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Refolo P, Sacchini D, Bloemen B, Grin J, Gutierrez-Ibarluzea I, Hofmann B, Oortwijn W, Raimondi C, Sampietro-Colom L, Sandman L, van der Wilt GJ, Spagnolo AG. On the normativity of evidence - Lessons from philosophy of science and the "VALIDATE" project. Eur Rev Med Pharmacol Sci 2023; 27:11202-11210. [PMID: 38095370 DOI: 10.26355/eurrev_202312_34560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
"Evidence" is a key term in medicine and health services research, including Health Technology Assessment (HTA). Randomized clinical trials (RCTs) have undoubtedly dominated the scene of generating evidence for a long period of time, becoming the hallmark of evidence-based medicine (EBM). However, due to a number of misunderstandings, the lay audience and some researchers have sometimes placed too much trust in RCTs compared to other methods of investigation. One of the principal misunderstandings is to consider RCTs findings as isolated and self-apparent pieces of information. In other words, what has been essentially lacking was the awareness of the value-context of the evidence and, in particular, the value- and theory-ladenness (normativity) of scientific knowledge. This paper aims to emphasize the normativity that exists in the production of scientific knowledge, and in particular in the conduct of RCTs as well as in the performance of HTA. The work is based on some lessons learned from Philosophy of Science and the European project "VALIDATE" (VALues In Doing Assessments of healthcare TEchnologies"). VALIDATE was a three-year EU Erasmus+ strategic partnerships project (2018-2021), in which training in the field of HTA was further optimized by using insights from political science and ethics (in accordance with the recent definition of HTA). Our analysis may reveal useful insights for addressing some challenges that HTA is going to face in the future.
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Affiliation(s)
- P Refolo
- Research Center for Clinical Bioethics and Medical Humanities, Università Cattolica del Sacro Cuore, Rome, Italy.
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Leahy TP, Durand-Zaleski I, Sampietro-Colom L, Kent S, Zöllner Y, Coyle D, Casadei G. The role of quantitative bias analysis for nonrandomized comparisons in health technology assessment: recommendations from an expert workshop. Int J Technol Assess Health Care 2023; 39:e68. [PMID: 37981828 DOI: 10.1017/s0266462323002702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
The use of treatment effects derived from nonrandomized studies (NRS) in health technology assessment (HTA) is growing. NRS carry an inherently greater risk of bias than randomized controlled trials (RCTs). Although bias can be mitigated to some extent through appropriate approaches to study design and analysis, concerns around data availability and quality and the absence of randomization mean residual biases typically render the interpretation of NRS challenging. Quantitative bias analysis (QBA) methods are a range of methods that use additional, typically external, data to understand the potential impact that unmeasured confounding and other biases including selection bias and time biases can have on the results (i.e., treatment effects) from an NRS. QBA has the potential to support HTA bodies in using NRS to support decision-making by quantifying the magnitude, direction, and uncertainty of biases. However, there are a number of key aspects of the use of QBA in HTA which have received limited discussion. This paper presents recommendations for the use of QBA in HTA developed using a multi-stakeholder workshop of experts in HTA with a focus on QBA for unmeasured confounding.
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Affiliation(s)
| | - Isabelle Durand-Zaleski
- AP-HP, Health Economics Research Unit, Department of Public Health, Henri Mondor Hospital, Paris, France
- Methods, UMRS 1153, French National Institute of Health and Medical Research, Paris, France
- Faculty of Medicine, Université Paris Est Creteil, Creteil, France
| | - Laura Sampietro-Colom
- Health Technology Assessment (HTA) Unit, Hospital Clinic of Barcelona, Barcelona, Spain
| | | | - York Zöllner
- Department of Health Sciences, HAW Hamburg, Hamburg, Germany
| | - Doug Coyle
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Gianluigi Casadei
- Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
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Malvehy J, Dreno B, Barba E, Dirshka T, Fumero E, Greis C, Gupta G, Lacarrubba F, Micali G, Moreno D, Pellacani G, Sampietro-Colom L, Stratigos A, Puig S. Smart e-Skin Cancer Care in Europe During and after the Covid-19 Pandemic: a Multidisciplinary Expert Consensus. Dermatol Pract Concept 2023; 13:e2023181. [PMID: 37557116 PMCID: PMC10412091 DOI: 10.5826/dpc.1303a181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Melanoma is the deadliest of all the skin cancers and its incidence is increasing every year in Europe. Patients with melanoma often present late to the specialist and treatment is delayed for many reasons (delay in patient consultation, misdiagnosis by general practitioners, and/or limited access to dermatologists). Beyond this, there are significant inequalities in skin cancer between population groups within the same country and between countries across Europe. The emergence of the COVID-19 pandemic only aggravated these health deficiencies. OBJECTIVES The aim was to create an expert opinion about the challenges in skin cancer management in Europe during the post COVID-19 acute pandemic and to identify and discuss the implementation of new technologies (including e-health and artificial intelligence defined as "Smart Skin Cancer Care") to overcome them. METHODS For this purpose, an ad-hoc questionnaire with items addressing topics of skin cancer care was developed, answered independently and discussed by a multidisciplinary European panel of experts comprising dermatologists, dermato-oncologists, patient advocacy representatives, digital health technology experts, and health technology assessment experts. RESULTS After all panel of experts discussions, a multidisciplinary expert opinion was created. CONCLUSIONS As a conclusion, the access to dermatologists is difficult and will be aggravated in the near future. This fact, together with important differences in Skin Cancer Care in Europe, suggest the need of a new approach to skin health, prevention and disease management paradigm (focused on integration of new technologies) to minimize the impact of skin cancer and to ensure optimal quality and equity.
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Affiliation(s)
- Josep Malvehy
- Dermatology Department. Hospital Clinic of Barcelona, Spain
- University of Barcelona, Barcelona, Spain. Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. Biomedical Research Networking Centre on Rare Diseases (CIBERER), ISCIII, Barcelona, Spain
| | - Brigitte Dreno
- Department of Dermatolo-Cancerology, CHU Nantes, CIC 1413, CRCINA, University Nantes, Nantes, France
| | - Enric Barba
- Spanish Melanoma Association, Barcelona, Spain
| | - Thomas Dirshka
- Centroderm Clinic, Wuppertal, and Faculty of Health, University Witten-Herdecke, Witten, Germany
| | | | - Christian Greis
- Department Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Girish Gupta
- University Department of Dermatology, Edinburgh Royal Infirmary, Lauriston Building, Edinburgh, UK
| | | | | | - David Moreno
- Dermatology Department, University Hospital Virgen Macarena, Seville, Spain
| | - Giovanni Pellacani
- Dermatology Department. Università degli Studi di Roma La Sapienza. Roma, Italy
| | - Laura Sampietro-Colom
- Assessment of Innovations and New Technologies Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Alexander Stratigos
- Department of Dermatology-Venereology, Andreas Sygros Hospital, National and Kapodestrian University of Athens, Athens, Greece
| | - Susanna Puig
- Dermatology Department. Hospital Clinic of Barcelona, Spain
- University of Barcelona, Barcelona, Spain. Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. Biomedical Research Networking Centre on Rare Diseases (CIBERER), ISCIII, Barcelona, Spain
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Tarricone R, Banks H, Ciani O, Brouwer W, Drummond MF, Leidl R, Martelli N, Sampietro-Colom L, Taylor RS. An Accelerated Access Pathway for Innovative High-risk Medical Devices under the new European Union Medical Devices and Health Technology Assessment Regulations? Analysis and Recommendations. Expert Rev Med Devices 2023; 20:259-271. [PMID: 36987818 DOI: 10.1080/17434440.2023.2192868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
INTRODUCTION The new European Union (EU) Regulations for medical devices (MDs) and health technology assessment (HTA) are welcome developments that will hopefully increase the quality of clinical evidence for MDs and reduce fragmentation in the EU market access process. To fully exploit anticipated benefits, their respective assessment processes should be closely coordinated, particularly for promising, highly innovative MDs. Accelerated approval is worth exploring for certain categories of high-risk MDs to keep the EU regulatory process competitive compared to ad-hoc accelerated MD approval processes elsewhere (e.g., US). AREAS COVERED Problems observed in worldwide accelerated drug and MD regulatory approval programs are reviewed, including greater uncertainty in pre-market clinical evidence generation and lack of oversight for post-approval evidence requirements. Implications for MD approval, HTA and coverage are explored. EXPERT OPINION Through analysis of two decades of drug and MD accelerated approval programs worldwide, recommendations for an Accelerated Access Pathway for select innovative, high-risk MDs are proposed that can fit the EU context, leverage the two new regulations, increase opportunities for Expert Panels to provide timely advice regarding manufacturers' evidence generation plans along the MD lifecycle (pre-, post-market), and safely speed patient access while promoting increased collaboration among Member States on coverage decisions.
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Affiliation(s)
| | - Helen Banks
- SDA Bocconi School of Management, Centre for Research on Health and Social Care Management (CERGAS), Milano, taly
| | - Oriana Ciani
- SDA Bocconi School of Management, Government, Health & Not-for-profit Division Health Economics & HTA, Milano, Italy
| | - Werner Brouwer
- Erasmus University Rotterdam, Erasmus School of Health Policy & Management (ESHPM), Rotterdam, Netherlands
| | - Michael F Drummond
- Centre for Health Economics, University of York, York, United Kingdom of Great Britain and Northern Ireland
| | - Reiner Leidl
- Ludwig-Maximilians-Universitat Munchen, Munich School of Management, Munchen, Germany
| | - Nicolas Martelli
- Assistance Publique Hopitaux de Paris, Pharmacy Department, Hôpital Européen Georges Pompidou, Paris, France
| | | | - Rod S Taylor
- University of Glasgow, Institute of Health and Wellbeing, Glasgow, United Kingdom of Great Britain and Northern Ireland
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Sampietro-Colom L, Fernandez-Barcelo C, Abbas I, Valdasquin B, Rabasseda N, García-Lorenzo B, Sanchez M, Sans M, Garcia N, Granados A. WtsWrng Interim Comparative Effectiveness Evaluation and Description of the Challenges to Develop, Assess, and Introduce This Novel Digital Application in a Traditional Health System. Int J Environ Res Public Health 2022; 19:13873. [PMID: 36360756 PMCID: PMC9654177 DOI: 10.3390/ijerph192113873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/21/2022] [Accepted: 10/22/2022] [Indexed: 06/16/2023]
Abstract
Science and technology have evolved quickly during the two decades of the 21st century, but healthcare systems are grounded in last century's structure and processes. Changes in the way health care is provided are demanded; digital transformation is a key driver making healthcare systems more accessible, agile, efficient, and citizen-centered. Nevertheless, the way healthcare systems function challenges the development (Innovation + Development and regulatory requirements), assessment (methodological guidance weaknesses), and adoption of digital applications (DAs). WtsWrng (WW), an innovative DA which uses images to interact with citizens for symptom triage and monitoring, is used as an example to show the challenges faced in its development and clinical validation and how these are being overcome. To prove WW's value from inception, novel approaches for evidence generation that allows for an agile and patient-centered development have been applied. Early scientific advice from NICE (UK) was sought for study design, an iterative development and interim analysis was performed, and different statistical parameters (Kappa, B statistic) were explored to face development and assessment challenges. WW triage accuracy at cutoff time ranged from 0.62 to 0.94 for the most frequent symptoms attending the Emergency Department (ED), with the observed concordance for the 12 most frequent diagnostics at hospital discharge fluctuating between 0.4 to 0.97; 8 of the diagnostics had a concordance greater than 0.8. This experience should provoke reflective thinking for DA developers, digital health scientists, regulators, health technology assessors, and payers.
