bluuebunny/crossref_metadata_2025_split huggingface dataset:
PD70 Cost-Effectiveness Of Deep Brain Stimulation For Epilepsy In Australia
Authors: Joglekar Rashmi , Pietzsch Jan , Garner Abigail , Ramirez Belinda , Gillespie John 
Published: January 2019

Introduction:Deep brain stimulation (DBS), which uses an implantable device to modulate brain activity, is an adjunctive treatment for partial-onset seizures in patients with medically refractory epilepsy. Our objective was to perform an exploratory cost-utility analysis of DBS in conjunction with medical therapy, compared with medical therapy alone, using the latest clinical data and costs for the Australian healthcare system.Methods:A deterministic five-state Markov model was used to project treatment response and outcomes over the patients’ lifetimes, based on 5-year data from the recent Stimulation of the Anterior Nucleus of the Thalamus for Epilepsy (SANTE) DBS trial and drug outcome data identified through a literature search. Costs were based on 2017 data for the Australian healthcare system, and response-specific utilities were derived from published literature. We estimated the lifetime discounted incremental cost-effectiveness ratio (ICER) in Australian dollars per quality-adjusted life-year (QALY) for patients 36 years of age, fifty-five percent of whom were men. Costs and effects were discounted at five percent per annum. The robustness of projections was evaluated through scenario and sensitivity analyses.Results:Under assumed continued treatment benefit, DBS was projected to add 3.48 QALYs over the patients’ lifetimes, at an increased cost of AUD 142,304 (USD 105,960), resulting in an ICER of AUD 40,951 (USD 30,492) per QALY gained. Reducing the analysis horizon to 20 years increased the ICER to AUD 49,803 (USD 37,083). Increasing the DBS generator life from 3 to 6 years decreased the ICER to AUD 23,956 (USD 17,838) per QALY. Longer follow-up periods and younger age at treatment were associated with greater cost effectiveness. Results were sensitive to assumptions about health state-specific utility estimates and long-term treatment effects.Conclusions:Our exploratory findings suggest that DBS is a cost-effective treatment strategy in the Australian healthcare system for patients with medically refractory epilepsy. DBS therapy might meaningfully improve patient outcome at a health economic profile that compares favorably to other well accepted therapies. Consideration of indirect costs would further add to this value proposition.
PD76 The Value Of Continuous Lateral Rotation Therapy In The ICU
Authors: Kang So Yeon , DiStefano Michael , Yehia Farah , Koszalka Maria , Padula William 
Published: January 2019

Introduction:Mechanical ventilation in the intensive care unit (ICU) increases the risk of hospital-acquired conditions (HACs) such as ventilator-associated pneumonia (VAP) and pressure injuries (PrI). Continuous lateral rotation therapy (CLRT) has been shown to reduce VAP and PrI incidence, but the value of switching to CLRT over standard care is presently unknown. We evaluate the cost-effectiveness of CLRT beds compared to standard care in ICUs and determine the return on investment (ROI) associated with its implementation.Methods:A Markov model was constructed to predict health state transitions from the time of ventilation through 28 days using the healthcare sector perspective. Daily transition probabilities were extrapolated from prospective clinical studies comparing CLRT with standard care. Costs were estimated in 2014 USD. Utility scores were extracted from the published literature. Cost per quality-adjusted life-years (QALYs) was calculated and sensitivity analyses were conducted. A secondary analysis from a societal perspective with a one-year time horizon included the costs of patient and caregiver lost productivity. ROI analysis was performed to estimate the net benefit and breakeven point of the investment. Value of Information analysis was performed to determine whether further research is warranted.Results:From both perspectives, CLRT was dominant. From the healthcare sector perspective, the expected cost for CLRT per patient was USD 47,165 compared to standard care at USD 49,258 per patient, showing that CLRT saves cost per patient. The expected effectiveness of CLRT per patient was 0.0418 QALYs compared to 0.0416 QALYs for standard care. CLRT was dominant in 99.94 percent of Monte Carlo simulations. CLRT also reached the break-even point after 5 months. Expected Value of Perfect Information was equal to 0.019, indicating little value of additional evidence at the current level of parameter uncertainty.Conclusions:CLRT is highly cost-effective compared to standard care by preventing ventilator-associated infections and PrIs in an ICU setting.
PD78 Minimally Invasive Capsulorhexis In Children's Cataracts
Authors: Sánchez-Gómez Luis María , Luengo-Matos Setefilla , Pablo Juan , Orrego Chalco , Polo-Desantos Mar 
Published: January 2019

