bluuebunny/crossref_metadata_2025_split huggingface dataset:
VP60 The Importance Of Patient Organizations Involvement In Health Technology Assessment
Authors: Apostolidis Kathi , Makaroff Lydia , De Lorenzo Francesco , Florindi Francesco 
Published: January 2018

INTRODUCTION:In Europe, the work done by the European Commission and the European Network for Health Technology Assessment (EUnetHTA) has consolidated the role of Health Technology Assessment (HTA), and promises to better harmonize its impact across European Union (EU) countries. However, more work is needed to improve patient involvement in assessing new health technology, and in developing research priorities.METHODS:The European Cancer Patient Coalition (ECPC) developed a model for engagement of patients in HTA based on the experience from:
•ECPC's ‘Value of Innovation in Oncology’ White Paper, which includes input from ECPC's membership•ECPC's leading role in the Patient Preferences in Benefit-Risk Assessments during the Drug Life Cycle (PREFER) study, funded by the Innovative Medicines Initiative, to develop guidelines on how patient-preference studies should be performed throughout the development of new medical treatments.RESULTS:The ECPC ‘Value of Innovation in Oncology’ White Paper was launched in 2017. The paper provides ECPC's policy position on key obstacles to equitable access to meaningful innovation. The paper recommends the establishment of an EU-wide HTA body to reduce delays and variations in access and to avoid duplication of effort by individual Member States. The paper also recommends that patients should be formally and routinely included in HTA policy and operations at EU and at national levels. These recommendations were also submitted to the European Commission's public consultation on strengthening EU cooperation on HTA.Through its work in PREFER, ECPC is helping to improve how patient preferences are measured and valued to capture the impact of health technology on patients daily life. Patient preferences are concerned with measuring how patients value components such as treatment end points, route of administration, treatment duration, treatment frequency, frequency of side-effects, price, and quality of life.CONCLUSIONS:Patient organization involvement in HTA is vital. Patient organizations offer unique insights, experiences, identify unmet needs, and can help to produce practical recommendations
VP95 The Monetary Value Of A Statistical Life Year: A Systematic Review
Authors: Schlander Michael , Schwarz Oliver , Schaefer Ramon 
Published: January 2018

INTRODUCTION:Among economists, there is widespread agreement that the monetary valuation of health gains should reflect the preferences of those who will be affected by resource allocation decisions. In the context of Health Technology Assessments (HTAs), this view implies a need for reliable empirical estimates of the value of statistical life year (VSLY), which should provide a useful point of reference for cost benefit analyses.METHODS:We conducted a systematic review of the literature on the economic value of a statistical life (VSL). We searched in the EconBiz and EconLit databases for studies, which reported VSL estimates based on original research and were published between 1995 and 2015. We classified studies by methodology, that is, revealed preference (RP) or stated preference (SP; that is, CV, contingent valuation, or DCE (discrete choice experiment) approach, and by regional origin of data. We transformed VSL estimates into VSLY expressed in year 2014 Euros, using life expectancy tables for the populations studied, a real discount rate of 3 percent, national Consumer Price Indices for inflating, and purchasing power parities for currency conversion. In addition, we calculated ratios of VSLY to gross domestic product (GDP) per capita.RESULTS:Our search yielded 120 studies appropriate for inclusion. From these, we extracted a total of 132 VSL estimates (RP, n = 60; SP, n = 72). The median VSLY was 6.4 times GDP/capita. Transformed into Euro (2014), the median VSLY was EUR165,000 (mean, EUR217,000). We found significant differences by regional source of data (North American, median EUR272,000; European, EUR158,000) and by method (RP, EUR241,000; SP: CV, EUR117,000; DCE, EUR187,000). VSLY estimates were sensitive to discount rate.CONCLUSIONS:Our data indicate that VSLY estimates based on empirical data exceed benchmarks commonly used in the context of HTAs. However, inter-study variability, methodological limitations, and normative considerations, all suggest to exercise caution before translating this observation into actual policy.
VP99 Economic Impact Of rpFVIII In The Management Of Acquired Hemophilia A
Authors: Lorenzoni Valentina , Triulzi Isotta , Turchetti Giuseppe 
Published: January 2018

