bluuebunny/crossref_metadata_2025_split huggingface dataset:
OP156 Systematic Review And Meta-Analysis Of The Perioperative Association Of Gabapentinoids With Sedation And Respiratory Depression After Abdominal Surgery
Authors: Mansour Laure Taher , Seow Warren , Procter Nathan , Alexander Lucy , Pule Lettie , Duncan Joanna , Papa Lora , Singh Charlene , Maddern Guy 
Published: December 2023

IntroductionWith the increasing popularity of enhanced recovery protocols and the growing opioid epidemic, recent pain management pathways have emphasized opioid-sparing measures. As a result, gabapentinoids are being used following surgery and have become one of the most common opioid-sparing analgesics prescribed. However, they are not without risk, with several cases of respiratory depression and oversedation being reported.MethodsThis systematic review and meta-analysis aimed to evaluate the impact of gabapentinoids on sedative complications following abdominal surgery in order to guide future clinical decisions. The Pubmed and Embase databases were searched according to PRISMA guidelines to identify randomized controlled trials comparing gabapentinoids with placebo following abdominal surgery with respect to sedation complications. The Cochrane Risk of Bias Tool was used to assess study quality. A comparative meta-analysis was performed on the data.ResultsOf the 3,988 studies retrieved, 19 were eligible for meta-analysis. Eleven of the 19 studies assessed pregabalin (100 to 1,200 mg) and eight assessed gabapentin (300 to 1,200 mg). Postoperative sedation scores were higher in the gabapentinoid group (p<0.01) relative to placebo. Subgroup analyses demonstrated higher scores two hours after surgery for gabapentinoids (p=0.03), but no statistical difference at 24 hours (p=0.19). Different doses did not yield any differences on forest plot analyses.Respiratory depression rates were higher in the gabapentinoid group, compared with placebo (p=0.02).ConclusionsThe preoperative use of gabapentinoids is associated with sedative complications, including respiratory depression. These results may help guide future perioperative pain protocols.
OP163 Applying A Local Economic Evaluation Framework To Make Evaluations More Relevant For Local Decision Makers
Authors: Gray Jodi , Karnon Jonathan 
Published: December 2023

IntroductionEconomic evaluation is infrequently used by local health services. To be useful to local decision makers, economic evaluations need to synthesize published evidence on effective interventions with local data and local stakeholder knowledge regarding patient and organizational contexts. A framework for local economic evaluation was applied by health economists working with a local health service to inform their decision-making regarding funding of health service delivery models to reduce hospital-acquired complications.MethodsThe framework engaged with local stakeholders to set priorities, assess the relevance of the published evidence, interpret local data, provide insight on the local context, and make recommendations to decision makers. It involved: (i) synthesizing the published evidence in a pragmatic review; (ii) determining local root causes and baseline incidence rates using local clinical and administrative data; and (iii) using expert elicitation to adjust published intervention effects to reflect the local context. This information was synthesized in a cost-consequence analysis that estimated the likely costs and effects of relevant interventions if they were implemented locally.ResultsLocal stakeholders selected hypoglycemia and urinary tract infections as targets for intervention. Tools and resources developed for each case study included: clinical audit tools and analysis files; pragmatic literature reviews with templates to present interventions to local stakeholders; an expert elicitation framework; and R code for cost-consequence analyses that apply published and elicited intervention effects to local data.ConclusionsThe framework provided a feasible and acceptable process for undertaking local economic evaluations. Engagement with local stakeholders ensured the evaluations produced were relevant and tailored to the local setting and were therefore useful to local decision makers. The tools and resources developed can be applied by other local health services. The framework itself can be used for other case studies. However, the time and cost associated with the evaluations was not sustainable and alternative models for applying the framework need to be explored.
PP33 The Cost-effectiveness Of Regorafenib In The Treatment Of Advanced Hepatocellular Carcinoma From A Canadian Perspective
Authors: Hussain Mohammad Salman , Singh Ambrish 
Published: December 2023

