bluuebunny/crossref_metadata_2025_split huggingface dataset:
PP79 Publication Trends Of Network Meta-analyses In Europe And Asia: A Focus On Cardiovascular Disease
Authors: Ng Alvin , Choi Min Hee , Evans Jennifer S 
Published: December 2023

IntroductionThe objective of this research was to compare trends in publications of network meta-analyses (NMAs) in cardiovascular diseases (CVDs) in Asia-Pacific (APAC; China, Japan, Singapore, South Korea, Thailand) and Europe (United Kingdom [UK], Germany, France, Spain, Italy), with a focus on volume, collaborations and methods.MethodsFreely available NMAs assessing pharmacological or surgical interventions for CVD in terms of mortality or major adverse cardiovascular events, published in 2012 or later, by authors affiliated with institutions in the target countries were identified via MEDLINE and Embase. CVDs were grouped using the International Classification of Diseases, Tenth Edition (ICD-10).ResultsAcross the 193 publications identified, heart diseases such as atrial fibrillation, aortic stenosis and heart failure (ICD-10 I30-I52) were the most common indications reported (38%). The majority of publications involved authors in APAC countries (63%) and 40% from Europe. Cumulative numbers of publications from APAC surpassed those from Europe from 2018 onwards. Authors were largely affiliated with institutions in China (50%), the UK (20%) and Italy (20%). One hundred and forty-five publications were by authors affiliated with institutions in a single country; 91 percent of publications from APAC and 44 percent from Europe, indicating different patterns of collaboration within these regions. In terms of reporting methodologies, 39 percent of included publications did not specify whether a frequentist or Bayesian framework was used (43% in APAC, 34% in Europe). Among those that reported, the Bayesian framework was more commonly used.ConclusionsWhilst there is a growing trend in NMA publication counts generally, the rate of increase in APAC was higher than Europe, particularly in the years following adoption of health technology assessment (HTA) procedures in APAC. The volume of publications not reporting the framework used was substantial, despite requirements for this in reporting guidelines e.g., PRISMA. Where reported, the Bayesian framework may have been favored due to its advocacy by some health technology assessment bodies.
PP90 Artificial Intelligence To Detect Ischemic Heart Disease In Non-traumatic Chest Pain At The Emergency Department – SmartHeart Study
Authors: Arana-arri Eunate , de Vicuña Aitor García , Carbajo Silvia , de Benito Sobrado Sara , Carreras Magdalena , Arrieta Irma , Bayon-Yusta Juan Carlos 
Published: December 2023

IntroductionAn estimated 17.9 million people died from cardiovascular diseases (CVDs) in 2019, which is 32 percent of all global deaths and 85 percent were due to heart attack and stroke. Chest pain is one of the most common reasons for presenting to the emergency department (ED). It is increasingly recognized that artificial intelligence (AI) will have a significant impact on the practice of medicine in the near future and may help with diagnosis and risk stratification. We aim to estimate a diagnostic prediction of acute myocardial infarction by the development and validation of an AI model.MethodsData on 134 variables of 3,986 consecutive patients who presented to the ED with non-traumatic chest pain were included in the analysis. Using AI tools, a neural network model was developed to establish the risk of acute myocardial infarction (AMI) to achieve n=150 patients over 18 years of age attending the ED.ResultsThe mean age was 65.5 (±13.7) years and 63.6 percent were male. Most (60.1%) patients were admitted to hospital, with only 20.3 percent diagnosed at hospital discharge with ischemic heart disease (IHD). All patients were followed up for two months, and 6.3 percent were readmitted to the ED, but none presented with an episode of IHD. In the data analysis of the entire sample we obtained a probability of diagnosing IHD by the SmartHeart model (S=93.1%, E=47.3%, PPV=31.0%, and NPV=96.4%). When we analyzed the sample of patients with no history of IHD (n=104), the diagnosis accuracy was as follows (S=100%, E=77.5%, PPV=42.8%, and NPV=100%).ConclusionsOur AI model provides information to predict patients who are suffering from acute IHD. AI has been reported to outperform emergency physicians and current risk stratification tools to diagnose IHD, but has rarely been integrated into practice. This study highlights the diagnostic applicability and accuracy of this type of tool and that is why studies should be implemented to see its effectiveness in routine practice in EDs.
PP97 How Health Technology Agencies Estimate Target Population Size For Medical Devices: The Example Of Spinal Cord Stimulation
Authors: Ade Apolline , Hallas Natalie , Vancauwenberghe Lydie , Vogt-Humberg Ilona , Holm Astrid , Lundsby Mette , Borgman Benny , Pellicer Beatriz , Borghetti Francesca , Strachan Liesl 
Published: December 2023

