1
|
Nunobe S, Endo H, Honda M, Watanabe M, Yamamoto H, Kanaji S, Kakeji Y, Kodera Y, Kitagawa Y. Impact of treatment guidelines and pivotal clinical trial results on a surgeon's decision regarding treatment for gastric cancer: a retrospective cohort study using the National Clinical Database. Surg Today 2024; 54:1084-1092. [PMID: 38402328 DOI: 10.1007/s00595-024-02814-0] [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: 10/23/2023] [Accepted: 01/28/2024] [Indexed: 02/26/2024]
Abstract
PURPOSES The present study evaluated the impact of clinical guidelines for gastric cancer surgery on surgeons' choice of procedure in real-world practice. We focused on the 2014 guideline revision recommending laparoscopic surgery and the evidence concerning splenectomy for prophylactic lymphadenectomy reported in 2015 using the National Clinical Database, which is the most comprehensive database in Japan. METHODS We investigated the monthly percentages of laparoscopic distal gastrectomies performed for stage I gastric cancer (LDG%) and splenectomies performed during total gastrectomy for advanced cancer (TGS%) between 2014 and 2017. We evaluated the descriptive statistics of the time-series changes in the LDG%, TGS%, and annual trends of outcomes. RESULTS In total, 124,787 patients were enrolled. The mean LDG% and TGS% were 69.8% and 9.2%, respectively. The LDG% and TGS% were 66.4% and 16.7%, respectively, in January 2014 and 73.1% and 5.9%, respectively, in December 2017. LDG% consistently increased, and TGS% showed a consistent downward trend throughout the observation period. There was no significant change in this trend after the publication of the guideline recommendations or clinical trial results. CONCLUSION No significant changes in surgical procedures were observed after publication of the guidelines or results of clinical trials.
Collapse
Affiliation(s)
- Souya Nunobe
- Department of Gastroenterological Surgery, Cancer Institute Ariake Hospital, 8-31, Ariake, 3-Chome, Koto-ku, Tokyo, 135-8550, Japan.
| | - Hideki Endo
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Michitaka Honda
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | - Masayuki Watanabe
- Department of Gastroenterological Surgery, Cancer Institute Ariake Hospital, 8-31, Ariake, 3-Chome, Koto-ku, Tokyo, 135-8550, Japan
| | - Hiroyuki Yamamoto
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shingo Kanaji
- Project Management Subcommittee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - Yoshihiro Kakeji
- Database Committee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuko Kitagawa
- The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| |
Collapse
|
2
|
Qouhafa M, Benaji B, Lebbar S, Soulaymani A, Nsiri B, El Yousfi Alaoui MH, Abdelrhani M, Azougagh M. Metric identification and mapping of reimbursable implant codes in Morocco to the global nomenclature (GMDN) and European (EUDAMED) of medical devices. ANNALES PHARMACEUTIQUES FRANÇAISES 2024:S0003-4509(24)00088-9. [PMID: 38821481 DOI: 10.1016/j.pharma.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/27/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND The list of medical devices (MD) eligible for reimbursement under the Compulsory Health Insurance in Morocco is set by Ministerial Order comprising 869 items between life-support equipment, external prostheses, and implants. The objective of the present study is to analyze the nomenclature of implantable medical devices (IMD) appearing on this list and compare them with the global nomenclature of MD (GMDN) and the European nomenclature of MD (EMDN). METHODS The study deals with (i) the mapping of the codes of the IMD list with 170 DM per cardinality and (ii) a metric identification by Sørensen-Dice coefficient of terminological similarity of the IMD with respect to the two databases. RESULTS The 170 IMD codes are mapped onto 493 terms in the GMDN and 344 terms in the EMDN. The 37.7% of implants are mapped to more than or equal to 2 terms of GMDN while 36.5% are mapped to more than or equal to 2 terms to the EMDN. The comparison of cardinality distributions has revealed no significant difference (P=0.430) between the two databases. The implants examined are divided into 11 categories whose strong similarity is given to active cardiovascular implants in the EMDN database with simDice=0.534. CONCLUSION Healthcare authorities need to align with nomenclature standards to improve interoperability and rely on a more efficient and rational regulatory process.
Collapse
Affiliation(s)
- Meryem Qouhafa
- Laboratoire biologie et santé, faculté des sciences, université Ibn Tofail, Kénitra, Morocco; Groupe de recherche d'ingénierie biomédicale et pharmaceutique, département d'ingénierie des technologies de la santé-(ENSAM Rabat), Mohammed V University Rabat, Rabat, Morocco; Higher Institute of Nursing and Technical Health Professions Rabat - Ministry of Health and Social Welfare, Rabat, Morocco.
