bluuebunny/crossref_metadata_2025_split huggingface dataset:
PP125 Patient-Focused Review Of Human Immunodeficiency Virus Benefit Package
Authors: Wong John , Co Stephanie Anne , Espinosa Christine Ingrid , Bermejo Raoul , Zeck Wilibald , Reyes Katherine Ann 
Published: January 2019

Introduction:The Philippines has an increasing number of newly diagnosed cases of human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS). In 2010, the Philippine National Health Insurance Corporation (PhilHealth) introduced an Outpatient HIV/AIDS Treatment (OHAT) package to cover the necessary basic healthcare expenses of patients. The objective of this study was to review patients’ perspectives on the OHAT package in terms of meeting health needs and providing economic risk protection.Methods:The study was divided into two phases: (i) patient surveys (PS); and (ii) health provider interviews (HPI). The PS focused on the health needs of package utilizers and non-utilizers, specifically their satisfaction with the current package coverage. The HPI focused on key personnel working at treatment hubs to gain insight on the impact of the OHAT package on facility operations, service delivery, and patient care.Results:The majority of patients were satisfied with the current package because of the reduced annual out-of-pocket (OOP) costs. However, continuing OOP expenditure was also the main reason for dissatisfaction. This was due to non-uniform provision of services across different hubs, mainly resulting from the unavailability of services and health provider discretion on final package inclusions. Non-coverage of opportunistic infection (OI) treatment and privacy issues were also noted as causes of dissatisfaction. Claim filing for formal membership requires an employer's signature for proof of contribution. Due to the fear of stigma some members created a second insurance account or shifted to an individual payment type, which increased OOP expenses.Conclusions:The OHAT package has increased access to services and medications for HIV/AIDS patients in the Philippines. Despite increasing package utilization there is still room to improve the package, especially with regard to addressing privacy needs and non-uniform package inclusions, and extending coverage to the treatment of OIs.
PP127 Issues On The Estimation Of The Opportunity Cost Threshold Value
Authors: Hernandez-Villafuerte Karla , Zamora Bernarda , Feng Yan , Parkin David , Devlin Nancy , Towse Adrian 
Published: January 2019

Introduction:There is no consensus on which methods to use to estimate an opportunity cost threshold for the efficient allocation of resources. Researchers have attempted to estimate an evidence-based threshold value, but only a few approaches have been considered and any estimate is currently used by policy makers. This study aims at exploring three assumptions normally applied in the threshold estimation: (i) approaches assume that there is always a displacement involving a loss of health; however, empirical studies suggest that one of the first responses of local health care purchasers is to squeeze greater efficiency out of providers; (ii) to be sure about the appropriate threshold it is necessary to know which health services purchasers are giving up to introduce a new treatment; current estimates bypass this lack of information by averaging the effects of changes in expenditure by clinical area; (iii) recent methodologies consider a single health outcome: mortality; however, health outcomes of many clinical areas may not be well reflected in mortality.Methods:We propose data envelopment analysis (DEA) as a methodology that can help to address these issues by considering efficiency to measure opportunity cost per Primary Health Trust (PCT) in England and by including several outcomes in addition to mortality. This is the first time that DEA is tested in this context.Results:Results suggest that the majority of health locations have the possibility of decreasing their expenditures between 1 percent and 15 percent without affecting outcomes.Conclusions:Estimation of the threshold should allow for observation of the actual level of inefficiencies as well as an ability to consider the previous capacity of health locations to respond to changes in expenditures. Moreover, it is crucial to select the appropriate set of health outcomes, such that they reflect health system priorities, otherwise, we would be estimating a threshold that does not reflect likely displacement.
PP147 Olaratumab With Doxorubicin For Advanced Soft Tissue Sarcoma
Authors: Tikhonova Irina , Jones-Hughes Tracey , Dunham James , Warren Fiona , Robinson Sophie , Hoyle Martin 
Published: January 2019