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Affiliation(s)
- Laura Sampietro-Colom
- Assessment of Innovations and New Technologies Unit, Research and Innovation Directorate, Clínic Barcelona University Hospital, 08036 Barcelona, Spain
- Mangrana Ventures S.L., 08006 Barcelona, Spain
| | - Carla Fernandez-Barcelo
- Assessment of Innovations and New Technologies Unit, Research and Innovation Directorate, Clínic Barcelona University Hospital, 08036 Barcelona, Spain
| | - Ismail Abbas
- Assessment of Innovations and New Technologies Unit, Research and Innovation Directorate, Clínic Barcelona University Hospital, 08036 Barcelona, Spain
| | - Blanca Valdasquin
- Assessment of Innovations and New Technologies Unit, Research and Innovation Directorate, Clínic Barcelona University Hospital, 08036 Barcelona, Spain
| | | | - Borja García-Lorenzo
- Assessment of Innovations and New Technologies Unit, Research and Innovation Directorate, Clínic Barcelona University Hospital, 08036 Barcelona, Spain
- Kronikgune Institute for Health Sciences Research, 48902 Barakaldo, Spain
| | - Miquel Sanchez
- Emergency Department, Clínic Barcelona University Hospital, 08036 Barcelona, Spain
| | - Mireia Sans
- CAP Comte Borrell, Consorci Atenció Primaria Salut Barcelona Esquerra—CAPSBE, 08029 Barcelona, Spain
- Health 2.0 Section of the Col·Legi Oficial de Metges de Barcelona, 08017 Barcelona, Spain
| | - Noemi Garcia
- CAP Comte Borrell, Consorci Atenció Primaria Salut Barcelona Esquerra—CAPSBE, 08029 Barcelona, Spain
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Refolo P, Bloemen B, Corsano B, Grin J, Gutierrez-Ibarluzea I, Hofmann B, Oortwijn W, Sampietro-Colom L, Sandman L, van der Wilt GJ, Sacchini D. Prioritization of COVID-19 vaccination. The added value of the "VALIDATE" approach. Health Policy 2022; 126:770-776. [PMID: 35623910 PMCID: PMC9121636 DOI: 10.1016/j.healthpol.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 05/04/2022] [Accepted: 05/14/2022] [Indexed: 11/17/2022]
Abstract
Prioritization of COVID-19 vaccines is one of the most relevant topics in the current pandemic emergency. Prioritization decisions are political decisions that are value-laden, and as such of ethical nature. Despite the clear political and ethical nature of this topic, prioritization decisions are often interpreted and presented as scientific decisions. The aim of this article is twofold. First, we aim to show critical points that characterize certain pandemic vaccination plans from the ethical viewpoint using four dimensions (problem definitions, incorporation of different perspectives, context, and specification). The four dimensions were drawn from findings of the European project “VALIDATE” (VALues In Doing Assessments of healthcare TEchnologies”, https://validatehta.eu). Second, we aim to reframe the issue about prioritization itself in the light of the four dimensions mentioned. Our conclusion is that policy-problem definitions, incorporation of different perspectives, contextual considerations and specification of moral principles seem to be common critical points of some vaccination plan documents. The European project “VALIDATE” seems to be able to provide a useful and profitable approach to address many of these critical points.
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Affiliation(s)
- Pietro Refolo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Healthcare Surveillance and Bioethics, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Bart Bloemen
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Barbara Corsano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Healthcare Surveillance and Bioethics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - John Grin
- University of Amsterdam, Amsterdam, The Netherlands
| | - Iñaki Gutierrez-Ibarluzea
- Basque Foundation for Health Innovation and Research (BIOEF), Barakaldo, Spain; Basque Office for HTA (Osteba), Barakaldo, Spain
| | - Bjørn Hofmann
- Department of Health Science, Norwegian University of Science and Technology, Gjøvik, Norway
| | - Wija Oortwijn
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Laura Sampietro-Colom
- Assessment of Innovations and New Technologies Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Lars Sandman
- Department of Health, Medicine and Caring Sciences, National Centre for Priorities in Health, Linköping University, Linköping, Sweden
| | - Gert Jan van der Wilt
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Dario Sacchini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Healthcare Surveillance and Bioethics, Università Cattolica del Sacro Cuore, Rome, Italy
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7
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Muñoz-Rojas G, García-Lorenzo B, Esteve D, Trias S, Caellas D, Sanz M, Mellado R, Peix T, Sampietro-Colom L, Pou N, Martínez-Pallí G, Ferrando C. Implementing a Rapid Response System in a tertiary-care hospital. A cost-effectiveness study. J Clin Monit Comput 2022; 36:1263-1269. [PMID: 35460504 DOI: 10.1007/s10877-022-00859-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/29/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The occurrence of adverse events (AE) in hospitalized patients substancially increases the risk of disability or death, having a major negative clinical and economic impact on public health. For early identification of patients at risk and to establish preventive measures, different healthcare systems have implemented rapid response systems (RRS). The aim of this study was to carry out a cost-effectiveness analysis of implementing a RRS in a tertiary-care hospital. METHODS We included all the patients admitted to Hospital Clínic de Barcelona from 1 to 2016 to 31 December 2016. The cost-effectiveness analysis was summarized as the incremental cost-effectiveness ratio (incremental cost divided by the incremental effectiveness of the two alternatives, RRS versus non-RRS). The effectiveness of the RRS, defined as improvements in health outcomes (AE, cardiopulmonary arrest and mortality), was obtained from the literature and applied to the included patient cohort. A budget impact analysis on the implementation of the RRS from a hospital perspective was performed over a 5-year time horizon. RESULTS 42,409 patients were included, and 448 (1.05%) had severe AE requiring ICU admission. The cost-effectiveness analysis showed an incremental cost (savings) of EUR - 1,471,101 of RRS versus the non-RRS. The budgetary impact showed a cost reduction of EUR 896,762.00 in the first year and EUR 1,588,579.00 from the second to the fifth year. CONCLUSIONS The present analysis shows the RRS as a dominant, less costly and more effective structure compared to the non-RRS.
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Affiliation(s)
- G Muñoz-Rojas
- Department of Anesthesiology and Critical Care, Hospital Clínic de Barcelona, Institut D'investigació August Pi i Sunyer, C/ Villarroel 170, 08036, Barcelona, Spain
| | - B García-Lorenzo
- Assessment of Innovations and New Technologies Unit, Hospital Clínic de Barcelona, Barcelona, Spain
- Kronikgune Institute for Health Services Research, Barakaldo, Basque Country, Spain
| | - D Esteve
- Respiratory Intensive Care Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - S Trias
- Surgical Area Management, Hospital Clínic de Barcelona, Barcelona, Spain
| | - D Caellas
- Information Systems Management, Hospital Clínic de Barcelona, Barcelona, Spain
| | - M Sanz
- Infrastructure Management, Hospital Clínic de Barcelona, Barcelona, Spain
| | - R Mellado
- Department of Anesthesiology and Critical Care, Hospital Clínic de Barcelona, Institut D'investigació August Pi i Sunyer, C/ Villarroel 170, 08036, Barcelona, Spain
- CIBER (Center of Biomedical Research in Respiratory Diseases), Instituto de Salud Carlos III, Madrid, Spain
| | - T Peix
- Surgical Area Management, Hospital Clínic de Barcelona, Barcelona, Spain
| | - L Sampietro-Colom
- Assessment of Innovations and New Technologies Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - N Pou
- Surgical Area Management, Hospital Clínic de Barcelona, Barcelona, Spain
| | - G Martínez-Pallí
- Department of Anesthesiology and Critical Care, Hospital Clínic de Barcelona, Institut D'investigació August Pi i Sunyer, C/ Villarroel 170, 08036, Barcelona, Spain
- CIBER (Center of Biomedical Research in Respiratory Diseases), Instituto de Salud Carlos III, Madrid, Spain
| | - Carlos Ferrando
- Department of Anesthesiology and Critical Care, Hospital Clínic de Barcelona, Institut D'investigació August Pi i Sunyer, C/ Villarroel 170, 08036, Barcelona, Spain.
- CIBER (Center of Biomedical Research in Respiratory Diseases), Instituto de Salud Carlos III, Madrid, Spain.
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8
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Malvehy J, Ginsberg R, Sampietro-Colom L, Ficapal J, Combalia M, Svedenhag P. New regulation of medical devices in the EU: impact in dermatology. J Eur Acad Dermatol Venereol 2021; 36:360-364. [PMID: 34816498 PMCID: PMC9299790 DOI: 10.1111/jdv.17830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/15/2021] [Accepted: 11/05/2021] [Indexed: 12/01/2022]
Abstract
Medical device (MD) is a broad term that encompasses products ranging from, for example, examination gloves to digital dermoscopy systems; all of which are regulated by a new regulatory framework in the EU from May 2021. The new Medical Device Regulation (MDR) (Regulation EU 2017/745) will have a significant effect on suppliers of MD and will have subsequent effects also for dermatologists and other clinicians. Medical device software and apps are reclassified leading to more stringent requirements on documentation within, e.g. clinical evidence, as well as regulatory authority control. The changes will likely have positive effects on quality, to the benefit of patients. There will, however, be implications affecting the availability and support of existing devices and the introduction of new devices, as well as a likely price increase due to the higher costs for suppliers. Dermatologists, other clinicians and administrators need to be aware of the effects of MDR to ensure that existing devices and new purchases can be used as planned. Specifically, clinicians need to be aware of the following: (i) improved quality of MD and follow‐up of incidents can be expected. (ii) Only ‘non‐significant’ updates will be permitted after May 2021 to many existing systems and devices unless approved under the new MDR. (iii) Existing devices that do not achieve approval under the new regulation will no longer be manufactured after May 2024. (iv) New products and methods will take longer time to be approved and available. (v) Prices will likely increase. (vi) Suppliers of products that do not fulfil the new regulation will disappear, and the availability of consumables, spare parts or upgrades might be discontinued. (vii) A trend to oligopoly may appear in the market. It is therefore important to check with your suppliers as to how and when they will adhere to the new MDR regulation.
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Affiliation(s)
- J Malvehy
- Department of Dermatology, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - L Sampietro-Colom
- Research & Innovation Directorate, Hospital Clinic of Barcelona, Barcelona, Spain
| | - J Ficapal
- Hospital Clinic of Barcelona, Barcelona, Spain
| | - M Combalia
- Hospital Clinic of Barcelona, Barcelona, Spain
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García-Lorenzo B, Fernández-Barceló C, Maduell F, Sampietro-Colom L. Health Technology Assessment of a new water quality monitoring technology: Impact of automation, digitalization and remoteness in dialysis units. PLoS One 2021; 16:e0247450. [PMID: 33630930 PMCID: PMC7906308 DOI: 10.1371/journal.pone.0247450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 02/06/2021] [Indexed: 11/18/2022] Open
Abstract
Background Water quality monitoring at the dialysis units (DU) is essential to ensure an appropriate dialysis fluid quality and guarantee an optimal and safe dialysis treatment to patients. This paper aims to evaluate the effectiveness, economic and organizational impact of automation, digitalization and remote water quality monitoring, through a New Water Technology (NWT) at a hospital DU to produce dialysis water, compared to a Conventional Water Technology (CWT). Methods A before-and-after study was carried out at the Hospital Clínic Barcelona. Data on CWT was collected during 1-year (control) and 7-month for the NWT (case). Data on water quality, resource use and unit cost were retrospective and prospectively collected. A comparative effectiveness analysis on the compliance rate of quality water parameters with the international guidelines between the NWT and the CWT was conducted. This was followed by a cost-minimization analysis and an organizational impact from the hospital perspective. An extensive deterministic sensitivity analysis was also performed. Results The NWT compared to the CWT showed no differences on effectiveness measured as the compliance rate on international requirements on water quality (100% vs. 100%), but the NWT yielded savings of 3,599 EUR/year compared to the CWT. The NWT offered more data accuracy (daily measures: 6 vs. 1 and missing data: 0 vs. 20 days/year), optimization of the DU employees’ workload (attendance to DU: 4 vs. 19 days/month) and workflow, through the remote and continuous monitoring, reliability of data and process regarding audits for quality control. Conclusions While the compliance of international recommendations on continuous monitoring was performed with the CWT, the NWT was efficient compared to the CWT, mainly due to the travel time needed by the technical operator to attend the DU. These results were scalable to other economic contexts. Nonetheless, they should be taken with caution either when the NWT equipment/maintenance cost are largely increased, or the workforce involvement is diminished.
