Search

Introduction: Access to medicines is a shared goal across healthcare stakeholders. Since health technology assessment (HTA) informs funding decisions, it shapes access to medicines. Despite its wide implementation, significant access variations due to HTA are observed across Europe. This paper elicited the opinions of European stakeholders on how HTA can be improved to facilitate access. Methods: A scoping review identified HTA features that influence access to medicines within markets and areas for improvement, while three access dimensions were identified (availability, affordability, timeliness). Using the Delphi method, we elicited the opinions of European stakeholders to validate the literature findings. Results: Nineteen participants from 14 countries participated in the Delphi panel. Thirteen HTA features that could be improved to optimise access to medicines in Europe were identified. Of these, 11 recorded a positive impact on at least one of the three access dimensions. HTA features had mostly a positive impact on timeliness and a less clear impact on affordability. 'Early scientific advice' and 'clarity in evidentiary requirements' showed a positive impact on all access dimensions. 'Established ways to deal with uncertainty during HTA' could improve medicines' availability and timeliness, while more 'reliance on real-world evidence' could expedite time to market access. Conclusions: Our results reiterate that increased transparency during HTA and the decision-making processes is essential; the use of and reliance on new evidence generation such as real-world evidence can optimise the availability of medicines; and better collaborations between regulatory institutions within and between countries are paramount for better access to medicines. [ABSTRACT FROM AUTHOR]

The Half-Transform Ansatz (HTA) is a proposed method to solve hyper-geometric equations in Quantum Phase Space by transforming a differential operator to an algebraic variable and including a specific exponential factor in the wave function, but the mechanism which provides this solution scheme is not known. Analysis of the HTA’s application to the Hydrogen atom suggests an underlying mechanism which the HTA is a part of. Observations of exponential factors that act on the wave function naturally suggest modeling quantum operator definitions as a point on a Riemannian manifold in the 4D Operator Space, a novel idea we call the Operator Space Manifold Theory. On this manifold, we explore the concepts of superposition, regions of unique energy eigenvalues, and translation operators. We also find the theoretical backing to derive the HTA and how Operator Space Manifold Theory can be used to describe and solve quantum systems by manipulating how a quantum state perceives position and momentum. [ABSTRACT FROM AUTHOR]

In response to rapidly rising pharmaceutical costs, many countries have introduced health technology assessment (HTA) as a 'fourth hurdle'. We evaluated the causal effect of HTA based regulation on access to pharmaceuticals by using the introduction of Germany's HTA system (AMNOG) in 2011. We obtained launch data on pharmaceuticals for 30 European countries from the IQVIA (formerly IMS) database. Using difference-in-difference models, we estimated the effect of AMNOG on launch delay, the ranking order of launch delays and the availability of pharmaceuticals. We then compared the results for Germany to Austria, Czechia, Italy, Portugal and the UK. Across all six countries, launch delay decreased from the pre-AMNOG period (25.01 months) to the post-AMNOG period (14.34 months). However, the introduction of AMNOG consistently reduced the magnitude of the decrease in launch delay in Germany compared to the comparator countries (staggered DiD: + 4.31 months, p = 0.05). Our logit results indicate that the availability of pharmaceuticals in Germany increased as a result of AMNOG (staggered logit: + 5.78%, p = 0.009). We provide evidence on the trade-off between regulation and access. This can help policymakers make better informed decisions to strike the right balance between cost savings achieved through HTA based regulation and access to pharmaceuticals. [ABSTRACT FROM AUTHOR]

Since the groundwork published by Torres-Vega and Frederick, the Quantum Phase Space Representation (QPSR) has been explored as a method for solving a multitude of physical systems and describing phenomena. Most recently, Valentino A. Simpao has developed a method, the Heaviside Operational Ansatz, to solve the Time Dependent Schrodinger Equation (TDSE) in the QPSR, but there are still no general, direct methods to solve the Time Independent Schrodinger Equation in the QPSR. There is also no current formulation of quarkonium in phase space. In this paper, we describe the strong interactions of non-relativistic heavy quarks using the Cornell potential, and present a method, the Half-Transform Ansatz, to cast the Schrodinger Equation into a hyper-geometric form which can be solved for the phase space wave function and its energy eigenvalues using the Nikiforov-Uvarov method. This solution can be generalized for any two particle system with a scleronomic potential made up of polynomial and reciprocal terms. These results are compared to experimental results and other theoretical models. We also analyze the behavior of these wave functions, which suggest a correlation between radial momentum and the upper limit of existence in charm-anticharm mesons. [ABSTRACT FROM AUTHOR]

