A new health technology: where is the consensus on a clinically worthwhile benefit?
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AIM: New therapies are often introduced into the NHS prior to full evaluation, leading to inequities in provision. Uncertainty exists regarding the value of photodynamic therapy in the treatment of neovascular age-related macular degeneration. We ascertained the availability of this treatment and the information used to inform clinical policy. METHODS: A postal survey of all clinical directors/lead consultants in the UK sought data on which (if any) patients were referred or treated with PDT by their unit, the sources of evidence informing clinical policy and the threshold of clinical benefit at which respondents would support the use of PDT. RESULTS: 123/152 questionnaires were returned. 42% of units make some provision for PDT on the NHS, including routine provision by 9%. 14.5% of units offer the option of care in the private sector, whilst 26.5% treated or referred no patients. The threshold at which respondents considered introduction of PDT would be justifiable varied widely. Respondents cited local literature review, advice from clinicians, guidance from the Royal College and information from the pharmaceutical industry as most influential in determining current policy. However, the National Institute for Clinical Excellence (NICE) and the Cochrane Library were anticipated as playing a greater role in shaping future practice. CONCLUSIONS: Substantial variation exists in the availability of PDT. Advocates of PDT may interpret our data as an indication of the NHS failing to provide an effective therapy equitably, whilst others may deduce that patients are receiving an under-evaluated treatment in routine clinical practice. The differing thresholds at which clinicians believe treatment would be justified may further exacerbate variations and the priority given to PDT. (+info)
Priority setting for new technologies in medicine: a transdisciplinary study.
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BACKGROUND: Decision makers in health care organizations struggle with how to set priorities for new technologies in medicine. Traditional approaches to priority setting for new technologies in medicine are insufficient and there is no widely accepted model that can guide decision makers. DISCUSSION: Daniels and Sabin have developed an ethically based account about how priority setting decisions should be made. We have developed an empirically based account of how priority setting decisions are made. In this paper, we integrate these two accounts into a transdisciplinary model of priority setting for new technologies in medicine that is both ethically and empirically based. SUMMARY: We have developed a transdisciplinary model of priority setting that provides guidance to decision makers that they can operationalize to help address priority setting problems in their institution. (+info)
A prospective, randomized, pragmatic, health outcomes trial evaluating the incorporation of hylan G-F 20 into the treatment paradigm for patients with knee osteoarthritis (Part 2 of 2): economic results.
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OBJECTIVE: Viscosupplementation with hylan G-F 20 has recently become registered for treatment of patients with osteoarthritis (OA) of the knee in most parts of the world. The cost effectiveness and cost utility of this new therapeutic modality were determined as part of a Canadian prospective, randomized, 1-year, open-label, multicentered trial. DESIGN: A total of 255 patients were randomized to 'Appropriate care with hylan G-F 20' (AC+H) or 'Appropriate care without hylan G-F 20' (AC). Costs (1999 Canadian dollars) were collected from the societal viewpoint and included all costs related to OA of the knee and OA in all joints. Patients completed a number of outcomes questionnaires including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Health Utilities Index Mark 3 (HUI3). Data were collected at clinic visits (baseline, 12 months) and by telephone (1, 2, 4, 6, 8, 10, and 12 months). RESULTS: The AC+H group over the year had higher costs ($2125-$1415=$710, P< 0.05), more patients improved (69%-40%=29%,P =0.0001), greater increases in HUI3 (0.13-0.03=0.10, P< 0.0001) and increased quality-adjusted life years (QALYs) (0.071, P< 0.05). The incremental cost-effectiveness ratio was $2505/patient improved. The incremental cost-utility ratio was $10000/QALY gained. Sensitivity analyses and a second cost perspective gave similar results. CONCLUSION: The cost-utility ratio is below the suggested Canadian adoption threshold. The results provide strong evidence for adoption of treatment with hylan G-F 20 in the patients and settings studied in the trial. (+info)
Effect of breast magnetic resonance imaging on the clinical management of women with early-stage breast carcinoma.
