24-27 April 2019, Seoul, Korea
AnnualConference
8th HTAsiaLink The
C o n t e n t s
Annual Conference24-27 April 2019, Seoul, Korea
About HTAsiaLink & 8th HTAsiaLink Annual Conference ................. 03
Welcome Messages .................................................................................... 05
Floor Plan ...................................................................................................... 07
Program
■ Pre-Conference Workshops : Wednesday 24 April 2019 .............. 08
■ Main Conference
DAY 1. Wednesday 24 April 2019 ............................................................... 09
DAY 2. Thursday 25 April 2019 ................................................................... 10
DAY 3. Friday 26 April 2019 ........................................................................ 13
DAY 4. Saturday 27 April 2019 .................................................................... 15
HTAsiaLink Members ................................................................................. 16
Organizing Committee ............................................................................... 19
Moderators/Speakers ................................................................................. 22
Abstracts
■ DAY 2. Thursday 25 April 2019
Oral Session ................................................................................................ 38
Moderator & Commentator ........................................................................... 89
Poster Session ............................................................................................ 91
Reviewer ................................................................................................... 109
■ DAY 3. Friday 26 April 2019
Oral Session ............................................................................................... 110
Moderator & Commentator ........................................................................ 136
Poster Session .......................................................................................... 138
Reviewer ................................................................................................... 150
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About HTAsiaLinkHTAsiaLink is a collaborative research network of Health Technology
Assessment (HTA) agencies in the Asia-Pacific region established on
September 2010. The network started with an aim to strengthen Health
Technology Assessment (HTA) research eff iciency by sharing HTA
information, experiences, and resources within the members. HTAsiaLink
also focuses on promoting HTA utilization, developing an eff icient
methodology for HTA, and encouraging HTA evidences implementation
for Universal Health Coverage. HTAsiaLink Annual Conference is the
representative academic event that facilitates the exchange of HTA
knowledge and experience among member agencies and identifies the
development plan for the network next year. Hosted by the member
agency annually designated by the HTAsiaLink Board, the conference
also functions as the capacity building platform that junior researchers
from the member agencies present their study and obtain productive
comments from international experts and peers. Around 34 agencies
from 17 different countries voluntarily join the network with the common
objective of HTA competency improvement. For more information about
HTAsiaLink, please visit http://www.htasialink.org.
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The 8th HTAsiaLink Annual Conference
It is a great pleasure for NECA to host HTAsiaLink Annual Conference at a time when HTA is gaining greater importance and global reputation. Under the theme Priority Setting for Universal Health Coverage, the 8th HTAsiaLink Annual Conference is held in Seoul 24-27 April, 2019 inviting distinguished speakers from the notable HTA agencies with about 250 participants from all around the world. The conference provides plenary sessions that discuss one, HTA in World, two, How to make a good decision in healthcare? three, How to collaborate better within the HTAsiasLink. These topics represent our efforts to find common ground to build capacity for developing HTA in a cohesive manner. This annual conference aims to outline the global HTA landscape and share the experiences of success and trial-and-errors while conducting HTA in each country’s own settings in order to discuss the imperatives to achieve UHC as an ultimate goal. About 80 abstracts in the field of economic evaluations, health system research and others will be orally presented, and this year there will be poster exhibition as well from many researchers of HTAsiaLink member agencies. Last but not least we would like to express our deep gratitude to the Korean Ministry of Health and Welfare, WHO, International Decision Support Initiative (iDSI), HITAP as the secretariat, HTAsiaLink Board and to the participants for their warm encouragement and support.
History of HTAsiaLink
Throughout the Asia, HTA agencies are relatively new. In 2006, the Health Intervention and Technology Assessment Program (HITAP) was established in Thailand. Consecutively in 2008, HTA division is established in Taiwan Center for Drug Evaluation (CDE) and the National Evidence-based healthcare Collaborating Agency (NECA) was founded in Korea. Soon after the establishment of HTA in CDE, HITAP and CDE started collaborations.In June, 2010, HITAP and NECA delegations met at the Health Technology Assessment International (HTAi) annual conference in Dublin, Ireland and agreed on the need of a collaborative networking among the regional health technology assessment (HTA) agencies and collaborative research.Finally, a consensus among three organizations (CDE, HITAP, and NECA) and individual researchers from Malaysia and Japan on potential collaboration among HTA agencies meeting in Thailand, 4th September, 2010, initially reached an agreement to distribute an HTA newsletter among agencies in the region. In January, 2011, during the international symposium and workshop for the Asian value for a QALY, hosted by NECA in Seoul, the agreement was reached on establishing the HTAsiaLink and undertaking collaborative researches thereafter. The founding organizational members are CDE, HITAP, and NECA.The first issue of HTAsiaLink Newsletter was distributed in June, 2011 and HITAP kindly volunteered to run the editorial office. The newsletter is currently distributed three times a year. In 2012, NECA is volunteered to create HTAsiaLink website and maintain the contents.
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Welcome Messages
Welcome to the 8th HTAsiaLink Annual Conference!
As the President of HTAsiaLink, it is a great pleasure for me to declare open the 8th HTAsiaLink Annual
Conference and I have the honor to host this meaningful event here in Seoul.
The theme of this 8th HTAsiaLink Annual Conference is Priority Setting for Universal Health Coverage. For
many years since we established HTAsiaLink, we have witnessed the crucial role that HTA plays in rational
healthcare decision makings. Recently, there has been a keen interest in numerous countries to engage
patient and public in the process of HTA. It signifies the trend that together with generating scientific
evidence for the safety and effectiveness of medical technologies, the value in social and ethical dimension
such as patient preference is gradually incorporated into the realm of HTA.
As the scope of healthcare has been expanded from biomedical interventions to other areas such as
behavior and social and environmental influences, we need to approach HTA in a broader context. Therefore,
the theme of this year’s conference on priority setting is a timely one.
The opportunities to understand the current status of HTA around the world and share the examples of
good healthcare decision making in a range of country settings will give us an insight to where we are now
and to where we should get going. Also, the chance to share successful experiences and challenges from
the countries whose HTA system is relatively new we could build consensus on how and what to prioritize in
the Asian-Pacific region to achieve UHC through HTA.
Not only that, I expect around eighty oral presentations and the poster exhibition from many researchers of
HTAsiaLink member agencies become the fruitful ground to envision the future of HTA together as well as
to enhance friendship for further collaboration.
Before coming to a close of these remarks, I would like to remind you a simple English saying: “Coming
together is a beginning, staying together is progress, and working together is success.” Since now we
already have the beginning, I sincerely hope this meaningful opportunity of debate and networking become
the cornerstone for enlightening progress and fruitful success in developing HTA.
Sincerely Yours,
Young Sung Lee, MD, Ph.D
President of HTAsiaLink
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I am Budi Hidayat, a member of Indonesian Health Technology Assessment Committee and Head of Center
for Health Economics and Policy Studies (CHEPS) University of Indonesia. I cordially welcome you all to the
8th HTAsiaLink at Seoul, South Korea and actively participate in several particular discussion including how
is the lesson learn of HTA implementation around the world; how to make a good decision in healthcare;
etc.
As the common understanding, HTA brings an important role to ensure the sustainability of Universal
Health Coverage (UHC) implementation given the limited financial resources. Moreover, this UHC policy
also comes with many challenges including how to define the ideal benefit packages mandated in the
UHC; quality of care; fairness for both health workers and community, etc. From those challenges, the
government requires a robust process and evidence to ensure the benefits package decisions under the
UHC are systematic, transparent, effective, and acceptable to all stakeholders. An amount of evidences
should represent both supply and demand side point of view which could offer a comprehensive
recommendation. In order to respond those particular conditions and challenges, the 8th HTAsiaLink
Annual Conference provides an opportunity to share, clarify, and debate the roles of HTA in the decision-
making process. In particular, we are keen to share the current situation for healthcare decision-making
process and deliberate on the beauty of HTA practice in Asia Countries.
I trust that the 8th HTAsiaLink Annual Conference in Seoul will be a great opportunity to share knowledge,
discuss, and get a novel idea on improving HTA practice in our own country. Given those expected goals of
this conference, I would like to appreciate NECA (National Evidence-based Healthcare Collaborating Agency)
as the organizing committee of 8th HTAsiaLink. Hopefully, this conference will raise a great value added to
all participants that eventually benefited to their home organization and countries. At last, on behalf of the
Indonesian team under the Ministry of Health and CHEPS for the next HTAsiaLink Host, I sincerely invite you
all to join the upcoming event in Bali, Indonesia. Terimakasih!
Budi Hidayat
Vice-President of HTAsiaLink
Head of Center for Health Economics and Policy Studies (CHEPS) University of Indonesia
Welcome Messages
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Floor Plan
8
Time Program
Room 1F Camellia (Dongbaek) 1F Magnolia (Mokryun) 1F Water lily (Sooryun)
9:00-10:20
Health Technology Assessment in Vaccine
Introduction to HTASolving the Unsolvable HTA Challenges through South-South Knowledge Exchange
Mark Jit London School of Hygiene & Tropical MedicineWanrudee Isranuwatchai HITAP JeongHoon Ahn Ewha Womans University
Iñaki Gutiérrez-Ibarluzea HTAiSophie Söderholm Werkö SBU / INAHTA
The detailed program is available on the official website.This workshop will last to 12:00.https://htasialink2019.org/program/program.html
10:20-10:40 Break
Room 1F Camellia (Dongbaek) 1F Magnolia (Mokryun) 2F Mugunghwa Hall
10:40-12:00
Journal SessionHTA for non-drug medical technologies
QALY estimation for HTA: The EuroQol approach
Wendy Babidge RACS, ASERNIP-SDavid Tivey RACS, ASERNIP-S
Junainah Sabirin MaHTAS of Ministry of Health MalaysiaBrendon Kearney HealthPactKun Zhao CNHDRC
Luo Nan NUSAtaru Igarashi University of Tokyo
12:00-13:00 Lunch
Pre-Conference Workshops I 24 April 2019
DAY1
9
TimeProgram
Opening 2F Mugunghwa Hall
13:00-13:40
Welcome Remarks Young-Sung Lee President of NECA
Opening Speech Do Tae Kang Deputy Minister for Healthcare Policy, Ministry of Health and Welfare
Opening Speech Prof. Sudigdo Sastroasmoro Chair of Indonesia Health Technology Assessment Committee (INAHTAC)
Group Photo
13:40-14:20
Keynote Speech 2F Mugunghwa Hall
Moderator Suwit Wibulpolprasert HITAP
Keynote speaker 1 Anthony Culyer University of York
Keynote speaker 2 Sarah Garner WHO
14:20-14:30 Break
14:30-16:30
[Plenary I ] HTA in World 2F Mugunghwa Hall
Moderator Brendon Kearney HealthPact Jeonghoon Ahn Ewha Womans University
Speaker 1 Sean Tunis CMTP
Speaker 2 Iñaki Gutiérrez-Ibarluzea HTAi
Speaker 3 Sophie Söderholm Werkö SBU / INAHTA
Speaker 4 Alexandre Lemgruber WHO PAHO
18:00-21:00 Dinner Reception 2F SNU Faculty Club
Main Conference I 24th April 2019
DAY1
10
Main Conference I 25th April 2019
DAY2
Time Program
9:30-11:00
[Plenary II ] How to make a good decision in healthcare? 2F Mugunghwa Hall
Moderator Anthony Culyer University of York
Tessa Edejer WHO
Speaker 1 Peter Hangoma University of Zambia
Speaker 2 Peter Baker Global Health and Development Group, Imperial College / iDSI
Speaker 3 Jasmine Pwu Ministry of Health and Welfare in Taiwan
Speaker 4 Somsak Chunharas HITAP
11:00-11:20 Break / Poster Viewing
Oral Presentation
Room 2F Mugunghwa Hall 1F Magnolia (Mokryun) 1F Water lily (Sooryun) 1F Camellia (Dongbaek)
11:20-11:40
EE01 Cost-utility analysis of direct acting antivirals for treatment of chronic hepatitis C genotype 1 and 6 in Vietnam
HSR01 Revision of the health screening package as part of the Health Insurance Card Scheme for migrants in Thailand
HSR02 Diagnostic performance, white coat hypertension, and mask hypertension of clinic and home blood pressure measurements comparing with ambulatory blood pressure measurements: A systematic review a nd meta-analysis of diagnostic studies
EE02 Costing and Cost-Effectiveness of a mHealth Intervention “ImTeCHO” in improving coverage of maternal, neonatal and child childhealth care in Tribal Areas of Gujarat, India
11:40-12:00
EE03 Budget impact analysis of nintedanib for treating idiopathic pulmonary fibrosis in Singapore
HSR03 Intrauterine system for dysmenorrhoea: Is it safe and effective?
HSR04 Endobronchial Valves: Carving a new treatment path for patients with severe emphysema in Malaysia
EE04 Type 2 diabetes in Vietnam: a cross-sectional, prevalence-based cost-of-illness study
12:00-12:20
EE05 Coronary computed tomography angiography vs. myocardial single photon emission computed tomography in patients with intermediate risk chest pain: a randomized clinical trial for cost-effectiveness comparison based on real-world cost
HSR05 Innovative UV light based imaging tools to improve hand hygiene compliance: A systematic review and meta-analysis of current literature
HSR06 Comparison of prices and reimbursem*nt status of patented cancer drugs in Singapore versus overseas countries
EE06 Budget impact analysis of implementing quality standards to improve the quality of antenatal care services in Thailand
*EE=Economic Evaluation, HSR=Health System Research
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Main Conference I 25th April 2019
DAY2
Time Program
Oral Presentation
Room 2F Mugunghwa Hall 1F Magnolia (Mokryun) 1F Water lily (Sooryun) 1F Camellia (Dongbaek)
12:20-12:40
EE07 Achieving best value for money in preventing noncommunicable diseases: an analysis of global evidence base and local case studies
HSR07 Appropriate health technology listing in China: exploring an multi-criteria decision analysis (MCDA) based priority setting framework
HSR08 The situation of Emergency Medical Services associated with falls in the elderly in Thailand: Policy Recommendation
EE08 Modelling optimal allocation of resources for basal insulin therapy among naïve insulin Type 2 diabetes patients
12:40-13:30 Lunch
13:30-13:50
EE09 Economic burden of transfusion dependent thalassaemia (TDT) on patient or family of TDT patient in Malaysia: A multicenter study
HSR09 Priority Setting for Health Technology Assessment (HTA) and Health Care Decision Making in Malaysia
HSR10 A review and assessment of health service planning in Thailand
EE10 Quality of life and economic burden assessment: Impact and treatment benefit related to eczema
13:50-14:10
EE11 Cost-effectiveness of sequenced treatment of chronic gout with urate lowering therapies in Singapore
HSR11 Role of Health Technology Assessment in the development of the Universal Coverage Scheme Benefits Package in Thailand
HSR12 Real world data to overcome HTA barriers to access to orphan medicines
EE12 Cost-effectiveness Analysis On Malaria Rapid Diagnostic Tests: Based On Real-world Data From China
14:10-14:30
EE13 Economic Evaluation of Clinical Pathways Management for Cerebral Infarction in Rural Area of China
HSR13 Stroke-related risk factors analysis on type-2 diabetes mellitus patients in China
HSR14 Evaluation of the medical device adverse events monitoring: based on national adverse event reports in China
EE14 Economic evaluation of XPERT MTB/RIF for diagnostic pulmonary tuberculosis in Thailand
14:30-14:50
EE15 Cost-utility analysis of transcatheter aortic valve implantation (TAVI) in aortic stenosis patients in Taiwan
HSR15 Evidence for diagnostic accuracy of blood glucose detection tests for type 2 diabetes and pre-diabetes
HSR16 The role of HTA in the development of the National List of Essential Medicines in Thailand
EE16 Carbetocin versus oxytocin for preventing secondary postpartum hemorrhage in caesarean section in the Philippines
14:50-15:10 Break / Poster Viewing
*EE=Economic Evaluation, HSR=Health System Research
12
Main Conference I 25th April 2019
DAY2
Time Program
Oral Presentation
Room 2F Mugunghwa Hall 1F Magnolia (Mokryun) 1F Water lily (Sooryun) 1F Camellia (Dongbaek)
15:10-15:30
EE17 The role of lifestyle modification in prevention for type 2 diabetes mellitus – an umbrella review
HSR17 Cost Analysis Study of Key Population Interventions to Fast Track the End of HIV in Thailand
HSR18 The current situation of preventive interventions for falls and dementia in community-dwelling Thai elderly: A mail survey
Other01 Cost effectiveness of sodium-glucose cotransporter 2 inhibitors in the treatment of metformin mono-therapy failed type 2 diabetes patients: a systematic review and meta-analysis of cost utility analyses
15:30-15:50
EE18 Cost-Utility Analysis of Adjuvant Trastuzumab Therapy for Her2-Positive Early Stage Breast Cancer in the Philippines
HSR19 Cancer Treatment: Is there a role for non-pharmacological interventions?
HSR20 High-Cost Technologies in the Asia Region
Other02 Systematic Review of Tolvaptan for the Treatment of Non-hypovolemic Hyponatremia
15:50-16:10
EE19 Screening for Type 2 Diabetes Mellitus: A Cost-effectiveness Analysis of Glycated Hemoglobin with Fasting Plasma Glucose (FPG) as confirmatory test versus FPG with Oral Glucose Tolerance Test as confirmatory test
HSR21 HTA-informed decisions on optimizing the national essential public health package in China
HSR22 The Effectiveness of Dabigatran, Rivaroxaban and VKA in patients with non-valvular atrial fibrillation (NVAF) using National insurance Claim Database in Japan
Other03 Integrated sensor augmented pump therapy (SAP) in patients with type 1 diabetes
16:10-16:30
EE20 Cost-utility of HPV DNA testing versus colposcopy with biopsy for cervical cancer diagnostic in women with atypical squamous cell of undetermined significant (ASC-US)
HSR23 Impact of physical rehabilitation in advanced cancer patients
HSR24 An Analysis of the Procurement Process and Prices of Medical Devices and Equipment Procured by Department of Health Hospitals in the Philippines in 2017
Other04 Applying multiple-criteria decision analysis (MCDA) to evaluation of new medicines: reimbursem*nt decision on treatment options of locally advanced and metastatic non-squamous cell lung cancer in patients with wild-type EGFR and ALK after platinum-containing chemotherapy
*EE=Economic Evaluation, HSR=Health System Research
13
Main Conference I 26th April 2019
DAY3
Time Program
Oral Presentation
Room 2F Mugunghwa Hall 1F Magnolia (Mokryun) 1F Water lily (Sooryun) 1F Camellia (Dongbaek)
09:00-09:20
EE21 Budget Impact analysis of Anti-Vascular Endothelial Growth Factor in Patients with Age Related Macular Degeneration
HSR25 Situational Transition from real practice of the Prevention and Control of Severe Thalassemia Program in Thailand
HSR26 An Evaluation of the National Health Examination Survey in Thailand: Management Matters
Other05 Approaches of Priority Setting for Vaccine Introduction: A Systematic Review
09:20-09:40
EE22 Cost-effectiveness analysis of HPV vaccination in China
HSR27 A practical application of Multiple Criteria Decision Analysis (MCDA) in the context of Health Technology Assessment (HTA): a pilot study on Ministry of Health Medicines Formulary (MOHMF) listing of respiratory inhalers (RI)
HSR28 Exploring the Healthcare Journey of Thalassaemia Patients in Malaysia
Other06 Development and evaluation of mobile health behaviour change intervention to support tobacco cessation in Thailand
09:40-10:00
EE23 Cost-Effectiveness of Tdap Booster for Prevention of Pertussis in Adults
HSR29 Systematic review of health technology assessment implementation frameworks
HSR30 Addressing the development of the Critical Illness Insurance Program in China: comparison for the status of 5 pilots in China
Other07 Implications of Contraceptive Service on Health in China from 1990 to 2017
10:00-10:20
EE24 Customers’ preferences and willingness to pay for a future dengue vaccination: an empirical evidence in Vietnam
HSR31 Establishment of the National Clinical Practice Guideline Program in the Philippines
HSR32 iDSI impact narrative – Indonesia chapter
Other08 Health state valuation patterns and relations to religiosity
10:20-10:40 Break / Poster Viewing
10:40-11:00
EE25 Cost-utility analysis alongside the randomised controlled trial of SMS to support smoking cessation services in Thailand
HSR33 AGREE II Assessment of Malaysian Clinical Practice Guidelines (CPG)
HSR34 Equality of reimbursem*nt for antiretroviral therapy costs among migrants in Thailand: an application of the concentration index
W/P01 Literature Review of Cost-Effectiveness Studies of 9-valent Human Papillomavirus (HPV) Vaccination
11:00-11:20
EE26 Cost-Effectiveness of pan-genotypic Sofosbuvir-Velpatasvir combination versus genotype dependent directly acting anti-viral drugs for treatment of hepatitis C patients in the universal coverage scheme of Punjab state in India
HSR35 Association between SLCO1B1 gene and myopathy risk in patients receiving statin : A systematic review and meta-analysis
HSR36 Assessing Districts Performance in Indonesia: A Data Envelopment Analysis and Qualitative Approach
W/P02 Cost-effectiveness of 13-Valent Pneumococcal Conjugate Vaccine in the treatment of Invasive Pneumococcal Disease among Children Under 5 in China
*EE=Economic Evaluation, HSR=Health System Research
14
Main Conference I 26th April 2019
DAY3
Time Program
Oral Presentation
Room 2F Mugunghwa Hall 1F Magnolia (Mokryun) 1F Water lily (Sooryun) 1F Camellia (Dongbaek)
11:20-11:40
EE27 Is radiofrequency ablation (RFA) cost-effective for treatment of atrial fibrillation (AF) in Malaysian context?
HSR37 Present Analysis of General Hospital at Level 2 and Above to Carry Out Disease Prevention and Control in Beijing
HSR38 An assessment of Monitoring and Evaluation systems in Timor Leste for managing resource availability at health facilities
W/P03 Developing a streamlined Health Technology Assessment framework to assess diagnostic imaging for staging of uncommon cancers
11:40-12:00
EE28 An Economic Evaluation of Policy Options for Renal Replacement Coverage in the Philippines
HSR39 Use of e-cigarettes among cigarette smoking Canadians who failed in their attempts to quit smoking
12:00-13:00 Lunch
Time Program
13:00-15:30
[Plenary III ] How to collaborate better within the HTAsiaLink? 2F Mugunghwa Hall
Moderator Kun Zhao CNHDRC
Takashi f*ckuda National Institute of Public Health
Speaker 1 Khanh Phuong Nguyen HSPI in Ministry of Health
Speaker 2 Anna Melissa Guerrero Department of Health Philippines
Speaker 3 Drg. Armansyah, MPPM Ministry of Health Republic of Indonesia
Speaker 4 Dechen Choiphel Ministry of Health Royal Government of Bhutan
Panelists Junainah Sabirin MaHTAS
Amanda Adler NICE
Sukyeong Kim NECA
Yot Teerawattananon HITAP
Kwong Hoe Ng ACE of Singapore MOH
Ryan Li Global Health and Development Group, Imperial College / iDSI
Jeffrey Hoch University of California, Davis
Ryota Nakamura HIAS in Hitotsubashi University
*EE=Economic Evaluation, HSR=Health System Research
15
Main Conference I 26th April 2019
Meeting I 27th April 2019
DAY3
DAY4
Time Program
15:30-15:40 Break / Poster Viewing
15:40-16:30
Closing 2F Mugunghwa Hall
Award Ceremony
Closing Remarks
Next Host : Indonesia
Time Program
9:00-10:30 Board Meeting 1F Rose Room, Byeol Chae SK Guest House
10:30-10:40 Break
10:40-12:00 Members Meeting 1F Rose Room, Byeol Chae SK Guest House
12:00-13:00 Lunch
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Young Sung LeePresidentNational Evidence-based Healthcare Collaborating Agency (NECA)South Korea
Budi HidayatProfessorCenter for Health Economics and Policy Studies (CHEPS), Universitas IndonesiaIndonesia
Yot TeerawattananonProgram Leader, Head of HITAP International UnitHealth Intervention and Technology Assessment Program (HITAP)Thailand
Brendon KearneyChairHealth Technology Reference Group (HTRG)Australia
Kun ZhaoDirector of Division of Health Policy Evaluation and Technology AssessmentChina National Health Development Research Center (CNHDRC)China
Asrul Akmal ShafieAssociate ProfessorSchool of Pharmaceutical Sciences, Universiti Sains Malaysia (USM)Malaysia
Kwong Hoe NgHead, Evaluation & Appraisal Team, Agency for Care Effectiveness (ACE)Ministry of HealthSingapore
Jasmine PwuDirectorNational Hepatitis C Program (NHCP) Office, Ministry of Health and WelfareTaiwan
Ryota NakamuraAssociate ProfessorHIAS Health, Research Center for Health Policy and Economics, Hitotsubashi Institute for Advanced Study (HIAS), Hitotsubashi UniversityJapan
HTAsiaLink Members
Board Members
17
National Institute of Public Health (NIPH)Japan
Member Affiliations
HTAsiaLink Members
Department of Health Research (DHR), Ministry of Health and Family Welfare, Government of IndiaIndia
The Australian Safety and Efficacy Register of New Interventional Procedures – Surgical (ASERNIP-S)Australia
Essential Medicines and Technology Division(EMTD), Department of Medical Services, Ministry of HealthBhutan
Malaysia Health Technology Assessment Section (MaHTAS), Ministry of Health Malaysia
Menzies School of Public, University of SydneyAustralia
The George Institute for Global HealthAustralia
The Department of Community Medicine and School of Public Health, Post Graduate Instittute of Medical Education and Research, ChandigarhIndia
Key Lab of Health Technology Assessment, National Health and Family Planning CommissionChina
Shanghai Health Technology Assessment Research Center, Shanghai Health Development Research CenterChina
Institute of Public Health Kalyani (IPHK)India
Centre for Health Policy, Planning and Management (CHPPM), Tata Institute of Social Sciences (TISS)India
Pharmaceutical Services Program, Ministry of HealthMalaysia
HTA-CPG Unit, Health Policy Development and Planning Bureau, Department of HealthPhilippines
18
HTAsiaLink Members
ProHES (Professional Healthcare Education and Research Center)Vietnam
Member Affiliations
Global Health and Development Group, Institute of Global Health Innovation, Imperial College LondonUnited Kingdom
Health Technology Assessment Program, Mahidol UniversityThailand
InaHTAC (Indonesia Health Technology Assessment Committee), Ministry of HealthRepublic of Indonesia
Health Services Research Institute (HSRI), Duke-NUS Medical SchoolSingapore
Health Services Research Unit, Changi General Hospital, Singapore Health Services (SingHealth)Singapore
Saw Swee Hock School of Public HealthSingapore
Priority Cost Effective Lessons for System Strengthening (PRICELESS), Wits School of Public HealthSouth Africa
Department of Health Convergence, Ewha Womans UniversitySouth Korea
Health System Research Unit, Department of Community Medicine, Faculty of Medicine, University of ColomboSri Lanka
Division of Health Technology Assessment, Center for Drug Evaluation (CDE)Taiwan
Big Data Research Center, Fu Jen Catholic UniversityTaiwan
Health Strategy and Policy Institute (HSPI)Vietnam
19
Organizing Committee
IOC Members
Wendy Babidge ASERNIP-S
Brendon Kearney HealthPact
Deepika Adhikari Essential Medicine and Technology Division, Ministry of Health Royal Government of Bhutan
Wudong Guo CNHDRC
Yingyao Chen Key Lab of Health Technology Assessment, National Health Commission, Fudan University
Budi Hidayat CHEPS, Universitas Indonesia
Ryota Nakamura Research Center for Health Policy and Economics, Hitotsubashi University
Junainah Sabirin MaHTAS
Diana Beatriz S. Bayani HTA Team Lead, Department of Health Philippines
Karris Jeon Singapore ACE
Pwee Keng Ho Changi General Hospital, Singapore Health Services, SingHealth
Manuj Weerasinghe Faculty of Medicine, University of Colombo
Wen-Wen Yang National Hepatitis C Program Office, MOHW
Chung-Lin Yang CDE
Pattara Leelahavarong HITAP
Usa Chaikledkaew Health Technology Assessment Program, Mahidol University
Organizing CommitteeChair: Young Sung Lee (NECA)
International OrganizingCommittee (IOC)
Local OrganizingCommittee (LOC)
Scientific AdvisoryCommittee (SAC)
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Organizing Committee
LOC MembersEunyoung Bae College of Pharmacy, Gyeongsang National University
Minwoo Cho College of Medicine, University of Ulsan
Taejin Lee Graduate School of Public Health, Seoul National University
Sangmu Lee Health Insurance Review and Assessment Service
Jeonghoon Ahn Ewha Womans University
Seok-Hyun Kim NECA
Chae-Min Sshin NECA
Insun Choi NECA
Bo Young Yoon NECA
SAC MembersBohyung Jang Korean Medicine, Kyung Hee University
Sun-Young Jung College of Pharmacy, Chung-Ang University
David Tivey ASERNIP-S
Ning Ma SERNIP-S
Brendon Kearney HealthPact
Dechen Choiphel Essential Medicine and Technology Division, Ministry of Health Royal Government of Bhutan
Pempa Essential Medicine and Technology Division, Ministry of Health Royal Government of Bhutan
Jiayan Huang Key Lab of Health Technology Assessment, National Health Commission, Fudan University
Kun Zhao CNHDRC
Bunyan Sui CNHDRC
Yingyao Chen Key Lab of Health Technology Assessment, National Health Commission, Fudan University
Sudigdo Sastroasmoro InaHTAC
Madiati Nadjib InaHTAC
Ying Yao Research Center for Health Policy and Economics, Hitotsubashi University
Ryota Nakamura Research Center for Health Policy and Economics, Hitotsubashi University
Izzuna Mudla Mohamed Ghazali MaHTAS
Roza Sarimin MaHTAS
Erni Zurina Romli MaHTAS
Junainah Sabirin MaHTAS
21
Organizing Committee
SAC Members
Asrul Akmal Shafie School of Pharmaceutical Sciences, Universiti Sains Malaysia
Diana Beatriz S. Bayani HTA Team Lead, Department of Health Philippines
Lin Liang ACE
Hansen Sun ACE
Sandi Chit Lwin Changi General Hospital, Singapore Health Services, SingHealth
Pwee Keng Ho Changi General Hospital, Singapore Health Services, SingHealth
Manuj Weerasinghe Faculty of Medicine, University of Colombo
Grace Hui-Min Wu National Hepatitis C Program Office, MOHW
Grace Li-Ying Huang CDE
Mei-Chi Lai CDE
Chung-Lin Yang CDE
Dr. Pritap*rn Kingkaew HITAP
Sitap*rn Youngkong Health Technology Assessment Program, Mahidol University
Montarat Thavorncharoensap Health Technology Assessment Program, Mahidol University
Usa Chaikledkaew Health Technology Assessment Program, Mahidol University
Anthony Culyer University of York and iDSI
John Cairns London School of Hygiene and Tropical MedicineKalipso Chalkidou Imperial College London
Mark Jit London School of Hygiene & Tropical Medicine
Olivia Wu University of Glasgow
Jeffrey Hoch Department of Public Health Sciences, University of California, Davis
Sukyeong Kim NECA
Min Jung Ko NECA
Chae-Min Shin NECA
Chong Yon Park NECA
Seok-Hyun Kim NECA
Ji Eun Choi NECA
Insun Choi NECA
Dong Ah Park NECA
Sangjin Shin NECA
Min-Jeong Kim NECA
Ah Ram Sul NECA
Wulsuk Lee NECA
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Suwit WibulpolprasertVice Chair of Health Intervention and Technology Assessment Foundation (HITAF)Dr. Suwit Wibulpolprasert is a public health specialist and policy advocate at national and global level. He began his career as a Director and practitioner in rural areas and has worked for Thai Food and Drug Administration, the Bureau of Health Policy and Planning, Deputy Permanent Secretary, and the senior expert in Health Economics and Disease Control. His current position is a global health advisor to the Ministry of Public Health. He is a well-known global health leader who fight to protect the benefit of poor people.Dr. Suwit was the first Program Director when Thailand started the Universal Health Coverage (UHC) in 2001 and have been the board member of the National Health Security Board which manage the UHC including this current term. He used to chair the Benefit package and service delivery and the National Essential Drug List committee. In additions, he is a board member of the National Electronics and Computer Technology Center (NECTEC), the National Nanotechnology Center (NANOTEC), the Executive Board of the National Health Commission Office (NHCO) and the Chair of the Committee for Yothi Health Innovation District Development.Dr. Suwit is also the vice chair of International Health Policy Program Foundation (IHPF) and Health Intervention and Technology Assessment Foundation (HITAF), the chair of the Institute for the Development of Human Research Protections Foundation (IHRPF), the chair of the Health and Society Creation Foundation, the chair of Road Safety Policy Foundation (RSPF) and the vice chair of Health Professional Education Foundation (NHPE).