| | - Brahim Benaji
- Groupe de recherche d'ingénierie biomédicale et pharmaceutique, département d'ingénierie des technologies de la santé-(ENSAM Rabat), Mohammed V University Rabat, Rabat, Morocco
| | - Souad Lebbar
- Laboratoire biologie et santé, faculté des sciences, université Ibn Tofail, Kénitra, Morocco
| | - Abdelmajid Soulaymani
- Laboratoire biologie et santé, faculté des sciences, université Ibn Tofail, Kénitra, Morocco
| | - Benayad Nsiri
- Groupe de recherche d'ingénierie biomédicale et pharmaceutique, département d'ingénierie des technologies de la santé-(ENSAM Rabat), Mohammed V University Rabat, Rabat, Morocco
| | - My Hachem El Yousfi Alaoui
- Groupe de recherche d'ingénierie biomédicale et pharmaceutique, département d'ingénierie des technologies de la santé-(ENSAM Rabat), Mohammed V University Rabat, Rabat, Morocco
| | - Mokhtari Abdelrhani
- Laboratoire biologie et santé, faculté des sciences, université Ibn Tofail, Kénitra, Morocco
| | - Mohammed Azougagh
- Groupe de recherche d'ingénierie biomédicale et pharmaceutique, département d'ingénierie des technologies de la santé-(ENSAM Rabat), Mohammed V University Rabat, Rabat, Morocco
| |
Collapse
|
3
|
Veljanoski D, Ng XY, Hill CS, Jamjoom AAB. Theory and evidence-base for a digital platform for the delivery of language tests during awake craniotomy and collaborative brain mapping. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2024; 6:e000234. [PMID: 38756704 PMCID: PMC11097893 DOI: 10.1136/bmjsit-2023-000234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 03/20/2024] [Indexed: 05/18/2024] Open
Abstract
Objectives Build the theoretical and evidence-base for a digital platform (map-OR) which delivers intraoperative language tests during awake craniotomy and facilitates collaborative sharing of brain mapping data. Design Mixed methodology study including two scoping reviews, international survey, synthesis of development guiding principles and a risk assessment using failure modes and effects analysis. Setting The two scoping reviews examined the literature published in the English language. International survey was completed by members of awake craniotomy teams from 14 countries. Main outcome measures Scoping review 1: number of technologies described for language mapping during awake craniotomy. Scoping review 2: barriers and facilitators to adopting novel technology in surgery. International survey: degree of language mapping technology penetration into clinical practice. Results A total of 12 research articles describing 6 technologies were included. The technologies required a range of hardware components including portable devices, virtual reality headsets and large integrated multiscreen stacks. The facilitators and barriers of technology adoption in surgery were extracted from 11 studies and mapped onto the 4 Unified Theory of Acceptance and Use of Technology constructs. A total of 37 awake craniotomy teams from 14 countries completed the survey. Of the responses, 20 (54.1%) delivered their language tests digitally, 10 (27.0%) delivered tests using cards and 7 (18.9%) used a combination of both. The most commonly used devices were tablet computers (67.7%; n=21) and the most common software used was Microsoft PowerPoint (60.6%; n=20). Four key risks for the proposed digital platform were identified, the highest risk being a software and internet connectivity failure during surgery. Conclusions This work represents a rigorous and structured approach to the development of a digital platform for standardized intraoperative language testing during awake craniotomy and for collaborative sharing of brain mapping data. Trial registration number Scoping review protocol registrations in OSF registries (scoping review 1: osf.io/su9xm; scoping review 2: osf.io/x4wsc).
Collapse
Affiliation(s)
| | - Xin Yi Ng
- Department of Medicine, Arrowe Park Hospital, Wirral, UK
| | - Ciaran Scott Hill
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Aimun A B Jamjoom
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
- Department of Neurosurgery, Barking Havering and Redbridge Hospitals NHS Trust, Romford, UK
| |
Collapse
|
4
|
Vonken L, de Bruijn GJ, Noordink A, Kremers S, Schneider F. Barriers and facilitators of implementation of new antibacterial technologies in patient care: an interview study with orthopedic healthcare professionals at a university hospital. BMC Health Serv Res 2024; 24:447. [PMID: 38594689 PMCID: PMC11005272 DOI: 10.1186/s12913-024-10878-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 03/19/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Antimicrobial resistance is a major global health threat. Therefore, promising new antibacterial technologies that could minimize our dependence on antibiotics should be widely adopted. This study aims to identify the barriers and facilitators of the adoption of new antibacterial technologies in hospital patient care. METHODS Semi-structured interviews, based on the Consolidated Framework for Implementation Research, were conducted with healthcare professionals related to the orthopedics department of an academic hospital in The Netherlands. RESULTS In total, 11 healthcare professionals were interviewed. Scientific evidence for the effectiveness of the technology was the most explicitly mentioned facilitator of adoption, but other (often contextual) factors were also considered to be important. At the level of the inner and outer setting, high costs and lacking coverage, competition from other firms, and problems with ordering and availability were the most explicit perceived barriers to adoption. Participants did not collectively feel the need for new antibacterial technologies. CONCLUSIONS Barriers and facilitators of the adoption of new antibacterial technologies were identified related to the technology, the hospital, and external factors. The implementation climate might have an indirect influence on adoption. New antibacterial technologies that are scientifically proven effective, affordable, and easily obtainable will most likely be adopted.