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Affiliation(s)
- Borja García-Lorenzo
- Assessment of Innovations and New Technologies Unit, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Catalonia, Spain
- * E-mail:
| | - Carla Fernández-Barceló
- Assessment of Innovations and New Technologies Unit, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Catalonia, Spain
| | - Francisco Maduell
- Department of Nephrology and Renal Transplantation, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Catalonia, Spain
| | - Laura Sampietro-Colom
- Assessment of Innovations and New Technologies Unit, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Catalonia, Spain
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10
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Garcia-Garcia S, García-Lorenzo B, Ramos PR, Gonzalez-Sanchez JJ, Culebras D, Restovic G, Alcover E, Pons I, Torales J, Reyes L, Sampietro-Colom L, Enseñat J. Cost-Effectiveness of Low-Field Intraoperative Magnetic Resonance in Glioma Surgery. Front Oncol 2020; 10:586679. [PMID: 33224884 PMCID: PMC7667256 DOI: 10.3389/fonc.2020.586679] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/09/2020] [Indexed: 12/01/2022] Open
Abstract
Object Low-field intraoperative magnetic resonance (LF-iMR) has demonstrated a slight increase in the extent of resection of intra-axial tumors while preserving patient`s neurological outcomes. However, whether this improvement is cost-effective or not is still matter of controversy. In this clinical investigation we sought to evaluate the cost-effectiveness of the implementation of a LF-iMR in glioma surgery. Methods Patients undergoing LF-iMR guided glioma surgery with gross total resection (GTR) intention were prospectively collected and compared to an historical cohort operated without this technology. Socio-demographic and clinical variables (pre and postoperative KPS; histopathological classification; Extent of resection; postoperative complications; need of re-intervention within the first year and 1-year postoperative survival) were collected and analyzed. Effectiveness variables were assessed in both groups: Postoperative Karnofsky performance status scale (pKPS); overall survival (OS); Progression-free survival (PFS); and a variable accounting for the number of patients with a greater than subtotal resection and same or higher postoperative KPS (R-KPS). All preoperative, procedural and postoperative costs linked to the treatment were considered for the cost-effectiveness analysis (diagnostic procedures, prosthesis, operating time, hospitalization, consumables, LF-iMR device, etc). Deterministic and probabilistic simulations were conducted to evaluate the consistency of our analysis. Results 50 patients were operated with LF-iMR assistance, while 146 belonged to the control group. GTR rate, pKPS, R-KPS, PFS, and 1-year OS were respectively 13,8% (not significative), 7 points (p < 0.05), 17% (p < 0.05), 38 days (p < 0.05), and 3.7% (not significative) higher in the intervention group. Cost-effectiveness analysis showed a mean incremental cost per patient of 789 € in the intervention group. Incremental cost-effectiveness ratios were 111 € per additional point of pKPS, 21 € per additional day free of progression, and 46 € per additional percentage point of R-KPS. Conclusion Glioma patients operated under LF-iMR guidance experience a better functional outcome, higher resection rates, less complications, better PFS rates but similar life expectancy compared to conventional techniques. In terms of efficiency, LF-iMR is very close to be a dominant technology in terms of R-KPS, PFS and pKPS.
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Affiliation(s)
| | - Borja García-Lorenzo
- Assessment of Innovations and New Technologies Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | | | | | - Diego Culebras
- Department of Neurological Surgery, Hospital Clinic, Barcelona, Spain
| | - Gabriela Restovic
- Assessment of Innovations and New Technologies Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Estanis Alcover
- Economic and Financial Management Department, Hospital Clinic, Barcelona, Spain
| | - Imma Pons
- Economic and Financial Management Department, Hospital Clinic, Barcelona, Spain
| | - Jorge Torales
- Department of Neurological Surgery, Hospital Clinic, Barcelona, Spain
| | - Luis Reyes
- Department of Neurological Surgery, Hospital Clinic, Barcelona, Spain
| | - Laura Sampietro-Colom
- Assessment of Innovations and New Technologies Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Joaquim Enseñat
- Department of Neurological Surgery, Hospital Clinic, Barcelona, Spain
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Tarricone R, Ciani O, Torbica A, Brouwer W, Chaloutsos G, Drummond MF, Martelli N, Persson U, Leidl R, Levin L, Sampietro-Colom L, Taylor RS. Lifecycle evidence requirements for high-risk implantable medical devices: a European perspective. Expert Rev Med Devices 2020; 17:993-1006. [PMID: 32975149 DOI: 10.1080/17434440.2020.1825074] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION The new European Union (EU) Regulations on medical devices and on in vitro diagnostics provide manufacturers and Notified Bodies with new tools to improve pre-market and post-market clinical evidence generation especially for high-risk products but fail to indicate what type of clinical evidence is appropriate at each stage of the whole lifecycle of medical devices. In this paper we address: i) the appropriate level and timing of clinical evidence throughout the lifecycle of high-risk implantable medical devices; and ii) how the clinical evidence generation ecosystem could be adapted to optimize patient access. AREAS COVERED The European regulatory and health technology assessment (HTA) contexts are reviewed, in relation to the lifecycle of high-risk medical devices and clinical evidence generation recommended by international network or endorsed by regulatory and HTA agencies in different jurisdictions. EXPERT OPINION Four stages are relevant for clinical evidence generation: i) pre-clinical, pre-market; ii) clinical, pre-market; iii) diffusion, post-market; and iv) obsolescence & replacement, post-market. Each stage has its own evaluation needs and specific studies are recommended to generate the appropriate evidence. Effective lifecycle planning requires anticipation of what evidence will be needed at each stage.
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Affiliation(s)
- Rosanna Tarricone
- Department of Social and Political Science, Bocconi University , Milan, Italy.,SDA Bocconi School of Management , Milan, Italy.,SDA Bocconi School of Management, Centre for Research on Health and Social Care Management (CERGAS) , Milan, Italy
| | - Oriana Ciani
- SDA Bocconi School of Management, Centre for Research on Health and Social Care Management (CERGAS) , Milan, Italy.,Institute of College and Medicine, University of Exeter, South Cloisters, St Luke's Campus , Exeter, UK
| | - Aleksandra Torbica
- Department of Social and Political Science, Bocconi University , Milan, Italy.,SDA Bocconi School of Management , Milan, Italy
| | - Werner Brouwer
- Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam , Rotterdam, PA, The Netherlands
| | - Georges Chaloutsos
- Biomedical Engineering Department, Onassis Cardiac Surgery Centre & Director , Athens, Greece
| | - Michael F Drummond
- Professor of Health Economics, Centre for Health Economics, University of York , York, UK
| | - Nicolas Martelli
- Associate Clinical Professor, Hôpital Européen Georges Pompidou , Paris, France
| | - Ulf Persson
- IHE, Swedish Institute for Health Economics , Lund, Sweden
| | - Reiner Leidl
- Institute of Health Economics and Healthcare Management, Helmholtz Zentrum München - German Research Center for Environmental Health (Gmbh) , Neuherberg, Germany
| | - Les Levin
- Chief Executive Officer & Scientific Officer, EXCITE International , Canada
| | - Laura Sampietro-Colom
- Deputy Director of Innovation, Head of Health Technology Assessment Unit at Hospital Clinic Barcelona , Spain
| | - Rod S Taylor
- Institute of Health and Wellbeing, University of Glasgow , Glasgow, UK
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12
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Moroni L, Restovic G, Cervera R, Espinosa G, Viñas O, García M, Sampietro-Colom L. Economic Analysis of the Use of Anti-DFS70 Antibody Test in Patients with Undifferentiated Systemic Autoimmune Disease Symptoms. J Rheumatol 2019; 47:1275-1284. [PMID: 31676692 DOI: 10.3899/jrheum.190533] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE In patients with antinuclear antibodies (ANA) and undifferentiated features of systemic autoimmune disease, the coexistence of monospecific anti-dense fine speckled 70 (anti-DFS70) antibodies is associated with a lower risk of progression to overt disease. Therefore, they might help in correctly classifying ANA- positive patients and avoiding unnecessary followup diagnostic procedures. The aim of this study was to analyze the economic effect of the introduction of the anti-DFS70 antibody test in a hospital setting. METHODS A case-control study was performed to detect monospecific anti-DFS70 antibodies in ANA-positive subjects with undifferentiated features (cases, n = 124) and with a defined systemic autoimmune disease (controls, n = 290). Based on current clinical practice, a decision tree was developed to represent the disease course of patients with undifferentiated features in the subsequent 3 years. A budget impact analysis (BIA) was performed to estimate the effect of implementing the screening for anti-DFS70 antibodies in the case group on the total costs. A sensitivity analysis was conducted to calculate the effect of the uncertainty of the input variables on the results. RESULTS Among the 124 patients in the case group, 5 (4.0%) tested positive for anti-DFS70 antibodies versus 4/290 (1.4%) in the control group (p = not significant). The mean cost per patient under the current clinical practice decreased from €3274 to €3192 in our scenario. The BIA reports cost savings of €10,128. CONCLUSION The introduction of anti-DFS70 antibody test would avoid unnecessary followup diagnostic procedures and minimize the use of health resources generated by suspicion of a potential systemic autoimmune disease.
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Affiliation(s)
- Luca Moroni
- From the Department of Autoimmune Diseases, the Department of Immunology, and the Assessment of Innovations and New Technologies Unit, Hospital Clínic, University of Barcelona, Barcelona; Fundació Clínic per la Recerca Biomèdica, Barcelona; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; the Unit of Immunology, Rheumatology, Allergy and Rare Diseases, San Raffaele Scientific Institute, Milan, Italy.,L. Moroni, MD, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, and Unit of Immunology, Rheumatology, Allergy and Rare Diseases, San Raffaele Scientific Institute; G. Restovic, MD, Fundació Clínic per la Recerca Biomèdica; R. Cervera, MD, PhD, FRCP, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, and IDIBAPS; G. Espinosa, MD, PhD, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, and IDIBAPS; O. Viñas, MD, Fundació Clínic per la Recerca Biomèdica, and Department of Immunology, Hospital Clínic, University of Barcelona; M. García, MD, Fundació Clínic per la Recerca Biomèdica, and Department of Immunology, Hospital Clínic, University of Barcelona; L. Sampietro-Colom, MD, Assessment of Innovations and New Technologies Unit, Hospital Clínic, University of Barcelona
| | - Gabriela Restovic
- From the Department of Autoimmune Diseases, the Department of Immunology, and the Assessment of Innovations and New Technologies Unit, Hospital Clínic, University of Barcelona, Barcelona; Fundació Clínic per la Recerca Biomèdica, Barcelona; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; the Unit of Immunology, Rheumatology, Allergy and Rare Diseases, San Raffaele Scientific Institute, Milan, Italy.,L. Moroni, MD, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, and Unit of Immunology, Rheumatology, Allergy and Rare Diseases, San Raffaele Scientific Institute; G. Restovic, MD, Fundació Clínic per la Recerca Biomèdica; R. Cervera, MD, PhD, FRCP, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, and IDIBAPS; G. Espinosa, MD, PhD, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, and IDIBAPS; O. Viñas, MD, Fundació Clínic per la Recerca Biomèdica, and Department of Immunology, Hospital Clínic, University of Barcelona; M. García, MD, Fundació Clínic per la Recerca Biomèdica, and Department of Immunology, Hospital Clínic, University of Barcelona; L. Sampietro-Colom, MD, Assessment of Innovations and New Technologies Unit, Hospital Clínic, University of Barcelona
| | - Ricard Cervera
- From the Department of Autoimmune Diseases, the Department of Immunology, and the Assessment of Innovations and New Technologies Unit, Hospital Clínic, University of Barcelona, Barcelona; Fundació Clínic per la Recerca Biomèdica, Barcelona; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; the Unit of Immunology, Rheumatology, Allergy and Rare Diseases, San Raffaele Scientific Institute, Milan, Italy. .,L. Moroni, MD, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, and Unit of Immunology, Rheumatology, Allergy and Rare Diseases, San Raffaele Scientific Institute; G. Restovic, MD, Fundació Clínic per la Recerca Biomèdica; R. Cervera, MD, PhD, FRCP, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, and IDIBAPS; G. Espinosa, MD, PhD, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, and IDIBAPS; O. Viñas, MD, Fundació Clínic per la Recerca Biomèdica, and Department of Immunology, Hospital Clínic, University of Barcelona; M. García, MD, Fundació Clínic per la Recerca Biomèdica, and Department of Immunology, Hospital Clínic, University of Barcelona; L. Sampietro-Colom, MD, Assessment of Innovations and New Technologies Unit, Hospital Clínic, University of Barcelona.