Moderator
Keynote
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Sarah Elizabeth GarnerCo-ordinator IAU of WHO Department of Essential Medicines and Health ProductsProfessor Sarah Garner is the Co-ordinator for the ‘Innovation, Access and Use’ Team in the Essential Medicines and Health Products Department at the World Health Organization. The Team’s portfolio includes the Essential Medicines and Diagnostics lists, Health Technology Assessment, procurement, pricing and supply chain. Sarah is a pharmacist specializing in innovation, with previous work focusing on development strategies and the interface between Health Technology Assessment, regulation and payers. Sarah is an honorary professor at UCL and Manchester Universities. Her previous roles have included the Associate Director for Science Policy and Research at the UK’s National Institute for Health and Care Excellence (NICE) and Pharmacist Lead for the UK Government’s Special Advisory Committee on Antimicrobial Resistance. Sarah has led policy work-packages of public private research partnerships funded by the EI Innovative Medicines Initiative (GetReal, ADAPTSMART and Big Data for Better Outcomes) which are developing policy proposals for the adaptive pathways and use of real-word data in pharmaceutical development, regulatory and HTA decision making. In 2010-11 Sarah was a Harkness Fellow in Healthcare Policy and Practice in the United States. Her research examined the impact of comparative effectiveness research and Health Technology Assessment on pharmaceutical and MedTech innovation.
Anthony CulyerEmeritus Professor of University of York Anthony J Culyer is emeritus professor of economics at York (England); Senior Fellow at the Institute of Health Policy, Management and Evaluation at the University of Toronto; Visiting Professor at Imperial College London, and Chair of the International Decision Support Initiative.He was the founding Organiser of the UK Health Economists’ Study Group. For 33 years he was the founding co-editor, with Joe Newhouse, of Journal of Health Economics. He was founding Vice Chair of the National Institute for Health and Care Excellence (NICE). For many years he was chair of the Department of Economics & Related Studies at York and, for six of them, was also deputy vice-chancellor. He has received many honours, including Founding Fellowship of the Academy of Medical Sciences (1998), Commander of the British Empire (CBE) (1999), Honorary Doctor of Economics, (Stockholm School of Economics, 1999), Fellowship of the Royal Society of Arts (1999), Honorary Fellowship of the Royal College of Physicians of London (2003). Honorary Membership of the Finnish Society for Health Economics (2013), Baxter Foundation’s William B. Graham Prize for Health Services Research (2015}, Emmett Hall Laureate and Hall Lecturer (2015), and the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Avedis Donabedian Outcomes Research Lifetime Achievement Award (2015).He has published widely, mostly in health economics. The third edition of his The Dictionary of Health Economics (Edward Elgar) came out in 2014. A collection of his non-technical essays called The Humble Economist is available on-line free of charge. He has been an amateur church organist, choir director and music composer.
Speaker
Keynote
24
Brendon KearneyChair of Health Policy Advisory Committee on Technology (HealthPACT)Professor Brendon Kearney has a list of achievements in the health services field that began as a junior hospital doctor in 1969, then advancing to senior managerial health positions.He has contributed to the development and improvement of the Australian healthcare system, proposing recommendations for change, developing statewide frameworks and serving the Australian, and in particular, South Australian community. In 2005, Professor Kearney was awarded the prestigious Sidney Sax Medal by the Australian Healthcare Association in recognition of an outstanding contribution to the field of health services policy, organisation, delivery and clinical research. In 2003 Professor Kearney was awarded a Member in the Order of Australia for service to Medical Administration in South Australia, recognizing his contribution to medical research promotion and his coordination for South Australia of the medical response team assisting victims of the Bali bombings. Professor Kearney is currently the Chair of Health Policy Advisory Committee on Technology (HealthPACT) and past Chair of EuroScan International Network whilst continuing a significant case load in South Australia.
Moderator
Plenary 1
Jeonghoon Ahn, PhD.Professor of Ewha Womans UniversityDr. Jeonghoon Ahn is an associate professor at the Ewha Womans University (Seoul, Korea). His main research area is economic evaluation of health technologies. Before joining the EWU in March 2016, Dr. Ahn was a senior research fellow and executive director at the NECA (2009 ~ 2016) and an assistant professor of pharmaceutical economics and Policy at the University of Southern California (USC). He received his B.A. in International Economics (1992) and M.A. in Economics (1994) from the Seoul National University, Korea, and Ph.D. in Economics (2000) from the USC. Dr. Ahn is currently serving in the Drug Reimbursem*nt Evaluation Committee of the Health Insurance Review and Assessment Agency (HIRA). He was elected as a board director for Health Technology Assessment International (HTAi) for a three year term (2014-2016) and International Network of Agencies for Health Technology Assessment (INAHTA) for three times (2012-2016). He also contributed to form a regional Health Technology Assessment agency network, the HTAsiaLink (www.htasialink.org), along with other experts in the region. Dr. Ahn is a member of the Local Organizing Committee of the 2019 HTAsiaLink Annual Conference in Seoul.
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Inaki Gutierrez-IbarluzeaVice-President of HTAiBSc and MSc in Sciences and Doctor in Sciences (NeuroScience) from the University of the Basque Country, Masters in Clinical Epidemiology from the Andalusian School of Public Health and Masters in Bioethics from the University Ramon Llul. He is the coordinator of the horizon scanning on life cycle of health technologies of Osteba, Basque Office for Health Technology Assessment. He is currently the Vice president of HTAi (2017-2019) and the Vice chair of EuroScan. Iñaki has advised different HTA initiatives in Argentina, Brazil, Colombia, Costa Rica, Mexico, South Africa, Tunisia, Norway, Israel, EEUU and Italy, WHO-EMRO-WPRO and PAHO regions and WHO medical devices. Iñaki is also an associated professor in the School of Nursing of Osakidetza Basque Health Service. He is associated editor of Frontiers in Pharmacology and GMS HTA journals. Author of more than 60 articles in peer reviewed journals, 2 monographies, 5 book chapters and more than 40 HTA reports.
Alexandre LemgruberRegional Advisor, Health Technologies of WHO/PAHOAlexandre Lemgruber is the Regional Advisor in Health Technologies at the Pan American Health Organization (PAHO), in Washington-DC, position which he holds since July 2011. He is responsible for providing technical cooperation for the countries in the Region of the Americas in areas such as Health Technology Assessment (HTA), incorporation of health technologies into health systems, regulation and management of medical devices. He is also responsible for the Secretariat of the HTA Network of the Americas (RedETSA).From 2003 to 2011 Mr. Lemgruber was the Head of the Office of Economic Evaluation of New Technologies, at the Brazilian Health Regulatory Agency (ANVISA), where he was responsible for proposing a price regulation policy based on HTA. He was the founder of the Brazilian Bulletin of HTA (BRATS), a member of the National Commission of Health Technologies Incorporation and one of the rapporteurs of the Brazilian Policy of Health Technology Management.Alexandre Lemgruber holds a Master’s Degree on Public Policies, specialization degree on Health Economics, and an undergraduate degree on Chemical Engineering.
Speaker
Plenary 1
26
Speaker
Plenary 1
Sophie Söderholm Werkö Manager of International Relations & Patient Engagement of SBUChair of INAHTADr. Sophie Werkö has an MSc in Business Administration and a PhD from the University of Stockholm. She has a longstanding engagement with HTA and joined the Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) in 2007 as a Project Director. In 2012 she was appointed Manager of International Relations and in 2015 she also became Manager of Patient Engagement. Sophie also serves as the Board Chair for the International Network of Agencies for Health Technology Assessment (INAHTA) and represents Sweden in the EU HTA Network (HTAN). She has participated in the work of the European network for Health Technology Assessment (EUnetHTA) since 2009 and serves, since 2016, as Associated Editor of the International Journal of Technology Assessment in Health Care and since 2014 of Research Involvement and Engagement.
Sean TunisPresident of HTAiFounder and CEO of Center for Medical Technology Policy (CMTP)Sean Tunis, MD, MSc. is the Founder and Senior Strategic Adviser of the Center for Medical Technology Policy in Baltimore, Maryland. CMTP is an independent, nonprofit organization working to strengthen the quality, relevance, and efficiency of clinical research. His work currently focuses on expanding infrastructure for the conduct of pragmatic clinical trials within the health care delivery systems, developing condition-specific evidentiary standards for reimbursem*nt, and promoting greater engagement of patients and consumers in clinical research. Dr. Tunis serves as President of Health Technology Assessment international and is a member of a number of other advisory boards for public and private sector organizations focused on issues of comparative effectiveness, innovation, health technology assessment, evidence-based medicine, clinical research, and reimbursem*nt.He received a B.S. degree in Biology and History of Science from the Cornell University School of Agriculture, and a medical degree and masters in Health Services Research from the Stanford University School of Medicine. Dr. Tunis did his residency training at UCLA and the University of Maryland in Emergency Medicine and Internal Medicine. He is board certified in Internal Medicine and holds adjunct faculty appointments at Johns Hopkins, Tufts and the University of California San Francisco Schools of Medicine.
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Moderator
Plenary 2
Anthony CulyerEmeritus Professor of University of YorkAnthony J Culyer is emeritus professor of economics at York (England); Senior Fellow at the Institute of Health Policy, Management and Evaluation at the University of Toronto; Visiting Professor at Imperial College London, and Chair of the International Decision Support Initiative.He was the founding Organiser of the UK Health Economists’ Study Group. For 33 years he was the founding co-editor, with Joe Newhouse, of Journal of Health Economics. He was founding Vice Chair of the National Institute for Health and Care Excellence (NICE). For many years he was chair of the Department of Economics & Related Studies at York and, for six of them, was also deputy vice-chancellor. He has received many honours, including Founding Fellowship of the Academy of Medical Sciences (1998), Commander of the British Empire (CBE) (1999), Honorary Doctor of Economics, (Stockholm School of Economics, 1999), Fellowship of the Royal Society of Arts (1999), Honorary Fellowship of the Royal College of Physicians of London (2003). Honorary Membership of the Finnish Society for Health Economics (2013), Baxter Foundation’s William B. Graham Prize for Health Services Research (2015}, Emmett Hall Laureate and Hall Lecturer (2015), and the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Avedis Donabedian Outcomes Research Lifetime Achievement Award (2015).He has published widely, mostly in health economics. The third edition of his The Dictionary of Health Economics (Edward Elgar) came out in 2014. A collection of his non-technical essays called The Humble Economist is available on-line free of charge. He has been an amateur church organist, choir director and music composer
Tessa EdejerCoordinator, Economic Analysis and Evaluation Unit, Health Systems Governance and Financing of WHODr. Anthony Kinghorn is a health economist and public health consultant working at Wits University, Johannesburg, South Africa. His focus is on evidence-based decision making and incorporating health economics into clinical and public health research and planning. He has an MBBCh (Wits), MA (Oxon) and DHEFM (UCT). Since the 1990s he has led operational and health economics research, as well as management and planning consultancies, in many African countries. He worked for Abt Associates, was a founding director of Health and Development Africa, and then became Health practice lead at HLSP/Mott MacDonald South Africa. Anthony has particular interest in HIV, TB and immunization economics and planning.
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Peter BakerDeputy Director of Global Health and Development Group, Imperial College / iDSIDr Peter Baker is the Deputy Director of the Global Health & Development Group, Imperial College London; and the Public Health Director & Lead for Eastern & Southern Africa, international Decision Support Initiative (iDSI). He is a public health specialist and Fellow of the UK's Faculty of Public Health. His expertise is in developing the institutions needed for evidence-based prioritisation in LMICs, health economics & financing, and in improving policies on the wider social determinants of health. He has previously worked for MSF, DFID, PRICELESS South Africa, King's Sierra Leone Partnership, Public Health England, and the NHS.
Speaker
Plenary 2
Somsak Chunharash*tAP
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Speaker
Plenary 2
Peter HangomaHead, Department of Health Policy and Management, School of Public Health, University of ZambiaDr. Hangoma is an Economist focusing on Health, Development Economics, and Applied Econometrics with expertise in Economic Evaluation, including but not limited to assessing the costs and cost-effectiveness of health technologies, projecting the costs and impacts of key health intervention for input in health strategic plans, and conducting cost-benefit analyses. Dr. Hangoma’s also evaluates the impact of key health and other intervention such as health insurance, user charges, social protection programs, and performance based financing on health and household welfare. He is an associate editor for the International Journal for Equity in Health (IJEH). Dr. Hangoma holds a joint appointment at the University of Zambia in the Department of Health Policy and Management, which he heads, and the Department of Economics, where he teaches graduate level statistics and development economics. He is a Principal Investigator for different projects at the Innovations for Poverty Action (IPA).Dr. Hangoma holds a PhD from the University of Bergen and he was a visiting PhD Economics scholar at the Norwegian School of Economics between 2014 and 2015 and the Swiss School of Public Health in 2013. He also holds an MA (Economics) and BA (Economics, Maths & Statistics) from the University of Zambia.
Jasmine PwuDirector of Ministry of Health and Welfare in TaiwanDr. Raoh-Fang (Jasmine) Pwu, is Director, National Hepatitis C Program Office, Ministry of Health and Welfare, in Taiwan. She also is adjunct Assistant Professor at the Taipei Medical University and Fu Jen Catholic University. Trained as an epidemiologist, Dr. Pwu has picked up the expertise in research designs and analysis of large/claims database early in her career. Along the research path she found that economic evaluations in healthcare quite interesting and determined to pursue a career in this field. She is one of the first researchers who are exceling modelling cost-effectiveness of medicines and public health interventions in Taiwan. During the time when she worked in the HTA unit of CDE, Taiwan, she and her team have built up many good examples of HTA system and research. Dr. Pwu has been involved in many regional and global HTA activities. She served on the INAHTA Board from 2010-2012. She and her HTA colleagues from Thailand and Korea created HTAsiaLink in 2010 and she served as their President from 2014 to 2016.
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Takashi f*ckudaDirector, Center for Outcomes Research and Economic Evaluation for Health of National Institute of Public HealthTakashi f*ckuda is Director of the Center for Outcomes Research and Economic Evaluation for Health (CORE2-Health; C2H) at the National Institute of Public Health, Japan. He received his PhD degree from the Graduate School of Medicine, The University of Tokyo, majored in Health Sciences. After his career as Assistant Professor of Health Administration at the Graduate School of Medicine, the University of Tokyo during 1995-2000, he worked as Associate Professor of Pharmacoeconomics at the Graduate School of Pharmaceutical Sciences, the University of Tokyo during 2001-2006. In 2007 as the School of Public Health was opened, he became Associate Professor of the Department of Health Economics and Epidemiology Research, the School of Public Health , the University of Tokyo. From November, 2011, he works for the National Institute of Public Health, which is the governmental research institute. He became Director of the Department of Health and Welfare Services in 2015. As new Center for Outcomes Research and Economic Evaluation for Health was opened in 2018, he was appointed as the first director of the center. His major research areas are health care economics, health care administration, and pharmacoeconomics.
Plenary 3
Moderator
Kun ZhaoDirector of CNHDRCDr. Kun Zhao is the professor and Director of Division of Health Policy Evaluation and Technology Assessment in China National Health Development Research Center which isaffiliated to Ministry of Health in China. Since 2007, Dr. Zhao plays the leading role in HTA development and training programs in China, and as principle investigators conducts a series of national HTA projects on cutting-edge devices, costly new drugs, immunotherapy anclinical procedures, such as DaVinci surgical robot related therapy, proton and heavy ion therapy, Cyberknife,Tomotherapy, Truebeam & Truebeam STX, Hepatitis B&C drugs, CIK immunotherapy, stem cell therapy, hemo and peritoneal dialysis for ESRD patients, HBV and HCV drug economic evaluation, HTA for secondary line of targeted drug for NSCLC . As PI, conducting several national evaluation projects such as the disease control priority setting in China for increasing by 1 year life expectancy, prioritization of maternal and children care program, the cost-effectiveness analysis of the vaccination preventing COPD from acute exacerbation, the study of HTA-based optimizing diagnosis and treatment pathways accompanying to provider payment reform in rural China. Also Dr Zhao is a member of ACE of Disease Control Priorities, Third Edition, ISPOR AP Chair (2018-2020), Asianet HTA Chair (2014-2016) and ISPOR HTA council committee member, HTAsiaLink board member and core author of university textbook of China HTA, and Program Evaluation. From 2009 to 2015, she got over 80 papers published in peer-review journals.
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Speaker
Plenary 3
Drg. Armansyah, MPPMDeputy Director For Economic Evaluation in Health Financing of Ministry of Health Republic of IndonesiaArmansyah is the Deputy Director for Economic Evaluation in Health Financing at Center for Health Financing and Health Insurance within the Ministry of Health in the Republic of Indonesia and is also a member of Indonesian Health Technology Assessment Committee (Ina-HTAC). In the ministry, he is responsible for preparing and developing technical policy in the field of effectiveness and efficiency in terms of health financing and HTA. His contribution in HTA development in Indonesia includes supervising and monitoring the institutional and assessment process until yielding policy recommendation is to be delivered to the Minister of Health
Dechen ChoiphelChief Program Officer of Essential Medicine and Technology Division, Department of Medical Services, Ministry of Health, Royal Government of BhutanDechen Choiphel holds master’s degree in nursing science and has dedicated his service at various levels and capacity in hospitals, programs, divisions and departments under Ministry of Health, Royal Government of Bhutan for the last thirty years. He is currently working as a Chief Program Officer of Essential Medicine and Technology Division. He has instituted first modern ICU in the country. He was awarded the grand order of the Drakpoi Thugsey Medal citation for recognition of dedication and commitment as an Emergency Medical Team and Silver Medal award from Royal Civil Service for serving more than twenty years. He has conducted research on “Bhutanese nurses’ perception of their role in patient education” and patient satisfaction surveys in the country to improve the delivery of quality healthcare services. He has successfully developed and implemented the national healthcare standards for quality assurance in healthcare facilities. He is the chair of pharmaceuticals and traditional medicines technical committee of Bhutan Standard Bureau (BSB) and technical committee to assess the proposals for establishment of private diagnostic centres. He is engaged in formulation of program policies and strategies, and responsible for assessment of HTA proposals and conducting HTA for introduction of new health technologies for its indication, safety, quality, efficacy and cost-effectiveness and providing the report for policy and decision making.
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Anna Melissa GuerreroDivision Chief of Pharmaceutical Division, Department of Health PhilippinesDr. Anna Melissa Guerrero is currently the Division Chief of the Pharmaceutical Division of the Department of Health Philippines heading the oversight and implementation of drug policy reforms which include drug pricing, access strategies, pharmaceutical reimbursem*nt, the essential medicines list and the use of TRIPS flexibilities. She is also currently the country focal point on HTA heading the institutionalization of health technology assessment in the Philippines.Dr. Guerrero finished her Doctor of Medicine at the University of the Philippines Manila in 1999 and later on obtained her Masters in Public Health focusing on HTA in 2012 at the University of Birmingham under the British Chevening Scholarship. She is a part-time faculty lecturer at the Ateneo de Manila Graduate School teaching health regulation and health technology assessment for graduate students of the the Masters of Public Management program.
Speaker
Plenary 3
Khanh Phuong NguyenHead of Health Strategy and Policy Institute, Ministry of HealthDr. Nguyen Khanh Phuong, 47, is currently head of the Health Economic Department under the Health Strategy and Policy Institute, Ministry of Health. She has served in the institute for more than 20 years and devoted her entire career to the healthcare sector in Vietnam. Dr. Phuong is viewed as a leading health economist with more than 20 years of experience in health financing, health economic and health system reform in Vietnam. She also has a strong background on policy evaluation and monitoring, research proposal design and development, provider payment methods, hospital services cost, health technology assessment and project evaluation. Dr. Nguyen Khanh Phuong has extensive experience in the healthcare sector, having held many positions such as coordinator, senior technical officer, principal investigator and national consultant. She has involved in several studies which provided evidence for developing important health policies such as health insurance, health financing reform… She is currently a member of HTAsiaLink Scientific Board, HTAi Asia Policy Forum Organizing Committee, Joint Learning Network.
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Panelist
Plenary 3
Amanda AdlerConsultant Physician, Cambridge, and Chair, NICE Technology Appraisal Committee of Addenbrooke’s Hospital and NICEDr. Amanda Adler chairs (since 2009) a Technology Appraisal Committee at the National Institute for Health and Care Excellence (NICE) evaluating drugs and devices across disease areas. She trained in economics, medicine, epidemiology, pharmacoepidemiology and pharmacovigilance. She is a consultant (senior) physician at Cambridge University Hospitals Foundation Trust (Addenbrooke's Hospital); her work covers diabetes and general medicine in the out-patient, in-patient and primary-care settings. In diabetes, she chaired the NICE Clinical Guidelines for Newer Agents for Type 2 Diabetes and the NICE Quality Standard for Diabetes; she was the clinical epidemiologist for the UK Prospective Diabetes Study (Oxford University); she is an advisor to the UK National Screening Committee and the NICE Connect Project, and is a technical expert to World Health Organization. She serves on an Expert Advisory Group for the UK Commission on Human Medicines and chaired the Expert Group on the Safety of Insulin for the UK’s Medicines and Health Products Regulatory Agency. Dr. Adler helps projects that set priorities under universal health coverage in collaboration with NICE, the World Bank, iDSI, OECD, and the Gates Foundation in, among other places, Vietnam, China, and the Philippines. She is a fellow of the Royal Statistical Society.
Jeffrey HochProfessor of University of California, DavisJeffrey Hoch received his PhD in health economics from the Johns Hopkins School of Public Health. He also holds a Masters in Economics from Johns Hopkins University, and a Bachelor of Arts degree in Quantitative Economics and Decision Sciences from the University of California at San Diego. Currently, he is a Professor and Chief in the Division of Health Policy and Management, Department of Public Health Sciences and the Associate Director of the Center for Healthcare Policy and Research at the University of California at Davis. Professor Hoch researches value in health care. He has published 175 peer-reviewed articles.As an award-winning teacher, Professor Hoch has taught Health Economics and Economic Evaluation classes throughout the world, giving over 235 invited presentations in 15 countries. Professor Hoch draws on a rich, international experience developing and leading applied health economics research groups and pursuing research making health economics more useful to decision makers. Professor Hoch continues to develop research interests related to health economics, health services research and health policy in cancer, mental health, and other health issues affecting poor and vulnerable populations.
34
Sukyeong KimSenior Research Fellow and International Cooperation Advisor of NECADr. Sukyeong Kim is Senior Research Fellow and International Cooperation Advisor of National Evidence-based Healthcare Collaborating Agency (NECA), Korean governmental agency for Health Technology Assessment. She plays the leading role in the field of health policy regarding local evidence generation and RWE, HTA system, R&D planning, optimal use of drugs and DUR, and patient safety.Since 2013 she joined NECA, she undertook several research projects focusing on HTA system, patient safety system and R&D for RWE. For more than ten years before she Joined NECA, Dr. Kim played the leading role in the Korean pharmaceutical benefit policy making, drug utilization researches planning and new health technology assessment program development in Health Insurance Review and Assessment Service (HIRA) as the principle investigator and director of Pharmaceutical Benefit Division and Research Department.As a representative of National HTA Agency of Korea, she is the Chair of ISPOR HTA Roundtable Asia Pacific (2016~2019), one of the regional body composing ISPOR HTA Council. She has been participating regional and international meetings and workshops on HTA, medicine policy and UHC in Asia Pacific countries.Dr. Kim received her bachelor’s degree in Pharmacy from Seoul National University and Master and PhD degree in Health Policy from the Graduate School of Public Health in Seoul National University. She was a visiting scholar at the Graduate School of Health Studies in Simmons College, Boston, USA for Biotechnology and Pharmaceutical Industry study.
Ryan LiAdviser, iDSI of Global Health and Development Group, Imperial College LondonDr. Ryan Li is Adviser at the Global Health and Development Group, Imperial College London. He is part of the international Decision Support Initiative (iDSI) overseeing monitoring and evaluation, strategic communications, and managing relationships with iDSI network partners including HITAP and their work in South-East Asia. He has over 10 years’ experience in clinical guidelines and quality improvement, and led on work on hospital quality improvement for stroke and for acute respiratory infections in Vietnam. He led ROAD2H, a research project to develop electronic health data and artificial-intelligence based tools to guide clinical decision making in China and Serbia. He read Experimental Psychology at Oxford University and gained his PhD at University College London.
Panelist
Plenary 3
35
Ryota NakamuraAssociate Professor of Hitotsubashi UniversityRyota Nakamura is an associate professor based in the Hitotsubashi Institute for Advanced Study(HIAS). He also serves as a visiting associate professor at the Institute of Statistical Mathematics. He is an applied microeconomist specialising in health. He holds a BA and an MA in Economics from Kyoto University and a PhD in Economics from the University of York in the UK. Prior to joining Hitotsubashi University in 2016, he held positions at the University of East Anglia and the University of York. His research interests include empirical and theoretical investigations of health-related behavior as well as healthcare systems to inform national and international public health policies, using a wide range of research methods including micro-econometric analysis of observational data(e.g. impact evaluation), economic experiment, modelling, and evidence synthesis.
Kwong Hoe NgPrincipal Head of ACE of Singapore MOHMr Ng is the Principal Head of Evaluation at the Agency for Care Effectiveness (ACE), Ministry of Health (MOH), Singapore. He is an experienced expert in health technology assessment who has a combined career in both public and private sectors in developed and emerging countries across the Asia Pacific, with 20 years of healthcare focused leadership in health economics, market access, pricing, outcomes research and pharmacy services. Since he joined MOH in 2015, his main task was to set up the agency by building capacity and streamlining processes and methodologies. He is currently leading a team of more than 40 staff across multiple work streams including evaluation of drugs and medical technologies, value-based pricing, economic modelling and guidance adoption.
Panelist
Plenary 3
36
Panelist
Plenary 3
Yot TeerawattananonFounder and Senior Researcher of HITAPYot is a founder of HITAP of the Thai Ministry of Public Health and a Visiting Professor at the National University of Singapore. He is co-founder of the HTAsiaLink and the international Decision Support Initiative (iDSI). He has published more than 130 journal articles and provided technical support to countries in Asia and Africa.
Junainah SabirinDeputy Director of MaHTAS, Medical Development Division, Ministry of Health, MalaysiaDr. Junainah Sabirin is the Deputy Director of the Malaysian Health Technology Assessment Section (MaHTAS), Medical Development Division, Ministry of Health, Malaysia. She has been working in MaHTAS for the last 11 years and has been involved in conducting health technology assessment for various types of health technologies as an input to policy or decision making for health technologies especially for facilities under the Ministry of Health, Malaysia. She is currently responsible for the planning, implementation and monitoring of HTA activities including economic evaluation and Value Based Medicine, Horizon Scanning activities, Evidence-based Clinical Practice Guidelines and training. Also has the experience of working in hospital, district health office and Disease Control Division, Ministry of Health, Malaysia.
