bluuebunny/crossref_metadata_2025_split huggingface dataset:
OP86 Identifying Surgical Procedures Of Low Or No-Added Value In Spain
Authors: Ibargoyen-Roteta Nora , Varela-Lema Leonor , Gutiérrez-Ibarluzea Iñaki , Benguria-Arrate Gaizka , Baños Elena , Atienza-Merino Gerardo , Martin Iñaki , Valentin Beatriz , Gavin Patricia , Kotzeva Anna , Garcia-Armesto Sandra 
Published: January 2018

INTRODUCTION:There is an increasing interest in divesting activities, giving rise to several initiatives both academic and governmental to identify and address one of the problems of health systems. In 2013 the Spanish Atlas of Variability in Clinical Practice (VPM) in collaboration with the Spanish Network of Health Technology Assessment (HTA) Agencies started a project with the purpose of providing elements to support a national strategy aimed at minimizing the use of doubtful procedures in the Spanish National Health System (1).METHODS:The identification, selection and definition of low added value procedures and the determination of the most cost-effective alternatives were carried out jointly between the AtlasVPM group and the HTA agencies of Andalusia (AETSA), Catalonia (AQUAS), Galicia (Avalia-t), Basque Country (Osteba), Madrid (UETS) and Aragon (IACS). The process consisted of the following phases: (i) Literature review; (ii) Preliminary list of procedures of dubious value; (iii) Analysis of feasibility and construction of the indicators (variability); and (iv) Empirical validation of the defined indicators. Different lists and sources of evidence were used to identify the procedures and evidence that support their low-value.RESULTS:The synthesis of the evidence gave rise to an initial list of fifty-nine procedures of doubtful value that could be classified as: obsolete or outdated procedures in comparison to more effective / cost-effective alternatives (n = 31), procedures of doubtful value when used outside their main indication (n = 17) and procedures for which the evidence around effectiveness was still insufficient (n = 11). With the advice of clinical experts and coders, the original list was reduced to seventeen procedures and after some adjustments to thirteen.CONCLUSIONS:Identifying procedures of low-added value is a complex task and is context dependent. Literature could be useful to identify a preliminary list but the analysis of the clinical practice, its variability and reasons that justify it are required to determine which procedures are good candidates for disinvestment.
OP125 A New Collaborative Approach To Assess Innovative Health Technologies
Authors: de Guise Michèle , Plamondon Geneviève , Simoncelli Mariève 
Published: January 2018

INTRODUCTION:Decision makers worldwide face the challenge of offering the best health care within a context of scarce resources. Technological developments have multiplied in the past decades, with the lifecycle of technologies becoming shorter. As a result, the traditional Health Technology Assessment (HTA) model is often caught in a too early, too late syndrome. In the province of Québec (Canada), there is no standardized process for assessing non-pharmaceutical technologies for reimbursement purposes, and technologies are therefore introduced via multiple sources. There are concerns that the introduction of some of the most promising technologies is delayed, and on the contrary, that others are introduced without providing a real added value to patients and the health system.METHODS:INESSS (Institut national d'excellence en santé et services sociaux), collectively with stakeholders of the Québec innovation field, has developed a dynamic process for assessing the added value of innovative technologies. POETIS (Processus optimisé d'évaluation des technologies innovantes en santé) aims to identify the technologies with the highest potential for positive impact on patients and the health system, in order to accelerate their implementation and promote their optimal use.RESULTS:POETIS comprises four phases aligned with the lifecycle of technologies: research and development, pre-implementation, limited implementation, and diffusion. It allows a continuum of assessment, from the promise of a technology to its real-world benefit. It differs from other approaches because of the sustained involvement of key stakeholders, including patients, and because it assesses technologies iteratively, therefore fostering their adaptation to better suit patients needs. It is hoped for the first technologies to be assessed in 2017.CONCLUSIONS:HTA has to adapt to the challenges of innovation, and this could be done with a lifecycle approach and an enhanced collaboration with end-users. Developed in Canada, the goals behind POETIS are common to many countries and the process could be adapted by other HTA agencies.
OP134 Predictors Of Public Health Outcomes: A Case Study From Turkey
Authors: Cinaroglu Songul , Baser Onur 
Published: January 2018

