bluuebunny/crossref_metadata_2025_split huggingface dataset:
OP23 Setting The Value Of New Technologies - A Survey
Authors: Tal Orna , Connelly Yaron 
Published: January 2019

Introduction:Technology assessment in hospital traditionally involves parameters of safety, effectiveness and costs. The prosperity of medical innovations in an era of scarce resources requires more precisely refined methodologies to measure ‘added value’. Our aim was to reveal the added values of technologies by asking professionals to prioritize their adoption into hospitals.Methods:Twelve innovative technologies that were discussed for adoption over three years were controversial regarding their actual “added value”. Fifty-two managerial health professionals ranked these technologies on two scales: hierarchic importance (league scale) and comparative score rating (CSR), reflecting willingness-to-pay (WTP). The distribution of ranking indicates the internal agreement (IA) among the participants.Results:There was only partial correlation between the two scales. For example, glucose-monitoring was ranked ‘highly important’ on the hierarchic (league) scale with high CSR/WTP, but with low IA. This can be interpreted as “a valuable technology but with disagreement on comprehensive adoption in the entire hospital”. The surgical robot was ranked ‘highly important’ on the hierarchic scale with low CSR/WTP, but with high IA, meaning “a valuable technology but with consensus to delay adoption in the hospital”. Overall, the participants raised thirty-two “values” that can be assorted into five clusters of significance: clinical effect (6 values), social/public dimension (8 values), patient-physician interaction (9 values), technological aspect (5 values) and policy-regulatory perception (4 values).Conclusions:We identified different ‘;patterns’ for defining the ‘value’ of various technologies. Revealing these aspects can create a “set of values” of relative weights that may explain the added value considerations in prioritization of decision making. Interestingly, there were technologies that were ranked low, but achieved a high rating. This can be explained by individual personal-oriented added value perspectives. Using this innovative tool to incorporate social value-based scores can assist in understanding the determinants, beyond the current traditional rationing mechanism, that guide professionals while prioritizing medical technologies.
OP49 An Alternative Cost-Effectiveness Model For Health Technology Delivery
Authors: Yan Charles , Armijo-Olivo Susan , Guo Bing , Zheng Yufei , Hill Michael , Mann Balraj , Jeerakathil Thomas , Kamal Noreen , Amlani Shy , Chuck Andy W. 
Published: January 2019

Introduction:The cost-effectiveness of endovascular therapy (EVT) compared to tissue plasminogen activator (tPA) alone for acute ischemic stroke (AIS) has been established in the literature. However, decision-makers still face challenges of how to best deliver EVT in a timely manner to maximize patient outcomes while minimizing the burden to the healthcare system, given that AIS has time-dependent treatment outcomes. The objective of this presentation is to report an optimization approach for improving health system value and outcomes for patients with AIS who are eligible for EVT in Alberta.Methods:An economic model was developed to compare combinations of “mothership” (transport directly to a comprehensive stroke center [CSC] to receive tPA and EVT) and “drip-and-ship” (transport to a primary stroke centre to receive tPA, followed by transport to a CSC to receive EVT) methods across Alberta. The model considered geographical variation and searched for the best delivery methods through a pairwise comparison of all possible strategies. The controlled variables including in the model were population densities, disease epidemiology, time/distance to hospitals, available medical services, treatment eligibility and efficacy, and costs. Patient outcomes were measured by functional independence. The model defined optimal strategies by identifying the transport methods that produced the highest probability of improved health outcomes at the lowest cost.Results:The analysis produced an optimization map showing optimal strategies for EVT delivery. The lifetime cost (standard deviation [SD]) per patient and likelihood (SD) of good outcomes was CAD 291,769 (CAD 11,576) [USD 226,207 (USD 8,975)] and 41.82 percent (0.013) when considering optimal clinical outcomes, and CAD 287,725 (CAD 4,141) [USD 223,097 (USD 3,211)] and 41.67 percent (0.016) when considering optimal economic efficiency.Conclusions:Our model reduces the gap that exists between health technology implementation and cost-effectiveness analysis; namely, neither fully addresses relative efficiency driven by geographical variation, which may misrepresent system value in local settings. Implementation strategies generated in our model capture full values in terms of patient outcomes and costs.
OP53 Comparing Approaches To Univariate Sensitivity Analysis
Authors: Teljeur Conor , Harrington Patricia , Ryan Máirín 
Published: January 2019

