bluuebunny/crossref_metadata_2025_split huggingface dataset:
Economic evaluation of hemodialysis: Implications for technology assessment in Greece
Authors: Kaitelidou Daphne , Ziroyanis Panagiotis N. , Maniadakis Nikolaos , Liaropoulos Lycurgus L. 
Published: April 2008

Objectives:Hemodialysis is a well-established treatment for 74 percent of end-stage renal disease (ESRD) patients in Greece. The purpose of this study is to provide an estimate of the direct cost of dialysis in a public hospital setting and an estimate of the loss of production for ESRD patients. The results will be useful for public health facility planning purposes.Methods:A socioeconomic prevalence-based analysis was performed using micro-economic evaluation of health-care resources consumed to provide hemodialysis for ESRD patients in 2000. Lost productivity costs due to illness were estimated for the patient and family using the human capital approach and the friction method. Indirect morbidity costs due to absence from work and long-term were estimated, as well as mortality costs. Mean gross income was used for both patient and family.Results:Total health-sector cost for hemodialysis in Greece exceeds €171 million, or €182 per session and €229 per inpatient day. There were 2,046 years lost due to mortality, and the potential productivity cost was estimated at €9.9 million, according to the human capital approach, and €303.000, according to the friction method. Total morbidity cost due to absence from work and early retirement was estimated at more than €273 million, according to the human capital approach, and €12.5, according to the friction method.Conclusions:Providing hemodialysis care for 0.05 percent of the population suffering from ESRD absorbs approximately 2 percent of total health expenditure in Greece. In addition to the cost for the National Health System, production loss due to mortality and morbidity from the disease are also considerable. Promoting alternative technologies such as organ transplantation and home dialysis as well as improving hemodialysis efficiency through satellite units are strategies that may prove more cost-effective and psychologically advantageous for the patients.
Determinants of the diffusion of computed tomography and magnetic resonance imaging
Authors: Oh Eun-Hwan , Imanaka Yuichi , Evans Edward 
Published: April 2008

Objectives:The aim of this study is to explain factors influential to the diffusion of computed tomography (CTs) and magnetic resonance imaging (MRIs).Methods:Variables were identified from a review of the literature on the diffusion of health technologies. A formal process was applied to build a conceptual model of the mechanism that drives technology diffusion. Variables for the analysis were classified as predisposing, enabling, or reinforcing factors, in keeping with a model commonly used to explain the diffusion of health behaviors. Multiple regression analysis was conducted using year 2000 OECD data.Results:The results of this study showed that total health expenditure per capita (p< .01, both CTs and MRIs) and flexible payment methods to hospitals (p< .05, both CTs and MRIs) were significantly associated with the diffusion of CTs and MRIs (adjusted R2= 0.477, 0.656, respectively).Conclusions:This study presents a systematically developed model of the mechanism governing technology diffusion. Important findings from the study show that purchasing power, represented by total health expenditure per capita and economic incentives to hospitals in the form of flexible payment methods, were positively correlated with diffusion. Another important achievement of our model is that it accounts for all thirty OECD member countries without excluding any as outliers. This study shows that variation across countries in the diffusion of medical technology can be explained well by a logical model with multiple variables, the results of which hold profound implications for health policy regarding the adoption of innovations.
International comparison of the definition and the practical application of health technology assessment
Authors: Draborg Eva , Gyrd-Hansen Dorte , Bo Poulsen Peter , Horder Mogens 
Published: April 2008

Objectives:Health Technology Assessment (HTA) is defined as a policy research approach that examines the short- and long-term social consequences of the application or use of technology. Internationally different institutions have translated this definition to local contexts. In Denmark, HTA is comprehensive with focus on four aspects of the problem in question (technology [clinical evidence], economy, patient, and organization). The objective of this study is to study how the application of HTA differs across leading countries and to study the extent to which Danish HTA reports differ from foreign HTAs.Methods:A sample of 433 HTA reports published in the period 1989–2002 by eleven leading institutions or agencies in Denmark and eight other countries were reviewed. We looked at the characteristics of the HTA with respect to focus on the four main aspects and the manner in which each aspect has been approached.Results:The study shows health technology procedures to be the most common type of health technology assessed in HTAs and literature review to be the most often used method of analysis. Policy recommendations are only present in approximately half of the HTA reports.Conclusions:In the HTAs one generally sees a great focus on the clinical aspect of health technologies, leaving the economic, the patient-related, and the organizational aspect much more unanalyzed. The Danish HTAs generally have a wider scope than HTAs produced in other countries and tend to focus more frequently on patient-related and organizational dimensions.
Meta-analysis when only the median survival times are known: A comparison with individual patient data results
Authors: Michiels Stefan , Piedbois Pascal , Burdett Sarah , Syz Nathalie , Stewart Lesley , Pignon Jean-Pierre 
Published: April 2008

