bluuebunny/crossref_metadata_2025_split huggingface dataset:
PP135 Cost-Effectiveness Of Cryoballoon Ablation In China: Real-World Results
Authors: Ming Jian , Sun Hui , Wang Gongru , Wei Yan , Chen Yingyao , Pong Raymond 
Published: January 2019

Introduction:Paroxysmal atrial fibrillation (PAF) represents a significant economic burden to the healthcare system. Catheter ablation is a commonly adopted treatments for PAF, and cryoballoon ablation (CBA) has been recently proven to be as effective as radiofrequency ablation (RFA). This study aims to evaluate the cost-effectiveness of CBA versus RFA in patients with drug-refractory PAF in China.Methods:A Markov model was developed to study the effects and the costs of CBA versus RFA. Cost and probability inputs data were obtained mainly from a real-world study of 85 CBA and 284 RFA patients treated in a tertiary hospital between July 2014 and July 2016. Propensity score matching was used to overcome retrospective bias, resulting in including 75 patients in each group. Input data gaps were closed with literature review and advisory board. A simulation was carried out for 14 cycles/years, and a discount rate of 3 percent was used. Then, a probabilistic sensitivity analysis was carried out with Monte Carlo approach.Results:In the base case scenario, the cumulative costs incurred by the CBA and RFA groups were CNY 132,222 (USD 20,767) and CNY 147,304 (USD 23,136), respectively. Over the 14-year period, the quality-adjusted life years (QALYs) gained by the CBA group was 7.85 versus 7.71 in the RFA group. The incremental cost-effectiveness ratio for CBA versus RFA was thus CNY 107,729 (USD 16,920)/QALY. Model results were most sensitive to the cost incurred during the first hospitalization, recurrence rate, and relative utility weights. The probability of CBA being cost-effective for willingness to pay thresholds of per capita GDP in China was estimated to be 99 percent.Conclusions:Compared with RFA, CBA is a cost-saving treatment providing increased QALYs. It represents good value for money for patients with drug-refractory PAF in China. However, further evidence needs to be generated from larger-scale studies in China.
PP138 Cost-Effectiveness Analysis Of Influenza A (H1N1) Chemoprophylaxis
Authors: Vecoso Luisa , Silva Marcus , Silva Everton , Resende Mariangela , Galvao Tais 
Published: January 2019

Introduction:Influenza A (H1N1) virus is the most relevant virus in death by flu complications. Oseltamivir and zanamivir are used for influenza prophylaxis in epidemics. We aimed to evaluate the efficacy of chemoprophylaxis for influenza A (H1N1) for the Brazilian health care system.Methods:We systematically searched the literature to identify efficacy results. Costs assessed from the system perspective were obtained from official Brazilian Ministry of Health systems, and completed from medical care at a university hospital of Campinas, Sao Paulo. Model outcomes were quality-adjusted life years (QALY) with willingness to pay BRL 30,000 (USD 8,212)/QALY and prevention of H1N1. A decision-tree model was used to calculate the incremental cost-effectiveness ratios for prophylaxis, compared to no prophylaxis. Deterministic and probabilistic sensitivity analyses were used to test robustness of the model.Results:Prophylaxis had 70 percent adherence to treatment, 9 percent adverse events, effectiveness in avoiding H1N1 (relative risk = 0.43; 95% confidence interval: 0.33, 0.57); no evidence of prophylaxis efficacy for complication, hospitalization and death was found. Both scenarios had 14 percent H1N1 attack rate, 67 percent of ambulatorial consult, 43 percent of inpatient care, 14 percent of deaths in hospital, 23 percent of intensive care where death was 40 percent. Utility was 0.50 during H1N1 infection, 0.23 with hospitalization, 0.195 less with adverse events, 0 for deaths and 0.885 for healthy. Cost was BRL39 (USD 11) for chemoprophylaxis; BRL 12 (USD 4) for outpatient care; BRL 5,728 (USD 1,568) for hospital admission; BRL 19,217 (USD 5,260) for intensive care; and BRL 292 (USD 80) for adverse events. Incremental cost of prophylaxis was BRL 40 (USD 11) and utility increased 0.004, which mean saving of BRL 2,921 (USD 780)/QALY. Prophylaxis saves BRL 338 (USD 92) per H1N1 case avoided. Univariate and probabilistic sensitivity analysis assure the robustness of results, with 43 percent probability of being of lower cost and higher effectiveness.Conclusions:Prophylaxis is cost-effective from the health care system perspective using utility and avoided H1N1 cases outcomes.
PP151 Comparison Of Patients Undergoing New Technology For Prostate Cancer
Authors: Silva Deyvid , Lazarini Letícia , Aline Araujo , Trindade Evelinda , Becker Otavio , Nishio Elizabeth 
Published: January 2019