Introduction:Minimally invasive capsulorhexis is an incision in the anterior capsule in the peripheral zone for cataract extraction. It allows reduction of the size of the lesion, ensuring a better transparency of the visual axis, preserving the capsule almost intact and a layer of lenticular epithelial cells. The procedure could have a potential regenerative effect of the lens in a natural way. The objective of this study is to assess the efficacy and safety of minimally invasive capsulorhexis to promote lens regeneration in children's cataracts.Methods:This technology was identified by the early Awareness and Alert System, “SINTESIS-new technologies” of Agencia de Evaluación de Tecnologías Sanitarias (AETS) Instituto de Salud Carlos III (ISCIII). An early assessment was conducted. The searched databases were: PubMed, Centre for Reviews and Dissemination (CRD), and Cochrane Library. Clinical studies using the procedure published in any language until 29 September 2017 were reviewed.Results:An open-label, randomized trial in pediatric cataract patients (age: 0–2 years) was retrieved. Twelve patients underwent minimally invasive capsulorhexis, while twenty-five patients received the standard treatment. Regarding efficacy, a transparent regenerated biconvex lens was found in 100 percent of eyes three months after surgery, but wasn't found in the control group. 100 percent of capsular openings healed within one month after surgery in the experimental group, but not in the control group. Both groups increased their visual acuity parameters without significant differences. Regarding safety, children receiving the standard technique had a higher incidence of corneal edema (eight percent in the intervention vs thirty percent in the control group), anterior chamber inflammation (seventeen percent vs seventy-four percent), additional laser capsulotomy (zero percent vs eighty-four percent) and increased visual axis opacification (four percent vs eighty-four percent).Conclusions:Minimally invasive capsulorhexis in children's cataracts seems to be a promising new procedure. Preliminary efficacy results were good and safety profile was better than standard treatment. However, it would be necessary to continue further studies to confirm these results.
PD79 Poor Design And Reporting Impacts The Value Of Systematic Reviews
Authors: Vreugdenburg Thomas , Cameron Alun , Wild Claudia 
Published: January 2019

Introduction:Systematic reviews are useful for identifying gaps in research, setting priorities for future research, and informing clinical practice and public policy decisions. However, appropriate methods are needed to ensure that systematic reviews are of suitable quality in order to maximize their potential to achieve impact. The aim of this study was to evaluate the quality and transparency of systematic reviews conducted on prostate artery embolization (PAE), a topic of considerable interest in urology.Methods:We conducted a cross-case analysis. Existing reviews were identified through a systematic search of four biomedical databases (Cochrane Library, York Centre for Reviews and Dissemination, Embase, Medline) from inception up to 8 December 2016. Systematic reviews that evaluated the safety and effectiveness of PAE to treat benign prostatic hyperplasia were included. Included reviews were critically appraised using the AMSTAR (A MeaSurement Tool to Assess systematic Reviews) tool, and were scored against the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) criteria.Results:From 536 search results, nine relevant systematic reviews were identified, of which eight were published in 2016. None of the included reviews were prospectively registered on the PROSPERO database. The median AMSTAR score was four of 11 (range 0–7). The most common methodological concerns were related to comprehensive searches (33 percent), inclusion of grey literature (0 percent), and evaluation of publication bias (0 percent). Reviews adequately reported a median of 17 of 21 items (range 6–19) against the PRISMA checklist.Conclusions:Despite the availability of robust guidelines for conducting systematic reviews, methodological limitations in reviews of PAE are prolific, leading to considerable heterogeneity. There is also a significant duplication of effort, which can be prevented by prospectively registering systematic reviews on PROSPERO. Reducing duplication and increasing methodological quality are imperative to reducing waste in urological research.
VP23 The New Cancer Drugs Fund: The Future Model Of Oncology Reimbursement
Authors: Walsh Sean , Macaulay Richard , Turkstra Erika , Tsang Ricky 
Published: January 2019

