bluuebunny/crossref_metadata_2025_split huggingface dataset:
PD22 Economic Evaluation Of Polygenic Risk Scores In Clinical Practice: A Systematic Review
Authors: Isonne Claudia , Iera Jessica , Pierri Francesco , Migliara Giuseppe , Baccolini Valentina , Sciurti Antonio , Siena Leonardo Maria , Leone Immacolata , Marzuillo Carolina , Villari Paolo 
Published: January 2025

IntroductionImplementation of polygenic risk scores (PRS) may improve disease prevention and management, but its benefits and costs are still to be quantified. The review aimed to summarize evidence on the economic evaluation of PRS, exploring how their use impacts healthcare resource utilization, cost outcomes, and overall cost-effectiveness in order to help guide healthcare decision-making and resource allocation.MethodsThe PubMed, Scopus, and Web of Science databases were searched. The search terms were constructed to identify full economic evaluations of healthcare programs containing PRS aimed at assessing the risk of diseases or other health outcomes in any target population. The search strategy was adapted to fit each database’s research criteria. The literature search was supplemented by scanning the reference lists of retrieved articles. No language or date restriction was applied. The database search was rerun just before the final analysis. This research was supported by the European Commission and the Ministry for Universities and Research under the National Recovery and Resilience Plan (M4C2-I1.3 Project PE_00000019 “HEAL ITALIA”).ResultsOf the 1,891 articles screened, seven economic evaluations were included. They were conducted between 2020 and 2022 in Asia (n=1), Australia (n=1), Europe (n=2), and the USA (n=3). The field of application was ophthalmology (n=2), oncology (n=1), cardiovascular (n=2), nephrology (n=1), and endocrinology (n=1). The time horizon was lifetime (57%) or between five and 40 years (43%). The most frequent viewpoint was the health system perspective (n=5). The target populations included healthy people or individuals at risk for a specific disease. Performing PRS tests was found to be a dominant strategy, with lower costs and better health outcomes in all studies.ConclusionsAlthough the integration of PRS in clinical practice seems to be a cost-effective strategy, the small number of studies available and the heterogeneity in the field of application and the target populations limits the generalizability of results. A health technology assessment approach could be useful for summarizing the evidence on all domains of PRS implementation.
PD23 Economic Evaluation Of Prophylactic Immunoglobulin Versus Prophylactic Antibiotics In Hematological Malignancies: Results From The RATIONAL Feasibility Trial
Authors: De Albornoz Sara Carrillo , Higgins Alisa , Petrie Dennis , Irving Adam , Fanning Laura , Weinkove Robert , Crispin Philip , Dendle Claire , Gilbertson Michael , Johnston Anna , Keegan Anastazia , Pepperell Dominic , Pullon Humphrey , Reynolds John , Tonder Tina van , Trotman Judith , Waters Neil , Wellard Cameron , Weston Helen , Morrissey Orla , Wood Erica , McQuilten Zoe 
Published: January 2025

