Evaluation of the Impact of a Technology Appraisal Process in England: The South and West Development and Evaluation Committee

2003 ◽  
Vol 8 (1) ◽  
pp. 18-24 ◽  
Author(s):  
Simon Dixon ◽  
Pat Coleman ◽  
Jon Nicholl ◽  
Alan Brennan ◽  
Sandra Touch
Keyword(s):  
Health Service ◽  
Routine Data ◽  
Clinical Excellence ◽  
Technology Appraisal ◽  
North West ◽  
Evaluation Committee ◽  
Health Authorities ◽  
Service Staff ◽  
The Cost ◽  
The Impact

Objectives: To examine the influence of the English National Health Service (NHS) South and West (S&W) region Development and Evaluation Committee (DEC) technology appraisal reports on purchasing and clinical decisions in the S&W and elsewhere in the NHS, and to estimate the cost of the DEC process. Methods: Two postal questionnaires examining issues of awareness, influence and quality of the DEC reports were sent to samples of clinical and managerial health service staff in S&W NHS region, the North West NHS region, and three other randomly selected health authorities elsewhere. Supplementary telephone interviews were undertaken with a subsample of staff. Trends in utilisation before and after the publication of four S&W DEC reports were examined using routine health service data. Results: Survey response rates ranged between 73% and 85%. Within health authorities in the S&W, agreement about the impact of the DEC in informing policy and purchasing decisions was consistently high, although responses from clinicians were more equivocal. In the topic areas examined, the impact of the DEC reports could not be separated from wider influences on practice. The cost of each DEC report is estimated to have been £24 659. Conclusions: Health service staff perceived that the S&W DEC process had had an impact on policy decisions and clinical practice locally; however, any actual impact on practice could not be identified with routine data. The approach used in this study would be valuable in evaluating the impact of the English NHS National Institute for Clinical Excellence.

scholarly journals Impact of health service provision on mothers and infants in a rural village in North West Frontier Province, Pakistan

1998 ◽  
Vol 1 (1) ◽  
pp. 51-59 ◽  
Author(s):  
Christine A Northrop-Clewes ◽  
Nisar Ahmad ◽  
Parvez I Paracha ◽  
David I Thurnham
Keyword(s):  
Health Service ◽  
Child Mortality ◽  
Demographic Data ◽  
Service Research ◽  
Low Literacy ◽  
Health Service Provision ◽  
North West ◽  
Neonatal Deaths ◽  
North West Frontier Province ◽  
The Impact

AbstractObjective:The objective of this paper is to examine the impact of the Health Service Research Project of the Pakistan Medical Research Council (PMRC) on mothers and infants in Budhni village, North West Frontier Province (NWFP), Pakistan.Methods:Information from the PMRC records on the socioeconomic and demographic situation over the last 10 years and anthropometric measurements made on all infants from 1986–96 were collected and analysed.Results:The demographic data showed a number of changes, namely a reduction in birth rate and improvements in perinatal, neonatal, infant and child mortality rates. Literacy in the village was poor (27 and 39% literate in 1986 and 1996, respectively) and female literacy showed no improvement (14%). Improvements in sanitation and in the water supply introduced by the PMRC had limited success, as clean water was subsequently contaminated by unclean hands and utensils, and 50% of the population continued to use open fields for sanitation. In 1986 only 27% of children 0–5 years were vaccinated, but by 1996, 96% of children had completed polio, diphtheria/pertussis/tetanus (DPT) and bacille Calmette-Guérin (BCG) vaccination programmes and 95% of women of child-bearing age were vaccinated against tetanus. Protection against tetanus reduced neonatal deaths and from 1333 onwards there have been no further cases.Anthropometric data for the period 1986–96 for infants (0–24 months) showed that at birth the majority of infants were close to the 50th National Centre for Health Statistics (NCHS) centile for weight and length, and only 5% of birth-weights were less than 2.5 kg. Growth charts showed faltering in length and weight and by 24-months length in both boys and girls was below the 3rd NCHS centile and weights were just above.Conclusions:Reductions in child mortality have occurred over the period 1986–96. However, the slow progress in adopting hygienic practices, despite health education, and the low literacy rates, particularly in women, may hamper continued improvement.