Purpose: 2021 marks the tenth anniversary of the AMNOG process and brought with it a new German administration—two good reasons to take stock of where we stand today, what has been achieved so far, and how the path of early benefit assessments in Germany should continue. Results: From the perspective of manufacturers of cancer drugs, the AMNOG process, as a constantly evolving system, has for the most part proved itself—which does not mean that there is no longer room for improvement. Significant improvements have been achieved in the area of early consultation of medical societies regarding the selection of the appropriate comparator therapy as well as in the reimbursement of biomarker diagnostic tests in the outpatient sector. However, there is still a need for improvement, especially in the areas of patient-relevant outcomes accepted by the G-BA, the inclusion of real-world data in evidence assessments, or the transfer of evidence from certain patient groups to others. Conclusion: The current AMNOG structures were developed for the most part at a time when no one saw immuno-oncology or gene and cell therapies coming, when there were no multi-tumor drug approvals, and when few imagined that within a few years, the established tumor entities would be broken down into dozens of sub-entities on the basis of molecular genetic markers. Society wants these and other advances, and the HTA process must, therefore, take this into account in a healthcare system based on solidarity. [ABSTRACT FROM AUTHOR]

Background: The present paper aims at evaluating the potential benefits of high-energy devices (HEDs) in the Italian surgical practice, defining the comparative efficacy and safety profiles, as well as the potential economic and organizational advantages for hospitals and patients, with respect to standard monopolar or bipolar devices. Methods: A Health Technology Assessment was conducted in 2021 assuming the hospital perspective, comparing HEDs and standard monopolar/bipolar devices, within eleven surgical settings: appendectomy, hepatic resections, colorectal resections, cholecystectomy, splenectomy, hemorrhoidectomy, thyroidectomy, esophago-gastrectomy, breast surgery, adrenalectomy, and pancreatectomy. The nine EUnetHTA Core Model dimensions were deployed considering a multi-methods approach. Both qualitative and quantitative methods were used: (1) a systematic literature review for the definition of the comparative efficacy and safety data; (2) administration of qualitative questionnaires, completed by 23 healthcare professionals (according to 7-item Likert scale, ranging from − 3 to + 3); and (3) health-economics tools, useful for the economic evaluation of the clinical pathway and budget impact analysis, and for the definition of the organizational and accessibility advantages, in terms of time or procedures' savings. Results: The literature declared a decrease in operating time and length of stay in using HEDs in most surgical settings. While HEDs would lead to a marginal investment for the conduction of 178,619 surgeries on annual basis, their routinely implementation would generate significant organizational savings. A decrease equal to − 5.25/−9.02% of operating room time and to − 5.03/−30.73% of length of stay emerged. An advantage in accessibility to surgery could be hypothesized in a 9% of increase, due to the gaining in operatory slots. Professionals' perceptions crystallized and confirmed literature evidence, declaring a better safety and effectiveness profile. An improvement in both patients and caregivers' quality-of-life emerged. Conclusions: The results have demonstrated the strategic relevance related to HEDs introduction, their economic sustainability, and feasibility, as well as the potentialities in process improvement. [ABSTRACT FROM AUTHOR]

