bluuebunny/crossref_metadata_2025_split huggingface dataset:
PP08 Evaluation Of Nutritional Status In Diabetic And Non-Diabetic Chronic Kidney Disease Patients Using A Web Tool
Authors: Rashid Ishfaq , Tiwari Pramil , D’Cruz Sanjay , Jaswal Shivani 
Published: December 2022

IntroductionPoor nutritional status, a complex consequence of numerous interrelated factors, is poorly characterized in patients with chronic kidney disease (CKD) before they commence dialysis. This study aimed to characterize the risk factors and prevalence of malnutrition among patients with CKD, with or without diabetes mellitus, before they underwent dialysis at a tertiary care public teaching hospital.MethodsThis longitudinal observational study utilized a Pt-Global web tool© to assess the nutritional status of patients based on their Subjective Global Assessment score as follows: a score of two to three indicates that patient and family education is required; scores of four to eight mean that intervention is required as indicated by symptoms; and a score of nine or more indicates a critical need for intervention. Glomerular filtration rate calculated using the Chronic Kidney Disease Epidemiology Collaboration equation was used as the measure of kidney function. Multinomial regression analyses were used to ascertain the predictors of poor nutritional status.ResultsA total of 450 patients (265 men and 185 women) who had CKD, with or without diabetes, and were not on dialysis were recruited during the period of study. The average age of the patients was 53.9 years (standard deviation 14.2). ‘Severe’ malnutrition was present in 152 (33.8%) patients, while 140 (31.1%) were ‘mildly or moderately’ malnourished, and 158 (35.1%) were ‘well-nourished’. Patients with CKD and diabetes were more severely malnourished: 68 were rated as mild or moderate (15.1%) and 91 were rated as severe (20.2%). The prevalence of malnutrition increased with the decline of residual renal function. Fatigue, loss of appetite, pain anywhere in the body, constipation, dry mouth, feeling full quickly, and physical and functional inactivity were the most common risk factors for poor nutritional status.ConclusionsThis study presents real-world evidence of poor nutritional status in patients with CKD and confirms that it is more common in individuals who are diabetic and have poor kidney function and hypoalbuminemia. Emphasis on nutrition in patients with CKD is important for improving their health.
PP09 Use Of Real-World Evidence For Managing Health Technologies Throughout The Life Cycle Of Transcatheter Aortic Valve Interventions
Authors: de Verteuil Danielle , Azzi Leila , Lambert Laurie , Boothroyd Lucy , Duranceau Marie-France , Pagé Élisabeth , Truchon Catherine 
Published: December 2022

IntroductionA Cardiology Evaluation Unit was established in 2004 within Québec’s Institut national d’excellence en santé et en services sociaux (INESSS) with a novel mandate to collect real-world evidence (RWE) to complement literature-based health technology assessment. In 2010 following publication of the seminal PARTNER trial, INESSS was mandated by the health ministry to review the evidence on transcatheter aortic valve intervention (TAVI) for patients with aortic stenosis. Herein we show how RWE was used to evaluate health system performance throughout the technology’s life cycle and inform organizational and clinical decisions.MethodsVarious products were diffused by INESSS over the years: a guidance (2012), an updated literature review (2017) and provincial standards (2017), in parallel with RWE reports covering TAVI use from 2013-2015, from 2013-2018, and a 2021 RWE report combined with administrative data covering transcatheter and surgical treatment of aortic stenosis from 2013-2019.ResultsBased on the guidance’s review of evidence, TAVI was initially recommended for patients considered at too high risk for the surgical approach, under the condition of continued evidence generation to address uncertainty. The subsequent literature review update highlighted that the indication for TAVI had been extended to patients at moderate surgical risk. INESSS produced standards in collaboration with clinical experts to optimize and harmonize the use of TAVI in designated centers. Evaluation of structures, processes and outcomes by INESSS continued until 2019, showing a continuous increase in the use of TAVI, improved short-term survival, and careful patient selection via a multidisciplinary process. RWE also highlighted the impact of TAVI on the overall organization of care for patients with aortic stenosis, as selection criteria further expanded to patients at lower surgical risk, raising important issues regarding patient selection processes, wait times, and longer-term outcomes.ConclusionsTAVI clinical practice is constantly evolving and leads to changes in the management of aortic stenosis. RWE provided essential organizational and clinical input to inform clinical guidance and decision-making by Québec policy-makers, clinicians and patients.
PP16 Machine Learning In The Treatment Of Spinal Deformities: Early Life-cycle Economic Analysis In Australia
Authors: Joglekar Rashmi , Shikule Aaron 
Published: December 2022