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DAY 3 Friday 26 April 2019
Oral Session ............................................................................................... 110
Moderator & Commentator .................................................................... 136
Poster Session ........................................................................................... 138
Reviewer ...................................................................................................... 150
Oral Session ................................................................................................. 38
Moderator & Commentator ...................................................................... 89
Poster Session ............................................................................................. 91
Reviewer ...................................................................................................... 109
DAY 2 Thursday 25 April 2019
A b s t r a c t s
Annual Conference24-27 April 2019, Seoul, Korea
38
Economic Evaluation
Time No. Title Country
11:20-11:40 EE01 Cost-utility analysis of direct acting antivirals for treatment of chronic hepatitis C genotype 1 and 6 in Vietnam Vietnam
11:20-11:40 EE02 Costing and Cost-Effectiveness of a mHealth Intervention “ImTeCHO” in improving coverage of maternal, neonatal and child childhealth care in Tribal Areas of Gujarat, India India
11:40-12:00 EE03 Budget impact analysis of nintedanib for treating idiopathic pulmonary fibrosis in Singapore Singapore
11:40-12:00 EE04 Type 2 diabetes in Vietnam: a cross-sectional, prevalence-based cost-of-illness study Vietnam
12:00-12:20 EE05Coronary computed tomography angiography vs.myocardial single photon emission computed tomography in patients with intermediate risk chest pain: a randomized clinical trial for cost-effectiveness comparison based on real-world cost
Republic of Korea
12:00-12:20 EE06 Budget impact analysis of implementing quality standards to improve the quality of antenatal care services in Thailand Thailand
12:20-12:40 EE07 Achieving best value for money in preventing noncommunicable diseases: an analysis of global evidence base and local case studies Japan
12:20-12:40 EE08 Modelling optimal allocation of resources for basal insulin therapy among naïve insulin Type 2 diabetes patients Malaysia
13:30-13:50 EE09 Economic burden of transfusion dependent thalassaemia (TDT) on patient or family of TDT patient in Malaysia: A multicenter study Malaysia
13:30-13:50 EE10 Quality of life and economic burden assessment: Impact and treatment benefit related to eczema Vietnam
13:50-14:10 EE11 Cost-effectiveness of sequenced treatment of chronic gout with urate lowering therapies in Singapore Singapore
13:50-14:10 EE12 Cost-effectiveness Analysis On Malaria Rapid Diagnostic Tests: Based On Real-world Data From China China
14:10-14:30 EE13 Economic Evaluation of Clinical Pathways Management for Cerebral Infarction in Rural Area of China China
ORAL SESSION
DAY 2 Thursday 25 April 2019
39
Economic Evaluation
Time No. Title Country
14:10-14:30 EE14 Economic evaluation of XPERT MTB/RIF for diagnostic pulmonary tuberculosis in Thailand Thailand
14:30-14:50 EE15 Cost-utility analysis of transcatheter aortic valve implantation (TAVI) in aortic stenosis patients in Taiwan Taiwan
14:30-14:50 EE16 Carbetocin versus oxytocin for preventing secondary postpartum hemorrhage in caesarean section in the Philippines Philippines
15:10-15:30 EE17 The role of lifestyle modification in prevention for type 2 diabetes mellitus – an umbrella review Vietnam
15:30-15:50 EE18 Cost-Utility Analysis of Adjuvant Trastuzumab Therapy for Her2-Positive Early Stage Breast Cancer in the Philippines Philippines
15:50-16:10 EE19Screening for Type 2 Diabetes Mellitus: A Cost-effectiveness Analysis of Glycated Hemoglobin with Fasting Plasma Glucose (FPG) as confirmatory test versus FPG with Oral Glucose Tolerance Test as confirmatory test
Singapore
16:10-16:30 EE20 Cost-utility of HPV DNA testing versus colposcopy with biopsy for cervical cancer diagnostic in women with atypical squamous cell of undetermined significant (ASC-US) Thailand
Health System Research
Time No. Title Country
11:20-11:40 HSR01 Revision of the health screening package as part of the Health Insurance Card Scheme for migrants in Thailand Thailand
11:20-11:40 HSR02Diagnostic performance, white coat hypertension, and mask hypertension of clinic and home blood pressure measurements comparing with ambulatory blood pressure measurements: A systematic review and meta-analysis of diagnostic studies
Thailand
11:40-12:00 HSR03 Intrauterine system for dysmenorrhoea: Is it safe and effective? Malaysia
11:40-12:00 HSR04 Endobronchial Valves: Carving a new treatment path for patients with severe emphysema in Malaysia Malaysia
12:00-12:20 HSR05 Innovative UV light based imaging tools to improve hand hygiene compliance: A systematic review and meta-analysis of current literature India
ORAL SESSION
DAY 2 Thursday 25 April 2019
40
Health System Research
Time No. Title Country
12:00-12:20 HSR06 Comparison of prices and reimbursem*nt status of patented cancer drugs in Singapore versus overseas countries Singapore
12:20-12:40 HSR07 Appropriate health technology listing in China: exploring an multi-criteria decision analysis (MCDA) based priority setting framework China
12:20-12:40 HSR08 The situation of Emergency Medical Services associated with falls in the elderly in Thailand: Policy Recommendation Thailand
13:30-13:50 HSR09 Priority Setting for Health Technology Assessment (HTA) and Health Care Decision Making in Malaysia Malaysia
13:30-13:50 HSR10 A review and assessment of health service planning in Thailand Thailand
13:50-14:10 HSR11 Role of Health Technology Assessment in the development of the Universal Coverage Scheme Benefits Package in Thailand Thailand
13:50-14:10 HSR12 Real world data to overcome HTA barriers to access to orphan medicines Republic of Korea
14:10-14:30 HSR13 Stroke-related risk factors analysis on type-2 diabetes mellitus patients in China China
14:10-14:30 HSR14 Evaluation of the medical device adverse events monitoring: based on national adverse event reports in China China
14:30-14:50 HSR15 Evidence for diagnostic accuracy of blood glucose detection tests for type 2 diabetes and pre-diabetes India
14:30-14:50 HSR16 The role of HTA in the development of the National List of Essential Medicines in Thailand Thailand
15:10-15:30 HSR17 Cost Analysis Study of Key Population Interventions to Fast Track the End of HIV in Thailand Thailand
15:10-15:30 HSR18 The current situation of preventive interventions for falls and dementia in community-dwelling Thai elderly: A mail survey Thailand
15:30-15:50 HSR19 Cancer Treatment: Is there a role for non-pharmacological interventions? Malaysia
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41
Health System Research
Time No. Title Country
15:30-15:50 HSR20 High-Cost Technologies in the Asia Region Australia
15:50-16:10 HSR21 HTA-informed decisions on optimizing the national essential public health package in China China
15:50-16:10 HSR22 The Effectiveness of Dabigatran, Rivaroxaban and VKA in patients with non-valvular atrial fibrillation (NVAF) using National insurance Claim Database in Japan Japan
16:10-16:30 HSR23 Impact of physical rehabilitation in advanced cancer patients Republic of Korea
16:10-16:30 HSR24 An Analysis of the Procurement Process and Prices of Medical Devices and Equipment Procured by Department of Health Hospitals in the Philippines in 2017 Philippines
Other
Time No. Title Country
15:10-15:30 Other01Cost effectiveness of sodium-glucose cotransporter 2 inhibitors in the treatment of metformin mono-therapy failed type 2 diabetes patients: a systematic review and meta-analysis of cost utility analyses
India
15:30-15:50 Other02 Systematic Review of Tolvaptan for the Treatment of Non-hypovolemic Hyponatremia Philippines
15:50-16:10 Other03 Integrated sensor augmented pump therapy (SAP) in patients with type 1 diabetes Singapore
16:10-16:30 Other04
Applying multiple-criteria decision analysis (MCDA) to evaluation of new medicines: reimbursem*nt decision on treatment options of locally advanced and metastatic non-squamous cell lung cancer in patients with wild-type EGFR and ALK after platinum-containing chemotherapy
Taiwan
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42
EE01
Cost-utility analysis of direct acting antivirals for treatment of chronic hepatitis C genotype 1 and 6 in Vietnam
Ong The Due1,2, Ammarin Thakkinstian1,3, Abhasnee Sobhonslidsuk4, Nguyen Khanh Phuong2, Montarat Thavorncharoensap1,5, Usa Chaikledkaew1,5
1 Health Technology Assessment (HTA) Postgraduate Program, Mahidol University;2 Health Strategy and Policy Institute, Vietnam Ministry of Health; 3 Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University; 4 Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University; 5 Social and Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University
OBJECTIVEVietnam’s Ministry of Health is currently revising the national health insurance drug list. Numerous new drugs such as Direct-Acting Antivirals (DAAs) for chronic hepatitis C treatment were proposed by many provincial departments of health and hospitals to be included. As current regulation requires cost-effectiveness evidence before inclusion, this study was conducted to generate evidence to inform policy makers whether DAAs should be included into the drug list.
METHODS A Markov model adapted from a published study was employed to compare costs and quality-adjusted life years (QALYs) of three proposed DAAs regimens including 1) Sofosbuvir/Ledipasvir (SOF/LDV), 2) Sofosbuvir+Daclatasvir (SOF+DCV), and 3) Grazoprevir/Elbasvir (GZR/EBR), with standard treatment, Pegylated-interferon+Ribavirin (PegIFN+RBV). Health-state transition probabilities were derived from relevant literatures, while virological responses were estimated from meta-analyses. A survey was conducted in Vietnam’s hospitals to identify costs and utility values. Analysis were conducted using societal perspective and incremental cost-effectiveness ratio (ICER) was presented as Vietnamese Dong per QALY gained. Uncertainty of parameters was investigated using one-way and probabilistic sensitivity analyses.
RESULTSThree DAAs regimens were found to have negative ICER values compared to PegIFN+RBV regimen, suggesting higher outcomes but lower costs. The parameters which caused high uncertainty were virological responses and transition probabilities. Additionally, the cost-effectiveness plane showed dominance of all three DAAs regimens compared with PegIFN+RBV, while the cost-effectiveness acceptability curves showed high cost-effectiveness of all three DAAs over PegIFN+RBV for all willingness to pay values.
DISCUSSION AND CONCLUSIONSCompared with the standard treatment, all three DAAs regimens were found to have superior clinical efficacy and cost-effectiveness. If treatments are given at early stage of chronic hepatitis C’s progression, it could potentially decrease complications and deaths from compensated cirrhosis, decompensated cirrhosis and hepatocellular carcinoma. It is therefore recommended to include DAAs regimens in the national health insurance drugs list of Vietnam.
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43
EE06
Budget impact analysis of implementing quality standards to improve the quality of antenatal care services in Thailand
1Phorntida Hadnorntun, 1Roongnapa Khampang, 1Suthasinee Kumluang, 1,2Thunyarat Anothaisintawee, 1Sonvanee Uansri, 1Sarayuth Khuntha, 1Yot Teerawattananon, and 1Sripen Tantivess1 Health Intervention and Technology Assessment Program, Thailand2 Mahidol University, Faculty of Medicine, Ramathibodi Hospital, Thailand
OBJECTIVEQuality standards (QS), a concise set of evidence-informed quality statements, were developed to improve the quality of antenatal care services in Thailand. This study aimed to assess the budget impact of implementing the QS.
METHODS Nine hospitals in the north, northeast, central, and south regions of Thailand were chosen based on performance in delivering antenatal care services. Twenty-six perinatal nurses were interviewed using a structured questionnaire to estimate the cost of providing services to prevent preterm labor, pre-eclampsia, and postpartum hemorrhage as described in the QS. The average cost of providing antenatal care services per patient was calculated using the ingredients-based method. The cost of providing antenatal care services at each hospital level and the number of high-risk pregnancies were used to calculate the overall budget impact of implementing the QS at the national level.
RESULTSThe average cost of providing services per patient was 8,057 baht (USD 245) for hospitals at second and third referral level and 9,489 baht (USD 288) for first-level referral and health-promoting hospitals. The overall budget impact of implementing the QS was approximately 3 billion baht in 2018 (USD 92 million).
DISCUSSION AND CONCLUSIONSSignificant financial impact of implementing the QS to prevent preterm labor, pre-eclampsia, and postpartum hemorrhage was found. Nevertheless, considering that better quality of services could save lives and resources in the long run, it may be reasonable to implement the QS.
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44
EE07
Achieving best value for money in preventing noncommunicable diseases: an analysis of global evidence base and local case studies
1Arisa Shichijo, 2 Tazeem Bhatia, 3Ryota Nakamura1 Hitotsubashi University, Japan 2 Public Health England, United Kingdom
OBJECTIVEWorld Health Organization introduced a concept of “best buy” policy interventions for noncommunicable diseases (NCDs), primarily based on global cost-effectiveness evidence, to provide decision makers in low and middle income countries (LMICs) with guidance of priority setting for preventive policies. However, scarcity of local evidence, coupled with contextual factors for implementation, still cast great uncertainty for decision makers in those countries. The objective of this study was to systematically assess an evidence base of interventions for NCD prevention, and to analyze contextual and conductive factors underpinning successful implementation of “best buy” policies.
METHODS First, we assessed characteristics and geographical distribution of evidence on population interventions for NCD prevention, from the Global Health Cost Effectiveness Analysis Registry, containing 4,494 evidence from cost-effectiveness analyses. Second, we analyzed 54 case studies of NCD preventive policies which we collected from policy makers and researchers from LMICs.
RESULTSWe found very limited evidence of cost effectiveness for NCD preventions, even for widely popular interventions such as taxation on tobacco and sugar sweetened beverages. For smoking control policies, we found evidence of “best buy” interventions in six regions (with country-specific studies only from 2 countries, Tanzania and Vietnam). Similarly, for alcohol control policies, we found evidence in one region and four (higher income) countries (Australia, Denmark, Mexico and the Netherlands). From the case studies of NCD prevention, we identified key contextual issues and factors for policy practice, including: evidence, relevance, leadership, governance, compliance, sustainability, multisectoral collaboration, community involvement and ethics.
DISCUSSION AND CONCLUSIONSOur results show that cost effectiveness as a single measure is unlikely to be sufficient for achieving allocative efficiency through implementing “best buy” policies for NCD prevention. Contextual factors and the process of implementation are crucial and key sources of uncertainty for policy makers, particularly when local evidence of cost effectiveness is scarce or even unavailable.
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45
EE08
Modelling optimal allocation of resources for basal insulin therapy among naïve insulin Type 2 diabetes patients
Asrul Akmal Shafie1, Chin Hui Ng1
1 Discipline of Social & Administrative Pharmacy, School of Pharmaceutical Sciences, 11800 Universiti Sains Malaysia, Penang, Malaysia
OBJECTIVETo determine the optimum allocation of insulin glargine among patients with Type 2 Diabetes Mellitus (T2DM) within a fixed budget.
METHODS The study divided T2DM patients based on age (younger than 40, between 40 and 60, and older than 60). Each age group was then divided by the HbA1c level (less than 8%, between 8% and 10%, and greater than 10%). A discrete event simulation model was used to estimate the costs and outcomes of the different subgroups of patients with T2DM. Then, the results were fed into an optimization model to determine the optimum allocation that is subject to varied and equity constraints.
RESULTSIf insulin glargine was replaced NPH insulin as default basal insulin regimen, at least RM5 million of drug cost may be needed, but a patient may be gained an additional 0.0096QALY gained over the lifetime when compared to the NPH insulin. A 10% increase of the basal insulin treatment budget and it equally allocating according to the size of each subgroup allowed 284 patients to use insulin glargine (+0.17QALY gained per year) after diminishing the cost of managing diabetes-related complications. If a similar budget allocated only for the subgroup with highest additional QALY gained, then the number of patients eligible to use insulin glargine may drop to 277 (+0.78QALY gained per year) but this method provided highest benefits gained. The additional budget, focused on the subgroup that has the lowest additional acquisitions cost, can increase the number of patients eligible to use insulin glargine to 287, but it provided the lowest additional QALY gained (+0.02).
DISCUSSION AND CONCLUSIONSDifferent allocation methods may influence the number of eligible patients and the total additional QALY can be gained. The decision maker must determine how close they would like to actualize the maximum QALY level while leveraging the health care system.
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46
EE09
Economic burden of transfusion dependant thalassaemia (TDT) on patient or family of TDT patient in Malaysia: A multicenter study
1Asrul Akmal Shafie, 1Jacqueline Wong Hui Yi, 1Syahireen Mohammed, 1Irwinder Kaur, 2Hishamshah Mohd Ibrahim1 Discipline of social and administration pharmacy, school of pharmaceutical science, Universiti Sains Malaysia 2 Institute of paediatric, Hospital Kuala Lumpur, Ministry of Health Malaysia
OBJECTIVEThalassaemia is a common genetic disorder in Malaysia where the mainstay of supportive treatment is regular blood transfusion accompanied with iron-chelating therapy (ICT). Transfusion dependent thalassaemia (TDT) is defines as patient who requires blood transfusion m ore than 100mL/Kg in a year. There are more than 4000 patients in Malaysia who are suffering from TDT, however there is limited data available on economic burden of this disease. Therefore, this study is designed to determine the economic burden of disease on patient and family of TDT children.
METHODS A cross-sectional survey was conducted by using convenient sampling method in 12 thalassaemia centers covering all regions in Malaysia. TDT patients/family members of TDT patients who were on ICT at age 2 years and above were approached and recruited during blood transfusion visit at respective thalassaemia center. The sample size required for this study was 357 with the margin error of 5% and 95% confidence level in TDT population size in Malaysia. TDT health utilisation survey was completed by interviewing respondent by trained research assistant. The survey form consists of 5 sections which are patient socio-demographic, medical history, patient and family resource used, productivity losses and transportation cost.Descriptive statistic will be used to summarise the dependent and independent variables. Distribution of the cost data will be further investigated and apply appropriate statistical methods to address skewness, excess zeros, multimodality or heavy right tails. Stepwise multiple regression analysis will be employed to analyse the relationship between cost (dependent variables) and potential predictor variables (independent variables).
POTENTIAL IMPACTBased on our knowledge, we have not found any economic burden study of thalassaemia employing patient specific cost data covering indirect costs in Malaysia. From this study, we will be able to identify the potential predictor variables which increase the financial burden on patient and family. By estimating the financial burden on patient and family, the overall cost of thalassaemia management in Malaysia can be established. The result will be used to inform decision maker to formulate and prioritise healthcare policies and interventions within the budget constraints to achieve policy efficiency.
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47
EE12
Cost-effectiveness Analysis On Malaria Rapid Diagnostic Tests: Based On Real-world Data From China
Du Yan-qiu1, Cao Jun2, Huang Jia-yan1
1 Key Lab of Health Technology Assessment (Ministry of Health); School of Public Health, Fudan University, China2 Jiangsu Institute of Parasitic Diseases, WHO Collaborating Centre for Research and Training on Malaria Elimination
OBJECTIVERDT is a potential alternative to microscopy since the former is easier to operation, and require limited training. There are many studies focusing on the effectiveness evaluation of RDT in moderate or high endemic areas, while few researches pay attention to the economic value of RDT, especially under the elimination phase, like China. Our study aims to fill in this gap.
METHODS A decision tree model was constructed for three malaria diagnostic strategies (microscopy, RDT, series test of RDT and microscopy). The CEA was conducted from health sector and patient perspective. Data collection was conducted in Jiangsu Province from 2016-2018, and the indicators including the necessary cost of patients, the cases that be diagnosed correctly, prevalence, and so on. A cohort of 300,000 febrile patients entered the decision model to simulate the diagnostic trajectory over a year and calculate incremental cost-effectiveness ratio (ICER). Univariate sensitivity analysis was conducted to test the robustness of the results.
RESULTSThere were little differences of effectiveness between microscopy (252 case), RDT (245 case) and series test (233 case). But the cost per confirmed malaria case was lower in RDT (US$7,912) than microscopy (US$12,018) and series test (US$8,294). Compared with RDT, microscopy diagnosed more cases with an ICER of US$155,135 per confirmed malaria case. Even considering 20 percent increase in RDT kit cost, the result of univariate sensitivity analysis show that RDT is still a cost-effective option. The results of CEA were not sensitive to antimalarial drug costs, even taking a 20-percent variation into account. Moreover, transportation expense paid by patients to see a doctor is a significant factor to affect the total cost of diagnosis strategy.
DISCUSSION AND CONCLUSIONSImplementing RDT in the elimination phase is a cost-effective way contributing to the malaria control.
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48
EE13
Economic Evaluation of Clinical Pathways Management for Cerebral Infarction in Rural Area of China
Guo Wudong, Kun Zhao, Li Xue, Wang Yaoling1 China National Health Development Research Center
OBJECTIVEOngoing reforms to China’s county-level public hospitals have generated an interest in developing evidence-based clinical pathways (CP). A pilot project in four counties has been embarked, linked with payment reform on cerebral infarction inpatient subjects. This study aimed to understand the impacts of the CP comprehensive intervention on treatment effectiveness and the use of resources.
METHODS A retrospective observational study was conducted using de-identified data collected from four pilot sites. A mixed-methods approaches have been adopted to process the data analysis, including propensity score matching (PSM), interrupted time series (ITS) with segmented regression, and cost-effectiveness analysis (CEA). Prior to ITS analysis, the PSM was employed to ensure the similarity of baseline characteristics between pre and post groups. Then ITS analysis has been performed to describe the overall effects of the intervention on pre-defined outcomes. Afterwards, a CEA analysis has been developed using Markov model with the help of Tree-age software, to calculate the incremental cost effectiveness ratio(ICER). Meanwhile, the probability sensitivity analysis (PSA) was performed to testify the influential factors.
RESULTSOut of 2753 patients, 765 subjects were included after using the nearest neighbor PSM for age, gender, severity of disease, number of complications. The ITS analyses results showed that the advantage of CP intervention in term of average length of stay, total hospitalization expenses, medication costs, laboratory expenses, and quality-adjusted life years (QALY) estimated by EQ-5D. The ICER was 16756 RMB/QALY, which favored the choice of CP intervention compared to threshold. The PSA analysis showed that age, the number of days in hospital, and admittance of CP are the top three influential factors in sensitivity analysis.
DISCUSSION AND CONCLUSIONSThe evaluation findings and lessons learned from the pilots were widely discussed and disseminated to policy-makers to enable evidence-based decision-making for CP implementation in rural China.
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49
EE15
Cost-utility analysis of transcatheter aortic valve implantation (TAVI) in aortic stenosis patients in Taiwan
1Yueh-Lung Peng, 2Churn-Shiouh Gau1 Center for Drug Evaluation, Taiwan2 Center for Drug Evaluation, Taiwan
OBJECTIVETranscatheter aortic valve implantation (TAVI) is considered as an alternative treatment on aortic stenosis patients with very high risk or who are inoperable. The aim of this study was to evaluate the cost effectiveness of TAVI in Taiwan.
METHODS A probabilistic Markov decision model was developed to compare the cost and quality-adjusted life years (QALYs) between TAVI and medical management (MM) on inoperable patients. This model was performed from the perspective of National Health Insurance in Taiwan over a 3-year time horizon. The cost included direct medical costs such as procedural, medical devices, hospitalization, and complications-related costs. The utility parameters were collected by using time trade-off (TTO) method. Discounting rate applied for both costs and QALYs was 3%.
RESULTSThe incremental cost for TAVI was $50,676, and the incremental benefit was about 0.5019 QALYs.The incremental cost-effectiveness ratio (ICER) for TAVI compared with MM was $100,974/QALY. The ICER is more than 3 times GDP in Taiwan ($62,000) which indicated that TAVI was not cost-effectiveness among these inoperable patients.
DISCUSSION AND CONCLUSIONSThe base-case analysis showed that TAVI was not cost-effectiveness comparing with MM in this 3-year model. However, the valve systems of TAVI have not been reimbursed in Taiwan yet and the cost of this medical device was much higher than MM. We excluded the cost of the valve systems as a scenario analysis. The ICER was $18,146/QALY and TAVI became a cost-effectiveness treatment for these inoperable patients.
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EE16
Carbetocin versus oxytocin for preventing secondary postpartum hemorrhage in caesarean section in the Philippines: A Markov model analysis
Jamaica Roanne Briones1 , Usa Chaikledkaew1,2, Pattarawalai Talungchit1,3, Montarat Thavorncharoensap1,2
1 Health Technology Assessment (HTA) Postgraduate Program, Mahidol University; 2 Social and Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University;3 Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Mahidol University
OBJECTIVEOne of the most common causes of maternal death in developing countries is postpartum hemorrhage (PPH), but studies exploring secondary PPH are uncommon. Recent network meta-analysis on uterotonic drugs for PPH prevention found that carbetocin is more efficacious that than oxytocin, however, it is more expensive (1,733 PHP) compared to oxytocin (76.92 PHP), with limited evidence on cost-effectiveness of its use. While previous economic evaluation studies suggest cost-effectiveness of carbetocin, these were from different income levels and focus on primary PPH. Therefore, we aimed to evaluate the cost-utility of carbetocin versus oxytocin in preventing secondary PPH caused by uterine atony in the Philippines.
METHODS We constructed a Markov model to estimate the cost-utility of carbetocin versus oxytocin to prevent secondary PPH by uterine atony in women undergoing cesarean delivery based on governmental perspective in a one-year time horizon. Transition probabilities and utility values were obtained from meta-analysis and relevant published studies. Moreover, cost items were identified through focused group discussions and unit costs were obtained from local and international published studies. The incremental cost-effectiveness ratio (ICER) was expressed as PHP per QALY gained. One-way and probabilistic sensitivity analyses were also applied to evaluate uncertainty of parameters.
RESULTSWe found carbetocin to be cost-effective for both deterministic (ICER= 87,516 PHP per QALY) and probabilistic results (ICER= 96,894 PHP per QALY), using a threshold of PHP 120,000 per QALY gained. In addition, carbetocin was considered dominant in 68.2% of the scenarios.
DISCUSSION AND CONCLUSIONSCarbetocin was found to be cost effective in the prevention of secondary PPH and could potentially lessen incidence of PPH events. However, further studies on parameters that causes variability such as utility values should be done before decisive conclusions.
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EE16
Economic evaluation of carbetocin as prophylaxis against postpartum hemorrhage in Cesarean Section in the Philippines
J.R. Briones1, P.Talungchit1,2, M. Thavorncharoensap1,3 , U. Chaikledkaew1,3
1 Health Technology Assessment (HTA) Postgraduate Program, Mahidol University;2 Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University;3 Social and Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University;
The corresponding author: Usa Chaikledkaew, [emailprotected]
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DAY 2 Thursday 25 April 2019
Proceeding Article
ABSTRACT
ObjectiveWe assessed the cost-effectiveness of carbetocin compared with oxytocin for the prevention of PPH caused by uterine atony in women undergoing elective Cesarean Section (CS) in the Philippines.
MethodsA decision-tree model was constructed to estimate the cost-utility of carbetocin versus oxytocin using the government’s perspective in a one-year time horizon. Using relevant input values, we computed the Incremental cost-effectiveness ratio (ICER), expressed as PHP per QALY gained. One-way and probabilistic sensitivity analyses were done to evaluate uncertainty of parameters.
ResultsCarbetocin was found to be cost-effective for both deterministic (ICER= 44,807 PhP/QALY) and probabilistic results (ICER=21,678.15 PhP/QALY gained), using a threshold of PHP 155,114 per QALY gained (1 GDP). In addition, carbetocin was considered dominant in 68.2% of the scenarios in the Monte-Carlo simulation.
Discussion and ConclusionCarbetocin demonstrates potential cost-effectiveness in preventing PPH, however, one-way sensitivity analysis shows that costs of the two drugs and the utility of bleeding patients cause greatest variability in ICER which limits us to have strong conclusions. As such, we recommend further studies on uncertain parameters before final recommendation.
KEYWORDScost utility analysis, carbetocin, oxytocin, postpartum hemorrhage, modelling
1. INTRODUCTION In the Philippines, 114 maternal deaths per 100,000 live births were noted for 2015, 30% of which were reportedly due to hemorrhage1.
The major cause of postpartum hemorrhage (PPH) is uterine atony – its prevention, consequently, would be critical to achieve progress to reduce PPH2.
Oxytocin is currently the country’s drug of choice as prophylactic uterotonics drug. However, given the short duration of the drug, multiple doses are usually needed. Another disadvantage is its need to be kept out from heat exposure3. Carbetocin, an alternative uterotonic drug, is explored to address these disadvantages.
Recent network meta-analysis on uterotonic drugs for PPH prevention found that carbetocin is efficacious than oxytocin4, however, it is more expensive (933 PHP) compared with oxytocin (76.92 PHP)5 with limited evidence on cost-effectiveness. With this, we explored the cost-effectiveness of carbetocin compared with oxytocin for the prevention of PPH by uterine atony in women undergoing elective cesarean section (CS).
52
2. METHODS We constructed a decision tree model to compare carbetocin with oxytocin as an alternative prophylactic uterotonic drug for PPH in
women undergoing elective CS in the third stage labor. In this evaluation, costs calculated based on the government’s perspective in Philippine peso were not discounted since we consider a one-year time horizon.
For the efficacy data, we referred to the network meta-analyses4, while transition probabilities and utility values were derived from relevant published studies5-8.To estimate costs, we referred to medical case rates reimbursed by Philhealth9, and Philippine Drug Price Reference Index10. We also performed univariate and probabilistic sensitivity analysis to measure uncertainties around the parameters.
3. RESULTS Both ICERs computed through deterministic (44,807 PhP/QALY gained) and probabilistic (21,678.15 PhP/QALY gained) process were
found to be both below the 1 GDP per capita threshold at 155,114 PHP.
Figure 2. Cost-effectiveness plane for the comparison of carbetocin (blue) versus oxytocin (red)
In the Monte-carlo simulation (Figure 2), it shows that carbetocin is more effective than oxytocin in 66.4% of scenarios, and is dominant choice in 23.5% of the scenarios. Univariate analysis revealed that ICER is most sensitive to changes in cost in: (1) carbetocin prophylactic dose, (2) oxytocin prophylactic dose, (3) oxytocin additional dose ,(4) carbetocin additional dose, (5) utility of patients with hemorrhage.Meanwhile, computing threshold sensitivity analysis shows that a price ceiling ratio of greater than 60,000 PHP would make the ICER of carbetocin equivalent to oxytocin. This ceiling ratio is less than the computed threshold for the ICER in the Philippines (155,114 PHP).
4. DISCUSSION Deterministic and probabilistic result of the analytic model using point estimates reflect that the ICER of carbetocin was below the
willingness-to-pay threshold, suggesting that carbetocin is a cost-effective prophylaxis for PPH. However in the cost-effectiveness plane (Figure 2), more than 30% of the scenarios is not considered cost effective and should be of
concern. Another point is that the one-way sensitivity analysis illustrates that the data used in the model – such as the costs and the utility values –poses uncertainty and should be further explored. Despite these uncertainties, it would be worthwhile to perform further studies to have a strong conclusion on the cost-effectiveness of carbetocin.
5. CONCLUSIONS The study shows potential of the cost-effectiveness of carbetocin compared with oxytocin. The results of this model could help improve
on management of PPH, but further work is needed. Studies should be conducted regarding the uncertain parameters such as the costs and the utility to conclusively inform practice. It is also suggested that a societal perspective should be pursued to better estimate costs.
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ACKNOWLEDGEMENTSThis work is a part of training in Health Technology Assessment (HTA)'s MSc degree, scholarship provided by Mahidol University and the International Decision Support Initiative (iDSI). It was produced as part of the International Decision Support Initiative (www.idsihealth.org), which supports countries to get the best value for money in health spending. iDSI receives funding support from the Bill & Melinda Gates Foundation, the UK Department for International Development, and the Rockefeller Foundation. The findings, interpretations and conclusions expressed in this article do not necessarily reflect the views of the aforementioned funding agencies.Conflict of interests: The authors declare that they have no conflict of interest
REFERENCES1. Philippine Statistics Office. MDG Watch as of May 2016 [internet]. Manila, Philippines; 2017 Feb [cited 2019 Apr 1]. Available from:
https://psa.gov.ph/sites/default/files/kmcd/MDG%20Watch%20as%20of%20May2016.pdf2. McDonald S. Management of the third stage of labor. J Midwifery Womens Health. 2007;52(3):254-61.3. Theunissen FJ, Chinery L, Pujar YV. Current research on carbetocin and implications for prevention of postpartum haemorrhage. Reprod
Health. 2018;15(Suppl 1):94.4. Gallos ID, Williams HM, Price MJ, Merriel A, Gee H, Lissauer D, et al. Uterotonic agents for preventing postpartum haemorrhage: a
network meta-analysis. Cochrane Database Syst Rev. 2018;4:CD011689.5. Department of Health. The Philippine Drug Price Reference Index. 5th ed. Manila, Philippines: Department of Health; 2018.6. Uy DL, Pangilinan NCP, Ricero-Cabingue, C. Carbetocin versus Oxytocin for the Prevention of Postpartum Hemorrhage Following
Elective Cesarean Section: Rizal Medical Center Experience. Philippine Journal of Obstetrics and Gynecology. 2013;37(2):71-9.7. Dr. Jose Fabella Memorial Hospital. Annual Health Facility Statistical Report. Manila, Philippines: Department of Health; 2016.8. Kohler S, Sidney AK, Diwan V, Lindholm L, Randive B, Vora K, et al. Postpartum quality of life in Indian women after vagin*l birth and
cesarean section: a pilot study using the EQ-5D-5L descriptive system. BMC Pregnancy Childbirth. 2018;18(1):427.9. Lim G, Melnyk V, Facco FL, Waters JH, Smith KJ. Cost-effectiveness Analysis of Intraoperative Cell Salvage for Obstetric Hemorrhage.
Anesthesiology: The Journal of the American Society of Anesthesiologists. 2018;128(2):328-37.10. Philhealth. List of Medical Case Rates [internet]. Manila, Philippines; 2017 Feb [cited 2019 Apr 1]. Available from: https://www.philhealth.
gov.ph/circulars/2017/annexes/0019/AnnexA-MedicalCaseRates.pdf
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EE17
The role of lifestyle modification in prevention for type 2 diabetes mellitus – an umbrella review
Phung Lam Toi1,2, Thunyarat Anothaisintawee1,3, Usa Chaikledkaew1,4, Jamaica Roanne Briones1, Ammarin Thakkinstian1,5
1 Health Technology Assessment Postgraduate Program, Mahidol University; 2 Health Strategy and Policy Institute, Ministry of Health;3 Department of Family Medicine, Ramathibodi Hospital, Mahidol University;4 Social Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University;5 Section for Clinical Epidemiology and Biostatistics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
OBJECTIVEAlthough evidences indicated the benefits of lifestyle modifications (LSM), many modalities were available, facing difficulty for healthcare providers in applying to their patients. Therefore, this umbrella review was done to synthesize all available evidences on LSM in prevention of type 2 diabetes (T2DM).
METHODS A systematic literature search using PubMed and Scopus was performed. Two independent reviewers selected studies based on following criteria: Studies were systematic review and meta-analysis (SRMA), assessed any effect of LSM interventions including diet, physical activity (PA), or combination of diet and PA, had the outcome as T2DM. Data extraction was done by two independent reviewers. Results of SRMA were described, corrected covered area (CCA) was applied to measure the degree of overlapping among previous SRMA.
RESULTSAmong 70 eligible SRMAs, 66/70 studies had low credibility with moderately overlapping with the CCA of 6% to 10%. SRMA of diet and PA were mainly (48/70) based on cohort studies in general population. Their results indicated that dietary patterns (i.e. Mediterranean diet, and diet with low glycemic index) inversely associated with T2DM with the pooled-RR (95% CI) of 0.73 (0.65-0.83) to 0.87 (0.82-0.93). All types of PA (i.e. high, moderate, low, and increased occupational PA) were protective effects in T2DM prevention with the pooled-RR of 0.49(0.32-0.74) to 0.83 (0.75-0.91). A total of 11 out of 70 SRMA included only randomized controlled trials (RCTs) to assess effects of combined diet and PA in risk people. They found that combined diet and PA were effective in T2DM prevention with the pooled-RR of 0.35 (0.14-0.85) to 0.65 (0.56-0.74).