Introduction: New requirements in Canada's pricing processes for patented drugs may exacerbate delays in regulatory and reimbursement reviews. This study seeks to better understand the impact of any additional delays on non-small cell lung cancer (NSCLC) patients by measuring the following: (a) durations and outcomes of regulatory and reimbursement reviews of NSCLC drugs in Canada and reference countries; (b) delays in Canada's reviews of three NSCLC drugs (nivolumab, afatinib, and pemetrexed [NAP]); and (c) estimating clinical, patient, and economic impacts of delays in Canada's reviews on access to NAP. Methods: Information from the Context Matters database and the literature (2005–2020) was used to evaluate the durations and outcomes of reimbursement reviews of NSCLC drugs in Canada and comparator countries. Public information was used to assess delays in Canada's reviews of NAP. Empirical modeling with data from the literature and the Southern Alberta Lung Cancer database was used to estimate the impact of delays in Canada's NAP reviews on patients (i.e., as losses in person-years of life and quality-adjusted life-years [QALYs]). Results: Regulatory and reimbursement reviews in countries of interest take 12–18 months. In Canada, reviews of NSCLC drugs took 216 days (median), with a 24% rejection rate (mean = 19%). Delays in NAP reviews ranged from 5 to 94 days at Health Canada, 0–80 days at CADTH/pCODR, and 12–797 days in Canadian provinces. These delays may have affected 6400 patients, who lost up to 1740 person-years of life and 1122 QALYs (valued at CA$112 million). Conclusion: Changes to Canada's prescription drug pricing processes may prolong reviews. [ABSTRACT FROM AUTHOR]

By using a case-study on a fall-prediction device for elderly patients with orthostatic hypotension we aim to demonstrate how the MAFEIP tool, developed as part of the European Innovation Programme on Active and Healthy Ageing (EIP on AHA), can be used to inform manufacturers on their product development based on a cost-effectiveness criterion. Secondly, we critically appraise the tool and suggest further improvements that may be needed for a larger-scale adoption of MAFEIP within and beside the EIP on AHA initiative. The model was implemented using the MAFEIP tool. Within the tool one way sensitivity analyses were performed to assess the robustness of the model against the relative effectiveness of the fall-prevention device at different price levels. The MAFEIP tool was applied to a novel fall-prediction device and used to estimate the expected cost-effectiveness and perform threshold analysis. In our case study, the device produced estimated gains of 0.035 QALYs per patient and incremental costs of £ 518 (incremental cost-effectiveness ratio £14,719). Based on the one-way sensitivity analysis, the maximum achievable price at a willingness to pay threshold of £20,000 per QALY is estimated close to £900. The MAFEIP allows to quickly create early economic models, and to explore model uncertainty by performing deterministic sensitivity analysis for single parameters. However, the integration within the MAFEIP of common analytical tools such as probabilistic sensitivity analysis and Value of information would greatly contribute to its relevance for evaluating innovative technologies within and beside the EIP on AHA initiative. [ABSTRACT FROM AUTHOR]

Purpose: Centrally authorised medicinal products (CAMPs) in the European Union may offer added therapeutic value (ATV) but may be linked to high prices and limited efficiency. Health technology assessment (HTA) and managed entry schemes (MES) may facilitate the reimbursement decision by providing reliable estimates of the medicinal product's value and costs and by controlling the remaining uncertainty, respectively. We investigated the impact of HTA criteria and the initiation of a MES on the reimbursement decision of CAMPs in Belgium. Methods: We selected all reimbursement submissions for new centrally authorised medicinal products in the 2010–2015 period. We retrieved data relating to the reimbursement decision, the HTA outcome and the use of a managed entry scheme. Results: The decision of the Minister was available for 115 dossiers, covering 36 (31.3%) orphan medicinal products (OMPs) and 79 ATV products. A MES was used in 41 submissions. A positive reimbursement decision was obtained in 65% of cases. The significant factors affecting the reimbursement decision were the approval of ATV, the medical need if it was considered 'important or major' and the use of a managed entry scheme. Price, budget impact and efficiency had no significant impact. Conclusions: Added therapeutic value and high medical need increase the odds for a positive reimbursement decision. No impact could be demonstrated of the cost-related HTA criteria. Cost elements may be biased by the use of a confidential MES. Without a MES, only 53% of the centrally authorised medicinal products, including OMPs, are reimbursed in Belgium. [ABSTRACT FROM AUTHOR]

