bluuebunny/crossref_metadata_2025_split huggingface dataset:
OP173 Estimating The Marginal Productivity Of Health Technology Adoption
Authors: Yan Charles , Mohamed Jemal , Saini Manik , Bacigalupo Robert , Bayat Selva , Round Jeff 
Published: December 2023

IntroductionDecisions to adopt health technologies rely, in part, on judgements about cost effectiveness. Cost effectiveness is commonly assessed against a willingness-to-pay threshold for health gains. Building an evidence base on the marginal productivity of health spending to inform the value of the threshold is increasingly of interest for resource allocation decision-making and technology implementation. We report on an in-progress analysis to inform a threshold for policy purposes in British Columbia, Canada.MethodsWe developed a ten-year panel-data model with instrumental variables, which lessens the degree of time-invariant confounding and addresses biased causal inferences caused by unobserved factors, to provide estimates of the marginal cost per health unit measured using quality-adjusted life-years (QALYs). We use the Johns Hopkins Adjusted Clinical Group (ACG) system and a British Columbia Health System Matrix to classify patients into six resource use bands (RUBs) ranging from ‘healthy’ to ‘very high morbidity’. Patients are also classified by chronic conditions and types of services. Place of residence and geographical region of health authorities are considered. Variables included age, gender, mortality and comorbidity rates, costs of hospitalizations, emergency department and physician visits, residential and home care, laboratory services, diagnosis and medications, and quality of life. Instrumental variables included sociodemographic characteristics as reported in the Canadian census.ResultsThe largest RUB was ‘moderate’ morbidity (39.3%), while the smallest was ‘healthy’ (1.5%). The youngest was the ‘low’ morbidity (mean 31, standard deviation [SD] 21) and the oldest was ‘very high’ (mean 69, SD 17). The healthy group had the smallest mean costs (CND563, SD CND4,121; equivalent to USD421, SD USD3,083). In contrast, the ‘very high’ group had the largest (CND20,398, SD CND36,188; equivalent to USD15,258, SD USD27,069). Age and gender standardized comorbidity index scores ranged from 0.05 to 6.41 (median 0.98). Additional analyses (e.g., costs per QALY) are ongoing and the results will be reported at the conference.ConclusionsOur empirical approach is robust and flexible, allowing estimates of marginal productivity according to factors such as disease, geographical region, service type, and care sector. This work has applications at the provincial and national levels and adds to methodological literature in the field.
OP176 Integrating Real-world Compliance In The Assessment Of Left Atrial Appendage Closure Versus Anticoagulation Therapy In Non-valvular Atrial Fibrillation
Authors: Pyne Sebastian , Tilden Dominic , Calcino Gordon , Mudge Mia 
Published: December 2023

IntroductionIn patients with non-valvular atrial fibrillation (NVAF), left atrial appendage closure (LAAC) has demonstrated non-inferior efficacy and safety relative to life-long oral anticoagulation therapy (OAT) in a four-year randomized controlled trial (RCT) (PRAGUE-17). Sub-optimal compliance to OAT in the real-world setting (Simmons 2016) has been associated with increased risk of stroke (Ozaki 2020) and may alter efficacy estimates derived from RCTs in which compliance is generally higher. The study aims to model disease outcomes in NVAF patients treated with LAAC versus lifelong OAT when applying trial versus real world compliance to OAT.MethodsReal-world compliance to OAT in the Australian setting was investigated in a 10 percent Pharmaceutical Benefits Schedule (PBS) sample scripts analysis which measured treatment adherence and persistence to new oral anticoagulants (NOACs) and warfarin. Design of the 10 percent PBS analysis was informed by the compliance to medicine working group report and included the longest follow-up of any OAT compliance study identified in the literature. A Markov cohort model was developed to estimate the expected numbers of strokes and major bleeding events in NVAF patients.ResultsRates of NOAC discontinuation in PRAGUE-17 was higher at 20 months median follow-up (6.5%) versus compliance in the Australian setting (35.4% and 30.0% according to 3 and 6 month ceasing rules at 20 months follow-up). Applying sub-optimal compliance to lifelong OAT demonstrated in the Australian setting resulted in higher numbers of strokes over a life time modelled time horizon compared with LAAC.ConclusionsReal world compliance to medicines should be a consideration in economic analysis comparing lifelong medications to one-off surgical interventions.
PP07 Vaccine Decision-making In Canada: Processes And Guidelines For Using Economic Evidence
Authors: Sander Beate , Krahn Murray , Bryan Stirling , Brouwer Werner , Jit Mark , Lee Karen , Naus Monika , Ozawa Sachiko , Prosser Lisa , Lathia Nina , Yeung Man Wah , Nam Austin , Tuite Ashleigh , House Althea , Tunis Matthew 
Published: December 2023

