bluuebunny/crossref_metadata_2025_split huggingface dataset:
PD178 Impacts Of COVID-19 On Mental Health Services: Telepsychiatry Efficacy And Substance Use Disorder Challenges In The USA
Authors: Kockaya Guvenc , Okcun Selin , Ozdemir Ekin Begum , Erkut Yaren , Kurnaz Mustafa , Tibet Birol 
Published: January 2025

IntroductionThe COVID-19 pandemic significantly affected mental health, particularly among individuals with existing issues, and altered mental health services. While the direct psychiatric effects of SARS‑CoV‑2 are unclear, there is potential for the virus to cross the blood-brain barrier, raising concerns about neural invasion and inflammation. This study explored these impacts and the implications for future psychiatric disorder epidemiology.MethodsThis study used a mixed-methods approach, combining a literature review on pandemic-related mental health impacts with an analysis of health databases and emergency room records from the USA. It compared pre-pandemic and pandemic data on telepsychiatry, in-person services, emergency visits, and opioid incidents, employing statistical analyses to identify key trends in healthcare utilization during the COVID-19 pandemic.ResultsDuring the COVID-19 pandemic, rates of telepsychiatry visit completion in the USA reached 74.2 percent, which was 6.68 times higher than in-person visits and indicated that telepsychiatry was an effective alternative. The use of in-person mental health services declined by 57 percent, while telehealth services increased by 1,925 percent, with a notable rise in telehealth for people with anxiety disorders. Concurrently, general emergency room visits dropped by 52 percent. In contrast, there was a 34 percent increase in opioid overdose deaths, reaching a record of 96,779 deaths in 12 months, which highlighted ongoing healthcare challenges in treating substance use disorders. The number of emergency room visits for opioid use disorder surpassed the 2019 value by May 2020.ConclusionsThe pandemic significantly shifted mental health services toward telepsychiatry, proving its effectiveness, especially for anxiety disorders. Despite reduced in-person service usage, telehealth played a vital role. However, the period saw heightened challenges in substance use disorders, marked by a significant increase in opioid overdoses and emergency visits for opioid use disorder, which underscored the need for adapted healthcare strategies.
PD185 Is The Incorporation Of Medications For Ultrarare Diseases In Brazil Predominantly Driven By Costs? A Shift In Paradigm
Authors: da Silva Pereira Curado Daniel , Machado-Rugolo Juliana , Komoda Denis Satoshi , de Paula de Sordi Monica Aparecida , Coneglian de Almeida Juliana Tereza , Fonseca Alan , Lima Silvana Molina , Theresa Weber Silke Anna , Modelli de Andrade Luis Gustavo , Tarride Jean-Eric , Thabane Lehana , de Almeida Cardoso Marilia Mastrocolla , Santos Marisa 
Published: January 2025

IntroductionIncorporating technologies for ultrarare diseases (URD) poses challenges for global health technology assessment (HTA) agencies. Difficulties include defining an analytical framework and establishing differentiated cost-effectiveness thresholds. The rise of technological innovations intensifies demands from healthcare professionals, media, and the general population, placing pressure on healthcare systems in developing countries.MethodsTo analyze ultrarare medicine costs in submissions to the Brazilian National Committee for Health Technology Incorporation (CONITEC), data from HTA reports on URD (from 2012 to 2022) were extracted. Diseases were classified as URD based on an epidemiological criterion or Orphanet consultation (prevalence ≤1 per 50,000 inhabitants). Extracted variables included initial and final prices, annual patient cost, incremental cost-effectiveness ratio (ICER), and initial and final CONITEC recommendations. Price differences were calculated by the Brazilian Medicines Market Regulation Chamber.ResultsAmong 53 reports, 30 featured economic evaluations, with only 13.3 percent initially receiving positive recommendations. However, eight gained favor, including post-consultation, price-conditioned, and risk sharing-based approvals. Annual medication costs ranged from USD17,439.20 to USD1,108,237.00 per patient, with discounts of between 25 and 64 percent. Despite some technologies having ICERs that were significantly higher than the national threshold, no statistical relationship was found between ICERs and recommendations. Monthly and annual costs varied, with higher costs for heterogeneous diseases and lower costs for metabolic conditions. Sensitivity analyses, using both deterministic and probabilistic analyses, were conducted in 58 percent of the reports.ConclusionsIncorporation of technologies for URD does not correlate with lower annual costs or increased discounts because costs are not considered in isolation by CONITEC’s decision-making process. Recognizing URD as a subgroup with distinct criteria may enhance the implementation of HTA processes tailored to the unique challenges of these conditions.
PD200 Implications Of The European Artificial Intelligence Act For Health Technology Assessment
Authors: Di Bidino Rossella , Arbia Giuseppe , Sacchini Dario , Cicchetti Americo 
Published: January 2025