IntroductionSpinal cord stimulation (SCS) is an effective and safe option for patients with refractory neuropathic pain, with positive health technology assessment (HTA) recommendations across Western Europe, yet SCS uptake remains low. Estimating target patient populations within HTAs may impact upon medical device uptake, pricing and access. However, there is a dearth of information on how this is typically conducted. This study aimed to compare the approaches of Western Europe HTA agencies for estimating the target population for SCS.MethodsA survey was conducted among members of the Health Economics and Reimbursement function from Western Europe to collect country-specific information on how HTA agencies assess the target population of medical devices (MD). The estimations of the target population for SCS were extracted from HTA publications and compared.ResultsEight Health Economics and Reimbursement (HER) Analysts from France, Germany, the United Kingdom (UK), Belgium, Spain, Italy, Sweden and Norway completed the survey. HTA Agencies in France, UK and Belgium routinely ask for epidemiological data in the manufacturer submission, whereas in Germany, Sweden and Norway the request is dependent on the type of HTA submission. All HTA agencies, except NICE (UK), perform an independent estimation of the target population. HTA agencies in Germany and UK typically use epidemiological data from industry. In all countries, the estimation of the target population may indirectly impact the price of the MD, especially when budget impact analysis indicates a potential high use of healthcare resources. Only France, Belgium and UK have published HTA recommendations about SCS, however the estimated target population, nor the number of patients with refractory neuropathic pain, is not always included. Only the French and UK HTA agencies publish an approximation of the target population for SCS using the number of patients implanted every year.ConclusionsThis study showed there is a lack of harmonization between Western European HTA agencies’ guidelines on the inclusion and estimation of target patient populations. The new EU HTA Regulation should help to address this situation.
PP99 Positron Emission Tomography Combined With Computed Tomography (PET/CT) Using 11-C Methionine (11C-MET)
Authors: Akhmetova Makpal , Aimanova Tansolpan , Okesh Makhabbat , Avdeyev Andrey , Albayev Rustam , Saduakassova Aigul , Lyugay Yekaterina , Tleulessova Indira , Turar Olzhas , Bariyeva Gulzada , Shanazarov Nasrulla 
Published: December 2023

IntroductionPositron emission tomography combined with computed tomography (PET/CT) using 11C-methionine (11C-MET) is used to detect astrocytomas and low-grade brain tumors, in the primary detection of all malignant and benign neoplasms of the central nervous system (CNS), and in order to monitor staging and evaluate the results of treatment.MethodsTo assess the clinical and economic effectiveness of PET/CT with the use of radiopharmaceutical drugs (RFLP) based on 11C-MET in the diagnosis of CNS neoplasms, a systematic review of literature by keywords in the Pubmed/MEDLINE database was conducted. The search result was 218 publications. The analysis included 21 publications that met the search criteria, including three meta-analyses and six systematic literature reviews.ResultsDiagnostic efficacy in distinguishing gliomas of high and low malignancy has moderate diagnostic accuracy (combined sensitivity and specificity were 80% and 72%, respectively), but higher sensitivity compared to Fludeoxyglucose F18 (18F-FDG). PET/CT with 11C-MET demonstrated good diagnostic value in detecting brain tumor recurrence (combined sensitivity and specificity of 92% and 87%, respectively) compared with 18F-FDG.ConclusionsPET/CT diagnostics of CNS neoplasms using the drug 11C-MET is an innovative technology with greater specificity and sensitivity than 18F-FDG, positively influences the subsequent surgery plan and identifies tumors previously undetermined by magnetic resonance imaging (MRI), CT or PET/CT with 18F-FDG.
PP103 Budget Impact Analysis Of Utilization Of WavelinQ Endo-arteriovenous Fistula System For Hemodialysis Patients: An Australian Hospital Perspective
Authors: Delaney Christopher , Agresta Blaise , Gupta Ritu , Papadopoulos George 
Published: December 2023