IntroductionPatients with hematological malignancies are at high risk of infections due to both the disease and the associated treatments. The use of immunoglobulin (Ig) to prevent infections is increasing in this population, but its cost effectiveness is unknown. This trial-based economic evaluation aimed to compare the cost effectiveness of prophylactic Ig with prophylactic antibiotics in patients with hematological malignancies.MethodsThe economic evaluation used individual patient data from the RATIONAL feasibility trial, which randomly assigned 63 adults with chronic lymphocytic leukemia, multiple myeloma, or lymphoma to prophylactic Ig or prophylactic antibiotics. The following two analyses were conducted to estimate the cost effectiveness of the two treatments over the 12-month trial period from the perspective of the Australian health system:(i) a cost-utility analysis (CUA) to assess the incremental cost per quality-adjusted life-year (QALY) gained using data collected with the EuroQol 5D-5L questionnaire; and(ii) a cost-effectiveness analysis (CEA) to assess the incremental cost per serious infection prevented (grade ≥3) and per infection prevented (any grade).ResultsThe total cost per patient was significantly higher in the Ig arm than in the antibiotic arm (difference AUD29,140 [USD19,000]). There were non-significant differences in health outcomes between the treatment arms: patients treated with Ig had fewer QALYs (difference −0.072) and serious infections (difference −0.26) than those given antibiotics, but more overall infections (difference 0.76). The incremental cost-effectiveness from the CUA indicated that Ig was more costly than antibiotics and associated with fewer QALYs. In the CEA, Ig costed an additional AUD111,262 (USD73,000) per serious infection prevented, but it was more costly than antibiotics and associated with more infections when all infections were included.ConclusionsThese results indicate that, on average, Ig prophylactic treatment may not be cost effective compared with prophylactic antibiotics for the group of patients with hematological malignancies recruited to the RATIONAL feasibility trial. Further research is needed to confirm these findings in a larger population and over the longer term.
PD27 The Cost Effectiveness Of Non-Hospital Cardiac Rehabilitation: A Systematic Review
Authors: Guirado-Fuentes Carmen , Duarte-Díaz Andrea , Ramos Estefania Herrera , Sacks Analía Abt , García-Pérez Lidia 
Published: January 2025

IntroductionCardiac rehabilitation (CR) with physical exercise is crucial for the secondary prevention of myocardial infarction and heart failure. However, according to published studies there are differences in access to hospital-based CR depending on sex, age, ethnicity, and geographical region. An alternative is CR in non-hospital settings such as primary care, the patient’s home, or another place by means of telerehabilitation.MethodsWe conducted a systematic review of full economic evaluations where non-hospital CR was compared with hospital CR in patients with ischemic heart disease or heart failure. Other eligibility criteria were model-based or clinical trial-based evaluations; studies reporting quality-adjusted life-years, years gained, or other clinical outcomes relevant to CR; and studies published in English or Spanish. Searches were conducted in June 2023 in various literature databases, including MEDLINE, Embase, CINAHL, Web of Science, INAHTA, PEDro, the Cost-Effectiveness Analysis Registry, and others. Study selection, data extraction, quality assessment, and evidence synthesis were conducted by one economist and checked by a second reviewer.ResultsNine studies were selected from the 673 references identified. Another study was identified through previous systematic reviews. Ten randomized clinical trials were included in the review. None of the studies found differences in effectiveness between hospital CR and non-hospital CR. Two studies found that non-hospital CR was less costly than hospital CR, whereas the remainder did not find any differences in costs between the two groups or were unable to demonstrate the statistical significance of any differences observed. The best conducted studies concluded that non-hospital CR was as effective as and less costly than hospital CR.ConclusionsNon-hospital CR was as cost effective as hospital CR for low- to-moderate risk patients. Based on the evidence, CR can be recommended in non-hospital settings. However, any form of CR should be evaluated after implementation because its complexity limits the generalizability of results across regions.
PD32 Incorporating Environmental Factors Into Health Technology Assessment Submissions: A Scoping Review
Authors: Briggs Andrew , Germeni Evi , Chen Jieling 
Published: January 2025

IntroductionA scoping review was conducted to understand which environmental factors are currently being discussed as candidates for inclusion in health technology assessments (HTAs). By mapping the current literature, the results of the scoping review will inform future work to assess the importance policymakers place on aspects of environmental concern.MethodsThe scoping review involved literature searches across three electronic databases (MEDLINE, CINAHL, and PsycINFO), encompassing articles published up to the end of 2023, to identify a starting set of articles. Backward and forward citation searching of relevant studies was then employed to expand the scoping review, with inclusion criteria established to select studies based on the specific focus on HTA. Screening was conducted independently by two reviewers in two stages: title and abstract and then full-text screening. Data extraction involved a structured approach, collating relevant information for thematic analysis.Results
While the scoping review is ongoing, emerging issues included: methods for incorporating environmental pollution externalities into HTAs; the impact of climate change on health outcomes; intergenerational equity of health outcomes and definitions of sustainability; environmental epidemiology; and the potential for technologies to mitigate the impact of climate change. The ongoing thematic analysis will synthesize the results of the scoping review using mapping and categorization to identify knowledge gaps.ConclusionsThe threat of climate change is the greatest issue faced by HTA in a generation, but this challenge is intersectoral and demands an intersectoral response. This paper identifies environmental concerns that might, in principle, be included within the HTA process. Ultimately, the HTA community must do its part to address the environmental crisis we face and move toward a more sustainable future.
PD33 Using Environmental Impact Data To Support Health Technology Assessment At The National Institute for Health and Care Excellence: An Options Appraisal
Authors: Elvidge Jamie , Kenny Juliet , Shah Koonal 
Published: January 2025