IntroductionThe European parliament is working on a proposal for an Artificial Intelligence (AI) Act. The goal is to guarantee that AI systems used in the European Union are “safe, transparent, traceable, non-discriminatory and environmentally friendly.” The Act is not directly linked to health technology assessment (HTA), but implications for HTA are expected.MethodsThe final aim of the AI Act is the adoption of harmonized rules for AI foundation models. Foundation models are designed to produce a wide variety of outputs that are being adopted across various sectors. Therefore, their adaptation to specific (clinical) needs plays a key role and has implications on the required training data. The goal of our analysis was to critically investigate the potential implications of the Act’s requirements for HTA. The analysis moves from the technology (foundation models in health care) to the requirements and adopted terminology.ResultsThe definition of methods to assess the adaptation of foundation models has become a priority for HTA. The Act focuses on data quality, transparency, human oversight, and accountability. Available frameworks, such as the one developed by the AI MIND project, include them, but experience is required. HTA must define how to adapt its methods and frameworks as well as the risk levels addressed by the Act. In addition, the reference to energy efficiency standards confirms the need for HTA to clarify the role of and methods for environmental impact assessment. Finally, the patient perspective has great relevance in relation to the risk of discrimination.ConclusionsThe AI Act confirms the importance of topics already debated in HTA that still need resolution and testing. Harmonization of rules for AI and approaches for HTA is the main challenge. The AI Act, the HTA regulation, and ongoing European Union projects (i.e., AI-MIND and European Digital Health Technology Assessment) are showing the route to follow in the coming years.
PD204 Comparison Of Reimbursement Systems In France Denmark, Norway, And The United Kingdom - Possibilities Of Implementation In Poland
Authors: Rdzanek Magdalena , Chmielewska Magdalena , Dawicki Marcin , Zawada Aleksandra 
Published: January 2025

IntroductionReimbursement schemes should be regularly updated to maintain a trade-off between costs for the system and access to medicines. The aim of this study was to review reimbursement systems in several European countries in terms of solutions that could have a positive impact on the health technology assessment (HTA) and reimbursement processes in Poland (e.g., increasing patient access to medicines while maintaining payers’ spending).MethodsSecondary publications and the websites of key institutions responsible for drug policy (the Ministry of Health, HTA agencies, and payers) in selected European countries were searched to find unique solutions that could have a positive impact on drug policies in Poland. The keywords used were “drug reimbursement” and “HTA”. A more specific search was conducted as needed.ResultsThe following solutions considered worthy of further consideration:•central organization of tenders for hospital drugs and conducting price negotiations with regional financial responsibility;•determining the maximum annual copayment per patient for reimbursed drugs;•complementary private health insurance that reduces patient copayments;•creating a separate path for hybrid drugs in the HTA and pricing processes;•increasing the number of consultations with the market authorization holder, clinical experts, and the public during drug evaluation; and•not accounting for the costs of lost productivity during HTA due to the discrimination of seniors and children.
ConclusionsMinor changes in the HTA process, such as increasing the role of consultations, as well as major systemic changes (e.g., introducing complementary private insurance, creating a separate path for hybrid drugs, and introducing a maximum annual copayment for reimbursed drugs) could improve patients’ access to drugs. Implementing these solutions requires significant adaptation of the local legal framework.
PD205 “Medical Fund” – A Novel Approach To Granting Individuals Access To Cutting-Edge Therapies
Authors: Jachimowicz Michał , Pruszko Cezary , Dziadek Karolina 
Published: January 2025