INTRODUCTION:In Turkey, there is a scarcity of knowledge about the predictors of health outcomes at a national level, and it is well known that there is a gap between rural and urban parts of developing countries in terms of the level of health outcomes. This study aims to find out predictor factors of the public health outcomes at a province level in Turkey.METHODS:Life expectancy at birth and mortality are used as public health outcome indicators. Logistic regression and Random Forest classification generated by using 50, 100, and 150 trees were used to compare prediction performance of health outcomes. The results of different prediction methods were recorded changing the “k” parameter from 3 to 20 in k-fold cross validation. The Area Under the ROC Curve (AUC) was used as a measure of prediction accuracy. Prediction performance differences were tested using Kruskall-Wallis analysis and visualized on a heatmap. Finally, predictor variables of public health outcomes were shown on a decision tree.RESULTS:Study results revealed that Logistic regression outperformed Random Forest classification. The difference between all prediction methods to predict public health outcome indicators was statistically significant (p<.000). The heatmap shows that AUC values to predict mortality have superior performance when compared with life expectancy at birth. Decision tree graphs present that the most important predictor variables were total number of beds for mortality and percentage of higher education graduates for life expectancy at birth.CONCLUSIONS:The results of this study represent a preliminary attempt to determine public health outcome indicators. It is hoped that the results of this study serve as a basis to understand the determinants of health care outcomes at province level with focus on a developing country. This study illustrates that there is a need to spend extra effort for future studies to analyze public health outcomes to improve social welfare functions in health systems.
PP039 Health Utility Values In Renal Cell Carcinoma: A Systematic Review
Authors: Lister Johanna , Stanisic Sanja , Neumann Monika , Dinet Jerome , Gabriel Sylvie 
Published: January 2018

INTRODUCTION:Advanced or metastatic renal cell-carcinoma (RCC) is associated with poor health outcomes; in particular in those whose disease progressed after first line treatment. A literature review was conducted to elucidate evidence on health-related utility associated with advanced and metastatic RCC.METHODS:A systematic literature search from 2006 onwards (date of search: July 2016) was conducted for studies evaluating health-related quality of life (QoL) and utility outcomes. Searches included Medline, Embase, National Health Service (NHS) Economic Evaluation Database and HTA Database and were supplemented by free internet search for key European Health Technology Assessment reports. Publications were limited to 2006 onwards as previous research (1) revealed no prior relevant evidence.RESULTS:The search yielded 4,178 records. The selection process revealed seventy-eight relevant publications. Generic EuroQol (EQ)-5D scale was most commonly used. Health-state utilities were assessed for specific treatments and at different time points. Mean reported value for patients after failure of one prior systemic therapy ranged from .79 - .62. For patients without progression (on and off-treatment) reported utility values were in range from .80 – .63. Utility in stable patients with adverse events ranged from .71 - .47. For patients with progressive diseases, utility was reported from .71 - .36. Utility for interventions due to skeletal-related events in patients with bone metastasis was reported to range between .46 and .15.CONCLUSIONS:Identified evidence confirms advanced or metastatic RCC leads to significant detriment to patients health-related utility. Further research efforts are warranted to assess health-state utility beyond clinical trial assessment.
PP041 Universal Coverage Through Innovative Telediagnosis Technology
Authors: Galvan Pedro , Velazquez Miguel , Rivas Ronald , Barrios Antonio , Hilario Enrique , Benitez Gualberto 
Published: January 2018

INTRODUCTION:Through technological innovations based information and communication technologies (ICT), advantageous telediagnostic systems can be developed to improve the health care of remote populations (1). In the context of universal coverage and the efficient use of available resources, there is a favorable opportunity to develop telemedicine towards an integrated ecosystem to improve health care in remote locations without access to specialists. This study, performed by the Telemedicine Unit (MoH) in collaboration with the Biomedical Engineering Dept (IICS-UNA) and the Basque Country University (UPV/EHU) evaluated a telediagnostic system implemented in 2014 in public health. The results of a cost utility analysis for this telediagnosis project in remote, regional and district hospitals in Paraguay are presented.METHODS:This is a prospective study, where the results of using telediagnosis implemented in remote hospitals over three years 2014–16 were evaulated. For these purposes, a utility analysis was carried out by comparing the cost of performing telediagnosis versus performing it “face to face” in a diagnosis center in the capital city.RESULTS:During the study 182,406 remote diagnoses were performed in the fifty-four remote hospitals using the telediagnosis tool. Of the total, 37.3 percent (68,085) corresponded to tomography (CT), 62.0 percent (113,059) to electrocardiography (ECG), 0.68 percent (1,243) to electroencephalography (EEG) and 0.01 percent (19) to ultrasound studies. The average cost of a tele-tomography, tele-ECG and tele-ultrasound was USD2.6, and USD8.6 for tele-EEG, respectively. The cost reduction through the telediagnosis was 26.4 times for tomography, 4.5 times for ECG, 8.0 times for EEG and 8.3 times for ultrasound. The cost utility analysis performed demonstrates an economic benefit of USD12.9 million to the citizens of the fifty-four communities included in this project.CONCLUSIONS:Despite the potential benefit of the telediagnosis (2) to facilitate the universal coverage, and optimize the use of scarce human and health financial resources shown in this study, other important aspects such as acceptance of the technology, patient satisfaction and a widespread use-assessment should be analyzed (3) before a large diffusion.
PP072 Applying Sensitivity Analysis For Robust Choice Of Health Technologies
Authors: Andellini Martina , Faggiano Francesco , Sabusco Francesca , Derrico Pietro , Ritrovato Matteo 
Published: January 2018

