bluuebunny/crossref_metadata_2025_split huggingface dataset:
VP66 Perception Of Decision Makers And Researchers Towards Health Technology Assessment In Ghana
Authors: Addo Rebecca , Hall Jane , Goodall Stephen , Haas Marion 
Published: January 2018

INTRODUCTION:In recent years, the Ghana health system has been faced with the challenge of financial sustainability. New ways of making decisions in a cost-effective manner that ensure efficient use of available resources is being explored. Consequently, Ghana has been pursuing the formal introduction of Health Technology Assessment (HTA) for decision making in the health system.However, the limited use and impact of HTA on health systems has been associated with reasons including, and not restricted to, the knowledge and perception of decision makers towards it (1-3). Therefore as Ghana gears towards using HTA formally, it is important to assess the knowledge and attitude of potential users and producers of HTA. This will provide useful information for the setting up of an HTA agency.METHODS:A qualitative research approach using in-depth interviews was utilized. Twenty-three decision makers both at the national and district levels, and four researchers were interviewed. Thematic analysis was conducted using NVivo software.RESULTS:Only seven respondents had knowledge about HTA. Respondents perceived HTA differently, and the word ‘technology’, was often misconstrued as a device for communication such as mobile phone. Two main barriers to the use of HTA emerged; lack of resources (human, data, and finance) and politico-cultural issues. To address these barriers respondents recommended that stakeholders be involved in decisions concerning the guidelines for its conduct, composition of the appraisal team, and the focus of HTA. Generating of human, data and financial resources were also indicated.CONCLUSIONS:There is paucity of knowledge about HTA in Ghana. For Ghana to successfully introduce HTA for health decision making and realize its expected benefits, there will be a need to address the perceived barriers in a comprehensive manner. Also, to mitigate data and human resource barrier, Ghana will have to examine the available local data and human resource to build on.
VP72 Development Trend Analysis On New Health Technology: Based On Euroscan
Authors: Jiang Chongyang , Zhou Ping , Xia Zhiyuan 
Published: January 2018

INTRODUCTION:Emerging health technologies (EHT) are important to meet the challenges faced by healthcare systems but a major pressure on health systems as well (1). The International Information Network on New and Emerging Health Technologies (EUROSCAN) is a collaborative network to manage the introduction of EHT and share information on the results of early identification and assessment of EHT (2). This article analyzed the early assessment reports of EHT during 2000–2016 published in the EUROSCAN database (3), in order to reflect the 21st century development trend of the EHT.METHODS:The EHT report data was downloaded by researchers from the official website of the EUROSCAN and arranged using Excel 2007. A descriptive analysis on the number and growth rate of EHT, distribution of technology type and specialties, developmental trend of the integrated technologies were conducted with SAS 9.3.RESULTS:Health technology early assessment reports (3,151) have been published in the past 17 years, of which drugs had the highest proportion (54.3 percent). Most of new and emerging health technologies were adopted in oncology and radiotherapy (32.2 percent). The average growth rate every 4 years of EHT from 2001 to 2016 was 34.6 percent, the fastest-growing period was between 2005 and 2008 (63.8 percent). Rehabilitation & disability was the fastest-growing EHT specialty (184.4 percent) and the integrated technologies was the fastest-growing EHT type (64.6 percent).CONCLUSIONS:With the objective needs of effective technologies to deal with cancer and chronic disease, as well as the revolution of science, EHT were in the process of vigorous development, especially oncology & radiotherapy technologies. The integrated technologies and the ones applied in multidisciplinary areas have become a new spotlight. Early identification and timely assessment of new and emerging health technologies has aroused wide public concern. It is suggested to establish an Early Awareness and Alert Systerm in China.
VP88 Transient Ischaemic Attack Referral (TIER) Intervention Development
Authors: Hampton Chelsey , Rees Nigel , Ali Khalid , Dewar Richard , Evans Lyn , Ford Gary , John Roger , Moore Chris , Obiako Mike , Porter Alison , Quinn Tom , Bulger Jenna , Jones Charlene , Seagrove Anne , Snooks Helen 
Published: January 2018