IntroductionAccess to innovative and expensive medicines is a significant challenge for Poland’s healthcare system. These therapies often do not meet the reimbursement criterion that is currently set at three times the gross domestic product per capita. Nevertheless, there are ongoing efforts to identify funds that can cover the cost of innovative and expensive medicines.MethodsA new legal act established the Medical Fund, which is an addition to the regular National Health Fund. The Medical Fund finances medical technologies recognized by the Polish healthcare system as highly innovative or of high clinical value. Lists of such therapies are prepared by the health technology assessment agency, in consultation with clinical experts, and then approved by the Ministry of Health. Simplified marketing authorization applications based on a budget impact analysis, a more straightforward assessment process, and a separate budget may allow patients to access these therapies faster.ResultsSince January 2022, ten highly innovative therapies have been funded for patients with conditions such as spinal muscular atrophy, acute hepatic porphyria, and primary hyperoxaluria. The reimbursement decisions were issued for a two-year period, during which data on treatment efficacy were collected. If the data collected after two years is insufficient to assess the treatment’s efficacy, the decision can be extended without an additional procedure for another two years. After two or four years, the marketing authorization holder must submit a reimbursement application based on a full health technology assessment report. Risk-sharing schemes based on clinical outcomes are mandatory.ConclusionsThe Medical Fund has granted early access to modern therapies. The decision to continue funding for a particular drug depends on whether registry results confirm data from experimental studies.
PD209 Social Burden Of Inflammatory Bowel Diseases In Poland: Impact Of Changes In Drug Programs On Social Security Expenditures
Authors: Binowski Grzegorz , Strządała Dominik , Dziadek Karolina , Nadzieja-Kozioł Agnieszka , Jakubowska Monika , Pruszko Cezary 
Published: January 2025

IntroductionCrohn’s disease and ulcerative colitis are chronic conditions that primarily affect young individuals of working age and can lead to severe and irreversible complications, which may result in the temporary or permanent inability to work. The objective of this report was to determine whether including broader reimbursement of innovative drugs would result in tangible benefits from a public expenditure perspective.MethodsSocial security and social insurance fund benefits paid to incapacitated patients between 2012 and 2021 were used to measure the effectiveness of the innovative drug reimbursement policy. The analysis included expenditures per patient and the full population. Disability and sickness benefits were classified as public transfers and were not included in the costs for the pharmacoeconomic analyses. However, they are crucial in evaluating the efficacy of treatment for a specific disease because they broaden the perspective of public spending. An increase in social benefit expenses per patient suggests a decline in the patient’s health status, whereas a decrease indicates an improvement.ResultsThe cost of disability benefits for patients diagnosed with Crohn’s disease and ulcerative colitis was approximately EUR5,814 annually. However, the cost of reimbursing drugs used in drug programs per patient was notably lower. The analysis results indicated positive changes in the amount and structure of social benefits for this patient population (e.g., fewer patients receiving disability benefits). This conclusion was further strengthened by an analysis of the data for each province separately.ConclusionsThe expansion of reimbursement for innovative drugs in the treatment of inflammatory bowel disease provides benefits for public spending.
PD215 Assessing Drug Pricing Disparities In Brazil’s Public And Private Healthcare Sectors
Authors: Borin Marcus Carvalho , Martins Carina Rejane , dos Reis Daniel Pitchon , Coelho Ribeiro Geraldo Jose , Tupinambas Julia Teixeira , de Castro Zocrato Karina , de Almeida Carvalho Lelia Maria , de Freitas Marcela Pinto , da Gloria Cruvinel Horta Maria , Barbosa Mariana Michel , Torres Talim Mariza Cristina , Loureiro Bersan Sergio Adriano , Bruschi Kelles Silvana Marcia 
Published: January 2025

