bluuebunny/crossref_metadata_2025_split huggingface dataset:
PP172 Recruiting Academic Physicians Without Financial Conflict Of Interest
Authors: Belghiti Jacques , Luzio Stéphanie , Fuks David , Emery Gregory 
Published: January 2018

INTRODUCTION:To minimize the potential impact of conflicts of interest on health recommendations, several health institutions may be reluctant to recruit academic physicians due to their potential close relationship with industry. The present study aimed at evaluating the influence of academic physicians (AP) on the “rate of deport” due to financial support in the national commission of the HAS assessing medical devices.METHODS:After the renewal of this commission in November 2015, introducing patients representatives and more academic physicians, two periods of 12 months immediately before and after that date have been compared regarding the rate of deport during the sessions. Deport were decided by the legal section of our institution one week before each meeting according to a complete analysis of potential financial conflict of interest related to the medical device assessed. Only members without significant financial conflicts were allowed to participate to the discussion and the vote. The assessment of potential conflict of interest of all members followed the same criteria during the two periods.RESULTS:The number of physicians increased in the second period (nineteen versus twenty-three) with a significant higher rate of academic physicians (63 percent versus 82 percent, p = .001). The mean attendance of physicians was significantly lower during the second period (80 percent versus 65 percent, p = .03). During the two periods, the number of meetings (n = 22) was similar and the number of dossiers assessing new products was comparable (96 versus 104, p = .872). The decision to reimburse the medical devices was similar in the two periods (78 percent versus 73 percent, p = .681). The number of cases when physicians’ members were deported for conflict of interest was similar during the two periods (30 versus 28, p = .482) with not any increase among academic physicians.CONCLUSIONS:This study showed that it is possible to recruit several academic physicians without major financial conflicts of interest providing that their status could alter their assiduity.
VP09 Arthroplasty Registers As A Tool For Health Technology Assessment
Authors: Domingo Laia , Martínez Olga , Arias Jorge , Nardi Joan , Puig Lluís , Espallargues Mireia 
Published: January 2018

INTRODUCTION:Our purpose is to present the potential for health technology assessment that arthroplasty registers may offer.METHODS:A revision of the health assessment uses and information collected by arthroplasty registers was made. The information provided from international networks like NORE, ISAR and ICOR was also considered. Arthroplasty registers collect data of patients undergoing joint replacement surgery (mainly hip and knee) along with implant information. They provide longitudinal information useful to assess implant survival (expressed as revision rate and calculated from the primary surgery to implant revision). They also data from the surgical procedure and, more recently, a number of registries incorporate patient reported outcomes (PROMs) information.RESULTS:Arthroplasty registers provide information from multiple perspectives:
(i)Decision-makers and healthcare providers/authorities: the comparison of revision rates by using funnel plots is a useful methodology to benchmark implants and to identify outliers, or models with significantly different revision rate in comparison to their peers. Besides, data available in registers has proven to be useful to define sets of indicators related to safety, effectiveness, efficiency, patient-centered healthcare and perceived health outcomes.(ii)Surgeons: Some ongoing initiatives, like ODEP, aiming at providing a benchmark rating for implant survivorship, are gaining interest by professionals promoting an evidence-based clinical practice.(iii)Industry: the large amount of data recorded so far may allow obtaining robust information of prosthesis behavior.(iv)Patients: there is an increasing number of registers that incorporate PROMs. Moreover, a growing interest to promote patient engagement in arthroplasty decision making has been observed.CONCLUSIONS:Long-standing arthroplasty registries have untapped potential. Beyond the assessment of implant survival, they have been consolidated as a useful tool for decision-makers, professionals, and patients. Next steps will be to promote joint analysis of national/regional registries to explore uncommon practices or new medical devices, and also to adapt to future regulations on implant traceability.
VP36 Cost-Effectiveness Of Non-Invasive Prenatal Testing For Down Syndrome
Authors: Orruño Estibalitz , Bayón Juan Carlos , Portillo Isabel , Asua José 
Published: January 2018