scholarly journals Febuxostat for the treatment of hyperuricaemia in people with gout: a single technology appraisal

2009 ◽  
Vol 13 (Suppl 3) ◽  
pp. 37-42
Author(s):  
M Stevenson ◽  
A Pandor
Keyword(s):  
Cost Effectiveness ◽  
Severe Disease ◽  
Treatment Algorithm ◽  
Clinical Excellence ◽  
Fixed Dose ◽  
Technology Appraisal ◽  
Tree Model ◽  
Open Label ◽  
Single Technology Appraisal ◽  
The Cost

This paper presents a summary of the evidence review group (ERG) report into the clinical effectiveness and cost-effectiveness of febuxostat for the management of hyperuricaemia in patients with gout based upon a review of the manufacturer’s submission to the National Institute for Health and Clinical Excellence (NICE) as part of the single technology appraisal (STA) process. The submission’s evidence came from two randomised controlled trials comparing the efficacy and safety of febuxostat with allopurinol. The trials were of reasonable methodological quality and measured a clinically relevant range of outcomes. A pooled clinical efficacy analysis showed that a daily dose of 80 mg or 120 mg of febuxostat was significantly more effective than fixed-dose allopurinol (300/100 mg/day) at lowering serum uric acid (sUA) levels to therapeutic targets (< 6 mg/dl); however, a large percentage of febuxostat patients did not achieve the primary end point and the fixed-dose allopurinol regimen may have introduced bias. There were no differences between treatments in more clinically important outcomes such as gout flares and tophi resolution after 52 weeks of treatment. No subgroup analyses were conducted for patients with renal impairment, non-responders to allopurinol or patients with severe disease. Supplementary data from a 2-year open-label extension study were also provided, but were difficult to interpret and poorly reported. The incidence of adverse events was similar between treatments, although more febuxostat recipients discontinued treatment prematurely. A decision tree model was developed to determine the cost-effectiveness of febuxostat. The scope was limited to the comparison of continual febuxostat treatment with continual allopurinol treatment. Switching between treatments or withdrawing treatment in patients whose sUA levels had not decreased was not permitted. The model predicted a cost-effectiveness of £16,324 [95% confidence interval (CI) £6281 to £239,928] per quality-adjusted life-year (QALY) gained for febuxostat compared with allopurinol after 2 years of treatment. The incremental cost per QALY was below £20,000 in 63% of the simulations undertaken. Changes in the time horizon did not materially affect the results. The ERG believes that the modelling structure employed was not appropriate to estimate the cost-effectiveness of febuxostat within a treatment algorithm. In addition, there were concerns about the methodology used for collecting data on key model inputs. Given these reservations the cost-effectiveness of febuxostat could not be determined. The guidance issued by NICE in August 2008 as a result of the STA states that febuxostat is recommended as an option for the management of chronic hyperuricaemia in gout only for people who are intolerant of allopurinol or for whom allopurinol is contraindicated.

scholarly journals Ireland Takes Action on Alcohol and Cancer

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 124s-124s
Author(s):  
A. Lyng ◽  
T. McCarthy ◽  
R. Glynn ◽  
S. Costello ◽  
A. Harte ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Service ◽  
Cancer Control ◽  
Later Life ◽  
Target Audience ◽  
Breast Cancers ◽  
Service Staff ◽  
The Impact ◽  
Alcohol Related Harm ◽  
Related Harm