Background: Japan has been preparing to implement a Health Technology Assessment (HTA) process in 2018. Through a 2-year pilot program implemented in 2016, the government examined the criteria for applicable products and the necessary infrastructure to review both the content and quality of the data and to conduct cost-effectiveness assessments to be incorporated into the current Japanese reimbursement and pricing scheme. A survey of the pharmaceutical industry was conducted to understand the current landscape and to identify issues and challenges of implementing HTA in Japan. Methods: A semi-structured 19-item questionnaire was designed, and a survey was conducted via face-to-face or phone interviews. Answers were transcribed in English after the interviews and confirmed by e-mail. The survey focuses on pharmaceutical companies that develop new innovative products to be associated with the planned HTA. Results: Differences between Japanese and global pharmaceutical companies were observed in terms of dedicated HTA teams in place, the use of quality of life data, and relationships with external vendors. Addressing a shortage of HTA professionals in Japan is critical to implement HTA. The survey found that list prices compared to those proposed by companies was an issue. Conclusions: Although the government decided to implement HTA for the pricing scheme in 2018, a shortage of experts and researchers remains a challenge. Findings suggest HTA should not be used solely to reduce pharmaceutical spending, as the impact by the HTA implementation will be temporary and discourage innovation. [ABSTRACT FROM AUTHOR]

This study intends to examine the main drivers of network relations among health technology assessment (HTA) organizations. Social network analysis was performed to determine the relations among HTA organizations and to visualize the main drivers of such collaboration. The members in HTA organizations such as International Society for Pharmacoeconomics and Outcomes Research, Health Technology Assessment international, International Network of Agencies for Health Technology Assessment, EuroScan, European Network for Health Technology Assessment, HTAsiaLink, and Health Technology Assessment Network for the Americas are said to create networks. Ten different HTA organizations were considered in the analysis, including the Ministry of Health (MoH) organizations, universities, for-profit organizations, and hospitals. The Fruchterman-Reingold algorithm was used to perform networking, and the average clustering coefficient and average path length were examined to measure collaborative performance. The network graph of the HTA ecosystem shows the highest collaborative frequency among HTA organizations, which are the members of MoH organizations, government agencies, universities, and nonprofit organizations. The average path length was 2.21, and the average clustering coefficient was 36.57, indicating an obvious clustering effect. The study results highlight that networking within the HTA ecosystem is driven by government organizations. Boosting the integration of the private sector into the system and creating data-sharing strategies are essential to foster HTA collaboration. Because HTA is shaped by local dynamics and no gold standard exists for HTA implementation, encouraging collaborative efforts is the only way to avoid redundant efforts and make health technologies available for everyone. [ABSTRACT FROM AUTHOR]

Purpose: To establish the appropriate number of Cardiac-CT and Cardio-MR examinations, to determine an economically justified and sustainable investment in these two technologies, for an exclusive cardiologic use. Materials and methods: From July 2013 to July 2014, through a survey in four different Italian Departments of Radiology, data on the costs of Cardiac-CT and Cardiac-MR examinations were collected. For the evaluation of the costs of examinations, it was used an analytical accounting system, considering only the direct costs (consumables, health personnel work time, equipment amortization/maintenance) and other costs (utilities, services, etc.). Indirect costs (general costs) were not assessed. It was made a simulation, assuming an exclusive use of the CT and MR equipments for Cardiac-CT and Cardiac-MR examinations, calculating the annual number necessary to arrive at the Break Even Point (BEP: the point at which cost or expenses and revenue are equal). Results: On the basis of the CT costs, in order to reach the BEP, performing only Cardiac-CT examinations, an average of 2641-2752 examinations/year is needed. The annual time commitment of the Medical Professional to ensure the number of examinations to reach the BEP is 2625-2750 h/year, equivalent to two Medical Doctors in a Cardiology Department. The recent Cardiac-CT Italian Registry, in the period January-June 2011, reports a number of examinations of 3455 patients in 47 different Centers, distributed throughout the whole national territory. With regard to MR, in order to reach the BEP, performing only Cardiac-MR examinations, an average of 2435-3123 examinations/year is needed. The annual time commitment of the Medical Professional to ensure the number of examinations to reach the BEP is 2437-3125 h/year, equivalent to two Medical Doctors in a Cardiology Department. The recent Cardiac-MR Italian Registry reports a number of examinations of 3776 patients in 40 Centers, distributed throughout the whole national territory. Conclusion: This research has shown that, only on the basis of costs, currently in Italy is anti-economic an exclusive use of CT or MR equipment for cardiac exams, unless it's not decided, regardless of the recent guidelines and clinical indications, to submit all patients with cardiac diseases (diseases of the coronary arteries and cardiomyopathies) to Cardiac-CT and Cardiac-MR examinations. This might likely to increase both the inappropriate examinations and either health spending and in the case of CT with important repercussions, in terms of radio-exposure, subject to forensic procedures. [ABSTRACT FROM AUTHOR]

