PP179 Health Technology Assessment Of Pediatric Intensive Care Ventilators

2019 ◽  
Vol 35 (S1) ◽  
pp. 70-71
Author(s):  
Roxana Di Mauro ◽  
Francesco Faggiano ◽  
Martina Andellini ◽  
Pietro Derrico ◽  
Matteo Ritrovato
Keyword(s):  
Intensive Care ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Pediatric Intensive Care ◽  
Evaluation Process ◽  
Clinical Effectiveness ◽  
Health Technology ◽  
Analytic Hierarchy ◽  
The Impact ◽  
Hierarchy Process

IntroductionA health technology assessment (HTA) process to evaluate the best intensive care ventilator manufacturers has been carried out in different pediatric intensive care units (ICUs) of Bambino Gesù Children's Hospital (OPBG). The purpose of this study is to determine: (i) the most relevant features of a ventilator to be considered between different manufacturers, and (ii) the methodology to conduct the assessment to support the decision-making process about the choice to adopt the suitable technology for OPBG.MethodsThe decision-oriented HTA method (Do-HTA), developed by the HTA unit of OPBG, was applied to conduct the assessment. Do-HTA involves the integration of the European Network for HTA (EUnetHTA) CoreModel and the Analytic Hierarchy Process with the support of an informatics tool. It provides the definition and numerical evaluation of assessment parameters to evaluate the performance of technologies. A literature review involving ICU professionals was used to define and weight the assessment elements on clinical, technical, organizational, economic, and safety domains. In particular, a subgroup of these domains has been included in a checklist for the comparative evaluation of different ventilator models, each of which was tested in three independent runs performed in three different ICUs.ResultsResults show that safety and clinical effectiveness had highest the impact within the evaluation, followed by organizational, technical and economic aspects. A percentage value per each ventilator has been assigned, representing the global performances regarding the assessment elements.ConclusionsThis study presents and discusses the benefits and drawbacks of innovative features of ventilators, all characteristics to be taken into account during the evaluation process and a methodology to conduct it. The project identified the best performing ventilator model through a collective decision, giving a reliable recommendation to the Hospital Decision Makers.

VP47 Health Technology Assessment Of Intensive Care Ventilators For Pediatric Patients

2017 ◽  
Vol 33 (S1) ◽  
pp. 168-169
Author(s):  
Francesco Faggiano ◽  
Martina Andellini ◽  
Federico Nocchi ◽  
Carlo Capussotto ◽  
Francesca Sabusco ◽  
...  
Keyword(s):  
Intensive Care ◽  
Economic Evaluation ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Scientific Evidence ◽  
Clinical Effectiveness ◽  
Health Technology ◽  
Assessment Process ◽  
Context Analysis ◽  
Analytic Hierarchy

INTRODUCTION:The purpose of the study was to evaluate different type and manufacturers of intensive care ventilators in order to support the healthcare decision-making process about the choice to adopt the best available technology for ventilation of pediatric patient in intensive care units at Bambino Gesù Children's Hospital.METHODS:The technology assessment process was developed by using a new methodology, the Decision-oriented Health Technology Assessment (HTA) (DoHTA), a new implementation of the European Network for Health Technology Assessment (EUnetHTA) CoreModel, integrating the Analytic Hierarchy Process (1). A literature review was carried out to gather evidence on safety and overall effectiveness of different kind of intensive care ventilators, with several ventilation modalities and strategies. The synthesis of scientific evidence, and results of the specific context analysis resulted in the definition of components of the decisional hierarchy structure, consisting in detailed characteristics of the technology's performances covering the aspects on feasibility, safety, efficacy, costs, and organizational and technical characteristics of the technology. A subgroup of these indicators has been included in a checklist form for the evaluation of different type and manufacturers of intensive care ventilators, each of which was tested in three independent runs performed in three different departments. In addition, an economic evaluation was also carried out.RESULTS:Preliminary DoHTA results showed that the domains with the highest impacts within the evaluation are safety and clinical effectiveness (34.8 percent and 25.7 percent, respectively) followed by organizational aspects, technical characteristics of technology and costs and economic evaluation. The final objective is to define the alternatives’ ranking through a comparison between alternative technologies’ performances.CONCLUSIONS:The technology assessment project allowed to identify strengths and limits of the most recent intensive care ventilator’ models in the specific contexts of use by involving all health professionals interested, and eventually identify the best option for the hospital.