Background:The hazard ratio (HR) is the most appropriate measure for time to event outcomes such as survival. In systematic reviews, HRs can be calculated either from the raw trial data obtained as part of an individual patient data (IPD) meta-analysis or from the appropriate trial-level summary statistics. However, the information required for the latter are seldom reported in sufficient detail to allow reviewers to calculate HRs. In contrast, the median survival and survival rates at specific time points are frequently presented. We aimed to evaluate retrospectively the performance of meta-analyses using median survival times and survival rates by comparing them with meta-analyses using IPD to calculate HRs.Methods:IPD from thirteen published meta-analyses (MAs) in cancers with high mortality rates were used. Median survival and survival rates were calculated from the IPD rather than taken from publications so that the same trials, patients, and extended follow-up are used in each analysis.Results and Conclusions:We show that using median survival times or survival rates at a particular point in time are not reasonable surrogate measures for meta-analyses of survival outcomes and that, wherever possible, HRs should be calculated. Individual trial publications reporting on time to event outcomes, therefore, should provide more detailed statistical information, preferably logHRs and their variances, or their estimators.
Cost-effectiveness analysis of medical documentation alternatives
Authors: Kopach Renata , Sadat Somayeh , Gallaway Ian D. , Geiger Glen , Ungar Wendy J. , Coyte Peter C. 
Published: April 2008

Objectives:The delay between patient discharge and the completion of the final discharge note have prompted hospitals to consider new information technologies. This study compared the relative cost-effectiveness of an automated medical documentation system to the current system in place at a Canadian hospital. There are significant expenditures associated with the choice of medical documentation system, yet the benefit to the patient population has not been studied.Methods:A systematic review of the literature was carried out. Cost data for the current documentation system were obtained from the study hospital. The costs of purchasing the automated system were obtained from the manufacturer. Other resource cost implications of the automated system were estimated based on information obtained from the Centre for Applied Health Informatics at the study hospital. The outcome was determined to be the average time (days) between patient discharge and note completion. A cost-effectiveness analysis was conducted. Sensitivity analyses were used to determine the robustness of the results.Results:The automated documentation system was associated with higher costs but better outcomes than the current system. The incremental cost-effectiveness ratio used for comparing the automated medical documentation system with the traditional system indicated that the incremental daily cost for decreasing a day in average note completion time per discharge note was 0.331 Canadian $/day over the study period (4 years).Conclusions:Although the automated documentation system was more expensive than the current system, it also provided qualitative benefits that were not considered in the cost-effectiveness analysis.
Cost-effectiveness of Herceptin®: A standard cost model for breast-cancer treatment in a Belgian university hospital
Authors: Neyt Mattias J. , Albrecht Johan A. , Clarysse Bart , Cocquyt Véronique F. 
Published: April 2008

Objectives: The objective of this study was to conduct a cost-effectiveness analysis of Herceptin® from the hospital's point of view. This new biotechnological pharmaceutical is a humanized monoclonal antibody that targets the HER2 receptor, an important anti-cancer target.Methods: A cost model with standard diagnostic and treatment options for breast cancer was set up for a Belgian university hospital in close collaboration with its specialists. Direct and indirect costs were calculated for each diagnostic and treatment option using the micro-costing method. Effectiveness was estimated through a literature study. The model allowed us to take cost consequences in other stages of the model into account and to calculate changes in monthly treatment costs from different “starting points.” With an incremental cost-effectiveness analysis, differences in costs and effectiveness with and without Herceptin® were compared.Results: Over the complete treatment period from diagnosis until the metastatic phase, monthly costs for the hospital rose from €85.07 to €90.35 for stage I diagnosed breast cancer when adding Herceptin® to the model. In the metastatic phase alone, these costs rose from €1,132.33 to €1,256.23. With Herceptin®, we found an extra cost of €3,981.44 per extra life-month.Conclusions: This cost-effectiveness ratio was rather high, because Herceptin® was quite expensive and the product was additive in its current use and did not replace existing treatments. Future research will concentrate on alternative applications of Herceptin® based on ongoing Herceptin® trials and expert opinions.
Evidence-Based Practice Center network and health technology assessment in the United States: Bridging the cultural gap
Authors: Sarría-Santamera Antonio , Matchar David B. , Westermann-Clark Emma V. , Patwardhan Meenal B. 
Published: April 2008

