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At least 271 records · Page 15Linked to original sources
PubMed2001

Impact of health technology assessment on preventive screening in Belgium: case studies of mammography in breast cancer, PSA screening in prostate cancer, and ultrasound in normal pregnancy.

OBJECTIVE: To describe how scientific evidence has influenced healthcare policy making in Belgium in the field of sickness prevention for mammography, PSA testing in prostate cancer screening, and use of ultrasound in pregnancy. METHODS: Review of published and gray literature and interviews with stakeholders and experts. RESULTS: At the end of 1999, a systematic national/regional screening program had not yet been implemented for any of the three screening strategies. A systematic breast cancer screening program is being prepared for implementation only in Flanders. This limited impact can be attributed to the fragmentation in healthcare policy, the different options among the different regions, fragmentation in healthcare practice, the strong impact of healthcare stakeholders (provider groups and sickness funds) on decision making, and limited attention to scientific evidence in health policy and technology assessment. CONCLUSIONS: Health technology assessment has had very little impact on policy and practice in use of mammography, PSA testing, and ultrasound in pregnancy in Belgium.

Adolescent↗
PubMed2004

Health technology assessment and policy from the economic perspective.

This article comments on the four country papers in this volume from an economic perspective. Different phases of the decision-making process, which can be supported by Health Technology Assessment (HTA), are considered. For each of these, there is large cross-country variation in the way in which HTA influences policy. Furthermore, economic themes regarding the relevance of HTA evidence for policy making, the position of cost-effectiveness in relation to other criteria vis-à-vis reimbursement decisions, the use of a cost per quality-adjusted life year threshold, and the incorporation of economic considerations in practice guidelines are discussed.

Cost-Benefit Analysis↗
PubMed2001

Health technology assessment and screening in The Netherlands: case studies of mammography in breast cancer, PSA screening in prostate cancer, and ultrasound in normal pregnancy.

OBJECTIVE: To review the assessment and implementation of three screening methods: mammography for breast cancer, screening for prostate cancer, and routine use of ultrasound in pregnancy. METHODS: To review policy documents and published papers dealing with prevention and screening in the Netherlands, focusing on the three screening methods specified. RESULTS: The results indicate that the Netherlands has an active establishment devoted to health technology assessment (HTA). The Netherlands government has also made prevention a high priority in the health services system. Within prevention policy, HTA is given an important place. The general policy is that prevention programs should meet high standards of effectiveness and efficiency, as well as ethical, legal, and social acceptability. In addition, the Netherlands may be unique in the world in having a specific law requiring that proposals for population screening must be carefully assessed before they are implemented. CONCLUSIONS: The three cases examined in this paper have all been assessed, and the conclusions are similar to those presented in the synthesis published in this issue (33). In the case of mammography, the assessment was followed by a rational implementation of a national screening program for breast cancer. In the other two cases, however, despite negative conclusions from assessment, the tests are frequently carried out, especially in what has been termed opportunistic screening. Prostate cancer screening seems to be spreading rapidly. Use of ultrasound in pregnancy is frequent, not necessarily for medical reasons but because parents wish to have a picture of their fetus. The conclusion is that HTA is well established in the Netherlands, as illustrated in these three cases, and policy is based on the assessments done. However, practice is not in accord with the assessment in the cases of prostate cancer and routine ultrasound. Policies to deal effectively with opportunistic screening are difficult to imagine.

Adult↗
PubMedDate not supplied

[Evaluation of health technologies and benefits entitlement in advanced social systems].

In the present study, health is considered a subject of insurance whose protection has become a Fundamental Right. In the same line, health care has acquired a contractual character whose "nature" has evolved from individual to collective, expressed in terms of "health care insurance", public or private. In such context, outcome measurement becomes necessary to be able to define the variables of the System and, subsequently, the contracting conditions. Having an understanding of the economic impact is required to analyze the costs and, in consequence, the financial necessities of the System; as well as the clinical results in order for the insured to have some realistic expectations of the benefits that can be expected from the health care that is offered. In turn, the vertiginous rhythm of technological innovation that characterizes the modern medicine forces to the continuous revision of the state of the art framed in a health sector whose multifactorial profile confers it growing complexity. In conclusion, health technology assessment becomes indispensable to identify health care effectiveness, to facilitate its efficient management, to define responsibilities and to offer guarantees to the users; all which is already part of an ethical body that, day by day with more clarity, is being configured by the legislation and that, in turn, guarantees the survival of the Health Care System.

English Abstract↗
PubMed2003

Normative models of health technology assessment and the social production of evidence about telehealth care.

