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Baffoe-Bonnie MS, Jameson Floyd K, Livinski AA, Grady C. A scoping review exploring cure definitions and language for inherited hemoglobinopathies. GENETICS IN MEDICINE OPEN 2023; 2:100838. [PMID: 38516178 PMCID: PMC10956708 DOI: 10.1016/j.gimo.2023.100838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Purpose Sickle cell disease and beta thalassemia are some of the first targets for potentially curative cell-based therapies. Currently, bone marrow transplants, stem cell transplants, and gene therapy are being researched and utilized for people living with these hemoglobinopathies. Although these therapies are often described as curative, there is not a clear definition of what cure means for these hemoglobinopathies. Methods Five databases were searched for this scoping review. Two reviewers screened each article at the title/abstract and full text levels using Covidence. Articles were included if they were (1) about bone marrow transplants, stem cell transplants, or gene therapy; (2) conditions of focus were sickle cell disease or beta thalassemia; and (3) reported original data on clinical outcomes, psychosocial outcomes, or key stakeholder perspectives and opinions. Data were collected by 2 reviewers also using Covidence, and analyses were conducted in Excel and R. Results We found that, although cure is widely and indiscriminately used, it is not often defined, and when cure is defined, there is no clear convergence or consensus on the definition. Furthermore, cure is often qualified and undefined euphemisms for cure are often used. We also report the major ways in which the success and complications of these treatment modalities are described. Conclusion We frame the significance of our findings by discussing their scientific, ethical, and social implications and focus on the need for precise and clear terminology that centers lived experience and acknowledges the interplay between scientific and lay expertise and perceptions.
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Affiliation(s)
- Marilyn S. Baffoe-Bonnie
- Health Disparities Unit, Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD
- Department of Bioethics, National Institutes of Health Clinical Center, Bethesda, MD
- Department of Sociology, Rutgers University, New Brunswick, NJ
| | - K. Jameson Floyd
- Health Disparities Unit, Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD
| | - Alicia A. Livinski
- National Institutes of Health Library, Office of Research Services, Office of the Director, National Institutes of Health, Bethesda, MD
| | - Christine Grady
- Department of Bioethics, National Institutes of Health Clinical Center, Bethesda, MD
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Muir JM, Radhakrishnan A, Freitag A, Ozer Stillman I, Sarri G. Reconstructing the value puzzle in health technology assessment: a pragmatic review to determine which modelling methods can account for additional value elements. Front Pharmacol 2023; 14:1197259. [PMID: 37521458 PMCID: PMC10372435 DOI: 10.3389/fphar.2023.1197259] [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: 03/30/2023] [Accepted: 07/05/2023] [Indexed: 08/01/2023] Open
Abstract
Health technology assessment (HTA) has traditionally relied on cost-effectiveness analysis (CEA) as a cornerstone of evaluation of new therapies, assessing the clinical validity and utility, the efficacy, and the cost-effectiveness of new interventions. The current format of cost-effectiveness analysis, however, does not allow for inclusion of more holistic aspects of health and, therefore, value elements for new technologies such as the impact on patients and society beyond its pure clinical and economic value. This study aimed to review the recent modelling attempts to expand the traditional cost-effectiveness analysis approach by incorporating additional elements of value in health technology assessment. A pragmatic literature review was conducted for articles published between 2012 and 2022 reporting cost-effectiveness analysis including value aspects beyond the clinical and cost-effectiveness estimates; searches identified 13 articles that were eligible for inclusion. These expanded modelling approaches mainly focused on integrating the impact of societal values and health equity in cost-effectiveness analysis, both of which were championed as important aspects of health technology assessment that should be incorporated into future technology assessments. The reviewed cost-effectiveness analysis methods included modification of the current cost-effectiveness analysis methodology (distributional cost-effectiveness analysis, augmented cost-effectiveness analysis, extended cost-effectiveness analysis) or the use of multi-criteria decision analysis. Of these approaches, augmented cost-effectiveness analysis appears to have the most potential by expanding traditional aspects of value, as it uses techniques already familiar to health technology assessment agencies but also allows space for incorporation of qualitative aspects of a product's value. This review showcases that methods to unravel additional value elements for technology assessment exist, therefore, patient access to promising technologies can be improved by moving the discussion from "if" to "how" additional value elements can inform decision-making.
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Wallace J, Richmond J, Howell J, Hajarizadeh B, Power J, Treloar C, Revill PA, Cowie B, Wang S, Stoové M, Pedrana A, Hellard M. Exploring the Public Health and Social Implications of Future Curative Hepatitis B Interventions. Viruses 2022; 14:v14112542. [PMID: 36423153 PMCID: PMC9693003 DOI: 10.3390/v14112542] [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: 10/04/2022] [Revised: 11/11/2022] [Accepted: 11/16/2022] [Indexed: 11/19/2022] Open
Abstract
Hepatitis B is a significant global health issue where the 296 million people estimated to live with the infection risk liver disease or cancer without clinical intervention. The World Health Organization has committed to eliminating viral hepatitis as a public health threat by 2030, with future curative hepatitis B interventions potentially revolutionizing public health responses to hepatitis B, and being essential for viral hepatitis elimination. Understanding the social and public health implications of any cure is imperative for its successful implementation. This exploratory research, using semi-structured qualitative interviews with a broad range of professional stakeholders identifies the public health elements needed to ensure that a hepatitis B cure can be accessed by all people with hepatitis B. Issues highlighted by the experience of hepatitis C cure access include preparatory work to reorientate policy settings, develop resourcing options, and the appropriateness of health service delivery models. While the form and complexity of curative hepatitis B interventions are to be determined, addressing current disparities in cascade of care figures is imperative with implementation models needing to respond to the cultural contexts, social implications, and health needs of people with hepatitis B, with cure endpoints and discourse being contested.
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Affiliation(s)
- Jack Wallace
- Burnet Institute, Melbourne, VIC 3004, Australia
- Australian Research Centre in Sex, Health and Society, Latrobe University, Bundoora, VIC 3083, Australia
- Centre for Social Research in Health, UNSW, Sydney, NSW 2052, Australia
- Correspondence: ; Tel.: +61-432850708
| | | | - Jessica Howell
- Burnet Institute, Melbourne, VIC 3004, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- Department of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
| | | | - Jennifer Power
- Australian Research Centre in Sex, Health and Society, Latrobe University, Bundoora, VIC 3083, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW, Sydney, NSW 2052, Australia
| | - Peter A. Revill
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Parkville, VIC 3010, Australia
- Department of Microbiology and Immunology, University of Melbourne, Parkville, VIC 3010, Australia
| | - Benjamin Cowie
- WHO Collaborating Centre for Viral Hepatitis, Peter Doherty Institute for Infection and Immunity, Parkville, VIC 3010, Australia
| | - Su Wang
- Center for Asian Health, Saint Barnabas Medical Center, RWJBarnabas-Rutgers Medical Group, Florham Park, NJ 07039, USA
| | - Mark Stoové
- Burnet Institute, Melbourne, VIC 3004, Australia
| | | | - Margaret Hellard
- Burnet Institute, Melbourne, VIC 3004, Australia
- Department of Infectious Diseases, Alfred Health & Monash University, Melbourne, VIC 3004, Australia
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