Purpose: We compared recently introduced Basic Medicines Lists of the Federation of Bosnia and Herzegovina (BH) (FBH Basic Lists (FBLs)) with the World Health Organization (WHO) Essential Medicines List (EML) and the evidence supporting the inclusion of additional medicines on FBLs. Methods: The sources of data included the 18th edition of the EML and the following FBLs: 2013 Hospital List, 2013 A List in Outpatient Setting, and 2012 List financed by the Federal Solidarity Fund. For medicines found on FBLs but not on EML, we searched the Cochrane Database of Systematic Reviews (CSR) and public health technology assessment (HTA) reports for evidence. Results: FBLs had 134 medicines and 17 combinations that were not on EML, as well as 9 medicines deleted and 4 rejected from EML. EML had 82 medicines and 10 combinations of medicines not included in FBLs. Out of 125 medicines on FBLs but not on EML, 52 (42 %) had good CSR evidence supporting their inclusion ( n = 38) or exclusion ( n = 14). For the rest ( n = 74), we found 24 favourable HTA reports. For the total of 89 medicines (27 %) listed on FBLs, we found no evidence (EML, CSR, HTA reports) good enough to justify their inclusion in FBLs. Conclusions: In circumstances of scarce financial resources, greater reliance on well-established, proven list is crucial. Independent, unbiased, high-quality evidence such as WHO EML, CSR and HTA reports (national or international with local adaptations) should be used when deciding on medicine reimbursement. [ABSTRACT FROM AUTHOR]

The College Voor Zorgverzekeringen (CVZ) provides guidance to the Dutch healthcare system on funding and use of new pharmaceutical technologies. This study examined the impact of evidence, process and context factors on CVZ decisions in 2004-2009. A data set of CVZ decisions pertaining to pharmaceutical technologies was created, including 29 variables extracted from published information. A three-category outcome variable was used, defined as the decision to 'recommend', 'restrict' or 'not recommend' a technology. Technologies included in list 1A/1B or on the expensive drug list were considered recommended; those included in list 2 or for which patient co-payment is required were considered restricted; technologies not included on any reimbursement list were classified as 'not recommended'. Using multinomial logistic regression, the relative contribution of explanatory variables on CVZ decisions was assessed. In all, 244 technology appraisals (256 technologies) were analysed, with 51 %, of technologies recommended, 33 % restricted and 16 % not recommended by CVZ for funding. The multinomial model showed significant associations ( p ≤ 0.10) between CVZ outcome and several variables, including: (1) use of an active comparator and demonstration of statistical superiority of the primary endpoint in clinical trials, (2) pharmaceutical budget impact associated with introduction of the technology, (3) therapeutic indication and (4) prevalence of the target population. Results confirm the value of a comprehensive and multivariate approach to understanding CVZ decision-making. [ABSTRACT FROM AUTHOR]