INTRODUCTION:The analysis of cell-free fetal DNA in maternal blood, also called Non-Invasive Prenatal Testing (NIPT), represents an emerging technology and a possible alternative/complement to current prenatal screening based on biochemical and sonographic markers for Down Syndrome (DS) detection.The aim of the study was to compare the application of NIPT with the prenatal diagnosis/screening procedures currently applied in the Basque Country.METHODS:An analytical decision model was developed to assess the costs and consequences, comparing current prenatal screening, NIPT as a contingency test in high-risk cases and NIPT as a first-line screening test. An economic analysis was conducted to determine which strategy was more cost-effective. Sensitivity analyses were performed (1).RESULTS:For a population of 97,074 pregnant women in gestational week 14 and a cut-off point of 1:270, NIPT as a contingent test was not cost-effective, detecting two cases less of DS and causing a lower number of miscarriages related to invasive-testing (4 versus 23) at a slightly lower cost (EUR8,111,351 versus EUR8,901,872).For risk cut-off points of 1:500 or 1:1000 for contingent NIPT, the number of DS cases detected increased, as did the cost. It could be cost-effective compared with current prenatal screening, (EUR61,763 or EUR256,123 per extra DS case detected, respectively).Using the NIPT as a primary test detected more DS cases (296 versus 271) and caused less miscarriages (5 versus 23), at a substantially higher cost (EUR41,395,645 versus EUR8,901,872). Cost-effectiveness analysis indicated that it was more expensive and more effective.Univariant sensitivity-analysis showed that when the price of the NIPT as primary test was EUR76, it was dominant compared with current prenatal screening. It was also cost-effective compared with the NIPT as a contingent test (EUR9,869 per extra DS case detected).CONCLUSIONS:The study shows that NIPT had higher detection rates for DS in different scenarios, but the cost constitutes a limiting factor for implementation in the Basque Health System.
VP64 Post-Graduation Selection Using Multi-Criteria Decision Analysis
Authors: Santos Marisa , Senna Kátia , Magliano Carlos , Baldissara Jessica 
Published: January 2018

INTRODUCTION:Selecting candidates for graduate programs is considered to be a complex task, often subject to failures, especially regarding to the appraisal of non-cognitive (1,2) skills (for example, Motivation). Identifying suitable candidates is important for the overall success of the graduate programs, since dropouts and low productivity negatively affect the program classification by the Brazilian Governmental Agency.This study aims to describe the use of Multicriteria Decision Analysis (3) in the selection of candidates for a master degree program in Health Technology Assessment (HTA).METHODS:The Multicriteria Decision Analysis (MCDA) technique was used to measure value in the selection of students applying for a masters degree program, in 2017, using Multi-Attribute Value Theory methods (MAVT) method. The examiners group consisting of full-time professors who selected the criteria, blinded ranked and assigned weight relative to each criterion, using swing weights technique, normalized to 100 percent. During the face to face interview with the students, each evaluator professor filled an individual spreadsheet based on pre-defined questions and curriculum analysis. The results were summarized with a mean. For criterion performance, a value from 0 until 3 was assigned if the candidate didn't meet the criterion, partially meet and fully meet. The performance scores were multiplied by the weight of each criterion, the results were summarized by simple additive model, and the candidates were ranked.RESULTS:An interview was conducted with the examining group evaluating MCDA asking for difficulties, time consumed and if the result was considered fair. Seven criteria were listed: “Comprehension of HTA”, “Motivation”, “Ability to disseminate information”, “Availability to attend the course”, “Scientific production”, “Potential to work in HTA area” and “Scientific writing skills”.The highest weight (24 percent) was attributed to the “Potential to work in HTA area” and “Scientific writing skills” (20 percent). The evaluating group was unanimous in considering the process easy, fast and fair.CONCLUSIONS:The MCDA technique was applied successfully in student selection. Further prospective studies are needed.
VP100 Disease Modelling Approaches In Multiple Sclerosis
Authors: Cortesi Paolo , Uzman Nilhan , Ferrario Matteo , Mantovani Lorenzo Giovanni 
Published: January 2018