IntroductionPatients with spinal deformity require implanted spinal rods to be specifically shaped to their anatomy. Spinal rods which are manually shaped in the operating theatre are prone to fracture and malpositioning. This emphasizes the need for preoperative planning, intraoperative imaging, and accurate shaping of the implant. The application of machine learning (ML) has enabled precision in shaping patient-specific rods, with the potential to reduce adverse events. Our objective is to assess the economic value of this technology, early in its lifecycle, in the context of Health Technology Assessment (HTA) in Australia.MethodsA budget impact analysis was performed to quantify the economic value of patient-specific spinal rods from an Australian payor perspective. Clinical outcomes were sourced from literature review, and cost inputs were obtained from Medicare, Private Health Data Bureau and Hospital Casemix Protocol Data databases.ResultsPreliminary analysis indicates that a reduction in the rate of revision surgery due to decreased instrument failure results in cost-savings to the healthcare system, despite a higher outlay for the patient-specific rods. Adolescents who may have remained sagittally malaligned after the implantation of manually bent rods are expected to derive the greatest benefit from this ML application. The key uncertainty in this analysis is the limited real-world data of this emerging technology. ML is an iterative process of continuous improvement, identifying correlations within the data collected. As additional surgical data are integrated into predictive models, we anticipate ML technology will enhance decision-making support in surgical strategy and enable better implant precision, resulting in further decreased operating time, reduced mechanical complications, and increased healthcare savings.ConclusionsML technology is enabling precision in patient-specific implants, which is expected to drive healthcare cost-savings due to a reduction in instrument failure. Fewer replacement surgeries are an important patient-relevant outcome, especially for adolescents with spinal deformity. This preliminary analysis demonstrates the economic value of ML enabled patient-specific rods to Australian payors, early in its lifecycle.
PP20 Effectiveness And Safety Of Autogenic Training As A Treatment For Medical Conditions
Authors: Alvarez-Perez Yolanda , Rivero-Santanta Amado , Perestelo-Perez Lilisbeth , Duarte-Diaz Andrea , Ramos-García Vanesa , Torres-Castaño Alezandra , Toledo-Chávarri Ana , González-González Nerea , Rodríguez-Rodríguez Leticia , González-Rodríguez Carlos , Serrano-Aguilar Pedro 
Published: December 2022

IntroductionAutogenic training consists of reaching a state of deep relaxation through mental representations of physical sensations in different parts of the body. It is a promising technique for improving the psychological well-being of people with chronic diseases, but there are no clinical practice guidelines recommending the use of autogenic training in this population. The aim of this work was to identify, critically evaluate, and synthesize the available evidence on the safety and effectiveness of autogenic training in the prevention and treatment of medical conditions.MethodsWe conducted a systematic search for systematic reviews and randomized controlled trials (RCTs) in MEDLINE, Embase, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials. The selection and assessment of risk of bias of the included studies was carried out independently by two reviewers.ResultsA total of 2,420 references were identified after eliminating duplicates. Of these, 141 were selected for reading the full text, and 13 systematic reviews and 18 RCTs were included. Compared with no intervention or delayed treatment, autogenic training significantly reduced levels of anxiety and depression as well as some physical symptoms (e.g., headaches and atopic dermatitis).ConclusionsAutogenic training could be useful for improving the psychological well-being and physical symptoms of patients with chronic health conditions and as an additional element in multicomponent intervention programs. However, these conclusions are not definitive due to the low number of studies available for each health condition and their high or unclear risk of bias.
PP26 Cost Utility Of Vaccination Against COVID-19 In Brazil
Authors: Fernandes Ricardo , Santos Marisa , Magliano Carlos Alberto , Thura Bernardo , Macedo Luana , Padila Matheus , França Ana Claudia , Braga Andressa 
Published: December 2022