Introduction:Prostate neoplasia affects more than one million people worldwide. Surgical treatments have evolved from open or video prostatectomy, up to the High Intensity Focused Ultrasound (HIFU) technique. HIFU studies cite less costs and better quality of life during the first year of follow-up. The objective of this study is to describe a consecutive series of eligible patients, with Gleason score 6 and 7, and compare resources used along those three treatment techniques.Methods:A comparative and retrospective study was conducted during the first 2017 semester, at Hospital de Transplantes de São Paulo, São Paulo city, Brazil. Consecutive eligible patients were matched by age, disease stage and profile and Gleason score 6 or 7. Resources used were assessed through medical records review and in- and out-patient visit interviews.Results:A total of 152 patients were followed: 50 underwent open surgery prostatectomy, 50 underwent video prostatectomy and 52 underwent HIFU. Mean age did not differ between groups (66.6, 64.1 and 65.6 years, respectively). All patients were followed for at least three months. The average operating room time was 4.7, 4.1 and 2.3 hours, and the average anesthetic recovery time was 2.0, 1.9 and 2.0 hours, respectively. Average inpatient length of stay was 2.5, 2.7 and 1.5 days, respectively. Postoperatively, nine (18 percent) open surgery patients, and 14 (28 percent) video-prostatectomy patients required an average of one full day of intensive care, compared to only one (2 percent) HIFU patient. During follow-up, the same effectiveness was observed between the groups, none required re-intervention. Thus, considering the 50 percent economy in hours of operating room and of days of hospital stay, as well as 10 times less use of intensive care unit days when the HIFU technique was compared to conventional surgeries, it is estimated the HIFU program allowed 30 percent cost savings.Conclusions:The HIFU program presented effectiveness and savings. The hospital can increase access to care for prostate neoplasia patients.
PP158 The Art Of Collaboration In Guideline Development
Authors: Moga Carmen , Scott Ann 
Published: January 2019

Introduction:Developing clinical practice guidelines (CPGs) is a collaborative, multi-stakeholder enterprise. Over the last 13 years, health technology assessment (HTA) researchers from the Institute of Health Economics (IHE) partnered in a unique manner with provincial clinicians and stakeholders to develop and update CPGs using an innovative adaptation method. The complexities, intricacies, and attributes for success are presented, with emphasis on the role played by HTA resources.Methods:A governance structure (Advisory Committee, Steering Committee, Guideline Development Group) was designed to provide adequate oversight and quick, effective decision making, facilitate progress of the activities, and provide a mechanism for involving a wide variety of participants in the guideline development processes—stakeholders who represent policy, multidisciplinary care practice, knowledge translation, and research.Results:The HTA researchers served various functions and played multiple translation roles in the guideline development process: acting as a hub for connecting researchers with government to address relevant policy questions; liaising with committees to translate clinical queries into searchable questions for information specialists; preparing background documents and compiling discussion materials to expedite review by committees; connecting committees with external stakeholders such as the provincial CPG program; and bringing lay advisors into the final review process. Elements for success included effective communication, development and use of consistent methods, reliance on the highest quality of research evidence, willingness to contribute and share expertise, awareness of other initiatives and projects, transparency and openness, efficiency, flexibility, respect, enthusiasm, commitment, and patience.Conclusions:The development of CPGs requires the establishment of sophisticated multi-stakeholder collaboration and time. HTA agencies are well positioned to be an effective translation hub connecting the various stakeholders by virtue of their inherent ability to communicate in the language of policy makers, clinicians, and patients, so that all participants understand enough to add their voice to the process.
PD05 Influence Of Economic Data In The Incorporation Of Medicines In Brazil
Authors: Santos André , Ribeiro André , Ruas Cristina 
Published: January 2019