INTRODUCTION:Acquired hemophilia A (AHA) is a rare coagulation disease characterized by frequent bleeding episodes treated with plasma-derived products and bypassing agents as rFVIIa and aPCC. Similar to the previous plasma-derived porcine FVIII and without its side effects, pFVIII (Obizur®) is a porcine recombinant factor VIII produced with the recombinant DNA technique. The study analyzes the economic impact of pFVIII compared to the other available therapies in order to manage the bleeding episodes in AHA patients.METHODS:To assess the impact of the introduction of pFVIII in the market-mix of products for the management of AHA a budget impact analysis was conducted from the perspective of the Italian National Health System (INHS) and considering a three-year time horizon. Consumption of products, products’ wastage, needs for additional treatment in case of failure of first line therapy, laboratory tests, hospitalization and drug wastage were considered for cost estimation. Model inputs were derived from literature, preliminary experience with the use of pFVIII for compassionate use, and from the updating of previous evidence by data collected among a panel of clinical experts. Univariate sensitivity analysis was performed to explore overall uncertainties in input parameters.RESULTS:The management of a bleeding episode considering conventional treatment is EUR8,229,621 per year, with an overall cost over three years equal to EUR24,688,864. The introduction of pFVIII leads to an overall costs saving ranging from EUR2,253,938 and EUR1,196,985 when the treatment duration is varied between 5 and 6.5 days, according to data from compassionate use or literature, respectively.CONCLUSIONS:The model outlined a significant reduction of all the components of direct costs for the INHS when Obizur® is introduced into the market with an ex-factory unit price equal to EUR2.32/IU.
VP129 Social Cost Benefit Analysis (SCBA) Of Three Alcohol Policy Measures
Authors: de Wit Ardine , van Gils Paul , Over Eelco , Lokkerbol Joran , Smit Filip , Mosca Ilaria , Spit Wim , de Kinderen Reina , Evers Silvia 
Published: January 2018

INTRODUCTION:Alcohol abuse and addiction lead to a high disease burden for the persons concerned. Moreover, it has economic consequences for society, including costs of health care, costs due to reduced productivity, criminal activities, traffic accidents, and violence, both in private and public domains. The aim of this study was to perform a social cost-benefit analysis (SCBA) of three policy measures (tax increase, reducing number of sales venues, and advertising ban) over a period of 50 years, along with the distribution of costs and benefits among stakeholders (1).METHODS:The analysis follows Dutch guidelines for performing SCBAs. Costs and benefits in eight different domains were comprehensively identified. Model simulations were used to estimate future social costs and benefits of three policy measures, compared to not intervening.RESULTS:Over a period of 50 years, the greatest social benefits were expected from a tax increase. The cumulative discounted net monetary benefit over a period of 50 years is EUR12 billion (95 percent Confidence Interval, CI EUR11-EUR13billion) in the 50 percent tax increase scenario. The net benefits of the other two measures are smaller. The cumulative discounted value to society of a 10 percent decrease in outlet density over a 50-year period amounts to EUR4 billion (range: EUR3 - EUR5 billion). A total media ban with an estimated reduction of 4 percent in alcohol consumption leads to an expected cumulative discounted value to society over a 50-year period of EUR7 billion.CONCLUSIONS:All policy scenarios lead more or less to positive effects for society. The greatest benefits are associated with measures aimed at raising the excise tax on alcohol. Estimations as made in this study may serve to inform alcohol policy in the Netherlands.
VP142 Assessing Human Enhancements: Exposing And Elucidating Ethical Issues
Authors: Hofmann Bjørn 
Published: January 2018