Telehealthcare is a rapidly growing field of clinical activity and technical development. These new technologies have caught the attention of clinicians and policy makers because they seem to offer more rapid access to specialist care, and the potential to solve structural problems around inequalities of service provision and distribution. However, as a field of clinical practice, telehealthcare has consistently been criticised because of the poor quality of the clinical and technical evidence that its proponents have marshalled. The problem of "evidence" is not a local one. In this paper, we undertake two tasks: first, we critically contrast the normative expectations of the wider field of Health Technology Assessment (HTA) with those configured within debates about Telehealthcare Evaluation; and second, we critically review models that provide structures within which the production of evidence about telehealthcare can take place. Our analysis focuses on the political projects configured within a literature aimed at stabilising evaluative knowledge production about telehealthcare in the face of substantial political and methodological problems.

Evidence-Based Medicine↗
PubMed2006

Case study of the comparison of data from conference abstracts and full-text articles in health technology assessment of rapidly evolving technologies: does it make a difference?

OBJECTIVES: The aim of this study was to examine (i) the consistency of reporting research findings presented in conference abstracts and presentations and subsequent full publications, (ii) the ability to judge methodological quality of trials from conference abstracts and presentations, and (iii) the effect of inclusion or exclusion of data from these sources on the pooled effect estimates in a meta-analysis. METHODS: This report is a case study of a selected health technology assessment review (TAR) of a rapidly evolving technology that had identified and included a meta-analysis of trial data from conference abstracts and presentations. RESULTS: The overall quality of reporting in abstracts and presentations was poor, especially in abstracts. There was incomplete or inconsistent reporting of data in the abstract/presentations. Most often inconsistencies were between conference slide presentations and data reported in published full-text articles. Sensitivity analyses indicated that using data only from published papers would not have altered the direction of any of the results when compared with those using published and abstract data. However, the statistical significance of three of ten results would have changed. If conference abstracts and presentations were excluded from the early analysis, the direction of effect and statistical significance would have changed in one result. The overall conclusions of the original analysis would not have been altered. CONCLUSIONS: There are inconsistencies in data presented as conference abstracts/presentations and those reported in subsequent published reports. These inconsistencies could impact the final assessment results. Data discrepancies identified across sources included in TARs should be highlighted and their impact assessed and discussed. Sensitivity analyses should be carried out with and without abstract/presentation data included in the analysis. Incomplete reporting in conference abstracts and presentations limits the ability of reviewers to assess confidently the methodological quality of trials.

Congresses as Topic↗
PubMed2003

Procalcitonin as a diagnostic test for sepsis: health technology assessment in the ICU.

Elevation in the serum concentration of procalcitonin (PCT) is associated with systemic infection. This association has led to the proposed use of PCT as a novel biomarker of bacterial sepsis. The advantages and limitations of the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) definitions of sepsis are an important consideration that affects the impact of any diagnostic test for sepsis and these issues are discussed. Our main objective is to perform a systematic health technology assessment of PCT as a diagnostic test for sepsis. In an adult intensive care unit (ICU) population, we identify a specific and important question-can PCT accurately distinguish sepsis in patients with systemic inflammatory response syndrome (SIRS) who have a suspected infection? Likelihood ratios are calculated from published data to attempt to find the best answer. The published evidence does not support a general claim that PCT is a useful decision support tool for diagnosing sepsis in patients who have SIRS. Procalcitonin has a slightly better ability to exclude the diagnosis of sepsis. The role for using PCT testing in the ICU will continue to evolve along with our understanding and definition of sepsis.

Biomarkers↗
PubMed2000

The case of Norplant as an example of media coverage over the life of a new health technology.

BACKGROUND: The contraceptive implant Norplant (levonorgestrel) had a fairly short life in the UK. This made it a convenient subject for a case study of how media coverage alters over time. We set out to produce a critical description of national newspaper coverage of Norplant over the course of its use in the UK. METHODS: We searched newspaper databases and press-clippings files for articles about Norplant printed between 1992 and 1996. For those that met our inclusion criteria, we extracted bibliographical data, made a standardised judgment about the "slant" of the article towards Norplant, and used qualitative techniques to analyse the content of the articles. FINDINGS: 101 national newspaper articles were included in the study. Norplant attracted media coverage over the course of its career, but the slant of articles shifted dramatically over time from a favourable to a negative presentation. This reflected the use of different story types over the course of time. Early reports presented Norplant very positively as either a clear improvement on existing contraceptive methods or a valuable addition to the range. Any disadvantages were down-played. The positive image of Norplant was reinforced immediately after its official launch by reports that it was in great demand but women might be denied access to it. Less than a year later, however, newspaper reports about Norplant were dominated by the stories of individual women who had had bad experiences with the product. INTERPRETATION: Three main reporting themes were seen. At first, Norplant was presented as a positive new development, and one that might be denied to people. In later coverage it became a flawed and damaging product. These themes recur in media reporting of health technologies, and the fact that they occur at different stages in a product's career means that a balanced assessment of the technology is not usually feasible from media reporting at any one time. An appreciation of the forms and implications of these reporting frameworks could help health-care providers and users to appraise media reports more critically.