IntroductionIn Brazil, equitable access to medications is critical. There are significant pricing disparities between the National Health System and private health care, which are influenced by the National Committee for Health Technology Incorporation (CONITEC) and Law 14.307. This study investigated these disparities, with aim of proposing strategies for equitable access and sustainability in health care.MethodsThis analysis compared prices between the public and private sectors for trastuzumab and adalimumab. Public sector prices were obtained from the Health Prices Database (HPD) and private sector prices were obtained from the Unimed National Table of Materials and Medications (TNUMM), as of May 2023. The study evaluated the extent of pricing discrepancies, considering Drug Market Regulation Chamber ceiling prices and industry discounts.ResultsThe cost of the trastuzumab biosimilar, KANJINTI® (Amgen Inc.), was BRL15.79 (USD3.24) per mg in the private sector, compared with BRL4.50 (USD0.92) per mg in the public sector (a 250% difference). The original version of adalimumab, HUMIRA® (AbbVie), was priced at BRL5,450.38 (USD1,120.53) in the TNUMM versus BRL2,445.46 (USD502.33) in the HPD (a 123% difference). The adalimumab biosimilar, HYRIMOZ® (Sandoz Inc.), was priced at BRL7,723.99 (USD1,586.87) in the TNUMM compared with BRL2,449.19 (USD503.05) in the HPD (a 215% price discrepancy).ConclusionsThe study highlights significant disparities in drug pricing between Brazil’s public and private healthcare sectors. These disparities affect the financial sustainability of private health entities and elevate costs for consumers, potentially increasing reliance on the National Health System. Policy revisions, price parity strategies, and further studies are vital for a sustainable healthcare system.
PD216 Efficiency Frontier Analysis: Supporting Sustainable Non-Small Cell Lung Cancer Healthcare Policies In Brazil
Authors: Borin Marcus Carvalho , Martins Carina Rejane , dos Reis Daniel Pitchon , Coelho Ribeiro Geraldo Jose , Tupinambas Julia Teixeira , de Castro Zocrato Karina , de Almeida Carvalho Lelia Maria , de Freitas Marcela Pinto , da Gloria Cruvinel Horta Maria , Barbosa Mariana Michel , Torres Talim Mariza Cristina , Loureiro Bersan Sergio Adriano , Bruschi Kelles Silvana Marcia 
Published: January 2025

IntroductionInformed healthcare policies in Brazil rely on robust health technology assessment (HTA), especially for conditions like non-small cell lung cancer (NSCLC). We present an efficiency frontier analysis to evaluate NSCLC treatments that correlates annual treatment costs with clinical outcomes, offering a systematic approach to enhance decision-making in the Brazilian healthcare context.MethodsThis quantitative study analyzed NSCLC drug costs within the Brazilian healthcare system and the clinical efficacy data of pivotal studies. The data were analyzed using Python and R software. The dataset comprised drug costs and hazard ratios for overall survival. After data preparation, which involved normalization and outlier management, we constructed an efficiency frontier by ranking drugs based on cost and effectiveness. A linear regression model was then developed to extrapolate this frontier, deriving a formula that predicts treatment costs for specified improvements in overall survival.ResultsThe analysis delineated an efficiency frontier and revealed cost-effective NSCLC treatments in Brazil. The following linear regression equation was derived: overall survival = (1.033551 − 0.000003) × treatment cost (USD). This allows for the estimation of appropriate treatment costs for new therapies based on their expected clinical outcomes. This initial model provides a foundation for estimating the economic impact of new treatments.ConclusionsThis preliminary efficiency frontier analysis offers a novel perspective for evaluating NSCLC treatment strategies in Brazil to support sustainable healthcare policy decisions. The model is subject to limitations due to the absence of a systematic literature review. However, it represents an initial step towards a more comprehensive HTA framework. Further research should refine the model by including systematic data collection and analysis.
PD218 Quantitative Analysis Of The Policy Text For Free Training Of Rural Order-Oriented Medical Students In China
Authors: Li Xiaona , Gao Min , Shao Jiaxian , Yu Yuncong , Yin Wenqiang , Chen Zhongming 
Published: January 2025