INTRODUCTION:Transient Ischaemic Attack (TIA) is a neurologic event with symptom resolution within 24 hours. Early specialist assessment of TIA reduces risk of stroke and death. National United Kingdom (UK) guidelines recommend patients with TIA are seen in specialist clinics within 24 hours (high risk) or seven days (low risk).We aimed to develop a complex intervention for patients with low risk TIA presenting to the emergency ambulance service. The intervention is being tested in the TIER feasibility trial, in line with Medical Research Council (MRC) guidance on staged development and evaluation of complex interventions.METHODS:We conducted three interrelated activities to produce the TIER intervention:
•Survey of UK Ambulance Services (n = 13) to gather information about TIA pathways already in use•Scoping review of literature describing prehospital care of patients with TIA•Synthesis of data and definition of intervention by specialist panel of: paramedics; Emergency Department (ED) and stroke consultants; service users; ambulance service managers.RESULTS:The panel used results to define the TIER intervention, to include:
1.Protocol for paramedics to assess patients presenting with TIA and identify and refer low risk patients for prompt (< 7day) specialist review at TIA clinic2.Patient Group Directive and information pack to allow paramedic administration of aspirin to patients left at home with referral to TIA clinic3.Referral process via ambulance control room4.Training package for paramedics5.Agreement with TIA clinic service provider including rapid review of referred patientsCONCLUSIONS:We followed MRC guidance to develop a clinical intervention for assessment and referral of low risk TIA patients attended by emergency ambulance paramedic. We are testing feasibility of implementing and evaluating this intervention in the TIER feasibility trial which may lead to fully powered multicentre randomized controlled trial (RCT) if predefined progression criteria are met.
VP101 Medical Devices For Treatment-resistant Hypertension: Health Technology Assessment Report
Authors: Jefferson Tom , Abraha Iosief , Amicosante Anna Maria Vincenza , Corio Mirella , Migliore Antonio , Cioni Roberto , Taddei Stefano , Cerbo Corrado Vassanelli Marina 
Published: January 2018

INTRODUCTION:While optimal medical therapy (OMT) represents the current standard of care for treatment-resistant hypertension, non-pharmaceutical therapeutic approaches, such as renal denervation and carotid baroreceptor stimulation therapy, have been proposed. The present Health Technology Assessment (HTA) project was aimed at assessing benefits and risk of those approaches versus OMT.METHODS:A systematic review of evidence on effectiveness and safety was performed together with a review of economic studies. A contextual analysis of market availability and use of the technology in Italy was also performed.RESULTS:In Italy, ninety-nine renal denervation procedures were performed in 2014. Ten studies from six trials were included in the review and meta-analysis. No evidence of dominance or increased harms of renal denervation compared to OMT were found. Four economic evaluations were included and reported dominance of renal denervation. These were based on short-term clinical data and three evaluations used the same Markov model assuming dominance of renal denervation. Estimated average prospective cost of the procedure was EUR6,129.90 (range EUR3,821.15 – EUR9,714.23). We updated the results of an earlier assessment published by an Italian Regional agency on carotid baroreceptor stimulation therapy (1). None of the three studies identified as ongoing in 2015 were completed or had published preliminary results and the technology was not assessed further within the present HTA project.CONCLUSIONS:Even if follow-up was limited to 6 months, randomised evidence showed no benefits of the procedure. Economic evaluations were unreliable, based on unrealistic assumptions of effectiveness and contrived therapy regimes. Further investment in renal denervation should await the results of well-designed and adequately followed-up trials assessing the impact of renal denervation on major cardiovascular events compared to OMT. Future economic evaluations should be based on realistic assumptions of cost and effectiveness.
VP115 Practical Issues Of Using Real-World Data In Effectiveness Research
Authors: Makady Amr , Stegenga Heather , Joyeux Alexandre , Lees Michael , Jonsson Pall 
Published: January 2018

INTRODUCTION:The Innovative Medicines Initiative, IMI-GetReal project aimed to explore incorporation of robust methods for real-world data (RWD) collection and synthesis earlier in the medicines development process, both by pharmaceutical companies and healthcare decision makers. The focus was on the potential use of RWD, alone or in combination with randomized controlled trials (RCTs), to demonstrate effectiveness of new interventions. Four case studies were conducted in multiple disease areas to examine methods for predicting drug effectiveness and the perspectives of different stakeholders on these methods. This study aimed to identify practical obstacles in accessing and using RWD and RCT data for effectiveness research conducted as part of these case studies.METHODS:Qualitative content analysis was conducted to identify and characterize key issues relating to accessing and analysing study data from external sources, both RWD and RCTs.RESULTS:Accessing RWD from registries proved difficult due to multiple reasons, including: complex and non-transparent application procedures, resistance from registry owners to discuss applications and datasets not being research-ready within project timeframes. There were also issues with the RWD eventually accessed, including a lack of individual participant data (IPD) and incomplete data. Where access to IPD from RCTs was obtainable, there were restrictions imposed on how it could be used. For example, it could not be used to target analysis on an individual product, but rather explore methodologies for data synthesis in a product-anonymised setting. This condition encouraged additional data sharing by other stakeholders.CONCLUSIONS:Despite the collaborative, multi-stakeholder nature of IMI-GetReal and proper disclosures with data owners, access to data proved challenging. Such barriers to data accessibility can delay effectiveness research, restrict opportunities for the development of methods incorporating RWD and diminish the potential use of RWD in decision making. Where data is intended to be used for this purpose, sufficient attention should be paid to these potential barriers.
VP136 The Impact Of Hospital Costing Methods On Economic Evaluations
Authors: Manetti Stefania , Leal Jose 
Published: January 2018