Background and context: The 2006 EU strategy to reduce alcohol-related harm focuses on protecting young people and children; preventing alcohol-related harm in adults; raising awareness of the impact of harmful alcohol consumption. Ireland is the first EU country to develop alcohol legislation with a focus on cancer control. The Irish Public Health Alcohol Bill (PHAB) aims to reduce alcohol harm. Each year in Ireland > 900 new cancer cases are attributed to alcohol. < 20% of people are aware of the link between alcohol and breast cancer. It was timely the theme for 2017 European Awareness Week on Alcohol Related Harm (20-24th Nov) was “Alcohol and Cancer”. Aim: Capitalising on the theme, Ireland's National Cancer Control Program partnered with the Health Service Alcohol Program for “Action on Alcohol” a national public campaign to - raise awareness of the link between alcohol and cancer - call the public to action, to assess alcohol intake using the drinks calculator on askaboutalcohol.ie - enhance support for the PHAB Strategy/Tactics: Overarching message: “Drinking alcohol increases your risk of developing cancer. Drink less to reduce the risk”. Each day a target audience and message was identified: Monday: Women – 1 in 8 breast cancers are caused by alcohol Tuesday: Youth – drinking less in your teens and 20s can reduce your risk of developing cancer in later life Wednesday: Men – drinking less cancer reduce your risk of developing mouth, head and neck cancer. Thursday: LGBT – drinking less can reduce your risk of developing 7 types of cancer Program/Policy process: Statutory bodies, NGOs and charities were briefed and supplied with partner packs containing key messages, social assets, supporting research and planned campaign activity: - Press release to local and national media and health service staff - Local radio interviews with spokespeople (cancer expert and target audience expert) - National radio advertisement highlighted link between alcohol and breast cancer - Articles in print and online media - Social media campaign. Outcomes: - askaboutalcohol.ie received 35,855 page views (highest in 2 week period) 1,157 direct Web site visits, 427 completed drinks calculator (previous fortnight 409 visits, 58 completed drinks calculator) - > 25k people read “6 alcohol-related health risks everyone in their 20s should know about”, 38% completed drinks calculator - 9 Facebook posts had 109,852 views - National TV program invited spokesperson for interview - National and local newspapers coverage. In the period after campaign the PHAB passed through the next stage of legislation process with an amendment nominated by senators to add cancer warning labels to alcohol products.What was learned: - Clear division of target audiences and themes provided varied content with a consistent message - Partner pack empowered partners to deliver messages - Allow time for structured collaboration and communication with partners in advance.

scholarly journals Clinical trials and drug cost savings for Italian health service

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Francesca D’Ambrosio ◽  
Gianfranco De Feo ◽  
Gerardo Botti ◽  
Arturo Capasso ◽  
Sandro Pignata ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Clinical Practice ◽  
Health Service ◽  
Market Price ◽  
Cost Savings ◽  
Antineoplastic Drugs ◽  
Experimental Drugs ◽  
Cost Of Drugs ◽  
The Cost ◽  
The Impact

Abstract Background The cost of anticancer drugs is constantly growing. The aim of this study was determine the impact in terms of cost reduction for anticancer drug in the Italian Health Service due to patient participation in clinical trials. Methods We evaluated the cost of drugs administered to patients treated in clinical trials at the National Cancer Institute of Naples in a four-week time period. Patients with a diagnosis of different cancers were considered, including adjuvant therapy and treatment for advanced disease, pharma sponsored and investigator initiated phase I, II and III clinical studies. We defined the expected standard treatment for each patient and we calculated the cost of the standard antineoplastic drugs that should be administered in clinical practice outside clinical trials. We used the market price of drugs to determine the cost savings value. Costs other than drugs were not included in the cost saving calculation. Results From 23.10.2017 to 17.11.2017, 126 patients were treated in 34 pharma sponsored and investigator initiated clinical trials, using experimental drugs provided free of charge by the sponsors, for an overall number of 152 cycles of therapy. If these patients were treated with conventional therapies in clinical practice the cost of antineoplastic drugs would account for 517,658 Euros, with an average of 5487 Euros saved per patients for a period of 4 weeks. Conclusions Clinical trials with investigational antineoplastic drugs provided free of charge by Sponsors render considerable cost savings, with a tangible benefit in clinical and administrative strategies to reduce drug expenditures.

The cost-effectiveness of patient-applied treatments for anogenital warts

2003 ◽  
Vol 14 (4) ◽  
pp. 228-234 ◽  
Author(s):  
Paul Williams ◽  
Geo von Krogh
Keyword(s):  
Cost Effectiveness ◽  
Health Service ◽  
Drug Acquisition ◽  
Sensitivity Analyses ◽  
Controlled Trials ◽  
Anogenital Warts ◽  
Health Service Provider ◽  
Wide Range ◽  
The Cost ◽  
The Impact

