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  • 1
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    Springer Science and Business Media LLC ; 2021
    In:  The European Journal of Health Economics Vol. 22, No. 3 ( 2021-04), p. 485-497
    In: The European Journal of Health Economics, Springer Science and Business Media LLC, Vol. 22, No. 3 ( 2021-04), p. 485-497
    Materialart: Online-Ressource
    ISSN: 1618-7598 , 1618-7601
    Sprache: Englisch
    Verlag: Springer Science and Business Media LLC
    Publikationsdatum: 2021
    ZDB Id: 2011428-X
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  • 2
    In: International Journal of Technology Assessment in Health Care, Cambridge University Press (CUP), Vol. 33, No. 2 ( 2017), p. 279-287
    Kurzfassung: Objectives: Health technology financing is often based on randomized controlled trials (RCTs), which are often the same ones used for licensing. Because they are designed to show the best possible results, typically Phase III studies are conducted under ideal and highly controlled conditions. Consequently, it is not surprising that technologies do not always perform in real life in the same way as controlled conditions. Because financing (and price paid) decisions can be made with overestimated results, health authorities need to ask whether health systems achieve the results they expect when they choose to pay for a technology. The optimal way to answer this question is to assess the performance of financed technologies in real-world settings. Health technology performance assessment (HTpA) refers to the systematic evaluation of the properties, effects, and/or impact of a health intervention or health technology in the real world to provide information for investment/disinvestment decisions and clinical guideline updates. The objective is to describe the development and principal aspects of the Guideline for HTpA commissioned by the Brazilian Ministry of Health. Methods: Our methods used include extensive literature review, refinement with experts across countries, and public consultation. Results: A comprehensive guideline was developed, which has been adopted by the Brazilian government. Conclusion: We believe the guideline, with its particular focus on disinvestment, along with the creation of a specific program for HTpA, will allow the institutionalization and continuous improvement of the scientific methods to use real-world evidence to optimize available resources not only in Brazil but across countries.
    Materialart: Online-Ressource
    ISSN: 0266-4623 , 1471-6348
    Sprache: Englisch
    Verlag: Cambridge University Press (CUP)
    Publikationsdatum: 2017
    ZDB Id: 2020486-3
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 3
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    Cambridge University Press (CUP) ; 2020
    In:  International Journal of Technology Assessment in Health Care Vol. 36, No. 1 ( 2020), p. 50-57
    In: International Journal of Technology Assessment in Health Care, Cambridge University Press (CUP), Vol. 36, No. 1 ( 2020), p. 50-57
    Kurzfassung: To synthetize the state of the art of methods for identifying candidate technologies for disinvestment and propose an evidence-based framework for executing this task. Methods An interpretative review was conducted. A systematic literature search was performed to identify secondary or tertiary research related to disinvestment initiatives and/or any type of research that specifically described one or more methods for identifying potential candidates technologies, services, or practices for disinvestment. An iterative and critical analysis of the methods described alongside the disinvestment initiatives was performed. Results Seventeen systematic reviews on disinvestment or related terms (health technology reassessment or medical reversal) were retrieved and methods of 45 disinvestment initiatives were compared. On the basis of this evidence, we proposed a new framework for identifying these technologies based on the wide definition of evidence provided by Lomas et al. The framework comprises seven basic approaches, eleven triggers and thirteen methods for applying these triggers, which were grouped in embedded and ad hoc methods. Conclusions Although identification methods have been described in the literature and tested in different contexts, the proliferation of terms and concepts used to describe this process creates considerable confusion. The proposed framework is a rigorous and flexible tool that could guide the implementation of strategies for identifying potential candidates for disinvestment.