DISCUSSION AND CONCLUSIONSEvidences from SRMA of RCTs suggested that combined diet and PA have high effects on T2DM prevention. Mono-intervention such as dietary control/pattern showed little imprecise effects on T2DM prevention. None of SRMA considered triplet-intervention, further updated SRMA is needed.
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Cost-utility analysis of adjuvant trastuzumab therapy for HER2-positive early breast cancer in the Philippines
Anne Julienne Genuino1, Usa Chaikledkaw1,2, Ammarin Thakkinstian1,3, Thanyanan Reungwetwattana4
1 Health Technology Assessment (HTA) Postgraduate Program, Mahidol University2 Social and Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University;3 Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University;4 Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University
OBJECTIVECurrent clinical guidelines recommend trastuzumab for HER2-positive early breast cancer (EBC) patients in the adjuvant settings. However, the accessibility of trastuzumab to many patients in the Philippines remains to be challenging because of its high cost. This study aims to assess the cost-effectiveness and budget impact of adjuvant trastuzumab therapy for HER2-positive EBC patients in the Philippines for policy decision-making whether trastuzumab should be nationally covered and implemented.
METHODS A Markov model-based cost-utility analysis and budget impact analysis were conducted to estimate the total costs incurred and quality-adjusted life years (QALYs) gained in using one year of adjuvant trastuzumab in addition to standard chemotherapy compared to standard chemotherapy regimen alone, over a lifetime horizon at 3.5% discounting rate per annum, applying a publicly-funded healthcare system perspective. The input parameters were sourced from local and international published data. One-way and probabilistic sensitivity analyses were performed to investigate parameters’ uncertainties. The results were presented as the incremental cost-effectiveness ratio (ICER) compared to the country cost-effectiveness threshold of one times GDP per capita (i.e., Philippine Peso [PHP] 120,000 QALY gained).
RESULTSOur findings showed that shifting to adjuvant trastuzumab therapy in addition to standard chemotherapy shall marginally yield outcomes with additional 1.09 QALYs compared to using standard chemotherapy. Every unit of QALY will incur additional cost of PHP 583,867. Implementing this therapy on a national scale will cost the government a total of PHP 13.78 billion in year one alone, plus about PHP 3 billion annually for the succeeding fiscal years.
DISCUSSION AND CONCLUSIONSOne year of adjuvant trastuzumab therapy in addition to the standard chemotherapy for HER2-positive EBC is not cost-effective in the Philippines, at the current country cost-effectiveness threshold. The current cost of trastuzumab therapy will have to significantly lower down by about one-half to achieve cost-effectiveness.
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Cost-utility analysis of adjuvant trastuzumab therapy for HER2-positive early-stage breast cancer in the Philippines
Anne Julienne Genuino1,2, Usa Chaikledkaew1,3, Anna Melissa Guerrero2, Ammarin Thakkinstian4, Thanyanan Reungwetwattana5
1 Health Technology Assessment (HTA) Postgraduate Program, Mahidol University, Thailand2 Pharmaceutical Division, Department of Health Philippines, Manila, Philippines3 Social and Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University,
Thailand4 Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Thailand5 Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand
Corresponding author: Usa Chaikledkaew, Ph.D., [emailprotected]
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Proceeding Article
Abstract
ObjectiveCurrent clinical guidelines recommend trastuzumab for HER2-positive early breast cancer (EBC) patients in the adjuvant settings. However, the accessibility of trastuzumab to many patients in the Philippines remains to be challenging because of its high cost. This study aims to assess the cost-effectiveness and budget impact of adjuvant trastuzumab therapy for HER2-positive EBC patients in the Philippines for policy decision-making whether trastuzumab should be nationally covered and implemented.
MethodsA Markov model-based cost-utility analysis and budget impact analysis were conducted to estimate the total costs incurred and quality-adjusted life years (QALYs) gained in using one year of adjuvant trastuzumab in addition to standard chemotherapy compared to standard chemotherapy regimen alone, over a lifetime horizon at 3.5% discounting rate per annum, applying a publicly-funded healthcare system perspective. The input parameters were sourced from local and international published data. One-way and probabilistic sensitivity analyses were performed to investigate parameters’ uncertainties. The results were presented as the incremental cost-effectiveness ratio (ICER) compared to the country cost-effectiveness threshold of one times GDP per capita (i.e., Philippine Peso [PHP] 120,000 QALY gained).
ResultsOur findings showed that shifting to adjuvant trastuzumab therapy in addition to standard chemotherapy shall yield additional 1.09 QALYs compared to using standard chemotherapy. Every unit of QALY will incur additional cost of PHP 583,867. Implementing this therapy on a national scale will cost the government addtional PHP 13.9 billion in year one alone, plus about PHP 3 billion annually for the succeeding fiscal years. Discussion and conclusions: One year of adjuvant trastuzumab therapy in addition to the standard chemotherapy for HER2-positive EBC is not cost-effective in the Philippines, at the current country cost-effectiveness threshold. The current cost of trastuzumab therapy will have to significantly lower down by about one-half to achieve cost-effectiveness.
Keywordstrastuzumab, cost-utility analysis, breast cancer, HER2-positive
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BACKGROUND Breast malignancy is currently the globally leading female cancer1. In the Philippines, it is the most prevalent cancer and the most common cause of female cancer deaths 2. About 15 to 20% of breast cancers overexpresses human epidermal growth factor receptor-2 (HER2) 3 – a more aggressive subtype of breast cancer 4. Both global 5, 6 and national clinical guidelines 7 recommend trastuzumab with chemotherapy regimens as treatment for HER2-positive EBC in adjuvant settings. Despite various policy access enablers, it remains to be costly and inaccessible in the Philippines. Therefore, we conducted this economic evaluation to assess the cost-effectiveness and budget impact of trastuzumab therapy in the Philippines, to guide coverage decisions.
METHODS We conducted a cost-utility analysis (CUA) using a five-state Markov model to calculate the costs and utilities of using one year of adjuvant trastuzumab with standard chemotherapy (i.e., doxorubicin - cyclophosphamide - docetaxel) versus chemotherapy alone. The cohorts were 50-year old women with HER2-positive EBC, modelled over a lifetime horizon using a publicly-funded healthcare system perspective, with a discounting rate of 3.5% per year applied to costs and outcomes. We measured the incremental cost-effectiveness ratio (ICER) as Philippine Peso (PHP) per Quality-adjusted life year (QALY) gained, and used the cost-effectiveness (CE) threshold value of PHP 120,000 per QALY gained. Threshold and budget impact analyses were also conducted. It was assumed in this model that: cycle length is one year; patients who progress to congestive heart failure (CHF) can only experience it once; cohort does not have any baseline co-morbidities; and use of hormonal therapies were not considered. The data sources for the baseline transition probabilities (TPs) were a retrospective pre-collected local data 8 and published literature 9, 10. We conducted a systematic review and meta-analysis of published trials 11-18 on its efficacy and safety 19 for the relative treatment effect. The utility values were sourced from a breast cancer quality of life in Vietnam 20. Costs were mostly sourced from government data 21, 22, 23; and, a local costing study 24. All costs were expressed in PHP 2017 values and inflation adjustments were applied as necessary by using the Consumer Price Indexes (CPI) 25. Both one-way and probabilistic sensitivity analyses (PSA) using second order Monte Carlo simulation replicated for 10,000 times were performed.
RESULTSTrastuzumab therapy was dominated with an ICER of PHP 583,867 per QALY gained. The total cost of trastuzumab therapy (i.e., PHP 1,076,607) needs decrease to PHP 563,842 to become cost-effective. Majority of the ICER plots from PSA were at the upper-right hand quadrant of the plane suggesting that using trastuzumab therapy compared to chemotherapy alone mostly yielded additional outcomes while most likely incurring additional costs. The cost-effectiveness acceptability curve shows that trastuzumab therapy’s probability of cost-effectiveness is 0%, while that for chemotherapy alone regimen is 100%. Among all input parameters varied, the ICER was most sensitive to changes in the duration of efficacy of trastuzumab, discounting rate for outcomes, hazard ratio for disease-free survival (DFS), cost of trastuzumab therapy, and TP from DFS to congestive heart failure state. The budget impact to cover 11,872 prevalent and 3,903 new cases in the Philippines is about PHP 13,909 million in year one alone, plus about PHP 3,000 million annually on the next four fiscal years.
DISCUSSIONIn this analysis, we project that shifting to trastuzumab therapy results to ICERs that exceed the threshold by 4.9 times more, suggesting that trastuzumab therapy is not cost-effective in the Philippines with 0% probability of being cost-effective at the threshold. Its cost-effectiveness will improve if its current therapy cost will reduce by one-half. Apart from value for money, our decision-makers will also have to consider the affordability of trastuzumab coverage. Its total acquisition cost for drug procurement alone considering national coverage will already reach PHP 7.36 billion – an amount that significantly exceeds the usual annual budget for the procurement of various breast cancer medicines covered under the DOH Breast Cancer Medicine Access Program (i.e., ranging from PHP 39 to 92 million from year 2009 to 2017) 26, 27.
CONCLUSION In conclusion, our CUA suggests that one year of adjuvant trastuzumab therapy in addition to the standard chemotherapy for HER2-positive EBC, is not cost-effective and unaffordable in the Philippines. The government needs to consider schemes to bring down its cost to improve its value for money and affordability, ultimately towards sustainable access to trastuzumab.
ACKNOWLEDGEMENTSThis work is a part of training in Health Technology Assessment (HTA)'s Master degree, which scholarship is provided by Mahidol University and the International Decision Support Initiative (iDSI). This work was produced as part of the International Decision Support Initiative (www.
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idsihealth.org), which supports countries to get the best value for money from health spending. iDSI receives funding support from the Bill & Melinda Gates Foundation, the UK Department for International Development, and the Rockefeller Foundation. The findings, interpretations and conclusions expressed in this article do not necessarily reflect the views of the aforementioned funding agencies.The authors are grateful to the Pharmaceutical Division, the National Breast Cancer Control Program of the DOH Philippines, and the Philippine Cancer Society.
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K, Mondo C, Lanas F, Prabhakaran D, Badr A, Elmaghawry M, Damasceno A, Tibazarwa K, Belley-Cote E, Balasubramanian K, Islam S, Yacoub MH, Huffman MD, Harkness K, Grinvalds A, McKelvie R, Bangdiwala SI, Yusuf S; INTER-CHF Investigators., Global mortality variations in patients with heart failure: results from the International Congestive Heart Failure (INTER-CHF) prospective cohort study. Lancet Glob Health. 2017 Jul;5(7):e665-e672., 2017.
11. Cameron D, P.-G.M., Gelber RD, Procter M, Goldhirsch A, de Azambuja E, et al. , 11 years' follow-up of trastuzumab after adjuvant chemotherapy in HER2-positive early breast cancer: final analysis of the HERceptin Adjuvant (HERA) trial. . Lancet, 2017. 3, 11 years' follow-up of trastuzumab after adjuvant chemotherapy in HER2-positive early breast cancer: final analysis of the HERceptin Adjuvant (HERA) trial. Lancet, 2017. 389(10075):1195-1205, 2017.
12. Perez EA, R.E., Suman VJ, Jeong JH, Sledge G, Geyer CE Jr, Martino S, Rastogi P, Gralow J, Swain SM, Winer EP, Colon-Otero G, Davidson NE, Mamounas E, Zujewski JA, Wolmark N., Trastuzumab Plus Adjuvant Chemotherapy for Human Epidermal Growth Factor Receptor 2–Positive Breast Cancer: Planned Joint Analysis of Overall Survival From NSABP B-31 and NCCTG N983. J Clin Oncol, 2014. 23(31):7811-9., 2014.
13. Romond EH, J.J., Rastogi P, Swain SM, Geyer CE Jr, Ewer MS, Rathi V, Fehrenbacher L, Brufsky A, Azar CA, Flynn PJ, Zapas JL, Polikoff J, Gross HM, Biggs DD, Atkins JN, Tan-Chiu E, Zheng P, Yothers G, Mamounas EP, Wolmark N., Seven-Year Follow-Up Assessment of Cardiac Function in NSABP B-31, a Randomized Trial Comparing Doxorubicin and Cyclophosphamide Followed by Pacl*taxel (ACP) With ACP Plus Trastuzumab As Adjuvant Therapy for Patients With Node-Positive, Human Epidermal Growth Factor Receptor 2–Positive Breast Cancer. J Clin Oncol, 2012. 30(31):3792-9., 2012.
14. Advani PP, B.K., Dockter TJ, Colon-Otero G, Perez EA, Long Term Cardiac Safety Analysis of NCCTG N9831 (Alliance) Adjuvant Trastuzumab Trial. J Clin Oncol, 2016. 34(6):581-7., 2016.
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17. Spielmann M, R.H., Delozier T, Canon JL, Romieu G, Bourgeois H, Extra JM, Serin D, Kerbrat P, Machiels JP, Lortholary A, Orfeuvre H, Campone M, Hardy-Bessard AC, Coudert B, Maerevoet M, Piot G, Kramar A, Martin AL, Penault-Llorca F, Trastuzumab for patients with axillary-node-positive breast cancer: results of the FNCLCC-PACS 04 trial. J Clin Oncol, 2009. 27(36):6129-34., 2009.
18. Joensuu H, K.-L.P., Huovinen R, Jukkola-Vuorinen A, Tanner M, Kokko R, Ahlgren J, Auvinen P, Saarni O, Helle L, Villman K, Nyandoto P, Nilsson G, Leinonen M, Kataja V, Bono P, Lindman H, Outcome of patients with HER2-positive breast cancer treated with or without adjuvant trastuzumab in the Finland Capecitabine Trial (FinXX). Acta Oncol, 2014. 53(2):186-94, 2014.
19. Genuino, A.J.M., Chaikledkaew, U., Ong, D.T., Reungwetwattana, T., Thakkinstian, A., Adjuvant Trastuzumab regimen for HER2-Positive Early-Stage Breast Cancer: A Systematic Review and Meta-Analysis. 2018, Graduate Programs in Health Technology Assessment, Mahidol University.
20. Anh NQ, N., H. V., Ha, N. T., Anh, N., Thuy, H., Hanh, N. T. M.,. . . Mendel, N. V, Assessment of the quality of life of breast and cervical cancer in Viet Nam in 2014, H. HSoP, Editor. 2014: Hanoi.
21. Corporation, P.H.I., PHIC Circular 0035 s.2013 - Implementing Guidelines on Medical and Procedure Case Rates. 2013, Philippine Health Insurance Corporation: Manila.
22. Philippines, D.o.H., The Philippine Drug Price Reference Index 2017, D.o.H. Philippines, Editor. 2018, Department of Health Philippines: Manila.
23. Division, D.o.H.P.-P., Breast Cancer Medicines Access Program Procurement Data 2011-2017, D.o.H.P.-P. Division, Editor. 2018.24. Wong, J.Q., Facility-Based Intervention Costing for the 48 Highest Burden Diseases in the Guaranteed Health Benefits Package of the
Department of Health and the Philippine Health Insurance Corporation, D.o.S.a. Technology, Editor. 2018, Department of Science and Technology - Philippine Council for Health Research and Development: Manila.
25. Group, T.W.B. Consumer price index (1960-2017) - International Monetary Fund, International Financial Statistics and data files. 2018 [cited 2018 July]; Available from: https://data.worldbank.org/indicator/FP.CPI.TOTL.
26. Division, D.P.-P., Total Spending for DOH BCMAP P. Division, Editor. 2018: Manila.27. Bureau, D.P.-D.P.a.C., Work and Financial Plan 2017 - Breast Cancer Drugs, D.P.a.C. Bureau, Editor. 2017: Manila.
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EE19
Screening for Type 2 Diabetes Mellitus: A Cost-effectiveness Analysis of Glycated Hemoglobin with Fasting Plasma Glucose (FPG) as confirmatory test versus FPG with Oral Glucose Tolerance Test as confirmatory test
1Ritika KAPOOR, 2Kelvin Bryan TAN, 2Deanette PANG, 1Qian YANG, 1,3E-Shyong TAI, 1Kee-Seng CHIA, 1,4Hwee-Lin WEE1 Saw Swee Hock School of Public Health, National University of Singapore (NUS), Singapore2 Policy Research and Economics Office, Ministry of Health, Singapore3 Department of Medicine, National University Health System and NUS, Singapore4 Department of Pharmacy, Faculty of Science, NUS, Singapore
OBJECTIVEScreening uptake for Type 2 diabetes mellitus (T2DM) is suboptimal. Use of glycated hemoglobin (HbA1c) may improve access to T2DM screening as fasting is not required and opportunistic testing may be conducted. Hence, we aimed to evaluate the cost-effectiveness of HbA1c followed by confirmatory fasting plasma glucose (cfmFPG) vs fasting plasma glucose (FPG) followed by confirmatory oral glucose tolerance test (cfmOGTT) for T2DM screening in Singapore.
METHODS A Markov microsimulation model was constructed with local costs, transition probabilities and utility values to simulate the lifetime cost and outcomes associated with two screening strategies for a hypothetical cohort of 40-year old Singaporeans not diagnosed with diabetes. Strategy1: FPG for all (uptake: 60%) + cfmOGTT for high risk individuals (6.1 ≤ FPG ≤6.9 mmol/l). Strategy2: HbA1c test for all (uptake: 72%) + cfmFPG for high risk individuals (6.1% ≤HbA1c ≤6.9%). Between 3-yearly screenings, an individual may be diagnosed with T2DM clinically or die from any cause. Individuals with T2DM may remain complication free, develop complications, or die from any cause / T2DM complications.
RESULTSWith increased uptake, HbA1c+cfmFPG diagnosed people with T2DM one year earlier, delays the onset of serious complications by one year and reduced the prevalence of serious complications by 4% compared to FPG+cfmOGTT. Hence, HbA1c+cfmFPG is cheaper and more effective (S$412 less; 0.0407 quality-adjusted life years (QALYs) gained, i.e. dominant). Varying the relative increase in uptake rate (0% to 20%), annual rate of serious complications (2% to 9%), and the proportion of individuals who are clinically diagnosed between screenings (10% to 75%) do not influence the conclusion.
DISCUSSION AND CONCLUSIONSCost savings from reducing complications rate would outweigh the greater screening costs (due to increased uptake) and management costs (due to earlier detection), resulting in screening using HbA1c+cfmFPG being a dominant strategy across various assumptions.
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HSR01
Revision of the health screening package as part of the Health Insurance Card Scheme for migrants in Thailand
1Maneechotirat Santi, 1Thanap*rn Bussabawalai, 1Danai Chinnacom, 1Suppawat Permpolsuk, 1Pattara Leelahavarong, 2Rapeepong Suphanchaimat,1Netnapis Suchonwanich1 Health Intervention and Technology Assessment Program Ministry of Public Health, Nonthaburi, Thailand 2 International Health Policy Program Ministry of Public Health, Nonthaburi, Thailand
OBJECTIVEIn 2004, the Ministry of Public Health (MOPH) introduced the Health Insurance Card Scheme for migrants who were not covered by the Social Security Scheme. Applicants are required to pass health screening before receiving insurance and work permits. However, the health screening package was set up approximately 10 years ago and has not been changed since then. This study aims to review and develop an updated health screening package conforming to current standards for migrants in Thailand.
METHODS Document reviews, secondary data analysis, and stakeholder meetings were employed to prioritize important health problems of migrants in Thailand. Literature and document reviews on the effectiveness and cost-effectiveness of screening interventions for those prioritized health problems were then conducted. Inputs from in-depth interviews with experts were considered along with information from document reviews in order to revise the health screening package.
RESULTSFactors that were considered in revising health screening interventions for migrants included cost of screening, workload of health officers, impact from health examinations, operational feasibility, characteristics and epidemiology of diseases, and relevant laws. Aspects of health screening that were considered in the revision include: 1) health screening for diseases as required by law (e.g. tuberculosis, syphilis, filariasis, leprosy, pregnancy test, drug addiction, chronic alcoholism, and psychosis); 2) removal of health screening tests that are not effective nor practical from the current list (e.g. syphilis, pregnancy test, drug addiction, chronic alcoholism, and psychosis); and 3) addition of other screening tests due to little additional costs (e.g. gonorrhea, hypertension, and major depression). Some screening tests (e.g. hepatitis B, malaria, and diabetes) should be performed depending on risk factors or symptoms of migrants.
DISCUSSION AND CONCLUSIONSThe MOPH may apply this revised screening package and should define screening measures for health problems and conditions based on this study’s reviews.
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HSR02
Diagnostic performance, white coat hypertension, and mask hypertension of clinic and home blood pressure measurements comparing with ambulatory blood pressure measurements: A systematic review and meta-analysis of diagnostic studies
Auttakiat Karnjanapiboonwong1, Thunyarat Anothaisintawee1,2, Usa Chaikledkaew1,3, 4Charungthai Dejthevap*rn, Ammarin Thakkinstian1,5
1 Health Technology Assessment (HTA) Postgraduate Program, Mahidol University; 2 Department of Family Medicine, Ramathibodi Hospital; 3 Social Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University;4 Division of Neurology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University;5 Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University
OBJECTIVESeveral approaches have been used for measuring blood pressure (BP) including clinic, home, and ambulatory blood pressure measurement (CBPM, HBPM, ABPM), the later is suggested as the reference standard. However, different methods yielded different diagnoses of hypertension (HT) with both under-diagnosis (known as masked hypertension (MHT)) and over-diagnosis (known as white coat hypertension (WCHT)).
METHODS Studies were identified from Medline and SCOPUS databases to June 2018. Studies were eligible if patients aged >18 years, CBPM or HBPM was study test, and ABPM was the standard-test. Outcomes of interests were HT, WCHT, and MHT. Diagnosis performances including sensitivity, specificity, diagnostic odds ratio(DOR), likelihood ratio positive(LR+), and area under receiver operating characteristic(ROC) were estimated. Bivariate mixed-effect logit model and hierarchic-summary ROC were applied for pooling diagnostic performances. %WCHT and %MHT were separately pooled using random-effect model.
RESULTStotal of 46 were eligible. For 22 studies of CBPM, pooled sensitivity, specificity, DOR, LR+, and ROC were 66%(95%CI: 58%,73%), 83%(75%,89%), 9.75(6.45,14.74), 3.98(2.75,5.75), and 0.80(0.76,0.83). Pooled %WCHT and %MHT were 31%(26%,35%) and 25%(22%,28%). Sub-group analyses in community-based setting and 24-hr-ABPM improved LR+ of 7.2( 4.9, 10.8) and 7.3(4.6,11.6), respectively. Repeated CBPM 4–5 times significantly reduced %WCHT and %MHT comparing with single measure, i.e., 32% versus 23% and 26% versus 15%. For 5 studies with HBPM, sensitivity, specificity, DOR, LR+, and RCO were 71%(58%,80%), 84%(73%,91%), 12.47(6.13,25.37), 4.38(2.58,7.41), and 0.84(0.80,0.87). The pooled %WCH and %MHT were 19%(10%,27%) and 31%(10%,52%).
DISCUSSION AND CONCLUSIONSPerformances of HBPM and CBPM for HT diagnosis are similar. Approximately 30% of those with positive-CBPM may have WCHT, and 30% of those with negative-HBPM may have MHT. Obtaining 4-5 measures of CBPM may improve performance. The 24-hr ABPM should be used for confirm diagnosis but better methods are needed targeting who should go to ABPM.
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HSR03
Intrauterine system for dysmenorrhoea: Is it safe and effective?
1Siti Mariam Mohtar, 1Dr. Junainah Sabirin, 2Dr. Ravichandran Jeganathan, 3Dr. Harris Njoo Suharjono1 Health Technology Assessment Section, Medical Development Division, Ministry of Health (MOH), Putrajaya, Malaysia 2 Hospital Sultanah Aminah, Johor Bahru, Malaysia3 Sarawak General Hospital, Malaysia
OBJECTIVETo assess the safety, effectiveness and economic implication of intrauterine system (LNG-IUS) for dysmenorrhoea as it is not included in the Ministry of Health Malaysia Formulary for this indication.
METHODS Relevant trials published until 3rd September 2017 were identified through Ovid MEDLINE, PubMed,Cochrane, Embase and online publishing site. Studies were selected based on inclusion and exclusion criteria and critically appraised using Critical Appraisal Skills Programme (CASP) and graded according to US/Canadian preventive services task force.
RESULTSA total of 487 titles were identified. There were seven studies included in this review: one Cochrane systematic review (SR), two randomised controlled trials (RCTs), three pre- and post-intervention studies and one cross-sectional study.In women with endometriosis, the use of LNG-IUS postoperatively significantly reduced the recurrence of painful periods compared with no treatment. There was no difference in the recurrence of painful periods between postoperative use of LNG-IUS and GnRH analogue in women with endometriosis. In women with adenomyosis, the mean Visual Analogue Pain scores decreased significantly after 36 months of using the LNG-IUS.LNG-IUS was safe and tolerable. Side effects reported were weight gain, headache and breast tenderness. There was no retrievable evidence on cost-effectiveness.
DISCUSSION AND CONCLUSIONSEvidences suggest that LNG-IUS was safe and effective in reducing recurrence and symptoms of dysmenorrhoea associated with endometriosis or adenomyosis. Hence, it may be used for management of dysmenorrnhoea associated with endometriosis or adenomyoisis. This report was used as a guide for reimbursem*nt of this treatment by insurance company.
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HSR04
ENDOBRONCHIAL VALVES: CARVING A NEW TREATMENT PATH FOR PATIENTS WITH SEVERE EMPHYSEMA IN MALAYSIA
1Erni Zurina Romli, 1Syful Azlie, 1Junainah Sabirin, 2Jamalul Azizi Abdul Rahman1 Health Technology Assessment Section, Medical Development Division, Ministry of Health, Putrajaya, Malaysia 2 Serdang Hospital, Selangor, Malaysia
OBJECTIVETo evaluate the effectiveness and safety of bronchoscopic treatment of emphysema using endobronchial valve (EBV) in patients with severe emphysema in view of the intention to include EBV as part of routine clinical management in Malaysia.
METHODS Studies were identified through electronic databases: MEDLINE, Embase, Cochrane Library and PubMed, in addition to the reference lists from review articles. Studies included based on inclusion and exclusion criteria, which then were critically appraised using Cochrane Collaboration’s tool for Randomised Controlled Trial (RCT) and graded according to US/Canadian preventive services task force. Data from RCTs were meta-analysed.
RESULTSSeven studies with the longest follow-up of 12 weeks were included. Significant improvement were seen in forced expiratory volume in 1 second (FEV1) and six-minute walking distance compared to control (medical treatment or sham bronchoscopy): pooled standardized mean difference (SMD) of 0.56 (95% confidence intervals [CI]: 0.43, 0.70) and pooled MD of 44.79 (95% CI: 22.58, 66.99) respectively. In addition, St George’s Respiratory Questionnaire score decreased (pooled MD of -6.70 units; 95% CI: -9.15,-4.25) in the intervention group which indicates significant improvement in quality of life (QoL). No significant differences in mortality between EBV and control (odds ratio [OR] 1.28; 95% CI: 0.60, 2.70). The adverse events were more in EBV group (OR 11.24; 95% CI: 5.94, 21.27), most commonly COPD exacerbation.
DISCUSSION AND CONCLUSIONSEBV therapy offers significant improvement in lung function and QoL up to 12 months for severe emphysema. Hence, it may be offered in selected centres with interventional pulmonologist. However, patient’s outcome research is warranted and cost implication should be considered.
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DAY 2 Thursday 25 April 2019
65
HSR07
Appropriate health technology listing in China: exploring an multi-criteria decision analysis (MCDA) based priority setting framework
Yingpeng Qiu; Kun Zhao; Yue Xiao; Yanran Li; Yanzu Chen1 China National Health Development Research Center
OBJECTIVEChina National Health Commission (CNHC) initiated a national program to promote appropriate health technologies(AHTs) among all county hospitals to improve accessibility to health care. Commissioned by CNHC, we aim to explore an explicit, stepwise and evidence-based framework to select AHTs for the program.
METHODS Based on a systemic literature review and expert consultation, a priority-setting framework based on multi-criteria decision analysis (MCDA) was developed for the listing. The framework contained five steps including problem structuring, definition of criteria, identification of candidates & evidence collection, priority setting and appraisal. Six criteria were identified to score and rank alternatives, which were health needs, maturity, safety, effectiveness, economic, operability and social and ethical impact. A expert committee with 13 shareholders was set up to conduct appraisals and recommend the final list to NHC, which contains decision makers, representatives of county-level hospitals, experts with various academic background.
RESULTSFirst, 58 candidate technologies were collected along with evidence under 6 criteria form 33 national clinical centers across the country; Then, a primary screening was conducted the by 24 clinical experts in 11 disciplines, in order to review and score all candidates against safety, effectiveness, operability and acceptability, and resulted in a screening list with 13 candidates; Further, the performance of these 13 candidates were scored and ranked against all 6 criteria by representatives form 4 country hospitals( the users of AHT), then a short list of 10 technologies was produced. Last, the expert committee conducted an appraisal meeting on the short list and recommended 4 technologies meeting all criteria to CNHC.
DISCUSSION AND CONCLUSIONSThis multi-stages priority framework was robust in this study, which made the process more transparent, evidence based and resulted into a jointly decision making against different criteria. The framework has potential to apply in other topic.
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DAY 2 Thursday 25 April 2019
66
HSR09
Priority Setting for Health Technology Assessment (HTA) and Health Care Decision Making in Malaysia
1Gan YN, 1Junainah S, 1Ros Aziah MR, 1Maharita AR, 1Nur Farhana M, 1Syful Azlie MF, 1Syaqirah A, 2Faridah Aryani MY, 2Saidatul Nurbaya B, 2Helwa Husna K.1 Malaysian Health Technology Assessment Section (MaHTAS), Ministry of Health Malaysia, 62590 Putrajaya, Malaysia. 2 Technical Advisory Committee (TAC) 2018-2019 member, Ministry of Health Malaysia, Putrajaya, Malaysia.
OBJECTIVETo review current explicit priority setting process for HTA in Malaysia in view of increasing needs for HTA reports to inform health care decision making.
METHODS MaHTAS priority setting database (January 2010-September 2018) was reviewed from October to November 2018 in terms of priority score based on five criteria of equal weightage (prevalence/disease burden, cost, effects on infrastructure and other services, availability of competing technologies and possibility of changing health status) which determines ranking. Rank and other factors (urgency, body of evidence and multidisciplinary involvement) were reviewed. The relationships between types of reports (full HTA or mini-HTA) and health technologies as well as recommendations were evaluated. Data were compiled and analysed using descriptive statistics, multiple linear regression and logistic regression via SPSS v22.
RESULTSOf 203 issues received, 109 were included for priority setting following exclusion from preliminary screening. All five prioritisation criteria were statistically significant towards priority score (p<0.05); prevalence/disease burden had the highest influence (regression coefficient B=1.004; 95% CI 0.997, 1.012); possibility of changing health status was the lowest (B=0.994; 95% CI 0.985, 1.003). Of nine types of health technologies, the likelihood of being conducted as full HTA report was only significant for programme-based (odds ratio (OR) 3.877; 95% CI 1.082, 13.886; p=0.037). Most full HTA reports [95.5% (21/22)] had positive recommendations (recommended/research purpose) compared to mini-HTA reports [54.5% (18/33)]. Recommendations of health technologies were implemented except for 5.5% (3/55) due to financial constraints.
DISCUSSION AND CONCLUSIONSCurrent prioritisation criteria and weightage were effective and should be continued. The greater influences of prevalence/disease burden and programme-based health technologies towards consideration for full HTA reports and effective implementation indicate that the current priority setting process plays an important role to support informed decision making in Malaysia. This may assist other HTA agencies in developing their priority setting process.