Background: Several Central and Eastern European (CEE) countries require cost-utility analyses (CUAs) to support reimbursement formulary listing. However, CUAs informed by local evidence are often unavailable, and the cost-effectiveness of the several currently reimbursed biologicals is unclear. Aim: To estimate the cost-effectiveness as multiples of per capita GDP/quality adjusted life years (QALY) of four biologicals (infliximab, etanercept, adalimumab, golimumab) currently reimbursed in six CEE countries in six inflammatory rheumatoid and bowel disease conditions. Methods: Systematic literature review of published cost-utility analyses in the selected conditions, using the United Kingdom (UK) as reference country and with study selection criteria set to optimize the transfer of results to the CEEs. Prices in each CEE country were pro-rated against UK prices using purchasing power parity (PPP)-adjusted per capita GDP, and local GDP per capita/QALY ratios estimated. Results: Central and Eastern European countries list prices were 144-333 % higher than pro rata prices. Out of 85 CUAs identified by previous systematic literature reviews, 15 were selected as a convenience sample for estimating the cost-effectiveness of biologicals in the CEE countries in terms of per capita GDP/QALY. Per capita GDP/QALY values varied from 0.42 to 6.4 across countries and conditions (Bulgaria: 0.97-6.38; Czech Republic: 0.42-2.76; Hungary: 0.54-3.54; Poland: 0.59-3.90; Romania: 0.77-5.07; Slovakia: 0.55-3.61). Conclusion: While results must be interpreted with caution, calculating pro rata (cost-effective) prices and per capita GDP/QALY ratios based on CUAs can aid reimbursement decision-making in the absence of analyses using local data. [ABSTRACT FROM AUTHOR]

Introduction: Health technology assessment (HTA) is a multidisciplinary approach to the evaluation of health-care technologies, which aims to support the decision-making process by driving medical, technical and economic knowledge. It is characterised by the contextual examination of epidemiological, clinical, economic, social, ethical and organisational implications. Main part: Even if it was born in fields other than medicine, HTA has progressively spread as an innovative tool to assess health-care technologies such as drugs, medical devices and surgical procedures. Through a scientific literature review the purpose of applying HTA to public health was explained and discussed. Tackling interventions to control health determinants has great potential for reducing the burden of disease and for promoting health in the general population. Anyway health expenditure for public health is low: this could threaten interventions and damage the role of public health itself. HTA could represent a guide to best invest in this field and to gain in efficacy and effectiveness in line with current strategies to implement health services in all sectors. Conclusion: HTA could represent a good tool to address all topics and problems pertaining to choices in public health and could allow decision-makers to best invest scarce available resources. [ABSTRACT FROM AUTHOR]

Citation frequencies and journal impact factors (JIFs) are being used more and more to assess the quality of research and allocate research resources. If these bibliometric indicators are not an adequate predictor of research quality, there could be severe negative consequences for research. To analyse to which extent citation frequencies and journal impact factors correlate with the methodological quality of clinical research articles included in an SBU systematic review of antibiotic prophylaxis in surgery. All 212 eligible original articles were extracted from the SBU systematic review 'Antibiotic Prophylaxis in Surgery' and categorized according to their methodological rigourness as high, moderate or low quality articles. Median of citation frequencies and JIFs were compared between the methodological quality groups using Kruskal-Wallis non-parametric test. An in-depth study of low-quality studies with higher citation frequencies/JIFs was also conducted. No significant differences were found in median citation frequencies ( p = 0.453) or JIFs ( p = 0.185) between the three quality groups. Studies that had high citation frequencies/JIFs but were assessed as low-quality lacked control groups, had high dropout rates or low internal validity. This study of antibiotic prophylaxis in surgery does not support the hypothesis that bibliometric indicators are a valid instrument for assessing methodological quality in clinical trials. This is a worrying observation, since bibliometric indicators have a major influence on research funding. However, further studies in other areas are needed. [ABSTRACT FROM AUTHOR]