Introduction:The National Institute for Health and Care Excellence (NICE) invited the manufacturer of olaratumab (Lartruvo®), Eli Lilly & Company Limited, to submit evidence for the clinical and cost effectiveness of this drug, in combination with doxorubicin, for advanced soft tissue sarcoma (STS) not amenable to surgery or radiotherapy, as part of the Institute's Single Technology Appraisal. The Peninsula Technology Assessment Group critically reviewed the submitted evidence.Methods:Clinical effectiveness was derived from an open-label, randomized controlled trial, JGDG. The economic analysis was based on a partitioned survival model with a time horizon of 25 years. The perspective was of the UK National Health Service (NHS) and Personal Social Services. Costs and benefits were discounted at 3.5 percent per year. The company's evidence was submitted in anticipation that olaratumab would be considered as an alternative to doxorubicin, which has been used as a first-line treatment for advanced STS. To improve the cost effectiveness of olaratumab, the company offered a discount through a Commercial Access Agreement with the NHS England.Results:In the company's submission, the mean base-case and probabilistic incremental cost-effectiveness ratios (ICERs) for olaratumab plus doxorubicin versus doxorubicin alone were GBP 46,076 (USD 61,403) and GBP 47,127 (USD 62,804) per quality-adjusted life-year (QALY) gained, respectively; the probability of this treatment being cost effective at the willingness-to-pay threshold of GBP 50,000 (USD 66,632) per QALY gained, applicable to end-of-life treatments, was 0.54. The respective estimates in our analysis were approximately GBP 60,000 (USD 79,959) per QALY gained, and the probability of cost-effectiveness was 0.21. The increase in the ICERs was primarily due to differences in extrapolation of overall survival, and drug administration costs.Conclusions:Based on the available evidence, olaratumab in combination with doxorubicin improves the survival of patients with advanced STS. However, this treatment is unlikely to be cost-effective. Olaratumab is now recommended for use within the Cancer Drugs Fund.
PP165 The Resurrection Of The Cost-Minimization Approach In England
Authors: Turkstra Erika , Wang George Duo , Liu Lok Wan , Mardiguian Silvy 
Published: January 2019

Introduction:For almost 20 years (1999–2017), the National Institute for Health and Care Excellence (NICE) focused primarily on cost utility analyses (CUA) for its health technology appraisals. This changed on the 01 April 2017, when a new fast track appraisal process was introduced for technologies that offer exceptional value for money. Under this process, a cost-comparison analysis can be included for technologies that are likely to provide similar or greater health benefits at a similar or lower cost to comparator technologies already recommended by NICE. This is in contrast to other jurisdictions (e.g. Scotland and Australia) that have long accepted cost-comparison analyses such as cost-minimization analyses (CMA) when a technology has comparable efficacy to relevant comparators. This research aimed to investigate if this new approach will have an impact on future appraisalsMethods:Publically available technology appraisal documents from NICE, Scottish Medicines Consortium (SMC), and Pharmaceutical Benefits Advisory Committee (PBAC) were screened (01/01/2016-01/12/2016), and the supportive economic analyses were identified and extracted.Results:In 2016, the proportion of CMA submissions that formed the basis of technology appraisals were 0/53 (0 percent), 17/55 (31 percent) and 25/82 (30 percent) for NICE, SMC and PBAC, respectively. The likelihood that a technology was recommended (with or without restrictions) for those technologies that were assessed using a CUA was 60 percent, 66 percent and 33 percent for NICE, SMC and PBAC, respectively, while technologies that were assessed using a CMA were associated with higher positive recommendation rates: 76 percent and 76 percent for SMC and PBAC, respectively.Conclusions:Incorporating a cost-minimization approach may result in more technologies being recommended by NICE through the fast track appraisal process, whereby the likelihood of a technology having a positive recommendation is much greater than the standard appraisal process.
PD01 IPC For Prevention Of VTE: An Economic Analysis
Authors: Erdol Sebnem , Ho Kwok , Saunders Rhodri , Torres Rafael , Ozols Audrey 
Published: January 2019

Introduction:Total hip and knee arthroplasty (THKA) patients are at risk of venous thromboembolism (VTE). Guidelines recommend 10–35 days of pharmacoprophylaxis, but this may induce bleeding resulting in increased healthcare costs. This study assessed whether using intermittent pneumatic compression (IPC) for VTE prophylaxis is associated with reduced healthcare costs compared to anticoagulants.Methods:Studies related to VTE and prophylaxis in THKA were identified by a structured search of the PubMed database. VTE incidence and cost data were Australia specific or, if not available, taken from other developed healthcare systems. A Markov model was used to estimate the incidence of deep vein thrombosis (DVT), pulmonary embolism (PE), death, post-thrombotic syndrome, as well as minor and major bleeding and heparin-induced-thrombocytopenia, to assess the budget impact of different VTE prophylaxis strategies. The time horizon was one year, low-molecular-weight-heparin (LMWH) was used as the reference intervention, and effectiveness data were obtained from meta-analyses.Results:A total of 102,459 THKA were performed in Australia in 2015. The twelve-day incidence of DVT and PE using LMWH prophylaxis were 4.48 percent and 0.25 percent, respectively, with minor and major bleeding occurred in 9.9 percent (within twelve days) and 1.9 percent (within 10 days) of the patients, respectively. The incidence of VTE was not different between LMWH and IPC after THKA. The model estimated that the total cost of post-operative care for THKA was AUD 101.7 million (USD 77 million) in 2015. A one percent-point change from LMWH to IPC prophylaxis (n=1025 patients) would reduce the total healthcare costs by AUD 317,361 (USD 240,274) per year (or AUD 310 (USD 235) per patient), primarily through reduced bleeding events (-72 minor and -3 major bleeds). Sensitivity analysis including 500 simulations demonstrated a likelihood of 100 percent for IPC to reduce both costs and bleeding events compared to LMWH. Similarly, a one percent-point change from dabigatran and rivaroxaban to IPC also resulted in total healthcare savings of AUD 320,580 (USD 242,711) and AUD 702,584 (USD 531,926) per year, respectively, with two-thirds and ninety-nine percent of the simulations favored IPC over dabigatran for bleeding and cost savings, respectively.Conclusions:Using IPC for VTE prophylaxis after THKA has the potential to substantially reduce total healthcare costs compared to anticoagulants, primarily through reduced bleeding events. IPC is suitable for all patients, but may be particularly cost-effective in the immediate postoperative period or in patients at high-risk of bleeding.
PD25 Principal Component Approximation: Medical Expenditure Panel Survey
Authors: Chao Yi-Sheng , Wu Chao-Jung 
Published: January 2019