Collapse
Affiliation(s)
- Lieve Vonken
- Department of Health Promotion, Research School CAPHRI, Maastricht University, P. Debyelaan 1, 6229 HA, Maastricht, The Netherlands.
| | - Gert-Jan de Bruijn
- Department of Communication Studies, University of Antwerp, Stadscampus, S.M.481 Sint-Jacobsstraat 2, 2000, Antwerpen, Belgium
| | - Annika Noordink
- Department of Health Promotion, Research School CAPHRI, Maastricht University, P. Debyelaan 1, 6229 HA, Maastricht, The Netherlands
| | - Stef Kremers
- Department of Health Promotion, Research School CAPHRI, Maastricht University, P. Debyelaan 1, 6229 HA, Maastricht, The Netherlands
| | - Francine Schneider
- Department of Health Promotion, Research School CAPHRI, Maastricht University, P. Debyelaan 1, 6229 HA, Maastricht, The Netherlands
| |
Collapse
|
5
|
Eckhardt H, Felgner S, Dreger M, Fuchs S, Ermann H, Rödiger H, Rombey T, Busse R, Henschke C, Panteli D. Utilization of innovative medical technologies in German inpatient care: does evidence matter? Health Res Policy Syst 2023; 21:100. [PMID: 37784100 PMCID: PMC10546629 DOI: 10.1186/s12961-023-01047-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 08/26/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND The reimbursement of new technologies in inpatient care is not always linked to a requirement for evidence-based evaluation of patient benefit. In Germany, every new technology approved for market was until recently eligible for reimbursement in inpatient care unless explicitly excluded. The aim of this work was (1) to investigate the type of evidence that was available at the time of introduction of 25 innovative technologies and how this evidence evolved over time, and (2) to explore the relationship between clinical evidence and utilization for these technologies in German inpatient care. METHODS This study combined different methods. A systematic search for evidence published between 2003 and 2017 was conducted in four bibliographic databases, clinical trial registries, resources for clinical guidelines, and health technology assessment-databases. Information was also collected on funding mechanisms and safety notices. Utilization was measured by hospital procedures captured in claims data. The body of evidence, funding and safety notices per technology were analyzed descriptively. The relationship between utilization and evidence was explored empirically using a multilevel regression analysis. RESULTS The number of included publications per technology ranges from two to 498. For all technologies, non-comparative studies form the bulk of the evidence. The number of randomized controlled clinical trials per technology ranges from zero to 19. Some technologies were utilized for several years without an adequate evidence base. A relationship between evidence and utilization could be shown for several but not all technologies. CONCLUSIONS This study reveals a mixed picture regarding the evidence available for new technologies, and the relationship between the development of evidence and the use of technologies over time. Although the influence of funding and safety notices requires further investigation, these results re-emphasize the need for strengthening market approval standards and HTA pathways as well as approaches such as coverage with evidence development.
Collapse
Affiliation(s)
- Helene Eckhardt
- Department of Health Care Management, Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany.
| | - Susanne Felgner
- Department of Health Care Management, Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany
- Berlin Centre for Health Economics Research (BerlinHECOR), Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany
| | - Marie Dreger
- Department of Health Care Management, Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany
- Berlin Centre for Health Economics Research (BerlinHECOR), Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany
| | - Sabine Fuchs
- Department of Health Care Management, Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany
| | - Hanna Ermann
- Department of Health Care Management, Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany
| | - Hendrikje Rödiger
- Department of Health Care Management, Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany
| | - Tanja Rombey
- Department of Health Care Management, Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany
| | - Reinhard Busse
- Department of Health Care Management, Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany
- Berlin Centre for Health Economics Research (BerlinHECOR), Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany
| | - Cornelia Henschke
- Department of Health Care Management, Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany
- Berlin Centre for Health Economics Research (BerlinHECOR), Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany
| | - Dimitra Panteli
- Department of Health Care Management, Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany
| |
Collapse
|
6
|
Armeni P, Meregaglia M, Borsoi L, Callea G, Torbica A, Benazzo F, Tarricone R. Collecting Physicians' Preferences on Medical Devices: Are We Doing It Right? Evidence from Italian Orthopedists Using 2 Different Stated Preference Methods. Med Decis Making 2023; 43:886-900. [PMID: 37837325 PMCID: PMC10848602 DOI: 10.1177/0272989x231201805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 08/15/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVES Physician preference items (PPIs) are high-cost medical devices for which clinicians express firm preferences with respect to a particular manufacturer or product. This study aims to identify the most important factors in the choice of new PPIs (hip or knee prosthesis) and infer about the existence of possible response biases in using 2 alternative stated preference techniques. METHODS Six key attributes with 3 levels each were identified based on a literature review and clinical experts' opinions. An online survey was administered to Italian hospital orthopedists using type 1 best-worst scaling (BWS) and binary discrete choice experiment (DCE). BWS data were analyzed through descriptive statistics and conditional logit model. A mixed logit regression model was applied to DCE data, and willingness-to-pay (WTP) was estimated. All analyses were conducted using Stata 16. RESULTS A sample of 108 orthopedists were enrolled. In BWS, the most important attribute was "clinical evidence," followed by "quality of products," while the least relevant items were "relationship with the sales representative" and "cost." DCE results suggested instead that orthopedists prefer high-quality products with robust clinical evidence, positive health technology assessment recommendation and affordable cost, and for which they have a consolidated experience of use and a good relationship with the sales representative. CONCLUSIONS The elicitation of preferences for PPIs using alternative methods can lead to different results. The BWS of type 1, which is similar to a ranking exercise, seems to be more affected by acquiescent responding and social desirability than the DCE, which introduces tradeoffs in the choice task and is likely to reveal more about true preferences. HIGHLIGHTS Physician preference items (PPIs) are medical devices particularly exposed to physicians' choice with regard to type of product and supplier.Some established techniques of collecting preferences can be affected by response biases such as acquiescent responding and social desirability.Discrete choice experiments, introducing more complex tradeoffs in the choice task, are likely to mitigate such biases and reveal true physicians' preferences for PPIs.
