OP103 CONITEC's Rapid Reports As Technical Support In The Litigation

2017 ◽  
Vol 33 (S1) ◽  
pp. 46-47
Author(s):  
Eliete Simabuku ◽  
Carla Biella ◽  
Izamara Catanheide ◽  
Sarah Silva ◽  
Vania Canuto
Keyword(s):  
Decision Making ◽  
Health System ◽  
Technical Assistance ◽  
Treatment Options ◽  
Technical Information ◽  
National Committee ◽  
Evidence Based ◽  
Health Technologies ◽  
Unified Health System ◽  
State Defense

INTRODUCTION:The Unified Health System (SUS) is based on the principle of health as a citizen's right and the state's duty, which must be guaranteed based on public policies. Although there are several legislations, lists of medicines and clinical guidelines, Brazilians who have been prescribed expensive technologies that are not part of the essential drug lists ask judges to issue court orders obliging public health managers to purchase these drugs or to provide elective medical procedures immediately. Due to the health technical inexperience from judges, prosecutors and public lawyers, a partnership has arisen for the National Committee for Health Technology Incorporation (CONITEC) to provide technical assistance to help their decision-making process. Thus the purpose of this study is to describe CONITEC's experiences in communicating with stakeholders in this process.METHODS:A case study method was used and information about the rapid reports developed by CONITEC's Executive Secretariat in response to the applicants in the period of 2012 to 2016, was retrieved from CONITEC database.RESULTS:Rapid reports (2,773) about health technologies incorporation such as medicines, procedures or medical devices were produced by CONITEC during this period. Most requests covering topics as treatments for diabetes, arterial hypertension, osteoporosis, oncology and epilepsy; diseases for which there are several treatment options in SUS. The data analysis indicated that CONITEC contributed to the evidence based decision-making. On one hand, the Prosecutor's Office has been increasingly requesting information before starting lawsuits and Judiciary Power has increasingly used evidence-based technical information before deciding on the concession of injunctions; on the other hand, from 2012 to 2016 the number of requests decreased for information to State defense in lawsuits that has been already established.CONCLUSIONS:There is a growing interest in technical knowledge for fair decision making that respects the current organization of the evidence-based health system.

scholarly journals Social participation in the health technology incorporation process into Unified Health System

2019 ◽  
Vol 53 ◽  
pp. 109
Author(s):  
Aline Silveira Silva ◽  
Maria Sharmila Alina de Sousa ◽  
Emília Vitória da Silva ◽  
Dayani Galato
Keyword(s):  
Health System ◽  
Social Participation ◽  
Health Technology ◽  
Public Consultation ◽  
National Committee ◽  
Health Technologies ◽  
Unified Health System ◽  
Health Council ◽  
Public Hearings ◽  
Other Information

OBJECTIVE: To describe the current process of social participation in the incorporation of health technologies in Brazil, within the context of the Unified Health System (SUS). METHODS: A descriptive study was conducted based on the analysis of official records of the actions of the National Committee for Health Technology Incorporation into Unified Health System and its website, from the beginning of its activities in January 2012 until December 2017. RESULTS: The findings indicate that, in Brazil, there are legal instruments related to social participation in health, including the health technology assessment (HTA) field. However, its implementation is relatively recent and has been carried out gradually. In addition to the legal instruments (National Health Council representative, public consultation and public hearing forecast), other information and transparency strategies have been shown to be allied to social participation in the incorporation of health technologies. However, activities such as legally provided public hearings have not yet been carried out. CONCLUSIONS: Several actions to foster social participation were developed over the analyzed period, but they need to be evaluated in order to maintain or improve them. In addition, there is a need for more qualified social participation in the various existing spaces, including those prescribed by law.

scholarly journals Announcing the Canadian Journal of Health Technologies — A New Journal From CADTH

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Nicole Mittmann
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Health System ◽  
Canadian Journal ◽  
Health Technology ◽  
Health Care Decision ◽  
Health Technologies ◽  
Care Decision

The COVID-19 pandemic has put a spotlight on science and reaffirmed the value of evidence in health care decision-making. CADTH is a major Canadian publisher of evidence, advice, and recommendations regarding the assessment and management of health technologies. The Canadian Journal of Health Technologies will publish CADTH work in a single, PubMed-indexed, online location, making it easier for our health system partners to search and find CADTH work. Through the Canadian Journal of Health Technologies, CADTH will expand its reach and its collaborations with producers and users of health technology assessments.