    Materialart: Online-Ressource
    ISSN: 0266-4623 , 1471-6348
    Sprache: Englisch
    Verlag: Cambridge University Press (CUP)
    Publikationsdatum: 2020
    ZDB Id: 2020486-3
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 4
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    Cambridge University Press (CUP) ; 2017
    In:  International Journal of Technology Assessment in Health Care Vol. 33, No. S1 ( 2017), p. 154-155
    In: International Journal of Technology Assessment in Health Care, Cambridge University Press (CUP), Vol. 33, No. S1 ( 2017), p. 154-155
    Kurzfassung: Over the past decades, early awareness and alert (EAA) activities and systems have gained importance and become a key early Health Technology Assessment (HTA) tool. While a pioneer in HTA, Sweden had no national level EAA activities until recently. We describe the evolution and current status of the Swedish EAA System. METHODS: This was a historical analysis based on the knowledge and experience of the authors supplemented by a targeted review of published and grey literature, as well as documents produced by or relating to the Swedish EAA System. Key milestones and a description of the current state of the Swedish EAA System are presented. RESULTS: Initiatives to establish a system for the identification and assessment of emerging health technologies in Sweden date back to the 1980s. Since the 1990s, the Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) supported the development of EuroScan and was one of its founding members. In the mid-2000s, an independent regional initiative, driven by the Stockholm Drug and Therapeutics Committee, resulted in the establishment of a regional horizon scanning unit. By 2009, this work had expanded to a collaboration between the four biggest regions in Sweden. The following year it was further expanded to the national level. Today, the Swedish EAA System carries out identification, filtration and prioritization of new drugs, early assessment of the prioritized drugs, and dissemination of the information. Its outputs are used to select new drugs for inclusion in the Swedish national process for managed introduction and follow-up. CONCLUSIONS: The Swedish EAA System started as a regional initiative and rapidly grew to become a national level activity. An important feature of the system today is its complete integration into the national process for managed introduction and follow-up of new drugs. The system will continue to evolve as a response both to the changing landscape of health innovations and to new policy initiatives at the regional, national and international levels.
    Materialart: Online-Ressource
    ISSN: 0266-4623 , 1471-6348
    Sprache: Englisch
    Verlag: Cambridge University Press (CUP)
    Publikationsdatum: 2017
    ZDB Id: 2020486-3
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 5
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    Cambridge University Press (CUP) ; 2018
    In:  International Journal of Technology Assessment in Health Care Vol. 34, No. S1 ( 2018), p. 82-83
    In: International Journal of Technology Assessment in Health Care, Cambridge University Press (CUP), Vol. 34, No. S1 ( 2018), p. 82-83
    Kurzfassung: The use of long-acting insulin analogues have been reported in patients with type 1 diabetes mellitus who exhibit important oscillations of their daily blood glucose, although the therapeutic benefits are lacking. The aim of this study was to evaluate the effectiveness and safety of the insulin analogue glargine compared detemir to support health decision-making. Methods: We performed a systematic review with meta-analysis of observational studies (cohort and registry), available in the MEDLINE (Pubmed), Latin American and Caribbean Health Sciences (LILACS), EMBASE and Cochrane Library databases (accessed August 2017), including research in the electronic journal Diabetes Care and gray literature. Several combinations of terms were used, including disease terms, interventions and type of study. The results evaluated were: glycated hemoglobin; weight gain; occurrence of severe hypoglycemia; total insulin dose; and, fasting capillary glycemia. Methodological quality was assessed using the Newcastle scale. The meta-analyses were performed in Review Manager® 5.2 software using a random effects model. Protocol number CRD42017054925 (International Prospective Register of Ongoing Systematic Reviews). Results: A total of 705 publications, eight cohort studies were included. The quality of included studies was classified as high. In the meta-analysis, the results for episodes of severe hypoglycemia (p = 0.002), measurements of fasting capillary glycemia (p = 0.01), and weight gain (p = 0.001) were favorable for detemir. The glycated hemoglobin endpoint (p = 0.49, heterogeneity = 89 percent) revealed high heterogeneity and no statistically significant difference between groups, showing no difference between the interventions for glycemic control. Conclusions: Although some results are favorable to detemir, it was not possible to identify significant differences in effectiveness and safety between the two analogues evaluated, requiring new long term studies and better quality of methodological studies.