Objectives:The purpose of this study was to identify the Evidence-Based Practice Center (EPC) network participants' perceptions of the characteristics of the EPC process and the relationship of the process to the success of EPC reports.Methods:Semistructured interviews were conducted with the three groups involved in the EPC: EPC staff, Agency for Healthcare Research and Quality (AHRQ) staff, and representatives of partner organizations.Results:The analysis of the coded transcripts revealed three related major themes, which form the conceptual basis for the interpretation presented here: the definition of a successful report, the determinants of a successful report, and the role of AHRQ in the process.Conclusions:A successful report is a report that is used. The ultimate success of the core health technology assessment objective, moving from research to policy, depends on balancing two values: excellence and relevance. Our findings are consistent with the “two communities thesis,” which postulates the existence of two camps that confer different values to excellence and relevance, with resulting tension. A promising model for approaching this tension is integration or collaboration, which requires linking researchers and policy makers, promoting productive dialogues about the formulation and timing of analysis, and early consideration of how the resulting analysis will be used. This effort suggests that actively blurring the frontiers between these two groups will enhance their interaction. Furthermore, enhancing the role of the AHRQ as scientific broker will maximize the potential of the EPC network.
Randomized trial of a brief physiotherapy intervention compared with usual physiotherapy for neck pain patients: Cost-effectiveness analysis
Authors: Manca Andrea , Epstein David M. , Torgerson David J. , Klaber Moffett Jennifer A. , Coulton Simon , Farrin Amanda J. , Hahn Seokyung , Jackson David A. , Richmond Stewart J. 
Published: April 2008

Objectives:To assess the cost-effectiveness ofbrief physiotherapyintervention versususual physiotherapymanagement in patients with neck pain of musculoskeletal origin in the community setting.Methods:A cost-effectiveness analysis was conducted alongside a multicenter pragmatic randomized controlled clinical trial. Individuals 18 years of age and older with neck pain of more than 2 weeks were recruited from physiotherapy departments with referrals from general practitioners (GPs) in the East Yorkshire and North Lincolnshire regions in the United Kingdom. A total of 139 patients were allocated to the brief intervention, and 129 to the usual physiotherapy. Resource use data were prospectively collected on the number of physiotherapy sessions, hospital stay, specialist, and GP visits. Quality-adjusted life years (QALYs) were estimated using EQ-5D data collected at baseline, 3 and 12 months from the start of the treatment. The economic evaluation was conducted from the U.K. National Health System perspective.Results:On average, brief intervention produced lower costs (£−68; 95 percent confidence interval [CI], £−103 to £−35) and marginally lower QALYs (−0.001; 95 percent CI, −0.030 to 0.028) compared with usual physiotherapy, resulting in an incremental cost per QALY of £68,000 for usual physiotherapy. These results are sensitive to patients' treatment preferences.Conclusions:Usual physiotherapy may not be good value for money for the average individual in this trial but could be a cost-effective strategy for those who are indifferent toward which treatment they receive.
Cost-effectiveness of a supplementary class-based exercise program in the treatment of knee osteoarthritis
Authors: Richardson Gerry , Hawkins Neil , McCarthy Christopher James , Mills Pauline Mary , Pullen Rachel , Roberts Christopher , Silman Alan , Oldham Jacqueline Ann 
Published: April 2008

Objectives:The aim of this study was to assess the cost-effectiveness of a class-based exercise program supplementing a home-based program when compared with a home-based program alone. In addition, we estimated the probability that the supplementary class program is cost-effective over a range of values of a decision maker's willingness to pay for an additional quality-adjusted life-year (QALY).Methods:The resource use and effectiveness data were collected as part of the clinical trial detailed elsewhere. Unit costs were estimated from published sources. The net benefit approach to cost-effectiveness analysis is used to estimate the probability of the intervention being cost-effective.Results:The addition of a supplementary class-based group results in an increase in QALYs and lower costs. For all plausible values of a decision maker's willingness to pay for a QALY, the supplementary class group is likely to be cost-effective.Conclusions:The addition of a class-based exercise program is likely to be cost-effective and, on current evidence, should be implemented.
Joint project of the international network of agencies for health technology assessment—Part 1: Survey results on diffusion, assessment, and clinical use of positron emission tomography
Authors: Hastings John , Adams Elizabeth J. 
Published: April 2008