INTRODUCTION:Human enhancement technologies need assessments, but they differ from other health technologies. Therefore we may need other methods for their assessment, also with regard to addressing its ethical issues. The objective of this paper is to describe the elaboration of a method for exposing and elucidating ethical issues with human cognitive enhancement. The approach is elaborated in order to support and facilitate open and transparent deliberation and decision making with an emerging type of technology with great potential and formative implications for individuals and society.METHODS:The literature search identified relevant approaches. Conventional content analysis of the identified papers and methods revealed their suitability for assessing human cognitive enhancement. Four selection criteria were applied and followed by method development. Pilot testing on smart-glasses (1) resulted in amendments.RESULTS:A method for exposing and elucidating ethical issues in the assessment of human cognitive enhancement technologies was developed based on three existing approaches in Health Technology Assessment (HTA) (2). The method consists of six steps and a guiding list of forty-three questions. An overview of the approach will be presented.CONCLUSIONS:A method for exposing and elucidating ethical issues in the assessment of human cognitive enhancement has been developed. The method paves the way for context specific ethical assessment and analysis of a new and emerging type of technology.
VP147 Implementing Electronic Health Record In A Children's Hospital
Authors: Andellini Martina , Faggiano Francesco , Sabusco Francesca , Derrico Pietro , Ritrovato Matteo 
Published: January 2018

INTRODUCTION:Since the adoption of electronic health record (EHR) systems, which contain large volumes of aggregated longitudinal clinical data, promises a number of substantial benefits including better care, improved safety issues and decreased healthcare costs (1). It is also associated with significant costs and large technical and organizational impacts, therefore it is important to conduct comprehensive evaluations of healthcare delivery outcomes. The purpose of the study is to gather evidence on safety and overall effectiveness of EHR implementation in Bambino Gesù Children's Hospital (OPBG).METHODS:Decision-oriented HTA (DoHTA) method (2) was applied to assess the technology on clinical, technical, organizational, economic, legal, ethical and safety domains. It's a new implementation of the European Network for Health Technology Assessment (EUnetHTA) CoreModel integrated with the Analytic Hierarchy Process. It allows defining an evaluation structure represented by a hierarchical decision tree filled by indicators of technology's performances, each of which was given a weight proportional to the impact that this criterion provides to achieve the purpose of the decision problem; finally, the alternatives’ ranking was defined.RESULTS:The multidisciplinary assessment took into consideration all of the aspects and recommendations about the benefits and disadvantages of EHR (3). The synthesis of scientific evidence integrated with results of the specific context analysis, resulted in the definition of components of the decisional hierarchy structure. In particular, EHR seems to offer many benefits in terms of safety and clinical effectiveness such as improved continuity and quality of care, and increased accessibility of the data. The implementation of EHR resulted in important organizational outcome such as EHR configuration, learning curve and training. For these reasons, the usability was the main technical characteristics of the technology taken into account. Finally, legal aspects on privacy and security of data, covered a key role in the assessment.CONCLUSIONS:A thorough evaluation of the EHR before its implementation has permitted hospital's decision makers to choose knowingly.
VP151 Endovenous Iron Deficiency Anemia Treatment In Inflammatory Bowel Disease: Hospital-based Health Technology Assessment
Authors: Stojanovic Jovana , Kheiraoui Flavia , Proli Enrica Maria , Scaldaferri Franco , Volpe Massimo , Di Pietro Maria Luisa , Zace Drieda , Gasbarrini Antonio , Fabrizio Laura , Boccia Stefania , Favaretti Carlo , Poscia Andrea 
Published: January 2018

INTRODUCTION:Iron Deficiency Anemia (IDA), a common cause of anemia in the world, is a frequently neglected disease that represents the main extraintestinal manifestation affecting patients with inflammatory bowel disease (IBD) (1). The release of new intravenous (IV) iron compounds represents a great opportunity for both physicians and patients, but the higher costs might hold back their optimal diffusion. A Health Technology Assessment (HTA) approach was used to provide insights on the sustainability of the IV iron formulations in a hospital setting, with a special focus on ferric carboxymaltose.METHODS:Epidemiology of IBD, as well as IDA associated with these conditions, was assessed with a systematic appraisal of the published literature. Data on efficacy and safety of IV iron formulations currently used in Italy were retrieved from the available medical electronic databases. A hospital based cost-analysis of the outpatient delivery of IV iron treatments was performed. Organizational and ethical implications were discussed.RESULTS:The reported prevalence of anemia in patients with IBD varies markedly from 10 to 73 percent for Crohn's Disease and from 9 to 67 percent for Ulcerative Colitis. Although there are no studies on direct comparison of different IV iron preparations, the literature indicates good efficacy and safety profiles of these formulations. However, ferric carboxymaltose seemed to provide a better and faster correction of hemoglobin and serum ferritin levels in iron-deficient patients (2,3). Our analyses indicated that ferric carboxymaltose, in spite of a greater price, would have positive benefits for the hospital, in terms of reduced costs related to individual patient management, and for the patients themselves, by reducing the number of infusions and accesses to health facilities.CONCLUSIONS:This hospital-based HTA reports an overall positive organizational, economic and ethical evaluation for the sustainable introduction of ferric carboxymaltose in the Italian outpatient setting.
VP165 Landscape Assessment: Patient Engagement In Health Technology Assessment
Authors: Oehrlein Elisabeth , Harris Jason , Labkoff Nicole , Perfetto Eleanor , Ziadeh Manal , El-Gendi Sarah , Ghorashi Bahareh , Boutin Marc 
Published: January 2018