VP214 Criteria That Influence The Brazilian Public Decision-Making

2017 ◽  
Vol 33 (S1) ◽  
pp. 248-248
Author(s):  
Andrea Brígida de Souza ◽  
Marisa Santos
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Health System ◽  
Public Health System ◽  
Bipolar Affective Disorder ◽  
Health Technology ◽  
Multiple Criteria ◽  
Emission Computed Tomography ◽  
Hematopoietic Stem ◽  
Health Technologies

INTRODUCTION:In Brazil, the National Committee for Health Technology Incorporation in the public health system (CONITEC) advises the Ministry of Health about incorporation, exclusion and alteration of health technologies in Brazilian public health system (SUS). Decision making considers multiple criteria, included or not in legislation. This analysis was the first step for a multiple-criteria decision analysis (MCDA) building. This study aims to identify criteria that influence Health Technology Assessment (HTA) for SUS.METHODS:Five real cases of controversial recommendations of technology incorporation made by CONITEC were reviewed by listening to the plenary recordings and reviewing committee minutes. The choice was guided by convenience, with prioritization according to CONITEC's members, using a pre-defined standardized form. Weight in decision making was also raised and identified. Selected technologies judgments were: Trastuzumab for metastatic/advanced Breast Cancer; Fingolimod for Multiple Sclerosis; Clozapine, Lamotrigine, Olanzapine, Quetiapine and Risperidone for Bipolar Affective Disorder; Hematopoietic stem cell transplantation for Sickle Cell Disease; and Positron Emission Computed Tomography (PET-CT) for Lung Cancer and for hepatic metastasis from Colorectal Cancer.RESULTS:The choice of different technologies allowed verifying specific criteria used for the incorporation of each type of technology, as well as the similar criteria discussed and used by all these technology types. In addition, some identified criteria were specific to the Brazilian reality, such as: “Incorporation by other countries”, “Potential technologies without registration in Brazil” and “Off-label use”. These criteria were not previously identified in studies conducted in other countries. Some criteria have been identified in all decisions, such as: efficacy, disease severity, quality and confidence in the evidences, logistic challenges for implementation, unmet needs, budget impact and treatment costs. Relative impact of cost-effectiveness was considered low.CONCLUSIONS:CONITEC's recordings are an important source to understand the Brazilian decision-making process. To identify the important criteria can help to standardize and improve the HTA process.

scholarly journals Strengthening evidence-based decision-making: is it possible without improving health system stewardship?

2011 ◽  
Vol 27 (6) ◽  
pp. 499-504 ◽  
Author(s):  
R. Majdzadeh ◽  
B. Yazdizadeh ◽  
S. Nedjat ◽  
J. Gholami ◽  
S. Ahghari
Keyword(s):  
Decision Making ◽  
Health System ◽  
Evidence Based ◽  
Evidence Based Decision Making

scholarly journals Health technology assessment in Finland

2009 ◽  
Vol 25 (S1) ◽  
pp. 102-107 ◽  
Author(s):  
Marjukka Mäkelä ◽  
Risto P. Roine
Keyword(s):  
Decision Making ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Health Technology ◽  
Evidence Based ◽  
Policy Makers ◽  
Health Technologies ◽  
Based Medicine ◽  
Special Responsibility ◽  
Made In

Since the 1990s, health policy makers in Finland have been supportive of evidence-based medicine and approaches to implement its results. The Finnish Office for Health Technology Assessment (Finohta) has grown from a small start in 1995 to a medium-sized health technology assessment (HTA) agency, with special responsibility in providing assessments to underpin national policies in screening. External evaluations enhanced the rapid growth. In the Finnish environment, decision making on health technologies is extremely decentralized, so Finohta has developed some practical tools for implementing HTA findings. The Managed Uptake of Medical Methods program links the hospital districts to agree on introduction of technologies. The Ohtanen database provides Finnish-language summaries of major assessments made in other countries.