Summary: The purpose of the study was to estimate the cost-effectiveness of balloon kyphoplasty compared to nonsurgical management and vertebroplasty for the treatment of hospitalised osteoporotic vertebral compression fractures in the UK. A cost-effectiveness model was constructed and used for analysis. Balloon kyphoplasty may be cost-effective compared to relevant alternatives. Introduction: The objective of this study was to estimate the cost-effectiveness of balloon kyphoplasty (BKP) for the treatment of patients hospitalised with acute osteoporotic vertebral compression fracture (OVCF) compared to percutaneous vertebroplasty (PVP) and nonsurgical management (NSM) in the UK. Methods: A Markov simulation model was developed to evaluate treatment with BKP, NSM and PVP in patients with symptomatic OVCF. Data on health-related quality of life (HRQoL) with acute OVCF were derived from the FREE and VERTOS II randomised clinical trials (RCTs) and normalised to the NSM arm in the FREE trial. Estimated differences in mortality among the treatments and costs for NSM were obtained from the literature whereas procedure costs for BKP and PVP were obtained from three National Health Service hospitals. It was assumed that BKP and PVP reduced hospital length of stay by 6 days compared to NSM. Results: The incremental cost-effectiveness ratio was estimated at Great Britain Pound Sterling (GBP) 2,706 per quality-adjusted life year (QALY) and GBP 15,982 per QALY compared to NSM and PVP, respectively. Sensitivity analysis showed that the cost-effectiveness of BKP vs. NSM was robust when mortality and HRQoL benefits with BKP were varied. The cost-effectiveness of BKP compared to PVP was particularly sensitive to changes in the mortality benefit. Conclusion: BKP may be a cost-effective strategy for the treatment of patients hospitalised with acute OVCF in the UK compared to NSM and PVP. Additional RCT data on the benefits of BKP and PVP compared to simulated sham surgery and further data on the mortality benefits with BKP compared to NSM and PVP would reduce uncertainty. [ABSTRACT FROM AUTHOR]

The article presents abstracts of papers presented at the 39th European Society of Clinical Pharmacy (ESCP) European Symposium on Clinical Pharmacy and the 3th Société Française de Pharmacie Clinique (SFPC) Congress: Clinical Pharmacy at the Front Line of Innovations in Lyon, France, including "Hallucinations Due to Therapeutic Doses of Ertapenem," "Carboplatin Dosage in Overweight Patient: Case Report" and "Severe Hypokalemia Associated With Flucloxacillin."

When a user interface needs to be designed for a task that depends on information integration, such as navigation, very few theoretical tools are available. Cognitive task analysis (CTA) and hierarchical task analysis (HTA) are the basic analysis techniques. A choice between them depends on the type of task or objective at hand. In this article, it is argued that for interface design a combination of CTA and HTA forms the basis of the interface definition. When this expanded to a full cognitive work analysis (CWA), it will form the human-factors analysis required for the user-interface design. [ABSTRACT FROM AUTHOR]

Objectives: Technology evaluation of integrated/digital OR is needed since very little literature has been published on the subject. The integrated OR is a technological solution intended for minimally invasive surgery where the surgeons have complete control of the environment, devices and image distribution. Before such an investment, Health Technology Assessment can be used as a method to evaluate what vendors' state, i.e. the fact that the integrated OR is a very effective and efficient solution. Then a follow-up evaluation could be useful after the installation to test the users' satisfaction and give suggestions to the community about real- experienced integrated OR advantage. Methods: A multiple answer questionnaire has been handed to 17 surgeons and 9 scrub nurses form Varese Town and University Hospital to evaluate the degree of satisfaction after 2 years of use of integrated ORs. Results: Surgeons and scrub nurses agree that the integrated OR can be very effective in increasing quality, risk reduction and surgery time reduction through the use of digitalized video acquisition system, boom-mounted devices and multiple displays. Scrub nurses are a little bit more confident than surgeons that medical device control could reduce the confusion inside the OR and reduce the number of setting errors. A very positive judgment was given to the system's teaching capabilities, but both surgeons and scrub nurses agree that a great degree of education and a cultural change are needed to use the system in a correct and complete way. Conclusions: Results show that there is a deep appreciation of the system which proved to be efficient (reducing surgery time and enhancing surgical quality) and effective. This is a pilot study based on few collected data, but the questionnaire could be handed to many hospitals where integrated ORs are present, in order to achieve a significant degree of assessment and find common topics to be considered fundamental especially in the evaluating phase. [ABSTRACT FROM AUTHOR]