INTRODUCTION:Understanding the current landscape of patient engagement across value decision-making bodies internationally is a critical first step toward improving the patient centricity of Health Technology Assessment (HTA). This study assessed: (i) Terms and definitions used; (ii) Patient engagement opportunities; (iii) Evidence of patient engagement.METHODS:A sample of country-specific HTA's (HTA; n = 6), professional organizations (PO; n = 4), and collaborations/independent organizations (CO; n = 3) was selected for representativeness. Information was gathered through: (i) targeted web search and (ii) emailing organizations directly. Definitions, HTA methods documents, and the three most recent evaluations were identified, abstracted, and compared. Data were collected between September-October 2016.RESULTS:Numerous terms are used to describe patient engagement: patient input (HTA = 1, PO = 1), patient-group submitted information (HTA = 1), cooperation with patients/users (HTA = 1), public consultation (HTA = 1), patient perspectives (HTA = 1, PO = 1), involvement of people affected (HTA = 1), patient involvement (HTA = 2), patient and public involvement (HTA = 1), lay involvement (HTA = 1), inclusion of patient representative (PO = 3), patient reports (PO = 1), patient preference (PO = 2), public consultation (CO = 1), stakeholder consultation (CO = 1), open input (CO = 1), stakeholder engagement (CO = 1), and patient participation (CO = 1). Opportunities for patient engagement were described as: patient questionnaire (HTA = 2); comment period (HTA = 1; CO = 1); committee participation (HTA = 3; PO = 3); propose topics (HTA = 1); draft guidance (HTA = 1); general stakeholder forum (CO = 1). While organizations outline opportunities for patient engagement, not all organizations have clear evidence the practices are used or have impact. Recent evaluations demonstrate clear evidence of engagement (HTA = 2); Unclear or mixed evidence (HTA = 1; PO = 1; CO = 2); No evidence (HTA = 3; PO = 3; CO = 1).CONCLUSIONS:There is substantial heterogeneity in the terms used to describe patient engagement activities across organizations. While a variety of opportunities for patient engagement are described, lack of clear evidence to how patient engagement practices are consistently used may contribute to the perception that engagement by HTAs.
VP172 Clinical Effectiveness Of A Predictive Risk Model In Primary Care
Authors: Snooks Helen , Porter Alison , Kingston Mark , Watkins Alan , Hutchings Hayley , Whitman Shirley , Davies Jan , Evans Bridie , Bailey-Jones Kerry , Burge-Jones Deborah , Dale Jeremy , Fitzsimmons Deborah , Heaven Martin , Howson Helen , John Gareth , Lewis Leo , Philips Ceri , Sewell Bernadette , Williams Victoria , Russell Ian 
Published: January 2018