PP178 Health Technology Assessment Of Laboratory Medicine

2019 ◽  
Vol 35 (S1) ◽  
pp. 70-70
Author(s):  
Roxana Di Mauro ◽  
Francesco Faggiano ◽  
Martina Andellini ◽  
Pietro Derrico ◽  
Matteo Ritrovato
Keyword(s):  
Health Technology Assessment ◽  
Technology Assessment ◽  
Evaluation Process ◽  
Health Technology ◽  
Turnaround Time ◽  
Laboratory Medicine ◽  
Accurate Analysis ◽  
Analytic Hierarchy ◽  
Qualitative Level ◽  
Technical Solutions

IntroductionRecent studies have investigated the re-organization and automation of laboratory medicine as a challenge for the hospital in terms of reduction of costs, turnaround time, workload, optimization of human and technological resources and improvement of safety. The purpose of this study was to conduct a health technology assessment (HTA) evaluation process about the possibility to re-organize and automate laboratory medicine at Bambino Gesù Children's Hospital.MethodsThe decision-oriented HTA (Do-HTA) method, involving the integration of the European Network for HTA (EUnetHTA) CoreModel and the Analytic Hierarchy Process, was applied to assess the best technology solution. Twenty-one professionals were involved to define tender specifications related to the adaptation works of the new dedicated rooms, and the automatic technologies and organizational solutions for the new laboratory department. Finally, two manufacturer companies were consulted.ResultsUsing Do-HTA, the study was focused on laboratory technologies while the infrastructure evaluation was conducted by the Engineering and Logistic Units of the hospital. Results showed that the total performance score of the first proposal was slightly higher (2.5 percent) than the second one, proving the comparable high qualitative level of both manufactures technologies. After an accurate analysis, evaluating all aspects (safety, clinical efficacy, cost, organization & technical criteria) and integrating the infrastructure evaluation, the decision has fallen upon the first company offer.ConclusionsThis HTA project provided an in-depth examination of two proposed technological and organizational solutions. Thanks to the Do-HTA method, which produced and developed data and all needed information, it was possible to guide and assist the decision makers on the choice between the two technical solutions.

scholarly journals Analytic Hierarchy Process (AHP) in Dynamic Configuration as a Tool for Health Technology Assessment (HTA): The Case of Biosensing Optoelectronics in Oncology

2019 ◽  
Vol 18 (05) ◽  
pp. 1533-1550 ◽  
Author(s):  
Giovanni Improta ◽  
Giuseppe Converso ◽  
Teresa Murino ◽  
Mosè Gallo ◽  
Antonietta Perrone ◽  
...  
Keyword(s):  
Analytic Hierarchy Process ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Decision Problem ◽  
Health Technology ◽  
Time Behavior ◽  
Dynamic Configuration ◽  
Analytic Hierarchy ◽  
Dynamic Framework ◽  
Hierarchy Process

The Analytic Hierarchy Process (AHP) is a methodology, based on both mathematical and psychological approaches, exploited to analyze and solve complex problems, in order to make the best decision. AHP is also widely employed for the evaluation of healthcare systems. It works by splitting the decision problem into a hierarchy of more easily-comprehended sub-problems, each of which can be independently analyzed. Starting from these assumptions, our work aims to implement a dynamic framework for the AHP methodology, able to overcome the static nature of the technique, taking into account the evaluations associated with criteria and sub-criteria as a function of time. In the context of this paper, the Dynamic AHP is implemented as a tool for Health Technology Assessment (HTA). Indeed, the proposed case study concerns the evaluation of a new health technology for the thyroglobulin assay in patients with differentiated thyroid cancer. To this aim, we have defined the decision problem and formalized criteria and sub-criteria hierarchically; then, in order to deal with the problem from a dynamical point of view, i.e., to take into account the time dependence of criteria and sub-criteria, we developed several System Dynamics models, one for each criterion. In this context, it is shown that the Dynamic AHP approach provides a dynamic evaluation of the system, which allows to identify the best decision by exploiting the information on the possible evolution of the problem due to its time behavior, rather than taking the decision at a fixed time point, as the Static AHP does.

scholarly journals Study of the use of antidepressants for depression in dementia: the HTA-SADD trial – a multicentre, randomised, double-blind, placebo-controlled trial of the clinical effectiveness and cost-effectiveness of sertraline and mirtazapine

2013 ◽  
Vol 17 (7) ◽  
pp. 1-166 ◽  
Author(s):  
S Banerjee ◽  
J Hellier ◽  
R Romeo ◽  
M Dewey ◽  
M Knapp ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Controlled Trial ◽  
Clinical Effectiveness ◽  
Health Technology ◽  
Double Blind ◽  
Data Set ◽  
Double Blind Placebo ◽  
The Impact