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DAY 2 Thursday 25 April 2019
67
HSR10
A review and assessment of health service planning in Thailand
1Thanap*rn Bussabawalai, 1Pattara Leelahavarong, 1Suppawat Permpolsuk, 1Kittiphong Thiboonboon, 1Sripen Tantivess1 Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
OBJECTIVEIn 2012, the Ministry of Public Health (MoPH) developed a new health service plan based on the concept of a seamless health service network and efficient referral system in order to enhance equal access to health services. The study aims to assess this health service plan and provide policy recommendations for improving the planning process in the future.
METHODS This study evaluated health service planning using the RAND framework, consisting of three themes including “vision” (goals and objectives of health service planning), “governance” (role of decision-makers and implementers), and “intelligence” (analysis of relevant and existing data). Document review and in-depth interviews with relevant national/regional policymakers as well as executives and healthcare providers in hospitals were employed for data collection.
RESULTSThe health service plans of each medical specialty were developed by a national-level committee. The plans cover goals, guidelines, and standard requirements of personnel and supplies for each service level. Then, the planning process is decentralized to the regional level to set their own strategic and action plans aligned to the national plans. However, many medical specialties were identified without prioritization which led to difficulties, for example, in management and resource allocation as well as work burden on both planners and implementers. Mainly government officers and healthcare providers were involved in planning, with little or no role of patients and healthcare payers. Data limitations were also a major problem, e.g. insufficient data, low quality data, lack of personnel to collect the data, etc. Moreover, a lack of continuity and rigor in monitoring and evaluation may lead to a lack of incentive to achieve the goals.
DISCUSSION AND CONCLUSIONSClear criteria for prioritization and balanced stakeholder participation are challenges for health service planning in Thailand. Additionally, continuous monitoring and evaluation, and data systems should be improved for further planning.
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DAY 2 Thursday 25 April 2019
68
HSR11
Role of Health Technology Assessment in the development of the Universal Coverage Scheme Benefits Package in Thailand
1Suradech Doungthipsirikul, 1Danai Chinacom and 1Akanittha Poonchai1 Health Intervention and Technology Assessment Program (HITAP)
BACKGROUNDThe Universal Coverage Benefits Package Development Project commenced in 2009. The project aims to use Heath Technology Assessment (HTA) to develop the benefits package under the Universal Coverage scheme (UCs).
OBJECTIVETo illustrate and critically analyze the results of using HTA in the development of the universal coverage benefits package in Thailand from 2009-2017.
METHODS A document review was performed on the meeting minutes and research reports related to the development of the health benefits package from 2009-2017.
RESULTSThe process developed had three major steps as follows: topic selection, conduct study, and results presentation to inform the policy maker. From 2009-2017, it was found that there were 133 health topics nominated by stakeholders for consideration in the development process. The topics covered included health care packages (40%), drugs and vaccines (32%), medical devices (30%), and screening and treatment (27%). Out of 133 topics nominated by stakeholders for prioritization, 65 were selected for further assessment. The results of 26 studies were presented to the Sub-committee for the development of Benefits Package and Service Delivery (SCBP). The SCBP made the decision to include 9 interventions in the benefits package, which were implemented in the benefits package under the Universal Coverage scheme. Moreover, our findings indicated that important factors for selecting interventions for the benefits package include not only value for money, but also budget impact, equity, and feasibility issues.
DISCUSSION AND CONCLUSIONSThe health benefit package development that requires commitment from all stakeholders involved in the process to ensure that universal health coverage is not only about universal access to health services, but also about collective policy participation. HTA is helpful for informing coverage decisions for health benefits packages because it enhances the legitimacy of policy decisions by increasing transparency, inclusiveness, and accountability of the process.
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DAY 2 Thursday 25 April 2019
69
HSR12
Real world data to overcome HTA barriers to access to orphan medicines
Jiyeon Kang 1 London School of Hygiene and Tropical Medicine
OBJECTIVEThis study reviews and compares reimbursem*nt recommendations for orphan medicines issued by health technology assessment (HTA) agencies in England, Scotland, France, and South Korea and identifies how real-world data (RWD) influences the reimbursem*nt status of the drug in the corresponding countries.
METHODS Clofarabine, an orphan medicine was reviewed by four agencies but only received a full reimbursem*nt recommendation from Health Insurance Review and Assessment service (HIRA). HTA appraisal documents are reviewed to compare each agencies' reimbursem*nt recommendations for clofarabine and to identify how each agency made its assessment.
RESULTSEach HTA agency shows different appraisals due to data availability. Shortly after approval by the European Medicines Agency (EMA) in May 2006, the Scottish Medicines Consortium (SMC) and the Haute Autorite de sante (HAS) approved clofarabine with several restrictions in December 2006. The National Institute for Health and Care Excellence (NICE) did not proceed with their appraisal. NHS England recently concluded that the evidence is not clear enough to make a positive recommendation. HIRA approved clofarabine in December 2013, as part of a Risk Sharing Agreement (RSA) with the condition that the manufacturer should generate additional evidence. Recently, following their review of the complete remission rate from a non-interventional study, HIRA will fully reimburse clofarabine without any restriction.
DISCUSSION AND CONCLUSIONSThus, HIRA used additional data from clinical practice to support their conditional approval. SMC recently adopted a new approach in which ultra-orphan medicines are available to clinicians while further data are gathered in order to make a final decision on routine use. The HIRA example and this new approach share the idea that RWD can help to overcome the appraisal challenges faced with orphan drugs and demonstrate how use of RWD can facilitate early access to orphan medicines by providing data for the assessment of clinical benefit and cost-effectiveness.
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DAY 2 Thursday 25 April 2019
70
HSR14
Evaluation of the medical device adverse events monitoring: based on national adverse event reports in China
ZHU Si1, HUANG Jia-yan1
1 Key Laboratory of Health Technology Assessment, MOH/ School of Public Health, Fudan University, Shanghai, 200032, China
OBJECTIVEMedical device adverse events monitoring is an important part of safety supervision of post-marketing. Analyzing the national medical device adverse event monitoring data can provide reference for the monitoring and prevention of medical device adverse events, further evaluating the safety and effectiveness of medical devices.
METHODS Using compound annual growth rates to provide a descriptive analysis of the trends in recent medical device adverse events among nationally Annual Reports of Medical Device Adverse Event Monitoring from 2013 to 2018.
RESULTSThe number of medical device adverse events in the whole country continued to grow in 2003 to 2017, with a compound annual growth rate of 62.09%. Among the reported sources of medical device adverse events, the using institutions accounted for nearly 90%. Medical institutions are the actual using places mainly involved in adverse events. Class II medical devices and Class III medical devices are the main categories of medical device that cause adverse events.
DISCUSSION AND CONCLUSIONSThe overall trends of medical device adverse events in China is stable. It is recommended to focusing on cultivating and improving the monitoring capabilities of relevant units, and strengthening the publicity of early warning and reporting of adverse events. Based on the whole life cycles management, production and operation enterprises should be encouraged to participate in monitoring and reporting of adverse events. And far more evaluation of safety and effectiveness should be involve in post-marketing medical devices to fill the gap of the passive monitoring system.
ORAL SESSION
DAY 2 Thursday 25 April 2019
71
HSR16
The role of HTA in the development of the National List of Essential Medicines in Thailand
Nitichen Kittiratchakool (presenter)1, Pattara Leelahavarong, Suradech Doungthipsirikul, Suthasinee Kumluang, Akanittha Poonchai, Danai Chinnacom, Netnapis Suchonwanich, Sripen Tantivess1 Health Intervention and Technology Assessment Program (HITAP)
OBJECTIVETo review health technology assessment (HTA) in Thailand with a focus on its role to support the development of the National List of Essential Medicines (NLEM), especially high-cost medicines.
METHODS A review of relevant key documents and HTA reports between 2008 and 2018 was performed with descriptive analysis. Additionally, the authors’ experiences gained in the area of HTA for the development of NLEM, such as informing health policy and decision-making processes, were considered.
RESULTSThe Thai NLEM is a pharmaceutical benefits list for all health insurance schemes. Over the last decade, there has been significant pressure on the government to include new high-cost technologies in every scheme despite limited resources. Since 2008, economic evaluation (an aspect of HTA) has been conducted to improve the list of high-cost medicines in the NLEM. Approximately 40 new medicines have been evaluated for cost-effectiveness and budget impact based on the national HTA methodological guidelines. These evaluations are conducted by researchers from universities and independent research institutes with contribution by relevant stakeholders. The quality of the studies is controlled by the Health Economics Working Group under the Subcommittee for Development of the NLEM. In case the analysis indicates that a new medicine is not cost-effective or unaffordable, a threshold price will be calculated for use in price negotiation. Moreover, in order to ensure affordability of and equitable access to some high-cost medicines, both HTA information and new purchasing models have been introduced in collaboration with public health authorities and pharmaceutical companies.
DISCUSSION AND CONCLUSIONSHTA is useful for the development of NLEM, which can improve patients’ access to high-cost medicines. However, the mechanism for identifying medicines for disinvestment and the process for monitoring and evaluation after inclusion are unclear. This may lead to a greater number of medicines in the list and a higher budget impact.
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DAY 2 Thursday 25 April 2019
72
HSR17
Cost Analysis Study of Key Population Interventions to Fast Track the End of HIV in Thailand
1Suppawat Permpolsuk (Presenter), 1Songyot Pilasant, 1Pattara Leelahavarong, 1Suthasinee Kumluang, 1Suradech Doungthipsirikul, 1Akanittha Poonchai, 2Arthorn Riewpaiboon, 2Braprut Sawatwipachai, 2Krittika Khotthong, Prapatsara Pongpunpisand1 Health Intervention and Technology Assessment Program (HITAP)2 Faculty of Pharmacy, Mahidol University
OBJECTIVEThailand’s HIV/AIDS Operational Plan sets out a ‘reach’, ‘recruit’, ‘test’, ‘treat’, ‘prevent’, and ‘retain’ (RRTTPR) framework for delivery of integrated HIV prevention and treatment services to key populations (KPs). In the near future, this operation that has been currently supported by international funders needs to transition from international donors to the Thai government. However, accurate information about cost of HIV activities along the RRTTPR in Thailand is limited and needed for budgeting. This study aims to estimate the unit costs of HIV activities along the RRTTPR cascade and use the information to inform the National Health Security Office (NHSO) as an input for setting the budgets for HIV activities in 2020.
METHODS The study used information of HIV activities along the RRTTPR cascade that had been operated during the fiscal year 2017 (Oct 2016–Sep 2017) to estimate the unit costs of each activity. Top-down approach was used to calculate total costs of activities, while micro-costing approach was used to detail enumeration and cost of inputs used in the production of services. Public Health Service Centre 28 (PHSC), The Planned Parenthood Association of Thailand (PPAT) and Sisters foundation were selected as the study sites to compare the costs from different service delivery models. Provider perspective was used in this study.
RESULTSFull cost of RRTTPR services in each site were approximately ranged from 1 to 6 million Thai Baht (THB). The unit cost of reach-to-test activities were 21,610 and 37,001 THB per patient from PHSC and PPAT. The unit cost of reach to retain activities were approximately 33,281 THB per person from Sisters.
DISCUSSION AND CONCLUSIONSThe minimum unit cost of RRTTPR was Sisters. However, the context of each study sites was effect to cost of RRTTPR activities. Result from these studies will be used to guide the national budgeting of NHSO for RRTTPR services in Thailand.
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DAY 2 Thursday 25 April 2019
73
HSR18
The current situation of preventive interventions for falls and dementia in community-dwelling Thai elderly: A mail survey
Wiithawat Pantumongkol1 (Presenter), Wantanee Kulpeng1, Thunyaratra Anothaisintawee1,2, Jitti Wisaiprom1 and Sripen Tantivess1
1 Health Intervention and Technology Assessment Program, Thailand 2 Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
OBJECTIVEFalls and dementia are the most common issues for the elderly because both can cause all types of injuries that result in decreased self-reliance. However, effective interventions to prevent falls and dementia in the elderly can help reduce the number of associated accidents, disabilities, and death. Thus, this study aims to assess the accessibility and distribution, frequency, and continuity of the implementation of preventive interventions for falls and dementia in the community-dwelling Thai elderly population.
METHODS This study was conducted by mailing surveys including a self-administered questionnaire to 9,827 senior citizen clubs under primary care units and public health service centers. Two thousand eight hundred and fifty-four questionnaires were returned (30.1%) and the data collected were analyzed using descriptive statistics.
RESULTSMost of the elderly clubs (75%-86%) provided prevention activities for falls and dementia, which consisted of physical exercises (gait balance and aerobic exercise) and cognitive trainings (brain-training games and 9-square-tables exercise). Moreover, some elderly clubs also conducted other types of physical exercises and cognitive trainings such as folk-dancing, praying, and meditation. The prevention activities for falls and dementia have been implemented for approximately 2 to 6 years and 2 to 4 years, respectively. In terms of frequency and duration per session, the activities in most of the elderly clubs occurred 1-2 times per month and lasted for approximately 30 minutes to 1 hour.
DISCUSSION AND CONCLUSIONSIn terms of accessibility and distribution, it was found that the majority of the elderly clubs organized similar activities with minor variations. However, several aspects of these activities including type, duration, frequency, and continuity were insufficient and could be ineffective in preventing falls and dementia.
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DAY 2 Thursday 25 April 2019
74
HSR19
CANCER TREATMENT: IS THERE A ROLE FOR NON-PHARMACOLOGICAL INTERVENTIONS?
1Syaqirah A, 1Junainah S1 Malaysian Health Technology Assessment Section (MaHTAS)
OBJECTIVEMalaysian Health Technology Assessment Section (MaHTAS) has conducted numerous assessments on interventions for cancer treatment. The study aims to review whether non-pharmacological interventions have a role in treating cancer patients.
METHODS In-depth analysis of health technology assessment (HTA) and mini-HTA reports, published from 1997 to 2018 on non-pharmacological interventions (medical devices, procedures and others) for cancer was conducted. Independent variables included were type of technology assessed, type of cancer, and level of evidence on effectiveness, safety and cost-effectiveness of the intervention. The dependent variable was recommendation of the technology either positive recommendation (recommended for routine use or in selective patients or for research purpose) or negative recommendation (not recommended for use). Data was analysed using descriptive statistics and Pearson Chi Square test via SPSS version 23.
RESULTSOf 418 published reports,17 (4%) assessed non-pharmacological intervention for cancer as mini-HTA while none was conducted as HTA. Most of these reports involved multiple types of cancer (64.7%) while others on specific organs e.g prostate (17.6%), breast (5.9%), liver (5.9%) and pancreas (5.9%). The technologies assessed was mostly procedures (93.3%) while only 6.7% were medical devices. Majority of technologies were positively recommended (82.4%). Fair to high level of evidence in effectiveness was significantly associated with positive recommendation while those with low level of evidence was associated with negative recommendation (x2=15.84, p<0.05). Similarly, significant association was found between the level of evidence on safety with recommendation (x2=6.68, p<0.05). No association was found between level of evidence on cost-effectiveness, type of technology and type of cancer with recommendation of a technology.
DISCUSSION AND CONCLUSIONSThe study found that majority of the assessed non-pharmacological intervention were positively recommended, illustrating their potential role in the treatment of cancer. However, more high quality evidence is required for certain interventions.
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DAY 2 Thursday 25 April 2019
75
HSR21
HTA-informed decisions on optimizing the national essential public health package in China
OBJECTIVESince 2009, China has initiated a national program on free provision of essential public health services. The national program has expanded both in terms of service categories and funding, showing China’s great commitment to universal health coverage. However, with slow down of public input in health sector, the government decided to prioritize interventions and optimize the package. Researchers in the Chinese National HTA agency was asked to design the tool and facilitate the decision process.
METHODS With multi-criteria decision analysis (MCDA) method, the researchers analyzed value dimensions in public health issues, and built an evidence matrix for the priority-setting decisions. Supported by HTA tools, they appraised interventions and services through literature review and field studies, and projected budget impact of potential adjustment decisions based on cost analysis results. A deliberative process of key stakeholder groups was taken, and their views were counted in making the final recommendations.
RESULTSBased on evidence review and scores of stakeholders’ judgment, 2 public health service interventions were recommended for removal, and another 2 for adjustment (one for merger, one for optimizing care pathway). Cost estimation and potential budgetary impact were also analyzed to support financial decisions.
DISCUSSION AND CONCLUSIONSHTA and MCDA are key tools for defining value criteria, evidence framework, and deliberative process for the essential public health program. However, lack of cost-effectiveness evidence hinders fine-tuned decisions on resource allocation. Continual health economic evaluation need to be conducted in near future.
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DAY 2 Thursday 25 April 2019
76
HSR22
The Effectiveness of Dabigatran, Rivaroxaban and VKA in patients with non-valvular atrial fibrillation (NVAF) using National insurance Claim Database in Japan
Daisuke SATO1
1 Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health
OBJECTIVENon-vitamin K antagonist oral anticoagulant (NOAC) is approved to anticoagulant for minimizing the risk of recurrence like stroke or transient ischemic attack (TIA) in patients with non-valvular atrial fibrillation (NVAF). However, no significant difference was found between NOACs and VKA for clinical effectiveness by a nationwide claim database. Our study evaluated the long-term effectiveness of NOAC and VKA in patients with NVAF using the Japanese National Insurance Claims Database (NDB). The purpose of this population-based retrospective study is aimed effectiveness between NOACs and VKA using national insurance claim database.
METHODS Our study used the Japanese National Insurance Claims Database (NDB) between April 2010 and December 2015. NDB includes diagnosis, medical treatment, medicine usage, device usage, and reimbursem*nt expenditure. Main diagnosis is NVAF(I48.x) and congestive heart failure:CHF(I50.x), excluding younger than 15-year-olds. We identified people with NOACs and VKAs based on Anatomical Therapeutic Chemical (ATC) classification code. We identified people with a first time purchase of a NOACs and VKAs. Endpoint and variable of outcome is stroke or ischemic stroke (I63.0-I63.9, I64.9), transient ischemic attack :TIA(G45.0-G45.9). The comorbidity index is thrombosis(I74.0-I74.9), lung embolism(I26.0-I26.9),acute myocardial infarction(I21.0-I21.9), I23.0-I23.9, Atherosclerosis(I70.x-I71.x,I73.9),diabetes(E10.x,E11.x),hypertention(I10.x-I13.x,I15.x),COPD(J44.x),valve diseases(I05.x-I06.x, I34.x-I35.x) ,and CHA2DS score. Payment variable is reimbursem*nt per patient and treatment days.
RESULTSThe rate of older than 85-year-old patients is 6.5 percent (NOACs) and 9.9 percent (VKAs). The comorbidity index of atherosclerosis and diabetes showed that NOACs were higher than VKAs. Endpoint of (ischemic) stroke and TIA presented no significant difference between NOACs (12.6 percent) and VKAs (12.3 percent ). Treatment days from of NOACs is 3 months shorter than VKAs, but the reimbursem*nt payment of NOACs is more 1.6 higher than VKAs.
DISCUSSION AND CONCLUSIONSOur observational study using national insurance claim database showed no significant to clinical effectiveness between NOACs and VKAs. Our study supported several previous observational studies using nationwide administrative claim database.
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DAY 2 Thursday 25 April 2019
77
HSR22
The Effectiveness of Dabigatran, Rivaroxaban and VKA in patients with non-valvular atrial fibrillation (NVAF) using National insurance Claim Database in Japan
Daisuke SATO1
1 Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health
[emailprotected]
ORAL SESSION
DAY 2 Thursday 25 April 2019
Proceeding Article
AbstractNon-vitamin K antagonist oral anticoagulants (NOACs), Apixaban, Argatroban, Dabigatran, Edoxaban,and Rivaroxaban are approved to anticoagulant for minimizing the risk of recurrence like stroke or bleeding event in in-hospital patients with non-valvular atrial fibrillation (NVAF). However, they are unknown that the difference between NOACs and vitamin k antagonist (VKAs) for the effectiveness. This study evaluated the effectiveness of NOACs and VKAs in patients with NVAF using nationwide claim database; the Japanese National Insurance Claims Database (NDB). This study selected patients between April 2010 and March 2018. NDB includes diagnosis, medical treatment, medicine usage, device usage, and reimbursem*nt expenditure. We extract to patients who has main diagnosis of NVAF(I48.x) and heart failure(HF)(I11.0,I50.x), excluding younger than 15-year-olds. We identified patient with NOACs and VKAs(based on Anatomical Therapeutic Chemical (ATC) classification code) with a first time purchase of a NOACs and VKAs. Clinical outcomes are set adverse events, Myocardial infarction (MI)(I21.x), Stroke(I63.x, I65.x,I61.x,I64.x,G45), Gastrointestinal bleeding(GB) (K25.0, K26.0,K27.0), and Renal failure (RF)(N17.x, N19, N99.x). Payment variables are reimbursem*nt per patient and treatment days. The number of NOACs and VKAs are 30,844 and 311,768 patients, respectively.The rate of older than 85-year-old patients is 23.0 percent (NOACs) and 27.7 percent (VKAs). Apixaban, Dabigatran, and Rivaroxaban were the lower rate of MI and RF than VKAs, but the rate of stroke for Apixaban, Dabigatran, and Rivaroxaban were higher than VKAs. Treatment days and the reimbursem*nt payment were less than VKAs. However, although Argatroban was similar to VKAs in treatment days and the reimbursem*nt payment, the rate of stroke was the highest among the other NOACs and VKAs.This observational study using national insurance claim database showed the effectiveness of NOACs and VKAs. The result of our study supported several previous studies which indicated the effectiveness of NOACs, but Argatroban could have the higher risk of stroke than other NOACs and VKAs.
KeywordNVAF, Apixaban, Dabigatran, Argatroban, Rivaroxaban
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1. INTRODUCTION Non-vitamin K antagonist oral anticoagulants (NOACs), Apixaban, Argatroban, Dabigatran, Edoxaban,and Rivaroxaban are approved to
anticoagulant for minimizing the risk of recurrence like stroke or bleeding event in in-hospital patients with non-valvular atrial fibrillation (NVAF). However, they are unknown that the difference between NOACs and VKAs for the effectiveness in nationwide. Our study evaluated the effectiveness of NOACs and VKA in patients with NVAF using the Japanese National Insurance Claims Database (NDB). It is possible to trace medical treatment, hospitalization, outpatient, pharmacy. A major strength of the NDB is its exhaustiveness or completeness of insurance claims. The NDB collects data from all insured people nationwide and covers 98.1 percent of the medical institutions in Japan. The insured medical treatment was based on medical practice determined by the Central Social Insurance Medical Council. It could be claimed for medical treatment in accordance with criteria for institutional structure or patients’ comorbidity. In the Japanese healthcare delivery system, insured people may visit any hospital or clinic at any time. Therefore, the NDB has claim information with the cross-medical institutions nationwide. Those data are consistent and can be used to follow patients receiving long-term care across institutions.
The purpose of this population-based retrospective study is aimed effectiveness between NOACs and VKAs using national insurance claim database.
2. METHODS Our study used the Japanese National Insurance Claims Database (NDB) between April 2010 and December 2015. NDB includes
diagnosis, medical treatment, medicine usage, device usage, and reimbursem*nt expenditure. We developed the standard datasets for cost-effectiveness analysis and generated patient episode dataset based on hospitalization and out-patients after discharge. Our study used extracted 10 percent random dataset for analysis.
This study selected patients between April 2010 and December 2015. NDB includes diagnosis, medical treatment, medicine usage, device usage, and reimbursem*nt expenditure. Main diagnosis is NVAF(I48.x) and heart failure(HF)(I11.0,I50.x), excluding younger than 15-year-olds. We identified people with NOACs and VKAs based on Anatomical Therapeutic Chemical(ATC) classification code such as Apixaban(B01AF02), Argatroban(B01AE03), Dabigatran(B01AE07), Edoxaban(B01AE03),and Rivaroxaban(B01AF01). We identified people with a first time purchase of a NOACs and VKAs. Endpoint set Myocardial infarction (MI)(I21.x), Stroke(I63.x, I65.x,I61.x,I64.x,G45), Gastrointestinal bleeding(GB) (K25.0, K26.0,K27.0), and Renal failure (RF)(N17.x, N19, N99.x). Payment variables are reimbursem*nt per patient and treatment days.
3. RESULTS The number of NOACs and VKAs are 30,844 and 311,768 patients, respectively. The rate of older than 85-year-old patients is 23.0
percent (NOACs) and 27.7 percent (VKAs). Apixaban, Dabigatran, and Rivaroxaban were the lower rate of MI and RF than VKAs(0.79%, 1.02%,0.35%,0.88% vs 3.95%). By
contrast, the rate of Infaction for Apixaban, Dabigatran, Edoxaban, and Rivaroxaban were higher than VKAs(21.59%,18.2%,10.03%,19.89%, and 6.06%). The rate of Stroke for Apixaban, Dabigatran, and Rivaroxaban were 0.69%, 0.77%, 0.37%,0.63% comparing with VKAs 0.23%. No significant the rate of GB among NOACs and VKAs.
Average reimbursem*nt payment was less than VKAs. Apixaban, Dabigatran, Edoxaban, and Rivaroxaban were 109,950 yen per patient, 108,624 yen per patient, 127,367 yen per patient, 109,559 yen per patient, respectively than VKAs , 166,472 yen per patient. However, although Argatroban was similar to VKAs in the average reimbursem*nt payment(168,216 yen per patient), the rate of stroke was the highest(59.4%) among the other NOACs and VKAs.
4. DISCUSSION This observational study using national insurance claim database showed the effectiveness of NVAF patient between NOACs and VKAs.
Our study supported several previous studies which demonstrated that Apixaban, Dabigatran, and Rivaroxaban were associated with lower rates of MI compared with VKAs by either clinical trial and national claims data in other countries. By contrast, this study indicated that NOACs had higher rates of Stroke, particularly, Argatroban could have the significant higher risk of stroke than other NOACs and VKAs. The higher risk of adverse events could be associated with increasing to the higher reimbursem*nt payment for Length of stay in hospital.
This study has several limitations. First, our data source, NDB did not include clinical information on CHA2DS2-VASc Score (congestive heart failure, hypertension, age ≥75 years, Diabetes, Stroke/Transient Ischemic Attack/Thromboembolism, Vascular Disease, age 65-74 years, sex category [female]), which is recommended in practice guidelines. Therefore, it might be not enough to adjust the patient background between NOACs and VKAs. Second, our subjects were limited to new in-patients who were prescribed NOACs and VKAs. The result of this study didn’t necessarily indicate all patients characteristics. Third, we extracted 10% random sampling of all patient information with the data dissemination standards of the NDB, so that it might be less enough to reflect to real-world.
5. CONCLUSIONS Using Japanese National claims Database, this study showed that the difference between NOACs and VKA for the effectiveness in
patients with NVAF. NOACs had lower risk of MI, but Argatroban had higher risk of Stroke than other NOACs and VKAs.
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REFERENCESAcknowledgments and Legal ResponsibilityThis work was supported by a Grant-in-Aid for Health Sciences Research from the Ministry of Health, Labour and Welfare of Japan (Grant Number H30-Seisaku-sh*tei-010) and The Ministry of Education, Culture, Sports, Science and Technology (MEXT). Handling of individual data in this work carry out by author and Mr. S. Yamakawa from Denno Labo Corporation. So, author attribute to all responsibility of this work, therefore, it is not any expression our institute’s opinion..
References1. Abraham NS, Singh S, Alexander GC, Heien H, Haas LR, Crown W, et al. Comparative risk of gastrointestinal bleeding with dabigatran,
rivaroxaban, and warfarin: population based cohort study. BMJ (Clinical research ed). 2015;350:h1857.2. Bang OY, Hong KS, Heo JH. Asian Patients with Stroke plus Atrial Fibrillation and the Dose of Non-Vitamin K Oral Anticoagulants.
Journal of stroke. 2016;18(2):169-78.3. Breithardt G, Baumgartner H, Berkowitz SD, Hellkamp AS, Piccini JP, Stevens SR, et al. Clinical characteristics and outcomes with
rivaroxaban vs. warfarin in patients with non-valvular atrial fibrillation but underlying native mitral and aortic valve disease participating in the ROCKET AF trial. European heart journal. 2014;35(47):3377-85.
4. Cameron C, Coyle D, Richter T, Kelly S, Gauthier K, Steiner S, et al. Systematic review and network meta-analysis comparing antithrombotic agents for the prevention of stroke and major bleeding in patients with atrial fibrillation. BMJ open. 2014;4(6):e004301.
5. Chang HY, Zhou M, Tang W, Alexander GC, Singh S. Risk of gastrointestinal bleeding associated with oral anticoagulants: population based retrospective cohort study. BMJ (Clinical research ed). 2015;350:h1585.
6. Chang SH, Chou IJ, Yeh YH, Chiou MJ, Wen MS, Kuo CT, et al. Association Between Use of Non-Vitamin K Oral Anticoagulants With and Without Concurrent Medications and Risk of Major Bleeding in Nonvalvular Atrial Fibrillation. Jama. 2017;318(13):1250-9.
7. Culebras A, Messe SR, Chaturvedi S, Kase CS, Gronseth G. Summary of evidence-based guideline update: prevention of stroke in nonvalvular atrial fibrillation: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2014;82(8):716-24.
8. Diener HC, Kleinschnitz C. Non-Vitamin K Oral Anticoagulants in Stroke Patients: Practical Issues. Journal of stroke. 2016;18(2):138-45.9. Douxfils J, Buckinx F, Mullier F, Minet V, Rabenda V, Reginster JY, et al. Dabigatran etexilate and risk of myocardial infarction, other
cardiovascular events, major bleeding, and all-cause mortality: a systematic review and meta-analysis of randomized controlled trials. Journal of the American Heart Association. 2014;3(3):e000515.
10. Gomez-Outes A, Terleira-Fernandez AI, Calvo-Rojas G, Suarez-Gea ML, Vargas-Castrillon E. Dabigatran, Rivaroxaban, or Apixaban versus Warfarin in Patients with Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-Analysis of Subgroups. Thrombosis. 2013;2013:640723.
11. Granger CB, Alexander JH, McMurray JJ, Lopes RD, Hylek EM, Hanna M, et al. Apixaban versus warfarin in patients with atrial fibrillation. The New England journal of medicine. 2011;365(11):981-92.
12. Halvorsen S, Atar D, Yang H, De Caterina R, Erol C, Garcia D, et al. Efficacy and safety of apixaban compared with warfarin according to age for stroke prevention in atrial fibrillation: observations from the ARISTOTLE trial. European heart journal. 2014;35(28):1864-72.
13. Huiart L, Ferdynus C, Renoux C, Beaugrand A, Lafarge S, Bruneau L, et al. Trends in initiation of direct oral anticoagulant therapies for atrial fibrillation in a national population-based cross-sectional study in the French health insurance databases. BMJ open. 2018;8(3):e018180.
14. Hurst KV, O'Callaghan JM, Handa A. Risk impact of edoxaban in the management of stroke and venous thromboembolism. Vascular health and risk management. 2016;12:329-35.
15. Inohara T, Xian Y, Liang L, Matsouaka RA, Saver JL, Smith EE, et al. Association of Intracerebral Hemorrhage Among Patients Taking Non-Vitamin K Antagonist vs Vitamin K Antagonist Oral Anticoagulants With In-Hospital Mortality. Jama. 2018;319(5):463-73.
16. January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC, Jr., et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation. 2014;130(23):e199-267.
17. Kato ET, Giugliano RP, Ruff CT, Koretsune Y, Yamash*ta T, Kiss RG, et al. Efficacy and Safety of Edoxaban in Elderly Patients With Atrial Fibrillation in the ENGAGE AF-TIMI 48 Trial. Journal of the American Heart Association. 2016;5(5).
18. Lip GYH, Keshishian A, Li X, Hamilton M, Masseria C, Gupta K, et al. Effectiveness and Safety of Oral Anticoagulants Among Nonvalvular Atrial Fibrillation Patients. Stroke. 2018;49(12):2933-44.