Collapse
Affiliation(s)
- Patrizio Armeni
- Research Centre on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Milan, Italy
| | - Michela Meregaglia
- Research Centre on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Milan, Italy
| | - Ludovica Borsoi
- Research Centre on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Milan, Italy
| | - Giuditta Callea
- Research Centre on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Milan, Italy
| | - Aleksandra Torbica
- Research Centre on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Milan, Italy
- Department of Social and Political Science, Bocconi University, Milan, Italy
| | - Francesco Benazzo
- Scuola Universitaria di Istruzione Superiore (IUSS), Pavia, Italy
- Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Rosanna Tarricone
- Research Centre on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Milan, Italy
- Department of Social and Political Science, Bocconi University, Milan, Italy
| |
Collapse
|
7
|
Conway J, Deschenes S, Pidborochynski T, Freed DH, van Manen M. Barriers and misconceptions of ex situ heart perfusion in pediatric donation. Pediatr Transplant 2023; 27:e14387. [PMID: 36087282 DOI: 10.1111/petr.14387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/13/2022] [Accepted: 08/19/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Despite efforts, pediatric HTx candidates continue to have high waitlist mortality due to limited donor availability. However, there is a significant number of offered hearts not used due to concerns of viability. ESHP is a method for continuous perfusion of the donor heart that allows assessment and extended out-of-body time. It is imperative to understand healthcare stakeholders' perspectives on ESHP for implementation. Therefore, the aims of this qualitative study were to: (1) Explore pediatric stakeholders' perspectives toward ESHP; and (2) Identify barriers to widespread adoption of this technology. METHODS Virtual focus groups were completed with pediatric HTx healthcare professional stakeholders. Following transcription of audio-recordings, the material was analyzed using content analysis. RESULTS Four focus groups were completed with 17 participants, representing 12 institutions and three countries. Focus groups revealed varied understanding of both current and potential uses of ESHP. Participants did see the potential benefits of extending out-of-body time for and the ability to evaluate donor heart quality. However, concerns were expressed relating to patient selection, wait-list times, post-HTx outcomes, adverse events, and technical issues. These were felt to be important to understand in order to justify the costs of ESHP and impact on the healthcare system. CONCLUSIONS This project represents the first qualitative formative evaluation of ESHP in pediatrics. The knowledge gained from stakeholders will form the basis for education initiatives, clinical trial design, and roll-out of new ESHP technologies designed for pediatrics.
Collapse
Affiliation(s)
- Jennifer Conway
- Division of Pediatric Cardiology, Stollery Children's Hospital, Edmonton, Alberta, Canada.,Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Sadie Deschenes
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | | | - Darren H Freed
- Department of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Michael van Manen
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.,John Dossetor Health Ethics Centre, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
8
|
Dreger M, Langhoff H, Henschke C. Adoption of large-scale medical equipment: the impact of competition in the German inpatient sector. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:791-805. [PMID: 34748115 PMCID: PMC9170654 DOI: 10.1007/s10198-021-01395-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 10/21/2021] [Indexed: 06/13/2023]
Abstract
The availability of large-scale medical equipment such as computed tomography (CT), magnet resonance imaging (MRI) and positron emission tomography (PET) scanners has increased rapidly worldwide over the last decades. Among OECD countries, Germany ranks high according to the number of imaging technologies and their applications per inhabitant. In contrast to other countries, there is no active governmental planning of large-scale medical equipment. We therefore investigated whether and how the adoption and distribution of CT, MRI and PET scanners in the German inpatient sector is subject to competition. Using a linear-probability model, we additionally examined the impact of regional, hospital- and population-based factors. In summary, our results indicate that the adoption rate by hospital sites decreases with the number of other sites being already equipped with the respective device and their proximity. However, the effect presumably depends on the technologies' stage within the diffusion process. No influence regarding the amount of state subsidies could be identified. Furthermore, hospital size and university status strongly affect the adoption.