ObjectiveDepression is common in dementia, causing considerable distress and other negative impacts. Treating it is a clinical priority, but the evidence base is sparse and equivocal. This trial aimed to determine clinical effectiveness of sertraline and mirtazapine in reducing depression 13 weeks post randomisation compared with placebo.DesignMulticentre, parallel-group, double-blind placebo-controlled randomised controlled trial of the clinical effectiveness of sertraline and mirtazapine with 13- and 39-week follow-up.SettingNine English old-age psychiatry services.ParticipantsA pragmatic trial.Eligibility: probable or possible Alzheimer's disease (AD), depression (4+ weeks) and Cornell Scale for Depression in Dementia (CSDD) score of 8+.Exclusions: clinically too critical (e.g. suicide risk); contraindication to medication; taking antidepressants; in another trial; and having no carer.Interventions(1) Sertraline; (2) mirtazapine; and (3) placebo, all with normal care. Target doses: 150 mg of sertraline or 45 mg of mirtazapine daily.Main outcome measuresOutcome: CSDD score.Randomisation: Allocated 1 : 1 : 1 through Trials Unit, independently of trial team. Stratified block randomisation by centre, with randomly varying block sizes; computer-generated randomisation.Blinding: Double blind: medication and placebo identical for each antidepressant. Referring clinicians, research workers, participants and pharmacies were blind. Statisticians blind until analyses completed.ResultsNumbers randomised: 326 participants randomised (111 placebo, 107 sertraline and 108 mirtazapine).Outcome: Differences in CSDD at 13 weeks from an adjusted linear-mixed model: mean difference (95% CI) placebo–sertraline 1.17 (−0.23 to 2.78;p = 0.102); placebo–mirtazapine 0.01 (−1.37 to 1.38;p = 0.991); and mirtazapine–sertraline 1.16 (−0.27 to 2.60;p = 0.112).Harms: Placebo group had fewer adverse reactions (29/111, 26%) than sertraline (46/107, 43%) or mirtazapine (44/108, 41%;p = 0.017); 39-week mortality equal, five deaths in each group.ConclusionsThis is a trial with negative findings but important clinical implications. The data suggest that the antidepressants tested, given with normal care, are not clinically effective (compared with placebo) for clinically significant depression in AD. This implies a need to change current practice of antidepressants being the first-line treatment of depression in AD. From the data generated we formulated the following recommendations for future work. (1) The secondary analyses presented here suggest that there would be value in carrying out a placebo-controlled trial of the clinical effectiveness and cost-effectiveness of mirtazapine in the management of Behavioural and Psychological Symptoms of Dementia. (2) A conclusion from this study is that it remains both ethical and essential for trials of new medication for depression in dementia to have a placebo arm. (3) Further research is required to evaluate the impact that treatments for depression in people with dementia can have on their carers not only in terms of any impacts on their quality of life, but also the time they spend care-giving. (4) There is a need for research into alternative biological and psychological therapies for depression in dementia. These could include evaluations of new classes of antidepressants (such as venlafaxine) or antidementia medication (e.g. cholinesterase inhibitors). (5) Research is needed to investigate the natural history of depression in dementia in the community when patients are not referred to secondary care services. (6) Further work is needed to investigate the cost modelling results in this rich data set, investigating carer burden and possible moderators to the treatment effects. (7) There is scope for reanalysis of the primary outcome in terms of carer and participant CSDD results.Trial registrationEudraCT Number – 2006–000105–38.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 17, No. 7. See the HTA programme website for further project information.

scholarly journals Integrating patients' views into health technology assessment: Analytic hierarchy process (AHP) as a method to elicit patient preferences

2011 ◽  
Vol 27 (4) ◽  
pp. 369-375 ◽  
Author(s):  
Marion Danner ◽  
J. Marjan Hummel ◽  
Fabian Volz ◽  
Jeannette G. van Manen ◽  
Beate Wiegard ◽  
...  
Keyword(s):  
Health Care ◽  
Analytic Hierarchy Process ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Antidepressant Treatment ◽  
Pairwise Comparison ◽  
Health Technology ◽  
Preference Elicitation ◽  
Analytic Hierarchy ◽  
Hierarchy Process

Background: Patient involvement is widely acknowledged to be a valuable component in health technology assessment (HTA) and healthcare decision making. However, quantitative approaches to ascertain patients' preferences for treatment endpoints are not yet established. The objective of this study is to introduce the analytic hierarchy process (AHP) as a preference elicitation method in HTA. Based on a systematic literature review on the use of AHP in health care in 2009, the German Institute for Quality and Efficiency in Health Care (IQWiG) initiated an AHP study related to its HTA work in 2010.Methods: The AHP study included two AHP workshops, one with twelve patients and one with seven healthcare professionals. In these workshops, both patients and professionals rated their preferences with respect to the importance of different endpoints of antidepressant treatment by a pairwise comparison of individual endpoints. These comparisons were performed and evaluated by the AHP method and relative weights were generated for each endpoint.Results: The AHP study indicates that AHP is a well-structured technique whose cognitive demands were well handled by patients and professionals. The two groups rated some of the included endpoints of antidepressant treatment differently. For both groups, however, the same six of the eleven endpoints analyzed accounted for more than 80 percent of the total weight.Conclusions: AHP can be used in HTA to give a quantitative dimension to patients' preferences for treatment endpoints. Preference elicitation could provide important information at various stages of HTA and challenge opinions on the importance of endpoints.

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