A model was developed to estimate the cost-effectiveness of podophyllotoxin and imiquimod for self-treatment of anogenital warts. The effectiveness endpoint was sustained clearance after treatment and a subsequent follow-up period of approximately 12 weeks. Effectiveness of podophyllotoxin was estimated from a quantitative summary of nine placebo-controlled trials, while effectiveness of imiquimod was based on a quantitative summary of six placebo-controlled trials. Costs were considered from a UK health service provider perspective; drug acquisition costs were obtained from the British National Formulary and health service costs of clinic attendance were based on a recent survey of GUM clinics. The impact of uncertainty was explored in a wide range of one-way and probabilistic (multi-way) sensitivity analyses. The cost per sustained clearance was 313 for podophyllotoxin and 606 for imiquimod. The modest and statistically insignificant incremental effectiveness of imiquimod was purchased at high cost—2476 per additional sustained clearance. Sensitivity analyses showed the economic superiority of podophyllotoxin to be robust and statistically very significant.

scholarly journals Assessing the impact of England's National Health Service R&D Health Technology Assessment program using the “payback” approach

2009 ◽  
Vol 25 (01) ◽  
pp. 1-5 ◽  
Author(s):  
James Raftery ◽  
Stephen Hanney ◽  
Colin Green ◽  
Martin Buxton
Keyword(s):  
National Health Service ◽  
Health Service ◽  
Health Technology Assessment ◽  
Case Studies ◽  
National Health ◽  
Technology Assessment ◽  
Clinical Excellence ◽  
Health Technology ◽  
The Mean ◽  
The Impact

Objectives:This study assesses the impact of the English National Health Service (NHS) Health Technology Assessment (HTA) program using the “payback” framework.Methods:A survey of lead investigators of all research projects funded by the HTA program 1993–2003 supplemented by more detailed case studies of sixteen projects.Results:Of 204 eligible projects, replies were received from 133 or 65 percent. The mean number of peer-reviewed publications per project was 2.9. Seventy-three percent of projects claimed to have had had an impact on policy and 42 percent on behavior. Technology Assessment Reports for the National Institute for Health and Clinical Excellence (NICE) had fewer than average publications but greater impact on policy. Half of all projects went on to secure further funding. The case studies confirmed the survey findings and indicated factors associated with impact.Conclusions:The HTA program performed relatively well in terms of “payback.” Facilitating factors included the program's emphasis on topics that matter to the NHS, rigorous methods and the existence of “policy customers” such as NICE.

scholarly journals Impact of workplace discrimination and harassment among National Health Service staff working in London trusts: results from the TIDES study

BJPsych Open ◽  
2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Rebecca D. Rhead ◽  
Zoe Chui ◽  
Ioannis Bakolis ◽  
Billy Gazard ◽  
Hannah Harwood ◽  
...  
Keyword(s):  
Job Satisfaction ◽  
National Health Service ◽  
Health Service ◽  
Sickness Absence ◽  
National Health ◽  
Turnover Rates ◽  
Physical And Mental Health ◽  
Cross Sectional Survey ◽  
Service Staff ◽  
The Impact

Background Harassment and discrimination in the National Health Service (NHS) has steadily increased over the past 5 years with London being the worst performing region. There is a lack of data and research on the impact this is having on staff health and job satisfaction. Such data are necessary to inform the development of effective workplace interventions to mitigate the effects these experiences have on staff. Aims Examine the impact of harassment and discrimination on NHS staff working in London trusts, utilising data from the 2019 TIDES cross-sectional survey. Method In total, 931 London-based healthcare practitioners participated in the TIDES survey. Regression analysis was used to examine associations between the sociodemographic characteristics of participants, exposure to discrimination and harassment, and how such exposures are associated with physical and mental health, job satisfaction and sickness absence. Results Women, Black ethnic minority staff, migrants, nurses and healthcare assistants were most at risk of discrimination and/or harassment. Experiencing either of the main exposures was associated with probable anxiety or depression. Experiencing harassment was also associated with moderate-to-severe somatic symptoms. Finally, both witnessing and experiencing the main exposures were associated with low job satisfaction and long periods of sickness absence. Conclusions NHS staff, particularly those working in London trusts, are exposed to unprecedented levels of discrimination and harassment from their colleagues. Within the context of an already stretched and under-resourced NHS, in order to combat poor job satisfaction and high turnover rates, the value of all healthcare practitioners must be visibly and continuously reinforced by all management and senior leaders.