Collapse
Affiliation(s)
- Marie Dreger
- Department of Health Care Management, Technische Universität Berlin, Straße des 17. Juni 135, 10623 Berlin, Germany
- Berlin Centre for Health Economics Research (BerlinHECOR), Technische Universität Berlin, Straße des 17. Juni 135, 10623 Berlin, Germany
| | - Hauke Langhoff
- Department of Health Care Management, Technische Universität Berlin, Straße des 17. Juni 135, 10623 Berlin, Germany
- Berlin Centre for Health Economics Research (BerlinHECOR), Technische Universität Berlin, Straße des 17. Juni 135, 10623 Berlin, Germany
| | - Cornelia Henschke
- Department of Health Care Management, Technische Universität Berlin, Straße des 17. Juni 135, 10623 Berlin, Germany
- Berlin Centre for Health Economics Research (BerlinHECOR), Technische Universität Berlin, Straße des 17. Juni 135, 10623 Berlin, Germany
- Fakultät für Gesundheitswissenschaften Brandenburg, Brandenburgische Technische Universität Cottbus-Senftenberg, Cottbus, Germany
| |
Collapse
|
9
|
Felgner S, Dreger M, Henschke C. Reasons for (not) choosing dental treatments—A qualitative study based on patients’ perspective. PLoS One 2022; 17:e0267656. [PMID: 35613130 PMCID: PMC9132305 DOI: 10.1371/journal.pone.0267656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 04/12/2022] [Indexed: 11/19/2022] Open
Abstract
Oral health is increasingly seen as a public health challenge due to the remarkable prevalence of oral diseases worldwide, the impact on general health, and health consequences that can arise for individuals. Compared to other health services, oral health services are usually not fully covered by statutory health insurance, which is seen as one reason in decision-making on dental treatments. Nevertheless, patients’ reasons for treatment decisions are not well understood although they can provide valuable insights. The objective of this study was to identify reasons of choice for dental treatments and to explore patients’ view on cost coverage in Germany. We conducted four focus group interviews with a total of 27 participants. The interviews were audiotaped and transcribed verbatim. Data was analyzed performing conventional content analysis. As part of a qualitative analysis, subcategories and categories were formed from identified reasons using an inductive approach. Our study supports and expands research in exploring patients’ decision-making on dental treatments. It highlights a variety of 53 reasons of choice for dental treatments from patients’ perspective, split in two categories “health care service”, and “dentist & dental office”. First category includes reasons regarding dental care performance (subcategories: “preconditions”, “treatment”, “costs”, and “outcomes”). Second category demonstrates reasons regarding dentists, office structures and processes (subcategories: "professional skills", "social skills", "office staff & equipment", and "office processes”). Reasons named “most important” by the participants are out-of-pocket payments, dentists’ training, and a relationship of trust between patient and dentist. Although the participants use incentive measures to lower financial burden, several perceived challenges exist. Identified reasons for choosing dental treatments provide a basis for further studies to quantify the relevance of these reasons from patients’ perspective. Based on this, the various reasons identified can be considered in future policies to improve patients’ utilization behavior, which can range from improved information sources to increased incentive measures.
Collapse
Affiliation(s)
- Susanne Felgner
- Department of Health Care Management, Berlin Centre of Health Economics Research Technische Universität Berlin, Berlin, Germany
- * E-mail:
| | - Marie Dreger
- Department of Health Care Management, Berlin Centre of Health Economics Research Technische Universität Berlin, Berlin, Germany
| | - Cornelia Henschke
- Department of Health Care Management, Berlin Centre of Health Economics Research Technische Universität Berlin, Berlin, Germany
| |
Collapse
|
10
|
Gendia M, Shamma HM. Examining the Factors Influencing Orthopedic Physician’s Decision to Purchase Medical Devices: Evidence from Kuwait. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2022; 15:37-58. [PMID: 35256865 PMCID: PMC8898043 DOI: 10.2147/mder.s343591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/06/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose It is explanatory and descriptive research to explain the relationship among factors influencing the orthopedic physician’s decision of purchasing medical devices and equipment. Methods Quantitative method will be used in this study as all heads of departments in MOH hospitals refused to make one-to-one interviews and suggested only questionnaires that will be high in confidentiality. Results For the first question: What is the ranking of factors that influence orthopedic physician decision in purchasing medical devices and equipment in MOH hospitals in Kuwait? According to HB analysis, the most preferred attribute is implant review in a journal and the lowest preferred factor is product training. Moreover, Brand was the second preferred attribute followed by leader influence. Surprisingly, price came after all these attributes. Physicians ranked technical support and sponsorship in the fifth and sixth places. For the second question: How can marketing and sales management predict orthopedic physicians' decisions before designing product proposals? This will assist M&S department in creating proposals that satisfy orthopedic physicians through expecting their decisions on various alternatives. Conclusion There is a good opportunity for all medical devices companies, after discussion with SMEs, either for growth or leaving stagnation phase. However, SMEs have no real understanding of what factors matter to the orthopedic physicians’ decision in purchasing medical devices and equipment. Thus, one of the goals of this research is to give M&S departments in medical devices companies with recommendations that will help them in forming attractive product offers to orthopedic physicians in MOH hospitals in Kuwait. Moreover, predicting the response from them in the future. In addition, four simulation scenarios have been conducted in this research to reach the best economic offer that maintains physicians attracted.
Collapse
Affiliation(s)
- Mohamed Gendia
- Al Sayer Medical Company, Shuwaikh Free Trade Zone, Kuwait
- Correspondence: Mohamed Gendia, Al-Salmiya, Qatar St, Kuwait, Tel +96597518109, Email
| | - Hamed M Shamma
- Marketing, The American University in Cairo, Cairo, Egypt
| |
Collapse
|
11
|
Broccard SP, Kasbi AA, Bagaria SP, Jones J, Shoudry M, Gabriel EM. Liquid biopsies for colorectal cancer: a narrative review of ongoing clinical trials and the current use of this technology at a comprehensive cancer center. J Gastrointest Oncol 2022; 13:438-449. [PMID: 35284120 PMCID: PMC8899730 DOI: 10.21037/jgo-21-470] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/30/2021] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVE In this review, we summarize ongoing clinical trials involving liquid biopsies (LB) for colorectal cancer (CRC), outlining the current landscape and the future implementation of this technology. We also describe the current use of LB in CRC treatment at our institution, the Mayo Clinic Enterprise. BACKGROUND The use of LB in CRC treatment merits close attention. Their role is being evaluated in the screening, non-intervention, intervention, and surveillance settings through many active trials. This, coupled with the technique's rapid integration into clinical practice, creates constant evolution of care. METHODS Review of ClinicalTrials.gov was performed identifying relevant and active trials involving LB for CRC. "Colorectal cancer" plus other terms including "liquid biopsies" and "ctDNA" were used as search terms, identifying 35 active trials. CONCLUSIONS LB use for the CRC is actively being investigated and requires close attention. Based on current evidence, Mayo Clinic Enterprise currently uses LB in the non-interventional, interventional and surveillance setting, but not for screening. Results of these trials may further establish the use of LB in the management of CRC.