Introduction:Since 2011, the process of incorporation of technologies into the Brazilian public health system (SUS) has been assisted by the National Commission for the Incorporation of Technologies in SUS (Conitec). The present work collected data of effectiveness, safety, cost-effectiveness, budget impact and other criteria from Conitec's reports to determine the influence of economic evaluations on issued recommendations.Methods:Data was collected from drug recommendation reports published by Conitec between 2012 and 2016 and organized in a Microsoft Excel® spreadsheet. The association of the incremental cost-effectiveness ratio (ICER) and the chance of incorporation was assessed through a binary logistic regression in R®.Results:Two hundred and sixty-six reports were issued by Conitec between 2012 and 2016. Data were collected from 169 reports evaluating requisitions of incorporation of new medicines. Of these, there were ninety-nine which recommended the incorporation. The most common ATC classes analyzed were immunosuppressants (34 drugs), other antineoplastic agents (16 drugs) and direct-acting antivirals (15 drugs). Of the seventy negative recommendations, thirty-five were due to cost-effectiveness, thirty-one due to efficacy, twenty-nine due to safety, forty due to the budget impact, and thirty-two due to other reasons. In general, the reports were considered to be of poor quality. Only 21.9 percent of the reports had ICERs. The binary logistic regression analysis did not present a statistically significant difference for the influence of the ICER on the recommendation decision with outcomes reported in life years gained (OR = 0.9999732; 95% Confidence Interval [CI] = 0.9999304 to 1.000016) or quality-adjusted life years (OR = 0.9999789; 95% CI = 0.9999321 to 1.000026).Conclusions:Economic evaluations appear to be a secondary criterion for Conitec's recommendations. Despite this, they are commonly used to justify non-incorporation of drugs into the public system.
PD20 ‘Where's Waldo?’ Incorporating Patient Aspects Into Rapid Reviews
Authors: Thompson Lorna , Harbour Jenny , Macpherson Karen 
Published: January 2019

Introduction:Patient and social aspects form a key domain within health technology assessments (HTAs) but are less well established in rapid HTA. Patient aspects can add value to HTAs by aiding in interpretation of variations in intervention effectiveness or providing context on the impact of interventions on patients’ lives. This poster describes initial experience of incorporating patient aspects into a rapid HTA for the Scottish National Health Service.Methods:A rapid review explored using qualitative literature to understand patient issues relating to transoral robotic surgery (TORS) for head and neck cancer. Literature searches identified qualitative studies or systematic reviews of qualitative studies using two search filters: one for patient perspectives and another for qualitative study designs.Results:No qualitative literature specific to the exact question posed in the HTA was identified. Instead the project focused on patient experiences of alternative treatments (radiotherapy or open surgery) and identifying patient-important outcomes, such as speech function or lack of facial disfigurement. Pragmatic decisions on study selection were required in the TORS review due to the large volume of literature identified: we only included the most recent studies and limited our selection to patients with specific forms of head and neck cancer. Selecting studies from a large volume of literature may be an issue for future rapid HTAs attempting to incorporate qualitative evidence. The qualitative studies were summarised and used to inform advice issued to NHSScotland by the Scottish Health Technologies Group (SHTG).Conclusions:Patient aspects can be incorporated into rapid HTAs using systematic and pragmatic approaches to identifying and summarizing qualitative literature. Future rapid HTAs by SHTG may include syntheses of qualitative studies rather than summaries. Patient submissions are also being piloted as a method of collating patient experiences.
PD24 Data Collection By Patient Groups To Provide Patient Input
Authors: Berglas Sarah , Rader Tamara , Mai Helen 
Published: January 2019