IntroductionTo speed up the construction of grassroots medical and health teams in China, free training of rural order-oriented medical students was launched in June 2010. Based on the theory of policy tools, a quantitative analysis of policy texts at the national level was conducted to explore the use of policy tools and to put forward corresponding suggestions for adjustments.MethodsFrom January to February 2023, the research team searched the Peking University Treasure Database and the official websites of the State Council, the National Health Commission, the Ministry of Education, and other ministries for national policy documents related to free training of order-oriented medical students published from June 2010 to May 2023. A policy tool and policy target analysis framework were used to quantitatively analyze the policy documents.ResultsA total of 16 policy documents were included and 213 policy provisions were extracted. From the perspective of policy tools, the proportion of policy provisions using imperative policy tools was the highest (63.4%), followed by advisory policy tools (18.8%). and reward-based policy tools (13.6%). Functional expansion tools (2.8%) and authoritative restructuring tools (1.4%) accounted for a relatively low proportion. The institutional education stage is the main policy target, with provisions accounting for 75 percent (162 articles), followed by the continuing education stage (17.6%; 38 articles), and the postgraduate education stage (7.4%; 16 articles).ConclusionsThe distribution of policy tools for the free training policy of rural order-oriented medical students in China needs to be balanced, and the internal combination of the same policy tools needs to be optimized. The policy targets were mainly concentrated in the education stage of universities.
PD222 Balancing Patient Preferences With Feasible Healthcare Delivery: Using Discrete Choice Experiments Alongside Knowledge Exchange To Inform Care Pathways
Authors: Holmes Emily , Morris Beth , Dixon Pete , Mathieson Amy , Ridsdale Leone , Morgan Myfanwy , McKinlay Alison , Dickson John , Goodacre Steve , Jackson Mike , Hughes Dyfrig , Marson Tony , Noble Adam 
Published: January 2025

IntroductionEmergency department (ED) visits for epilepsy are common, costly, and often clinically unnecessary. Configuration of care pathways (CPs) that could divert people away from ED offer an alternative. The aim was to measure patient and carer preferences for alternative CPs and to explore the feasibility of implementing the preferred CPs in the National Health Service (NHS) England with a wider group of stakeholders.MethodsFormative work (provider survey, service-user interviews, knowledge exchange, and think-aloud piloting) informed a discrete choice experiment (DCE) with six attributes: access to care plan, conveyance, time, epilepsy specialist today, general practitioner (GP) notification, and epilepsy specialist follow-up. This was hosted online with random assignment to two of three scenarios (home, public, or atypical). Logistic regression generated preference weights that were used to calculate the utility of CPs. The highest ranked CPs plus a status quo were discussed at three online knowledge exchange workshops. The nominal group technique was used to ascertain stakeholder views on preference evidence and to seek group consensus on optimal feasible alternatives.ResultsA sample of 427 people with epilepsy and 167 friends or family completed the survey. People with epilepsy preferred paramedics to have access to care plan, non-conveyance, one to three hours, epilepsy specialists today, GP notification, and specialist follow-up within two to three weeks. Family and friends differed when considering atypical seizures, favoring conveyance to urgent treatment centers and shorter time. Optimal configuration of services from service users’ perspectives outranked current practice. Knowledge exchange (n=27 participants) identified the optimal CP as feasible but identified two scenarios for resource reallocation: care plan substitutes specialist advice today and times of strain on NHS resources.ConclusionsPreferences differed to current practice but had minimal variation by seizure type or stakeholder. This study clearly identified optimal and feasible alternative CPs. The mixed-methods approach allowed for robust measurement of preferences, whilst knowledge exchange examined feasibility to enhance implementation of optimal alternative CPs in the future.