IntroductionA high proportion of patients with end-stage kidney disease (ESKD) are treated with hemodialysis (HD). To lower morbidity and maintain overall cost control in patients with ESKD, it is crucial for health systems to establish and maintain durable hemodialysis (HD) access. Our objective was to assess the budget impact of utilizing the ‘WavelinQ Endo Arteriovenous Fistula (AVF) system’ (WavelinQ) for HD patients.MethodsA one-year economic model from the Hospital (Flinders Medical Centre, FMC) perspective was developed with Australian epidemiological and costing data. Clinical data were collected from real-world sources. The incident (n=50) and prevalent (n=250) cohorts were based on FMC utilization patterns. The current standard of care was surgical AVF (sAVF) and/or central venous catheters (CVC). With introduction of WavelinQ into practice, the substitution rate was set at 50 percent in new patients and ten percent amongst existing patients. Index procedure and reinterventions costs for the patient were based on the weighted average cost using National Efficient Price Determination 2020 to 21. Total costs preWavelinQ introduction were compared to post WavelinQ substitution to determine the budget impact.ResultsBased on FMC expected patient cohort and WavelinQ substitution rates, the mean annual cost savings per incident and prevalent patient were AUD26,873 and AUD3,549, respectively, which lead to overall mean annual cost savings per patient of AUD7,437. The calculated per patient additional upfront cost of AUD7,010 with the WavelinQ index procedure versus sAVF was more than offset by the savings due to less post-procedure reinterventions. Overall, at the assumed substitution rates with WavelinQ, the model predicted a cost saving of approximately AUD2.2 million dollars for FMC.ConclusionsThe use of WavelinQ is expected to lead to cost savings of AUD2.2 million dollars from the FMC perspective. Hospitals should consider not just the increase in upfront costs but also potential savings from less reintervention procedures. There is a need for continued research on the budget impact of different HD modalities across multiple settings.
PP105 Efficacy, Effectiveness And Safety Of Letermovir For Prophylaxis Of Cytomegalovirus Infection And Disease Post-Allogeneic Hematopoietic Stem Cell Transplantation
Authors: Muniz Júnior Roberto Lúcio , do Nascimento Martins Álex Brunno , Alvernaz dos Santos Bárbara Rodrigues , Ferreira Bambirra Eduardo Henrique , Prata Luana Oliveira , Araújo Maiara Silva , Borin Marcus Carvalho , de Assis Acurcio Francisco , Alvares-Teodoro Juliana , Guerra Júnior Augusto Afonso 
Published: December 2023

IntroductionClinically significant cytomegalovirus infection (CSI-CMV) is an important factor associated with mortality in patients undergoing hematopoietic stem cell transplantation (HSCT). It is estimated that the incidence of CSI-CMV in the post-HSCT period is 30 percent to 70 percent in transplanted individuals. Therefore, CSI-CMV is considered a complication in allogeneic HSCT, which can trigger Cytomegalovirus disease (CMVD). Letermovir is an antiviral agent indicated especially for the prophylaxis of CMVD post-HSCT. The objective of this work was to evaluate the efficacy, effectiveness and safety of letermovir, comparing it with placebo or other existing prophylactic treatments.MethodsA systematic review was carried out according to PRISMA 2020. A strategy was developed for searching electronic bibliographic databases. Retrieved publications were selected by a pair of reviewers. The same pair performed the data extraction. A qualitative assessment of the efficacy, effectiveness and safety of letermovir was performed.ResultsEighteen studies were included, being experimental and observational. Overall, the pivotal RCT demonstrates the efficacy of letermovir in reducing the incidence of CSI-CMV. However, there was no statistically significant difference in all-cause mortality and letermovir-related overall survival, events of graft versus host disease, neutropenia, acute kidney disease and 48-week mortality. Observational studies, in general, present results similar to those found in the pivotal RCT. The main adverse events associated with letermovir were peripheral edema (14.5%), vomiting (18.5%), headache (13.9%), cough (14.2%), abdominal pain (11.8%) and fatigue (13.4%).ConclusionsThe prophylactic use of letermovir in CMV-R+ patients after allogeneic HSCT demonstrates beneficial results in the prevention of CSI-CMV. However, there were no identified improvements for other outcomes. As for safety, it was observed that there is still little information about adverse events related to the drug, and studies assessing this aspect are needed for better comprehension.
PP122 The Feasibility Assessment For Domestic Introduction Of Newborn Pulse Oximetry Screening For Critical Congenital Heart Disease
Authors: Choi Miyoung , Kim Jimin , Choi Byung Min , Shin Jeonghee , Park Chanmi , Ha Gisu , Shin Hong Joo , Choi Eui Kyung 
Published: December 2023