Objectives: The International Network of Agencies for Health Technology Assessment (INAHTA) has been tracking activities associated with the clinical use of positron emission tomography (PET) in its members' healthcare systems since 1997 and published its first Joint Project report on PET in 1999. Part 1 of this Joint Project report presents survey results on diffusion, assessment activities, and policy for clinical use related to PET among INAHTA members since 1999.Methods: INAHTA members were surveyed in 2003–2004.Results: Twenty-seven INAHTA agencies (69 percent response rate) from nineteen countries responded to the survey. Dedicated PET systems are the most universally installed systems to date. Mobile scanners and modified gamma cameras are used occasionally as lower cost alternatives, and interest in PET–computed tomography hybrid models is rising despite limited assessment of impact on service planning. PET was used and assessed most commonly for managing patients with cancer. All respondents reported having some form of public funding for clinical PET frequently linked to data collection for the purpose of gathering evidence to refine clinical use and guide resource allocation toward indications that maximize clinical and cost-effectiveness.Conclusions: The use of HTA within a continuous quality improvement framework can help optimize scarce resources for evaluation and use of high cost diagnostic technologies such as PET, particularly where potential clinical or cost-effectiveness is considerable but conclusive evidence is lacking.
Integration of health technology assessment recommendations into organizational and clinical practice: A case study in Catalonia
Authors: Gagnon Marie-Pierre , Sánchez Emília , Pons Joan M. V. 
Published: April 2008

Objectives:Evaluating the impact of recommendations based upon health technology assessment (HTA) represents a challenge for both HTA agencies and healthcare policy makers. This research sought to understand factors affecting the uptake of HTA recommendations to support decision making with respect to the introduction of three health technologies.Methods:Using a multidimensional framework, based upon a combination of theoretical models, a case study was conducted. A total of twenty-eight semistructured interviews were done with physicians from fifteen hospitals and other stakeholders in Catalonia. Interview content was analyzed iteratively and classified according to theoretical dimensions and contextual factors.Results:At the sociopolitical level, factors related to the organization and financing of the health system were found to affect the utilization of HTA recommendations. At the healthcare organization level, existing collaborations between the hospital and the HTA agency favored the integration of recommendations into practices. Formalism in the organization also influenced the utilization of HTA recommendations. At the professional level, the high degree of autonomy of specialists, the importance of peers and collegial control, and the definition of professional roles and responsibilities influenced physicians' willingness to integrate HTA recommendations into their practice.Conclusions:This study offers a comprehensive framework to understand the complex dynamics that affect adoption of health technologies in organizational and professional practices. The findings suggest some avenues to promote the integration of HTA recommendations into practices and, thus, increase the utilization of scientific evidence to support decision making in health care.
Early assessment of the likely cost-effectiveness of a new technology: A Markov model with probabilistic sensitivity analysis of computer-assisted total knee replacement
Authors: Dong Hengjin , Buxton Martin 
Published: April 2008

Objectives:The objective of this study is to apply a Markov model to compare cost-effectiveness of total knee replacement (TKR) using computer-assisted surgery (CAS) with that of TKR using a conventional manual method in the absence of formal clinical trial evidence.Methods:A structured search was carried out to identify evidence relating to the clinical outcome, cost, and effectiveness of TKR. Nine Markov states were identified based on the progress of the disease after TKR. Effectiveness was expressed by quality-adjusted life years (QALYs). The simulation was carried out initially for 120 cycles of a month each, starting with 1,000 TKRs. A discount rate of 3.5 percent was used for both cost and effectiveness in the incremental cost-effectiveness analysis. Then, a probabilistic sensitivity analysis was carried out using a Monte Carlo approach with 10,000 iterations.Results:Computer-assisted TKR was a long-term cost-effective technology, but the QALYs gained were small. After the first 2 years, the incremental cost per QALY of computer-assisted TKR was dominant because of cheaper and more QALYs. The incremental cost-effectiveness ratio (ICER) was sensitive to the “effect of CAS,” to the CAS extra cost, and to the utility of the state “Normal health after primary TKR,” but it was not sensitive to utilities of other Markov states. Both probabilistic and deterministic analyses produced similar cumulative serious or minor complication rates and complex or simple revision rates. They also produced similar ICERs.Conclusions:Compared with conventional TKR, computer-assisted TKR is a cost-saving technology in the long-term and may offer small additional QALYs. The “effect of CAS” is to reduce revision rates and complications through more accurate and precise alignment, and although the conclusions from the model, even when allowing for a full probabilistic analysis of uncertainty, are clear, the “effect of CAS” on the rate of revisions awaits long-term clinical evidence.