Introduction:Fully probabilistic analyses are now standard for economic models, with all parameters varied according to probability distributions. Using univariate sensitivity analyses to explore the influence of different parameters on the model results are also standard. Although there are several approaches available, there has been little discussion of the merits of each or justification for the method used in any given analysis. The aim of this study was to compare three approaches to univariate sensitivity analysis using a case study.Methods:We considered three univariate sensitivity analysis approaches: (i) set one parameter at its upper and lower bounds while all others are set at their mean value; (ii) analysis of variance; and (iii) set one parameter at its mean and vary all others. We compared these approaches using an economic model of mechanical thrombectomy for the treatment of acute ischemic stroke, considering outcomes of incremental costs, incremental quality-adjusted life-years (QALYs), and net monetary benefit (NMB).Results:For incremental costs and QALYs the correlation between the approaches was moderate to high, with correlation coefficients between 0.46 and 0.94. For NMB the correlation between approaches was also high (range 0.89 to 0.98), but some of the most influential parameters were ranked differently. Setting one parameter at its upper and lower bounds was the only method that facilitated an analysis of direction of influence.Conclusions:The three approaches addressed different but relevant questions. Setting individual parameters at their bounds is effectively a systematic scenario analysis and may be misleading to decision makers. Analysis of variance may be more easily interpreted, but it has disadvantages. Setting a parameter at its mean, while varying other parameters, is similar to value of information analysis. As with any sensitivity analysis, it is imperative that the uncertainty associated with each parameter is adequately captured in the model.
OP64 Review Of Economic Evaluations Of Next-Generation Precision Oncology
Authors: Weymann Deirdre , Pataky Reka , Regier Dean A. 
Published: January 2019

Introduction:Proponents of precision oncology report that genomic testing has the potential to reduce health system costs and improve patient health. Yet, testing also involves significant expenditures that challenge the sustainability of adopting technologies into routine practice. Our study explores the availability and scope of economic evaluations of precision oncology informed by next-generation sequencing (NGS).Methods:We searched Medline (PubMed), Embase (Ovid), and Web of Science databases for English-language full-text peer reviewed articles published between 2000 and 2016. We focused our search on articles that estimated the benefit of precision oncology in relation to its costs. We excluded studies that did not undertake full economic evaluations or did not focus on NGS. We reviewed all included studies and summarized key methodological and empirical study characteristics.Results:Fifty-five economic evaluations met our inclusion criteria. The first study was published in 2005 and the number of published studies increased steadily, from three studies between 2005 and 2007 to twenty-six between 2014 and 2016. Most studies evaluated multiplex panels (86 percent). Testing was frequently used to diagnose patients (24 percent) or predict prognosis (67 percent), rather than identify targeted therapies (7 percent). Methods varied considerably and cost-effectiveness differed according to test type, test strategy, and cancer type. Deterministic and probabilistic analyses were typically used to characterize uncertainty (91% percent and 75% percent).Conclusions:While the availability of economic evidence examining precision oncology increased over time, methods used often did not align with current guidelines. Future evaluations should undertake extensive sensitivity analysis to address all sources of uncertainty associated with rapidly changing NGS technologies. Further, additional research is needed evaluating the cost-effectiveness of more comprehensive next-generation technologies prior to implementing these on a wider scale.
OP77 Conducting Rapid Assessments: Lessons From 25 Years Of Good Practice
Authors: Corabian Paula , Guo Bing , Armijo-Olivo Susan , Moga Carmen , Scott Ann 
Published: January 2019

Introduction:The Health Technology Assessment (HTA) Program at the Institute of Health Economics (IHE) has conducted rapid assessments (RAs) for 25 years. The presentation draws on this experience to chart the evolution of RAs over a 25-year relationship between a policy maker and an arms-length HTA agency to quantify the effects of this partnership on the RAs produced.Methods:The number, types, and methodological attributes of RAs produced over a 25-year partnership with a single requestor were reviewed. The reasons for developmental changes in RA products over time were charted to document the push-pull tension between requestor needs and HTA best practice. The elements contributing to the relevance and impact, or not, of the RAs were also identified.Results:Results demonstrated the dynamic relationship required for HTA researchers to meet best practice and requestor needs. As literature search spans lengthened and data analyses became more complex, limitations were imposed on RAs to fulfill the requirements of timeliness, utility, and best practice. Adaptations were driven by requestor, researcher, and the external policy environment. Facilitators of RA utility for HTA requestors include: asking focused, well-articulated questions; specifying the request's purpose; providing detailed information about local context and other relevant issues; and understanding the risk of bias associated with RAs. Considerations for HTA doers include: assembling a team using a triage process; involving requestors throughout RA development; negotiating deliverables and timelines using a HTA product matrix; transparently reporting methods; narratively describing methodological issues; and internally reviewing the draft RAs.Conclusions:RAs are a useful component of HTA programs. To keep these products relevant and useful, HTA agencies must allow RAs to evolve according to need, but with grounding in good practice. Negotiating the line between rigor and relevance is a key skill for HTA agencies. Having the right team is helpful.
OP97 Digital Home Services: Overcoming Critical Barriers In Early Decision Making
Authors: Stome Linn Nathalie , Norrud Arne , Fjordholm Martin , Kvaerner Kari 
Published: January 2019