Collapse
Affiliation(s)
| | | | | | - Jeremy Jones
- Division of Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Mira Shoudry
- Section of Surgical Oncology, Mayo Clinic, Jacksonville, FL, USA
| | | |
Collapse
|
12
|
Kierkegaard P, Hicks T, Allen AJ, Yang Y, Hayward G, Glogowska M, Nicholson BD, Buckle P. Strategies to implement SARS-CoV-2 point-of-care testing into primary care settings: a qualitative secondary analysis guided by the Behaviour Change Wheel. Implement Sci Commun 2021; 2:139. [PMID: 34922624 PMCID: PMC8684208 DOI: 10.1186/s43058-021-00242-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/17/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The purpose of this study is to develop a theory-driven understanding of the barriers and facilitators underpinning physicians' attitudes and capabilities to implementing SARS-CoV-2 point-of-care (POC) testing into primary care practices. METHODS We used a secondary qualitative analysis approach to re-analyse data from a qualitative, interview study of 22 primary care physicians from 21 primary care practices across three regions in England. We followed the three-step method based on the Behaviour Change Wheel to identify the barriers to implementing SARS-CoV-2 POC testing and identified strategies to address these challenges. RESULTS Several factors underpinned primary care physicians' attitudes and capabilities to implement SARS-CoV-2 POC testing into practice. First, limited knowledge of the SARS-CoV-2 POC testing landscape and a demanding workload affected physicians' willingness to use the tests. Second, there was scepticism about the insufficient evidence pertaining to the clinical efficacy and utility of POC tests, which affected physicians' confidence in the accuracy of tests. Third, physicians would adopt POC tests if they were prescribed and recommended by authorities. Fourth, physicians required professional education and training to increase their confidence in using POC tests but also suggested that healthcare assistants should administer the tests. Fifth, physicians expressed concerns about their limited workload capacity and that extra resources are needed to accommodate any anticipated changes. Sixth, information sharing across practices shaped perceptions of POC tests and the quality of information influenced physician perceptions. Seventh, financial incentives could motivate physicians and were also needed to cover the associated costs of testing. Eighth, physicians were worried that society will view primary care as an alternative to community testing centres, which would change perceptions around their professional identity. Ninth, physicians' perception of assurance/risk influenced their willingness to use POC testing if it could help identify infectious individuals, but they were also concerned about the risk of occupational exposure and potentially losing staff members who would need to self-isolate. CONCLUSIONS Improving primary care physicians' knowledgebase of SARS-CoV-2 POC tests, introducing policies to embed testing into practice, and providing resources to meet the anticipated demands of testing are critical to implementing testing into practice.
Collapse
Affiliation(s)
- Patrick Kierkegaard
- NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Praed Street, London, W2 1NY, UK.
- CRUK Convergence Science Center, Institute for Cancer Research & Imperial College London, Roderic Hill Building, South Kensington Campus, Exhibition Road, London, SW7 2AZ, UK.
| | - Timothy Hicks
- NIHR Newcastle In Vitro Diagnostics Co-Operative, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
- Translational and Clinical Research Institute, The Medical School, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - A Joy Allen
- NIHR Newcastle In Vitro Diagnostics Co-Operative, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
- Translational and Clinical Research Institute, The Medical School, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - Yaling Yang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Gail Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
- NIHR Community Healthcare MedTech and In-Vitro Diagnostics Co-operative, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Margaret Glogowska
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Brian D Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
- NIHR Community Healthcare MedTech and In-Vitro Diagnostics Co-operative, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Peter Buckle
- NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Praed Street, London, W2 1NY, UK
| |
Collapse
|
13
|
Dreger M, Eckhardt H, Felgner S, Ermann H, Lantzsch H, Rombey T, Busse R, Henschke C, Panteli D. Implementation of innovative medical technologies in German inpatient care: patterns of utilization and evidence development. Implement Sci 2021; 16:94. [PMID: 34717677 PMCID: PMC8556925 DOI: 10.1186/s13012-021-01159-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/02/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Innovative medical technologies are commonly associated with positive expectations. At the time of their introduction into care, there is often little evidence available regarding their benefits and harms. Accordingly, some innovative medical technologies with a lack of evidence are used widely until or even though findings of adverse events emerge, while others with study results supporting their safety and effectiveness remain underused. This study aims at examining the diffusion patterns of innovative medical technologies in German inpatient care between 2005 and 2017 while simultaneously considering evidence development. METHODS Based on a qualitatively derived typology and a quantitative clustering of the adoption curves, a representative sample of 21 technologies was selected for further evaluation. Published scientific evidence on efficacy/effectiveness and safety of the technologies was identified and extracted in a systematic approach. Derived from a two-dimensional classification according to the degree of utilization and availability of supportive evidence, the diffusion patterns were then assigned to the categories "Success" (widespread/positive), "Hazard" (widespread/negative), "Overadoption" (widespread/limited or none), "Underadoption" (cautious/positive), "Vigilance" (cautious/negative), and "Prudence" (cautious/limited or none). RESULTS Overall, we found limited evidence on the examined technologies regarding both the quantity and quality of published randomized controlled trials. Thus, the categories "Prudence" and "Overadoption" together account for nearly three-quarters of the years evaluated, followed by "Success" with 17%. Even when evidence is available, the transfer of knowledge into practice appears to be inhibited. CONCLUSIONS The successful implementation of safe and effective innovative medical technologies into practice requires substantial further efforts by policymakers to strengthen systematic knowledge generation and translation. Creating an environment that encourages the conduct of rigorous studies, promotes knowledge translation, and rewards innovative medical technologies according to their added value is a prerequisite for the diffusion of valuable health care.
