Non-drug Technologies Research Articles

PP135 Setting The Scope For Assessing e-Health Technologies In Hungary

IntroductionE-health and m-health are emerging health technology fields that could possibly give a new scope to health technology assessment (HTA). The Division for Health Technology Assessment (DfHTA) is currently assessing medicines and non-drug technologies (medical devices intended for patient use or for use in hospitals). The experience assessing medical devices for use in hospitals yielded difficulties which could also arise from the critical appraisal of e-health or m-health technologies. The objective of this study was to explore the foundations for HTA guidance on e-health or m-health technologies.MethodsA targeted literature review was conducted to map the current status of technology assessment practices for e-health and m-health technologies and to assess its concordance with current reimbursement processes in countries belonging to the Organisation for Economic Co-operation and Development. Experiences from past evaluations of other medical devices that could not be evaluated under the current guidance guided the literature search. The findings of this research were used to create a recommendation to amend the current Hungarian Guideline for Health Economic Analyses.ResultsThe resulting articles of the targeted literature review provided an insight into current practices on of assessing e-health and m-health products, particularly with respect to the domains of safety, quality, and impact. Recommendations suggested including a list of requirements for companies to submit for critical evaluations of e-health and m-health technologies, in support of a self-assessment approach.ConclusionsAs for other HTA bodies, there is an urgent need for the DfHTA to increase its capacity to assess digital health technologies for entry into the healthcare system, with a focus on the relevant clinical domains. The reimbursement process for these technologies remains a challenge for public funding bodies.

The main clinical symptoms in patients with posterior vaginal wall prolapse and modern non-drug technologies for its relief

Background. Rectocele is one of the leading causes of abnormal position and dysfunction of the pelvic floor and rectum.
 Objective: to develop and scientifically substantiate the use of a rehabilitation complex, including general magnetotherapy, electromyostimulation with biofeedback in combination with fractional microablative CO2 laser therapy in patients of different age groups with rectocele after surgery.
 Methods. The article presents the results of treatment of 100 women with rectocele, who were divided into main and control groups, within each group, depending on their age, they were divided into 2 subgroups: women of childbearing age were included in subgroup A, and women of peri- and menopausal age were included in subgroup B. Patients of the main group in the early postoperative period after plastic surgery for rectocele (from 1 day) were given a course of General magnetotherapy and in the late postoperative period (one month after the operation) a set of measures was performed, consisting of a course of electromyostimulation with biological connection of the pelvic floor muscles 2 intravaginal procedures of fractional microablative CO2 laser therapy at intervals of 45 weeks. Patients of the control group after surgical treatment of rectocele in the late postoperative period received symptomatic therapy, including painkillers and spasmolytics and a set of Kegel exercises.
 Results. Significant improvements in postoperative treatment were observed in patients of the main group: pelvic pain and periodic pain in the lower abdomen and lower back disappeared in 100% of cases; the main complaints related to violation of rectal emptying and urination were preserved in no more than 57% of cases, sexual complaints in 5%; in 95% of cases, general, vegetative and pre-climacteric complaints disappeared.
 Conclusion. As a result of the conducted research, it is shown that under the influence of the developed rehabilitation complex, regardless of age, there was a highly reliable dynamics of all complaints due to the influence of physical factors included in it on various pathogenetic links in the development of the disease.

Prevention of meteopathy in patients with arterial hypertension: a pilot comparative randomized study

The influence of change in the weather on the risk of developing meteopathic response in patients with arterial hypertension have been extensively studied in recent times. The potency of non-drug technologies in prevention and correction of meteopathy is also actively exploring. The open randomized, prospective and comparative study aimed to estimate the efficiency of carbon dioxide gas-air baths for the prevention of meteopathy in patients with arterial hypertension.

THE APPLICATION OF THE NON-DRUG TECHNOLOGIES FOR THE MEDICAL REHABILITATION OF THE PATIENTS PRESENTING WITH CHRONIC GENERALIZED PERIODONTITIS

The article is devoted to the problem of medical rehabilitation of the patients presenting with periodontal pathologies with the use of drug-free technologies. The results of the comprehensive examination, diagnostics, and treatment of 69 patients with mild chronic generalized periodontitis and 115 patients suffering from chronic generalized periodontitis of moderate severity are presented. The methods for the combined treatment of the patients with mild and moderately severe chronic generalized periodontitis were developed based on the application of the non-drug technologies. The effectiveness of the complex treatment was evaluated. The study has demonstrated positive dynamics of the patients’ conditions manifested as the decrease of the index of hygiene by 43.0 ± 0.3%, the index of bleeding by 52.0 ± 0.06%, and the gingival index by 49.00± 0.08%. The effectiveness of the treatment increased in the patients who received the basal treatment supplemented by a complex of natural components.

PRM40 - Evidence Gaps In Economic Evaluations For Non-Drug Technologies: A Canadian Cost Perspective

PRM40 - Evidence Gaps In Economic Evaluations For Non-Drug Technologies: A Canadian Cost Perspective

Integrated neurorehabilitation with paraproteinassociated peripheral neuropathy

Nowadays, treatment of paraproteinemic polyneuropathy is a fairly complex interdisciplinary process. The main method of therapy is still the use of chemotherapeutic drugs as means of pathogenetic treatment of the underlying disease. However, the use of chemotherapy with neurotoxicity can cause development of toxic polyneuropathy which increases neurological deficit. Any comprehensive neurorehabilitation program for patients with these forms of polyneuropathies have not been developed to date. The article presents data of clinical observations of 26 patients with paraproteinemic polyneuropathy which had undergone a course of neurorehabilitation treatment, both medical and nondrug technologies, including the methods of kinesiotherapy and physiotherapy.