Introduction:Principal component analysis (PCA) is important to summarize data or reduce dimensionality. However, one disadvantage of using PCA is the interpretability of the principal components (PCs), especially in a high-dimensional database. This study aims to analyze the patterns of variance accumulation according to PCA loadings and to approximate PCs with input variables from sample data sets.Methods:There were three data sets of various sizes used to understand the performance of PC approximation: Hitters; SF-12v2 subset of the 2004 to 2011 Medical Expenditure Panel Survey (MEPS); and, the full set of 1996 to 2011 MEPS data. The variables in three data sets were first centered and scaled before PCA. PCs approximation was studied with two approaches. First, the PC loadings were squared to estimate the variance contribution by variables to PCs. The other method was to use forward-stepwise regression to approximate PCs with all input variables.Results:The first few PCs represented large portions of total variances in each data set. Approximating PCs using stepwise regression could more efficiently identify the input variables that explain large portions of PC variances than approximating according to PCA loadings in three data sets. It required few numbers of variables to explain more than eighty percent of the PC variances.Conclusions:Approximating and interpreting PCs with stepwise regression is highly feasible. Approximating PCs can help i) interpret PCs with input variables, ii) understand the major sources of variances in data sets, iii) select unique sources of information and iv) search and rank input variables according to the proportions of PC variance explained. This is an approach to systematically understand databases and search for variables that are highly representative of databases.
PD26 Principal Component Approximation: Canadian Health Measures Survey
Authors: Chao Yi-Sheng , Wu Chao-Jung 
Published: January 2019

Introduction:Principal component analysis (PCA) is used for dimension reduction and data summary. However, principal components (PCs) cannot be easily interpreted. To interpret PCs, this study compares two methods to approximate PCs. One uses the PCA loadings to understand how input variables are projected to PCs. The other uses forward-stepwise regression to determine the proportions of PC variances explained by input variables.Methods:Two data sets derived from the Canadian Health Measures Survey (CHMS) were used to test the concept of PC approximation: a spirometry subset with the measures from the first trial of spirometry; and, full data set that contained representative variables. Variables were centered and scaled. PCA were conducted with 282 and twenty-three variables respectively. PCs were approximated with two methods.Results:The first PC (PC1) could explain 12.1 percent and 50.3 percent of total variances in respective data sets. The leading variables explained 89.6 percent and 79.0 percent of the variances of PC1 in respective data sets. It required one and two variables to explain more than 80 percent of the variances of PC1, respectively. Measures related to physical development were the leading variables to approximate PC1 and lung function variables were leading to approximate PC2 in the full data set. The leading variable to approximate PC1 of the spirometry subset were forced expiratory volume (FEV) 0.5/forced vital capacity (FVC) (percent) and FEV1/FVC (percent).Conclusions:Approximating PCs with input variables were highly feasible and helpful for the interpretation of PCs, especially for the first PCs. This method is also useful to identify major or unique sources of variances in data sets. The variables related to physical development are the variables related to the most variations in the full data set. The leading variable in the spirometry subset, FEV0.5/FVC (percent), is not well studied for its application in clinical use.
PD27 A Case Study Of Equity In Health From Zhejiang Province, China
Authors: Sun Xueshan , Zhang Hao , Hu Xiaoqian , Gu Shuyan , Zhen Xuemei , Gu Yuxuan , Huang Minzhuo , Wei Jingming , Dong Hengjin 
Published: January 2019

