made to ensure their activities continue.