19. Lopes RD, Al-Khatib SM, Wallentin L, Yang H, Ansell J, Bahit MC, et al. Efficacy and safety of apixaban compared with warfarin according to patient risk of stroke and of bleeding in atrial fibrillation: a secondary analysis of a randomised controlled trial. Lancet (London, England). 2012;380(9855):1749-58.
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20. Nielsen PB, Skjoth F, Sogaard M, Kjaeldgaard JN, Lip GY, Larsen TB. Effectiveness and safety of reduced dose non-vitamin K antagonist oral anticoagulants and warfarin in patients with atrial fibrillation: propensity weighted nationwide cohort study. BMJ (Clinical research ed). 2017;356:j510.
21. Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke W, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. The New England journal of medicine. 2011;365(10):883-91.
22. Seligman SJ. Uninterrupted Dabigatran versus Warfarin for Ablation in Atrial Fibrillation. The New England journal of medicine. 2017;377(5):495.
23. Wang KL, Lip GY, Lin SJ, Chiang CE. Non-Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention in Asian Patients With Nonvalvular Atrial Fibrillation: Meta-Analysis. Stroke. 2015;46(9):2555-61.
Table1. Characteristics of NOACs and VKAs Patients
Table2. Distribution of Effectiveness of NOACs and VKAs patients
Table3. Mean Net Healthcare Expenditures with NOACs and VKAs
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HTAsia Link Format Abstract Cost effectiveness of sodium-glucose cotransporter 2 inhibitors in the treatment of metformin monotherapy failed type 2 diabetes patients: a systematic review and meta-analysis of cost utility analyses
1,2Bagepally BS, 1,3Gurav Y, 1,4Anothaisintawee T, 1,5Youngkong S, 1,5Usa Chaikledkaew, 1,6Thakkinstian A1 Health Technology Assessment Post Graduate Program, Mahidol University, Bangkok, Thailand.2 ICMR-National Institute of Epidemiology, Chennai, India3 ICMR-National Institute of Virology, Pune, India4 Department of Family Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd, Ratchathewi, Bangkok, 10400,
Thailand.5 Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.6 Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
OBJECTIVEType 2 Diabetes (T2DM) and associated chronic health ailments are leading economic burden to society. Sodium glucose cotransporter-2 (SGLT2) inhibitors are recent class of anti-diabetic medications with beneficial clinical efficacy. Current economic evaluation reviews reported descriptive summaries of economic results without quantitative synthesis. This systematic review and meta-analysis was therefore conducted, which aimed to quantitatively pool incremental net benefit (INB) of SGLT2 inhibitors in metformin monotherapy failed T2DM.
METHODS Cost-utility studies relevant to interventions of interest were identified from Pubmed, Scopus, Proquest, Cochrane-library and Tufts Cost-effective Analysis Registry since inception to June 2018. Details of study characteristics, economic model inputs, measures of central tendency & dispersion of economic costs and outcomes were extracted. Risk of bias was assessed using biases in economic studies (ECOBIAS) checklist. The INB was calculated for each study with converting monetary units to purchasing power parity adjusting for US$ 2017. This was then pooled across studies stratifying by level of country’s income using a random-effect model if heterogeneity was present, otherwise a fixed-effect model was used. Heterogeneity was assessed using Q test and I2 statistic.
RESULTSA total of 13 studies with 22 comparisons, mainly from high-income countries, were eligible. Six and 4 studies compared SGLT2 with dipeptidyl peptidase-4 inhibitors (DPP4i) and sulfonylureas, respectively. The pooled INBs for these corresponding comparisons were $164.95 (95% CI: $-534.71, $864.61; I2=0%) and $3,675.09 (95% CI: $1,656.46, $5,693.71; I2=85.4%), respectively. This could be interpreted that SGLT2s versus sulfonylureas were cost-effective and SGLT2s versus DPP4i were not cost-effective.
DISCUSSION AND CONCLUSIONSSGLT2 drugs were cost-effective comparing with sulfonylureas but not for DPP4i. Most evidences are from high-income countries with few comparative drug-groups and may not be representative of actual global scenario. Further studies from middle and lower economies as well as other comparators are still required.
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Cost-effectiveness of sodium-glucose cotransporter 2 inhibitors in the treatment of metformin monotherapy failed type 2 diabetes patients: A systematic review and meta-analysis of cost utility analyses
Bagepally BS1,2, Gurav Y1,3, Anothaisintawee T1,4, Youngkong S1,5, Chaikledkaew U1,5, Thakkinstian A1,6
1 Health Technology Assessment Post Graduate Program, Mahidol University, Bangkok, Thailand2 ICMR-National Institute of Epidemiology, Chennai, India3 ICMR-National Institute of Virology, Pune, India4 Department of Family Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd, Ratchathewi, Bangkok, 10400,
Thailand.5 Faculty of Pharmacy, Mahidol University, Bangkok, Thailand. 6Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi
Hospital, Mahidol University, Bangkok, Thailand.6 Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Corresponding Author: Prof. Ammarin Thakkinstian Email: [emailprotected] Count: Abstract: 260 Manuscript (Excluding reference) = 645
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Proceeding Article
Abstract
OBJECTIVEType 2 Diabetes (T2DM) and associated chronic health ailments are leading economic burden to society. Sodium glucose cotransporter-2 (SGLT2) inhibitors are the recent anti-diabetic medications with beneficial clinical efficacy. This systematic review and meta-analysis was conducted to quantitatively pool incremental net benefit (INB) of SGLT2 inhibitors in metformin monotherapy failed T2DM.
METHODSRelevant cost-utility studies were identified from Pubmed, Scopus, Proquest, Cochrane-library and Tufts Cost-effective Analysis Registry up to June 2018. Details of study characteristics, economic model inputs, costs and outcomes were extracted. Risk of bias was assessed using biases in economic studies (ECOBIAS) checklist. The INB was calculated with monetary units adjusting with purchasing power parity for US$ 2017. This was then pooled across studies stratifying by level of country’s income using a random-effect model if heterogeneity was present, otherwise a fixed-effect model was used. Heterogeneity was assessed using Q test and I2 statistic.
RESULTSA total of 13 studies with 22 comparisons, mainly from high-income countries, were eligible. Six and 4 studies compared SGLT2 with dipeptidyl peptidase-4 inhibitors (DPP4i) and sulfonylureas, respectively. The pooled INBs (95% CI) for these corresponding comparisons were $164.95 ($-534.71, $864.61; I2=0%) and $3,675.09 ($1,656.46, $5,693.71; I2=85.4%), respectively. This could be interpreted that SGLT2s versus sulfonylureas were cost-effective whereas SGLT2s versus DPP4i were not cost-effective.DISCUSSION AND CONCLUSIONS: SGLT2 drugs were cost-effective comparing with sulfonylureas but not for DPP4i. Most evidences are from high-income countries with few comparative drug-groups and may not be representative of actual global scenario. Further studies from middle and lower economies as well as other comparators are still required.
Key WordDiabetes, Economic evaluations, SGLT2, Sulfonylureas, DPP4i,
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INTRODUCTIONType 2 diabetes mellitus (T2DM) is growing epidemically, which burden to not only healthcare1 but also economic lost to individuals, family, and countries2,3. The initial treatment is metformin monotherapy4 but duplet or triplet therapies can be prescribed by adding sulfonylurea, thiazolidinedione, dipeptidyl peptidase-4 (DPP4i) inhibitors, sodium-glucose co-transporter-2 inhibitor (SGLT2i), glucagon-like peptide-1 (GLP1) receptor agonist, or basal insulin for patients who failed from monotherapy4. SGLT2i reported to be better in-terms of overall mortality, cardiovascular death and heart failure compared to other anti-diabetic drugs5-7 but economical evidences (e.g., cost-effectiveness or cost utility) are still controversial8-10. This study therefore aimed to pool incremental net benefit (INB) of any of SGLT2i compared to other anti-diabetic treatments in patients with metformin-monotherapy failure.
METHODSReview methods were followed preferred reporting items for systematic reviews and meta-analyses guideline11 and registered (Prospero-ID: CRD42018105193). Relevant studies were identified from Pubmed, Scopus, Proquest, Cochrane-library and Tufts Cost-effective Analysis Registry since inception to June 2018. Studies were selected if they reported economic evaluations with interventions of interest that reported incremental cost effectiveness ratio (ICER), quality adjusted life years (QALY), or INB gained. Characteristics of studies and economic data (i.e., cost(C), effectiveness(E), incremental costs(ΔC) & effectiveness(ΔE) willingness to pay threshold (WTPT) and ICER were extracted. Risk of bias was assessed using modified economic evaluations bias (ECOBIAS) checklist12. The outcome parameter of interest was INB of SGLT2 versus others, in which positive INB indicates cost-effectiveness13,14. Due to variations in reporting with incomplete data which is not ready for pooling, data was simulated if necessary, according to predefined scenarios. All monetary units, except for non-GDP based threshold, were adjusted for consumer price index (CPI) and purchasing power parity (PPP) conversion rates for year 201715. INB and its variance were estimated and pooled across studies14 stratified by country’s income using a random-effect model if heterogeneity was present, otherwise with fixed-effect model. Heterogeneity was assessed using Q test and I2 statistic.
RESULTSA total of 362 studies were identified, of which 13 studies9,10,16-26 with 22 comparisons were eligible for meta-analysis (Figure 1). Most of studies were from high income countries with similar profile of bias on ECO-BIAS checklist12.
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Figure-1. Study selection process.
INBs of SGLT2 versus DDP4i10,19,21,22,25,26 were hom*ogenous across studies (I2=0), they were thus pooled using fixed-effect model yielding the TINB (95% CI) of $164.95 ($-534.71, $864.61), see Figure 2A. Five studies10,19,22,25,26 compared SGLT2 versus sulfonylureas. Their INBs were highly heterogeneous (I2=85.4%) with the TINB of $3,675.09 ($1,656.46, $5,693.71), see Figure 2B. On a subgroup analysis, among countries with higher GDP (median ≥$19,254) had lower heterogeneity (I2=1.9%).
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Figure-2. pooling of INB, A. SGLT2 versus DPP4i, B. SGLT versus sulfonylureas.
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DISCUSSIONWe performed a systematic review and meta-analysis of cost-effectiveness of SGLT2 comparing with DPP4i and sulfonylureas indicating cost-ineffective for DDP4i but cost-effective for sulfonylurea, though the later high heterogeneity. Meta-analysis of economic studies poses multiple challenges due to various styles of reports (no measures of dispersion), model input parameters, level of countries’ income, WTP, perspectives, costs and measurements, etc. These concerns were addressed by defining priory scenario-based data extraction and monetary unit’s adjustment with CPI & PPP. In addition, the INB was used as the effect measure instead of ICER, as for limitations of ICER27. Furthermore, variation of model input parameters across primary studies was concerned by performing multiple subgroup and sensitivity analyses. Current study bridges the knowledge gap of no synthesis of economic parameters of T2DM economic evaluation studies, which provide only descriptive summaries of economic parameters3,28,29. This meta-analysis of economic studies provides a synopsis of direction of cost-effectiveness with a global overview and such results would be useful for policy makers from resource limited countries.
CONCLUSIONSSGLT2 drugs yields better health benefit for the money spent than Sulfonylureas but not with DPP4i inhibitors. Further studies are needed from low and middle-income countries as well as with other anti-diabetic drugs.
AcknowledgementsBSB and YG acknowledges the financial fellowship support by Department of Health Research, Govt. of India through a fellowship under Human Resource development program, Indian Council of Medical Research.This work is a part of training in Health Technology Assessment (HTA)'s PhD/Master degree, which scholarship is provided by Mahidol University and the International Decision Support Initiative (iDSI). This work was produced as part of the International Decision Support Initiative (www.idsihealth.org), which supports countries to get the best value for money from health spending. iDSI receives funding support from the Bill and Melinda Gates Foundation, the UK Department for International Development, and the Rockefeller Foundation. The findings, interpretations and conclusions expressed in this article do not necessarily reflect the views of the aforementioned funding agencies.This manuscript is an important part of the training of Dr. Bhavani Shankara Bagepally who is a Master’s student in Health Technology Assessment in the Faculty of Pharmacy and Faculty of Graduate Studies, Mahidol University, Bangkok Thailand.
CONFLICT OF INTERESTNone
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7. Zheng SL, Roddick AJ, Aghar-Jaffar R, Shun-Shin MJ, Francis D, Oliver N, et al. Association Between Use of Sodium-Glucose Cotransporter 2 Inhibitors, Glucagon-like Peptide 1 Agonists, and Dipeptidyl Peptidase 4 Inhibitors With All-Cause Mortality in Patients With Type 2 Diabetes: A Systematic Review and Meta-analysis. JAMA. 2018 17;319(15):1580–91.
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Gastroenterol Hepatol. 2004 Jun;16(6):543–9. 14. Crespo C, Monleon A, Díaz W, Ríos M. Comparative efficiency research (COMER): meta-analysis of cost-effectiveness studies. BMC
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Applying multiple-criteria decision analysis (MCDA) to evaluation of new medicines: reimbursem*nt decision on treatment options of locally advanced and metastatic non-squamous cell lung cancer in patients with wild-type EGFR and ALK after platinum-containing chemotherapy
1Mei-chi Lai, 1Szu-Ting Hsieh, 1Chao-Ming Chang, 1Shu-chen Chu, 1Li-Ying(Grace) Huang, 1Churn-Shiouh Gau, 1Kai-Ling Kao1 Division of Health Technology Assessment/Center for Drug Evaluation, Taiwan
OBJECTIVEThis study aimed to adopt an multiple-criteria decision analysis (MCDA) approach to build a preliminary value framework for evaluation of novel treatment options in locally advanced and metastatic non-squamous cell lung cancer in patients harboring wild-type EGFR and ALK who have received platinum-containing chemotherapy, including atezolizumab, nivolumab, pembrolizumab, pemetrexed, gefitinib and erlotinib.
METHODS By using the EVIDEM framework, twelve criteria were defined based on literature reviews and expert consultation. The twelve criteria were categorized into five domains, which can be explicitly measured and assessed: (1) need for intervention, (2) type of benefit of intervention, (3) comparative outcomes of intervention, (4) knowledge about intervention, and (5) economic impact of intervention. Experts in public health and pharmacoeconomics, previous government officials, clinical experts, members from the appraisal committee, and representatives of the patient groups were invited to rate the preference of the five domains. Preferences were elicited from the results of the survey using the analytic hierarchy process.
RESULTSRegarding the priority for decision making, need for intervention (24.44%), type of benefit of intervention (22.69%), and comparative outcomes of the intervention (21.33%) were rated with higher preference; economic consequences of intervention (16.54%) and knowledge about intervention (15%) were the least preferred domains. In terms of the treatment options, pembrolizumab was rated with the highest overall preference value score of 74.3 out of 100, followed by atezolizumab, nivolumab, pemetrexed, gefitinib, and Erlotinib.
DISCUSSION AND CONCLUSIONSThis pilot study was attempted to apply the MCDA method to reimbursem*nt decision making. By eliciting the preferences of relevant stakeholders, MCDA could be used to assess the priorities of decision-making processes for complicated health policy, including reimbursem*nt policy. The trade-off between additional organizational costs of implementing an MCDA approach and the benefits of improved decision making process should be taken into consideration.
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Moderator
DAY 2 Thursday 25 April 2019
EEProfessor Jeonghoon Ahn, Ewha Womans University Dr. Takashi f*ckuda, National Institute of Public Health Dr. Wanrudee Isaranuwatchai, HITAP Professor Mark Jit, London School of Hygiene & Tropical MedicineAssociate Prof. Dr. Sukhontha Kongsin, Mahidol University Dr. Ryan Li, Global Health and Development Group, Imperial College LondonDr. Aronrag Cooper Meeyai, Mahidol UniversityDr. Arthorn Riewpaiboon, Mahidol UniversityDr. Montarat Thavorncharoensap, Mahidol UniversityMr. Suthee U-sathap*rn, Mahidol University
HSRDr. Cynthia Chen, HITAPMs. Saudamini Dabak, HITAPDr. Sarah Elizabeth Garner, WHO Department of Essential Medicines and Health ProductsAssistant Prof. Dr. Pojjana Hunchangsith, Mahidol UniversityProfessor Bohyung Jang, KyungHee University Professor Sun-Young Jung, Chung-Ang UniversityProfessor Brendon Kearney, HealthPact Dr. Sukyeong Kim, NECAProfessor Taejin Lee, Seoul National University Dr. Juhwan Oh, NECADr. Nithat Sirichotiratana, Mahidol UniversityProfessor Ammarin Thakkinstian, Mahidol University
OtherProfessor Chardsumon Prutipinyo, Mahidol UniversityAssistant Prof. Dr. Sitap*rn Youngkong, Mahidol University
90
Commentator
DAY 2 Thursday 25 April 2019
EEDr. Peter Baker, Global Health and Development Group, Imperial College / iDSIProfessor John Cairns, LSHTM Dr. Insun Choi, NECADr. Peter Coyte, University of TorontoProfessor Anthony Culyer, Universigty of York Professor Iñaki Gutiérrez-Ibarluzea, HTAiDr. Peter Hangoma, University of ZambiaDr. Pattara Leelahavarong, Mahidol UniversityDr. Wee Hwee Lin, Saw Swee Hock School of Public Health, National University of Singapore Dr. Aronrag Cooper Meeyai, Mahidol University Professor Alec Morton, University of Strathclyde Dr. Jasmine Pwu, Ministry of Health and Welfare in TaiwanMs. Waranya Rattanavipapong, HITAPDr. Sophie Söderholm Werkö, SBU / INAHTA
HSRAssociate Prof. Wendy Babidge, RACSPhD. YingYao Chen, NHC Key Lab of Health Technology Assessment, Fudan University Dr. Tessa Edejer, World Health Organization Dr. Sarah Elizabeth Garner, WHO Department of Essential Medicines and Health ProductsProfessor Jeffrey Hoch, University of California, DavisDr. Pwee Keng Ho, IJTAHC / SMJDr. Min-Jeong Kim, NECADr. Seok-Hyun Kim, NECA Dr. Min Jung Ko, NECADr. Alexandre Lemgruber, WHO PAHODr. Ryota Nakamura, Hitotsubashi UniversityDr. Chong Yon Park, NECADr. Junainah Sabirin, MaHTASDr. Sophie Söderholm Werkö, SBU / INAHTAProfessor Kun Zhao, CNHDRC
OtherProfessor John Cairns, LSHTM Dr. Yot Teerawattananon, HITAPDr. David Tivey, Royal Australasian College of Surgeons, ASERNIP-S
91
Area No. Title Country
HSR PS1-01 International Experience of Health Financing Under Social Health Insurance and its Implications for China China
HSR PS1-02 Assessment of Capacity Building of Member States of WHO South-East Asia Region in Global Health Thailand
HSR PS1-03 Utilization of Health Technology Assessment Reports in the Philippines Philippines
HSR PS1-04 Analysis on disease spectrum and health expenditures of the low incomes: the practice of Poverty Alleviation Project in Hebei Province of China China
HSR PS1-05 Implementing Type-2 Diabetes Management (T2DM) in Rural China China
HSR PS1-06 A systematic review and meta-analysis of screening, diagnostic accuracy, and risk factors for hearing loss among under five children in South Asian Region India
HSR PS1-07 Evaluation Study of Public Health Interventions using HTA methods in South Korea: the Community Primary Care Pilot Project Republic of Korea
EE PS1-08 Cost of delivering Cataract services at different levels of health care facilities in India India
EE PS1-09 Assessing the Feasibility of Including Ultrasound Screening among Pregnant Mothers in the National Health Insurance Program Philippines
¬EE PS1-10 Economic evaluation of hepatitis A vaccines by the level of income country: A systematic review India
EE PS1-11 Cost-utility analysis of different renal replacement therapy modalities for end stage renal disease patients in Thailand Thailand
EE PS1-12 Antimicrobial Susceptibility Testing Costing Analysis China
Other PS1-13 Comparison of Valuation Methods for Health States from Novel Health-related Quality of Life Instrument with 8 Items (HINT-8) Republic of Korea
Other PS1-14 Health-Related Quality Of Life Of Malaysian Children With Transfusion-Dependent Thalassemia Using The PedsQL™ 4.0 Generic Core Scales Malaysia
Other PS1-15 Exploring Influencing Factors of Launching Life-course Healthcare Services for Women in China: A Qualitative Study China
Other PS1-16 Antibiotic Prophylaxis of Catheter-Associated Urinary Tract Infections: Systematic Review and Network Meta-Analysis Thailand
POSTER SESSION
DAY 2 Thursday 25 April 2019
92
PS01
International Experience of Health Financing Under Social Health Insurance and its Implications for China
1Yu-Jie Yang, 1A-Yan Mao, 1Wu-Qi Qiu, 1Pei Dong 1Yue-li Meng, 1En-Huan Du, 2Chen Qiao1 Institute of Medical Information, Chinese Academy of Medical Sciences, Beijing, China2 School of Health Management and Education, Capital Medical University, Beijing, China
OBJECTIVEAs the core module of the health system, health financing plays a fundamental role in the realization of other functions of the system, such as service delivery, resource production and management. How to raise, rationally allocate and effectively utilize health resources is an important part of carrying out research on health system. This paper aimed to make a comprehensive analysis of health financing characteristics and historical experience of the countries with social health insurance system(SHI), in order to provide reference for improving China’s health financing mechanism, optimizing financing structure and expanding financing channels.
METHODS By means of literature research, PubMed, Scopus, CNKI and Wanfang database were reviewed to summarize the health financing experience and reform measures in Germany, France, Japan, and Korea. The World Bank and OECD databases also were searched to analyze and compare the structure, total amount and its trends of health financing in typical countries.
RESULTSFrom 1970 to 2015, the total health expenditure(THE) of SHI countries increased with GDP growth, and the growth rate was more obvious. In the composition of health financing, public health expenditure accounted for an increasing proportion of THE, reaching about 80% in 2015 (excluding Korea). The main health financing characteristics of SHI countries were that the basic insurance system was enforced through legislation, insurance funds were shared by the government, employers and employees, and to achieve risk sharing by implementing social pooling.
DISCUSSION AND CONCLUSIONSThe rational design of health financing system is inseparable from the government's responsibility. China should give full play to the government's functions and develop diversified health financing channels. At the same time, the government should actively promote the integration of health security system to improve the financing fairness, and pay attention to the financing for the ageing population, and develop long-term care insurance.
POSTER SESSION
DAY 2 Thursday 25 April 2019
93
PS03
UTILIZATION OF HEALTH TECHNOLOGY ASSESSMENT REPORTS IN THE PHILIPPINES
1Geovin Dexter Uy, 1,2Bernadette Joy Almirol1 Health Technology Assessment Unit, Department of Health, Philippines2 College of Public Health, University of the Philippines Manila
OBJECTIVEThe HTA Unit in the Department of Health was established July 2017 to aid DOH and PhilHealth in making more efficient resource allocation decisions. Demonstrating the capacity of the Unit to produce high-quality outputs is considered a critical step to having health system impact. This study focused on utilization of all reports produced by HTA Unit for the past year.
METHODS A research utilization framework developed by Gerhardus and Landry was used, comprising of six steps: awareness, acceptance, policy process, policy decision, practice, and outcome. Current level of awareness on having an HTA Unit was scanned across stakeholders; acceptance of reports was analyzed through a survey. Roles of reports in making decisions and future policy were examined.
RESULTSImprovements in seeking HTA Unit for evidence generation by stakeholders was evident. A total of 13 reports were produced, wherein majority were performed on drugs due to high demand of Formulary Executive Council for HTA (n=7). Respondents positively described reports as comprehensive, well-written, and well-researched. Having pre-approved protocols and better distinction of facts from expert opinions were suggested. Reports were mainly used as evidence for approval (n=2) or disapproval (n=5) of drugs for inclusion to the Philippine National Formulary. Discussions regarding price negotiations were initiated. Additionally, policy reviews (n=1), procurement decisions (n=1), and recommendations for further research (n=2) were determined as other uses of the reports. There were also decisions that did not follow HTA recommendations or were made prior to completion of the studies.
DISCUSSION AND CONCLUSIONSPublication barriers, capacity barriers, and political barriers were observed as hindering factors to attain maximum effects of HTA reports. HTA studies should be expanded to other health technologies. Effects on practices and outcomes were deemed too early to measure; however, utilization must still be continuously monitored to eventually measure impact of HTA.
POSTER SESSION
DAY 2 Thursday 25 April 2019
94
PS05
Implementing Type-2 Diabetes Management (T2DM) in Rural China
Yaoling Wang, Wudong Guo, Xue Li, Kun Zhao1 China National Health Development Research Center
OBJECTIVEThe increase in the prevalence of diabetes and the need for health care delivery modifications call for collaborations between each level of providers. A Type-2 diabetes management program (T2DM) was implemented in a rural area. This study aims to contribute to evaluating integrated care initiatives outcomes by examining the implementation of integrated care for T2DM.
METHODS An embedded questionnaires and semi-structured interviews were employed. The PRECEDE-PROCEED Model was used to study the relationship between care groups, patient involvement, health professional cooperation, evidence-based care protocols (Referral Standard) and a shared clinical information system. Also, a retrospective medical record review was completed.
RESULTSThe implementation of the T2DM indicates that integrated care outcomes adhered to empowerment, access and support, local needs and barriers, and care coordination scale. It also shown that local clinic may only offer advice on risk reduction rather than specific diagnosis and treatment to affect patients’ behavior change. More skilled diagnosis and treatment will be offer in upper level of medical institutions. The skill set required for diabetes is complex, requiring problem-solving skills and the use of multiple technologies for testing and medication. The challenges in the T2DM also call for additional professional supports to promote diagnosis and treatment skills and outcomes for people with diabetes.
DISCUSSION AND CONCLUSIONSBarriers to the implementation of T2DM included insufficient integration between the patient databases, decreased access to care, insufficient standard protocol for early prevention, diagnosis and even treatment. Economic and IT system barriers as discussed were one of the most problematic areas of integrated care implementation. Future efforts should focus on areas that this study found to be problematic or to not have received enough attention. The detailed analysis herein will serve to facilitate translation of the T2DM to the decision making.
POSTER SESSION
DAY 2 Thursday 25 April 2019
95
PS06
A systematic review and meta-analysis of screening, diagnostic accuracy, and risk factors for hearing loss among under five children in South Asian Region
Ramesh Athe*, Rinshu Dwivedi, Sanghamitra Pati1 HTA Indian Hub, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha-751023, India
OBJECTIVECongenital hearing impairment in infants and children has been linked with lifelong deficits in speech and language acquisition, poor academic performance, individual and social maladjustments, and emotional difficulties. Study aims to combine evidence from randomized controlled trials to assess the accuracy of hearing screening procedures, relative diagnostic test of different hearing examination and risk indicators which are associated with partial and permanent hearing loss among neonatal and under five children.
METHODS The steps in this process were conducted according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis) guidelines for meta-analysis. The following databases were searched: Medline, Embase, the Cochrane Library, PubMed, ProQuest, and secondary references. Prior to the title and abstract screening, a screening form and data extraction will be developed based on the inclusion and exclusion criteria. Analyses were performed to calculate summary estimates on risk indicators and test procedure by using fixed/random effects model. Meta-regression and covariate analyses were performed to explore the influence of confounders on the net pooled effect.
POTENTIAL IMPACTAccording to the protocol at the screening, diagnostic investigations should have been completed before under five children. Auditory stimuli during the first 6 months of life are critical for the development of speech and language skills. Several studies have shown that infants who receive intervention before the age of 6 months have better school outcomes, and improved language and communication skills by ages 2 to 5 years. Without early intervention, children with hearing loss will show irreversible deficit in communication, psychosocial skills and literacy. Premature infants have many concomitant risk factors which influence the occurrence of hearing deficit.
POSTER SESSION
DAY 2 Thursday 25 April 2019
96
PS07
Evaluation Study of Public Health Interventions using HTA methods in South Korea: the Community Primary Care Pilot Project
Hee-Sun, Kim 1, Bit-Na Yoo 1, Chong Yon, Park 1
1 Office of Policy Research for Future Healthcare, National Evidence-based Healthcare Collaborating Agency, Seoul
OBJECTIVEHealth Technology Assessment (HTA) research is being used to rationalize insurance finances and allocate efficient medical resources. In the recent years, the evaluation of public health interventions (PHI) poses some challenges, and HTA methods for PHI need to be adapted.In Korea, efforts are being made to provide information on decision-making for the health and medical system through HTA research. Accordingly, this paper introduces the evaluation of the primary care intervention for hypertension and diabetes in the Community Primary Care Pilot Project.
METHODS This assessment of primary care intervention covered a comprehensive consultation of doctors and educational consultations (physical activity, nutrition). The procedures and methods for the evaluation comprised three steps.
RESULTSFirst, in the analysis design process, the analysis model and question were included. The analytic question is formulated by designing a logical model and through systematic literature reviews. The second step was deriving the evaluation indicators based on the analysis question and collecting the evaluation resource (e.g., Project Data Base, questionnaire, public corporation data collaboration) according to it. Third, the process of analyzing was included into operational indicators for monitoring the operation and effective indicators for evaluating the effects of intervention. The effect evaluation was estimated by the comparison group selection by the propensity score matching and the analysis of the difference-in-difference. Economic evaluation (cost-benefit analysis) was also included in evaluation of intervention outcomes.
DISCUSSION AND CONCLUSIONSAs the HTA study was implemented to create a basis for the safety, effectiveness, and economic efficiency of a single medical technology, this evaluation study of primary care intervention was conducted as the assessment of the multiple interventions. Therefore, it is necessary to make efforts to expand not only the analysis and assessment of individual medical technologies but also the evaluate services centered on patients in public health.
POSTER SESSION
DAY 2 Thursday 25 April 2019
97
PS08
Cost of delivering Cataract services at different levels of health care facilities in India
Oshima Sachin, Jyotsna Naik , Malkeet Singh, Himanshi Tomar, Kavitha Rajsekhar, Vijay Kumar Gauba1 Department of Health Research, Ministry of Health and Family Welfare, Govt of India.
OBJECTIVECataract constitutes 60-70% of blindness reported from India. Evidence suggests that Phacoemulsification and Small Incision Cataract Surgery are the two most commonly used cataract surgeries in India along with foldable and rigid PMMA lenses. For cataract surgery, a globally cost effective intervention, cost is still a barrier especially for people in lower socioeconomic strata in India. Variation in costs between different providers of cataract surgery exists in the Indian healthcare system. In the absence of a country wide costing database in India, some of these variations need to be addressed so that a true picture of the cost of different type of cataract surgeries and intraocular lenses at different levels of healthcare can be elucidated and considered by the policy maker for making policy decisions. Costs of cataract surgery reported from India are a decade old / are representative of only a particular type of health facility from India which cannot be generalised for undertaking a health technology assessment. The study aimed to estimate the unit cost of providing two commonly utilized types of cataract surgery, Phacoemulsification and MSICS across different levels of healthcare facilities in India from the healthcare perspective.
METHODS Health facilities for costing were chosen based on the number of cataract surgeries being undertaken across different levels of healthcare in India . Primary cost data was collected from four different health care facilities – NGO of a secondary level from Tier 1 and Tier 2 city and secondary and tertiary public hospitals from Tier 1 city in India .using a validated cost data collection tool adapted for cataract surgery and a time allocation sheet for personnel undertaking multiple duties. Economic cost data was collected from a healthcare provider perspective using bottom up costing methodology to calculate overall costs of cataract surgery on one eye, including pre- and postoperative care using standard methodologies. Costs were collected under the heads of capital, human resource, drugs and consumables, overheads and equipment. Costs were annualized where applicable. Time allocation of human resource to different services was collected by structured interviews. Shared resources were appropriately apportioned and finally unit cost of services was calculated. The out of pocket expenditure of cataract –of self-reported cases and hospitalisations in different levels of healthcare was determined from NSSO data (2014).