IntroductionHepatocellular carcinoma (HCC) is the most common form of liver cancer and the fourth leading cause of cancer-related death globally. There are unmet needs for effective systematic therapy. The findings of the RESORCE trial highlighted the improvement in overall survival with regorafenib in advanced HCC patients progressing on sorafenib treatment. This study aimed to assess the cost-effectiveness of regorafenib compared with best supportive care (BSC) for advanced HCC from the Canadian healthcare system perspective.MethodsWe developed a Markov model based on four health states: live with adverse events, live without adverse events, progression, and dead. Health outcomes were measured using life-years (LYs), and quality-adjusted life-years (QALYs), and costs were presented in Canadian dollars (CAD). Clinical inputs were derived from the RESORCE trial. A 1.5 percent discount rate was applied to costs and outcomes. One-way and probabilistic sensitivity analyses were performed to assess the uncertainty in findings due to variability in parameters. TreeAge Pro software was used for model implementation.ResultsThe use of regorafenib results in a gain of 0.38 LYs and 0.25 QALYs as compared to BSC with a high incremental cost of CAD26,954 (USD22,313). The ICER for regorafenib compared with BSC was CAD105,850/QALY (USD87,624/QALY) in the base-case analysis. Further, probabilistic sensitivity analyses revealed regorafenib not to be cost-effective at a willingness-to-pay threshold of CAD50,000/QALY.ConclusionsRegorafenib was not found to be cost-effective in the treatment of advanced HCC because of the lower health benefits and higher incremental costs. Lowering the official price of regorafenib or use for only selected patients who can achieve maximum benefits would enhance its cost-effectiveness and treatment preference value.
PP40 Structuring Unstructured Medical Device Reimbursement In India
Authors: Goel Ashwin , Fahim Arif , Pusha Monika , Kataria Kirti 
Published: December 2023

IntroductionAs India makes rapid strides towards universal health coverage, focusing on medical device reimbursement is key to ensuring patient access to device-based technologies. The nascent medical device reimbursement process offers a promising opportunity for interventions driven by a diverse group of stakeholders. We conducted policy research to capture these diverse perspectives and highlight key elements to develop a structured framework for reimbursement.MethodsThis research was a two-part process, including secondary research with expert interviews followed by policy research using focus group discussions (FGDs) through an online workshop with key stakeholders. We developed a white paper proposing changes to the reimbursement pathway, based on a benchmarking study of global markets and interviews with experts in the field. As a next step, key changes proposed in the white paper were deliberated upon by three focus groups (six to eight participants). Group participants were selected by quota sampling and represented key stakeholders in the reimbursement process. A discussion guide was used to capture participants’ opinions and an addendum to the white paper was released highlighting small, actionable, and impactful changes to the reimbursement process.ResultsFGDs with key stakeholders highlighted the need to establish a more structured, inclusive, and transparent process. Accordingly, we proposed key recommendations to the medical device reimbursement process in India. A first change is the creation of an online submission portal allowing different healthcare stakeholders to submit new technologies for consideration through a streamlined pathway. Secondly, we proposed enhancing evaluation transparency by improving availability of publicly shared information on the evaluation process, metrics, and assessment timelines. We also suggested adoption of adaptive health technology assessments to leverage existing evidence for faster, efficient decision-making.ConclusionsThrough this process, we created a pragmatic and concrete call for a stronger voice from care-providers and patient groups in the evaluation process. Consecutively, the proposed innovative framework introducing value-based incentives for implantable medical devices will be instrumental in enabling access to quality health care for poor patients. These strategies follow the principles of value-based care and will go a long way in achieving better health outcomes for the population. The scientific initiative has been made possible with the support of St. Jude Medical India Pvt Ltd (now Abbott).
PP42 Insights Of Health Technology Assessment In Brazilian Health Unified System: Areas Of Interests In Health
Authors: Pires Wolney , Borges Stefani , Rodrigues Fernanda , da Costa Nathalia , Louly Priscila , Prado Clementina , Santos Vania 
Published: December 2023

IntroductionThe National Committee for Health Technology Incorporation of the Brazilian Public Health System’ s (Conitec) principle is to advise the Ministry of Health (MS) in the tasks related to incorporation, exclusion or modification of any health technologies into the Unified Health System (SUS). Moreover, this also involves alteration of clinical protocols or therapeutic guidelines. All of the recommendations consider the international classification of diseases (CID) as a common language that allows health professionals and managers to understand standardized information, to identify trends and benefits of recommendations in each therapeutic area.MethodsThis exploratory, descriptive and retrospective study aims to provide qualitative and quantitative data from the technologies evaluated by the Conitec in the period June 2012 to November 2022. Data were extracted in Conitec’s website.ResultsThe searches resulted in 763 recommendations in total. Among them, the most evaluated therapeutic area was Infectology with 126 technologies (16.5%). In this field the highlighted diseases and conditions were Hepatitis 42 (33.3%); HIV 23 (18.3%) and COVID-19 11 (8.7%). In Oncology, 113 recommended technologies (14.8%) were identified, in order of prominence for the diseases: Breast Cancer 21 (18.6%); Colorectal Cancer 11 (9.7%); Leukemias 17 (15.0%). In the Respiratory Diseases area, 89 technologies (11.7%) were recommended, among them: Chronic obstructive pulmonary disease (COPD) 17 (19.1%); Asthma 15 (16.9%) and COVID-19 11 (12.4%). These results clarify which diseases are most needing new technologies to be treated.ConclusionsThe results show what conditions and fields in health needs to be prioritized for public policies and prevention measures. This study demonstrates how important is to make accessible the public health information, improving public knowledge and social actions in SUS.
PP44 Time Is Now: Advancing Value Assessment Of Cancer Therapies To Help Eliminate Cancer As The Cause Of Death
Authors: Ryan James 
Published: December 2023

