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Objectives: In spring 2020, The European network for Health Technology Assessment (EUnetHTA) decided to join forces to produce best evidence to inform health policy in the COVID-19 pandemic. The objective of this paper is to describe the process and output of the coordinated and collaborative activities of EUnetHTA. Methods: Relevant published and internal documents were retrieved for a descriptive analysis of EUnetHTA processes, methods, and outputs related to EUnetHTA's response to the pandemic. Results: Process : In April 2020, a COVID-19 task force was set up and a survey collected pressing health policy questions across Europe. Two coordinating agencies for diagnostic tests and therapeutics were assigned. A process for prioritization and selection was set up for therapeutics, as well as explicit starting and stopping rules. Methodology : To increase a timely response, it was agreed that the rapid collaborative reviews (rapid CRs) would not require the consultation of manufacturers and the involvement of external experts, but would not differ in the methods and conduct of the systematic search, review, and synthesis of all available evidence, nor in the requirement for reviewing by EUnetHTA partners. Final reports : The joint effort resulted in the production of two rapid CRs on diagnostic tests, nineteen collaborative rolling reviews on therapeutics, three of which later moved to rapid CRs. Conclusions: During COVID-19 pandemic, the EUnetHTA partners proved capable of prompt collaboration, which allowed speeding up the production and release of high-quality EUnetHTA outputs, while the relationships with the other European institutions facilitated their quick dissemination. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of multi-morbidity is rising and the provision of person-centred integrated health and social care is seen as an appropriate response to the needs of people with multi-morbidity. To contribute to a better evidence-base of integrated care for multimorbidity, the Horizon2020-funded project SELFIE (Sustainable intEgrated care modeLs for multi-morbidity: delivery, FInancing and performance) adopted an innovative evaluation approach: Multi-Criteria Decision Analysis (MCDA). MCDA includes a more comprehensive set of outcomes compared to conventional health technology assessment while still summarising these outcomes in a single value. This workshop presents results of the MCDAs of 4 of the 17 integrated care programmes that were evaluated in SELFIE: the Croatian National Strategy for Palliative Care, the Care Chain for Frail Elderly in the Netherlands, the Catalan Population Health Management approach in Barcelona-Esquerra, and the Better Together in Amsterdam North programme for people facing problems in multiple life domains like health, employment, and housing. Methods: All case studies used a common MCDA methodology in which the performance of the programmes, in comparison to usual care, was measured longitudinally on a core set of 8 outcomes and some programme-specific outcomes. The core set includes Physical Functioning, Psychological Well-being, Social Relationships and Participation, Enjoyment of Life, Resilience, Person-centeredness, Continuity of Care, and Costs. The choice of outcomes was largely driven by focus groups with people with multi-morbidity. The outcomes were weighted by their importance and summed into an overall value score. The weights were obtained in a Discrete Choice Experiment among different stakeholders: 1) patients with multi-morbidity, 2) partners and informal caregivers, 3) professionals, 4) payers, and 5) policy makers (n=150 per group per country). Swing Weighting was used also. Results: Preliminary results showed that the overall value score for integrated care was (slightly) higher than for usual care, in all programmes. For the Croatian palliative care strategy this was mainly due to higher partial value scores for Psychological Wellbeing and Person-centeredness, resulting from the combination of improvements in these outcomes and their relatively high weights. The higher value score for the Dutch frail elderly programme was driven by Enjoyment of Life and Person-centeredness, the first of which had the highest weight of all outcomes. The higher value score of the Spanish population health management programme resulted from an improvement in Physical Functioning and a reduction in costs of acute, potentially avoidable, hospitalizations, despite the relatively low weight of the latter. The improvement due to the programme for people with multiple problems was driven by improvements in Enjoyment of Life, and Psychological Wellbeing. Results were consistent across stakeholder groups. Sensitivity analysis with Swing Weights showed similar results. Probabilistic sensitivity analyses indicated that in the vast majority of repetitions the value score was highest for integrated care. Discussion: These results were obtained in quasi-experimental studies, using propensity score matching to improve the comparability between groups. Conclusion: MCDA, which combines the effects on and weights of Triple Aim outcomes, suggests that integrated care is preferred to usual care by all stakeholders, although some differences were small. [ABSTRACT FROM AUTHOR]