RESULTSThe Average Cost of Cataract Surgery from the health system perspective reported after primary cost data collection from three secondary centres Cost of Phacoemulsification Cataract Surgery Package Rs 9606/-Cost of MSICS Cataract Surgery Package Rs 7405/-Cost of Cataract Surgery from the health system perspective reported after primary cost data collection from a tertiary hospital settingCost of Phacoemulsification Cataract Surgery Package Rs 13017.51/-Cost of MSICS Cataract Surgery Package Rs 9215.89/-Out of Pocket Expenditure for cataract surgery in Community Health Centre /District hospitalsFor self-reported cases Rs 145/-For Hospitalisations Rs 2577/-Out of Pocket Expenditure for cataract surgery in Public HospitalsFor self-reported cases Rs /361-For Hospitalisations Rs /4263-
DISCUSSION AND CONCLUSIONSThe cost of cataract packages for Phacoemulsification with foldable lens and small incision cataract surgery with rigid PMMA lenses was suggested as 9606 INR and 7405 INR respectively which includes initial OPD consultation, diagnostic tests (optometry, vision test etc.), counselling, pre-surgery/anaesthetics, surgery, ward, drugs, medical consumables, lens, food for patient and one attendant and one follow-up visit cost. This primary study of cost of cataract surgery provides vital cost data input required for conducting a comprehensive HTA for cataract surgery in India which was necessary to inform governmental agencies like the RSBY &NPPA.
POSTER SESSION
DAY 2 Thursday 25 April 2019
98
PS010
Economic evaluation of hepatitis A vaccines by the level of income country: A systematic review
Yogesh Gurav1,2, Bhavani Shankara Bagepally2,3, Montarat Thavorncharoensap2,4*, Ammarin Thakkinstian2,5
1 ICMR- National Institute of Virology, Pune, India2 Health Technology Assessment (HTA) Graduate program, Mahidol University, Bangkok, Thailand3 ICMR- National Institute of Epidemiology, Chennai, India4 Social and Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University,
Bangkok, Thailand5 Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
OBJECTIVEAccording to the World Health Organization, the cost-effectiveness of hepatitis A vaccination along with the incidence of hepatitis A and a change in its endemicity should be considered in the integration of the vaccine into national immunization schedule. To date, several economic evaluations on hepatitis A vaccination were conducted globally. Our study aims to systematically review the evidences on cost-effectiveness of hepatitis A vaccination and characteristics of the methodology by level of income of the country.
METHODS PubMed and Scopus were searched from inception to November 2018. Reference lists of the retrieved articles were also searched. Economic evaluation studies including cost effectiveness analysis (CEA), cost benefit analysis (CBA) and cost utility analysis (CUA) comparing hepatitis A vaccine (inactivated or attenuated) Vs no vaccine, which reported at least one economic evaluation outcome such as incremental cost effectiveness ratio (ICER), quality adjusted life year (QALY), disability adjusted life year (DALY), life year (LY) and cost were included.
RESULTSA total of 40 out of 1725 studies were included in the review. Of them, 25, 9, 5, 1 studies were from high income, upper middle income, low middle income, and low income countries, respectively. Majority of studies used Markov model (n=20), decision tree (n=6), and dynamic model (n=5). The discount rate, time horizon, and perspective of analysis varied across studies. Hepatitis A vaccination was cost-effective among following contexts: In children (68.7%), adults (14.3%), high income (63.6%), middle income (76.9%), low income (100.0%), low endemicity (50.0%), very low endemicity (60.0%), and intermediate endemicity countries (86.7%).
DISCUSSION AND CONCLUSIONSIn low and middle-income countries with a high incidence area of hepatitis A infection, universal vaccination of infants/children and adolescents are likely to be cost-effective. Nevertheless, it should be noted that the methodology varied across studies. Several aspects should be considered in transferring the economic evaluation results across jurisdictions.
POSTER SESSION
DAY 2 Thursday 25 April 2019
99
PS10
Economic evaluation of hepatitis A vaccines by the level of income country: A systematic review
Yogesh Gurav1,2, Bhavani Shankara Bagepally2,3, Montarat Thavorncharoensap2,4*, Ammarin Thakkinstian2,5
1 ICMR- National Institute of Virology, Pune, India2 Health Technology Assessment (HTA) Graduate program, Mahidol University, Bangkok, Thailand3 ICMR- National Institute of Epidemiology, Chennai, India4 Social and Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University,
Bangkok, Thailand5 Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
The corresponding author: Montarat Thavorncharoensap*, [emailprotected]
ORAL SESSION
DAY 2 Thursday 25 April 2019
Proceeding Article
ABSTRACT
OBJECTIVEAccording to the World Health Organization, the cost-effectiveness of hepatitis A vaccination along with the incidence of hepatitis A and a change in its endemicity should be considered in the integration of the vaccine into national immunization schedule. To date, several economic evaluations on hepatitis A vaccination were conducted globally. Our study aims to systematically review the evidences on cost-effectiveness of hepatitis A vaccination and characteristics of the methodology by level of income of the country.
METHODSPubMed and Scopus were searched from inception to November 2018. Reference lists of the retrieved articles were also searched. Economic evaluation studies including cost effectiveness analysis (CEA), cost benefit analysis (CBA) and cost utility analysis (CUA) comparing hepatitis A vaccine (inactivated or attenuated) Vs no vaccine, which reported at least one economic evaluation outcome such as incremental cost effectiveness ratio (ICER), quality adjusted life year (QALY), disability adjusted life year (DALY), life year (LY) and cost were included.
RESULTSA total of 40 out of 1725 studies were included in the review. Of them, 25, 9, 5, 1 studies were from high income, upper middle income, low middle income, and low income countries, respectively. Majority of studies used Markov model (n=20), decision tree (n=6), and dynamic model (n=5). The discount rate, time horizon, and perspective of analysis varied across studies. Hepatitis A vaccination was cost-effective among following contexts: In children (68.7%), adults (14.3%), high income (63.6%), middle income (76.9%), low income (100.0%), low endemicity (50.0%), very low endemicity (60.0%), and intermediate endemicity countries (86.7%).
DISCUSSION AND CONCLUSIONIn low and middle-income countries with a high incidence area of hepatitis A infection, universal vaccination of infants/children and adolescents are likely to be cost-effective. Nevertheless, it should be noted that the methodology varied across studies. Several aspects should be considered in transferring the economic evaluation results across jurisdictions.
Key wordsHepatitis A vaccine, economic evaluation, systematic review
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INTRODUCTION According to the World Health Organization, the cost-effectiveness of hepatitis A vaccination along with the incidence of hepatitis A and a change in its endemicity should be considered in the integration of the vaccine into national immunization schedule1. To date, several economic evaluation studies on hepatitis A vaccination were conducted globally2,3. This study was conducted to systematically review evidences of the cost-effectiveness of hepatitis A vaccination and characteristics of the methodology by income level of the country.
METHODSPubMed and Scopus database were searched from inception until November 2018. Reference lists of the retrieved articles were also searched so as to ensure complete search. Economic evaluation studies including cost effectiveness analysis (CEA), cost benefit analysis (CBA) and cost utility analysis (CUA) comparing hepatitis A vaccine (inactivated or attenuated) versus no vaccine, which reported at least one economic evaluation outcome such as incremental cost effectiveness ratio (ICER), quality adjusted life year (QALY), disability adjusted life year (DALY), life year (LY) and cost were included in the systematic review. The studies conducted in animals or studies which reported only clinical effectiveness of hepatitis A vaccine, laboratory investigation on hepatitis A, disease burden studies, outbreak investigations with epidemiological findings or studies with inadequate economic outcome data were excluded. Studies reported only cost of illness of hepatitis A, systematic reviews or narrated reviews done on economic evaluation of hepatitis A vaccination, studies done with other vaccines (typhoid, hepatitis B etc) in combination with hepatitis A vaccine, editorial review, and abstracts published in conferences were considered as ineligible and hence excluded from study. Risk of bias assessment was conducted using ECOBIAS checklist4. This checklist help to identify 22 biases, included in two parts. Biases in part A includes overall checklist of bias in economic evaluation and part B informs about model specific aspects4. Income level of the country was classified as per the World Bank5, based on GNI (Gross National Income) per capita (in current US Dollars) as: Low-income countries (LIC) (< 1,005), Lower-middle income countries (LMIC) (1,006 - 3,955), Upper-middle income countries (UMIC) (3,956 - 12,235), High-income countries (HIC) (> 12,235).
RESULTS Among 1725 records identified through database searching, One hundred and fourteen full articles were accessed for eligibility and later 40 papers were included in the systematic review, as shown in Figure 1.
Figure1. PRISMA flow diagram for study selection showing included studies
Of these included studies, 25, 9, 5, and 1 studies were from high income, upper middle income, low middle income, and low income countries, respectively (Table 1).
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Table 1. Characteristics of the included studies (n=40)
(CBA= Cost benefit analysis, CEA: Cost effective analysis, CUA: Cost utility analysis)
Majority of studies used Markov model (n=20), decision tree (n=6), and dynamic model (n=5). The discount rate, time horizon, and perspective of analysis varied across studies (Table 2).
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Table 2. Quality of reporting economic evaluation studies by income level
(CE: Cost effectiveness, DALY: Disability adjusted life year, ICER: Incremental cost effectiveness ratio, LY: Life year, PSA: Probabilistic sensitivity analysis, QALY: Quality adjusted life year)
As shown in Table 2, comparator information was clearly stated in all studies regardless of income level. Model types was described in all studies conducted in high-income, and upper middle-income countries. Model parameters were stated adequately in 68.0%, 77.8%, and 20.0% of studies conducted in high income, upper-middle income, and low income countries, respectively. On the other hand, probabilistic sensitivity analysis (PSA) results and cost-effectiveness (CE) plan were less likely to be presented (Table 2). Among 40 studies, risk of bias as assessment using ECOBIAS checklist showed that bias related to double counting addressed was unclear among 22.0% studies and bias related to reporting and dissemination was not reported by 82.0% studies.Evidence of hepatitis A vaccination cost- effectiveness was shown in Table 3.
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Table 3. Evidence of Cost effectiveness of Hepatitis A vaccination
It was revealed that Hepatitis A vaccination was cost-effective among studies conducted among children (68.7%), adults (14.3%), high income countries (63.6%), middle income countries (76.9%), low income countries (100.0%), low endemicity countries (50.0%), very low endemicity countries (60.0%), and intermediate endemicity countries (86.7%). In addition, it was found that hepatitis A vaccination is cost-saving among children (66.7%), travelers (100.0%), health care professionals (100.0%), and military personals (100.0%) (Table 3).
DISCUSSIONThis systematic review suggests that universal vaccination of hepatitis A in children is more likely to be cost-effective than adolescents and adults. In addition, hepatitis A vaccination is more likely to be cost-effective in middle income and low-income countries than high income countries. Consistent with WHO guideline1, it is more likely to be cost-effective among intermediate and low endemicity area as compared to very low endemicity area. Our study found that the quality of methodology used in high income and upper-middle income countries was comparable. To date, a number of economic evaluation studies conducted in low-middle income and low-income countries is limited. As the integration of hepatitis A vaccination into national immunization schedule should consider cost-effectiveness evidence, more studies should be conducted in low income countries. In transferring the economic evaluation results across jurisdiction, several aspects should be carefully considered. Cost effectiveness of hepatitis A vaccines are more likely to be influenced by risk of hepatitis A as seen in the population living in high incidence area of hepatitis A and/or among certain population group due to their occupation or life style e.g., travelers, military personals, prison inmates and food handlers. In these risk group hepatitis A vaccinations was seems to be economically attractive6-12.CONCLUSIONS: In low and middle-income countries with a high and intermediate incidence of hepatitis A infection, universal vaccination of children are likely to be cost-effective. Nevertheless, it should be noted that the methodology varied across studies.
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ACKNOWLEDGEMENT:YG and BSB acknowledges the financial fellowship support by the Department of Health Research, Govt. of India through a fellowship under Human Resource Development Program, Indian Council of Medical Research, New Delhi, India. This work is a part of training in Health Technology Assessment (HTA)'s Master degree, for which scholarship is provided by the International Decision Support Initiative (iDSI). This work was produced as part of the International Decision Support Initiative (www.idsihealth.org) which supports countries to get the best value for money from health spending. iDSI receives funding support from the Bill and Melinda Gates Foundation, the UK Department for International Development, and the Rockefeller Foundation. The findings, interpretations and conclusions expressed in this article do not necessarily reflect the views of the aforementioned funding agencies.This manuscript is an important part of the training of Dr. Yogesh Krishnarao Gurav, who is a Master’s student in Health Technology Assessment (International programme) at the Faculty of Pharmacy, Faculty of Medicine Ramathibodi Hospital, Faculty of Medicine Siriraj Hospital, Faculty of Public Health, Faculty of Social Sciences and Humanities, Institution for Population and Social Research and Faculty of Graduate Studies in Mahidol University, Bangkok, Thailand.
REFERENCES1. World Health Organization. WHO position paper on hepatitis a vaccines – June 2012. Weekly Epidemiological Record [Internet] Geneva:
World Health Organization; 2012;87: 261-76 [cited 2018 Mar 23] Available from: http://www.who.int/wer/2012/wer8728_29.pdf?ua=1.2. Anonychuk A, Tricco A, Bauch C, Pham B, Gilca V, Duval B et al. Cost-effectiveness analyses of hepatitis A vaccine: a systematic
review to explore the effect of methodological quality on the economic attractiveness of vaccination strategies. Pharmacoeconomics. 2008;26(1):17-32.
3. Suwantika A, Yegenoglu S, Riewpaiboon A, Tu H, Postma M. Economic evaluations of hepatitis A vaccination in middle-income countries. Expert Review of Vaccines. 2013;12(12):1479-94.
4. Adarkwah C, Gils P, Hiligsmann M, Evers S. Risk of bias in model-based economic evaluations: the ECOBIAS checklist. Expert Rev. Pharmacoecon. Outcomes Res. 2015:1-11. DOI: 10.1586/14737167.2015.1103185
5. The World Bank. New country classifications by income level: 2017-2018[Internet]. The World Bank; 2018 [cited 2018 Nov 25]. Available from: https://blogs.worldbank.org/opendata/new-country-classifications-income-level-2017-2018.
6. Arnal J, Frisas O, Garuz R, Antonanzas F. Cost effectiveness of hepatitis A virus immunisation in Spain. Pharmacoeconomics. 1997;12(3):361-73.
7. Jacobs R, Saab S, Meyerhoff A. The cost effectiveness of hepatitis immunization for US college students. Journal of American College Health. 2003;51(6):227-36.
8. Jacobs R, Rosenthal P, Meyerhoff AS. Cost effectiveness of hepatitis A/B versus hepatitis B vaccination for US prison inmates. Vaccine. 2004;22(9-10):1241-48.
9. Jacobs R, Grover S, Meyerhoff A, Paivana T. Cost effectiveness of vaccinating food service workers against hepatitis A infection. Journal of Food Protection. 2000;63(6):768-74.
10. Buma C, Beutels P, Damme P, Tormans G, Doorslaer E, Leentvaar-Kuijpers A. An economic evaluation of hepatitis A vaccination in Dutch military personnel. Military Medicine. 1998;163(8):564-67.
11. Tormans G, Damme P, Doorslaer E. Cost-effectiveness analysis of hepatitis A prevention in travellers. Vaccine. 1992;10(1): S88-S92.12. Doorslaer E, Tormans G, Damme P. Cost‐effectiveness analysis of vaccination against hepatitis A in travellers. Journal of medical
virology. 1994; 44:463-69.
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PS011
Cost-utility analysis of different renal replacement therapy modalities for end stage renal disease patients in Thailand
Montira Assanatham1,2, Atip*rn Ingsathit2,3, Ammarin Thakkinstian1,3, Usa Chaikledkaew1,4
1 Health Technology Assessment Postgraduate Program, Mahidol University; 2 Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University; 3 Section for Clinical Epidemiology and Biostatistics, Ramathibodi Hospital, Mahidol University; 4 Social Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University
OBJECTIVEEnd stage renal disease (ESRD) is one of the leading causes of morbidity and mortality with high economic burden. Renal replacement therapy (RRT) has been used for treatment managements of ESRD but there have yet been economic evaluations of RRT modalities in Thailand. We therefore conducted economic evaluation study, which aimed to evaluate the cost-utility of different RRT modalities in Thailand.
METHODS Our interested RRT modalities were continuous ambulatory peritoneal dialysis (CAPD), hemodialysis (HD), living related kidney transplantation (LRKT), and deceased donor kidney transplantation (DDKT) in adult ESRD. A Markov model-based cost-utility analysis was used to determine lifetime cost, life years (LY) saved, and quality adjusted life years (QALY) of each intervention in both societal and government perspectives. Input parameters were retrieved from Thai Renal Replacement (TRT) cohort, Thai Transplantation Society (TTS) Annual Report and literature reviews. Incremental cost effectiveness ratio (ICER) in Thai Baht (THB) per LY or QALY of each RRT modality comparing with PD were estimated. Three percent annually discount rate was used for cost and outcome. Probabilistic sensitivity analysis and one-way sensitivity analysis were performed for uncertainty analysis.
RESULTSSwitching from providing PD first to HD, PD to LRKT and PD to DDKT yielded increasing health benefit with the ICER per QALY of 202,756, 381,779, and 415,931 THB, respectively. One-way sensitivity analysis indicated that a total medical care cost of CAPD in subsequent year was the most sensitive parameter.
DISCUSSION AND CONCLUSIONSAt current willingness to pay of 160,000 THB, CAPD as an initial treatment is still the optimal intervention for ESRD patients. If the decision-makers willing to pay more than 600,000 THB, LRKT will dominate all other RRT modalities.
POSTER SESSION
DAY 2 Thursday 25 April 2019
106
PS13
COMPARISON OF VALUATION METHODS FOR HEALTH STATES FROM NOVEL HEALTH-RELATED QUALITY OF LIFE INSTRUMENT WITH 8 ITEMS (HINT-8)
1 Lee HJ, 2 Kim SH, 3 Ock M, 4 Jo MW1 Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaboration Agency, Seoul, Republic of Korea2 Department of Nursing, College of Nursing, Dankook University, Cheonan, Republic of Korea3 Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea4 Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Republic of Korea
OBJECTIVEThis study aimed to compare the ranking method to standard gamble (SG), time trade-off (TTO), and visual analogue scale (VAS) for health-state valuation methods.
METHODS The survey of 408 adults was conducted to measure their preferences for the health states from Health-related Quality of Life Instrument with 8 items (HINT-8) using computer-assisted personal interviewing from September to October 2015. Out of them, 100 adults participated in retest 7 to 10 days later. Respondents assessed nine health states from HINT-8. The difficulty in valuation, average time conducting valuation task per health state, inconsistency and quality weights were calculated. We examined convergent validity using a correlation analysis, and reliability using intraclass correlation coefficients (ICC) and Kendall’s tau. Modelling to generate quality weights for all health states from HINT-8 was conducted. All the analyses were conducted for each method.
RESULTSOut of the respondents conducting ranking method, 58.1% said that it was easy to perform ranking method. The time valuing one health state using the ranking method was the shortest. The respondents not showing strong inconsistencies in the ranking method were the most. The quality weights from SG were the highest, followed by TTO, VAS and ranking method. Similar to the quality weights from the cardinal methods, the worse the health states were, the lower the quality weights were in the ranking method. The quality weights from the ranking method showed high correlation with those from cardinal methods (Pearson’s r, Spearman’s rho > 0.9). The ICC was more than 0.9 and Kendall’s tau was more than 0.9, which were higher than other methods. The logical consistencies of regression coefficients of ranking method were maintained except some coefficients.
DISCUSSION AND CONCLUSIONSThe present results will serve as a basis for expanding the use of the ranking method for health state valuation method.
POSTER SESSION
DAY 2 Thursday 25 April 2019
107
PS014
Health-Related Quality Of Life Of Malaysian Children With Transfusion-Dependent Thalassemia Using The PedsQL™ 4.0 Generic Core Scales
1Irwinder Kaur Chhabra, 1Asrul Akmal Shafie, 1Jacqueline Wong Hui Yi, 1,2Noor Syahireen Mohammed, 3Hishamshah Mohd Ibrahim1 Discipline of Social & Administrative Pharmacy, School of Pharmaceutical Science, Universiti Sains Malaysia, 11800, Pulau Pinang, Malaysia 2 Clinical Research Center, Hospital Sultanah Bahiyah, KM 6, Jalan Langgar, 05460 Alor Setar, Kedah Darul Aman, Malaysia 3 Institute of Paediatrics, Hospital Kuala Lumpur, Kuala Lumpur, Jalan Pahang, 50580, Malaysia
OBJECTIVEThe main objective is to describe the health-related quality of life (HRQoL) and the factors affecting it in Malaysian children with Transfusion-dependent Thalassemia (TDT).
METHODS A cross-sectional HRQoL survey involving TDT children aged between 2-18 years old from 12 different centers around Malaysia was conducted using the PedsQL™ 4.0 Generic Core Scales questionnaire. The relationship between HRQoL scores with various sociodemographic and clinical factors were tested using association, correlation and regression analysis.
RESULTSA total of 345 samples were obtained. The mean Total Summary Score was 80.3 ± 13.8. Psychosocial Health Summary Score (mean = 79.3 ± 14.7) was lower compared to the Physical Health Summary Score (mean = 82.3 ± 16.4). The school functioning subscale had the lowest mean (mean = 69.9 ± 20.1) amongst the health dimensions. Based on a simple regression analysis, age, tertiary education, years of transfusion, the use of monotherapy iron chelation therapy and the presence of iron overload complications were significant predictors for the Total Summary Score outcome.
DISCUSSION AND CONCLUSIONSTransfusion-dependent thalassemia (TDT) is a chronic condition which affects a child’s health-related quality of life in various dimensions. The HRQoL of TDT children decreases as they grow older. Modifiable factors such as the choice of iron chelation therapy and the prevention of iron overload development should be emphasized during treatment to help improve the HRQoL. Further efforts are needed to improve the psychosocial health and school functioning dimensions of TDT children in Malaysia. Understanding how the disease and treatment of TDT affects them is imperative in improving the delivery of care.
POSTER SESSION
DAY 2 Thursday 25 April 2019
108
PS15
Exploring Influencing Factors of Launching Life-course Healthcare Services for Women in China: A Qualitative Study
1,2Changqian Wu, 1,2Siyuan He, 1,2,3Xu Qian, 1,2Hong Jiang 1 Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China2 Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China (Fudan University)3 Corresponding author. No. 138 Yi Xue Yuan Road, Shanghai, 200032, PR China
OBJECTIVEIn the past decades, China has made great achievements in reducing maternal and child mortality. However, the gap of health policies between different age groups of women remained in China. Previous studies had found innovative healthcare services targeted for female adolescents and the middle-aged had many barriers and poor effects. The objective of this study was to explore and understand factors influencing the implementation of such healthcare services in maternal and child health centers (MCHC) for women throughout their life course in China.
METHODS Semi-structured in-depth interviews were conducted with three directors of women's healthcare departments in province-level MCHC of Jiangsu, Hubei and Shaanxi provinces by purposive sampling, representing each manager's perspectives in east, middle and west regions of China. All interviews were audio-taped, transcribed and analyzed adopting thematic analysis.
RESULTSNine themes emerged during the qualitative data analysis. They were population demand, governmental support, institution leaders' attention, guarantee of human resources, financial support or income generation, excellent facilities, regulatory standards, promotion of relevant scientific researches and multi-institutional cooperation.
DISCUSSION AND CONCLUSIONSTo expand the content as well as to improve the quality of women's healthcare services in China, following suggestions are proposed for related stakeholders. Firstly, to strengthen the government leadership and multi-sectoral cooperation to make up for blank areas of women's healthcare policies. Secondly, to advocate the concept of “Healthy China” among all industries of society to enhance the public's health literacy. Thirdly, to include cost-effective health care services on the medical insurance list based on health economic evaluation and to explore reasonable charging standards in medical markets through pilot projects. Lastly, to establish an appropriate performance measurement mechanism for fully mobilizing the enthusiasm of MCH professionals. More researches in specific aspects to evaluate outreaching healthcare services for women in China are needed.
POSTER SESSION
DAY 2 Thursday 25 April 2019
109
Poster Session
DAY 2 Thursday 25 April 2019
ReviewerProfessor John Cairns, LSHTMPhD. YingYao Chen, NHC Key Lab of Health Technology Assessment, Fudan University Dr. Seok-Hyun Kim, NECADr. Ryota Nakamura, Hitotsubashi University
110
Economic Evaluation
Time No. Title Country
09:00-09:20 EE21 Budget Impact analysis of Anti-Vascular Endothelial Growth Factor in Patients with Age Related Macular Degeneration
Republic of Korea
09:20-09:40 EE22 Cost-effectiveness analysis of HPV vaccination in China China
09:40-10:00 EE23 Cost-Effectiveness of Tdap Booster for Prevention of Pertussis in Adults Singapore
10:00-10:20 EE24 Customers’ preferences and willingness to pay for a future dengue vaccination: an empirical evidence in Vietnam Vietnam
10:40-11:00 EE25 Cost-utility analysis alongside the randomised controlled trial of SMS to support smoking cessation services in Thailand Thailand
11:00-11:20 EE26Cost-Effectiveness of pan-genotypic Sofosbuvir-Velpatasvir combination versus genotype dependent directly acting anti-viral drugs for treatment of hepatitis C patients in the universal coverage scheme of Punjab state in India
India
11:20-11:40 EE27 Is radiofrequency ablation (RFA) cost-effective for treatment of atrial fibrillation (AF) in Malaysian context? Malaysia
11:40-12:00 EE28 An Economic Evaluation of Policy Options for Renal Replacement Coverage in the Philippines Philippines
Health System Research
Time No. Title Country
09:00-09:20 HSR25 Situational Transition from real practice of the Prevention and Control of Severe Thalassemia Program in Thailand Thailand
09:00-09:20 HSR26 An Evaluation of the National Health Examination Survey in Thailand: Management Matters Thailand
09:20-09:40 HSR27A practical application of Multiple Criteria Decision Analysis (MCDA) in the context of Health Technology Assessment (HTA): a pilot study on Ministry of Health Medicines Formulary (MOHMF) listing of respiratory inhalers (RI)
Malaysia
09:20-09:40 HSR28 Exploring the Healthcare Journey of Thalassaemia Patients in Malaysia Malaysia
ORAL SESSION
DAY 3 Friday 26 April 2019
111
Health System Research
Time No. Title Country
09:40-10:00 HSR29 Systematic review of health technology assessment implementation frameworks Singapore
09:40-10:00 HSR30 Addressing the development of the Critical Illness Insurance Program in China: comparison for the status of 5 pilots in China China
10:00-10:20 HSR31 Establishment of the National Clinical Practice Guideline Program in the Philippines Philippines
10:00-10:20 HSR32 iDSI impact narrative – Indonesia chapter Thailand
10:40-11:00 HSR33 AGREE II Assessment of Malaysian Clinical Practice Guidelines (CPG) Malaysia
10:40-11:00 HSR34 Equality of reimbursem*nt for antiretroviral therapy costs among migrants in Thailand: an application of the concentration index Thailand
11:00-11:20 HSR35 Association between SLCO1B1 gene and myopathy risk in patients receiving statin : A systematic review and meta-analysis Thailand
11:00-11:20 HSR36 Assessing Districts Performance in Indonesia: A Data Envelopment Analysis and Qualitative Approach Indonesia
11:20-11:40 HSR37 Present Analysis of General Hospital at Level 2 and Above to Carry Out Disease Prevention and Control in Beijing China
11:20-11:40 HSR38 An assessment of Monitoring and Evaluation systems in Timor Leste for managing resource availability at health facilities Thailand
11:40-12:00 HSR39 Use of e-cigarettes among cigarette smoking Canadians who failed in their attempts to quit smoking Canada
ORAL SESSION
DAY 3 Friday 26 April 2019
112
Other
Time No. Title Country
09:00-09:20 Other05 Approaches of Priority Setting for Vaccine Introduction: A Systematic Review Bangladesh
09:20-09:40 Other06 Development and evaluation of mobile health behaviour change intervention to support tobacco cessation in Thailand Thailand
09:40-10:00 Other07 Implications of Contraceptive Service on Health in China from 1990 to 2017 China
10:00-10:20 Other08 Health state valuation patterns and relations to religiosity Malaysia
Work in process
Time No. Title Country
10:40-11:00 W/P01 Literature Review of Cost-Effectiveness Studies of 9-valent Human Papillomavirus (HPV) Vaccination China
11:00-11:20 W/P02 Cost-effectiveness of 13-Valent Pneumococcal Conjugate Vaccine in the treatment of Invasive Pneumococcal Disease among Children Under 5 in China China
11:20-11:40 W/P03 Developing a streamlined Health Technology Assessment framework to assess diagnostic imaging for staging of uncommon cancers Australia
ORAL SESSION
DAY 3 Friday 26 April 2019
113
EE21
Budget Impact analysis of Anti-Vascular Endothelial Growth Factor in Patients with Age-related Macular Degeneration
1Jangmi Yang, 1Sang Jin Shin, 1Jae Kyung Suh, 1Songhee Cho, 1Hajin Tchoe, 1Min Joo Kang, 1, 2Donghyun Jee1 National Evidence based Health Care Collaborating Agency, Seoul, Korea2 Department of Ophthalmology and Visual Science, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
OBJECTIVEThis study aimed to investigate the optimal strategy to give more age-related macular degeneration (AMD) patients anti-vascular endothelial growth factors (anti-VEGFs) therapy with less burden impact on National Health Insurance (NHI) to the hypothetical reimbursem*nt condition and the change of environment
METHODS The budget impacts by changes of reimbursem*nt condition and environment in anti-VEGF treatments for AMD patients were estimated over the next five years (2018-2022). Four scenarios were assumed based on the change of Anti-VEGF treatment patterns by the current reimbursem*nt condition (scenario 1), the hypothetical reimbursem*nt condition (scenario 2), the introduction of biosimilar of anti-VEGF (scenario 3) or the prescription of off-label drug bevacizumab (scenario 4). The number of patients, anti-VEGF treatments and medical costs of each scenario were calculated by claims data of the Korea National Health Insurance (NHI) and the anti-VEGF prescription data in a hospital.
RESULTSThe budget impact of Anti-VEGF injection in patients with AMD over the next 5 years was estimated to about 440.3 billion or 560.1 billion KRW in scenario 1 or 2 respectively. Under a supposition of using biosimilar products of Anti-VEGF since 2020 (scenario 3), the estimated budget of NIH was approximately 521 billion KRW (scenario 3). If the off-label drug, bevacizumab is reimbursed, roughly 419.7 billion KRW will be required for NHI’s budget (scenario 4).
DISCUSSION AND CONCLUSIONSThe expected budget of NIH for patients with AMD was expected to increase substantially due to the elimination of the current reimbursem*nt standard which is limited to the number of injection, 14 times. However, actual calculated budget was increased to moderate, due to new limitation by visual acuity of 0.1 or less or in case of scarring / atrophic lesion. Introduction of biosimilars and bevacizumab can be considered as another option for anti-VEGF treatment for AMD.
ORAL SESSION
DAY 3 Friday 26 April 2019
114
ORAL SESSION
DAY 3 Friday 26 April 2019
EE25
Cost-utility analysis alongside the randomised controlled trial of SMS to support smoking cessation services in Thailand
1Sarayuth Khuntha, 1Pritap*rn Kingkaew, 1Phorntida Hadnorntun, 1Pattara Leelahavarong1 Health Intervention and Technology Assessment Program (HITAP), Thailand
OBJECTIVEThai population smoked around 19%, smoking-related diseases caused about 75 billion Thai baht (THB) loss. SMS supporting smoking cessation was developed and evaluated (ISRCTN16022919). This study aims to conduct cost-utility analysis alongside the trial of SMS compared to existing smoking cessation services (‘do-nothing’) in Thailand.