IntroductionThe National Health Service (NHS) in England aims to be carbon neutral by 2045, acknowledging the link between planetary and human health. By 2028, NHS suppliers will need to report carbon footprint data for their products, including the medicines and technologies that the National Institute for Health and Care Excellence (NICE) appraises. Additionally, company level data are already being reported. This type of data may provide NICE with an opportunity to support system environmental sustainability goals.MethodsThe NICE Science Policy and Research team conducted an options appraisal to consider the feasibility and acceptability of different ways NICE might engage with environmental impact data (EID). We held discussions with NICE teams that could be affected by the collection and use of EID. Discussions examined the array of potential options for NICE—from being a simple conduit for EID to incorporating EID into its decision-making—and sought to identify those that were practical for further consideration. We then discussed these options with key external stakeholders (NHS England, industry, and commissioners) to understand their expected usefulness and practicality.ResultsSeveral options for NICE to use EID were identified as suitable for further consideration. Using company level data, NICE could encourage companies to engage with NHS sustainability goals by citing their carbon reduction plans alongside guidance or using them to prioritize its activities. Using product level data, NICE could pilot an evaluation comparing the environmental outcomes of competing health technologies that have no differential direct health outcomes. NICE could also publish environmental impact assessment tools to help commissioners consider EID in procurement decisions. Better data and methodological standards are needed before NICE might consider embedding product-level EID in its usual decision-making frameworks.ConclusionsOur options appraisal has identified several ways that NICE might start to engage with EID to have a positive impact on NHS sustainability goals and wider planetary health. Future work will scope out how these activities should proceed. The identified options are not necessarily mutually exclusive and may evolve as the data and methods around sustainable health care continue to advance.
PD34 Ethics In Health Technology Assessment – A Case Study Of Prosthetic Care And Proposal For An Empirical Approach
Authors: Baumann Martina 
Published: January 2025

IntroductionMedical devices cause significant spending in healthcare systems and provide methodological challenges for health technology assessment (HTA). This poster presents the results of a dissertation on the HTA of prosthetic limb technology and care, with a focus on the ethical implications of this aspect of health care. It is also a case study for ethics in HTA more generally, which will contribute to methodological discussions in this field.MethodsThe methodology was based on Hofmann´s Socratic approach and empirical ethics. Literature reviews of HTA reports and ethics and social science literature on limb prosthetics and care were supplemented by semi-structured interviews with 16 prosthesis wearers and 18 stakeholders (e.g., insurance payers and orthopedic technicians) from Germany. This material served to identify and prioritize ethical issues and dive deeper into the causes of unequal access to prosthetic limbs. Beauchamp and Childress´ principlism and Norman Daniels’ theory of just health were used to describe ethical requirements and conflicts and to discuss the limits of normative recommendations that HTA can provide for decision-makers.ResultsThere were 42 ethical aspects related to limb prosthetic technology and care identified, reflecting also general challenges for HTA like artificial intelligence in health and resource scarcity in times of multiple crises. The perspectives of patients and stakeholders provided evidence for unequal access to limb prosthetics that was dependent on socioeconomic status, age, and living region. This is due to a combination of legal framework conditions (not supporting evidence-based reimbursement), socioeconomic success factors in interaction with gatekeepers, non-optimal quality of care (due to lack of data use and scarcity of professionals), and political non-willingness to address rationing–as well as the lack of HTAs.ConclusionsAccess issues in prosthetic care and their implications for patient wellbeing, efficiency, and sustainability may be generalizable to a certain extent to other medical device types and healthcare systems. Governments should provide resources, and synergies with health services research could be leveraged to enable HTA to address the challenges of medical device and ethical assessment.
PD35 A Decade In Review: Assessing The Quality Of Clinical Evidence For Oncology Drugs Submitted To A National Health Technology Assessment Agency
Authors: Eames Heather , Leahy Joy , Trela-larsen Lea , McCullagh Laura 
Published: January 2025