IntroductionCritical congenital heart disease (CCHD) refers to a group of heart defects that cause serious, life-threatening symptoms in the neonatal period and requires timely surgical or catheter interventions. We reviewed evidence for incorporating a mandatory neonatal CCHD screening test as a national public health project for all neonates born in Korea by analyzing the validity and cost-effectiveness of neonatal CCHD screening using pulse oximetry in Korea.MethodsWe performed a rapid literature review to establish models for the diagnostic accuracy and economic evaluation of pulse oximetry. Also, we analyzed the prevalence, mortality, and medical expenditure for different types of CCHD using the national health insurance (NHI) data. We analyzed the cost-effectiveness of pulse oximetry by comparing the group of neonates who received a combination of a physical examination and pulse oximetry, and group of neonates who only received a physical examination. For the cost-effectiveness analysis for the CCHD screening test in this study, we used a duration of one year, diagnostic accuracy as the clinical endpoint, and Life Year Gain (LYG) as the effectiveness indicator.ResultsWe used recent systematic review he pooled sensitivity can be enhanced from 76.5 percent (pulse oximetry alone) to 92 percent (combined with physical examination). We used a total of 2,334 neonates with CCHD data for the economic model. Our analysis revealed that adding pulse oximetry to the routine neonatal physical examination leads to 2.34 of LYG and a cost difference of USD1,080,602, showing a ICER of KRW610,063,240 (USD461,857)/LYG.ConclusionsConsidering the benefit of LYG and cost of reducing the complications and after effects of newborns with CCHD who survived early diagnosis, it is considered to be worthwhile in Korea for a mandatory screening test.
PP124 Patisiran For Patients With Hereditary Transthyretin Amyloidosis (hATTR) With Stage 2 Polyneuropathy Or Who Have An Inadequate Response To Tafamidis
Authors: Borin Marcus , Martins Álex Brunno , Alvernaz Bárbara , Gargano Ludmila , Júnior Roberto , Magalhães Wagner , Acúrcio Francisco , Alvares-Teodoro Juliana , Guerra Augusto 
Published: December 2023

IntroductionHereditary Transthyretin amyloidosis (hATTR) is a rare autosomal dominant, multisystemic, progressive, and potentially fatal genetic disease. Currently, the only drug made available in the Brazilian National Health System to treat hATTR is tafamidis meglumine, indicated for symptomatic adult patients in early stage (stage 1) and not undergoing liver transplantation for amyloidosis associated with hATTR.MethodsA systematic review was conducted in the databases MEDLINE via Pubmed, Embase, The Cochrane Library, and LILACS addressing the question “Is patisiran treatment effective and safe for patients diagnosed with ATTRh amyloidosis with stage 2 polyneuropathy or who have an inadequate response to tafamidis?”ResultsThe 13 studies included in the review demonstrate the efficacy of patisiran in reducing the neuropathic progression of the disease, as evidenced by decreased mNIS+7 scale scores following 18-month use of the drug. Improvements in the quality of life of patients taking patisiran have been reported, as measured by reduced scores on the Norfolk-QoL-DN scale. Patisiran has also been shown to be effective in reducing NT-proBNP, a marker related to cardiac stress. Improvements in the nutritional status of patients taking patisiran were demonstrated by increasing modified body mass index (BMI). Good tolerability of patisiran was observed by patients using it. Most adverse events were classified as mild or moderate. The studies indicated that the occurrence of deaths is similar between the patisiran and placebo groups. Most deaths were related to cardiac events and were not associated with the use of patisiran.ConclusionsThe use of patisiran in patients with hATTR demonstrated efficacy in reducing the neuropathic progression of the disease, evidenced by decreased mNIS+7 scale scores, improvements in quality of life as measured by reduced Norfolk-QoL-D scale scores, and reduced NT-proBNP. The drug patisiran was well tolerated, with most adverse events rated as mild and moderate.
PP127 Early Health Technology Assessment (HTA) Of Medical Technologies To Inform Subsidy Decision-making In Singapore
Authors: Batcagan-Abueg Ada PM , Soon Swee Sung , Ju Hong , Ng Kwong 
Published: December 2023