The evaluation of integrated care programmes for individuals with multi-morbidity requires a broader evaluation framework and a broader definition of added value than is common in costutility analysis. This is possible through the use of Multi-Criteria Decision Analysis MCDA. This paper describes the seven steps of an MCDA approach to evaluate 17 different integrated care programmes for individuals with multi-morbidity in 8 European countries that partake in the SELFIE project, a four-year EU-funded project. In step one, qualitative research is undertaken to better understand the decision-context of these programmes. The programmes face decisions related to their sustainability in terms of their reimbursement, continuation, extension, and/or wider implementation. In step two, a uniform set of decision criteria was defined in terms of eight outcomes measured across the 17 programmes: physical functioning, psychological wellbeing, social relationships and participation, enjoyment of life, resilience, person-centeredness, continuity of care, and total health and social care costs. These are supplemented by programme-type specific outcomes. Step three describes the quasi-experimental studies designed to measure the performance of the programmes on the decision criteria. Step four gives the details of the two methods Discrete Choice Experiment and Swing Weighting to determine the relative importance of the decision criteria among five groups of stakeholders in each country. Step five describes the value-based method of MCDA by which the performance of the programmes on each decision criterion is combined with the weight of the respective criterion, to come to an overall value score. Step six describes how we deal with uncertainty and introduces the Conditional Multi- Attribute Acceptability Curve. Step seven addresses the interpretation of results in stakeholder workshops. By discussing the challenges involved in creating a uniform MCDA approach for the evaluation of different programmes, this paper provides guidance to future evaluations and stimulates debate on how to properly evaluate integrated care for individuals with multi-morbidity. [ABSTRACT FROM AUTHOR]

Introduction: SELFIE is a new EU-Horizon2020 funded project, which started on September 1st 2015 and is entitled "Sustainable intEgrated care modeLs for multi-morbidity: delivery, FInancing and performance". SELFIE stands out from other EU-funded projects on integrated care by adopting a broad health economic approach. SELFIE will perform empirical research of promising integrated care models which specifically target individuals with multi-morbidity. It will conduct policy evaluations of financing/payments schemes with different incentives to support integration of care within and across the health care, long-term care and social care sectors. It will develop methods for price-setting, tools for performance monitoring, and strategies for implementation of integrated care in different healthcare systems and contexts including Central and Eastern European Countries. But the first stream of research in SELFIE consists of the development of a conceptual framework on integrated care for multimorbidity, the identification of specific programs in developed countries, and qualitative research on these programs. Methods: To inform the conceptual framework, scientific literature was searched in online databases (i.e. Pubmed, Embase, Scopus, Web of Science, Cochrane, PsycInfo, and sociological & Social Services Abstracts via ProQuest) and combined with grey literature from OECD, WHO and EU. Studies and reports concerning frameworks/models, integrated care, and multimorbidity were selected. These sources were also used to identify implemented integrated care programs in the EU. In later phases of SELFIE, these programs will be scored and rankordered on a number of criteria in order to select the most promising ones. The latter will be included in the qualitative and quantitative empirical evaluation using Multi-Criteria Decision Analyses (MCDA). MCDA assesses the performance of different integrated care programs on a number of criteria related to the Triple Aim of integrated care (i.e. patient experience, health/wellbeing and costs) and combines them with relative weights that Patients, their Partners, the Professionals, the Payers and the Policy makers (5 Ps) assign to the importance of the criteria. Weights will be obtained o.a. via Discrete Choice Experiments. As little is known about the dynamics, success factors and obstacles for ICC programs dealing with multimorbidity, a research approach from the qualitative paradigm, the thick description, is used to gain more insight in their social fabric. Results: The literature search resulted in x unique studies of which y were included in our selection. At the time this abstract was written, information from the studies was being retrieved and the identification of implemented integrated care programs for multi-morbidity was in progress. At the conference we will present the first results, including the conceptual framework, the approach for the qualitative in-depth study of specific programs and the methods developed for the MCDA. The focus of the results will be on elements of integrated care particularly relevant for individuals with multi-morbidity. Examples of such elements are a holistic assessment of an individual's needs, preferences, skills, life-style and illnessperceptions across the entire spectrum of diseases that the individual has, and person-centred care that accounts for overlap and interaction between clinical guidelines/protocols for different diseases and avoids polypharmacy. Discussion and conclusion: The ICIC-16 will be an ideal conference to present the SELFIE study for the first time to a large and broad audience and the results will be interesting to many attendees. The discussion will include the need to develop integrated care approaches for multi-morbidity, the elements that constitute integrated care suitable for people with multimorbidity and the potential of using MCDA to facilitate a broad evaluation of integrated care. This project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 634288. The content of this abstract reflects only the SELFIE groups' views and the European Commission is not liable for any use that may be made of the information contained herein. [ABSTRACT FROM AUTHOR]

INTRODUCTION:Sudden cardiac arrest (SCA) is the most common cause of death in patients with coronary artery disease. Mostly, ventricular tachycardia (VT) and ventricular fibrillation (VF) are the underlying aetiology of SCA, which is claimed to be successfully treated by a novel therapy, a wearable cardioverter defibrillator (WCD, LifeVest®).The assessment, performed within the European Network for HTA (EUnetHTA), aimed to provide valid data on clinical effectiveness and safety of the WCD. Furthermore, the project intended to elicit patients views on aspects regarding their cardiac disease and the WCD therapy as well as to identify neglected outcomes.METHODS:A synthesis of evidence on the basis of a systematic literature search in Medline via Ovid, Embase, the Cochrane Library, and the Centre for Reviews and Dissemination (CRD) databases was performed. The search was complemented by citation tracking and handsearch.A face-to-face semi-structured focus group interview was performed with five cardiac disease patients in the scoping phase.RESULTS:Since no prospective controlled trials were found, no assessment of effectiveness could be performed. With regard to safety, five prospective studies were included, but the quality of the body of evidence was very low. Adverse events (AEs) reported were skin rash/itching (6 percent), false alarms (14 percent), palpitations/lightheadedness/fainting (9 percent) and discontinuation due to comfort/lifestyle issues (16-22 percent). Serious adverse events (SAEs) were inappropriate shocks (0-2 percent) and unsuccessful shocks (0-.7 percent). Frequency of SAEs leading to death was 0-.3 percent.Patients of the focus group reported that experiencing a sense of security was crucial to them. The WCD therapy was not considered an option for weeks or months, due to expected restrictions in living a ‘normal’ and secure life.CONCLUSIONS:No statement can be made about the device effectiveness – further research is needed. More data and more adequate reporting of AEs and SAEs are needed in order to establish the device safety. In particular, more data is needed for risk stratification of high risk patients in order to further narrow down the wide range of indications for the WCD use. [ABSTRACT FROM PUBLISHER]