IntroductionEarlier cancer diagnosis and advances in science are resulting in improved patient and societal outcomes. However, payer frameworks and methods can find it difficult to keep pace with scientific progress, evolution of endpoints, and assess the wider value of these advances.MethodsA multidisciplinary, international group of experts working in the cancer field was brought together to reach consensus on key principles of defining and assessing of cancer treatment value. A Delphi-based approach including surveys, virtual panels, interviews and structured online discussions was used to reach consensus. This work was initiated and funded by AstraZeneca.ResultsTwenty-four experts from across the world (including patient advocates, oncologists, health economists, regulators, members of payer and health technology assessment (HTA) bodies) reached consensus on seven key principles across two themes, oncology relevant endpoints and dimensions of value. Three of the seven principles were found to be of particular relevance to HTA bodies and payers: assessing broad economic impact of new medicines (including socio-economic and caregiver impact), where early-stage cancer treatments can enhance patients’ ability to lead productive lives and contribute to economic activity; consider other value aspects of relevance to patients and society; use of Managed Entry Agreements (MEAs) supported by ongoing evidence collection to help address decision-maker evidence needs and address clinical uncertainty.ConclusionsIncentivizing access to early-stage treatments can promote cancer control, improved outcomes and generate long-term societal benefit. Furthermore, early diagnosis and treatment at earlier stages of cancer can be cost-effective, and sometimes cost-saving, as well as provide opportunities for cure. Expanding value components in therapy assessments to include, for example, insurance value, the value of choice, scientific spillovers, and wider societal perspectives, along with structured MEAs to manage clinical uncertainty and balance budgets will help realize the potential to eliminate cancer as the cause of death.
PP53 Increasing Emergence Of Novel Digital Health Technologies Identified Through Horizon Scanning
Authors: Ng Zhen Long , Ju Hong , Ng Jaryl , Ng Kwong 
Published: December 2023

IntroductionRecently, there have been calls for the development of new health technology assessment (HTA) methodologies to address the growing emergence of novel digital health technologies (DHTs). In particular, the lack of robust evidence base and technology-specific considerations of DHTs, such as software updates, present challenges for evaluation with conventional HTA methods. In Singapore, the Agency for Care Effectiveness (ACE) has established a horizon scanning (HS) system to provide the healthcare system with advance notice on emerging medical technologies (MedTechs) that may enter the Singapore market. This study aims to investigate the anticipated emergence of DHTs identified by ACE’s HS system and the potential implications on subsequent HTA methodology.MethodsBased on ACE’s HS methodology, which is in line with international best practices, new and emerging MedTechs that address the top five local disease burden (i.e., cardiovascular, cancer, mental, neurological and musculoskeletal disorders) were identified from various sources and monitored for its development. These MedTechs were further filtered to shortlist potential technologies for HS assessment based on its innovative nature and appropriate time horizon to local regulatory approval. For this exercise, the filtered MedTechs were classified into categories such as DHTs, comprising technologies involving software or artificial intelligence (AI), and non-DHTs.ResultsBetween 2021 and 2022, ACE has completed two topic filtration exercises. Based on 807 and 1,231 monitored MedTechs, 35 and 42 technologies remained after filtration, respectively. Among them, six out of 35 (17%) and 15 out of 42 (36%) filtered MedTechs were classified as DHTs, accounting for approximately two-fold increase in the number of DHTs shortlisted year-on-year. These DHTs include standalone AI software, software in a medical device, and digital therapeutics.ConclusionsThere is a substantial increase in DHTs identified that are anticipated to enter the local healthcare system. Given their unique characteristics, this may call for the modification of current HTA method to enable meaningful evaluation of DHTs.
PP70 Mapping Of Health Technology Assessment In China: A Comparative Study Between 2016 And 2021
Authors: Liu Shimeng , Xia Yu , Yang Yi , Ming Jian , Sun Hui , Wei Yan , Chen Yingyao 
Published: December 2023