INTRODUCTION:New approaches are needed to safely reduce emergency admissions to hospital by targeting interventions effectively in primary care. A predictive risk stratification tool (PRISM) identifies each registered patient's risk of an emergency admission in the following year, allowing practitioners to identify and manage those at higher risk. We evaluated the introduction of PRISM in primary care in one area of the United Kingdom, assessing its impact on emergency admissions and other service use.METHODS:We conducted a randomized stepped wedge trial with cluster-defined control and intervention phases, and participant-level anonymized linked outcomes. PRISM was implemented in eleven primary care practice clusters (total thirty-two practices) over a year from March 2013. We analyzed routine linked data outcomes for 18 months.RESULTS:We included outcomes for 230,099 registered patients, assigned to ranked risk groups.Overall, the rate of emergency admissions was higher in the intervention phase than in the control phase: adjusted difference in number of emergency admissions per participant per year at risk, delta = .011 (95 percent Confidence Interval, CI .010, .013). Patients in the intervention phase spent more days in hospital per year: adjusted delta = .029 (95 percent CI .026, .031). Both effects were consistent across risk groups.Primary care activity increased in the intervention phase overall delta = .011 (95 percent CI .007, .014), except for the two highest risk groups which showed a decrease in the number of days with recorded activity.CONCLUSIONS:Introduction of a predictive risk model in primary care was associated with increased emergency episodes across the general practice population and at each risk level, in contrast to the intended purpose of the model. Future evaluation work could assess the impact of targeting of different services to patients across different levels of risk, rather than the current policy focus on those at highest risk.
VP173 Determinants Of Behavioral Health System Efficiency In Organisation For Economic Co-operation And Development (OECD) Countries
Authors: Cinaroglu Songul , Baser Onur 
Published: January 2018

INTRODUCTION:This study examined the technical efficiency determinants of each Organisation for Economic Co-operation and Development (OECD) country's behavioral health system (BHS).METHODS:The technical efficiency of each OECD country's BHS was analyzed through data envelopment analysis with model combinations ranging from 1–11 models, with each model constructed with different BHS input and output variable combinations. A decision tree was generated from the efficiency scores of the model with the highest mean technical efficiency score as a predictor variable. Data was obtained from 2013 OECD and Eurostat statistics.RESULTS:Different model combinations indicated that the model with the highest mean technical efficiency score (.9214) for OECD countries included (i) input variables for smoking, alcohol consumption, daily fruit consumption, the number of psychiatrists, the percentage of live births of young mothers first children, and the time devoted to leisure and personal care and (ii) output variables for death rate by mental and behavioral disorders, diabetes hospital admissions in adults, and suicide rates. Among all model combinations, >45 percent of OECD countries have an efficient BHS. The decision tree graph shows that daily fruit consumption, smoking, and suicide rates are predictor variables of the technical efficiency of an OECD country's BHS.CONCLUSIONS:The study results offer important insights regarding the development of BHS in OECD countries. Health policymakers must develop collaborative activities and implement comprehensive policies promoting internationally-oriented BHS in order to improve the health status of people worldwide and reduce health inequality.
VP184 A Cost Analysis Of Flash Glucose Monitoring Systems In Veneto Region
Authors: Curto Alessandro , Torbol Marika , Cavazzana Anna , Andretta Margherita , Scroccaro Giovanna 
Published: January 2018

INTRODUCTION:A novel, sensor-based, factory-calibrated Flash Monitoring System (FMS) has recently proved to be an effective alternative to conventional self-monitoring of blood glucose (SMBG) in patients affected by type 1 and type 2 diabetes. The 14-days adhesive sensor, that continuously measures glucose levels in the interstitial fluid, can transfer glucose levels data to a handheld reader or a smartphone equipped with a specific medical app. The uptake of the new technology has been limited so far, because of its high costs. A cost analysis has been conducted to identify the optimal target population of introducing FSM in Veneto.METHODS:The model was designed with a 1-year time horizon for patients with diabetes using intensive insulin in Veneto region. The costs of the new technology was estimated using inputs from the two main randomized controlled trials (the IMPACT study and the REPLACE study) published in the international literature, Regional evidence-based guidelines and administrative database. Resource utilization included strips, lancets, needles, sensors, distribution and patients training. Regional unit costs were adopted.RESULTS:FSM has not shown so far relevant and statically significant benefits in terms of severe adverse events’ reduction. Estimated yearly costs for a FSM user included glucose monitoring, technology training and distribution costs, for a total of EUR1277 per patient. The new technology has been shown to be affordable in diabetic patients with i) 4years<age<18years, ii) continuous subcutaneous insulin infusion and iii) ≥5 blood glucose monitoring per day.CONCLUSIONS:The Veneto Region should carefully consider prescribing extension to other diabetic patients categories, since the high cost of the new technology. A strict prescribing monitoring is strongly recommended with the aim of ensuring appropriateness and avoiding overspending.