Introduction:The Cancer Drugs Fund (CDF) was set up in 2011 in England to enable patients to access oncology therapies that are not routinely publicly funded. In April 2016, the CDF became a temporary reimbursement fund under the remit of the National Institute for Health and Care Excellence (NICE) with the aim of collecting observational data to inform subsequent technology appraisals. This study aims to evaluate how the reformed CDF has been utilized in the 18 months since this reform.Methods:NICE Final Appraisal Determinations for Single Technology Appraisals of oncology drugs from (29 July 2016 to 24 November 2017) were identified and key data extracted.Results:Seventy-four oncology drug:indication appraisals were identified, 54 (73 percent) were recommended/optimized, 10 (14 percent) were not recommended and 10 drug:indication pairings (14 percent: osimertinib, brentuximab vedotin, pembrolizumab, olaratumab, obinutuzumab, venetoclax, nivolumab [3 indications], and ibrutinib) were referred to the CDF. For most, the greatest uncertainty in their cost-effectiveness analyses related to their survival benefits, intended to primarily be resolved through subsequent clinical trial readouts. However, for venetoclax, ibrutinib and brentuximab, the main areas of uncertainty (relating to comparative survival benefit, pre-progression mortality, and rate of subsequent stem cell transplants, respectively) are expected to be resolved primarily through observational data collected under the CDF.Conclusions:The newly reformed CDF has been utilized in a minority of cases. Typically, the CDF acts as a temporary access mechanism for treatments that receive market authorization based on early/single-arm trial data until longer-term and/or Phase III data are available. However, venetoclax, brentuximab, and ibrutinib demonstrate how the CDF may address significant areas of uncertainty through the collection of uncontrolled observational data. For venetoclax, with only single-arm supportive clinical trial data, observational data of this intervention and appropriate comparator are to be collected, providing a potential case study of how to appropriately manage reimbursement in the face of significant clinical uncertainty.
VP24 HTA To Assess Esthetic Procedures In France: Haute Autorité de Santé (HAS) Seven Year Experience
Authors: Lhuillier-Nkandjeu Huguette , Guzina Irena , Daurat Veronique , Squalli Nadia , Merle Nathalie , David Denis-Jean , Carbonneil Cedric 
Published: January 2019

Introduction:The Health Technology Assessment (HTA) of esthetic procedures was performed by the French National Authority for Health (HAS), at the request of the French Ministry of Health (MoH), and under a new regulatory framework enabling the government to ban esthetic procedures considered harmful or potentially harmful to patients and consumers by HAS. Objectives: Describe HAS’ seven year experience with the safety assessment of four esthetic procedures.Methods:This is an HAS review of its methods used in four HTAs for the following evaluated techniques: lipolysis; cryolipolysis; esthetic mesotherapy; and, ultraviolet (UV) radiation in tanning devices. The review aimed to describe how these assessments have been undertaken and information sources used, from 2010 to 2017, to appreciate the safety profile of these procedures.Results:A systematic literature review (SRL) and analysis was performed for all four HTAs. Since findings did not allow for thorough appreciation of safety, additional sources of information were consulted to address evidence gaps. Sources may have included any combination of the following: i) National and international health care authority data and alerts ii) Legal and ethical frameworks iii) Public consultation iv) Expert opinion v) Patient-consumer association opinion vi) Economic analysisConclusions:An adaptation of the HTA methodology was necessary to meet the specific requirements of these assessments. Despite sources accumulated and consulted within the seven year period, quantitative data were found insufficient to fully appreciate the safety profile for any one of the studied esthetic procedures. National regulatory reinforcement on the reporting of adverse events, with implementation of a centralized online tool, is expected to generate and capture reliable data on the frequency and severity of adverse events associated with esthetic procedures. Recent European Union (EU) regulatory requirements on the safety and performance of medical devices include equipment used for esthetic procedures, indicating agreement and alignment on national and EU-level monitoring efforts.
VP30 The Use Of Artificial Intelligence In Health Technology Assessment
Authors: Jonsson Egon 
Published: January 2019