IntroductionTo ensure accurate and objective comparisons between interventions, the best available clinical evidence must be used. This updated analysis sought to review the quality of clinical evidence submitted by applicant companies to a national health technology assessment (HTA) agency in Ireland. This analysis aimed to assess the association between the quality of clinical evidence and the reimbursement recommendation.MethodsA retrospective analysis of the clinical evidence supporting all oncology HTAs submitted to the National Centre for Pharmacoeconomics (NCPE) from May 2012 to December 2023 was conducted. NCPE recommendations were classed as “conditional-positive/positive” or “conditional-negative/negative” for the purposes of this analysis. Data extraction of key clinical evidence characteristics relating to the main clinical trial and indirect treatment comparison (ITC), if applicable, was informed by EUnetHTA guidance. Trends in clinical evidence characteristics were assessed over time. Potential associations between the quality of clinical evidence and reimbursement recommendations were investigated using a hierarchy of chi-squared tests and multivariate regression analysis.ResultsThis analysis included 101 completed HTAs, 84 of which were supported by traditional randomized controlled trials (RCTs). The proportion of HTAs supported by single-arm trials (SATs) increased to 55.6 percent in 2023. HTAs supported by RCTs were more likely to receive a “conditional-positive/positive” recommendation, compared with those supported by SATs (42.8% versus 17.6%). Most of the RCTs were open-label studies (n=49), however recommendations were similar among HTAs supported by blinded and open-label studies. The overall survival data maturity was variable. ITCs were required in 76 HTAs, mostly supported by anchored ITCs. SATs supported by unanchored ITCs were more likely to receive a “conditional-positive/positive” recommendation than naïve comparisons.ConclusionsReliance on SATs and open-label studies has increased over the past decade. This analysis proposes that HTAs supported by RCTs remain the gold standard for HTA. A key limitation of this study is that the quality of evidence submitted is only one domain of the HTA evaluation process. No tests were statistically significant, which was partly explained by the small sample sizes.
PD36 Assigning GRADE Levels To An Overview Of Reviews Using General Principles Identified From Current GRADE Guidelines
Authors: Dullea Andrew , O’Sullivan Lydia , O’Brien Kirsty , Harrington Patricia , McGarry Maeve , Ahern Susan , McGarry Maeve , Walsh Kieran A. , Smith Susan , Ryan Máirín 
Published: January 2025

IntroductionExisting guidelines on overviews of reviews and umbrella reviews recommend an assessment of the certainty of evidence but provide limited guidance on how to apply GRADE to such a complex evidence synthesis. We present one approach to applying GRADE to an overview of reviews developed using general principles derived from current GRADE guidelines.MethodsThe methods were developed in an iterative and exploratory fashion following discussion with 11 methodologists and health services researchers. Key principles were distilled on the five GRADE domains (risk of bias, inconsistency, imprecision, indirectness, and publication bias) from the relevant GRADE guidelines, particularly those on test accuracy.ResultsA ‘general principles’ approach of applying the five domains of GRADE to an overview of reviews and arriving at an overall summary judgment for outcomes was developed. These methods were successfully applied to an overview of reviews on 18F-prostate specific membrane antigen positron emission tomography and computed tomography in the staging of patients with high-risk or recurrent prostate cancer.ConclusionsOur approach distilled key principles from relevant GRADE guidelines and allowed us to apply GRADE to a complex body of evidence. Such an approach may be of interest to other researchers working on overviews of reviews or umbrella reviews.
PD39 First Approach For Assessing Statistical Significance In Industry Funded Matching-Adjusted Indirect Comparison Studies: A Scoping Review
Authors: Farinasso Cecilia , da Rocha Aline , Medeiros Flávia , Marra Lays , Parreira Patricia , Oliveira Layssa , Ferreira Vinicius , Lucchetta Rosa , De Oliveira Junior Haliton Alves 
Published: January 2025