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PURPOSE: To determine the impact of breast magnetic resonance imaging (MRI) on the clinical management of patients with early-stage breast cancer. PATIENTS AND METHODS: A review was performed of the records of 207 women with early-stage breast cancer (including five women with bilateral disease) who underwent breast MRI during work-up for breast conservation treatment. All patients presented with clinical stage 0, I, or II disease. For each patient, a determination was made whether the breast MRI affected the clinical management, and if so, whether the patient was well served by the change in management. RESULTS: The MRI findings affected the clinical management in 43 cases (20% of 212 breast cancers). Based on the pathology findings and the overall clinical course for each case, the breast MRI was judged to have had a strongly favorable effect on management in 18 cases (8%), a somewhat favorable effect in six cases (3%), an uncertain effect in five cases (2%), a somewhat unfavorable effect in 11 cases (5%), and a strongly unfavorable effect in three cases (1%). The effect of MRI was not significantly different for invasive carcinoma compared with ductal carcinoma-in-situ (all P > or =.27). However, the effect of MRI was significantly greater when the MRI was performed before an excisional biopsy (P =.0011) or for larger tumors (P =.0089). CONCLUSIONS: Breast MRI alters the clinical management for a sizable fraction of women with early-stage breast cancer and appears to offer clinically useful information for determining optimal local treatment. (+info)
Health technology: challenge to public health.
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Health technology includes drugs, procedures, techniques, and equipment used by health professionals to provide health care, and the organizational and supporting systems within which the care is delivered. Such new technology may comprehend new drugs, new medical devices and appliances, new medical activities and surgical procedures, health promotion and disease prevention activities, and organizational and supporting systems. To achieve maximal use of available resources and constant selection among alternatives offered, health technology assessment is indispensable as a scientific effort to determine the extent to which and under what conditions a specific technology is efficacious, effective, safe, and cost-effective. Since today the greatest benefit to patients must be achieved at the lowest cost, one of the ways to achieve this goal is to promote health technology assessment and thus build the healthcare infrastructure on more scientific and objective foundations. (+info)
A nice try that fails: the Swedish Council on Technology Assessment in Health Care (SBU) evaluation of the effect of treatment of alcohol and drug problems: the epidemiologist's view.
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BACKGROUND AND AIMS: The Swedish Council on Technology Assessment in Health Care (SBU) has recently published a large, >800-page systematic review. It reviews brief interventions to reduce alcohol intake, long-term prognosis of substance dependence, obstetric questions and economic aspects of addiction treatments. The main part aims to evaluate treatments on alcohol and other addictive substances by meta-analytical techniques. RESULTS AND CONCLUSIONS: The report summarizes 641 individual studies. Unfortunately, several methods are weak, some inadequately documented, and many conclusions rest on shaky grounds. (+info)
The Swedish State Health Technology Board (SBU) report on treatment of alcohol and drug misuse: an economist's view.
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The Swedish State Health Technology Board (SBU) has published a Report on the treatment of alcohol and drug misuse (SBU, 2001). This article is a brief Commentary on the economic issues raised in Chapter 9 of the Report, in particular, the question of 'how cost-effective are the different treatment alternatives?' An outline is given of how the authors approached the economic work, with particular reference to a standard checklist approach to judging the quality of published economic appraisals. A paucity of such appraisals was retrieved and detailed review of just 16 papers was undertaken. The authors are critical of the lack of quality of economic work in the substance misuse area and their main points are summarized here. The main conclusion drawn is that no economic judgements can be made about alternative treatment approaches, and more study and research are needed in this area. Chapter 9 is, on balance, a good attempt at a critical review of the economic appraisal literature. Unfortunately the main Report provides a series of summary judgements on the effectiveness or otherwise of alternative treatments, which, while recognizing the need for further cost-effectiveness work, essentially ignores the conclusion drawn in the economics chapter. This is likely to do a disservice to the cause of appropriate resource allocation in the substance misuse area. (+info)
A rapid usability assessment methodology to support the choice of clinical information systems: a case study.
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We present here an adapted methodology integrating usability engineering and early evaluation procedures to support the choice of a Clinical Information System in the context of a standard Call for Tender. We illustrate the application of this methodology with a case study. We integrated a standard 'contextual task and activity analysis' into the choice process and then drew up usability recommendations for the choice of an application. We organized a one-week on-site exhibition and test for each candidate company. During the test sessions, we performed a rapid usability assessment. The final choice of the application is strongly and positively influenced by the results of the usability assessment. (+info)