Introduction:To make itself more relevant in a longer perspective health technology assessment (HTA) will have to make use of novel ways to improve its services; in particular in terms of rapid response, cost savings and reduction of risk of bias. The use of artificial intelligence (AI) offers significant assistance at essentially all stages of any HTA. It can search, retrieve, read and organize relevant literature, not only from traditional databases but from numerous data sources related to specific issues (e.g. clinical trials, health outcomes, payment of services), and from databases in other areas such as in social, justice, and educational services, and public health.Methods:This presentation will explain the use and feasibility of AI in HTAs based on the findings from a currently ongoing project in the province of Alberta Canada. It will (i) provide an overview of AI in healthcare, (ii) outline selected international efforts of using AI in systematic reviews, such as the Robotreviewer, (iii) describe the information needed, and the development of the algorithms for using AI in HTAs, and (iv) report on the findings from a comparative study of human versus AI resources in performing an HTA.Results:This project has just started, however preliminary findings from the comparative analysis of AI versus human performance on a specific topic for HTA will be presented.Conclusions:It is expected that the comparative study will demonstrate that artificial intelligence will become a useful tool in HTA in that it will significantly speed up systematic reviews, and decrease the risk of bias in syntheses of findings from research.
Observed Spatiotemporal Changes in the Mechanisms of Extreme Water Available for Runoff in the Western United States
Authors: Yan Hongxiang , Sun Ning , Wigmosta Mark , Skaggs Richard , Leung L. Ruby , Coleman Andre , Hou Zhangshuan 
Published: January 2019

AbstractThis paper presents the first study to identity, in historical records, regional changes in the mechanisms of extreme water available for runoff (W). We used a quality‐controlled Snowpack Telemetry data set (1979–2017) combined with the nonparametric regional Kendall test to examine changes in annual maximum W under four hydrometeorological conditions (melt only/rain‐on‐snow/all melt/all melt plus rainfall) over the mountainous regions of the western United States. Under a warming climate, our analyses indicated significant declining trends in annual maximum W at regional scale under all four conditions. The annual maximum of all melt plus rainfall decreased significantly by 15% in the southwestern United States, while the frequency of rain‐on‐snow events increased significantly by 32% in the northwestern United States. The annual maximum snowmelt only decreased significantly by 21% across the entire western United States. Our results confirmed that interaction between regional humidity and solar radiation with warming temperature helps drive these changes.
Role of Arctic Sea Ice in the 2014–2015 Eurasian Warm Winter
Authors: Xie Jinbo , Zhang Minghua , Liu Hailong 
Published: January 2019

AbstractBecause of large internal variabilities, the role of Arctic sea ice concentration (SIC) on regional climate cannot be easily separated. This study uses two groups of large ensemble atmospheric model simulations under climatological and observed SIC boundary conditions to investigate the role of SIC in the 2014–2015 December to February Eurasian warm winter (DJF15). It is shown that the SIC has large impact on the probability distribution function of the DJF15 temperature and pressure fields. The anomalous high Barents Sea ice during the 2014–2015 autumn and winter leads to significant shift in the probability distribution function skewness of the DJF15 surface temperature (from −0.13 to −0.48) and the related sea level pressure (from −0.18 to 0.32) that favor more occurrences of warm temperature anomaly and positive North Atlantic Oscillation‐like pattern. This asymmetry is consistent with anomalous forcing in phase with the anomalies of the sea level pressure field.
The South American Low‐Level Jet: A New Climatology, Variability, and Changes
Authors: Montini Tessa L. , Jones Charles , Carvalho Leila M. V. 
Published: January 2019