Contraceptive Agents, Female↗
PubMedDate not supplied

Low-power lasers in medicine. A report by the Australian Health Technology Advisory Committee (AHTAC) June 1994.

Low-power lasers are those that deliver an output power in the milliwatt (mW) range. Output is typically between 1 and 30 mW, but can be up to 100 mW; It has been suggested that low power lasers cause biostimulation--a photochemical response to laser light inducing biochemical alterations in cells. However, there is no universally agreed theory to explain the mechanism of the claimed effects of treatment; The wavelengths, treatment protocols and conditions to be treated are not established; Low-power lasers are in widespread use for the treatment, in the main, of a range of musculoskeletal problems, despite little published evidence of efficacy; Evidence from controlled trials is inconclusive and conflicting; The Australian Health Technology Advisory Committee considers that the efficacy of low-power lasers in the treatment of musculoskeletal and other conditions is not established. The Committee therefore recommends that; those who use this technology should take steps to obtain unequivocal evidence of benefit from appropriately designed and conducted trials; and in any clinical use of such lasers, the treatment protocols should be clearly defined.

Humans↗
PubMed2006

Evidence-based practice center network and health technology assessment in the United States: bridging the cultural gap.

OBJECTIVES: The purpose of this study was to identify the Evidence-Based Practice Center (EPC) network participants' perceptions of the characteristics of the EPC process and the relationship of the process to the success of EPC reports. METHODS: Semistructured interviews were conducted with the three groups involved in the EPC: EPC staff, Agency for Healthcare Research and Quality (AHRQ) staff, and representatives of partner organizations. RESULTS: The analysis of the coded transcripts revealed three related major themes, which form the conceptual basis for the interpretation presented here: the definition of a successful report, the determinants of a successful report, and the role of AHRQ in the process. CONCLUSIONS: A successful report is a report that is used. The ultimate success of the core health technology assessment objective, moving from research to policy, depends on balancing two values: excellence and relevance. Our findings are consistent with the "two communities thesis," which postulates the existence of two camps that confer different values to excellence and relevance, with resulting tension. A promising model for approaching this tension is integration or collaboration, which requires linking researchers and policy makers, promoting productive dialogues about the formulation and timing of analysis, and early consideration of how the resulting analysis will be used. This effort suggests that actively blurring the frontiers between these two groups will enhance their interaction. Furthermore, enhancing the role of the AHRQ as scientific broker will maximize the potential of the EPC network.

Cultural Diversity↗
PubMed1994

Standardizing economic appraisal of health technology in the European Community.

The article criticizes the present variability of economic appraisal methodologies and supports their standardization as a means of ensuring the comparability of the results of studies done by different researchers. Standards should be theoretically sound and feasible, and are probably best attained by consensus between the research community and users. Standardization is not without some dangers, e.g. the risk of excessive rigidity or the discouragement of further methodological research. These dangers can however be easily avoided and are likely to be overcome by the potential benefits: comparability and transferability of the results of the studies; increased credibility and, hence, broader use of economic appraisal as a regular tool for decision making. It will also ensure that if applied in regulatory or reimbursement decisions in the EC Member States, economic evaluation does not contribute to create market barriers to the free movement of products within the Single Market of health technologies.

Cost-Benefit Analysis↗
PubMed2006

Are we measuring what matters in health technology assessment of disease management? Systematic literature review.

