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Julian E, Solà-Morales O, Garcia MJ, Brinkhuis F, Pavlovic M, Martín-Saborido C, Doeswijk R, Giuliani R, Willemsen A, Goettsch W, Wörmann B, Dafni U, Bucher HC, Pérez-Valderrama B, Bernardini R, Gianfrate F, Uyl-de Groot CA, Ruof J. The Role of Medical Societies and the Relevance of Clinical Perspective in the Evolving EU HTA Process: Insights Generated at the 2023 Fall Convention and Survey of the European Access Academy. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2024; 12:128-143. [PMID: 39072306 PMCID: PMC11270181 DOI: 10.3390/jmahp12030011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/30/2024] [Accepted: 06/14/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND This work aimed to determine the role and action points for the involvement of medical societies in the European Health Technology Assessment (EU HTA) Methods: An online pre-convention survey was developed addressing four areas related to the EU HTA: (i) medical societies' role; (ii) role of clinical guidelines; (iii) interface with the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS); and (iv) approaching 'best-available evidence' (BAE). A descriptive analysis of questionnaire outcomes was conducted to inform the European Access Academy (EAA) Fall Convention 2023. Within the working groups (WGs), action points were identified and prioritised. RESULTS A total of 57 experts from 15 countries responded to the survey. The WGs were attended by (i) 11, (ii) 10, (iii) 12, and (iv) 12 experts, respectively, representing a variety of national backgrounds and stakeholder profiles. The most relevant action points identified were as follows: (i) incorporation of clinical context into population, intervention, comparator, outcomes (PICO) schemes, (ii) timely provision of up-to-date therapeutic guidelines, (iii) ensuring the inclusion of MCBS insights into the EU HTA process, and (iv) considering randomized controlled trials (RCTs) as the gold standard and leveraging regulatory insights if development programs only include single-arm trials. CONCLUSIONS The involvement of medical societies is a critical success factor for the EU HTA. The identified key action points foster the involvement of patient associations and medical societies.
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Affiliation(s)
- Elaine Julian
- Secretariat of the European Access Academy (EAA), 4059 Basel, Switzerland
| | - Oriol Solà-Morales
- HiTT Foundation, International University of Catalonia-UIC, 08015 Barcelona, Spain
| | | | - Francine Brinkhuis
- Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, 3584 CS Utrecht, The Netherlands
- National Health Care Institute, 1110 AH Diemen, The Netherlands
| | - Mira Pavlovic
- Medicines Development and Training (MDT) Services, 75020 Paris, France
| | | | - Robin Doeswijk
- European Hematology Association (EHA), 2514 AA The Hague, The Netherlands
| | - Rosa Giuliani
- Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
| | - Anne Willemsen
- National Health Care Institute, 1110 AH Diemen, The Netherlands
| | - Wim Goettsch
- Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, 3584 CS Utrecht, The Netherlands
- National Health Care Institute, 1110 AH Diemen, The Netherlands
| | - Bernhard Wörmann
- German Association of Hematology and Oncology (DGHO), 10178 Berlin, Germany
- Division of Hematology, Oncology and Tumor Immunology, Department of Medicine, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Urania Dafni
- European Society for Medical Oncology (ESMO), 6900 Lugano, Switzerland
- National and Kapodistrian University of Athens, and Frontier Science Foundation Hellas, 15773 Athens, Greece
| | - Heiner C. Bucher
- Division of Clinical Epidemiology, University Hospital Basel and University of Basel, 4051 Basel, Switzerland
| | | | - Renato Bernardini
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), Section of Pharmacology, University of Catania, 95124 Catania, Italy
| | | | - Carin A. Uyl-de Groot
- Erasmus School of Health Policy & Management, Institute for Medical Technology Assessment, Erasmus, University Rotterdam, 3062 Rotterdam, The Netherlands
| | - Jörg Ruof
- Medical School of Hanover, 30625 Hanover, Germany
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Breuking SH, De Ruigh AA, Hermans FJR, Schuit E, Combs CA, de Tejada BM, Oudijk MA, Mol BW, Pajkrt E. Progestogen maintenance therapy for prolongation of pregnancy after an episode of preterm labour: A systematic review and meta-analysis. BJOG 2023; 130:1306-1316. [PMID: 37077041 DOI: 10.1111/1471-0528.17499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 03/11/2023] [Accepted: 03/24/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Evidence for progestogen maintenance therapy after an episode of preterm labour (PTL) is contradictory. OBJECTIVES To assess effectiveness of progestogen maintenance therapy after an episode of PTL. SEARCH STRATEGY An electronic search in Central Cochrane, Ovid Embase, Ovid Medline and clinical trial databases was performed. SELECTION CRITERIA Randomised controlled trials (RCT) investigating women between 16+0 and 37+0 weeks of gestation with an episode of PTL who were treated with progestogen maintenance therapy compared with a control group. DATA COLLECTION AND ANALYSIS Systematic review and meta-analysis were conducted. The primary outcome was latency time in days. Secondary neonatal and maternal outcomes are consistent with the core outcome set for preterm birth studies. Studies were extensively assessed for data trustworthiness (integrity) and risk of bias. MAIN RESULTS Thirteen RCT (1722 women) were included. Progestogen maintenance therapy demonstrated a longer latency time of 4.32 days compared with controls (mean difference [MD] 4.32, 95% CI 0.40-8.24) and neonates were born with a higher birthweight (MD 124.25 g, 95% CI 8.99-239.51). No differences were found for other perinatal outcomes. However, when analysing studies with low risk of bias only (five RCT, 591 women), a significantly longer latency time could not be shown (MD 2.44 days; 95% CI -4.55 to 9.42). CONCLUSIONS Progestogen maintenance therapy after PTL might have a modest effect on prolongation of latency time. When analysing low risk of bias studies only, this effect was not demonstrated. Validation through further research, preferably by an individual patient data meta-analysis is highly recommended.