AbstractThe South American low‐level jet (SALLJ) east of the Andes plays an important role in regional weather and hydrology by transporting large amounts of moisture from the Amazon to the subtropics. A new methodology is introduced for detecting SALLJ events based on seasonal‐percentile thresholds of wind speed and wind shear. Direct comparisons are made between new and conventional fixed‐threshold methods. Identification of SALLJ events is compared between five different reanalysis products and validated against available radiosonde observations. A new climatology of the SALLJ is presented for one particular reanalysis during a 38‐year period (1979–2016). Based on this new definition, the present study analyzes the spatiotemporal variability of the SALLJ on seasonal and interannual timescales, as well as trends in the jet over recent decades. Results show that the interannual variability of the jet's strength and frequency is significantly modulated by the El Niño Southern Oscillation, especially during spring. Trends in the vertically integrated moisture transport during SALLJ days reveal significant increases in the northwesterly moisture flux associated with the jet toward southern Brazil in spring, summer, and fall. These changes likely contribute to the increase in precipitation and extreme precipitation events observed over southeastern South America in recent decades.
Seasonal Bias in Soil Carbonate Formation and Its Implications for Interpreting High‐Resolution Paleoarchives: Evidence From Southern Utah
Authors: Huth T. E. , Cerling T. E. , Marchetti D. W. , Bowling D. R. , Ellwein A. L. , Passey B. H. 
Published: January 2019

AbstractPedogenic carbonate is commonly used as a paleoarchive, but its interpretation is limited by our understanding of its formation conditions. We investigated laminated soil carbonate rinds as a high‐resolution paleoarchive in Torrey, Utah, USA, by characterizing and modeling their formation conditions. We compared late Holocene (<5 ka) soil carbonate conventional (C and O) and “clumped” isotopes to modern soil environment and isotope measurements: soil CO2 partial pressure, soil temperature, soil moisture, δ13C‐soil CO2, δ18O precipitation, and δ18O‐soil water. Data unambiguously identified a strong summer seasonality bias, but modeling suggested soil carbonate formed several times throughout the year during infiltration events causing dissolution‐formation reactions. This apparent discrepancy resulted from preferential preservation of calcite formed from the largest annual infiltration events (summer) overprinting previously formed calcite. Soil carbonate therefore formed predominantly due to changes in soil water content. As soil CO2 was at its annual maximum during soil carbonate formation, assuming uniformly low soil CO2 formation conditions for soil carbonate in estimating paleoatmospheric CO2 is likely not viable. Additionally, we showed modern summer δ13C‐soil CO2 and soil CO2 measurements could not produce a modeled δ13C‐soil carbonate consistent with late Holocene observations. We suggest using multiple lines of evidence to identify nonanalogous modern conditions. Finally, a nearly linear radiocarbon age model from a laminated rind showed that rinds can be used as a high‐resolution paleoarchive if samples are from a single depth and the timing and conditions of soil carbonate formation can be constrained through time.
Soil Chemistry Aspects of Predicting Future Phosphorus Requirements in Sub‐Saharan Africa
Authors: Magnone Daniel , Niasar Vahid J. , Bouwman Alexander F. , Beusen Arthur H. W. , van der Zee Sjoerd E. A. T. M. , Sattari Sheida Z. 
Published: January 2019

AbstractPhosphorus (P) is a finite resource and critical to plant growth and therefore food security. Regional‐ and continental‐scale studies propose how much P would be required to feed the world by 2050. These indicate that Sub‐Saharan Africa soils have the highest soil P deficit globally. However, the spatial heterogeneity of the P deficit caused by heterogeneous soil chemistry in the continental scale has never been addressed. We provide a combination of a broadly adopted P‐sorption model that is integrated into a highly influential, large‐scale soil phosphorus cycling model. As a result, we show significant differences between the model outputs in both the soil‐P concentrations and total P required to produce future crops for the same predicted scenarios. These results indicate the importance of soil chemistry for soil‐nutrient modeling and highlight that previous influential studies may have overestimated P required. This is particularly the case in Somalia where conventional modeling predicts twice as much P required to 2050 as our new proposed model.