INTRODUCTION:In the past decades the cost-effectiveness of new effective disease-modifying therapies (DMTs) for Relapsing Remitting Multiple Sclerosis (RRMS) form was assessed through decision analytical models. Recently, new treatment option for the Primary Progressive (PPMS) form was developed. Aim of this work was assessing the similarities and differences of PPMS and RRMS and their impact in the development of decision analytical model for PPMS.METHODS:Literature review was performed to retrieve information on natural history of PPMS and RRMS and impact of DMTs agents on the progression of these conditions. Further, a review of the published cost-effectiveness models for RRMS was performed. Based on these data, an analysis on the difference and similarities between the two MS forms that could have an impact on the development of decision analytical model for PPMS was performed.RESULTS:Based on the analysis, similar structure model used for RRMS could be applied for PPMS. Health states of the model could be based on Expanded Disability Status Scale score as already done for RRMS. The relapse events considered for RRMS should not be included in PPMS model, and no possibility to develop another form, as the Secondary Progressive, should be included. While RRMS models should include at least a second line treatment option due to alternative DMTs available, only first treatment line should be considered for PPMS. Assessing data available to populate the model, poor data on the natural history, utility and cost associated to PPMS were available and assumption or expert opinions will be needed to overcome the lack of robust data.CONCLUSIONS:A decision analytical model for PPMS can use a similar structure used in the models for RRMS. However, more robust data on PPMS and some structural change are needed to provide a good tool to assess cost-effectiveness of DMTS in PPMS.
VP103 Health Technology Assessment Of Genetic Tests For Cystic Fibrosis Carrier Screening In Italy
Authors: Vukovic Vladimir , Agodi Antonella , Assael Baroukh , Calabro' Giovanna Elisa , Campanella Paolo , Castellani Carlo , Coviello Domenico , Di Pietro Maria Luisa , Favaretti Carlo , Gurrieri Fiorella , Ripabelli Giancarlo , Sbrogio' Luca , Teleman Adele Anna , Boccia Stefania 
Published: January 2018

INTRODUCTION:Cystic Fibrosis (CF) is a genetic disorder caused by mutations in CFTR gene. In Italy, reported prevalence is approximately .70 per 10,000 inhabitants (1). The practice and recommendations for Cystic Fibrosis carrier screening are very heterogeneous in Europe. A proposal of a carrier genetic test in the general population raises many questions. Health Technology Assessment (HTA) could offer a sound methodological basis for this evaluation. The aim of this work was to summarize the available evidence, using the HTA approach, on the genetic tests for Cystic Fibrosis carrier screening.METHODS:A systematic literature search was used to find the best available international and national evidence on genetics test for CF carrier screening. In this report, we specifically addressed the health problem of disease, description and technical characteristics of tests – its analytic and clinical validity, and clinical utility. Economic evaluation of different scenarios was synthesized from the literature. Ethical, organizational, and social aspects of CF and genetic screening were also considered.RESULTS:Several screening strategies have been evaluated in the literature and screening options can be characterized by different timing, model and place of screening (2). The reported cost of a screening test ranged from EUR25 to EUR212 (3). Estimated life time cost of care for CF patients ranged from EUR291,048 to EUR1,105,452. Ethical analysis emphasized that the use of these tests is an advantage in terms of the acquisition of knowledge and of responsible management of choices, but at the same time raises many ethical questions. Social considerations reported among patients and their families an overall positive attitude toward population CF carrier screening.CONCLUSIONS:The advances in the molecular genetics technology have made CF carrier testing reliable and affordable. The multidisciplinary approach of this HTA provided an evidence-based evaluation of genetic tests and offers a firm scientific background for the decision-makers to consider the implementation of a screening for Cystic Fibrosis carriers into the Italian health care system.
VP116 Comparison Between Time To Off Treatment And Italian Medicines Agency Registries Treatment Duration
Authors: Vittoria Gabriele , Fascì Antonio , Ferrario Matteo , Giuliani Giovanni 
Published: January 2018