Introduction:The Canadian Agency for Drugs and Technologies in Health (CADTH) Common Drug Review and pan-Canadian Oncology Drug Review programs incorporate perspectives and experiences from patients and family members who might be affected by the resulting funding recommendation. Perspectives are provided by patient groups who use different approaches to gather patient input.Methods:We analyzed a random sample of ninety-three patient input submissions, drawn from a sampling frame of 532 submissions given to CADTH between June 2010 and June 2016. We looked at how groups described their information gathering methods in the original submissions or the published Clinical Guidance Reports.Results:Approaches were categorized according to whether they involved primary (n = 86) or secondary data collection (n = 130) and further sub categorized according to how data was collected. Primary data included: personal experiences, as described by the submission's author (n = 16); surveys conducted specifically for the submission (n=34); and new interviews of patients and family members on disease and drug experiences (n = 36). Half (forty-seven of ninety-three) of the patient input submissions included experiences of one or more patients who had received the drug under review. Secondary data included: published literature (n = 31); existing surveys (n = 27); past conversations with patients and family members (n = 36); experiences of patient group staff interacting with patients and family members (n = 19); and advice from clinical experts (n = 17). Many patient input submissions (sixty-eight out of ninety-three) reported multiple approaches to collect data. Use of two approaches was most common (thirty-seven out of ninety-three) with five or six approaches used in three of ninety-three submissions.Conclusions:Despite resource and timing challenges, many patient groups gather primary data to share with CADTH and find individuals with experience of the drug under review.
PD44 Multi-Comparator Incremental Cost-Effectiveness Ratio: A New Framework For Cost-Effectiveness Analysis
Authors: Lucherini Stefano , Hughes Robert , Okhuoya Paul 
Published: January 2019

Introduction:Current practice in cost-effectiveness analysis (CEA) involves the estimation of the incremental cost-effectiveness ratio (ICER) between a new intervention and one alternative comparator reflecting the standard of care. As this focuses on pairwise comparisons, rather than considering the whole range of available alternatives at any given time, this method fails to capture the full impact of bringing the new intervention to market.Methods:A multi-comparator ICER (MC-ICER) evaluating the impact of the new technology on patients treated with all comparators used in clinical practice, rather than a theoretical ‘second-best’ alternative only, was estimated. This can be achieved by weighting the incremental costs and benefits for each comparator by its change in market share to generate an MC-ICER. This is shown using a stylized example with three comparators.Results:The traditional ICER against the second-best alternative was USD 200,000 per QALY, while the estimated multi-comparator ICER is USD 133,548 per QALY, corresponding to a 33 percent decrease. This reflects the fact that patients who switch to the new intervention are not only those who had been previously treated with one particular comparator, as is assumed in a traditional CEA. The difference between the traditional ICER and the MC-ICER depends on how the new intervention impacts on the uptake of each comparator.Conclusions:Results show that, when comparator selection was made excluding dominated and extendedly-dominated alternatives, the MC-ICER, produced using the method described above, is lower than the traditional ICER comparing the new intervention to the second-best comparator. This captures the fact that patients may switch to the new intervention not only from the second-best comparator, but from the whole range of alternative treatments. Such patient movements determine the real impact, or opportunity cost, of the new intervention on the healthcare system and, therefore, should be captured in CEA alongside traditional one-way ICERs.
VP21 Factors Associated With Recommendations On Drugs For Rare Diseases
Authors: Nagase Fernanda Inagaki , Sun Jian , Stafinski Tania , Menon Devidas 
Published: January 2019

Introduction:In Canada, reimbursement recommendations on drugs for common and rare indications (for example, orphan drugs) are made through the pan-Canadian Oncology Drug Review (pCODR) and the Common Drug Review (CDR). However, some stakeholders have called for a separate mechanism for orphan drugs, arguing that existing processes place too much weight on their high price tags. The purpose of this study was to examine factors associated with positive recommendations on drugs for rare diseases.Methods:Information was extracted from CDR and pCODR recommendations on drugs for diseases (prevalence of less than 1 in 2,000) up to April 2018. Univariate and multivariate logistic regression models were applied to explore the influence of the following variables on recommendations: year; prevalence; clinical safety and effectiveness (safety, quality of life, symptoms, surrogate outcomes, and survival); quality of evidence (availability of comparative data, external validity, and bias); unmet need; treatment cost; and incremental cost-effective ratio (ICER). Two-way interactions were also tested.Results:Of 128 recommendations, fifty-four (77 percent) and forty (69 percent) were positive for cancer and non-cancer indications, respectively. For cancer indications, all submissions reporting meaningful improvements in surrogate, quality of life, and survival outcomes were significantly more likely to have a positive recommendation. Submissions showing a lack of external validity were significantly less likely to receive a positive recommendation. For non-cancer indications, more recent submissions and those presenting no safety issues were associated with positive recommendations. Prevalence, treatment cost, and ICER were not determinants of positive or negative recommendations.Conclusions:For both cancer and non-cancer orphan drugs, impact on clinical safety and effectiveness, rather than cost, appears to be a key factor in the formulation of recommendations.
Compact polarimetry for automotive applications
Authors: Erhart Christian , Lutz Steffen , Mutschler Marc A. , Scharf Philipp A. , Walter Thomas , Mantz Hubert , Weigel Robert 
Published: January 2019

