bluuebunny/crossref_metadata_2025_split huggingface dataset:
OP30 From Framework To Action: Implementing Patient Engagement
Authors: Lang Amy , Wells David 
Published: January 2019

Introduction:This session will share lessons learned from implementing a comprehensive patient and public engagement framework (developed by winners of the 2017 Egon Jonsson Award) in one government agency's health technology assessment (HTA) process. The presentation will share strategic and operational considerations for successful implementation, and the early effects of patient involvement activities on the agency's HTA recommendations.Methods:This presentation used a case study approach to understand the application of the framework described above.Results:The comprehensive framework by Abelson and colleagues describes many different public and patient engagement activities that could be conducted at each stage of an HTA process. Health Quality Ontario has chosen to focus on engaging patients to: prioritize topics; develop an additional evidence stream on patient preferences and values; serve on a committee that reviews the HTA, deliberates, and makes recommendations; and provide feedback on draft recommendations. Strategic considerations for these decisions include: aligning engagement activities to an evidence-focused organizational culture, and investing in engagement activities earlier in the HTA process to allow for sufficient consideration of the patient voice in developing recommendations. These activities have impacted the agency's organizational culture, and evidence suggests they have also influenced recommendations for what should be publicly funded. Patient engagement activities have also led to increased feedback from the public and patients for some HTAs and the associated draft recommendations.Conclusions:Public agencies must make strategic decisions about how and when to invest scarce resources in patient and public engagement. Investing in direct patient engagement as an additional stream of evidence and supporting the involvement of health system users in decision-making has had a significant impact on HTA deliberations and recommendations. For some HTAs, these activities have facilitated greater public engagement as well.
OP33 Adopting Health Technologies: NICE Approach For Evidence Into Action
Authors: Chesworth Elaine , Wyart Katie , Chrisp Paul 
Published: January 2019

Introduction:Evidence and guidance alone do not change practice. A multitude of factors are influential upon whether a particular health technology is adopted in practice. The adoption team at the National Institute for Health and Care Excellence (NICE) engages with healthcare professionals to develop specifically tailored support for the adoption of NICE health technology assessments (NICE medical technologies, diagnostics and technology appraisal guidance).Methods:The NICE adoption team uses a structured process which involves engagement of healthcare professionals with experience or knowledge of the technology to identify the barriers to adoption. This information is used to populate the topic selection tool which presents the impact of adopting the technology under five headings: care pathway change; finance; difficulty to implement; education; and, patient acceptance. The result indicates which guidance would benefit from adoption support: plan and develop tailored solutions to address barriers to adoption which include a resource impact assessment and targeted communications; quality assure; and, publish tailored resources.Results:Examples of tailored outputs include: adoption resources sharing real world experiences of sites that have adopted the technology; and, NICE pilot projects, where the adoption team work closely with sites to support adoption of the technology at a local level. The team then share learning and results from the project to facilitate: engagement with national planning groups to coordinate wider scale adoption; resource impact assessments which help local cost impact of adoption to be estimated; engagement with general and specialist media; and, influencing national tariff.Conclusions:NICE's processes have evolved to facilitate the development of a wider variety of more tailored resources, to support adoption of NICE health technology assessments guidance into practice. We will continue to engage with healthcare professionals and be responsive in our processes to ensure the packages of adoption support are tailored to need.
OP60 Optimising Risk-Based Screening: The Case Of Diabetic Eye Disease
Authors: Sampson Christopher , James Marilyn , Whynes David , Eleuteri Antonio , Harding Simon 
Published: January 2019