IntroductionWhen indirectly compared trials are too heterogeneous to provide a reliable estimate, matching-adjusted indirect comparison (MAIC) studies can be employed. This technique is commonly used for oncology treatments. MAIC is an indirect comparison that adjusts effect-modifying variables through propensity score methods. The objective of this study was to map the characteristics of MAIC studies in oncology.MethodsWe performed a scoping review of the characteristics of MAIC studies that applied MAIC to compare active treatments in oncology. The literature search was last updated in August 2023 in PubMed, Embase, and the Cochrane Library. We extracted sources of funding, outcomes reported, and whether the results were significantly in favor of the trial for which individual patient data (IPD) were available or for the aggregate data. We then calculated the relative risk (RR) and confidence interval (CI) of an outcome favoring the IPD trial technology that was also funded by industry.ResultsA total of 90 studies were included in the review. The pharmaceutical industry was the most frequent funder (n=78; 87%); the source of the IPD data was not reported in 68 studies (76%). In total, 391 efficacy outcome estimates were reported in base case analyses. The risk of favoring IPD while being funded by industry was 93 percent, while the risk of favoring IPD while having other sources of funding was 61 percent (RR 1.520, 95% CI: 1.146, 2.016; p=0.004). Specifically, the RR was 1.246 (95% CI: 0.891, 1.743) for overall survival and 1.426 (95% CI: 0.959, 2.120) for progression-free survival.ConclusionsMAIC results are influenced by the choice and number of effect-modifying variables used for matching the population. National Institute for Health and Care Excellence guidelines consider it necessary to provide evidence that the matched estimate will be less biased than the unmatched one. We have concluded that industry funded MAIC studies may be more likely to report results favoring IPD than studies with another funding source.
PD50 Does The New Healthcare Reform Improve Job Satisfaction Among Village Clinic Doctors In China? A Meta-Analysis
Authors: Zhou Lifang , Yu Yuncong , Liu Junping , Shao Jiaxian , Yin Wenqiang , Yu Qianqian , Chen Zhongming 
Published: January 2025

IntroductionSince 2009, the Chinese government has launched a new health system reform that affected primary healthcare significantly. We aimed to analyze the factors associated with job satisfaction among village clinic doctors since the new healthcare reform, and to provide a reference for the next stage of reform.MethodsWe systematically searched one English (PubMed) and two Chinese literature databases (CNKI and Wanfang Data). Cross-sectional studies containing information related to job satisfaction among village clinic doctors in China were included. The total job satisfaction among village clinic doctors was estimated using a random effects meta-analysis. Differences in study-level characteristics among groups were estimated using subgroup analysis and meta-regression.ResultsWe identified 17 cross-sectional studies investigating a total of 28,468 village clinic doctors in China. The pooled job satisfaction value was 0.40 (95% confidence interval [CI]: 0.32, 0.49). The results showed that lower job satisfaction was reported in the period from 2016 to 2020 (0.33, 95% CI: 0.23, 0.42) than in the period from 2010 to 2015 (0.51, 95% CI: 0.33, 0.70). The main factors influencing job satisfaction among village clinic doctors were salary (odds ration [OR] 1.71, 95% CI: 1.23, 2.36), number of training sessions (OR 2.56, 95% CI: 1.68, 3.90), age (OR 3.45, 95% CI: 2.22, 5.35), and level of education (OR 0.68, 95% CI: 0.40, 1.15).ConclusionsSince the new health system reform, only 40 percent of village clinic doctors in China are satisfied with their work and it is likely this figure will continue to decrease. Those with higher salaries, more training sessions, and greater age had higher job satisfaction. In contrast, village clinic doctors with a higher level of education had lower job satisfaction.