IntroductionCanada’s National Advisory Committee on Immunization (NACI) makes recommendations on the use of human vaccines. Provinces and territories subsequently use the advice to make decisions on public funding and program implementation. Traditionally, NACI reviewed vaccine characteristics and burden of illness.With its recent expanded mandate, NACI now considers cost-effectiveness via economic evaluations, among other decision determinants. As such, new processes and guidelines were needed to formalize the incorporation of economic evidence into federal vaccine decision-making.MethodsTwo task groups were convened respectively to develop NACI’s “Economic Process” and “Guidelines for the Economic Evaluation of Vaccination Programs in Canada”. The groups conducted environmental scans to inform their work, as well as engaged with government partners, decision-makers, academics, national immunization technical advisory groups from other countries, health technology assessment agencies, industry, patient groups, among others.ResultsThe Economic Process outlines when and how NACI incorporates economic evidence for vaccine recommendation. For instance, it describes how policy questions are prioritized given institutional capacity constraints for generating economic evidence. It also describes how policy questions are assessed to determine the appropriate type of economic evidence required (i.e., systematic review, economic evaluation, multi-model comparison of external models).The Economic Guidelines provide recommendations in 15 chapters on how to conduct economic evaluations (i.e., from defining the decision problem to reporting). Unlike other health technologies, vaccines have the potential to affect both vaccinated and unvaccinated individuals. Hence, the Guidelines consider population-level impacts such as externalities (e.g., herd immunity, age-shifting of disease) and spillover effects. They also discuss equity considerations and non-health impacts of vaccines such as to productivity, consumption and education.ConclusionsThe Economic Process and Economic Guidelines promote the generation and use of credible and standardized economic evidence. They advocate for transparency, allowing evidence to be used across jurisdictions beyond Canada. Next steps include documentation of user feedback, incorporation of Indigenous considerations, and formal evaluations.
PP09 Capturing Broader Effects Of Influenza Vaccination Program In Economic Evaluation: Systematic Literature Review
Authors: Choi Seulki , Byrnes Joshua , Kim Hansoo 
Published: December 2023