Introduction:Equity is the core of primary care. The issue of equity in health has become urgent and China has attached increasing attention to it. With rapid economic development and great change of the policy on medical insurance, the pattern of equity in health has changed a lot. Reform of healthcare in Zhejiang province is at the forefront of China; studies on Zhejiang are of great significance to the whole country. This paper aims to measure the equity in health from the perspectives of health needs and health seeking behavior, and provides suggestions for decision making.Methods:A household survey was conducted in August 2016. A sample of 1000 households, 2807 individuals in Zhejiang was obtained with the multi-stage stratified cluster sampling method. Descriptive analysis and Chi-square test were adopted in the analysis. The value of concentration index was used to measure the equity.Results:This study finds that the poor have more urgent health needs and poorer health situation compared with the rich. The utilization of outpatient services was almost equal, whilst the utilization of hospitalization was pro-rich (the rich use more).Individuals with employer-based medical insurance use more outpatient services than those with rural and urban medical insurance. Compared to the rich, there were more people in the poorer income groups who didn't use inpatient services due to financial difficulties.Conclusions:The issue of equity in health has attracted broad attention in the world, and China is no exception. We measured and analyzed the equity of health needs and absent rate of health services. We find that the poor have more urgent health needs and high absent rate of inpatient services compared with the rich. Income level and medical insurance may well explain the equity of outpatient and inequity of hospitalization. In view of the pro-rich inequity of hospitalization, more financial protection should be provided for the poor.
PD49 Social Preferences In HTA: A Pilot Analysis In CLN2 Disease
Authors: Bakshi Sumeet , Schlander Michael , Telser Harry , Sola-Morales Oriol , Moro Domenico , Butt Thomas , Olaye Andrew , Jain Mohit 
Published: January 2019

Introduction:It is established that the current cost effectiveness health technology assessment (HTA) paradigm does not appropriately value rare disease technologies. Social willingness-to-pay (SWTP) has been suggested to be higher for rare disease technologies, it's inclusion into existing HTA framework could better reflect social preferences (SP) and enable a more equitable evaluation of rare disease technologies. Our study aims to estimate SP and SWTP for a rare disorder, CLN2 disease.Methods:Relevant attributes for CLN2 disease were developed and validated by literature review and focus groups with patient's primary caregivers. An elicitation survey (discrete choice experiment (DCE) WTP and relative social willingness to pay (RS-WTP)) was developed using the selected attributes and levels of each attribute. The survey instruments and attributes/levels were tested and validated in a pre-pilot survey (n = 103) and a subsequent pilot survey (n = 286) of the United Kingdom (UK) general population. Information about CLN2 disease was provided to respondents and their understanding of the disease was tested including assessment of framing effects. The main survey with the general UK population (n = 4,009) is now complete.Results:Eight hundred and twenty-six people were contacted, of which 286 completed the DCE, 113 abandoned the survey before the DCE and 92 abandoned after the DCE. There were no significant differences in characteristics of respondents completing the DCE and those starting but not completing the DCE. Median survey completion time was 20 minutes with 90 percent of participants completing in a single sitting. Median score for the understanding test was 3 (Min = 0 and Max = 4). Incoherencies in WTP estimates were analyzed enabling us introduce relevant modifications and select the most appropriate attribute levels.Conclusions:DCE and RS-WTP potentially are appropriate methods for assessment of social preferences. The selected attributes/levels for the experiment in CLN2 disease have been validated in this pilot.
PD60 Public Consultations And Their Influence On Health Decisions
Authors: Mega Tacila , Rabelo Roberta , Silva Aline , de Brito Artur Felipe 
Published: January 2019

Introduction:Public consultation is one of the phases provided by the law that rules the health technology incorporation process in Brazilian Public Health System (SUS). In the Brazilian model, anyone can participate as long as he/she identifies her/himself. During the decision-making process these suggestions are analyzed by the National Committee for Health Technology Incorporation (CONITEC) and, sometimes, they are responsible for changing a preliminary recommendation for a technology. This study aims to identify the health technologies for which CONITEC revised the initial negative recommendations due to the contributions received during the public consultation.Methods:A descriptive study using as input data the information on coverage decisions available on the CONITEC website.Results:Since CONITEC's creation until October 2017, CONITEC enacted 241 public consultations. Fifteen cases of change to the preliminary negative recommendation were found and among these eight (53 percent) had the economic studies or proposed technology price reconsidered by the companies. In the other seven decisions, the Board also regarded as important the reasons for changing the initial recommendation: new evidence on efficacy and safety as well as the analysis of different outcomes previously unconsidered in the preliminary assessment.Conclusions:During the public consultations, besides technical-scientific information, personal experiences and opinion reports on each health technology analyzed, CONITEC received new price offers and economic studies from the applicants. This new material has allowed, in some cases, these technologies to become competitive and to be included as alternatives to those already available, provided there is no clinical impairment. This study reinforces the importance of the public consultation and social participation in the process of health technologies incorporation in Brazil, considering its capacity to add new information to the decision-making process.