Introduction:There is a lack of adoption and diffusion of health innovations needed to drive the implementation of important breakthroughs in value-based health care. To stimulate organizational changes, decision-makers need to see potential benefit at an early stage. The aim of the present study was to assess the potential effects of a conceptualized intention to provide digital home-based care and compare it to the current provision of such care. The new intervention aims to strengthen the municipality's care services by offering a digital communication platform to recipients of home-based health services and their dependents. The platform is designed to be implemented nationally and is in line with home service needs identified in several white papers.Methods:An interdisciplinary team united to determine and quantify potential effects of the project. Effects of the digitalized service were distinguished in priced quantitative, unpriced quantitative and qualitative effects. A ten-year present value calculation with a calculation rate of four percent was used for the estimates. A risk analysis was also carried out.Results:The present value calculation resulted in estimated savings equal to EUR 25.8 million , with present value investments costs of EUR 5.5 million over ten years. This resulted in net present value per invested euro in the public sector equal to EUR 3.2. Overall assessment of uncertainty related to the intervention's socio-economic profitability was deemed average. Based on data quantified estimates from the conceptual phase, the project succeeded in the decision-making and funding needed to proceed into the next developmental phase of the project.Conclusions:The present approach to early assessment may provide much desired decision support in an early innovation phase when data are still missing. Our experience is that early stakeholder involvement and the early assessment and quantification of value gains are of utmost importance to overcome the critical barriers to organization health innovations.
OP99 Sustaining Mobile Health Interventions In Vietnam: The Challenges
Authors: Lam Jeffrey , Dang Linh , Phan Ngoc , Trinh Hue , Vu Nguyen , Nguyen Cuong 
Published: January 2019

Introduction:Mobile health (mHealth) is increasingly being seen as a promising solution to the multiple health system challenges that Vietnam faces, including inadequate health service provision. Nevertheless, there is limited published information describing the sustainability of such mHealth solutions in the Vietnamese context. This study reviewed the available projects and interventions to evaluate factors challenging sustainability of mHealth initiatives in Vietnam.Methods:A multimodal scoping study was designed to collect data from various sources: published literature, government reports, unpublished literature, conference presentations, online documents, and key informant interviews. Relevant mHealth initiatives were identified and selected through electronic searches and informal discussions with key stakeholders. Collected data was charted and classified by thematic analysis. Challenges to the sustainability of mHealth initiatives were discussed in the context of the strengths, weaknesses, opportunities, and threats (SWOT).Results:Twenty mHealth initiatives with relevant information and available data were collected, covering the period from 2010 to 2017. Fifteen (75 percent) were primarily funded by external donors, one (5 percent) was government supported, and four (20 percent) were self-funded projects. Five (25 percent) were on-going, and fifteen (75 percent) were completed at the time of data collection. Four (20 percent) out of the completed initiatives were continuing to use materials, infrastructure, and technology to engage end-users.Conclusions:The high percentage of external funding, complicated governmental bureaucracy and lack of government commitment, electronic medical record standardization, and legislation relating to mHealth are amongst the largest challenges to mHealth sustainability in Vietnam. In addition, findings demonstrate it is crucial for project managers of mHealth initiatives to build strong relationships with the Vietnam government and advocate for their mHealth initiatives in order to promote sustainability.
OP104 Moving Forward Hospital-Based Health Technology Assessment: Public Procurement Of Innovation
Authors: Restovic Gabriela , Sagarra Joan , Sampietro-Colom Laura , Sitges Marta 
Published: January 2019