IntroductionDecision-making for vaccination programs requires additional consideration on broader effects. The cost-effectiveness guidelines published by the Professional Society for Health Economics and Outcomes Research (ISPOR) working group recommends considering broader effects such as herd protection. Whilst difficulty to produce robust data for such factors might hinder quicker decisions, they are important features of vaccination programs and some of them were the narratives that dominated over the COVID-19 pandemic. In this systematic literature review, the perspectives taken and inclusion of broader effects were investigated for recent influenza vaccine economic evaluations.MethodsThe search strategy based on the terms influenza vaccination and cost-effectiveness was carried out on Embase and PubMed. Considering the publication date of the ISPOR guidelines, articles since 2019 were searched. The review focus was the perspectives taken and inclusion of broader benefits in the analysis. A link between perspective and inclusion of broader effects was tested with a Chi-square
test.ResultsThe total number of full cost-effectiveness articles screened was 48. Of those, the number of articles performed from both the perspectives was 18 (37.5%), and 13 articles (27.1%) considered the perspective of payer only. For those that had both perspectives considered, the ICER reported from the societal perspective was consistently lower than that from the payer perspective. Thirty-one articles (65%) included any of the broader effects. However, broader effects considered were limited to indirect protection (17 articles, 35.4%) and productivity loss (22 articles, 45.8%). The relation between perspective and inclusion of broader effects was significant (p=0.04).ConclusionsThis review highlights that studies performed using both payer and societal perspectives as recommended by the ISPOR research guidelines are not many, while more favorable outcomes were presented when the societal perspective was adapted. Broader effects included are productivity loss and indirect protection.For other broader effects specified in the research guidelines, there are not many attempts to include those in economic evaluations.
PP10 Preventing The Winter Quadruple Threat: The Value Of Hospital Bed Capacity Freed Up By Vaccination
Authors: Neri Margherita , Brassel Simon , Schirrmacher Hannah , Mendes Diana , Vyse Andrew , Steuten Lotte , Hamson Elizabeth 
Published: December 2023

IntroductionHospitals in England experience extremely high levels of bed occupancy in the winter. In these circumstances, vaccine-preventable hospitalizations due to seasonal respiratory infections, have a high cost because of the missed opportunity to treat other patients on the waiting list.This study sought to generate evidence on the hospitalizations that vaccines for older adults against seasonal influenza (flu), pneumococcal disease (PD), respiratory syncytial virus (RSV) and COVID-19 may prevent during the winter season (October-March) in England. The monetary value of the vaccine-preventable hospitalizations was estimated using a conventional reference costing method and a novel opportunity costing approach.MethodsBased on retrospective analysis of Hospital Episode Statistics data on hospitalizations in England, and efficacy and observed coverage rates per vaccination program, we estimated the number of bed-days that current vaccines against flu, PD and COVID-19, and a hypothetical RSV vaccine, could free up by preventing hospitalizations in the winter among older adults. We valued the freed-up bed-days (1) as the cost of prevented hospitalizations (reference cost); (2) as the Net Monetary Benefit (NMB) generated by alternative uses of the freed-up bed-days. The opportunity cost of vaccines-preventable hospitalizations is (2) when they would be an optimal use of beds or (1)+(2) when they would be a suboptimal use.ResultsIn the winter months, vaccination programs targeting flu, PD and RSV for older adults could collectively prevent 72,813 bed days and save over £45million (USD56 million) in hospitalization costs. The COVID-19 vaccine could prevent over 2 billion bed days and save GBP1.3 billion. Importantly, the value of hospital beds freed up by vaccination is likely to be 1.1–2 times larger (£48–£93 million [USD60-116 million] for flu, PD and RSV; £1.4–£2.8 billion [USD1.8-3.5 billion] for COVID-19) when quantified in opportunity cost terms. Scenario analysis replacing the current vaccine used in the adult PD program with the newly licensed pneumococcal conjugate 20-valent vaccine (PCV20), would increase the impact of each modelled outcome for this program by approximately 38 times.ConclusionsVaccines for flu, PD, RSV and COVID-19 could prevent a significant number of hospitalizations in the winter. The value of the associated freed-up bed capacity is likely to be underestimated by conventional reference costing methods.
PP19 Health Technology Assessment Reports In Brazilian Unified Health System: Number Of Potential Beneficiaries in 2022
Authors: Borges Stefani , Rodrigues Fernanda , Pires Wolney , da Costa Nathalia , Maldonado Thatiara , Louly Priscila , Prado Clementina , Santos Vania 
Published: December 2023