Introduction:There is growing evidence that many people attending annual screening for diabetic retinopathy in the United Kingdom (UK) are at low risk of developing the disease. This has led to new policy statements. However, the basis on which to establish a risk-based individualized variable-recall screening program has not yet been determined. We present a methodology for using information on an individual's risk factors to improve the allocation of resources within a screening program.Methods:We developed a patient-level state-transition model to evaluate the cost-effectiveness of risk-based screening for diabetic retinopathy in the UK. The model incorporated a recently developed risk calculation engine that predicts an individual's risk of disease onset, and allocated individuals to alternative screening recall periods according to this level of risk. Using the findings, we demonstrate a means of estimating: (i) a threshold level of risk, above which individuals should be invited to screening, and (ii) the optimum screening recall period for an individual, based on the expected cost-effectiveness of screening and treatment.Results:The cost-effectiveness analysis demonstrated that standardized screening (current practice) is the least cost-effective program. Individualized screening can improve outcomes at a reduced cost. We found it feasible – though computationally expensive – to incorporate a risk calculation engine into a decision model in Microsoft Excel. In an optimized screening program, the majority or patients would be invited to attend screening at least two years after a negative screening result.Conclusions:Individualized risk-based screening is likely to be cost-effective in the context of diabetic eye disease in the UK. It is expected that risk calculation engines will be developed in other disease areas in the future, and used to allocate screening and treatment at the individual level. It is important that researchers develop robust methods for combining risk calculation engines into decision analytic models and health technology assessment more broadly.
OP68 Methods For The Economic Evaluation Of Precision Medicine
Authors: Pataky Reka , Regier Dean 
Published: January 2019

Introduction:Methods that accommodate heterogeneity in outcomes are not widely used in economic evaluation. With the growth of precision medicine (PM), where choice of treatment is informed by the molecular characteristics of the patient or disease, we expect to see greater heterogeneity in effectiveness and cost of interventions. Our objective was to compare analytical frameworks for valuing heterogeneity in economic evaluation, and consider their strengths and weaknesses for applications in PM.Methods:We conducted a literature review to identify papers that proposed an analytical framework for economic evaluation of a health intervention, and that placed a value on heterogeneous effects. We compared the frameworks considering the purpose of the analysis, including where in the product lifecycle the framework could be used, the types of PM interventions where the framework could be applied, and its ability to address methodological challenges of evaluating PM.Results:Five analytical frameworks were identified: covariate adjustment methods, value of stratification, value of heterogeneity (VoH), expected value of individualized care (EVIC), and loss with respect to efficient diffusion (LED) metrics. Each framework addresses a slightly different research question, and is suited to different settings and interventions. With the exception of covariate adjustment, all focus on maximizing net benefit within certain constraints and quantify the opportunity cost of ignoring heterogeneity. Only VoH considers the relationship between heterogeneity and uncertainty, and no framework explicitly includes the cost or uncertainty associated with identifying subgroups.Conclusions:The ability to value heterogeneity is a critical component of economic evaluations of PM. The choice of an appropriate analytical framework will help strengthen the quality of economic evidence available to support health technology assessment of PM technologies, informing PM adoption decisions, and supporting efficient allocation of health care resources.
OP73 Problems And Promises Of Health Technologies: The Merits Of Early Health Technology Assessment
Authors: Grutters Janneke , Govers Tim , Nijboer Jorte , van der Wilt Gert Jan , Rongen Jan , Rovers Maroeska 
Published: January 2019

Introduction:Novel health technologies are being developed at a dizzying pace. The need to avoid unnecessary innovations and accelerate the adoption of valuable innovations is among the most important challenges facing healthcare systems today. To contribute to this challenge, we performed 30 so-called ‘early health technology assessments’ (HTA) over the last three years. We quantified the potential value, both in effects and cost. We will present our experience with performing these constructive assessments, as well as their feasibility and value in informing decisions.Methods:We performed secondary analyses on an existing database of 30 assessments. We analyzed the phase of development, stakeholders involved, type of decision informed, and the technology's next steps.Results:Out of the 30 technologies, four (13 percent) were in the idea screening phase, and had not yet started the development. Here, the room for improvement (headroom) was assessed. For 16 (53 percent) technologies that were under development but not yet studied, we performed headroom and threshold analyses. For the 10 (33 percent) developed technologies where some (pilot) data were already available, scenario and/or cost-effectiveness analyses were performed. The assessments, that were commissioned by developers, clinicians or hospital managers informed evidence-based decisions on (further) development, focus, research design or adoption in clinical practice. Preliminary results suggest that after the assessment, decisions were made to stop further development (n=2), continue outside healthcare (n=1), change the target population (n=3) or change the proposed positioning in the care pathway and/or value proposition (n=4).Conclusions:Stakeholders deemed an early, formative assessment useful in informing development, research and adoption decisions, in different stages of development. Even before developing a technology, headroom analyses appeared to be feasible and useful. Consequences of the assessments mostly related to a shift in focus, which may result in more efficient research and development, as well as more valuable innovations.
OP101 Hospital-Based Health Technology Assessment At UW Medicine
Authors: Landaas Erik , Devlin Allison , Walerius Erik , Buckingham Sandra , Flum David , Pellegrini Carlos , Yoshioka Francine , Thiebe Jackie , Sullivan Sean 
Published: January 2019