AbstractThough compact polarimetric approaches have been developed and applied in space and geo researching systems they have not been taken into consideration in automotive applications, yet. A sensor system has been designed to conduct polarimetric measurements in the 77 GHz frequency band, which is permitted for automotive usage. This system is able to transceive linearly as well as circularly polarized electromagnetic continuous waves. Depending on the case of application, the frequency output can be set statically or modulated over time within adjustable parameters. Hence, a variety of compact polarimetric modes can be performed and compared with full polarimetric approaches. Two compact polarimetric modes, dual-circular polarimetric mode, and circular-transmit-linear-receive, will be introduced and applied in this contribution. Their operability in this frequency range will be investigated after the microstrip antennas as well as the beam focusing dielectrical lense are characterized. Finally, results of a realistical measurement set-up will confirm the practicability of compact polarimetric approaches for double bounce recognition.
Solar Wind Directional Change Triggering Flapping Motions of the Current Sheet: MMS Observations
Authors: Wang G. Q. , Zhang T. L. , Wu M. Y. , Schmid D. , Cao J. B. , Volwerk M. 
Published: January 2019

AbstractWe report on a flapping motion event near the substorm onset on 17 June 2017 using Magnetospheric Multiscale (MMS) mission data. A strong current density with a maximum value of ~190 nA/m2 is observed during the flapping. The north‐to‐south (south‐to‐north) crossing of the neutral sheet corresponds to an increase (a decrease) of the ZGSM component of the solar wind VZ, SW. The periods (~8 min) of the flapping and variations of VZ, SW are almost equal. In addition, dVZ, SW/dt and dBX/dt observed by MMS exhibit a strong negative correlation. These observations suggest that the flapping motions are triggered by the solar wind directional change via creating a motion of the current sheet in the north‐south direction. The pressure difference between the northern and southern lobes caused by the solar wind is expected to be a possible contribution to the formation of the flapping.
Scalable En Echelon Shear‐Fracture Aperture‐Roughness Mechanism: Theory, Validation, and Implications
Authors: Frash Luke P. , Carey J. William , Welch Nathan J. 
Published: January 2019

AbstractShear fractures can facilitate fluid conductivity through rock. Aperture and roughness are controlling characteristics for a fracture's fluid conductivity. Inspired by en echelon fractures, we develop a shear “fracturelet” model that predicts anisotropic aperture with respect to the direction of shearing, rougher (nonplanar) rather than smoother (planar) fractures, and the bounds of this roughness for a coalesced fracture. This tendency for rougher fracture creation is validated by in situ X‐ray images and fluid conductivity measurements from triaxial direct shear experiments on anhydrite and shale. These experiments were conducted at confining stresses from 4 to 30 MPa and shear displacement magnitudes from 0 to 2 mm on initially intact rock specimens. Hydraulic, dilatational, and local fracture apertures were measured in the experiments. Apertures exhibited strong anisotropy with more conductive flow paths forming perpendicular to the direction of shearing. Local and dilatational aperture were found to be positively correlated with increasing shear displacement but hydraulic aperture was found to vary significantly, always having values smaller than the other aperture measures at factors ranging from 0.6 to 0.0. An implication of these results is that shear fractures have a mechanism for simultaneously exhibiting very low fluid conductivity and high fluid storage volume.