IntroductionUniversal access to health public services was established in Brazil 32 years ago. However, health technology assessment (HTA) as a requirement for the decision-making process in the Unified Health System (SUS) was defined only in 2011 with the National Committee for Health Technology Incorporation of the SUS (Conitec), which advises the Ministry of Health on the decision to incorporate health technologies into the SUS. All of Conitec’s recommendations are based on the best available scientific evidence regarding efficacy, effectiveness, and safety of a technology, but also include economic evaluation studies of these technologies, developed from the perspective of the SUS. Considering this an estimate of the population eligible for use of the technology under evaluation, if it is incorporated into the SUS, it is considered in the decision-making process.MethodsThis descriptive study, based on open access data from Conitec’s website, aimed at identifying the estimated number of patients potentially benefitting by the recommendations published in 2022, from January to November. Since each report includes an estimate for the first five years of incorporation of the technologies, all data were collected to check whether population growth was considered.ResultsFinally, 38 recommendation reports were identified, with 28 reports on incorporation and 10 reports for expansion of technology use. Among them, they related to 31 medicines and seven procedures or products. In the first year after incorporating the listed technologies, a total of 7,767,321 potential beneficiary patients were estimated, while over five years the total number would increase to approximately 7,967,874 patients. There were recommended drugs for rare diseases whose benefited population did not exceed the estimate of 10 patients per year; as an example is cerliponase alfa for treating neuronal ceroid lipofuscinosis. In another example, an estimate of 4,494,539 women would benefit by incorporated contraceptives into the SUS.ConclusionsThis study describes how accessible public health is becoming, meeting more health policies, showing potential to benefit more patients every day and showing what trends can be expected in the future.
PP20 Vaccines market access pathways in Asia-Pacific (APAC) – analysis and recommendations for improvement
Authors: Best Alex , Lim KyungHwa , Adam Aisha , Taurel Anne-Frieda , Feng Jun 
Published: December 2023

IntroductionImmunization is one of the most effective public health interventions, saving millions of lives annually. However, complex and heterogenous market access pathways can impact timely and equitable population access to vaccines. Focusing on five Asia-Pacific (APAC) countries, this study described the current vaccine market access landscape and analyzed the success factors for National Immunization Program (NIP) inclusion.MethodsThe study was conducted in two phases (i) pragmatic literature review to map current regulatory and funding pathways and identify information gaps in China, Japan, Korea, Taiwan and Australia (ii) targeted interviews with market access and policy experts in each market to identify drivers and barriers to NIP inclusion.ResultsRegulatory approval, driven by safety and efficacy data, followed by introduction in the private market was commonly observed in all markets. However, pathways to NIP inclusion varied within and between markets. In all markets expert panels such as National Immunization Technical Advisory Groups (NITAG) were identified to play a crucial role in providing advice to governments on NIP inclusion. Health technology assessment was increasingly used to inform decision making. However, the assessment frameworks utilized were typically designed for medicines, rather than the unique features of vaccines.Japan, Korea and Australia provided relatively consistent coverage via national programs, despite the different processes employed to review, recommend and reimburse vaccines. In some cases, the reimbursement timeframe varied significantly for different vaccines within the same market. China and Taiwan provided coverage at the regional level, which required engagement with multiple local authorities to enable access. The key barriers to patient access were budget limitations, long reimbursement timeframes and a lack of coverage consistency. Early stakeholder engagement, local epidemiology and cost-effectiveness evidence were the main success factors for NIP inclusion.ConclusionsFunding pathways for vaccines in APAC are heterogenous. Adopting the Asia-Pacific Economic Cooperation (APEC) Action Plan on Vaccination Across the Life Course could increase vaccine coverage through alignment, collaboration, and improvement of reimbursement pathways in APAC.
PP23 A Health Technology Assessment Of Computerized Clinical Decision Support Systems: Challenges And Lessons Learnt
Authors: Moltó-Puigmartí Carolina , Gallastegui-Calvache Edurne , Cirillo Davide , Vivanco-Hidalgo Rosa Maria 
Published: December 2023