IntroductionMedical technologies are evolving rapidly, with many new and expensive technologies entering the market constantly, challenging the sustainability of the public healthcare system. Early health technology assessment (HTA) to inform subsidy decision for innovative medical technologies, before they diffuse into the public healthcare system, may drive appropriate early adoption or curtail inappropriate use. This abstract describes the Agency for Care Effectiveness (ACE)’s experience in conducting early HTAs and key challenges faced.MethodsDuring ACE’s 2021 topic prioritization exercise, ACE took a proactive approach by considering medical technologies identified from horizon scanning (HS) for subsidy evaluation. Two topics were shortlisted from HS. Standard HTA evaluation framework and local clinician consultation were used to define the evaluation scope and clinical pathways. Literature search and appraisal were conducted for safety, effectiveness, and economic evidence. Budget impact estimations and organizational feasibility assessment were additional domains considered for subsidy decision-making by the Ministry of Health Medical Technology Advisory Committee (MTAC).ResultsMTAC did not recommend subsidy for the two technologies due to weak evidence base, largely due to a lack of comparative evidence, small samples, short-term follow-ups, or heterogeneity of population. Additional considerations included potentially high budget impact or organizational feasibility issues such as substantial capital and maintenance cost and infrastructure reconfiguration required. During the evaluation, key challenges of assessing such technologies in their early diffusion within the healthcare system were: (i) differing clinical opinions on whether the technology meets an unmet need; (ii) uncertain place in the clinical management algorithm for the relevant indications; (iii) sparse and weak evidence; (iv) uncertain financial implications to the healthcare system due to a lack of available local costs.ConclusionsEarly HTA on medical technologies identified from HS can be a useful tool to guide subsidy decisions; however, several challenges exist. Careful selection of technologies and timing of evaluation are critical. Seeking stakeholder inputs earlier would ensure shortlisting appropriate technologies with greater clinical need for HTA.
PP138 Awareness Of Health Technology Assessment And Its Predictors Among Medical Students In Public Universities In Klang Valley, Malaysia
Authors: Mohamad Nur Farhana , Mansor Zawiah , Mahmud Aidalina , Ismail Suriani , Mohamed Ghazali Izzuna Mudla , Sarimin Roza 
Published: December 2023

IntroductionLack of awareness has been recognized as one of the most important barriers in the implementation of health technology assessment (HTA) across numerous countries. Medical students have been identified as a vital target group to instill an awareness, basic knowledge, and positive attitude towards HTA from the beginning of their medical career. Presently, there was no study found conducted on HTA awareness in medical students in Malaysia. This study aims to determine the level of awareness of HTA, and its predictors among clinical year medical students in public universities in Klang Valley, Malaysia.MethodsA cross-sectional study using the stratified random sampling method was conducted among clinical year medical students in four public universities in Klang Valley, Malaysia. The data on level of awareness of HTA and its associated factors were collected using a self-administered online questionnaire. Data were analyzed using IBM SPSS version 27 to determine the level of awareness of HTA, its associated factors and predictors.ResultsThe total number of study participants was 323 and the response rate was 90 percent. The analysis showed that 69 percent of respondents had low level of awareness of HTA while 31 percent had high level of awareness of HTA. Factors associated with the level of awareness of HTA was attitude towards HTA (p < 0.001). The predictors of level of awareness of HTA were attitude towards HTA (Adjusted Odds Ratio (AOR) = 7.417, 95% confidence interval [CI]: 3.491, 15.758), peer interaction on HTA (AOR = 0.320, 95% CI: 0.115, 0.888), and previous training on HTA (AOR = 4.849, 95% CI: 1.096, 21.444).ConclusionsThe majority of clinical year medical students in public university have low awareness of HTA which can be predicted by the level of attitude, peer interaction and training of HTA. Therefore, it is important to increase awareness among these future medical practitioners to encourage evidence-based decision-making. Early exposure and introduction of HTA in the current university curriculum in collaboration with a local HTA agency can be recommended to increase awareness as well as to improve students’ attitude towards HTA.