INTRODUCTION:The aim of this work is to evaluate the stability and robustness of the solution obtained at the end of the Health Technology Assessment (HTA) process by conducting a sensitivity analysis. Sensitivity analysis allows identification of the elements representing the source of uncertainty and to determine the impact of this variability on the stability of the assessment results, in order to provide more adequate and objective support to decision-making process.METHODS:A new method for health technologies evaluation, Decision-oriented HTA (1), which integrates the Analytic Hierarchy Process (AHP) (2) in the model Core Model® of the European Network for HTA (EUnetHTA) was taken into account. In this context, a mathematical model was implemented to conduct a sensitivity analysis on weights and on performance values of the technology alternatives evaluated. The objective is to evaluate the effects on AHP results induced by a change on initial values of each criterion of the decision-making model. Sensitivity analysis was carried out by calculating the minimum changes of the weights and performances needed to reverse the current ranking of alternatives technologies (3).RESULTS:This approach was applied to some technology assessment studies such as video-laparoscopy, femtosecond laser, da Vinci robot, to test their efficacy and reliability. It is very important to perform a sensitivity analysis and assure the stability of the solution when the performance values associated to the technology alternatives are close because, in this case, a small change of performance values reversed the ranking of alternatives technologies.CONCLUSIONS:Applying sensitivity analysis to such decision-making processes is essential to ensure the consistency of final decisions. This evidence has shown that this method allows for a more rapid interpretation of results, thus facilitating the choice of decision-makers about the decision to invest or not in new technology.
PP079 The Construction Of Database Using Japanese National Claims Database
Authors: Sato Daisuke , Shiroiwa Takeru , Fukuda Takashi 
Published: January 2018

INTRODUCTION:In 2014, the Ministry of Health, Labor and Welfare (MHLW) in Japan began to assume a cost-effectiveness perspective. Some expensive pharmaceutical and medical devices have been regulated, which resulted in a drastic change of the healthcare system.The Japanese National Insurance Claims Database (NDB) is an administrative database based on claims data from Medical Insurance Claims since 2008. The government enacted the Act on Assurance of Medical Care for Elderly People during health care reform in 2008. In 2006, the MHLW commenced discussions on a framework for the optimization of the healthcare expenses, which aimed to evaluate the structure of the increase in healthcare expenditure.The NDB was developed as a tool for investigation and analysis by the MHLW in the context of the Healthcare reform. In addition, the NDB was used for the development of academic research in order to contribute to the implementation and evaluation of healthcare policy management.A major strength of the NDB is its exhaustiveness or completeness of insurance claims. The NDB collects data from all insured people nationwide and covers all medical institutions in Japan.METHODS:We applied to the Expert Meeting on Provision of Medical Insurance Claims to examine the research plan, items extracted, and data management. Inpatient and Outpatient information was extracted on medical procedures and payment. Diagnoses for both inpatients and outpatients are coded according to the International Classification of Diseases Tenth Edition (ICD-10). The coding of treatments and surgeries follow Japan's local procedure and surgical coding, which was specifically developed for insurance claims.RESULTS:We generated any personally traceable patient ID from the “hash ID” generated by patient name, sex, date of birth, and insurer number with the aim of protecting personal identifying information in the NDB. The disease of stroke was defined to analyze the database for cost-effectiveness analysis, and to connect disease information to. The prescription claims information described pharmaceutical names, prescription date, total dose, and number of days.CONCLUSIONS:Our study showed the new standard way of analysis for cost-effectiveness analysis using the Japanese National Insurance Claims Database.
PP109 Horizon Scanning For Information Providing In Brazil
Authors: Gomes Pollyanna , Vidal Avila , de Souza Andrea Brígida , Canuto Vania , Petramale Clarice 
Published: January 2018