INTRODUCTION:The Italian Medicines Agency Registry represents a tool that could be a precious source of information regarding the mean treatment duration of a drug in a real world context. Monitoring registries are applied at the national level after market authorization and are designed not only to apply the Managed Entry Agreements (MEAs) but also to collect Real World Data on drugs safety, effectiveness and real life utilization. The purpose of this analysis was to compare the treatment duration from clinical trials and the mean treatment duration calculated using data from monitoring registries (1).METHODS:For each drug included in the analysis it was collected the treatment duration from Time To Off Treatment curves for the experimental drug (eTTOT) from Phase III clinical trials and the mean treatment duration data calculated by using the number of cycles (converted in months of treatment) of all treated patients extracted from AIFA registries (TTAR). The mean ratios between the Time of Treatment of Italian Medicines Agency and Experimental arm time to off treatment were calculated to identify potential correlations. High level of correlation was expected if Time to Payment By Result /Time To Off Treatment ratio was close to 1 (±.2).RESULTS:Six Roche products or different indications of the same product were identified as candidates for the analysis from 2013 to 2016. The mean TTAR/eTTOT ratio observed in patients treated from 2013 to 2016 was .97 (±.10), meaning that the mean treatment duration calculated from AIFA Registries is strongly comparable with the treatment duration observed in clinical trials. In one case the TTAR is even more major than eTTOT.CONCLUSIONS:A high level of correlation between TTAR and eTTOT was found. Additional analyses considering different cohorts of patients over time could be useful to have a more precise estimate of real world drug utilization. Even though RCTs remain the gold standard for demonstrating clinical efficacy in restricted trial setting, Real World Evidence from AIFA registries can contribute to the evidence base needed for healthcare decisions.
VP131 Comparison Of Variation Methods For One-Way Sensitivity Analyses
Authors: McQueen Robert , Campbell Jonathan 
Published: January 2018

INTRODUCTION:A common approach to one-way sensitivity analysis is to vary inputs by a constant percentage. An alternative is to derive ranges using evidence-based probability distributions from published sources. Our objective was to compare one-way sensitivity analysis results when using these two approaches for a reference case model, along with two additional case studies.METHODS:For the reference case, we replicated a published Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) cost-effectiveness Markov model (zidovudine versus zidovudine plus lamivudine in the UK) using TreeAge®. Health states included three HIV/AIDS states and death. We generated one-way sensitivity analyses by varying inputs in two ways: (i) using ±15 percent for all inputs, and (ii) using the 2.5 and 97.5 percentile values of the evidence-based probability distributions for all inputs. Our outcome was the mean difference between lower and upper incremental cost-effectiveness ratios (ICERs) for each variation method for the ten most influential inputs. We assessed the number of inputs with a mean difference between lower and upper ICERs of >10 percent of the deterministic ICER.RESULTS:The deterministic ICER was GBP7,654/QALY (quality adjusted life year) for combination therapy versus monotherapy. The mean difference in ICER uncertainty for the evidence-based vs. ±15 percent variation method was GBP3,251/QALY (p = .0096). Six inputs had a mean difference in ICER uncertainty of >10 percent of GBP7,654/QALY (that is, mean difference in ICER uncertainty > GBP765) for the evidence-based variation method, compared to only two inputs for the constant percentage variation method.CONCLUSIONS:For the reference case, the magnitude of uncertainty in the outcome was larger for the evidence-based variation method compared to the constant percentage variation method. Evidence-based uncertainty in inputs should be used in all sensitivity analyses to reflect realistic uncertainty in an outcome and aid decision-making about future research strategies. Additional case studies will be presented using validated models in diabetes and asthma.
VP166 Selecting Rapid Review Methods For Health Technology Assessment
Authors: Kaltenthaler Eva , Cooper Katy , Martyn-St James Marrissa , Pandor Abdullah , Wong Ruth 
Published: January 2018