Presents a case of a 60-year-old man that was considered for splenectomy because of an extremely enlarged spleen. Performance of scintigraphy study with 99mTc-antigranulocyte antibodies (AGAb); Cancellation of splenectomy after finding low and variable accumulation of the AGAb in the spleen and liver of the patient; Benefits of AGAb for the patient.

The opportunity cost of inappropriate health policy decisions is greater in Central and Eastern European (CEE) compared with Western European (WE) countries because of poorer population health and more limited healthcare resources. Application of health technology assessment (HTA) prior to healthcare financing decisions can improve the allocative efficiency of scarce resources. However, few CEE countries have a clear roadmap for HTA implementation. Examples from high-income countries may not be directly relevant, as CEE countries cannot allocate so much financial and human resources for substantiating policy decisions with evidence. Our objective was to describe the main HTA implementation scenarios in CEE countries and summarize the most important questions related to capacity building, financing HTA research, process and organizational structure for HTA, standardization of HTA methodology, use of local data, scope of mandatory HTA, decision criteria, and international collaboration in HTA. Although HTA implementation strategies from the region can be relevant examples for other CEE countries with similar cultural environment and economic status, HTA roadmaps are not still fully transferable without taking into account country-specific aspects, such as country size, gross domestic product per capita, major social values, public health priorities, and fragmentation of healthcare financing., (© 2016 The Authors. Health Economics published by John Wiley & Sons Ltd.)

Introduction: Tobacco smoking claims 700,000 lives every year in Europe and the cost of tobacco smoking in the EU is estimated between €98 and €130 billion annually; direct medical care costs and indirect costs such as workday losses each represent half of this amount. Policymakers all across Europe are in need of bespoke information on the economic and wider returns of investing in evidence-based tobacco control, including smoking cessation agendas. EQUIPT is designed to test the transferability of one such economic evidence base-the English Tobacco Return on Investment (ROI) tool-to other EU member states., Methods and Analysis: EQUIPT is a multicentre, interdisciplinary comparative effectiveness research study in public health. The Tobacco ROI tool already developed in England by the National Institute for Health and Care Excellence (NICE) will be adapted to meet the needs of European decision-makers, following transferability criteria. Stakeholders' needs and intention to use ROI tools in sample countries (Germany, Hungary, Spain and the Netherlands) will be analysed through interviews and surveys and complemented by secondary analysis of the contextual and other factors. Informed by this contextual analysis, the next phase will develop country-specific ROI tools in sample countries using a mix of economic modelling and Visual Basic programming. The results from the country-specific ROI models will then be compared to derive policy proposals that are transferable to other EU states, from which a centralised web tool will be developed. This will then be made available to stakeholders to cater for different decision-making contexts across Europe., Ethics and Dissemination: The Brunel University Ethics Committee and relevant authorities in each of the participating countries approved the protocol. EQUIPT has a dedicated work package on dissemination, focusing on stakeholders' communication needs. Results will be disseminated via peer-reviewed publications, e-learning resources and policy briefs., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Background and Research Question: The authors address the question of whether vascular endothelial growth factor inhibitors (anti-VEGF) lead to better clinical outcomes than current treatments in patients with clinically manifest diabetic macular oedema (DMO), which is the leading cause of vision loss in the working age population in developed countries., Methods: The authors performed a systematic literature search in common databases and compiled the evidence according to the GRADE methodology. The authors analysed clinically relevant improvement of visual acuity, vision-related quality of life and local or systemic adverse events., Results: In a proportion of patients (on average 25%), VEGF inhibitors result in better visual acuity (≥15 ETDRS letters or equivalent) than in patients treated with laser photocoagulation or sham injection. The number of injections required for long-term improvement as well as the general long-term efficacy is unknown. The evidence is not sufficient to confirm safety of the products in patients with DMO and does not suggest superiority of a single product., Conclusion: For some patients with DMO, VEGF inhibitors seem to be more effective as a short-term treatment option than alternative therapies. The evidence is not of sufficient quality to confirm safety. Decisions on financing should take into account the high price difference between the products and ongoing research.