| | - Gerard Espinosa
- From the Department of Autoimmune Diseases, the Department of Immunology, and the Assessment of Innovations and New Technologies Unit, Hospital Clínic, University of Barcelona, Barcelona; Fundació Clínic per la Recerca Biomèdica, Barcelona; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; the Unit of Immunology, Rheumatology, Allergy and Rare Diseases, San Raffaele Scientific Institute, Milan, Italy.,L. Moroni, MD, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, and Unit of Immunology, Rheumatology, Allergy and Rare Diseases, San Raffaele Scientific Institute; G. Restovic, MD, Fundació Clínic per la Recerca Biomèdica; R. Cervera, MD, PhD, FRCP, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, and IDIBAPS; G. Espinosa, MD, PhD, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, and IDIBAPS; O. Viñas, MD, Fundació Clínic per la Recerca Biomèdica, and Department of Immunology, Hospital Clínic, University of Barcelona; M. García, MD, Fundació Clínic per la Recerca Biomèdica, and Department of Immunology, Hospital Clínic, University of Barcelona; L. Sampietro-Colom, MD, Assessment of Innovations and New Technologies Unit, Hospital Clínic, University of Barcelona
| | - Odette Viñas
- From the Department of Autoimmune Diseases, the Department of Immunology, and the Assessment of Innovations and New Technologies Unit, Hospital Clínic, University of Barcelona, Barcelona; Fundació Clínic per la Recerca Biomèdica, Barcelona; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; the Unit of Immunology, Rheumatology, Allergy and Rare Diseases, San Raffaele Scientific Institute, Milan, Italy.,L. Moroni, MD, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, and Unit of Immunology, Rheumatology, Allergy and Rare Diseases, San Raffaele Scientific Institute; G. Restovic, MD, Fundació Clínic per la Recerca Biomèdica; R. Cervera, MD, PhD, FRCP, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, and IDIBAPS; G. Espinosa, MD, PhD, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, and IDIBAPS; O. Viñas, MD, Fundació Clínic per la Recerca Biomèdica, and Department of Immunology, Hospital Clínic, University of Barcelona; M. García, MD, Fundació Clínic per la Recerca Biomèdica, and Department of Immunology, Hospital Clínic, University of Barcelona; L. Sampietro-Colom, MD, Assessment of Innovations and New Technologies Unit, Hospital Clínic, University of Barcelona
| | - Milagros García
- From the Department of Autoimmune Diseases, the Department of Immunology, and the Assessment of Innovations and New Technologies Unit, Hospital Clínic, University of Barcelona, Barcelona; Fundació Clínic per la Recerca Biomèdica, Barcelona; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; the Unit of Immunology, Rheumatology, Allergy and Rare Diseases, San Raffaele Scientific Institute, Milan, Italy.,L. Moroni, MD, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, and Unit of Immunology, Rheumatology, Allergy and Rare Diseases, San Raffaele Scientific Institute; G. Restovic, MD, Fundació Clínic per la Recerca Biomèdica; R. Cervera, MD, PhD, FRCP, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, and IDIBAPS; G. Espinosa, MD, PhD, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, and IDIBAPS; O. Viñas, MD, Fundació Clínic per la Recerca Biomèdica, and Department of Immunology, Hospital Clínic, University of Barcelona; M. García, MD, Fundació Clínic per la Recerca Biomèdica, and Department of Immunology, Hospital Clínic, University of Barcelona; L. Sampietro-Colom, MD, Assessment of Innovations and New Technologies Unit, Hospital Clínic, University of Barcelona
| | - Laura Sampietro-Colom
- From the Department of Autoimmune Diseases, the Department of Immunology, and the Assessment of Innovations and New Technologies Unit, Hospital Clínic, University of Barcelona, Barcelona; Fundació Clínic per la Recerca Biomèdica, Barcelona; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; the Unit of Immunology, Rheumatology, Allergy and Rare Diseases, San Raffaele Scientific Institute, Milan, Italy.,L. Moroni, MD, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, and Unit of Immunology, Rheumatology, Allergy and Rare Diseases, San Raffaele Scientific Institute; G. Restovic, MD, Fundació Clínic per la Recerca Biomèdica; R. Cervera, MD, PhD, FRCP, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, and IDIBAPS; G. Espinosa, MD, PhD, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, and IDIBAPS; O. Viñas, MD, Fundació Clínic per la Recerca Biomèdica, and Department of Immunology, Hospital Clínic, University of Barcelona; M. García, MD, Fundació Clínic per la Recerca Biomèdica, and Department of Immunology, Hospital Clínic, University of Barcelona; L. Sampietro-Colom, MD, Assessment of Innovations and New Technologies Unit, Hospital Clínic, University of Barcelona
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Crespo C, Linhart M, Acosta J, Soto-Iglesias D, Martínez M, Jáuregui B, Mira Á, Restovic G, Sagarra J, Auricchio A, Fahn B, Boltyenkov A, Lasalvia L, Sampietro-Colom L, Berruezo A. Optimisation of cardiac resynchronisation therapy device selection guided by cardiac magnetic resonance imaging: Cost-effectiveness analysis. Eur J Prev Cardiol 2019; 27:622-632. [PMID: 31487998 DOI: 10.1177/2047487319873149] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND A recent study showed that the presence and characteristics of myocardial scar could independently predict appropriate implantable cardioverter-defibrillator therapies and the risk of sudden cardiac death in patients receiving a de novo cardiac resynchronisation device. DESIGN The aim was to evaluate the cost-effectiveness of cardiac magnetic resonance imaging-based algorithms versus clinical practice in the decision-making process for the implantation of a cardiac resynchronisation device pacemaker versus cardiac resynchronisation device implantable cardioverter-defibrillator device in heart failure patients with indication for cardiac resynchronisation therapy. METHODS An incidental Markov model was developed to simulate the lifetime progression of a heart failure patient cohort. Key health variables included in the model were New York Heart Association functional class, hospitalisations, sudden cardiac death and total mortality. The analysis was done from the healthcare system perspective. Costs (€2017), survival and quality-adjusted life years were assessed. RESULTS At 5-year follow-up, algorithm I reduced mortality by 39% in patients with a cardiac resynchronisation device pacemaker who were underprotected due to misclassification by clinical protocol. This approach had the highest quality-adjusted life years (algorithm I 3.257 quality-adjusted life years; algorithm II 3.196 quality-adjusted life years; clinical protocol 3.167 quality-adjusted life years) and the lowest lifetime costs per patient (€20,960, €22,319 and €28,447, respectively). Algorithm I would improve results for three subgroups: non-ischaemic, New York Heart Association class III-IV and ≥65 years old. Furthermore, implementing this approach could generate an estimated €702 million in health system savings annually in European Society of Cardiology countries. CONCLUSION The application of cardiac magnetic resonance imaging-based algorithms could improve survival and quality-adjusted life years at a lower cost than current clinical practice (dominant strategy) used for assigning cardiac resynchronisation device pacemakers and cardiac resynchronisation device implantable cardioverter-defibrillators to heart failure patients.
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Affiliation(s)
- Carlos Crespo
- GM Statistics Department, Universitat de Barcelona, Spain.,Axentiva Solutions, Tacoronte, Spain
| | - Markus Linhart
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain
| | - Juan Acosta
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain
| | - David Soto-Iglesias
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain
| | - Mikel Martínez
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain
| | - Beatriz Jáuregui
- Cardiology Department, Heart Institute, Teknon Medical Center, Spain
| | - Áurea Mira
- Center for Biomedical Diagnosis (CDB), Hospital Clinic, Spain.,Department of Biomedicine, University of Barcelona, Spain
| | | | - Joan Sagarra
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain
| | - Angelo Auricchio
- Division of Cardiology, Fondazione Cardiocentro Ticino, Switzerland
| | | | | | | | | | - Antonio Berruezo
- Cardiology Department, Heart Institute, Teknon Medical Center, Spain.,Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Instituto de Salud Carlos III, Spain
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Pichon-Riviere A, Soto NC, Augustovski FA, García Martí S, Sampietro-Colom L. [Health technology assessment for decision-making in Latin America: good practice principles]. Rev Panam Salud Publica 2018; 41:e138. [PMID: 29466522 PMCID: PMC6660880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 05/31/2017] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVE Identify the most relevant, applicable, and priority good practice principles in health technology assessment (HTA) in Latin America, and potential barriers to implementing them in the region. METHODS HTA good practice principles postulated worldwide were identified and then explored through a deliberative process in a forum of evaluators, funders, and technology producers. RESULTS Forty-two representatives from ten Latin American countries participated in the forum. The good practice principles postulated at the international level were considered valid and potentially applicable in Latin America. Five principles were identified as priorities and as having greater potential to be expanded at this time: transparency in carrying out HTA; involvement of stakeholders in the HTA process; existence of mechanisms to appeal decisions; existence of clear mechanisms for HTA priority-setting; and existence of a clear link between assessment and decision-making. The main challenge identified was to find a balance between application of these principles and available resources, to prevent the planned improvements from jeopardizing report production times and failing to meet decision-makers' needs. CONCLUSIONS The main recommendation was to gradually advance in improving HTA and its link to decision-making by developing appropriate processes for each country, without attempting to impose, in the short term, standards taken from examples at the international level without adequate adaptation to the local context.
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Affiliation(s)
- Andrés Pichon-Riviere
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina. La correspondencia se debe dirigir a Natalie C Soto. Correo electrónico:
| | - Natalie C Soto
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina. La correspondencia se debe dirigir a Natalie C Soto. Correo electrónico:
| | - Federico Ariel Augustovski
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina. La correspondencia se debe dirigir a Natalie C Soto. Correo electrónico:
| | - Sebastián García Martí
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina. La correspondencia se debe dirigir a Natalie C Soto. Correo electrónico:
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Pichon-Riviere A, Soto NC, Augustovski FA, García Martí S, Sampietro-Colom L. Evaluación de tecnologías sanitarias para la toma de decisiones en Latinoamérica: principios de buenas prácticas. Rev Panam Salud Publica 2017. [PMID: 29466522 PMCID: PMC6660880 DOI: 10.26633/rpsp.2017.138] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objetivo. Identificar los principios de buenas prácticas en la Evaluación de las Tecnologías Sanitarias (ETESA) más relevantes, aplicables y prioritarios en Latinoamérica; y las potenciales barreras para implementarlos en la región. Métodos. Se identificaron los principios de buenas prácticas en ETESA postulados a nivel mundial y luego se exploraron mediante un proceso deliberativo en un Foro de evaluadores, financiadores y productores de tecnologías. Resultados. El Foro contó con la participación de 42 representantes de diez países Latinoamericanos. Los principios de buenas prácticas postulados a nivel internacional fueron considerados válidos y potencialmente aplicables en Latinoamérica. Cinco principios fueron identificados como prioritarios y con mayor potencial para ser profundizados en estos momentos: transparencia en los procesos de realización de ETESA; Involucramiento de actores relevantes en el proceso de ETESA; existencia de mecanismos de apelación de las decisiones; existencia de mecanismos claros para el establecimiento de prioridades en ETESA; y existencia de un vínculo claro entre la evaluación y la toma de decisión. El principal reto identificado fue encontrar un equilibrio entre la aplicación de estos principios y los recursos disponibles para prevenir que las mejoras a introducir atenten contra los tiempos de producción de informes y la adecuación a las necesidades de los decisores. Conclusiones. La principal recomendación fue avanzar gradualmente en mejorar la ETESA y su vínculo con la toma de decisión desarrollando procesos apropiados para cada país, sin pretender imponer a corto plazo estándares tomados de ejemplos a nivel internacional sin la adecuada adaptación al contexto local.
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Affiliation(s)
| | - Natalie C Soto
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina. La correspondencia se debe dirigir a Natalie C Soto. Correo electrónico:
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16
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Alonso-Alconada L, Barbazan J, Candamio S, Falco JL, Anton C, Martin-Saborido C, Fuster G, Sampedro M, Grande C, Lado R, Sampietro-Colom L, Crego E, Figueiras S, Leon-Mateos L, Lopez-Lopez R, Abal M. PrediCTC, liquid biopsy in precision oncology: a technology transfer experience in the Spanish health system. Clin Transl Oncol 2017; 20:630-638. [PMID: 29058262 DOI: 10.1007/s12094-017-1760-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 09/30/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE Management of metastatic disease in oncology includes monitoring of therapy response principally by imaging techniques like CT scan. In addition to some limitations, the irruption of liquid biopsy and its application in personalized medicine has encouraged the development of more efficient technologies for prognosis and follow-up of patients in advanced disease. METHODS PrediCTC constitutes a panel of genes for the assessment of circulating tumor cells (CTC) in metastatic colorectal cancer patients, with demonstrated improved efficiency compared to CT scan for the evaluation of early therapy response in a multicenter prospective study. In this work, we designed and developed a technology transfer strategy to define the market opportunity for an eventual implementation of PrediCTC in the clinical practice. RESULTS This included the definition of the regulatory framework, the analysis of the regulatory roadmap needed for CE mark, a benchmarking study, the design of a product development strategy, a revision of intellectual property, a cost-effectiveness study and an expert panel consultation. CONCLUSION The definition and analysis of an appropriate technology transfer strategy and the correct balance among regulatory, financial and technical determinants are critical for the transformation of a promising technology into a viable technology, and for the decision of implementing liquid biopsy in the monitoring of therapy response in advanced disease.