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Affiliation(s)
- Sofie H Breuking
- Department of Obstetrics and Gynaecology, Research Institute(s), Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Annemijn A De Ruigh
- Department of Obstetrics and Gynaecology, Research Institute(s), Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Frederik J R Hermans
- Department of Obstetrics and Gynaecology, Research Institute(s), Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Ewoud Schuit
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - C Andrew Combs
- Obstetrix Medical Group, Pediatrix Center for Research, Education, Quality and Safety, Sunrise, Florida, USA
| | - Begoña Martinez de Tejada
- Department of Paediatrics, Gynaecology and Obstetrics, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Martijn A Oudijk
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ben W Mol
- Paediatrics and Reproductive Health, Monash University, Melbourne, Victoria, Australia
| | - Eva Pajkrt
- Department of Obstetrics and Gynaecology, Research Institute(s), Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
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Endometrial Scratching for Improving Endometrial Receptivity: a Critical Review of Old and New Clinical Evidence. Reprod Sci 2022; 30:1701-1711. [DOI: 10.1007/s43032-022-01125-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 11/05/2022] [Indexed: 12/12/2022]
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Levi-Setti PE, Busnelli A, Bodina A, De Luca R, Scaravelli G. 2017–2018 Assisted Reproduction Cost Analysis Performance Indexes: Lombardy County Case Study. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:693715. [PMID: 36303956 PMCID: PMC9580757 DOI: 10.3389/frph.2021.693715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: The aim of the present study was to analyze the IVF success rates and the economic cost per delivery in all the public funded IVF Units in Lombardy in the 2017–2018 period and to assess any significant difference in ART outcomes among the enrolled centers. Methods: Analysis of costs for the 2017 and 2018 fresh transfer delivery rate (DR) and Cumulative delivery rate (CDR) considering both fresh and frozen cycles were extracted from the ART Italian Registry on oocytes retrievals, fresh and frozen embryos and oocytes embryo transfer performed in 22 Lombardy IVF Units. Results: In 2017, 29,718 procedures were performed, resulting in 4,543 pregnancies and 3,253 deliveries. In 2018, there were 29,708 procedures, 4,665 pregnancies and 3,348 deliveries. Pregnancies lost to follow up were 5.0% with a (range of 0–67.68%) in 2017 and 3.4% (range of 0–45.1%) in 2018. The cost reimbursement for the cycles were €2,232 ($2,611) for oocyte retrieval and €2,194 ($2,567) for embryo transfer, excluding ovarian stimulation therapy and luteal phase support. 19.33 (5.80). The DR was 13.23 ± 5.69% (range 2.86–29.11%) in 2017 and 19.33 ± 5.80% in 2018 (range 11.82–34.98 %) and the CDR was 19.86 ± 9.38% (range 4.43–37.88%) in 2017 and 21.32 ± 8.84% (range 4.24–37.11%). The mean multiple pregnancy delivery rate (MDR) was 11.08 ± 5.55% (range 0.00–22.73%) in 2017 and 10.41 ± 4.99% (range 1.33–22.22%) in 2018. The mean CDR cost in euros was 26,227 ± 14,737 in 2017 and 25,018 ± 16,039 in 2018. The mean CDR cost among centers was 12,480 to 76,725 in 2017 and 12,973 to 86,203 in 2018. Conclusions: Our findings show impressive differences in the DR and CDR among centers and the importance of cryopreservation in patients' safety and economic cost reduction suggesting the formulation of specific KPI's (Key performance indexes) and minimal performance indexes (PI) as a basis for the allocation of public or insurance resources. In particular, the reduction of multiple pregnancy rates costs, may lead to a more widespread use of ART even in lower resources countries.
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Affiliation(s)
- Paolo Emanuele Levi-Setti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Division of Gynecology and Reproductive Medicine, Department of Gynaecology, Fertility Center, IRCCS Humanitas Research Hospital, Milan, Italy
- *Correspondence: Paolo Emanuele Levi-Setti
| | - Andrea Busnelli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Division of Gynecology and Reproductive Medicine, Department of Gynaecology, Fertility Center, IRCCS Humanitas Research Hospital, Milan, Italy
| | | | - Roberto De Luca
- Assisted Reproduction Techniques Italian National Register, National Centre for Diseases, Prevention and Health Promotion, National Health Institute, Rome, Italy
| | - Giulia Scaravelli
- Assisted Reproduction Techniques Italian National Register, National Centre for Diseases, Prevention and Health Promotion, National Health Institute, Rome, Italy
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