Introduction:Innovation procurement is a key enabler to improve the quality and efficiency of public healthcare services by driving innovation from demand side to meet concrete public healthcare provider needs. Catalan Health Services (CatSalut) aims to optimize healthcare services through innovative solutions that encompass both innovative technologies and new processes of care. Answering this aim, the Hospital Clinic of Barcelona (HCB) is participating in an Innovative Pilot Program to optimize the efficiency in the management of Aortic Valve Stenosis (AVS) using an adaptation of the methods and knowledge from hospital-based health technology assessment (HB-HTA).Methods:The first step was to identify unmet needs, main bottlenecks and problems in the comprehensive management of aortic valve stenosis (AVS) (from primary care to hospital discharge). Innovative technologies, solutions and health care organizations were proactively scanned through literature review and professional expertise. Lists of solutions were proposed through an inclusive stakeholder participation process.Results:A new healthcare model was proposed to be evaluated in the next three years based on an integral, transversal and multidisciplinary management of AVS (named MITMEVA). For each new proposed solution, the management, work streams, expected impact and key performance indicators (based on stakeholder information demands) were defined. To test the potential of the proposal, a theoretical modeling of the economic, clinical and process impacts of implementation was performed based on available scientific evidence, local professional and economic data. This analysis shows more quality-adjusted life years, fewer adverse effects and lower cost with the new proposed model.Conclusions:HB-HTA usually recommends for/against investments. In the era of value based procurement, HB-HTA can also help in developing a Public Procurement of innovative solutions (PPI) project and in testing proactively its potential impact in healthcare, which will be later tested in real life. Therefore, adapting HB-HTA to hospital innovative procurement is another way for health technology assessment to push for the implementation and testing of high value innovative technologies.
OP118 Women's Preferences And Perspectives On Cervical Cancer Screening
Authors: Majid Umair , Kandasamy Sujane , Arora Neha , Vanstone Meredith 
Published: January 2019

Introduction:Cervical cancer screening (CCS) is conducted through multiple testing modalities including Papanicolaou smears and more recently, HPV Testing. Participation in CCS is influenced by a multitude of barriers and facilitators governed by the preferences, values, and beliefs of women. This presentation will discuss the findings from a Patient Perspectives and Experiences review for a CADTH Health Technology Assessment on HPV Testing for Primary Cervical Cancer Screening.Methods:A systematic literature search yielded 4864 citations published from 1 January 2002 to 1 November 2017. One hundred and six eligible studies were analyzed using the qualitative meta-synthesis methodology.Results:The social location, circumstances and resources available to women significantly influence how they negotiate the factors that influence their CCS participation. Some of the factors we identified are Emotions, Understanding Personal Risk, Logistics, and Multiple Roles of Women. In this presentation, we will discuss how these factors interact with a woman's social location to influence women's choices and preferences about engaging in cervical cancer screening. Specifically, we describe an analysis that conceptualizes social location as a balancing fulcrum, which changes the force exerted by factors acting as incentives and disincentives. Women who experience social and material deprivation may find that disincentives are harder to overcome than women who have access to ample social and material resources. More incentives in quantity and strength would tip the balance in favor of incentives and increase CCS participation. This presentation will also describe how incentives and disincentives were operationalized in the context of a patient perspectives and experiences review for a health technology assessment.Conclusions:Women's decisions to participate in CCS are influenced by many factors. The way women negotiate these factors is closely related to their personal circumstances and the availability of social, material, and financial resources.
OP125 Increasing Capacity For Utilization Of Health Technology Assessment
Authors: Amanya John Vianney , Wamboga Joshua 
Published: January 2019

Introduction:Increased capacity for utilization of Health Technology Assessment (HTA) is key to ensuring high-impact; affordable health technologies reach the people who need them most. It also enables an environment for research in access to lifesaving technologies and innovations. The number of people suffering from one or more chronic diseases is rapidly increasing and the existing systems of care are not adequately addressing this increase. Increased HTA visibility provides an opportunity for a formal connection of Health Technologies (HTs), building a new working relationship among patients and healthcare professionals, health system strengthening, engagement of patients /consumers and health care professionals for follow up on existing HTs, and assessing new Health Technology innovations.Methods:We reviewed existing HTA literature, and hosted a meeting of fifty participants at the first HTA meeting representing different health stakeholders including patients. The meeting explored innovative synergies that addressed best practices in health policy and technological decision making, and opportunities for integrating HTA in Uganda's Health system.Results:Induced practical skills in coordinating a number of uncoordinated health technologies to over forty participants, an HTA strategy developed to complement national HTA initiatives and to generate information and tools to facilitate the start of hospital-based HTA initiatives in hospitals countrywide and regionally, to improve quality and efficiency of current initiatives. An HTA association, “Uganda Association of Health Technology Assessment - UAHTA” was formed, and a work plan for piloting hospital based HTA was developed.Conclusions:A Health Technology Assessment (HTA) system will enable comprehensive patient-centered, integrated (as opposed to simultaneous but independent) assessment of complex health technologies. There is a need for increased capacity and partnerships towards evidence generation, and accountability measures.