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Affiliation(s)
- L Alonso-Alconada
- Translational Medical Oncology, CIBERONC, Health Research Institute of Santiago (IDIS), University Hospital of Santiago (SERGAS), Trav. Choupana s/n, 15706, Santiago de Compostela, Spain
| | - J Barbazan
- Translational Medical Oncology, CIBERONC, Health Research Institute of Santiago (IDIS), University Hospital of Santiago (SERGAS), Trav. Choupana s/n, 15706, Santiago de Compostela, Spain
| | - S Candamio
- Translational Medical Oncology, CIBERONC, Health Research Institute of Santiago (IDIS), University Hospital of Santiago (SERGAS), Trav. Choupana s/n, 15706, Santiago de Compostela, Spain
| | - J L Falco
- Antares Consulting, Barcelona, Spain
| | - C Anton
- UETeS, Universidad Francisco de Vitoria, Madrid, Spain
| | | | | | - M Sampedro
- Department of Innovation and Transfer, Ramon Dominguez Foundation, Santiago de Compostela, Spain
| | - C Grande
- Medical and Health Technology Innovation Platform (ITEMAS), Galician Network, Santiago de Compostela, Spain
| | - R Lado
- Medical and Health Technology Innovation Platform (ITEMAS), Galician Network, Santiago de Compostela, Spain
| | - L Sampietro-Colom
- Health Technology Assessment Unit, Clinic Hospital, Barcelona, Spain
| | - E Crego
- EFT Consulting, Santiago de Compostela, Spain
| | - S Figueiras
- Health Knowledge Agency (ACIS), Galician Health System (SERGAS), Santiago de Compostela, Spain
| | - L Leon-Mateos
- Health Knowledge Agency (ACIS), Galician Health System (SERGAS), Santiago de Compostela, Spain
| | - R Lopez-Lopez
- Translational Medical Oncology, CIBERONC, Health Research Institute of Santiago (IDIS), University Hospital of Santiago (SERGAS), Trav. Choupana s/n, 15706, Santiago de Compostela, Spain
| | - M Abal
- Translational Medical Oncology, CIBERONC, Health Research Institute of Santiago (IDIS), University Hospital of Santiago (SERGAS), Trav. Choupana s/n, 15706, Santiago de Compostela, Spain.
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17
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Soto M, Sampietro-Colom L, Lasalvia L, Mira A, Jiménez W, Navasa M. Cost-effectiveness of enhanced liver fibrosis test to assess liver fibrosis in chronic hepatitis C virus and alcoholic liver disease patients. World J Gastroenterol 2017; 23:3163-3173. [PMID: 28533673 PMCID: PMC5423053 DOI: 10.3748/wjg.v23.i17.3163] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 03/03/2017] [Accepted: 03/15/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To assess liver fibrosis (LF) in hepatitis C virus (HCV) and alcoholic liver disease (ALD), estimate health outcomes and costs of new noninvasive testing strategies
METHODS A Markov model was developed to simulate LF progression in HCV and ALD for a cohort of 40-year-old men with abnormal levels of transaminases. Three different testing alternatives were studied: a single liver biopsy; annual Enhanced liver fibrosis (ELF™) followed by liver stiffness measurement (LSM) imaging as a confirmation test if the ELF test is positive; and annual ELF test without LSM. The analysis was performed from the perspective of a university hospital in Spain. Clinical data were obtained from published literature. Costs were sourced from administrative databases of the hospital. Deterministic and probabilistic sensitivity analyses were performed.
RESULTS In HCV patients, annual sequential ELF test/LSM and annual ELF test alone prevented respectively 12.9 and 13.3 liver fibrosis-related deaths per 100 persons tested, compared to biopsy. The incremental cost-effectiveness ratios (ICERs) were respectively €13400 and €11500 per quality-adjusted life year (QALY). In ALD, fibrosis-related deaths decreased by 11.7 and 22.1 per 100 persons tested respectively with sequential ELF test/LSM and annual ELF test alone. ICERs were €280 and €190 per QALY, respectively.
CONCLUSION The use of the ELF test with or without a confirmation LSM are cost-effective options compared to a single liver biopsy for testing liver fibrosis in HCV and ALD patients in Spain.
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Zboromyrska Y, De la Calle C, Soto M, Sampietro-Colom L, Soriano A, Alvarez-Martínez MJ, Almela M, Marco F, Arjona R, Cobos-Trigueros N, Morata L, Mensa J, Martínez JA, Mira A, Vila J. Rapid Diagnosis of Staphylococcal Catheter-Related Bacteraemia in Direct Blood Samples by Real-Time PCR. PLoS One 2016; 11:e0161684. [PMID: 27571200 PMCID: PMC5003366 DOI: 10.1371/journal.pone.0161684] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 08/10/2016] [Indexed: 11/18/2022] Open
Abstract
Catheter-related bacteremia (CRB) is an important cause of morbidity and mortality among hospitalized patients, being staphylococci the main etiologic agents. The objective of this study was to assess the use of a PCR-based assay for detection of staphylococci directly from blood obtained through the catheter to diagnose CRB caused by these microorganisms and to perform a cost-effectiveness analysis. A total of 92 patients with suspected CRB were included in the study. Samples were obtained through the catheter. Paired blood cultures were processed by standard culture methods and 4 ml blood samples were processed by GeneXpert-MRSA assay for the detection of methicillin-susceptible (MSSA) or methicillin-resistant (MRSA) Staphylococcus aureus, and methicillin-resistant coagulase-negative staphylococci (MR-CoNS). Sixteen CRB caused by staphylococci were diagnosed among 92 suspected patients. GeneXpert detected 14 out of 16 cases (87.5%), including 4 MSSA and 10 MR-CoNS in approximately 1 hour after specimen receipt. The sensitivity and specificity of GeneXpert were 87.5% (CI 95%: 60.4-97.8) and 92.1% (CI 95%: 83-96.7), respectively, compared with standard culture methods. The sensitivity of GeneXpert for S. aureus was 100%. Regarding a cost-effectiveness analysis, the incremental cost of using GeneXpert was of 31.1€ per patient while the incremental cost-effectiveness ratio of GeneXpert compared with blood culture alones was about 180€ per life year gained. In conclusion, GeneXpert can be used directly with blood samples obtained through infected catheters to detect S. aureus and MR-CoNS in approximately 1h after sampling. In addition, it is cost-effective especially in areas with high prevalence of staphylococcal CRB.
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Affiliation(s)
- Yuliya Zboromyrska
- Department of Clinical Microbiology, Biomedical Diagnostic Centre (CDB), Hospital Clínic, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Cristina De la Calle
- Department of Infectious Diseases, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Marcelo Soto
- Health Technology Assessment Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Laura Sampietro-Colom
- Health Technology Assessment Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Míriam José Alvarez-Martínez
- Department of Clinical Microbiology, Biomedical Diagnostic Centre (CDB), Hospital Clínic, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Manel Almela
- Department of Clinical Microbiology, Biomedical Diagnostic Centre (CDB), Hospital Clínic, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Francesc Marco
- Department of Clinical Microbiology, Biomedical Diagnostic Centre (CDB), Hospital Clínic, School of Medicine, University of Barcelona, Barcelona, Spain
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Ruth Arjona
- Department of Clinical Microbiology, Biomedical Diagnostic Centre (CDB), Hospital Clínic, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Nazaret Cobos-Trigueros
- Department of Infectious Diseases, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Laura Morata
- Department of Infectious Diseases, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - José Mensa
- Department of Infectious Diseases, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - José Antonio Martínez
- Department of Infectious Diseases, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Aurea Mira
- CDB, Hospital Clínic, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Jordi Vila
- Department of Clinical Microbiology, Biomedical Diagnostic Centre (CDB), Hospital Clínic, School of Medicine, University of Barcelona, Barcelona, Spain
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, University of Barcelona, Barcelona, Spain
- * E-mail:
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Soto M, Sampietro-Colom L, Sagarra J, Brugada-Terradellas J. InnovaSEC en acción: coste-efectividad de Barostim para el tratamiento de la hipertensión arterial refractaria en España. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2015.11.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
The majority of healthcare in Canada is universally provided and publicly funded through the provincial government.
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Affiliation(s)
- Laura Sampietro-Colom
- 0000 0000 9635 9413grid.410458.cAssessment of Innovations and New Technologies, Hospital Clinic Barcelona, Barcelona, Catalonia, Spain
| | - Janet Martin
- 0000 0004 1936 8884grid.39381.30Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI), Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario Canada
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21
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Soto M, Sampietro-Colom L, Sagarra J, Brugada-Terradellas J. InnovaSEC in Action: Cost-effectiveness of Barostim in the Treatment of Refractory Hypertension in Spain. ACTA ACUST UNITED AC 2016; 69:563-71. [PMID: 26907729 DOI: 10.1016/j.rec.2015.11.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 11/11/2015] [Indexed: 12/14/2022]
Abstract
INTRODUCTION AND OBJECTIVES In Spain, 0.3% of patients with hypertension are refractory to conventional treatment. The complications resulting from deficient control of this condition can lead to poor quality of life for the patient and considerable health care costs. Barostim is an implantable device designed to lower blood pressure in these patients. The aim of this study was to analyze the cost-effectiveness of Barostim compared with drug therapy in hypertensive patients refractory to conventional treatment (at least 3 antihypertensive drugs, including 1 diuretic agent). METHODS We used a Markov model adapted to the epidemiology of the Spanish population to simulate the natural history of a cohort of patients with refractory hypertension over their lifetime. Data on the effectiveness of the treatments studied were obtained from the literature, and data on costs were taken from hospital administrative databases and official sources. Deterministic and probabilistic sensitivity analyses were conducted. RESULTS Barostim increased the number of quality-adjusted life years by 0.78 and reduced the number of hypertension-associated clinical events. The incremental cost-effectiveness ratio in a cohort of men reached 68 726 euros per year of quality-adjusted life. One of the main elements that makes this technology costly is the need for battery replacement. The results were robust. CONCLUSIONS Barostim is not a cost-effective strategy for the treatment of refractory hypertension in Spain. The cost-effectiveness ratio could be improved by future reductions in the cost of the battery.
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Affiliation(s)
- Marcelo Soto
- Fundació Clínic per a la Recerca Biomèdica, Barcelona, Spain.
| | - Laura Sampietro-Colom
- Unidad de Evaluación de Innovaciones y Nuevas Tecnologías, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Joan Sagarra
- Institut Clínic del Tòrax (ICT), Hospital Clínic de Barcelona, Barcelona, Spain
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Soto M, Sampietro-Colom L, Vilella A, Pantoja E, Asenjo M, Arjona R, Hurtado JC, Trilla A, Alvarez-Martínez MJ, Mira A, Vila J, Marcos MA. Economic Impact of a New Rapid PCR Assay for Detecting Influenza Virus in an Emergency Department and Hospitalized Patients. PLoS One 2016; 11:e0146620. [PMID: 26788921 PMCID: PMC4720278 DOI: 10.1371/journal.pone.0146620] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 12/18/2015] [Indexed: 12/27/2022] Open
Abstract
Seasonal influenza causes significant morbidity and mortality and has a substantial economic impact on the healthcare system. The main objective of this study was to compare the cost per patient for a rapid commercial PCR assay (Xpert® Flu) with an in-house real-time PCR test for detecting influenza virus. Community patients with influenza like-illness attending the Emergency Department (ED) as well as hospitalized patients in the Hospital Clínic of Barcelona were included. Costs were evaluated from the perspective of the hospital considering the use of resources directly related to influenza testing and treatment. For the purpose of this study, 366 and 691 patients were tested in 2013 and 2014, respectively. The Xpert® Flu test reduced the mean waiting time for patients in the ED by 9.1 hours and decreased the mean isolation time of hospitalized patients by 23.7 hours. This was associated with a 103€ (or about $113) reduction in the cost per patient tested in the ED and 64€ ($70) per hospitalized patient. Sensitivity analyses showed that Xpert® Flu is likely to be cost-saving in hospitals with different contexts and prices.