scholarly journals Impact of Cultural Practices During Labor and Delivery on Maternal and Child Health Service Utilization and Associated Factors in Awi, East and West Gojjam Zones, Amhara Region, North West Ethiopia: Community Based Cross Sectional Study

2021 ◽  
Author(s):  
MFM Misganaw Fikrie Melesse ◽  
YBB Yibelu Bazezew Bitew ◽  
KND Kumneger Nigussie Dessie ◽  
DBW Demeke Binalf Wondim ◽  
TMB Tefera Marie Bereka
Keyword(s):  
Health Service ◽  
Service Utilization ◽  
Health Service Utilization ◽  
Cultural Practices ◽  
Cross Sectional Study ◽  
Child Health Service ◽  
Labor And Delivery ◽  
Cross Sectional ◽  
North West ◽  
The Impact

Abstract Background: Cultural practices are traditional and customary practices of a particular ethnic or any other social group. The time of labor and delivery is a period at which such practices and beliefs present in every society in the world with a varied degree in type, depth, and dependency. Thus, this research was aimed to assess the impact of cultural practices during labor and delivery on maternal and child health service utilization and associated factors in Awi, West, and East Gojjam Zones North West Ethiopia.Method: Community based cross-sectional study was conducted on women of the reproductive age group who have at least one pregnancy history in Awi, West, and East Gojjam Zones from January 1 to May 30, 2020. The multistage cluster sampling technique was used to select 845 study participants. Data was collected through a pre-tested and structured interview questionnaire, entered and cleaned using EPI info version 7.2, and exported to SPSS version 23 for analysis. Bivariable and multivariable logistic regression was employed to assess the association of the variables and a P-value less than 0.05 was declared as statistically significant.Result: The study revealed that the magnitude of home delivery due to the impact of cultural practices was 31.2% with 95% CI: 28.3 to 34.4. Educational status (AOR=5.2, 95% CI: 1.8, 14.7), parity (AOR=2.7, 95% CI: 1.3, 5.4), cultural practice experienced during labor and delivery (AOR=2.1, 95% CI: 1.3, 3.4), history of abortion (AOR=2.0, 95% CI: 1.2, 3.1) and antenatal care follow up (AOR=33.8, 95% CI: 20.5, 55.7) had statistically significant association with impact of cultural practices on health service utilization during labor and delivery. Conclusion: This study showed that the impact of cultural practices on health service utilization during childbirth was high in Awi, West, and East Gojjam Zones. Working on antenatal care follow up and women education in a culturally acceptable manner may reduce the impact of cultural practices on health service utilization during labor and delivery

scholarly journals Exploration of the difference in results of economic submissions to the National Institute of Clinical Excellence by manufacturers and assessment groups

2007 ◽  
Vol 23 (1) ◽  
pp. 96-100 ◽  
Author(s):  
Deven Chauhan ◽  
Alec H. Miners ◽  
Alastair J. Fischer
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Clinical Excellence ◽  
Economic Evaluations ◽  
Technology Appraisal ◽  
Single Technology Appraisal ◽  
Cost Estimates ◽  
The Difference ◽  
The Cost

Objectives:A recent study showed that estimates of cost-effectiveness submitted to National Institute for Health and Clinical Excellence (NICE) by manufacturers had significantly lower incremental cost-effectiveness ratios (ICERs) than those submitted by university-based Assessment Groups. This study extends that analysis.Methods:Data were abstracted from relevant NICE documentation for thirty-two of eighty-two possible appraisals.Results:The results from the analysis showed that sources of the difference in ICERs appear to be the effectiveness estimates relating to the comparator technology and the cost estimates relating to the technology under evaluation. That is, manufacturers estimated lower average benefits for the comparator technology and lower costs relating to the technology under evaluation compared with estimates submitted by the Assessment Groups.Conclusions:These findings may be particularly important, given the introduction of the “Single Technology Appraisal.” Considerable difficulties were encountered when undertaking this study, highlighting, above all else, the complexity of explaining why results from economic evaluations purporting to answer the same question diverge.

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