Copyright of Medizinische Klinik (Urban & Vogel) is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Balloon kyphoplasty (BKP) is a procedure used to treat vertebral compression fractures (VCFs). We developed a cost-effectiveness model to evaluate BKP in United Kingsdom patients with hospitalised VCFs and estimated the cost-effectiveness of BKP compared to non-surgical management. The results indicate that BKP provides a cost-effective alternative for treating these patients. VCFs of osteoporotic patients are associated with chronic pain, a reduction in health-related quality of life (QoL) and high healthcare costs. BKP is a minimally invasive procedure that has resulted in pain relief, vertebral body height-restoration, decreased kyphosis and improved physical functioning in patients with symptomatic VCFs. BKP was shown to improve health-related QoL in a 12-month interim analysis of a randomised phase-III trial. The objectives of this study were to develop a Markov cost-effectiveness model to evaluate BKP in patients with painful hospitalised VCFs and to estimate the cost-effectiveness of BKP compared with non-surgical management in a UK setting. It was assumed that QoL-benefits found at 12 months linearly approached zero during another 2 years, and that patients receiving BKP warranted six fewer hospital bed days compared with patients given non-surgical management. The procedure was associated with quality-adjusted life-years (QALY)-gains of 0.17 and cost/QALY-gains at £8,800. The results were sensitive to assumptions about avoided length of hospital-stay and persistence of kyphoplasty-related QoL-benefits. In conclusion, the results indicate that BKP provides a cost-effective alternative for treating patients with hospitalised VCFs in a UK-setting. [ABSTRACT FROM AUTHOR]

Hepatocellular carcinoma (HCC) is the most common malignancy in the world, especially in China. Early diagnosis of new and recurrent hepatocellular carcinoma, followed by timely treatment, will help decrease mortality. Currently biomarkers are not satisfactory. Better diagnostic methods are highly demanded. In this study, we have used in silico identification and RT-PCR test and discovered a hepatoma associated gene (HTA). Knockdown of endogenous HTA expression was performed by small interfering RNA in malignant hepatocyte HepG2. Then we tested the cell proliferative ability of these cells in vitro and in vivo. HTA was expressed specifically in some kinds of tumors, but not detected in any normal tissues. It was expressed especially high in hepatocellular carcinoma. Knockdown of endogenous HTA expression in HepG2 by small interfering RNA attenuated HCC cell growth. HCA is a very good marker for tumors, especially for HCC. It could play important roles in HCC development and progression and can be a promising molecular target for the development of new diagnostic and therapeutic strategies for HCC. [ABSTRACT FROM AUTHOR]

Copyright of Andrologie (11662654) is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Diabetologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Health technology assessment (HTA) is currently one of the major challenges in assessing medical innovations and healthcare systems. In Europe, the European Network for Health Technology Assessment (EUnetHTA) has been aspiring to develop and implement standards for international sharing of HTA results and studies. Slovakia and many other EU countries do not have an established HTA system yet. This paper is focused on an exact description of the EUnetHTA Core Model individual domains applied to the process of selecting patients in the terminal stage of prostate cancer for Radium-223 treatment under particular conditions of the Institute of Nuclear and Molecular Medicine (INMM) in Košice, Slovakia.Results: We produced the first pilot HTA report using the HTA Core Model in Slovakia. The main objective was to collect all relevant information on the particular technology, and provide its summary to the interested stakeholders on one spot. Rather than applying detailed individual items, i.e. assessment elements and assessment element cards, we concentrated on the content of individual domains and tried to fill them with the best country, facility and intervention related data. The dataset consisted of 52 patients that finished the treatment in the period 2015-2017. The patients were carefully selected according to the Radium-223 producer’s criteria. Only 33 patients received the full therapy consisting of six applications; their average survival was 10.5 months from the application of the last dose.Conclusions: Based on the results of our analyzes, we recommended several changes to the INMM processes and patient follow-up checks during the treatment process in order to make the therapy more effective. The greatest benefit is expected after the implementation of a 68Ge/68Ga generator in 2018, as the selection of patients suitable for the Radium-223 treatment will improve. We showed that the HTA Core Model can be implemented in Slovakia, even under conditions of no formal HTA support or institutionalization. [ABSTRACT FROM AUTHOR]