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Affiliation(s)
- Marcelo Soto
- Fundació Clínic per a la Recerca Biomèdica, Barcelona, Spain
- * E-mail:
| | - Laura Sampietro-Colom
- Health Technology Assessment Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Anna Vilella
- Public Health Department, Hospital Clínic, University of Barcelona, Barcelona, Spain
- ISGlobal Barcelona Institute for Global Health, Barcelona, Spain
| | - Efraín Pantoja
- Public Health Department, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - María Asenjo
- Emergency Department, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Ruth Arjona
- ISGlobal Barcelona Institute for Global Health, Barcelona, Spain
- Department of Clinical Microbiology, Biomedical Diagnostic Centre (CDB), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Juan Carlos Hurtado
- ISGlobal Barcelona Institute for Global Health, Barcelona, Spain
- Department of Clinical Microbiology, Biomedical Diagnostic Centre (CDB), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Antoni Trilla
- Public Health Department, Hospital Clínic, University of Barcelona, Barcelona, Spain
- ISGlobal Barcelona Institute for Global Health, Barcelona, Spain
| | - Míriam José Alvarez-Martínez
- ISGlobal Barcelona Institute for Global Health, Barcelona, Spain
- Department of Clinical Microbiology, Biomedical Diagnostic Centre (CDB), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Aurea Mira
- Biomedical Diagnostic Centre (CDB), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Jordi Vila
- ISGlobal Barcelona Institute for Global Health, Barcelona, Spain
- Department of Clinical Microbiology, Biomedical Diagnostic Centre (CDB), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - María Angeles Marcos
- ISGlobal Barcelona Institute for Global Health, Barcelona, Spain
- Department of Clinical Microbiology, Biomedical Diagnostic Centre (CDB), Hospital Clínic, University of Barcelona, Barcelona, Spain
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Sampietro-Colom L, Brugada-Terradellas J, González-Juanatey JR. Introducción de innovaciones en el área de la patología cardiaca en España: InnovaSEC. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2015.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kidholm K, Ølholm AM, Birk-Olsen M, Cicchetti A, Fure B, Halmesmäki E, Kahveci R, Kiivet RA, Wasserfallen JB, Wild C, Sampietro-Colom L. Hospital managers' need for information in decision-making--An interview study in nine European countries. Health Policy 2015; 119:1424-32. [PMID: 26362086 DOI: 10.1016/j.healthpol.2015.08.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 08/13/2015] [Accepted: 08/17/2015] [Indexed: 11/17/2022]
Abstract
Assessments of new health technologies in Europe are often made at the hospital level. However, the guidelines for health technology assessment (HTA), e.g. the EUnetHTA Core Model, are produced by national HTA organizations and focus on decision-making at the national level. This paper describes the results of an interview study with European hospital managers about their need for information when deciding about investments in new treatments. The study is part of the AdHopHTA project. Face-to-face, structured interviews were conducted with 53 hospital managers from nine European countries. The hospital managers identified the clinical, economic, safety and organizational aspects of new treatments as being the most relevant for decision-making. With regard to economic aspects, the hospital managers typically had a narrower focus on budget impact and reimbursement. In addition to the information included in traditional HTAs, hospital managers sometimes needed information on the political and strategic aspects of new treatments, in particular the relationship between the treatment and the strategic goals of the hospital. If further studies are able to verify our results, guidelines for hospital-based HTA should be altered to reflect the information needs of hospital managers when deciding about investments in new treatments.
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Affiliation(s)
- Kristian Kidholm
- Odense University Hospital, Department for Quality, Research and Health Technology Assessment, Sdr. Boulevard 29, 5000 Odense C, Denmark.
| | - Anne Mette Ølholm
- Odense University Hospital, Department for Quality, Research and Health Technology Assessment, Sdr. Boulevard 29, 5000 Odense C, Denmark.
| | - Mette Birk-Olsen
- Odense University Hospital, Department for Quality, Research and Health Technology Assessment, Sdr. Boulevard 29, 5000 Odense C, Denmark.
| | - Americo Cicchetti
- Catholic University of the Sacred Heart, Department of Economics and Management and ALTEMS (Graduate School of Health Economics and Management), Largo F. Vito 1, 00168 Rome, Italy.
| | - Brynjar Fure
- The National Knowledge Center for the Health Services, P.O. Box 7004 St Olavs plass, N-0130 Oslo, Norway.
| | - Esa Halmesmäki
- Helsinki and Uusimaa Hospital District, P.O. Box 705, 00029 Hus, Finland.
| | - Rabia Kahveci
- Ankara Numune Training and Research Hospital, HTA Unit (ANHTA), Ulku Mahallesi Talatpasa Bulvari No. 5, Altindag, 06100 Ankara, Turkey.
| | - Raul-Allan Kiivet
- Medical Direction, Tartu University Clinics, L.Puusepp st 1a, Tartu 50406, Estonia.
| | - Jean-Blaise Wasserfallen
- Medical Direction, Lausanne University Hospital (CHUV), Bugnon 21, Lausanne VD CH-1011, Switzerland.
| | - Claudia Wild
- Ludwig Boltzmann Institute für Health Technology Assessment, Garnisongasse 7/20, 1090 Wien/Vienna, Austria.
| | - Laura Sampietro-Colom
- Evaluation of Innovation and New Technologies, Hospital Clínic Barcelona, C/ Villarroel 170, 1.7., 08036 Barcelona, Spain.
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Agustí A, Antó JM, Auffray C, Barbé F, Barreiro E, Dorca J, Escarrabill J, Faner R, Furlong LI, Garcia-Aymerich J, Gea J, Lindmark B, Monsó E, Plaza V, Puhan MA, Roca J, Ruiz-Manzano J, Sampietro-Colom L, Sanz F, Serrano L, Sharpe J, Sibila O, Silverman EK, Sterk PJ, Sznajder JI. Personalized respiratory medicine: exploring the horizon, addressing the issues. Summary of a BRN-AJRCCM workshop held in Barcelona on June 12, 2014. Am J Respir Crit Care Med 2015; 191:391-401. [PMID: 25531178 PMCID: PMC4351599 DOI: 10.1164/rccm.201410-1935pp] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 11/21/2014] [Indexed: 12/29/2022] Open
Abstract
This Pulmonary Perspective summarizes the content and main conclusions of an international workshop on personalized respiratory medicine coorganized by the Barcelona Respiratory Network ( www.brn.cat ) and the AJRCCM in June 2014. It discusses (1) its definition and historical, social, legal, and ethical aspects; (2) the view from different disciplines, including basic science, epidemiology, bioinformatics, and network/systems medicine; (3) the bottlenecks and opportunities identified by some currently ongoing projects; and (4) the implications for the individual, the healthcare system and the pharmaceutical industry. The authors hope that, although it is not a systematic review on the subject, this document can be a useful reference for researchers, clinicians, healthcare managers, policy-makers, and industry parties interested in personalized respiratory medicine.
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Affiliation(s)
- Alvar Agustí
- Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Josep Maria Antó
- Centre for Research in Environmental Epidemiology, Hospital del Mar Medical Research Institute, Universitat Pompeu Fabra, Centros de Investigación Biomédica en Red Epidemiología y Salud Pública, Barcelona, Spain
| | - Charles Auffray
- European Institute for Systems Biology and Medicine, Lyon, France
| | - Ferran Barbé
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Institut de Recerca Biomèdica de Lleida, Lleida, Spain
| | - Esther Barreiro
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Pulmonology Department, Hospital del Mar-Hospital del Mar Medical Research Institute, CEXS, Universitat Pompeu Fabra, Barcelona Biomedical Research Park, Barcelona, Spain
| | - Jordi Dorca
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Hospital University Bellvitge, University Barcelona, El Institut d’Investigació Biomèdica de Bellvitge, Hospitalet Ll., Spain
| | - Joan Escarrabill
- Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University Barcelona, Spain
| | - Rosa Faner
- Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Laura I. Furlong
- Research Programme on Biomedical Informatics, Hospital del Mar Medical Research Institute, University Pompeu Fabra, Barcelona, Spain
| | - Judith Garcia-Aymerich
- Centre for Research in Environmental Epidemiology, Hospital del Mar Medical Research Institute, Universitat Pompeu Fabra, Centros de Investigación Biomédica en Red Epidemiología y Salud Pública, Barcelona, Spain
| | - Joaquim Gea
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Pulmonology Department, Hospital del Mar-Hospital del Mar Medical Research Institute, CEXS, Universitat Pompeu Fabra, Barcelona Biomedical Research Park, Barcelona, Spain
| | | | - Eduard Monsó
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Hospital University Parc Taulí, Sabadell, Spain
| | - Vicente Plaza
- Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, University Autonoma de Barcelona, Barcelona, Spain
| | - Milo A. Puhan
- Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Josep Roca
- Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Juan Ruiz-Manzano
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Hospital University Germans Trias i Pujol, University Autónoma Barcelona, Badalona, Spain
| | - Laura Sampietro-Colom
- Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University Barcelona, Spain
| | - Ferran Sanz
- Research Programme on Biomedical Informatics, Hospital del Mar Medical Research Institute, University Pompeu Fabra, Barcelona, Spain
| | - Luis Serrano
- European Molecular Biology Laboratory/Centre for Genomic Regulation Systems Biology Research Unit, Centre for Genomic Regulation, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
| | - James Sharpe
- European Molecular Biology Laboratory/Centre for Genomic Regulation Systems Biology Research Unit, Centre for Genomic Regulation, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
| | - Oriol Sibila
- Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, University Autonoma de Barcelona, Barcelona, Spain
| | - Edwin K. Silverman
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Peter J. Sterk
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; and
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Gutiérrez-Moreno S, Alsina-Gibert M, Sampietro-Colom L, Pedregosa-Fauste S, Ayala-Blanco P. Estudio coste-beneficio del trasplante de membrana amniótica para úlceras venosas de extremidades inferiores refractarias a tratamiento convencional. Actas Dermo-Sifiliográficas 2011; 102:284-8. [DOI: 10.1016/j.ad.2011.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 01/05/2011] [Accepted: 01/25/2011] [Indexed: 11/15/2022] Open
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Gutiérrez-Moreno S, Alsina-Gibert M, Sampietro-Colom L, Pedregosa-Fauste S, Ayala-Blanco P. Cost-Benefit Analysis of Amniotic Membrane Transplantation for Venous Ulcers of the Legs That Are Refractory to Conventional Treatment. Actas Dermo-Sifiliográficas (English Edition) 2011. [DOI: 10.1016/s1578-2190(11)70804-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Subirana Casacuberta M, Fargues García I, Esteve Reig J, Sampietro-Colom L, Esteve Ortega M. [Nursing staff and patient results: systematic review about the existing relationship]. Rev Enferm 2010; 33:14-26. [PMID: 20201195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Review the evidence about the relationship between nursing staff characteristics and patient care results. METHODS Systematic Review Research at CENTRAL, the Cochrane Plus library MEDLINE CINAHL, EMBASE and PsycINFO until June 2009. Original studies on adult patients checked into hospitals in acute care sections of whatever design have been included, these studies were published either in Spanish or English. Two independent reviewers evaluated the quality of these studies under the GRDAE system and extracted data. RESULTS 55 studies were included. Patient-nurse ratio has repercussions on costs, mortality and the appearance of complications. Controversy on the repercussion regarding care quality. The relationship of nursing hours per patient has repercussions on satisfaction, infection, cardiac alterations, bleeding, average hospital stay net costs, sepsis, and ulcers. Controversy on repercussions regarding falls, medication errors and life quality decreases the complications, and promotes self-care. Nurses-emotional states bears an influence on falls and medication errors. CONCLUSION There is a relationship between the nursing staff and patient care results. This review's results have to be considered with caution and evaluated as a tendency since quality conditions their interpretation. Nursing staffs acquire a special relevance in the Spanish health system context due to changes produced in the population and type of patient, the deficit of professionals, and the modification of nursing study plans.
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Sampietro-Colom L, Costa D, Busqué A, Lacasa C. [Planning by service organisation priorities. The process of preparing strategic service-organisation plans]. Med Clin (Barc) 2009; 131 Suppl 4:47-54. [PMID: 19195478 DOI: 10.1016/s0025-7753(08)76475-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Strategic planning designs the general setting and the strategic principles of a healthcare system, as well as the general guidelines that govern the development of a health system. Strategic service-organisation plans deal with translating healthcare policies into service policies and respond, principally, to the need for services; these give rise to problems that require a solution. They are developed in line with advances in scientific knowledge, the implementation and current characteristics of the healthcare services and the evolution in the competences of professional teams. There are five stages for their development: identification of health/service requirements; prioritisation of needs in health/services; definition of and agreement on service organisation models (care model and service portfolio); the preparation of and agreement on territorial action plans; introduction and evaluation. A conceptual framework is presented along with practical applications carried out in Catalonia.