Introduction:New medical technologies are an important part of delivering innovative healthcare, however, expanding use of medical technology is a major contributor to rising costs. The increase in medical spending is related to new technologies being rapidly developed, marketed and adopted; and often being incorporated into health systems with little evidence. They also come with higher prices when compared to existing technologies.Methods:We describe how University of Washington (UW) Medicine has designed, and developed a new hospital-based health technology assessment (HB-HTA) program, Smart Innovation. Smart Innovation will replace a fragmented and complex set of purchasing and coverage-decision processes. The program will streamline the decision-making process for new medical technologies and balance quick turnaround with rigorous evidence standards. The program is also being developed in collaboration with UW Medicine's Value Analysis team, an evidence-based purchasing team and MedApproved, a new centralized software program for medical purchasing at UW Medicine.Results:Smart Innovation has been reviewing technologies during its first year and has received encouraging results. For example, by adopting a new liver ablation technology, UW Medicine has estimated improved patient outcomes by reducing the number of procedures and adverse events; as well as saving approximately USD 8,000 per patient. Additionally, The Smart Innovation program has achieved projected cost avoidance from deciding not to adopt uncertain or investigational technologies. For example, by not adopting a new bladder cancer screen, our models indicate UW Medicine will avoid spending USD 1.5 million per year.Conclusions:Smart Innovation is proving to be an effective program for reviewing and making critical healthcare policy decisions that is showing significant fiscal and patient improvements for UW Medicine. As the program continues to grow and become embedded into UW Medicine, its impacts will become even more valuable and system-wide.
OP124 Research Gaps In Health Technology Assessment In Brazil
Authors: Ell Erica , Leite Betânia , Gomes Dalila , Rego Daniela , Gonçalvez Lenilson , Leão Luciana Simões Camara , Couto Patrícia , Sachetti Camile Giaretta 
Published: January 2019

Introduction:In 2017 the Brazilian Ministry of Health (BMH), through the Department of Science and Technology (DECIT) and in partnership with the Hospital Alemão Oswaldo Cruz (HAOC), financially supported research activities focused on health technology assessment (HTA) on topics deemed important by the BMH. The aim was to help resolve the priority health problems of the Brazilian population and to strengthen the management of the Unified Health System, within the scope of HTA.Methods:A survey of HTA research needs was carried out in all BMH sectors through internal meetings conducted by representatives from each of the sectors. The problems and needs were then discussed, prioritized, and transformed into research lines in a workshop sponsored jointly by DECIT and the HAOC. Following this, a specific public call was made to the HTA community to comment on the prioritized research lines. The submitted research projects were then judged and selected by a committee of experts in the field. The approved projects were contracted, and when the projects were completed the results were presented and discussed by the researchers in a final seminar for representatives of the BMH technical areas.Results:A total of 135 research gaps were identified, of which forty-two lines of research were included in the research call after the prioritization workshop and the search for evidence in the literature. The call involved an amount of BRL one million (USD 280,442), and seventeen research projects were financed, including two systematic reviews, seven rapid reviews, and eight economic evaluations.Conclusions:The promotion of research by the BMH has enabled the search for scientific evidence to support public policies and decision making in health services.
OP144 Health Economics In Clinical Practice Guidelines: The Know-Do Gap
Authors: Scott Ann , Moga Carmen , Harstall Christa 
Published: January 2019