    Materialart: Online-Ressource
    ISSN: 0266-4623 , 1471-6348
    Sprache: Englisch
    Verlag: Cambridge University Press (CUP)
    Publikationsdatum: 2018
    ZDB Id: 2020486-3
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 6
    In: International Journal of Technology Assessment in Health Care, Cambridge University Press (CUP), Vol. 34, No. S1 ( 2018), p. 122-122
    Kurzfassung: Quality of life (QoL) is an important health measure and is widely used to assess the difference between treatments for Type 1 Diabetes Mellitus (T1DM) since the desirable glycemic control and the minimization of episodes of hypoglycemia are fundamental aspects for a better QoL. This study aims to identify the factors associated with QoL in patients with T1DM. Methods: A cross-sectional study (approved by ethics committee) was carried out in the state of Minas Gerais with 401 T1DM patients who used insulin glargine (GLA) selected in March 2017, and 179 patients who used insulin-neutral protamine (NPH) selected between January and February 2014, and both groups were treated by Brazilian National Health System (SUS). A questionnaire with three blocks was used: A) sociodemographic data; B) clinical data and access to the service; and C) QoL by Euroqol (EQ-5D-3L). We used multiple linear regression model by the forward stepwise method to access the correlation between the utilities of the EQ-5D-3L and all the explanatory variables (blocks A and B). We adopted the significance level and confidence interval of 95 percent (95% CI). Results: Of the 580 patients evaluated, 54 percent were women, 47 percent were in the age group between 18–40 years, 53 percent reported to be non-black. The EQ-5D-3L analysis showed patients treated with insulin analogue GLA had an average utility of 0.849 and those treated with NPH insulin 0.722 (p 〈 0.000). Individuals young, very good/good health self-perception, having not been bedridden in the last 15 days, zero to three medical appointments in the last year, no hospitalization in the last year, regular physical activity in the last 15 days to practice physical exercise, having between zero and three comorbidities and no severe hypoglycemia in the last 30 days were explained 41.3 percent of QoL. The type of insulin therapy, GLA or NPH, did not enter into the final multiple regression model. Conclusions: The findings of this study pointed to a lack of correlation between insulin therapy and QoL of patients with T1DM. Sociodemographic and clinical factors were more important to explain the QoL of diabetics. In addition, the evidence pointed to the importance of episodes of hypoglycemia for Qol. Of the 191 episodes of hypoglycemia (non-severe and severe) reported, 66 percent were from patients treated with GLA.
    Materialart: Online-Ressource
    ISSN: 0266-4623 , 1471-6348
    Sprache: Englisch
    Verlag: Cambridge University Press (CUP)
    Publikationsdatum: 2018
    ZDB Id: 2020486-3
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 7
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    Cambridge University Press (CUP) ; 2019
    In:  International Journal of Technology Assessment in Health Care Vol. 35, No. S1 ( 2019), p. 96-96
    In: International Journal of Technology Assessment in Health Care, Cambridge University Press (CUP), Vol. 35, No. S1 ( 2019), p. 96-96
    Kurzfassung: The growing prevalence of non-communicable diseases, combined with greater recognition of the effectiveness of lipid lowering agents (LLAs), has fuelled their increasing use in recent years. Similarly, increasing recognition of mental health and, arguably, societal expectations and pressures, has driven appreciable growth in antidepressant prescribing in recent years. Concurrent with this, growing resource pressures enhanced by the continual launch of new premium priced medicines necessitates reforms and initiatives within finite budgets. Scotland has introduced multiple measures in recent years to improve both the quality and efficiency of prescribing. There is a need to document these initiatives and outcomes to provide future direction. Methods Assessment of the utilization (items dispensed) and expenditure of key LLAs (mainly statins) and SSRIs between 2001 and 2017 in Scotland alongside initiatives. Results Multiple interventions have increased international non-proprietary name (INN) prescribing (99% for statins and up to 99.9% for SSRIs). They have also increased preferential prescribing of generic versus patented statins with low costs for generics, reduced inappropriate prescribing of ezetimibe due to effectiveness concerns, and increased the prescribing of higher dose statins (71% in 2015). These measures have resulted in a 50% reduction in LLA expenditure between 2001 and 2015 despite a 412% increase in utilization. Initiatives to reduce the prescribing of escitalopram as lack of evidence demonstrating cost-benefits over generic citalopram, along with high INN prescribing, achieved a 73.7% reduction in SSRI expenditure between 2001 and 2017 despite a 2.34-fold increase in utilisation. Concerns with paroxetine, and more recently citalopram and escitalopram following safety warnings, resulted in a considerable reduction in their use alongside a significant increase in sertraline. Conclusions Generic availability coupled with multiple measures has resulted in appreciable shifts in statin and SSRI prescribing behavior and reduced ezetimibe prescribing, resulting in improvements in both the quality and efficiency of prescribing to provide future direction.