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Sampietro-Colom L, Espallargues M, Rodríguez E, Comas M, Alonso J, Castells X, Pinto J. Wide Social Participation in Prioritizing Patients on Waiting Lists for Joint Replacement: A Conjoint Analysis. Med Decis Making 2008; 28:554-66. [DOI: 10.1177/0272989x08315235] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective. The aim was to develop a priority scoring system for patients on waiting lists for joint replacement based on a wide social participation, and to analyze the differences among participants. Methods. Conjoint analysis. Focus groups in combination with a nominal technique were employed to identify the priority criteria (N= 36). A rank-ordered logit model was then applied for scoring estimations. Participants (N= 860) represented: consultants, allied-health professionals, patients and their relatives, and the general population of Catalonia. Results. Clinical and social criteria were selected, and their relative importance (over 100 points) was: pain (33), difficulty in doing activities of daily living (21), disease severity (18), limitations on ability to work (10), having someone to look after the patient (9), being a caregiver (6), and recovery probability (4). Estimated criteria coefficients had the expected positive sign and all were statistically significant (P < 0.001). There were differences between groups; pain was rated higher by patients/relatives, and difficulty in doing activities was rated lower by patients/relatives and the general public. Most interaction terms for these criteria and groups were significant (P < 0.001). Consultants and allied-health professionals had the most similar prioritization pattern (r= 0.97). Conclusion. Both clinical and social criteria are considered for prioritization of joint replacement surgery from a wide social perspective. The preference among professional and social groups varies and this might impact the result of patient prioritization. A wide social participation for obtaining adequate prioritizing systems for patients on waiting lists is desirable.
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Affiliation(s)
- L. Sampietro-Colom
- Office for the Assessment of Innovation and New Technologies, Fundació Clínic, Barcelona, Spain, , Catalan Agency for Health Technology Assessment and Research (CAHTA), Barcelona, Spain
| | - M. Espallargues
- Catalan Agency for Health Technology Assessment and Research (CAHTA), Barcelona, Spain
| | - E. Rodríguez
- Department of Applied Economics, Universidad de Vigo, Vigo, Spain
| | - M. Comas
- Evaluation and Clinical Epidemiology Department, Hospital del Mar-IMAS, Barcelona, Spain, Health Services Research Unit, Institut Municipal d'Investigació Médica (IMIM-Hospital del Mar), Barcelona, Spain
| | - J. Alonso
- Health Services Research Unit, Institut Municipal d'Investigació Médica (IMIM-Hospital del Mar), Barcelona, Spain, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - X. Castells
- Evaluation and Clinical Epidemiology Department, Hospital del Mar-IMAS, Barcelona, Spain, Health Services Research Unit, Institut Municipal d'Investigació Médica (IMIM-Hospital del Mar), Barcelona, Spain (MC, JA, XC)
| | - J.L. Pinto
- Centre for Research in Economy and Health (CRES), Universitat Pompeu Fabra, Barcelona, Spain
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Gené-Badia J, Ascaso C, Escaramis-Babiano G, Catalán-Ramos A, Pujol-Ribera E, Sampietro-Colom L. Population and primary health-care team characteristics explain the quality of the service. Health Policy 2008; 86:335-44. [PMID: 18241954 DOI: 10.1016/j.healthpol.2007.11.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Revised: 11/12/2007] [Accepted: 11/22/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To identify the characteristics of the primary health-care (PHC) team's structure and of the assigned population affecting service quality dimensions, and to check whether the PHC team's performance varies when assessing the service quality using crude values or those adjusted by the structural factors that affect it. RESEARCH DESIGN Cross-sectional descriptive study. SUBJECTS 213 Catalan PHC teams. MEASUREMENTS Service quality indicators measured in three dimensions: (1) access and physician-patient relationship; (2) team coordination and (3) evidence-based practice. The PHC team structural factors studied are: experience, setting (urban or rural), geographical dispersion, teaching activities and managerial structure. The catchment population characteristics analysed are: age, socio-economic level, mortality, and the proportion of the population that are immigrants. RESULTS Access and physician-patient relationship dimension were not affected by the studied structural factors. Team coordination improved in rural teams and in those providing care for older populations. Evidence-based practice was found to be higher in teaching teams, in more experienced teams and in those attending populations with a lower socio-economic level. Adjusted service quality indicator values substantially modify the PHC team quality ranking carried out on the basis of its crude values, especially in the team coordination and evidence-based practice dimensions. CONCLUSIONS A fair evaluation of PHC team performance must be based on its health-care service quality indicators adjusted for setting, age and socio-economic level of the catchment population and for the team's experience and teaching activities.
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Gené-Badia J, Ascaso C, Escaramis-Babiano G, Sampietro-Colom L, Catalán-Ramos A, Sans-Corrales M, Pujol-Ribera E. Personalised care, access, quality and team coordination are the main dimensions of family medicine output. Fam Pract 2007; 24:41-7. [PMID: 17079249 DOI: 10.1093/fampra/cml056] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Health organisations continually seek good output indicators of family medicine health care provision because they are accountable to society, they need to compare services, and need to evaluate the impact of organisational reforms. OBJECTIVES Using the sources of information routinely available in health-service management, we sought to assess the groups of components of primary health care output that best serve to define the outcome of family medicine services. DESIGN Cross-sectional descriptive study. SITE: Primary health care in Catalunya. PARTICIPANTS 213 primary health care teams. MEASUREMENTS Information was collected on team structure, user satisfaction, quality-of-professional-life of the health care professionals, and physicians' drug prescription. Confirmatory Factor Analysis was used to assess the number of dimensions that best explained the family medicine outcome. RESULTS The model that best fits the structure of the data (AGFI=0.778) is that which consists of three dimensions i.e. (1) the individual accessibility to the services and professional-patient relationship; (2) the coordination within the health care team; (3) the scientific-technical quality of the service. The first two of these dimensions were correlated between themselves, but the third was totally independent of the other two. CONCLUSIONS Using sources of information that are routinely employed in primary health care services management, the model enables the measurement of the output of family medicine by considering the dimensions such as inter-personnel relationships, internal coordination of the team and the scientific-technical quality of the service. Despite its simplicity, this measure of the output incorporates the views not only of the users but of the health care professionals, as well.
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Gené-Badia J, Escaramis-Babiano G, Sans-Corrales M, Sampietro-Colom L, Aguado-Menguy F, Cabezas-Peña C, de Puelles PG. Impact of economic incentives on quality of professional life and on end-user satisfaction in primary care. Health Policy 2007; 80:2-10. [PMID: 16546287 DOI: 10.1016/j.healthpol.2006.02.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2005] [Accepted: 02/09/2006] [Indexed: 11/23/2022]
Abstract
BACKGROUND A new economic incentive scheme based on (i) quality of care objectives for physicians, and (ii) professional development for both physicians and nurses, was introduced in primary care teams. OBJECTIVE To assess weather the implementation of these economic incentive schemes has had an impact on the quality of professional life (QPL) of both physicians and nurses and on end-user satisfaction. METHODS Before-after study. Participants are 257 primary care teams in Catalonia, Spain, in the period 2002-2003. QPL and end-user satisfaction were used as outcome measures. RESULTS QPL was improved in terms of the dimension "perception of support from the management structure" among physicians (4.897 versus 5.220; p<0.001) as well as nurses (5.272 versus 5.638; p<0.001). Further, physicians perceived an increase in the dimension "demands made upon them" (6.124 versus 6.364; p<0.001), differently from the nurses group (5.8191 versus 5.929; p=0.063). Overall, user satisfaction did not vary significantly, although a positive relationship was found between "perception of support from the management structure" and user satisfaction among nurses (beta=0.078, p=0.007), and a negative relationship between "demands made upon them" and user satisfaction in the case of physicians (beta=-0.057, p=0.011). CONCLUSIONS Incentives related to quality of care annual targets may increase physicians' perception of burden and it may have a negative impact on consumer satisfaction. Incentives on long-term professional development seem to be related to an increase in professionals' perception of support from the management structure. Among nurses, this increase is related to an improvement of user satisfaction.
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Affiliation(s)
- Joan Gené-Badia
- Consorci d'Atenció Primària de Salut de l'Eixample (CAPSE), Barcelona, Spain.
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Sampietro-Colom L, Espallargues M, Comas M, Rodríguez E, Castells X, Pinto JL. Priorización de pacientes en lista de espera para cirugía de cataratas: diferencias en las preferencias entre ciudadanos. Gaceta Sanitaria 2006; 20:342-51. [PMID: 17040642 DOI: 10.1157/13093201] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To estimate and compare citizen preferences regarding patient prioritization for cataract surgery. METHOD A conjoint analysis was performed. Priority criteria were identified and selected using 4 focus/nominal groups consisting of the general public, patients/relatives, allied health-professionals and specialists from Catalonia (n=36). Preferences elicitation (score of criteria): representative sample survey of the above mentioned groups (n=771) and rank-ordered logit model application. Differences were assessed by group analysis and their comparison. RESULTS The criteria selected and their relative importance were: visual impairment (45%), difficulty in performing activities of daily living (ADL) (15%), limitation of ability to work (14%), being looked after by someone (11%), being a caregiver (8%), and recovery probability (7%). Differences in scores were observed among groups. Visual impairment was scored more highly by the general public and patients/relatives than by other groups (p<0.001). These two groups also assigned less importance to difficulty in performing ADL (p<0.001). The probability of recovery was the least scored criterion by most groups. Correlations among the order of hypothetical patient scenarios were high (r>0.9). However, the final order of patients on the waiting list could differ by up to 27 positions when different group scores were applied. CONCLUSIONS Social and clinical criteria were considered important. The observed differences among citizens regarding how to prioritize patients on the waiting lists indicates the need to take into account the preferences of all groups of citizens.
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Affiliation(s)
- Laura Sampietro-Colom
- Agencia de Evaluación de Tecnología e Investigación Médicas Dirección de Planificación y Evaluación, Departamento de Salud, Generalidad de Cataluña, Barcelona, Spain.
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Pujol Ribera E, Gené Badia J, Sans Corrales M, Sampietro-Colom L, Pasarín Rua MI, Iglesias-Pérez B, Casajuana-Brunet J, Escaramis-Babiano G. El producto de la atención primaria definido por profesionales y usuarios. Gaceta Sanitaria 2006; 20:209-19. [PMID: 16756859 DOI: 10.1157/13088852] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To identify the components of the primary health care (PHC) product defined by health professionals and users in order to establish indicators for evaluation. METHODS Qualitative methodology was used with group techniques: a nominal group (health professionals) and focus groups (users). The study was performed in PHC centers in Catalonia (Spain). There were 7 groups: a) family physicians and pediatricians; b) nurses and social workers; c) staff from admissions units and customer services; d) other medical specialists; e) users; f) managers, pharmacists, pharmacologists, and technicians. Participants responded to the question: "Which features should be evaluated in the services that should be provided by PHC?". A content analysis was performed. Textual data were broken down into units and then grouped into categories, following analogy criteria. The interpretative context of the research team was taken into account. RESULTS Health professionals and users identified 4 dimensions of the PHC product, coinciding with its basic attributes: a) access to services; b) coordination and continuity of the PHC teams with other levels of healthcare; c) relationship between health professionals and users, and d) scientific-technical quality of the PHC teams and the portfolio of services. Equity, satisfaction and efficiency appeared as keystones in all the components of the product identified. CONCLUSION There was broad agreement in the product definition among health professionals and users. The relationship between health professionals and patients was a key element in all groups. The four dimensions should be included in the evaluation of PHC teams.