IntroductionThe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), is a single-strand ribonucleic acid virus that was first identified in January 2020 in patients with viral pneumonia in Wuhan, China. The virus has since spread rapidly around the world, leading the World Health Organization to declare it a pandemic on 11 March 2020. In Brazil there have been 21.8 million cases of SARS-CoV-2 infection and 608,500 deaths. The objective of this study was to evaluate the cost utility of the Oxford, CoronaVac, and Janssen vaccines from the perspective of the Brazilian public health system.MethodsThree microsimulation models were constructed using individual data. The simulations contained seven transition states related to the natural history of COVID-19. The model with a daily cycle had a time horizon of one year and used data from 289 days of the pandemic. The analysis considered direct medical costs from the Brazilian health system perspective. Outpatient, hospital, and mortality databases were used for the model inputs and patient data were stratified by age. Effective vaccines reduced the likelihood of patients becoming ill. Information on the quality of life of patients receiving treatment in the outpatient or hospital setting and disease sequelae were extracted from the published literature. The main outcome of the analysis was quality-adjusted life-years (QALYs).ResultsThe vaccines had incremental cost-utility ratios ranging from USD 4,121 (Oxford) to USD 3,160 per QALY (CoronaVac). The older the population, the lower the incremental cost-utility ratio. Given a willingness-to-pay threshold of BRL 3,129 per QALY, all the vaccines were considered cost effective in the probabilistic sensitivity analysis. The incremental cost-effectiveness ratio stratified by age ranged from USD 6,327 per QALY in patients older than 75 years (Janssen) to USD 20,993 per QALY in patients younger than 59 years (CoronaVac).ConclusionsThe results of this analysis, stratified by patient age, can help in the preparation of a vaccination prioritization plan.
PP35 Defecography (Evacuation Proctography) For The Evaluation Of Pelvic Floor Disorders: A Literature Review
Authors: Akhmedullin Ruslan , Avdeyev Andrey , Benberin Valeriy , Shanazarov Nasrulla , Bariyeva Gulzada , Okesh Makhabbat , Akhmetova Makpal , Aimanova Tansolpan 
Published: December 2022

IntroductionPelvic floor diseases (PFD) often affect the adult population, with approximately 50 percent of women aged 50 years and older suffering from PFD. The condition has complex symptoms that may lead to stress and a negative impact on the quality of life. The USA spends about USD 1 billion annually on inpatient costs as a result of more than 700,000 emergency department visits and 50,000 hospitalizations associated with PFD. Defecography is currently the most commonly used method of diagnostic imaging used to evaluate PFD. This technology is not available in the Republic of Kazakhstan, despite its high diagnostic value.MethodsIn order to assess the clinical effectiveness of defecography, we have conducted a literature search in the MEDLINE database. We selected articles with pairwise comparisons of defecography with other tests: anorectal manometry; balloon expulsion test; electromyography; magnetic resonance imaging (MRI); and, ultrasound.ResultsThe findings are primarily based on two meta-analysis (91 studies representing 10,768 cases). The results have been evaluated according to the detection frequency and omission of the following signs: cystocele, middle compartment descent, rectocele, intussusception, rectal prolapse, enterocele, and perineal descent. The literature review did not reveal significant difference in diagnostic value between MR defecography and defecography based on X-ray. However, the imaging endpoints (detection rate of structural and functional abnormalities) for defecography based on X-ray were significantly better than plain radiography.ConclusionsThe defecography is currently considered the gold standard and the most commonly used tool of diagnosis. The implementation does not require an expensive equipment purchase (MR defecography) and is reproducible on conventional X-ray equipment if the necessary inventory is available.
PP40 Health Apps To Manage Depression: Can We Separate The Grain From The Chaff? EvalDepApps Project
Authors: Carrion Carme , Sales-Masnou Ariadna , Eis Sophie , Robles Noemí , Puigdomènech Elisa , Duarte-Díaz Andrea , Vidal-Alaball Josep , Perestelo Lilisbeth , Davins Meritxell , Solà-Morales Oriol 
Published: December 2022