The ‘Number Needed to Treat’ and the ‘Adjusted NNT’ in Health Care Decision-Making

1998 ◽  
Vol 3 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Jack Dowie
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Evidence Based Medicine ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Clinical Decision ◽  
Population Based ◽  
Number Needed To Treat ◽  
Evidence Based ◽  
Based Medicine

Within ‘evidence-based medicine and health care’ the ‘number needed to treat’ (NNT) has been promoted as the most clinically useful measure of the effectiveness of interventions as established by research. Is the NNT, in either its simple or adjusted form, ‘easily understood’, ‘intuitively meaningful’, ‘clinically useful’ and likely to bring about the substantial improvements in patient care and public health envisaged by those who recommend its use? The key evidence against the NNT is the consistent format effect revealed in studies that present respondents with mathematically-equivalent statements regarding trial results. Problems of understanding aside, trying to overcome the limitations of the simple (major adverse event) NNT by adding an equivalent measure for harm (‘number needed to harm’ NNH) means the NNT loses its key claim to be a single yardstick. Integration of the NNT and NNH, and attempts to take into account the wider consequences of treatment options, can be attempted by either a ‘clinical judgement’ or an analytical route. The former means abandoning the explicit and rigorous transparency urged in evidence-based medicine. The attempt to produce an ‘adjusted’ NNT by an analytical approach has succeeded, but the procedure involves carrying out a prior decision analysis. The calculation of an adjusted NNT from that analysis is a redundant extra step, the only action necessary being comparison of the results for each option and determination of the optimal one. The adjusted NNT has no role in clinical decision-making, defined as requiring patient utilities, because the latter are measurable only on an interval scale and cannot be transformed into a ratio measure (which the adjusted NNT is implied to be). In any case, the NNT always represents the intrusion of population-based reasoning into clinical decision-making.

scholarly journals A Model for Determining the Number of Health Technologies in the Health Systems: An Approach Combining Multiple Attributes Decision Making and Goal Programming

2020 ◽  
Author(s):  
Hosein Arman ◽  
Efat Mohamadi ◽  
Mohammadreza Mobinizadeh
Keyword(s):  
Decision Making ◽  
Health System ◽  
Policy Making ◽  
Technology Policy ◽  
Health Technology ◽  
Evaluation Study ◽  
Health Technologies ◽  
Multi Objective ◽  
Limited Budget ◽  
Multiple Attributes Decision Making

In recent years, health technology policy-making science has gone beyond just a health technology assessment or systematic review or economic evaluation study and the science of operational research in decision making, i.e. multi-attributes and multi-objective decision-making has been included. Hence, currently, health technology policy-making follows a seven-step process. After a technology undergoes these steps and is proven that it is useful for the health system, it must be determined how many of it is needed in the health system. Determining the required number of health technologies is a challenge that remains to be considered. Therefore, this study  was designed to overcome this problem. The authors intend to introduce a multi-objective decision-making methodology considering the limited budget, to determine the number of technologies required to complete for the health technology policymaking cycle.

Experiences and hidden needs of older patients, their families and their physicians in palliative chemotherapy decision-making: a qualitative study

2020 ◽  
Vol 50 (7) ◽  
pp. 779-786 ◽  
Author(s):  
Rie Tsuboi ◽  
Mihoko Sugishita ◽  
Yoshihisa Hirakawa ◽  
Yuichi Ando
Keyword(s):  
Decision Making ◽  
Advanced Cancer ◽  
Older Patients ◽  
Palliative Chemotherapy ◽  
Treatment Options ◽  
Spiritual Needs ◽  
Evidence Based ◽  
Psychological Issues ◽  
Individual Interviews ◽  
To Receive

Abstract Objective This study aimed to clarify the experiences and hidden needs of older patients with advanced cancer, their families and their physicians in palliative chemotherapy decision-making. Materials and Methods We conducted in-depth qualitative individual interviews with content analysis. Patients who were diagnosed as having advanced cancer, were aged ≥70 years (n = 15, median [range] = 77 [70–82] years) and had volunteered to receive palliative chemotherapy within the past 6 months were enrolled. Their families and physicians were also interviewed. Results The following four themes were identified: (i) physician’s awareness of paternalism; (ii) readiness for communication of serious news; (iii) spiritual care need assessment and (iv) support as a team. The patients and families expected physicians to demonstrate paternalism in their decision-making because they were unconfident about their self-determination capability. Although the physicians were aware of this expectation, they encountered difficulties in recommending treatment and communicating with older patients. The patients had spiritual pain since the time of diagnosis. Psychological issues were rarely discussed during decision-making and treatment, triggering feelings of isolation in the patients and their families. Conclusion Older patients and their families expected a paternalistic approach by the physicians for palliative chemotherapy decision-making. The physicians found it difficult to offer treatment options because of older patient diversity and limitations in evidence-based strategies. Therefore multidisciplinary approaches and evidence-based decision support aids are warranted. Because older patients and their families often have unexpressed psychological burdens including unmet spiritual needs, medical professionals should provide psychological care from the time of diagnosis.