INTRODUCTION:There are several methods to cost hospital contacts when estimating the cost effectiveness of a new intervention. In England, the National Insitute for Health and Care Excellence (NICE) recommends the use of diagnosis-related group (DRG)-based costs as a valuable way of costing hospital resource use. There are three main sources of unit costs of a DRG: (i) tariffs as used for reimbursement purposes, (ii) benchmarking finished consultant episode (FCE)-level reference costs and (iii) benchmarking spell-level reference costs.The purpose of this work is to compare the implications of choosing a particular source of DRG-based unit costs when conducting an economic evaluation.METHODS:As a case study, we used a cost-utility model developed to compare secondary fracture prevention models of care for hip fracture patients (1). A Markov model was derived from large primary and hospital care administrative datasets in England. Utilities were informed by a meta-regression of thirty-two studies. Hospital resource use (inpatient, outpatient, critical care and emergency care) was valued using the three different 2014–15 DRG-based unit costs and regression-based costing models were derived from 33,000 hip fracture patients to inform the health states of the model (2). For each source of DRG-based costs, we calculated mean life years, Quality-Adjusted Life Years (QALYs) and costs for a representative male and female associated with three models of care: (i) orthogeriatrician (OG)-led, (ii) nurse-led fracture liaison services and (iii) usual care.RESULTS:Using the benchmarking FCE-level DRG-based costs, the OG-led model was estimated to be the most effective model of care (1.77 QALYs, 95 percent Confidence Interval, CI 1.56-1.98) at a threshold of GBP30,000/QALY. However, it also resulted in the highest costs per patient. We will report the cost-effectiveness results using the two remaining DRG-based costs.CONCLUSIONS:Choosing a particular hospital costing method may have an impact on economic evaluations. We will reflect on the implications for the estimated hospital costs, decision uncertainty and adoption of models of care.
VP140 Methods For Ethical Analysis In The Health Technology Assessment
Authors: Martins Raysa , Barreto Jorge , Elias Flavia 
Published: January 2018

INTRODUCTION:This paper is based on a narrative review to identify and describe approaches to incorporate ethical aspects in Health Technology Assessment (HTA). On the first decade HTA was being established as a new area of research, the social and ethical dimensions seemed to play an essential role. This perspective, centered on the social impact of technology contrasts with the current definition, which focuses on the technical conditions of technology, especially properties and effects. Some authors have discussed the obstacles to include the ethical dimension into this area to a large extent. Those authors were motivated by the perception that there are few sections explicitly dedicated to these dimensions in the evaluation reports.METHODS:We searched these scientific databases: Pubmed, Cochrane Library, Centre for Review and Dissemination (CRD), PDQ - Evidence and Virtual Health Library (VHL), and selected studies that presented procedures and methodologies for the inclusion of ethical analysis in HTA.RESULTS:A total of 308 articles were retrieved, nine of them were included. The identified methods were classified into four groups according to the parameters and procedures: (i) normative-based evaluation, (ii) case comparison-based evaluation; (iii) predefined questionnaire application-based evaluation and iv) debate and deliberation-based evaluation.The result showed a great diversity of approaches (1 - 3) for the inclusion of the ethical dimension in the evaluation studies of health technologies, which can even be used together. It is suggested that its use considers the characteristics and needs of each different application contexts.CONCLUSIONS:This work presented as methodological base of approaches for the integration of the ethical dimension in the HTA field. Nonetheless, the proposed approaches to the incorporation of philosophical field of ethics into the systematization and objectivity field of the HTA reveal a considerable approach diversity that is applied productively. Since it has been agreed that technology evaluation is contextual, different approaches would help to meet the needs for possible adjustment.
VP149 Sustained Low Efficiency Dialysis (SLED): A Rapid Review
Authors: Aung Khin Chaw Yu , Chow Wai Leng , Tong Shao Chuen 
Published: January 2018