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Abstract
OBJECTIVES The increasing availability of information about health care suggests an expanding role for consumers to exercise their preferences in health-care decision-making. Numerous methods are available to assess consumer preferences in health care. We conducted a systematic review to characterize the study of women's preferences about health care. METHODS A MEDLINE search from 1965 to July 1999 was conducted as well as hand searches of the Medical Decision Making Journal (1981-1999) and references from retrieved articles. Only original articles on women's health issues were selected. Information on thirty-one variables related to study characteristics and preferences were extracted by two independent investigators. A third investigator resolved disagreements. Qualitative and quantitative analyses were conducted to synthesize the data. RESULTS Four hundred eighty-three studies were identified in the initial search. Seventy articles were selected for review based on title, abstract, and inclusion criteria. There was an increase in published articles and number of methods used to elicit preferences. White women were studied more than black women (p < .001). Preferences were mainly studied in outpatient settings (p < .005) and in the United States, United Kingdom, and Canada (83 percent). Preferences related to participation in decision-making were the most common (21 percent). Only 4 percent of the studies were performed to inform the debate for public policy questions. Willingness to pay was the method most used (11 percent), followed by category scaling (10 percent), rating scale (9 percent), standard-gamble (6 percent). Preferences for individual particular (opposed to sequential and health states) outcomes (68 percent), different treatments/tests (47 percent), and related to a treatment episode (31 percent) were addressed. Information regarding diseases, conditions, or procedures was given in 57 percent of studies. Information provided was mainly written (37 percent) and included positive and negative potential outcomes (67 percent). There is no relationship between the method or tool used for delivery information and the choice performed. CONCLUSIONS The literature on preferences in women's health care is limited to a fairly homogeneous population (white women from the United States, United Kingdom, and Canada). Additionally, use of utility-based measures to capture preferences has decreased over time while others methods (e.g., time trade-off [TTO], contingent valuation) have increased. Women's preferences are not necessarily uniform even when asked similar questions using similar tools. Little information on women's preferences exists to inform policy-makers about women's health care.
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Sampietro-Colom L, Espallargues M, Reina MD, Marsó E, Valderas JM, Estrada MD. [Citizens opinions, experiences and perceptions about waiting lists for elective cataract surgery and hip and knee replacement. ]. Aten Primaria 2004; 33:86-94. [PMID: 14967125 PMCID: PMC7669176 DOI: 10.1016/s0212-6567(04)79356-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The aim of this study is to describe the views, perceptions and personal experience around elective cataract and hip and knee replacement waiting lists in Catalonia in order to improve their management. DESIGN Qualitative methodology: four focus groups for each procedure. PLACE Conducted between February-March 2000 at the Catalan Health Services headquarters. PARTICIPANTS Each focus group included consultants (ophtalmologists, orthopedic surgeons, rheumatologists, rehabilitators, GPs), other related health professionals (nurses, social workers, physiotherapists, opticians/optometrist, GPs), patients and relatives and general population. Participants were selected through researchers and the clinical scientific committees. All of them followed a pre-established inclusion criteria. MAIN MEASURES The analysis of the information was performed using the content analysis technique (contents of sessions were transcripted and information classified according to themes). RESULTS Ten themes were identified. Waiting lists were argued to be a consequence of lack of resources, bad management and conflict of interest among consultants. Overall, the health care authority responsibility for the solution was acknowledged, although some participants claim more citizen participation. Among proposed solutions, prevention and education, more resources and improved management were found. Furthermore, a better physician-patient communication was considered essential. All the groups disagreed with the implicit current prioritisation system, however none wanted to assume the responsibility. CONCLUSIONS Citizen's perceptions and personal experiences point to a multifactorial approach to waiting lists management, which would ameliorate the problem and lead to a better social acceptance.
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Luthi JC, Lund MJ, Sampietro-Colom L, Kleinbaum DG, Ballard DJ, McClellan WM. Readmissions and the quality of care in patients hospitalized with heart failure. Int J Qual Health Care 2004; 15:413-21. [PMID: 14527985 DOI: 10.1093/intqhc/mzg055] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Clinical practice guidelines based on the results of randomized clinical trials recommend that patients with heart failure due to left ventricular systolic dysfunction (LVSD) be treated with angiotensin-converting enzyme inhibitors (ACEI) at doses shown to reduce mortality and readmission. This study examined the relationship between ACEI use at discharge and readmission among patients with heart failure due to LVSD. METHODS AND RESULTS Data were abstracted from the medical records of 2943 randomly selected patients hospitalized for heart failure in 50 hospitals. The outcome of interest was the number of readmissions occurring up to 21 months after discharge. Six-hundred and eleven patients were eligible for analysis. Compared with patients discharged at a recommended ACEI dose, patients not prescribed an ACEI at discharge had an adjusted rate ratio of readmission (RR) of 1.74 [95% confidence interval (CI) 1.22-2.48], while patients prescribed an ACEI at less than a recommended dose had an RR of 1.24 (95% CI 0.91-1.69) (P = 0.005 for the trend). CONCLUSION Our results show that ACEI use at discharge in patients with LVSD is associated with decreased rate of readmission. These findings suggest that compliance with the ACEI prescribing recommendations listed in clinical practice guidelines for patients with heart failure due to LVSD confers benefit.
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Jonsson E, Banta HD, Henshall C, Sampietro-Colom L. Summary report of the ECHTA/ECAHI project. European Collaboration for Health Technology Assessment/Assessment of Health Interventions. Int J Technol Assess Health Care 2002; 18:218-37. [PMID: 12053423 DOI: 10.1017/s0266462302000247] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Health technology assessment (HTA) seeks to inform health policy makers by using the best scientific evidence on the medical, social, economic, and ethical implications of investments in health care. Technology is broadly defined to include the drugs, devices, medical, and surgical procedures used in health care, as well as measures for prevention and rehabilitation of disease, and the organizational and support systems in which health care is provided.
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Affiliation(s)
- Egon Jonsson
- Karolinska Institute and The Swedish Council on Technology Assessment in Health Care (SBU), Sweden
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Jonsson E, Banta HD, Henshall C, Sampietro-Colom L. Executive summary of the ECHTA/ECAHI project. European Collaboration for Health Technology Assessment/Assessment of Health Interventions. Int J Technol Assess Health Care 2002; 18:213-7. [PMID: 12053422 DOI: 10.1017/s0266462302000235] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Health technology is an indispensable part of any nation's healthcare system. During the past 50 years, all member states that comprise the European Union have increased their technological base for health care, both in terms of knowledge and by investments in equipment, devices, and pharmaceuticals. Generally, this process has gone well. However, several problems have emerged related to the acquisition, diffusion, and use of modern health technology. Concerns have been also raised about the effectiveness and efficiency of already established procedures in health care.
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Affiliation(s)
- Egon Jonsson
- Karolinska Institute and The Swedish Council on Technology Assessment in Health Care (SBU), Sweden
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Espallargues M, Sampietro-Colom L, Estrada MD, Solà M, del Rio L, Setoain J, Granados A. Identifying bone-mass-related risk factors for fracture to guide bone densitometry measurements: a systematic review of the literature. Osteoporos Int 2001; 12:811-22. [PMID: 11716183 DOI: 10.1007/s001980170031] [Citation(s) in RCA: 200] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Available evidence suggests that fracture prediction with bone densitometry may improve when used on people at high risk of osteoporotic fractures. The objectives of this literature review were: (1) to identify risk factors for fracture that are associated with the development of a low bone mass for both men and women; (2) to describe and assess the relationship between these factors and the risk of fracture; and (3) to classify them according to the strength of their association with fracture incidence. Studies were identified from MEDLINE (1982-1997), HealthSTAR (1975-1997) and The Cochrane Library (1997) databases. Pre-stated inclusion criteria (original analytic studies assessing risk factors for osteoporotic fractures in men and women) and methodologic quality were assessed by two independent investigators. Information on the study design and analysis, characteristics of participants, exposure (risk factor) and outcome measures (relative risk and odds ratios for fracture incidence), control for potential confounding factors and risk estimates was extracted using a standardized protocol. Qualitative and meta-analytic techniques were used for data synthesis. As a result, risk factors were classified into three groups according to their strength of association with fracture: high risk (RR > or = 2), moderate risk (1 < RR < 2) and no risk or protective (RR < or = 1). Of approximately 80 risk factors identified from 94 cohort and 72 case-control studies, 15% were classified in the high-risk group, including low body weight, loss of weight, physical inactivity, the consumption of corticosteroids or anticonvulsants, primary hyperparathyroidism, diabetes mellitus type 1, anorexia nervosa, gastrectomy, pernicious anemia, and aging (> 70-80 years). Eighteen percent and 8% of risk factors were classified in the moderate and no risk group respectively, whereas 60% showed either a lack of scientific evidence confirming their association with fracture or contradictory results. An efficient strategy for bone densitometry provision may thus be its selective use in those individuals who present with several strong or moderate risk factors for fracture related to bone mass loss.
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Affiliation(s)
- M Espallargues
- Catalan Agency for Health Technology Assessment and Research, Barcelona, Spain.
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Abstract
The Spanish Constitution of 1978 established a healthcare system available to everyone and free at the point of service. The General Health Law of 1986 also established the framework for a National Health System (NHS). The Constitution and the law form the regulatory framework for the devolution of healthcare services to the Autonomous Regions. All the 17 Autonomous Regions have complete power regarding public health and planning. However, responsibilities on healthcare financing, organization, provision, and management have devolved to only seven Autonomous Regions. Financial support for health services comes mostly from taxes. Global budgets are a mechanism used by hospitals to control the acquisition of medium and low health technology. Major capital investments for health technology are controlled by the central government in 10 Autonomous Regions (population coverage of 38%) and by the Regional Health Services in the seven remaining Autonomous Regions. In 1995 a regulation for basing the introduction of new procedures and medical equipment on the assessment of safety, efficacy, and efficiency was issued. Health technology assessment (HTA) has a long history in Spain, beginning with the Advisory Board on High Technology in the government of Catalonia in 1984. This board evolved into the Catalan Agency for HTA (CAHTA) in 1994. The Basque Country established a unit for HTA in 1992 (Osteba) and the Andalusian government created an agency in 1996 (AETSA). A national agency for HTA (AETS) was established in 1994. These different programs coordinate their work and together act as an Advisory Committee of the Interregional Council of the NHS.
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Affiliation(s)
- A Granados
- Catalan Agency for Health Technology Assessment
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Hailey D, Sampietro-Colom L, Marshall D, Rico R, Granados A, Asua J. The effectiveness of bone density measurement and associated treatments for prevention of fractures. An international collaborative review. Int J Technol Assess Health Care 1998; 14:237-54. [PMID: 9611900 DOI: 10.1017/s0266462300012228] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This review assesses the evidence regarding the effectiveness of bone density measurement (BDM) screening and related interventions--hormone replacement therapy (HRT) and intranasal salmon calcitonin (SCT[N])--in menopausal women to prevent fractures in later life. Data sources included systematic reviews of evidence and relevant primary studies identified through literature searches on MEDLINE and EMBASE. Study selection included trials of BDM screening programs, prospective studies examining the predictive value of BDM, randomized controlled trials, cohort studies, and case-control studies of HRT and SCT (N). The evidence was evaluated using a classification system incorporating study design and quality. Outcomes were measured in terms of relative risk of fracture for a 1 SD decrease in bone mineral density below the age-adjusted mean, relative risks or odds ratios for fractures associated with treatments, and proportion of hip fractures potentially prevented by BDM screening linked to treatments. Fair evidence from prospective cohort studies suggests that BDM can predict the risk of fractures, but not with high accuracy. Fair evidence from low-quality randomized controlled trials and observational studies suggests that HRT and SCT(N) are efficacious in preventing fractures. Good evidence supports the efficacy of these treatments in preserving bone mass, but there is fair evidence that the effect wears off after cessation of therapy. There is little evidence on the impact of screening menopausal women with BDM in association with HRT or SCT(N) treatment. Estimates based on combining existing evidence regarding the predictive value of BDM and efficacy of HRT suggests that 1-7% of hip fractures might be prevented.
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Affiliation(s)
- D Hailey
- Alberta Heritage Foundation for Medical Research
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Hailey D, Marshall D, Sampietro-Colom L, Rico R, Granados A, Asua J, Jonsson E. International collaboration in health technology assessment: a study of technologies used in management of osteoporosis. Health Policy 1998; 43:233-41. [PMID: 10178573 DOI: 10.1016/s0168-8510(97)00099-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A collaborative study was undertaken by members of the International Network of Agencies for Health Technology Assessment (INAHTA). The evidence of the effectiveness of bone density measurement and selected treatments in preventing fractures in later life was reviewed. There was fair evidence that bone density measurement can predict risk of fractures and that hormone replacement therapy and intranasal salmon calcitonin preserve bone mass and decrease the risk of fractures. However, it was estimated that only 1-7% of hip fractures would be prevented if these technologies were used in a screening program for menopausal women. Results of the assessment were endorsed by 13 INAHTA members, disseminated widely and provided input to policy and further work in this area. The project demonstrated the feasibility of international collaborative health technology assessment.
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Affiliation(s)
- D Hailey
- Alberta Heritage Foundation for Medical Research, Edmonton, Canada.
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