INTRODUCTION:The last five years represented an advanced season for the establishment and reinforcement of the Brazilian Ministry of Health's Horizon Scanning System. The recognition of Horizon Scanning (HS) as a tool for evidence- based decision making has been reflected in the requests for information directed to the Horizon Scanning's team. These requests for information about new and emerging technologies come from cabinets offices and thematic departments of the Ministry of Health. The methodology of Horizon Scanning assessments described in EuroScan's toolkit1 has been applied to guarantee that the information reach stakeholders at the right time. The National Committee for Health Technology Incorporation (CONITEC) was accepted as a member of EuroScan (1) in 2016, and this represented another important step of Brazil's HS System.METHODS:In order to provide the specific information requested, the assessments of the technologies are done. So, databases on ongoing clinical trials, commercial pharmaceutical database, registration and licensing sites, proceedings and abstracts of scientific conferences and scientific databases are checked to collect the information. The extent and depth of the assessments depends on the stakeholders needs and time available to complete them. However, information as how the technology works, the clinical burden of disease, if there are available technologies in the Brazilian Public Health System to treat the disease, safety and effectiveness data, the regulatory status in the world as well costs, social, ethical and legal concerns are commonly given.RESULTS:The information provided using the HS methodology is used by stakeholders for several purposes as to defend the Ministry of Health in the Courts in the typical Latin American phenomena called “judicialization of health;” in assistance of the decision making of incorporation of technologies by the Brazilian Public Health and to support the definition of which medicines would be more strategic for establishment of Public-private partnerships for development of medicines, the named “Productive Development Partnerships (PDPs)”.CONCLUSIONS:The assessment of the technologies and the prediction of its potential for impact has helped the health policy making process in Brazil.
PP117 Isosorbide And Nifedipine In Chagas Patients: A Systematic Review
Authors: Cruz Luciane , Migliavaca Celina Borges , Stein Cinara , Colpani Verônica , Miguel Sandro , Falavigna Maicon 
Published: January 2018

INTRODUCTION:Chagas disease, caused by the parasite Trypanosoma cruzi, affects more than seven million people worldwide and it is considered by the World Health Organization (WHO) a neglected tropical disease (1). About one third of Chagas patients develop gastrointestinal disorders, such as dysphagia and achalasia. Management of the disease focuses on symptom improvement and drugs that relax the lower esophageal sphincter pressure (LESP), such as isosorbide and nifedipine. However, the use of these therapies is doubtful because of their side effects and palliative approach (2). The objective of this systematic review is to assess the effectiveness of isosorbide and nifedipine on gastrointestinal manifestation of Chagas disease.METHODS:We searched MEDLINE, EMBASE and LILACS databases to retrieve potentially relevant articles from inception to December 2016. Inclusion criteria: clinical trials, cohorts or cross-sectional design; adults (>18 years old); assessment of effects of isosorbide or nifedipine on gastrointestinal symptoms in Chagas patients. Two reviewers independently screened titles and abstracts, selected eligible studies and extracted data from each study. PROSPERO registration number: CRD42017055143.RESULTS:Eight studies were included (two case series, two clinical trials and four crossovers). Three studies evaluated the effect of isosorbide in LESP and three in esophageal emptying. All of them found that isosorbide rapidly reduces LESP and increases esophageal emptying rates, improving dysphagia. However, several patients reported collateral effects, such as gastroesophageal reflux, headaches and dizziness. One study evaluated the effect of nifedipine on LESP and one on esophageal emptying. Nifedipine decreased LESP, but there was no effect on esophageal emptying.CONCLUSIONS:The available evidence shows isosorbide is effective in the management of gastrointestinal symptoms. Frequently health care of Chagas disease patients is delivered by primary care physicians. So, information on effectiveness of interventions can be aggregated to clinical guidelines, having an important value to inform general practitioners on the decision-making process regarding treatment of this group of patients, avoiding referencing to a specialized care.
PP124 The HTAi Vortal: A Comparative Analysis
Authors: Chalon Patrice 
Published: January 2018

INTRODUCTION:The HTAi Vortal is a product of the HTAi Information Retrieval Group (IRG) which has collected resources in the field of Health Technology Assessment (HTA) since 2005.In 2011, a new technical platform was set up and the legacy Vortal content was split in three sections: HTA producers and networks, Selected references and Career development (including trainings). The same year, a fourth section was created to host a new product of the IRG: SuRe.info.In 2014, the Vortal added a new service to other Interest sub groups of HTAi: the hosting of “Custom bibliographies”. But while the Vortal was probably quite unique in 2005, other Websites have been developed since then to offer quite similar functionalities.The present communication aims at evaluating how the Vortal compares with similar tools existing on the Web.METHODS:Vortal competitors have been identified using a quick empirical search of the Web.Functionalities have been identified by testing the website or their archive; maintainers have been sometimes contacted to ask for complementary information. A grid listing all functionalities has been established and filled in with the collected information.RESULTS:Several competitors have been identified. The Vortal presents functionalities similar to online tools, but detailing level is different. Also, the Vortal provides a better integration resulting in more efficiency. And, the Vortal is the only Web platform to offer a service of publication of custom bibliographies to the different HTAi Interest Sub Groups.CONCLUSIONS:After 12 years of existence, the HTAi Vortal is still a recognized online resource about HTA. While some existing functionalities are to be found in other online tools, some remain unique to the Vortal. Further research is needed to evaluate the preferences of people with interest in HTA.