Collapse
Affiliation(s)
- Marie Dreger
- Department of Health Care Management, Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany.
- Berlin Centre for Health Economics Research (BerlinHECOR), Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany.
| | - Helene Eckhardt
- Department of Health Care Management, Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany
| | - Susanne Felgner
- Department of Health Care Management, Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany
- Berlin Centre for Health Economics Research (BerlinHECOR), Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany
| | - Hanna Ermann
- Department of Health Care Management, Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany
| | - Hendrikje Lantzsch
- Department of Health Care Management, Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany
| | - Tanja Rombey
- Department of Health Care Management, Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany
| | - Reinhard Busse
- Department of Health Care Management, Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany
- Berlin Centre for Health Economics Research (BerlinHECOR), Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany
| | - Cornelia Henschke
- Department of Health Care Management, Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany
- Berlin Centre for Health Economics Research (BerlinHECOR), Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany
| | - Dimitra Panteli
- Department of Health Care Management, Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany
| |
Collapse
|
14
|
May SG, Huber C, Roach M, Shafrin J, Aubry W, Lakdawalla D, Kane JM, Forma F. Adoption of Digital Health Technologies in the Practice of Behavioral Health: Qualitative Case Study of Glucose Monitoring Technology. J Med Internet Res 2021; 23:e18119. [PMID: 33533725 PMCID: PMC7889421 DOI: 10.2196/18119] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 08/05/2020] [Accepted: 11/23/2020] [Indexed: 12/20/2022] Open
Abstract
Background Evaluation of patients with serious mental illness (SMI) relies largely on patient or caregiver self-reported symptoms. New digital technologies are being developed to better quantify the longitudinal symptomology of patients with SMI and facilitate disease management. However, as these new technologies become more widely available, psychiatrists may be uncertain about how to integrate them into daily practice. To better understand how digital tools might be integrated into the treatment of patients with SMI, this study examines a case study of a successful technology adoption by physicians: endocrinologists’ adoption of digital glucometers. Objective This study aims to understand the key facilitators of and barriers to clinician and patient adoption of digital glucose monitoring technologies to identify lessons that may be applicable across other chronic diseases, including SMIs. Methods We conducted focus groups with practicing endocrinologists from 2 large metropolitan areas using a semistructured discussion guide designed to elicit perspectives of and experiences with technology adoption. The thematic analysis identified barriers to and facilitators of integrating digital glucometers into clinical practice. Participants also provided recommendations for integrating digital health technologies into clinical practice more broadly. Results A total of 10 endocrinologists were enrolled: 60% (6/10) male; a mean of 18.4 years in practice (SD 5.6); and 80% (8/10) working in a group practice setting. Participants stated that digital glucometers represented a significant change in the treatment paradigm for diabetes care and facilitated more effective care delivery and patient engagement. Barriers to the adoption of digital glucometers included lack of coverage, provider reimbursement, and data management support, as well as patient heterogeneity. Participant recommendations to increase the use of digital health technologies included expanding reimbursement for clinician time, streamlining data management processes, and customizing the technologies to patient needs. Conclusions Digital glucose monitoring technologies have facilitated more effective, individualized care delivery and have improved patient engagement and health outcomes. However, key challenges faced by the endocrinologists included lack of reimbursement for clinician time and nonstandardized data management across devices. Key recommendations that may be relevant for other diseases include improved data analytics to quickly and accurately synthesize data for patient care management, streamlined software, and standardized metrics.