IntroductionComputerized Clinical Decision Support Systems (cCDSS) are promising digital health tools whose development and use are increasing. The Agency for Health Quality and Assessment of Catalonia (AQuAS) received a request from the Spanish Ministry of Health, through the Spanish Network of Health Technology Assessment (HTA) Agencies (RedETS), to perform an HTA of cCDSS for cancer. We present the challenges that arose during the evaluation process.MethodsWe evaluated the safety, effectiveness and cost-effectiveness through a systematic literature review. We involved two clinicians and a technology expert to gain insight into the pathology and technology, respectively. To identify cCDSS used in Spain, we consulted with the Spanish regulatory agency (AEMPS) and the Spanish Federation of Healthcare Technology Companies (FENIN), plus did a survey among Spanish hospitals. To understand applicable regulations, we reviewed the European regulation (MDR) and consulted the Medical Device Coordination Group from the European Commission, AEMPS, and a regional regulatory expert.ResultsThe scientific literature revealed large heterogeneity in the definition of cCDSS (e.g., from simple online prognostic calculators to complex commercial software using machine learning), making the literature search and screening arduous. Many articles dealt with cCDSS that do not qualify as medical devices, are not in the market anymore, are currently used as newer versions or are developed in-house. Next, we faced the difficulty to attain a comprehensive overview of the tools in use in the country. In terms of legislation, we observed that similar tools might receive different classifications in different jurisdictions, and the complexity of the MDR might lead to the need for a case-by-case discussion at a National level.ConclusionsWe identified many challenges in the HTA of cCDSS. The first step for proper assessment is a clear definition of the device and version to be evaluated. Multiple stakeholders must be involved, and alignment between regulatory and HTA agencies is key. We expect that the European Database on Medical Devices (EUDAMED) will help in the identification of existing cCDSS and hence ease their assessment.
PP27 The Private Healthcare Responses Against COVID-19 Emergencies In Brazil
Authors: Kelles Silvana , Pereira Camila , Martins Carina , Reis Daniel , Azevedo Ernesto , Ribeiro Geraldo , Zocrato Karina , Carvalho Lélia , Freitas Marcela , Horta Maria , Barbosa Mariana , Talim Mariza , Borin Marcus 
Published: December 2023

IntroductionThe Corona Virus Disease 2019 (COVID-19) pandemic is the biggest public health crisis of all time. Private health care plays a major role in health globally. We conducted a study to document the engagement of a Brazilian private health care organization to influence decisions to private and public health emergencies of COVID-19.MethodsThis retrospective study evaluated the outputs of the health technology assessment (HTA) group of Unimed-BH, a private Health Maintenance Organization (HMO) with 1.5 million participants in Belo Horizonte, Minas Gerais state. The study evaluated the impacts on the overview of health local decisions in the municipality and the national supplementary health agency (ANS) during the period from March 2020 to December 2022.ResultsDuring the pandemic, Unimed-BH made all its sanitary decisions based on scientific research, such as the use of masks and appropriate medications. Even though some medicines, such as regdanvimab, were authorized for emergency use by the Brazilian Health Regulatory Agency (ANVISA), Unimed-BH did not recommend their use due to uncertain evidence, and months later, ANVISA withdrew the registration.Unimed-BH also conducted a systematic review of ivermectin for COVID-19 treatment, which showed no effect, and therefore did not recommend its use. Additionally, Unimed-BH provided weekly updates on COVID-19 data, including suspected and confirmed cases, hospitalizations, and deaths in their customer portfolio. The organization also actively supported the decisions made by ANS and municipal managers using evidence and statistics on the pandemic. The Unimed-BH HTA group produced a total of 167 reports from March 2020 to December 2022.ConclusionsBelo Horizonte had the lowest in-hospital mortality rates with COVID-19 in Brazil. Unimed-BH’s HTA reports provided evidence-based assessments for decision-making, proposed partnership with policymakers, fomented information transparency, and strict follow-up on pandemic numbers, which may have contributed to the lower fatality rate in our city. These findings underscore the importance of private healthcare organizations in responding to COVID-19 emergencies, and their potential to support evidence-based decision-making and minimize the impact of the pandemic.