INTRODUCTION:Rapid reviews are of increasing importance within Health Technology Assessment (HTA) due to the need for timely evidence to underpin the assessment of new technologies as well as financial constraints. There are many rapid review methods available (1) although there is little guidance as to the most suitable methods (2). A recent paper outlines issues to consider when selecting rapid review methods (3). The aim of this presentation is to present key aspects to consider when selecting rapid review methods.METHODS:We searched the evidence base for guidance on the selection of rapid review methods. We also examined three recently completed systematic reviews to identify rapid review methods used, the reasons for selection and the strengths and weaknesses of each method. Finally we identified key aspects to consider when selecting rapid review methods.RESULTS:The evidence on guidance identified for the selection of rapid review methods was very limited. The analysis of the three reviews found that each review had distinctly different challenges, such as large numbers of relevant trials and heterogeneity in terms of populations, interventions, comparators and outcomes. All reviews included at least ten randomized controlled trials and numerous outcome measures. Three different approaches to the rapid review of the evidence were used in the three reviews. Key themes to consider when selecting rapid review methods were identified. These include: the size and nature of the evidence base, the characteristics of included studies and the expectations of those commissioning the review.CONCLUSIONS:Rapid review methods need to be chosen to fit the needs of the review, each of which may have different challenges. Collaboration between those producing rapid reviews and commissioners is crucial when choosing methods to ensure that the needs of commissioners are met and limitations associated with the chosen methods are understood.
VP177 Older People With Cancer: To Treat Or Not To Treat With Chemotherapy?
Authors: Boland Angela , Pilkington Gerlinde , Greenhalgh Janette , Dickson Rumona 
Published: January 2018

INTRODUCTION:Older people with cancer are less likely to receive radical treatment for cancer. We conducted a series of systematic reviews to explore the effectiveness and tolerability of systemic anti-cancer therapy for older people with cancer. The reviews were conducted on behalf of the National Cancer Equality Initiative to establish an understanding of the current body of research and to enable the development of more personalized treatment protocols for elderly patients that take into account fitness and personal choice.METHODS:We conducted six systematic reviews that considered the effectiveness and tolerability of treatment for older people with cancer (breast, colorectal, lung, renal cell, chronic myeloid leukaemia and non-Hodgkin's lymphoma). Four electronic databases were searched from 2010 to 2013. Data were extracted on a range of outcomes from published studies (randomised controlled trials, subgroup analyses, pooled analyses, cohort studies and retrospective studies).RESULTS:We found a large quantity of published research from a wide range of study types. We included a total of 490 studies (64 randomized controlled trials, 30 subgroup analyses, 24 pooled analyses, 255 cohort studies, and 117 retrospective studies).Most of the randomized controlled trials enrolled fitter and healthier patients than those seen in routine clinical practice. The evidence indicates that older patients with good performance status can, and do, respond well to chemotherapy, frequently achieving similar survival benefit to younger patients.We found no consistent definitions of ‘old’ or ‘elderly’ and these varied from 50 years to 85 years across studies.The study results demonstrate that comprehensive geriatric assessment has not been routinely conducted in clinical cancer studies and that readily available assessment tools were not used by study investigators.CONCLUSIONS:Age should not be a barrier to treatment for the older population. Research is needed to determine which treatment regimens offer the appropriate balance of clinical effect and likelihood of adverse events within older populations. Future randomized controlled trials could be designed to include either higher proportions of older people, or only older people.
The Best Breakfast in Town: A Comprehensive Research Methods Project
Authors: Rosen Amanda M. 
Published: January 2018

ABSTRACT
When instructors are first tasked with teaching the research methods course for their department, a common reaction is frustration and panic. Although all political scientists are trained in research methods, few besides methodologists view it as their primary or strongest area of expertise, and they are aware that the course rarely returns high teaching evaluations (Fletcher and Painter-Main 2014). Likewise, students approach their required research methods course with extreme anxiety, viewing it as the math class they were trying to avoid by majoring in political science (Bernstein and Allen 2013; Coleman and Conrad 2007). With instructors unhappily teaching the class and students dreading taking it, there is a “perfect storm” of attitudes and beliefs that is hardly likely to lead to a productive learning environment. The challenge driving this article is how to teach research methods in a rigorous, engaging way that promotes student learning without tanking scores on teaching evaluations.