    Materialart: Online-Ressource
    ISSN: 0266-4623 , 1471-6348
    Sprache: Englisch
    Verlag: Cambridge University Press (CUP)
    Publikationsdatum: 2019
    ZDB Id: 2020486-3
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 8
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    Cambridge University Press (CUP) ; 2018
    In:  International Journal of Technology Assessment in Health Care Vol. 34, No. S1 ( 2018), p. 39-40
    In: International Journal of Technology Assessment in Health Care, Cambridge University Press (CUP), Vol. 34, No. S1 ( 2018), p. 39-40
    Kurzfassung: Patients are the people who, with their informed consent, receive medical interventions. It is important, therefore, that patients have an understanding of interventions and their potential as a treatment for their condition. Patients are becoming more informed about their health care and the treatments that are available to them. At a population level, the potential benefits and harms of treatments need to be regularly assessed. This is part of healthcare decision making at a policy level about what treatments are publically available. As technology develops and old methods are replaced by new and evidence-based interventions and procedures, healthcare payers look to streamline their payment schedules and disinvest in old technologies and procedures. Some users of health care are reluctant to let go of outmoded methods, so disinvestment is best achieved through transparent processes. Successful engagement with key stakeholders of health care, engaging with payers, health service administrators, clinicians and patients, can facilitate implementation of disinvestment processes. Methods: To assist in this process, Health Technology Assessment International (HTAi) Interest Groups and EuroScan have come together to develop the following key points to consider in the involvement and engagement of clinicians, patients, and the public in the disinvestment of services and technologies. Results: The best time to involve clinicians and patient representatives is right at the beginning of the process. Clinicians and patients can make valuable contributions as advisory committee members. The disinvestment processes may be led by clinicians, payers, or independent organizations. This will likely influence commitment of clinicians to the process. Conclusions: Broader consultation with clinicians, patients and the public in the development and consideration of draft reports and recommendations can increase the transparency of the disinvestment process. Consultation is an important means of obtaining buy in. Feedback needs to be seen as taken seriously, and explanations given for any changes made or not made to the report and its recommendations.
    Materialart: Online-Ressource
    ISSN: 0266-4623 , 1471-6348
    Sprache: Englisch
    Verlag: Cambridge University Press (CUP)
    Publikationsdatum: 2018
    ZDB Id: 2020486-3
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 9
    In: Current Medical Research and Opinion, Informa UK Limited, Vol. 35, No. 4 ( 2019-04-03), p. 697-704
    Materialart: Online-Ressource
    ISSN: 0300-7995 , 1473-4877
    Sprache: Englisch
    Verlag: Informa UK Limited
    Publikationsdatum: 2019
    ZDB Id: 2034331-0
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 10
    In: International Journal of Antimicrobial Agents, Elsevier BV, Vol. 54, No. 3 ( 2019-09), p. 273-282
    Materialart: Online-Ressource
    ISSN: 0924-8579
    Sprache: Englisch
    Verlag: Elsevier BV
    Publikationsdatum: 2019
    ZDB Id: 2011829-6
    SSG: 15,3
    Standort Signatur Einschränkungen Verfügbarkeit
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