Introduction:Clinical practice guidelines (CPGs) are an ideal implementation mechanism for promoting effective clinical practice, but without due consideration of costs they may do more harm than good and become a source of inefficiency. The Alberta Guideline Adaptation Program sought current best practice for incorporating economic information into CPGs to better leverage health technology assessment (HTA) and health economic expertise in its guideline development program.Methods:A comprehensive, systematic review of published and grey literature was undertaken to: (i) catalogue theoretical frameworks and practical methods for incorporating economic information into CPGs and forecasting the post-implementation economic impact of CPGs; (ii) summarize current methods for evaluating the economic impact of CPGs; and, (iii) identify barriers and facilitators to incorporating economic information into CPGs.Results:Rigorous economic analyses were infrequently incorporated in CPG development. While a selection of guidance documents and CPG manuals published between 2001 and 2017 by leading CPG developers emphasized the health economist's role and the importance of incorporating economic evidence into CPGs, few provided adequate guidance on the best way to do this. There is no agreement on how best to monitor the economic impact of CPGs. Analysis of a sample of over 100 studies published between 2005 and 2013 identified the three main methods currently used to assess the post-implementation economic impact of CPGs: pre-test/post-test cost analyses, mapping studies, and modelled cost-effectiveness studies. The key elements of each study type were summarized and compared.Conclusions:The review highlighted the under-recognized know-do gap among developers with respect to using health economics information and expertise in CPG development. It identified the advantages and potential limitations of applying health economics to CPG development, as well as areas where developers can better utilize HTA researchers and health economists to improve the quality of guidelines and better document the resource implications and feasibility of the interventions they recommend.
OP157 Quo Vadis Romanian Health Technology Assessment?
Authors: Pana Adrian , Cosa Ioana Cristina 
Published: January 2019

Introduction:The Romanian healthcare system has been struggling to use a more transparent approach in evaluating health care technologies for more than 10 years. No systemic and satisfactory approach to evaluate health technologies was implemented until the present. The objective of the presentation is to describe the characteristics of the HTA system used by the Romanian healthcare authority as well as the consequences of the drug assessments by using the actual Romanian health technology assessment (HTA) evaluation framework, from the initiation in May 2014 to the end of year 2017.Methods:The drug reimbursement context and the healthcare legislation regarding HTA evaluation were studied. A critical appraisal of the scorecard was conducted, taking into consideration general principles of the health technology assessment. A descriptive analysis covering the assessment drug reports issued by the National Agency for Drug and Medical Devices (NADMD) issued between May 2014 and December 2017 was presented, together with the decision made by the Ministry of Health and the Romanian government.Results:During the analyzed period of time, more than 10 updates of the reimbursement list were implemented by the Ministry of Health. By November 2017, more than 180 drugs (new INN, new indications or fix dose combinations) were included in the reimbursement system with conditional or unconditional reimbursement; more than 230 reports were assessed by the NADMD. While the new drugs reimbursed between May 2014 and November 2017, in the most part demonstrated cost savings, a lot of new innovative drugs proposed to be evaluated were rejected since the drugs had no comparators on the Romanian market and their costs were considered to have a negative impact on the healthcare budget.Conclusions:The rapid HTA assessment has many strengths, by using a proper scorecard. Limitations and weakness of the actual scorecard were identified, mainly regarding the lack of a basic budget impact analysis which must include at least the direct healthcare cost, as well as the imported results of different healthcare environments that are not matching the Romanian context. Opportunities to implement a more rapid and accurate HTA evaluation are identified since the scorecard could be updated in order to address the HTA general principles.
OP166 How Responsive Is Industry To Value Based Procurement?
Authors: Restovic Gabriela , Cuenca Nuria , Rodriguez Ferran , Verboven Yves , Sampietro-Colom Laura 
Published: January 2019

Introduction:The European Union (EU) directive (2014/24) on public procurement strives to stimulate innovation and seeks for methodologies to implement a quality/cost based approach to search for the most economically advantageous tendering (MEAT). MedTech Europe launched the MEAT value-based-procurement (VBP) framework and tool which considers product's value from different perspectives/dimensions. Results from the first EU pilot, testing the feasibility to use the MEAT framework at a university hospital, are presented.Methods:The framework and tool were tested using two types of technologies: high volume (underpads, diapers) and highly specialized (transcatheter aortic valve implantation). Companies were invited to participate following standard procurement rules. For each dimension, criteria, metrics and weights were defined, using multidisciplinary hospital teams. In parallel, companies were asked to do the same. Product performance scores were obtained from companies’ information. Challenges to implement MEAT in real life were identified through face-to-face meetings.Results:The process was well perceived by companies and hospital. Nevertheless, the level of information provided by companies was heterogeneous (quantity and quality). A match in the cost and outcome criteria was observed between hospital and companies; but relative weights assigned differed. Value propositions and robustness of information provided by companies varied across technologies and size of companies. Implementing the MEAT VBP framework and tool need extra time and knowledge.Conclusions:MEAT VBP value technologies ahead of price, leading to the most economic advantageous purchasing. Nevertheless its implementation in real life is limited.