INTRODUCTION:This rapid review aimed to determine the effectiveness of Sustained Low Efficiency Dialysis (SLED) when compared to Continuous Renal Replacement Therapy (CRRT) and Continuous Veno-Venous Hemofiltration (CVVH) in the treatment of acute renal failure (ARF) with a view to implementing SLED in a tertiary hospital in 2014.METHODS:A rapid review was performed on the effect of SLED for patients with ARF compared with CRRT or CVVH. The outcomes of interest were mortality, hemodynamic stability, reduced utilization of intensive care unit (ICU) and cost-effectiveness. The search terms ("sustained low-efficiency dialysis[MESH]”) were used to search PubMed, the Cochrane Library, UK NHS Centre for Reviews and Dissemination databases and the US National Guidelines Clearinghouse for relevant articles until 2014.RESULTS:Four observational and two randomized controlled trial (RCT) studies were found. The results showed that 90-day mortality, was similar between groups (SLED: 49.6 percent versus CVVH: 55.6 percent, p = .43). Hemodynamic stability did not differ between SLED and CVVH and between SLED and CRRT. Patients in the SLED group had significantly fewer days of mechanical ventilation (17.7 ± 19.4 versus 20.9 ± 19.8, p = .047) and fewer days in the ICU (19.6 ± 20.1 versus 23.7 ± 21.9, p = .04). Patients treated with SLED needed fewer blood transfusions (1,375 ± 2,573 ml versus 1,976 ± 3,316 ml, p = .02) and had a substantial reduction in nursing time (p < .001). The hospital weekly costs were CAD1,431 for SLED, CAD2,607 for CRRT with heparin, and CAD 3,089 for CRRT with citrate. Dialysis using SLED was associated with higher first post-dialysis mean arterial pressure (p = .003) than those treated with CVVH, which led to lower mortality.CONCLUSIONS:The evidence suggests that SLED can be used as an alternative to CRRT, as the outcomes were similar. SLED provides solute removal equivalent to CRRT at significantly lower cost.
VP163 Patient Involvement In The Development Of Multi-Criteria Decision Tool
Authors: Gagnon Marie-Pierre , L'Espérance Sylvain , Lindsay Carmen , Rhainds Marc , Coulombe Martin , Rousseau François 
Published: January 2018

INTRODUCTION:Healthcare organizations should assess the relevance of both existing and new practices. Involving patients in decisions regarding which health technologies and interventions should be prioritized could favor a better fit between strategic choices and patients needs.METHODS:Following a systematic review of existing multi-criteria decision support tools and a consultation with hospital clinicians and managers, a set of potentially relevant criteria was identified. A three-round modified Delphi study was then conducted among four groups (hospital managers, heads of department, clinicians, and patient representatives) in order to reach consensus on criteria that should be considered in the tool.RESULTS:In total, seventy-four participants completed the third round of the Delphi study. Consensus was obtained on twelve criteria. There were some significant differences between groups in priority scores given to criteria. Patient representatives differed significantly from other groups on two criteria. Their ranking of the accessibility criteria was higher, and their ranking of the organizational aspect criteria was lower than for the other groups.CONCLUSIONS:Patient representatives can be involved in the development of a multi-criteria decision support tool to identify, evaluate and prioritize high value-added health technologies and interventions in order to enhancing clinical appropriateness The fact that accessibility aspects were more important for patient representatives calls for specific attention to these criteria when prioritizing health technologies or interventions. Furthermore, we need to ensure that the decisions made regarding the relevance of these technologies and interventions also reflect patients’ preferences.
VP169 Grouping Treat-to-Target Studies In Systematic Reviews
Authors: Martyn-St James Marrissa , Hock Emma , Wong Ruth , Stevenson Matt , Wailoo Allan 
Published: January 2018

INTRODUCTION:A Health Technology Assessment (HTA) systematic review was undertaken in rheumatoid arthritis (RA) of treat-to-target (TTT) studies (n = 16) in which studies were grouped according to: TTT versus usual care, trials comparing different targets, or trials comparing different treatment protocols. To our knowledge, this was the first RA TTT review where studies were grouped in this way. We wanted to compare if our approach had been adopted in reviews of hypertension, hyperlipidemia or diabetes.METHODS:We searched MEDLINE for systematic reviews (SRs) of TTT studies in hypertension, hyperlipidaemia or diabetes.RESULTS:Eleven SRs were included; eight were in diabetes, and four were in hypertension, while none were in hyperlipidaemia. The diabetes SRs evaluated different insulin regimens (n = 3), non-insulin medications (n = 1), any antidiabetic treatment (n = 2), metformin monotherapy versus combination therapy (n = 1), and tight versus conventional glucose control (n = 1). The metformin review grouped studies by outcome whereas all other diabetes SRs grouped studies by treatment. Two hypertension SRs evaluated the effects of any treatment on two blood pressure targets, whereas one evaluated two different treatment regimen effects on the same blood pressure target. No SR in hypertension or diabetes included a mix of TTT versus usual care, and/or same treatment protocol different targets, and/or different treatment protocols same target study designs.CONCLUSIONS:In RA TTT does not refer to a single concept but a range of different approaches to the treatment of patients and the evidence reflects this. Whilst our approach to grouping RA TTT studies in a review was novel, this made it complex for us to synthesize evidence and draw general conclusions. We did not identify any TTT reviews in hypertension or diabetes including a mix of the TTT approaches we identified in RA. At present, a comparison of the strengths and limitations of our TTT review study grouping with reviews of hypertension, hyperlipidemia or diabetes cannot be made.