OBJECTIVES: An overview was produced of indicators currently used to assess disease management programs and, based on these findings, provide a framework regarding sets of indicators that should be used when taking the aims and types of disease management programs into account. METHODS: A systematic literature review was performed. RESULTS: Thirty-six studies met the inclusion criteria. It appeared that a link between aims of disease management and evaluated structure, process, as well as outcome indicators does not exist in a substantial part of published studies on disease management of diabetes and asthma/chronic obstructive pulmonary disease, especially when efficiency of care is concerned. Furthermore, structure indicators are largely missing from the evaluations, although these are of major importance for the interpretation of outcomes for purposes of decision-making. Efficiency of disease management is mainly evaluated by means of process indicators; the use of outcome indicators is less common. Within a framework, structure, process, and outcome indicators for effectiveness and efficiency are recommended for each type of disease management program. CONCLUSIONS: The link between aims of disease management and evaluated structure, process, and outcome indicators does not exist in a substantial part of published studies on disease management. The added value of this study mainly lies in the development of a framework to guide the choice of indicators for health technology assessment of disease management.

Decision Making↗
PubMed2003

Health economic evaluation in Japan: a case study of one aspect of health technology assessment.

There is a burgeoning literature in health economic evaluation, with this form of analysis becoming increasingly influential at the health policy making level in a number of countries. However, a search of the literature reveals that in Japan, the world's second largest health care market, very little health economic evaluation has been undertaken. The main reason for the lack of interest in economic evaluation is that the fee-for-service and strict price regulation that characterises the system of health care financing in Japan is not conducive to this form of analysis. Moreover, the government and many researchers are satisfied that the current organisation of health care has given long life and low infant mortality at low cost. Even if it is accepted that low health care costs and good health prevail in Japan, slower economic growth rates, an ageing population and the development of new medical technologies will place increasing pressure on health care resources and will necessitate a more rational use of these resources. Good economic evaluation, by weighing benefits against costs, has an important role to play.

Budgets↗
PubMedDate not supplied

Ethical considerations for the utilization of tele-health technologies in home and hospice care by the nursing profession.

Home care, including hospice care, is a growing component of the current healthcare system and pertains to care services that are provided to individuals, their family members, and caregivers in their own residence. Both domains face funding limitations as life expectancy and the segment of the population older than 65 years increase. Tele-health, defined as the use of advanced telecommunication technologies to enable communication between patients and healthcare providers separated by geographic distance, is perceived as a concept that can enhance both home and hospice care and address some of the current challenges. This article discusses ethical challenges associated with the utilization of tele-health technologies by the nursing profession in the home setting. These factors form a framework for the ethical considerations that result from the introduction of these technologies in nursing practice. Specifically, the article discusses the issue of privacy and confidentiality of patient data, informed consent, equity of access, promoting dependency versus independence, the lack of human touch and the impact of technology on the nurse-patient relationship, and the medicalization of the home environment. These issues constitute a road map both for nursing practitioners who are aiming to provide an efficient delivery of services in the home and for nursing administrators who are asked to make judgments about the use of tele-health technology as a supplement to traditional care and as a cost-saving tool.

Confidentiality↗
PubMed2003

Images of health technology in national and local strategies.

OBJECTIVES: This paper examines the potential of various models relating technology to society and institutional structures to inform health policy. Among the models discussed are various versions of technological determinism, social constructivism, actor network theory and critical theory. METHODS: The paper considers recent developments in policy and strategy that aim to shape the way the UK's National Health Service (NHS) integrates Information and Communication Technologies (ICTs) into health care and considers what these alternative models highlight or emphasise, and how they might influence the activities of setting local implementation strategies. RESULTS AND CONCLUSIONS: Contemporary ICTs are often presented as having a particular relevance and power in reforming or transforming the delivery of health care. Understanding how such technologies might be conceived of, implemented and become an integral part of some future health care system is an important and challenging task that requires innovative theoretical treatments.

Computer Communication Networks↗
PubMed1987

Health technology assessment: problems and challenges.

From a national perspective, the central prerequisite of the proper application of medical technology is the timely determination of efficacy, cost, safety, and societal impact. This applies to both the introduction of the new methods and the retirement of older methods that may have outlived their usefulness. Within that framework, the rapid diffusion of innovative methods of great value must be balanced against the cost of premature enthusiasm for techniques with little or no incremental diagnostic or therapeutic gain. A nongovernmental Council on Health Care Technology Assessment of the Institute of Medicine-National Academy of Sciences was established by the Congress in 1986. The Council was charged to serve as an information clearing-house, a center to promote research and education, and a stimulus to establish better methods of assessment and more prompt identification of potentially important technologies. It represents virtually all of the constituencies concerned with adequate evaluation of new and existing methods. The Council confronts the critical problems of timing, bias, the quality of primary data collection, new methods of secondary data analysis, the nature of the "laboratory" in which technology assessment is best accomplished, the "exploitative" character of technology assessment research, appropriate diffusion, and ethnical issues. The appropriate use of technology in modern health care depends on the resolution of these issues.

Organizations↗