scholarly journals Evidence-Based Medicine in Daily Surgical Decision Making: A Survey-Based Comparison between the UK and Germany

2014 ◽  
Vol 54 (1-2) ◽  
pp. 14-23 ◽  
Author(s):  
Andreas A. Schnitzbauer ◽  
Andrea Proneth ◽  
Liset Pengel ◽  
Jörg Ansorg ◽  
Matthias Anthuber ◽  
...  
Keyword(s):  
Decision Making ◽  
Health System ◽  
Evidence Based Medicine ◽  
Clinical Work ◽  
Free Text ◽  
Evidence Based ◽  
Mailing Lists ◽  
Interdisciplinary Approaches ◽  
The Uk ◽  
Based Medicine

Background: Evidence-based medicine (EbM) is a vital part of reasonable and conclusive decision making for clinicians in daily clinical work. To analyze the knowledge and the attitude of surgeons towards EbM, a survey was performed in the UK and Germany. Methods: A web-based questionnaire was distributed via mailing lists from the Royal College of Surgeons of England (RCSE) and the Berufsverband Deutscher Chirurgen (BDC). Our primary aim was to get information about knowledge of EbM amongst German and British surgeons. Results: A total of 549 individuals opened the questionnaire, but only 198 questionnaires were complete and valid for analysis. In total, 40,000 recipients were approached via the mailing lists of the BDC and RCSE. The response rate was equally low in both countries. On a scale from 1 (unimportant) to 10 (very important), all participants rated EbM as very important for daily clinical decision making (7.3 ± 1.9) as well as for patients (7.8 ± 1.9) and the national health system (7.8 ± 1.9). On a scale from 1 (unimportant) to 5 (very important), systematic reviews (4.6 ± 0.6) and randomized controlled trials (4.6 ± 0.6) were identified as the highest levels of study designs to enhance evidence in medicine. British surgeons considered EbM to be more important in daily clinical work when compared to data from German surgeons (7.9 ± 1.6 vs. 6.7 ± 2.1, p < 0.001). Subgroup analysis showed different results in some categories; however, a pattern to explain the differences was not evident. Personal requirements expressed in a free text field emphasized the results and reflected concerns such as broad unwillingness and lack of interdisciplinary approaches for patients (n = 59: 25 in the UK and 34 in Germany). Conclusion: The overall results show that EbM is believed to be important by surgeons in the UK and Germany. However, perception of EbM in the respective health system (UK vs. Germany) may be different. Nonetheless, EbM is an important tool to navigate through daily clinical problems although a discrepancy between the knowledge of theoretical abstract terms and difficulties in implementing EbM in daily clinical work has been detected. The provision of infrastructure, courses and structured education as a permanent instrument will advance the knowledge, application and improvement of EbM in the future.

Demonstrating the influence of HTA: INAHTA member stories of HTA impact

2020 ◽  
pp. 1-6
Author(s):  
Sophie Söderholm Werkö ◽  
Tracy Merlin ◽  
Laurie Jean Lambert ◽  
Paul Fennessy ◽  
Ana Pérez Galán ◽  
...  
Keyword(s):  
Decision Making ◽  
Health System ◽  
Positive Impact ◽  
Qualitative Evaluation ◽  
Health Technology ◽  
Publicly Funded ◽  
Central Function ◽  
Health Technologies ◽  
Story Sharing ◽  
Document Review

Abstract A central function of health technology assessment (HTA) agencies is the production of HTA reports to support evidence-informed policy and decision making. HTA agencies are interested in understanding the mechanisms of HTA impact, which can be understood as the influence or impact of HTA report findings on decision making at various levels of the health system. The members of the International Network of Agencies for HTA (INAHTA) meet at their annual Congress where impact story sharing is one important activity. This paper summarizes four stories of HTA impact that were finalists for the David Hailey Award for Best Impact Story. The methods to measure impact include: document review; claims analysis and review of reimbursement status; citation analysis; qualitative evaluation of stakeholders’ views; and review of media response. HTA agency staff also observed changes in government activities and priorities based on the HTA. Impact assessment can provide information to improve the HTA process, for example, the value of patient and clinician engagement in the HTA process to better define the assessment question and literature reviews in a more holistic and balanced way. HTA reports produced by publicly funded HTA agencies are valued by health systems around the globe as they support decision making regarding the appropriate use, pricing, reimbursement, and disinvestment of health technologies. HTAs can also have a positive impact on information sharing between different levels of government and across stakeholder groups. These stories show how HTA can have a significant impact, irrespective of the health system and health technology being assessed.

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