IntroductionThe use of mobile applications in the treatment of health issues is more frequently becoming common practice. Apps are fast, versatile, and manageable tools that allow the empowerment of patients and professionals, and can reduce the possible stigmatization suffered by some patients, mainly in mental health. There are more than 325,000 health apps on the market, but their impact remains unclear. There are several initiatives to define how health applications should be assessed, however, all of them address only partial aspects of the evaluation. The theoretical frameworks existing to date highlight the need to develop new tools and methodologies to assess mobile applications whose objective is the management of specific pathologies.MethodsThe primary goal of the EvalDepApps project is to develop and pilot an assessment tool for mobile applications whose main objectives are the treatment, monitoring or social support of people suffering from depression. The project is inspired by the results and lessons learnt from a previous project, EVALAPPS, whose central aim was to develop a tool to assess health apps targeted toward the management of overweight and obesity. The first steps of the EvalDepApps project are: (i) to explore and characterize the current landscape of mobile applications available in the market to treat depression through a systematic appraisal, and (ii) to review the existing evidence about the effectiveness and safety of these applications through systematic research of the existing evidence.ResultsPreliminary results show that all the depression management studies were by design based on cognitive-behavioral therapy (CBT) interventions (n=17) and the main management tools included in the services (web or apps) are psychoeducation and coaching (14), together with self-monitoring and feedback messaging (13).ConclusionsMoreover, although health apps seem to be an interesting strategy to treat depression, there are very few apps available on the markets (30) and the supporting evidence is very limited. This result uncovers a need for further systematic and clinically oriented validation and testing of such apps.
PP43 Impact Of The COVID-19 Pandemic In The Brazilian National Committee for Health Technology Incorporation (Conitec) Recommendation Process
Authors: Cardoso Marilia , Thabane Lehana , Rugolo Juliana , Curado Daniel , Modelli Luis Gustavo , Lima Silvana , Weber Silke 
Published: December 2022

IntroductionHealth Technology Assessment (HTA) Process assists decision-making in health policies. The COVID-19 pandemic caused a high demand on protocol or guideline updates and incorporation of new drugs or therapies, overwhelming local agencies. A recent study reported that major HTA bodies in England, Scotland, Germany, and Canada reduced their number of drug recommendations in 2020, due to reprioritization of resources and COVID-related challenges. The present study aimed to evaluate the impact of the COVID-19 pandemic at the Brazilian National Committee for Health Technology Incorporation (Conitec) recommendation process.MethodsThis descriptive study evaluated all official recommendation reports available on the Government website in 2020 and 2021, extracting the data of disease category, technology type, the aim of the report, Public Involvement, and final result for the recommendation. The results were presented in tabular and graphical form using the machine learning, through the software R studio and excel.ResultsA total of 168 documents were evaluated, including guidelines and recommendation reports, with no reduction in the number of evaluations considering 2019. In 2020, there was a more significant evaluation of guidelines, and in 2021, a report on the non-incorporation of technologies. There were four specific documents about COVID 19, including vaccines and hospital care guidelines. The most incorporated and non-incorporated technologies were medication, targeting rare and highly prevalent diseases in balance. The Brazilian government was the main proposer. These results are part of the study “A Survey about the core methods of the recommendation reports for Brazilian Ministry of Health carried out by Brazilian Health Technology Assessment Centers”, which will characterize and analyze the core methods of the recommendation reports conducted by the Brazilian HTA Centers.ConclusionsThe pandemic had a low impact on demands in the routine of the Conitec. Establish indicators and technological norms applicable to health services, contribute to the identification of possible new practices, methods or criteria.
PP46 INEAS Guidelines For Pharmacoeconomic Evaluation: Focus On Health-Related Quality of Life Recommendations
Authors: Chemli Jaafar , Harzallah Nabil , Grati Hela , Jebali Marie Christine , Jameleddine Mouna , Hamouda Chokri 
Published: December 2022