FREQUENTLY ILL CHILDREN. PHYSIOTHERAPIST'S VIEW

The prevention of frequent respiratory infections in children is one of the urgent issues of modern pediatrics. At present the range of non-drug technologies of prevention of acute respiratory infections (ARI) in children has considerably increased due to the appearance of new effective methods of physical rehabilitation. The article gives a literary review of the main methods of drug prevention of frequent ARI in childhood applied in practical healthcare on the modern stage.

Current status of health technology reassessment of non-drug technologies: survey and key informant interviews

BackgroundHealth Technology Reassessment (HTR) is a structured, evidence-based assessment of the clinical, social, ethical and economic effects of a technology currently used in the health care system, to inform optimal use of that technology in comparison to its alternatives. Little is known about current international HTR practices. The objective of this research was to summarize experience-based information gathered from international experts on the development, initiation and implementation of a HTR program.MethodsA mixed methods approach, using a survey and in-depth interviews, was adopted. The survey covered 8 concepts: prioritization/identification of potentially obsolete technologies; program development; implementation; mitigation; program championing; stakeholder engagement; monitoring; and reinvestment. Members of Health Technology Assessment International (HTAi) and the International Network of Agencies for Health Technology Assessment (INAHTA) formed the sampling frame. Participation was solicited via email and the survey was administered online using SurveyMonkey. Survey results were analyzed using descriptive statistics. To gather more in-depth knowledge, semi-structured interviews were conducted among organizations with active HTR programs. Interview questions were developed using the same 8 concepts. The hour-long interviews were recorded, transcribed and analyzed using constant comparative analysis.ResultsNinety-five individuals responded to the survey: 49 were not discussing HTR, 21 were beginning to discuss HTR, nine were imminently developing a program, and 16 participants had programs and were completing reassessments. The survey results revealed that methods vary widely and that although HTR is a powerful tool, it is currently not being used to its full potential. Of the 16 with active programs, nine agreed to participate in follow-up interviews. Interview participants identified early and extensive stakeholder engagement as the most important factors for success. A lack of top-down support and financial and human resources are inhibiting program development.DiscussionHTR is in its infancy. Although HTRs are being conducted, there are no standardized approaches. However, much can be learned from current international work. Future work should focus on developing a comprehensive methodology, reporting the processes of reassessments and sharing successes and challenges in a common platform.

Coverage with evidence development: The Ontario experience

For non-drug technologies, there is often residual uncertainty following systematic review, mainly due to inadequate evidence of efficacy. The unwillingness to make decisions in the presence of uncertainty may lead to passive diffusion and intuitive decision making with or without public pressure. This may affect health system sustainability. There is increasing interest in post-market evaluation through processes that include coverage with evidence development (CED) to address residual uncertainty regarding effectiveness and cost-effectiveness. Global experience of CED has been slow to develop despite their potential contribution to decision making. Ontario's field evaluation program to better inform decision making represents a collaboration between physicians, policy decision makers and academic centers. We report results of the first ten CEDs from this program to assess whether they achieved their objective of influencing policy by addressing residual uncertainty following systematic review. Since 2003, nineteen field evaluation studies to resolve residual uncertainty following systematic review have been completed, ten of which met the criteria of CED and are the focus of this report. There was more than one patient subgroup or intervention in three of the CEDs. This provided the basis for evaluating thirteen outcomes. In each case, the CED addressed the uncertainty and led to a decision based on the systematic review and CED result. The CEDs led to adoption of the technology in six instances, modified adoption in three instances and withdrawal in four instances. CED makes an important contribution to translating evidence to decision making. Methodologies are needed to increase the scope and reduce timelines for CEDs, such as the use of linked comprehensive and robust data sets and collaborative studies with other jurisdictions. CED before making long-term funding decisions, especially where there is uncertainty of effectiveness, safety or cost-effectiveness, should be increasingly funded by health systems.

From idealistic rookies to a regional leader: The history of health technology assessment in Poland

In 1989, Poland started to slowly release itself not only from the burden of a half-century of communist indoctrination and soviet exploitation, but also from the consequences of the Semashko model of healthcare organization: low doctors' salaries, primary care based on multispecialty groups, overdeveloped hospital infrastructure, and limited access to sophisticated interventions overcome by patients' unofficial payments. A few years after the 1998 workshop on health technology assessment (HTA) in Budapest, the first HTA reports were elaborated in the National Center for Quality Assessment in Health Care, which could mark the beginning of HTA in Poland. Several individuals and organizations have been involved in developing HTA, both from noncommercial and commercial standpoints. A goal to establish a national HTA agency appeared among the priorities of the Polish Ministry of Health in 2004 and was realized a year later. The Agency for HTA in Poland published guidelines on HTA and established a sound and transparent two-step (assessment-appraisal) process for preparing recommendations on public financing of both drugs and nondrug technologies. The recommendations of the Agency's Consultative Council were warmly welcomed by the public payer. However, the recent major restructuring of the Agency and new drug reimbursement decisions aroused doubts as to keeping transparency of the decision-making processes.

Health technology assessment in Canada

Canada's health system is a unique combination of public financing and private provision. With the significant government role in financing health services, health technology assessment (HTA) has found a ready audience as a form of policy research. In addition, Canada has been a leader in HTA and is entering a phase of deepening and maturation of HTA activities. The relative absence of dramatic change in the overall health system, coupled with public faith in the Canadian approach has been favorable to HTA's development in Canada. Emerging issues, beyond the demographic and economic pressures facing all Organisation for Economic Co-operation and Development health systems, include the convergence of assessment modalities and organizations for drug and nondrug technologies, increasing public concerns about the viability of Canada's approach to healthcare services, and the transition of HTA from an activity targeting macro-level policy makers to a management tool for healthcare facilities and providers.