IntroductionThis study aimed to compare changes in the level of health technology assessment (HTA) development from 2016 to 2021, and to inform policies and decisions to promote further development of HTA in China.MethodsWe conducted a cross-sectional and anonymous web-based survey to relevant stakeholders in China in 2016 and 2021 respectively. The mapping of the HTA instrument was used to reflect the HTA development from eight domains. To reduce the influence of confounders and to compare the mapping outcomes between 2016 and 2021 groups, we performed 1:1 propensity score matching methodology in this study. Univariate analysis was performed to compare the differences in these two groups. We also compared the overall results with that of a mapping study that included ten countries.ResultsA total of 212 and 255 respondents completed the survey in 2016 and 2021 respectively. After propensity score matching methodology, 183 cases from the 2016 group and 2021 group were matched. Overall, the mean score of 2021 in most of the domains was higher than in 2016 in China (p < 0.05), matching the level of HTA institutionalization and dissemination strategy, except for the assessment domain. Although China scored significantly lower among the three developed countries, the overall HTA development score for China was comparable among the ten countries.ConclusionsOur study suggested the level of HTA development in China has made great progress from 2016 to 2021. Prior to HTA activities, the researcher or policy makers should first formulate an explicit assessment goal and scope, and during the assessment process, more attention should be paid to the clinical effectiveness and cost-effectiveness indicator to ensure a higher quality of HTA evidence.
PP81 Efficacy Of Transcranial Direct Current Stimulation For Depressive Episode Disorders
Authors: do Nascimento Martins Álex Brunno , Alvernaz dos Santos Bárbara Rodrigues , Pereira Elder Gomes , Prata Luana Oliveira , Araujo Maiara Silva , Muniz Júnior Roberto Lúcio , de Morais Martins Ursula Carolina , Guerra Júnior Augusto Afonso , de Assis Acúrcio Francisco , Teodoro Juliana Álvares 
Published: December 2023

IntroductionDepression is a general term that describes different depressive disorders which are highly prevalent and disabling, characterized by decreases in quality of life. Transcranial Direct Current Stimulation (tDCS) is a non-invasive brain modulation technique used, among other purposes, for the treatment of chronic pain and headache. In order to clarify the effect of this stimulation on depressive disorders, the objective of this review was to evaluate efficacy and safety of treatment with tDCS for depressive disorders.MethodsA systematic research study was carried out on 30 June 2022 in MEDLINE (by Pubmed), Embase, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), PsycInfo e Global Mental Health databases. Were included systematic reviews (SR) with meta-analysis that selected patients with depression, in use of tDCS, using as comparator sham stimulation (placebo) or any other treatment (pharmacologic or no) or any comparison between pre-and post-intervention.ResultsEight SR with meta-analysis of randomized clinical trials (RCTs) on the efficacy and safety of tDCS in the treatment of depressive disorders were retrieved. Subjects were assessed for clinical response, remission, change in scores on depression scales, occurrence of procedure-related adverse events, and treatment dropout. Three systematic reviews showed results that point to the effectiveness of tDCS for the clinical response outcome and one considering the remission outcome. As for the outcome measured by the change in depression scale scores, all included reviews showed favorable results for tDCS. It is noteworthy that the studies included in the reviews have methodological limitations. With regard to safety, an increased risk treatment-emergent mania or hypomania (TEM) has been observed.ConclusionsThe tDCS association with antidepressants showed favorable results to this technology in a sample with depression and varied clinical characteristics. Regarding safety of this technology, tDCS did not show adverse effects of greater severity, but was verified to have an increased risk of TEM.
PP110 Knowledge Transfer From Scoping Review Into Primary Research In The Context Of Clinical Practice Guidelines Update
Authors: Sabalete Trinidad , Blasco Juan Antonio , Engelhard Ruth , Gracia Javier 
Published: December 2023

IntroductionIn the development and update process of clinical practice guidelines (CPG) is necessary to focus research questions as much as possible to optimize the systematic reviews. We carried out a scoping review as a precursor to a systematic review to update the recommendation of a CPG for the Management of Patients with Autism Spectrum Disorders in Primary Care. To our knowledge, there is limited information in the existing literature on graphical options for visually presenting scales or other available instruments and classification in a timeline graph.MethodsWe conducted a systematic search to identify instruments for screening of neurodevelopmental disorders and early detection and diagnosis of autism spectrum disorder (ASD). All studies were analyzed to retrieve scales and other instruments used in the assessment of neurodevelopment in the preschool children, and detection of signs and symptoms of neurodevelopment disorder or ASD. We developed a timeline graphic to compile all of the instruments retrieved.ResultsThe information about the name of instrument, type, age of application, diagnostic accuracy, and context of validation was transferred to spreadsheet of the software program Microsoft Excel in tabular format. The instruments found were finally categorized according to the role of each of them in the diagnostic of autism, and age in which they are used. We developed a timeline graph for visually presenting classified instruments according to utility in the routine developmental surveillance, detection of specific signs and symptoms of ASD and diagnostics and evaluation of autism.ConclusionsThe proposed graphical timeline could assist methodologists and researchers in identifying gaps of evidence and lines of research related to use and validation in different contexts the scales and other instruments actually developed. The process of review of evidence can provide information useful for future research in the context of primary research. The relationship between groups of work of health technology assessment and primary research promote the knowledge transfer and optimization of research.