Collapse
Affiliation(s)
| | | | | | | | - Wade Aubry
- Philip R Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, United States
| | | | - John M Kane
- School of Medicine, Hofstra University, Hempstead, NY, United States.,Northwell Health, New York, NY, United States
| | - Felicia Forma
- Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, NJ, United States
| |
Collapse
|
15
|
Deng Q, Lu J, Zeng Z, Zheng Y, Liu W. Dynamics of Health Technology Diffusion in the Integrated Care System (DHTDICS): A Development and Validation Study in China. Risk Manag Healthc Policy 2021; 14:331-344. [PMID: 33536802 PMCID: PMC7850575 DOI: 10.2147/rmhp.s293144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/08/2021] [Indexed: 01/29/2023] Open
Abstract
Background Limited diffusion of health technology has greatly halted the improvement of resource integration and healthcare outcomes. The importance of understanding the dynamics of health technology diffusion is increasingly highlighted. However, the dynamic mechanism of health technology diffusion in the context of the integrated care system (ICS) remained largely unknown. Purpose To develop and validate the scale on Dynamics of Health Technology Diffusion in Integrated Care System (DHTDICS) for providing an instrument to investigate the health technology diffusion in the ICS in China, by taking the Des-gamma-Carboxy Prothrombin (DCP) test as an example. Methods Based on previous classical theories such as the theory of planned behavior (TPB), technology acceptance model (TAM), and technology-organization-environment framework (TOE), the scale with 34 items was initially developed. It was tested in a cross-sectional questionnaire survey including 246 participants from February to August 2019 in China. Cronbach’s alpha, corrected item-total correlation, and factor loadings were used to assess reliability. Exploratory factor analysis and confirmatory factor analysis were applied to evaluate the validity by assessing factor structures and correlations. Results Reliability analysis revealed excellent internal consistency. Acceptable validity was confirmed through tests of convergent validity and discriminant validity. Regarding the domains that DHTDICS contributes, the results highlighted 4 domains: personal beliefs (including dimensions of attitudes, subjective norms and perceived behavioral control), technical drivers (including dimensions of ease of use and price rationality), organizational readiness (including dimensions of organizational culture, technology absorptive willingness and technology sharing willingness), and external environment (dimension of industry competition pressure). Conclusion The findings confirmed the reliability and validity of the scale on DHTDICS. The scale will be not only a scientific tool in determining the dynamics of health technology diffusion in the ICS, but also a helpful reference for developing future interventions to promote health technology diffusion.
Collapse
Affiliation(s)
- Qingwen Deng
- Department of Health Management, School of Public Health, Fujian Medical University, Fuzhou 350122, People's Republic of China
| | - Junhong Lu
- Department of Health Management, School of Public Health, Fujian Medical University, Fuzhou 350122, People's Republic of China
| | - Zhichao Zeng
- Department of Health Management, School of Public Health, Fujian Medical University, Fuzhou 350122, People's Republic of China
| | - Yuhang Zheng
- Department of Health Management, School of Public Health, Fujian Medical University, Fuzhou 350122, People's Republic of China
| | - Wenbin Liu
- Department of Health Management, School of Public Health, Fujian Medical University, Fuzhou 350122, People's Republic of China
| |
Collapse
|
16
|
Huynh-Le MP, Shults RC, Connor MJ, Hattangadi-Gluth JA. Adverse Events Associated With Radium-223 in Metastatic Prostate Cancer: Disproportionality Analysis of FDA Data Reflecting Worldwide Utilization. Clin Genitourin Cancer 2019; 18:192-200.e2. [PMID: 31902714 DOI: 10.1016/j.clgc.2019.11.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/06/2019] [Accepted: 11/27/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Radionuclide radium-223 improves survival in men with metastatic castrate-resistant prostate cancer. The United States (US) Food and Drug Administration Adverse Events Reporting System (FAERS) is a post-market pharmacovigilance database valuable for adverse event (AE) assessments. We analyzed FAERS to identify disproportionate AE signals related to radium-223, and to explore radium-223's international utilization. MATERIALS AND METHODS We identified 2182 radium-223 cases associated with AE(s) from 2013 to 2018. The duration of radium-223 therapy was calculated. Reporting odds ratio (ROR) and proportional reporting ratio (PRR), with 95% confidence intervals (CIs), were calculated for AEs of interest. ROR shows disproportionate signals if the lower limit of the 95% CI > 1. PRR shows disproportionate signals if PRR ≥ 2, χ2 statistic ≥ 4, and ≥ 3 AEs were reported. We identified any US Food and Drug Administration enforcement actions for radium-223. RESULTS A majority (60.8%) of events occurred outside the US. Among patients with radium-223-associated AEs, the median therapy duration was only 56 days (corresponding to 2-3 treatment cycles). Disproportionate signals were detected for general health deterioration (ROR, 5.03; 95% CI, 4.23-5.98 and PRR, 4.94; 95% CI, 4.16-5.87), bone pain (ROR, 4.53; 95% CI, 3.67-5.59 and PRR, 4.48; 95% CI, 3.63-5.53), and hematologic AEs including anemia (ROR, 2.89; 95% CI, 2.55-3.27 and PRR, 2.80; 95% CI, 2.48-3.17), thrombocytopenia (ROR, 3.22; 95% CI, 2.77-3.74 and PRR, 3.16; 95% CI, 2.72-3.67), and pancytopenia/bone marrow failure (ROR, 4.83; 95% CI, 4.11-5.67 and PRR, 4.73; 95% CI, 4.03-5.55). There were no enforcement actions for radium-223. CONCLUSIONS Patients with metastatic castrate-resistant prostate cancer experiencing AEs are only receiving one-half the prescription dose of radium-223 required for survival benefit. Radium-223 is associated with health deterioration, bone pain, and hematologic AEs. Real-world analyses are important for ongoing radium-223 risk-benefit assessments.
Collapse
Affiliation(s)
- Minh-Phuong Huynh-Le
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Randall C Shults
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Michael J Connor
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Jona A Hattangadi-Gluth
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA.
| |
Collapse
|