IntroductionIn many low- and middle-income countries scarcity of local data on health outcomes and health-related quality of life (HRQoL) is a hindrance to conducting cost-effectiveness analyses. The Tunisian National Authority for Accreditation and Assessment in Healthcare (INEAS) developed a set of methodological guidelines to support pharmaceutical companies in the submission of health technology assessment (HTA) dossiers. The guidelines include INEAS’ methodological choices for pharmacoeconomic analysis, which take into consideration the specificities and constraints of the Tunisian context. We aimed to present the principal recommendations of the Tunisian guidelines for pharmacoeconomic studies, with a focus on patient-reported outcome and HRQoL measurement.MethodsThe INEAS pharmacoeconomic analysis guidelines were reviewed and the recommendations regarding outcome measurement and HRQoL were retrieved and reported.ResultsTo populate the economic model, INEAS recommends using the best available evidence. Health outcomes should be measured in terms of life-years gained and quality-adjusted life-years (QALYs); disability-adjusted life-years can be used but are not the preferred method. To estimate QALYs, INEAS favors the indirect measure of patient preferences with a validated measurement instrument. Alternatively, other measures of utility may be used, including those identified through a systematic review of the scientific literature and the publications of other HTA agencies. Justification and details of the source of the data must be provided. The utility values selected should be recent and representative of the Tunisian population, as far as possible. The guidelines refer to a set of generic preference-based HRQoL instruments, including the EuroQol five-dimensions (EQ5D), the Health Utilities Index Mark 2 (HUI2) and Mark 3 (HUI3), and the Short-Form Six-Dimension (SF-6D), but do not provide any explicit recommendations on their use.ConclusionsThe INEAS pharmacoeconomic analysis guidelines adhere to international best practices but provide more flexibility for overcoming the lack of local data. The INEAS economic guidelines constitutes a further milestone in the process of implementing HTA in Tunisia and in the Middle Eastern and African regions.
PP51 Strengths And Limitations Of Migraine Management Guidelines In The USA and Europe: A Targeted Literature Review
Authors: Perry Richard , Mills Kayla , Ford Janet H. , McCosh Zach 
Published: December 2022

IntroductionMigraine, the second leading cause of disability worldwide, remains underdiagnosed and undertreated. Considering the high burden of migraine, we analyzed the strengths and limitations of existing migraine management guidelines.MethodsA targeted literature review was conducted using MEDLINE on 24 March 2021 to identify current migraine management guidelines (including policies and position statements) published in the English language from France, Germany, Italy, Spain, the United Kingdom, and the USA. This was supplemented by a gray literature search. Disease state or pharmacological management guidelines for adults with migraine comprising any of the following perspectives were included: health economics; payer; health technology assessment; treatment access; and impact of guideline implementation on economic or disease burden. Guidelines were analyzed using the Centers for Disease Control and Prevention (CDC) policy analytical framework, which comprises three domains: problem identification, policy analysis, and strategy or policy development, with ranking criteria for each.ResultsOf 39 selected guidelines, 25 adequately identified problems related to migraine, 35 sufficiently reviewed the literature on migraine treatment, three failed to cite literature, and one lacked sufficient content. Twenty-three guidelines targeted healthcare professionals. Almost all guidelines lacked a stepwise migraine treatment approach; only the American Academy of Family Physicians guideline offered first- and second-line treatment options. Four guidelines mentioned current political forces, and coverage of economic or budgetary impact aspects was limited. Numerous guidelines described the substantial economic burden of migraine and were categorized as ‘high’ for benefits. Public health impact was categorized as ‘high’ for 28 guidelines and budgetary impact was rated as ‘more favorable’ for 27 guidelines. Thirteen guidelines defined a strategy for the intended purpose. Only the United States Department of Health and Human Services pain management guideline met all of the CDC criteria.ConclusionsFuture policies on migraine management may benefit from the inclusion of information on economic data, political feasibility, and public health impact. Furthermore, migraine management guidelines could potentially be improved by considering a comprehensive treatment approach and guideline implementation, as well as addressing knowledge gaps in disease state, public health, and economic aspects.