METHODS A Markov model was developed to evaluate lifetime costs and quality-adjusted life years (QALYs) gained from preventing smoking-related diseases by providing SMS. Smoking abstinence was around 33-49% from the trial. Healthcare costs of smoking-related diseases were retrieved from the Thai national databases. Future costs and QALYs were discounted at 3% annually, the societal perspective was adopted. Smoker was assumed to receive SMS once and developed one smoking-related disease in their lifetime. Ten-year lag-time of developing smoking-related diseases was adopted. Parameter uncertainties were assessed by one-way sensitivity analysis and probabilistic sensitivity analysis.
RESULTSLifetime costs of smoker receiving SMS were 62,910-65,033 THB, of ‘do-nothing’ was 68,988 THB. QALYs of smoker receiving SMS were 15.725-15.728, of ‘do-nothing’ was 15.716. SMS saved future healthcare costs and increased QALYs compared to ‘do-nothing’. The mean incremental cost-effectiveness ratio (ICER) was -488,188 THB/QALY gained that was altered by utility of smoker/quitter (-633,720 THB/QALY gained) and probability of re-smoking (-526,540 and -462,397 THB/QALY gained).
DISCUSSION AND CONCLUSIONSSMS was cost-saving that increased QALYs and reduced future healthcare costs. SMS cost and effectiveness retained only in the first cycle since it was delivered once. If SMS was provided repeatedly, SMS cost would increase but healthcare costs might decrease because a probability of smoking abstinence was repetitive. This model may underestimate the benefits of SMS preventing more smoking-related diseases. There is no significant difference when applying lag-time. Even utility of smoker/quitter and probability of re-smoking changed the ICER, SMS remained cost-saving. Therefore, SMS was recommended to be added to the existing smoking cessation services in Thailand.
115
EE27
Is radiofrequency ablation (RFA) cost-effective for treatment of atrial fibrillation (AF) in Malaysian context?
1Syful Azlie MF, 1Ku Nurhasni AR 2Abdul Kahar AG, 3Maznah D, 4Zafar A1 Ministry of Health Malaysia2 Serdang Hospital 3 University of Malaya4 University Malaysia Sarawak
OBJECTIVEUtilisation of RFA for treatment of AF is very limited. Hence, to estimate the incremental cost-effectiveness ratio (ICER) of using RFA as second-line therapy in patients with AF who were unsuccessfully treated with antiarrhythmic drugs (AADs).
METHODS A decision tree model using TreeAge Pro 2017 software was developed to estimate the costs and utility effects of RFA. Clinical parameters and utilities data applied in the model were obtained from published literature while costs were mainly estimated from MalaysianDRG v2.0 Executive Information System (EIS) databases and Consumer Price Guide, Pharmaceutical Service Division. Costs was presented in Ringgit Malaysia (RM) 2017 values. The perspective of Ministry of Health was used and the benefits were measured in quality adjusted life years (QALYs). Deterministic sensitivity analysis was performed as one way sensitivity analysis to determine the parameter uncertainty.
RESULTSIn the base-case analysis, the model indicated that RFA compared to AAD leads to a gain of 0.10 QALY at an additional cost of RM 5,620.26 thus generates an ICER of RM 56,825.41 per QALY gained per patient. A sensitivity analysis suggested that the cost of ablation is the major factor that influenced the cost-effectiveness ratio. Reducing the cost of RFA by 20% to 50% from current cost improved the ICER to RM 39,550.47 and RM 13,638.08 per QALY gained, respectively.
DISCUSSION AND CONCLUSIONSThe ICER for the base-case was slightly higher than the suggested cost-effectiveness threshold for Malaysia (≤ 1 GDP per capita: RM 41,328.00). Reduction in cost of RFA produces a much lower ICER and thus can be considered cost-effective strategy for treatment of AF. These results may be used for price negotiation or might be useful in future budgetary planning to ensure the affordability and sustainability of the access to this treatment.
ORAL SESSION
DAY 3 Friday 26 April 2019
116
ORAL SESSION
DAY 3 Friday 26 April 2019
HSR25
Situational Transition from real practice of the Prevention and Control of Severe Thalassemia Program in Thailand
Salakjit Chuenchom (presenter), Thanap*rn Bussabawalai, Akanittha Poonchai, Natthida Malathong, Orapan Onjon, Wililak Saengsri, Sonvanee Uansri, Pattara Leelahavarong, Sripen Tantivess1 Health Intervention and Technology Assessment Program (HITAP)
OBJECTIVEIn Thailand, the Ministry of Public Health has announced the National Thalassemia Action Plan B.E. 2550-2554 with the aims to reduce a number of newborns with severe thalassemia and to improve patient’s quality of life. Also, the National Health Security Office (NHSO) has implemented the strategic plan so-called “Thalassemia Prevention and Control Program” B.E. 2557- 2559. The objective of this study is to assess governance system of the thalassemia prevention and control program in Thailand of the thalassemia prevention and control program in Thailand.
METHODS This study employed qualitative approach. Document reviews and in-depth interview with key informants were conducted. Key informants were purposively selected, comprised policy makers, relevant government officers at national and regional levels, and health care providers at district and provincial levels.
RESULTSThe long-term prevention and control program has made the thalassemia implementation as a part of the routine. Also, thalassemia was not included as the main key performance indicator of Ministry of Public Health. These factors lead to following problems: lack of monitoring and evaluation, lack of continuity in policy implementation, and lack of support for the necessary implementations such as development of skills and knowledge for health care providers, and development of media materials to educate the public. Further problems relating to governance system included difficulty of communication or transition policies as well as lack of cooperation or coordination between national organizations. Moreover, the information system of thalassemia was considered as redundancy and cannot be used practically.
DISCUSSION AND CONCLUSIONSRelevant stakeholders should jointly develop systems and database to monitor and evaluate the policy implementation at national, regional, and provincial levels. Also, channels for policy communication and feedbacks between agencies at central and regional levels, and health care providers should be appropriately developed.
117
HSR26
An Evaluation of the National Health Examination Survey in Thailand: Management Matters
1Wilailak Saengsri (presenter), 1Jomkwan Yothasamut, 1Sripen Tantivess 1 Health Intervention and Technology Assessment Program (HITAP)
OBJECTIVEIn Thailand, a series of National Health Examination Survey (NHES) has been conducted every five years since 1991 until the most recent iteration, NHES V (2012-2015). Nevertheless, a systematic evaluation of the survey has never been conducted. The objective of this study is to assess the management functions of the NHES and provide recommendations for future development.
METHODS This study used qualitative approaches to collect data including narrative literature review and in-depth interviews with 26 key informants. Three management functions, namely organization responsible for conducting NHES, planning for survey, and funding agencies were focused. Data was analyzed using thematic analysis approach.
RESULTSA key finding of this evaluation is the frequent change of organization responsible for conducting NHES. The Ministry of Public Health carried out planning and facilitating of NHES I-II. From NHES III onward, a specialized office affiliated with the Health System Research Institute (HSRI) has since taken charge of the survey. The HSRI plans to transfer the conduct of the NHES VI to the university hospital. These changes result in no long-term capacity development plan for survey practitioners and their institutes, and an ineffective management of survey data resource access. Other critical problems involving the conduct of NHES include an inadequate oversight by appointed steering-committee, unstable funding, and unpractical planning for fieldwork (NHES V).
DISCUSSION AND CONCLUSIONSDespite the recognition for NHES potential contributions to evidence-based policy development over the last two decades, a series of NHES has yet to be institutionalized. To strengthen long-term development of NHES, this evaluation study suggested that the HSRI should be responsible for directing NHES programs in accordance with country’s health survey policy. Moreover, the collaboration between funding agencies, the National Statistical Office, academic institutes, clinical and public health experts, health institutes in all levels as well as local government authorities should be firmly established.
ORAL SESSION
DAY 3 Friday 26 April 2019
118
ORAL SESSION
DAY 3 Friday 26 April 2019
HSR27
A practical application of Multiple Criteria Decision Analysis (MCDA) in the context of Health Technology Assessment (HTA): a pilot study on Ministry of Health Medicines Formulary (MOHMF) listing of respiratory inhalers (RI)
1Yee Vern Yong, 1Nurulmaya Ahmad Sa’ad, 1Siti Hajar Mahamad Dom, 1Rosliza Lajis, 1Siow Yen Liau, 1Faridah Aryani Md Yusof, 2Asrul Akmal Shafie1 Formulary Management Branch, Pharmaceutical Services Programme, Ministry of Health Malaysia2 School of Pharmaceutical Sciences, Universiti Sains Malaysia
OBJECTIVEStructured, explicit approach to MOHMF listing decisions on RI is needed as none performs favourably on both drug and device attributes. This study aimed to develop an applicable MCDA framework to inform decision-makers (DM) in making value-based MOHMF listing decisions on RI.
METHODS Framework development involved relevant specialists and pharmacists as the stakeholders. First, criteria and performance measures were identified through literatures and group discussions with expert committees (EC), and validated by stakeholders. Economic and non-economic criteria were then weighted by stakeholders using point allocation and adjusted SMART-SWING methods, respectively. Finally, economic criterion was scored using linear partial value function whilst performance measures of non-economic criteria were scored based on stakeholders consensus, both on 0-100 scale. This framework was then applied by stakeholders through discussions at the stage of measuring alternatives (new listing proposals and existing alternatives in MOHMF, N=27) performance on each criterion, using data gathered from the highest level available of published evidences and pharmaceutical companies. Performances were analyzed using Microsoft® Excel 2014 and the aggregation formula used was additive model. Either data on affordability or number of patients was presented alongside the aggregated scores for deliberation with EC prior presentation to DM for decision-making.
RESULTSThe MCDA framework consisted of 8 criteria and 10 sub-criteria. Economic criterion was weighted 30%. Among non-economic criteria, “patient suitability” and “reimbursem*nt/listing status elsewhere” were weighted highest (22.87%) and lowest (4.23%), respectively. EC had supported one new listing, recommended to delist five and proposed changes in prescribing requirement on five existing alternatives. Recommendations agreed by DM, and changes to MOHMF were made accordingly.
DISCUSSION AND CONCLUSIONSThis is a comprehensive MCDA framework for RI. Its outputs not only had successfully informed DM in making value-based decisions, but also a useful cost-containment strategy. This framework is adaptable for future HTA use on drug-device products.
119
HSR28
Exploring the Healthcare Journey of Thalassaemia Patients in Malaysia
1Noor Syahireen Mohammed, 1Jacqueline Wong Hui Yi, 1Irwinder Kaur Chhabra, 2Hishamshah Mohd Ibrahim, 1Asrul Akmal Shafie 1 School of Pharmaceutical Sciences, Universiti Sains Malaysia2 Pediatric Institute, Hospital Kuala Lumpur, Malaysia
OBJECTIVEThe aim of this study is to explore thalassaemia patient’s experience in receiving treatment in public hospitals in Malaysia.
METHODS An explanatory qualitative study using semi-structured interviews combined with process mapping were conducted in seven public hospitals in five different states in Malaysia. Purposive sampling was used to select subjects from a population of adult patients and parents to pediatric thalassaemia patients. Audio recordings were then transcribed verbatim by different investigators and transcription were then compared to ensure validity. Data were then thematically analysed.
RESULTSA total of 23 adult patients and parents to pediatric patients were interviewed where empirically derived flow charts of patients’ reported journey were mapped. In general, the paths patient experience in getting treatment are almost similar across different states. However, some states do require multiple visits to hospital in a month for blood tests and transfusions. Themes identified include the access to initial diagnosis and current treatment, challenges, awareness and emotional journey.
DISCUSSION AND CONCLUSIONSThis study reveals vital insight of patient’s challenges in getting treatment in public hospitals and highlights the disparity of treatment path between hospitals. The findings suggest some correctional measures must be taken by service provider to ensure optimal healthcare delivery to thalassaemia patients in Malaysia.
ORAL SESSION
DAY 3 Friday 26 April 2019
120
ORAL SESSION
DAY 3 Friday 26 April 2019
HSR30
Addressing the development of the Critical Illness Insurance Program in China: comparison for the status of 5 pilots in China
1Liu Yuehua, 1Zhang Ruilin, 2Du Tiantian, 1Liu Zhao, 1Wang Yitong, 1Zhang Fan, 1Kun Zhao 1 China National Health Development Research Center2 Institute for Hospital Management of Tsinghua University
OBJECTIVEThe current Chinese Basic Medical Insurance has covered both rural and urban people in China, yet the burden of high healthcare expenditure is threatening the living status of low-income households. The Critical Illness Insurance Program(CIIP) is a separated healthcare insurance program to expand the coverage of the Basic Medical Insurance System, aiming to prevent patients from being reduced to poverty by unaffordable healthcare costs. Different schemes of the CIIP have been launched across different areas of China. From the perspective of targeted governance, the present study assessed the effectiveness of the critical illness insurance coverage among 5 pilot areas representing different economic development and cultures from 2013 to 2015.
METHODS Data is collected from 5 selected provinces across China (Hebei, Fujian, Hubei, Jilin, Qinghai). Descriptive analysis was conducted for indicators including deductibles, premiums, benefit packages, and reimbursem*nt rates. The analysis was conducted using Stata 13.0.
RESULTSThe proportions of Critical Illness Insurance Reimbursem*nt were all over 10% among the five pilot areas. The lowest deductible line was 5,000 CNY (about 724 US$) in Qinghai Province, a rather underdeveloped area, and the highest was 29,000 CNY (about 4,202 US$) in Fuzhou, a better-developed area in 2015. The reimbursem*nt expenses varied, and the actual gap between some areas could be 3-5 times of the amount.
DISCUSSION AND CONCLUSIONSThe deductibles in the rather developed areas were higher than the other areas, and in this case, people who have a heavier disease burden will be benefited from the Critical Illness Insurance Program. On the other hand, the lower deductible brought in more beneficiaries, losing the specificity as a targeted policy. A specific target population group and a reasonable set of both upper and lower limitation considering different conditions of areas would be a key to improve the effectiveness of CIIP.
121
HSR31
ESTABLISHMENT OF THE NATIONAL CLINICAL PRACTICE GUIDELINE PROGRAM IN THE PHILIPPINES
1Nicole Bautista, 1Janielle Kristine Go, 1Geovin Dexter Uy 2Leonila Dans, 2,3Maria Asuncion Silvestre 1 Health Technology Assessment Unit, Department of Health - Philippines 2 Asia Pacific Center for Evidence Based Healthcare, Philippines3 Kalusugan ng Mag-Ina, Inc., Philippines
OBJECTIVEThe lack of standardized process for the development and use of clinical practice guidelines (CPGs) resulted to variations in the quality and strength of recommendations of CPGs in the country. The study documented the process of institutionalizing the National Clinical Practice Guideline Program (NCP) that ensures a systematic generation and utilization of CPGs in the Philippines.
METHODS Literature review, and multi-stakeholder consultations through focus group discussions, and key informant interviews were conducted for the creation of national policy. Different offices in Department of Health and other stakeholders such as clinical epidemiologists, evidence-based medicine practitioners, academicians, medical/professional societies, and other method experts were consulted.
RESULTSScoping yielded 87 CPGs produced in the Philippines before January 1, 2017, which were mostly developed by specialty medical societies. Variation in the processes utilized for the development were noted. About half of the current CPGs used internationally accepted GRADE approach. Only 4.4% of the most burdensome disease conditions in the Philippines have existing local CPGs. Due to these findings, a policy on institutionalization and implementation of NCP, which would standardize prioritization, generation, dissemination, and implementation of CPGs, was developed. This establishes the process for CPG development, governance structure, and respective roles and responsibilities of offices involved. The policy also included integration of NCP with health technology assessment, whose evidence may inform or be informed by the program. Furthermore, a CPG manual was also developed to support its proper implementation.
DISCUSSION AND CONCLUSIONSCPGs is crucial to standardize clinical practice. Ongoing projects include capacity mapping and training on CPG development that supports NCP. Currently, it is evident that further strengthening of the awareness and capacity of relevant stakeholders through workshops and training sessions is recommended. It is recommended that utilization of CPGs cleared through the program be monitored in clinical setting within the next years.
ORAL SESSION
DAY 3 Friday 26 April 2019
122
ORAL SESSION
DAY 3 Friday 26 April 2019
HSR32
iDSI impact narrative – Indonesia chapter
1Sharma M, 2Li R, 1Teerawattananon Y 1 Health Intervention Technology Assessment Program, Thailand2 Global Health and Development Group, Imperial College London
OBJECTIVEThe International Decision Support Initiative (iDSI) led by core partner Health Intervention Technology Assessment Program (HITAP), has been liaising with the Health Technology Assessment Committee (HTAC), Indonesia, since 2014 to build a sustainable Health Technology Assessment (HTA) infrastructure that complements the health system. This study aims to establish meaningful links between activities and overall impact of this partnership in HTA-development in Indonesia.
METHODS A framework of theorized components and relationships or the iDSI theory of change was used to guide this evaluation. We triangulated the arguments using evaluations conducted by external surveyors, field reports, grey literature, and discussions with relevant stakeholders.
RESULTsh*tAP’s technical support encompassed various activities such as completion of eight HTA studies, national HTA guidelines, providing scholarships for higher education, hosting interns, liaising with global subject-matter experts, facilitating participation in policy forums, stakeholder engagement events. These activities were instrumental in strengthening the network of suppliers and users of evidence-informed policy products and routine generation of evidence products leading to an increased political commitment and buy-in for HTA. For instance, in the last two years, the national healthcare provider stepped forth as a funder for the HTAC in contrast to the early years where the activities were supported by external funding agencies. Further, the HTA guidelines have been endorsed by the MoPH and results from five out of the eight studies have been considered by the policymakers.
DISCUSSION AND CONCLUSIONSIn five years, this collaboration has been conducive in furthering evidence-based policy making in Indonesia. Forming a causality chain linking activities to ultimate policy changes is complex and diffuse due to many external factors (political context, social factors etc.). However, in its early years, the HTAC with iDSI support have successfully laid the cornerstone of a functioning HTA system in Indonesia.
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HSR33
AGREE II Assessment of Malaysian Clinical Practice Guidelines (CPG)
1Mohd. Aminuddin Mohd Yusof, 1Noor Ayuni Bazura Muhamad, 1Chong Chin Eu, 1Siti Mariam Mohtar1 Health Technology Assessment Section, Medical Development Division, Ministry of Health, Malaysia
OBJECTIVETo assess the degree of adherence to Appraisal of Guidelines for Research & Evaluation (AGREE) II of Malaysian clinical practice guidelines (CPG), as a quality audit of the CPGs
METHODS A cross-sectional study on five years of assessment on Malaysian CPGs’ methodology using AGREE II by Technical Advisory Committee (TAC) CPG was conducted. Adherence to six domains with 23 items in AGREE II was analysed and improvements for shortcomings proposed.
RESULTSA total of 37 CPGs were assessed by trained TAC CPG from 2014 to 2018. There was almost equal number of CPGs produced by Malaysian Health Technology Assessment Section (MaHTAS) and non-MaHTAS. Among the six domains, Domain 6 (Editorial Independence) scored persistently high with a mean score of 91.0% while Domain 2 (Stakeholder Involvement) the lowest with 71.9%. Domain 5 (Applicability) had the widest range of scores (51.7%) among all the CPGs. On the other hand, Domain 1 (Scope and Purpose) had the lowest range of 24.6%. Individual CPG with low domain score (below 60%) were mainly non-MaHTAS CPGs and found in Domain 5. Recurrent issues in the domain were barriers/facilitators/resource implications not addressed and algorithms not well developed. Other important issues raised were no proper involvement of stakeholders (both professionals and patients) in Domain 2 and key messages were being mistakenly included in recommendations in Domain 4 (Clarity of Presentation).
DISCUSSION AND CONCLUSIONSIn general, there was good adherence of AGREE II requirements of evidence-based CPG produced locally. Guidelines developers should try to address problematic items in Domain 2, 4 and 5. In relation to this, algorithms and recommendations are important to be developed properly by CPG developers as these will influence the utilisation of well-developed CPGs. Limitations in CPG methodology by non-MaHTAS CPG developers can be resolved by close engagement with MaHTAS and provision of standardised format of CPG writing.
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HSR34
Equality of reimbursem*nt for antiretroviral therapy costs among migrants in Thailand: an application of the concentration index
1Roongnapa Khampang, 1Thanap*rn Bussabawalai, 1Maneechotirat Santi, 1Danai Chinnacom, 1Suppawat Permpolsuk, 2Rapeepong Suphunchaimat 1 Health Intervention and Technology Assessment Program2 International Health Policy Program
OBJECTIVEGeographical maldistribution of access to antiretroviral therapy (ART) among migrants has been a critical concern in the Thai health system in recent years. This study aims to assess the equality of reimbursem*nt for ART costs among insured migrants in Thailand through the application of the ‘concentration index’ (CI).
METHODS A cross-sectional quantitative design, using provincial-level data, was employed. The dataset comprised (1) reimbursem*nt data of antiretroviral therapy between 2015 and 2016 obtained from the database of the Division of Health Economics and Health Security of the Ministry of Public Health, Thailand, and (2) information about Gross Provincial Product (GPP) per capita in the respective years. Descriptive statistics, Spearman’s rank correlation, and concentration index (CI) analysis were performed.
RESULTSOverall, the average reimbursem*nt rates for ART costs among migrants who were covered by the Health Insurance Card Scheme (HICS) were 0.31 percent in 2015 and 0.28 percent in 2016. Spearman’s correlation analysis found a negative relationship between reimbursem*nt rate and provincial economic status in both years. Yet, statistical significance was not found. In the CI analysis, significant CI was found in both years, showing CI =- 0.32 (p = 0.04) in 2015 and CI = -0.24, (p=0.02) in 2016. The negative CI implies that the distribution of reimbursem*nt for ART costs was more concentrated in less wealthy provinces.
DISCUSSION AND CONCLUSIONSThis study demonstrates that access to ART among migrants was well distributed towards the poor who are more susceptible to HIV infections. Migrants in wealthier provinces can also access to ART through different channels including cooperative projects for HIV interventions provided by intergovernmental and non-governmental organizations. It is recommended that the related bodies should maintain the current practice and policy on access to ART among migrants.
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HSR36
Assessing Districts Performance in Indonesia: A Data Envelopment Analysis and Qualitative Approach
1,2Mazda Novi Mukhlisa, 2Windi Haryani, 2Indra Yoga, 2Rosa Estetika1 Indonesia Health Technology Assessment Committee 2 Center for Health Financing and Health Insurance, Ministry of Health, Republic of Indonesia
OBJECTIVEHealth Operational Fund for promotive and preventive programs increases every year. Despite that, health outcomes remain low. The objective of our study was to measure the technical efficiency of public health programs that use Health Operational Fund in Indonesia. Public health programs in this study were maternal, neonatal and child health, and also immunization.
METHODS Using Health Production Model, we conducted a quantitative approach to measure the efficiency of 315 districts across 34 provinces in Indonesia. Efficiency score was measured by running Data Envelopment Analysis (DEA). Inputs included Health Operational Fund expenditures, the sufficiency of doctors, midwives, nurses and other staffs, primary healthcare facilities ratio, and Posyandu ratio while outputs were antenatal care, neonatal care, under-five year growth monitoring, and immunization coverage. We also conducted a qualitative approach to explore more about the source of inefficiency by interviewing and focus group discussion of informants from six districts.
RESULTSOur results indicated wide variation in efficiency among districts. The average efficiency score was 63% with minimal and maximal scores were 15% and 100%, respectively. High performing districts were in affluent areas or inaccessible areas. Qualitative results showed that districts with bottom-up and top-down planning and the exact basis for budget distribution, as well as various criteria for priority setting, have higher performance than those which have not. Specific problems also play role in low performing districts, such as high-risk population in the remote area or halal issue in vaccines.
DISCUSSION AND CONCLUSIONSBy examining how the budget was allocated and managed, and programs were implemented, monitored and evaluated, districts still have the potential to improve their efficiency in achieving health output using their health resources. In addition, the Government of Indonesia needs to pay more attention to low performing districts which use more inputs yet have low outputs.
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HSR37
Present Analysis of General Hospital at Level 2 and Above to Carry Out Dise-ase Prevention and Control in Beijing
1Yueli Meng 1Wuqi Qiu 1Kun Wang 1Xiaoling Yan 1*Ayan Mao1 Institute of Medical Information/Medical Library, Chinese Academy of Medical Sciences & Peking Union Medical College
OBJECTIVEIt has no clear policies and laws and regulations on the public healt functions of medical institutions, and lacking of relevant performance appraisal in China. It was the aim of this study to evaluate the present situation of general hos-pital at level 2 and above to carry out disease prevention and control in Beijing, in order to provide references for comprehensively carrying out the performance appris-al of disease prevention and control services in medical institutions.
METHODS A questionnaire survey was conducted among 44 public tertiary general hospitals and 28 public secondary hospitals in Beijing. The content of the survey includes the basic situation of the hospital, the setting of public health departments, the personnel, the responsibility of disease prevention and control and the workload statistics of various responsibilities in 2015-2017. SPSS 24.0 was used for statistical description.
RESULTS(1) According to present laws and regulations, the disease prevention and control functions that medical institutions should undertake include 8 categories and 72 items. At present, Beijing has carried out relatively adequate work in the diagnosis and treatment management of infectious diseases, cause of death monitor-ing and immune prevention (96.4%, 95.8% and 65.6%, respectively). However, the prevention and control of chronic diseases, environmental health monitoring, occupat-ional health management and mental health services still need to be strengthened (57.3%, 50.9%, 45.8% and 30.6% respectively). (2) The cognition of disease preven-tion and control personnel in medical institutions is not enough. In addition, the ser-vice value of disease prevention and control personnel can not be reflected, resulti-ng in the low motivation in work. (3) The construction of public health informatization in medical institutions needs to be strengthened. The results of the questionnaire showed that some disease prevention and control functions lacked corresponding workload statistics (only 10-20%).
DISCUSSION AND CONCLUSIONSClear division of disease prevention and control responsibilities and work statistics are the basis of public health performance apprai-sal. The health administrative department should clarify the public health functions of various medical institutions and strengthen the protection of relevant laws and policies, especially in chronic disease management and mental health services. Meanwhile, perfecting the compensation mechanism for public health services in public hospitals, and improving the construction of public health information system in public hospitals.
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HSR38
An assessment of Monitoring and Evaluation systems in Timor Leste for managing resource availability at health facilities
1Juliet Eames1 Health Intervention and Technology Assessment Program (HITAP)
OBJECTIVEThis study aimed to evaluate the effectiveness of the ‘Health Facility Readiness’ assessment survey used by the Monitoring and Evaluation (M&E) Department, Ministry of Health in Timor Leste, in ensuring facilities have necessary resources to provide health services.
METHODS A mixed-methods approach was adopted. Results from Timor Leste’s ‘Facility Readiness Assessment’ surveys 2014-2018 were analysed for trends in availability of health inputs and quality of data submitted. National documents were reviewed to understand the services expected. Key informant interviews, focus group discussions and a World Café with respondents from all health sector levels provided information on the M&E system strengths and weaknesses. Qualitative data was analysed thematically.
RESULTSAssessments of resource availability at health facilities are conducted by National Health Programmes, in parallel to the assessment implemented by the M&E departments. Programmes also assess health outputs and outcomes. The M&E department readiness assessment was found to be useful for understanding resource availability and potentially problem resolution. However, it was found that the survey design does not capture some critical elements of facility readiness. Additionally, lack of capacity and resources constrains quantity and quality of data, in turn limiting the use of the data in planning. Additionally, there is variation in the process of reporting and sharing data between relevant bodies. All these factors contribute to identified resource gaps persisting.
DISCUSSION AND CONCLUSIONSThere is a need for more comprehensive and systematisd assessments with an emphasis on the quality of data collected, in order for data to be integrated into resource planning and to improve health facility readiness. A stronger understanding of the M&E department as a research body to assess all elements of Timor Leste’s health sector, rather than as separate health department working in parallel, could also strengthen health sector data and facilitate improved health outcomes.
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HSR39
Use of E-cigarettes among Cigarette Smoking Canadians Who Failed in Their Attempts to Quit Smoking
1,2Rui Fu, MSc 1,2.3Audrey Laporte, PhD 1,2,3Peter C. Coyte, PhD1 Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada2 Canadian Centre for Health Economics, Toronto, ON, Canada3 Institute of Clinical Evaluative Sciences, Toronto, ON, Canada
OBJECTIVEE-cigarettes have been promoted as a healthier alternative to regular cigarettes and a novel aid for smoking cessation. However, use of e-cigarettes among Canadian smokers who failed in their attempts to quit smoking has not been fully described. We address this gap by analyzing data from the 2015 Canadian Tobacco, Alcohol, and Drugs Survey. The objective of the present study was two-fold: (1) to identify predictors of using e-cigarettes; and (2) to find those factors that were associated with using e-cigarettes to quit smoking.
METHODS A bivariate probit model with a correction for potential sample selection was built to identify predictors of using e-cigarettes and using the device specifically to quit smoking.
RESULTSPoor mental health, consumption of other tobacco products, and use of drugs were associated with increased e-cigarette use. Prevalence of e-cigarette is high among young smokers whose motivation for use appears to be unrelated to smoking cessation.
DISCUSSION AND CONCLUSIONSThe study findings highlight the importance of age restrictions on the purchasing of e-cigarettes and regulations of advertising to younger people. The strong association between e-cigarette use and the consumption of other tobacco products and drugs warrants future joint efforts towards harm reduction. The findings of this study will inform debate over the best design of legislation and public health policies aimed at regulating access to and use of e-cigarettes.
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Other05
Approaches of Priority Setting for Vaccine Introduction: A Systematic Review
1,2Sabbir Haider, 1.3Montarat Thavorncharoensap, 4Praveen Thokala, 1,3Sitap*rn Youngkong1 Health Technology Assessment (HTA) Postgraduate Program, Mahidol University, Bangkok, Thailand;2 Health Economics Unit, Ministry of Health and Family Welfare, Bangladesh;3 Social and Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University,
Bangkok, Thailand;4 The University of Sheffield, United Kingdom (UK)
OBJECTIVEThe priority setting of vaccine introduction depends on different criteria either explicitly or implicitly. Systematic transparent priority setting can explicate difficulties to select appropriate vaccines for introduction. This study aims to systemically review the approaches of priority setting process for vaccine introduction of different countries.
METHODS Relevant studies were identified from PubMed and Scopus databases. The following medical subject heading terms and key words - vaccine, immunization, priority setting, decision making, policy making, introduction and adoption were applied in identifying relevant studies. The search was conducted from the inception to 21 November, 2018 with no language restriction. After removing duplicates, studies not focused on priority setting process, non-human vaccine, reviews, and opinions were excluded.
RESULTSTotal 6,421 articles were identified after removal of duplicates from PubMed and Scopus. After exclusion of 6,367 studies, 54 studies were full-text screened. Finally, 14 articles were included in this systematic review. The selected studies are from the year 2000 to 2017. Studies were from following countries: Brazil; Colombia; Poland; Indonesia; Australia; India; Thailand; Tanzania; Qatar; Uruguay; Chile; France; Belgium; and Republic of Korea. Objectives of the studies were to identify process of vaccine introduction (n=6), decision making for introducing new vaccine (n=4), policy making for vaccine introduction (n=2), and identification of criteria on new vaccine introduction (n=2). Approaches for selecting criteria were expert opinion (n=9), multi-criteria decision analysis (n=3), and DELPHI technique (n=2). Disease burden (71%), budget impact (50%), vaccine effectiveness (43%), and vaccine safety (43%) were the major criteria to elicit preferences for introducing new vaccines.
DISCUSSION AND CONCLUSIONSThis systematic review provides policy makers different evidence based approaches and criteria for vaccine introduction. Countries can conduct appropriate process of vaccine introduction by applying approaches and criteria selection process from this review.
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Other06
Development and evaluation of mobile health behaviour change intervention to support tobacco cessation in Thailand
Pritap*rn Kingkaew, Liz Glidewell, Rebecca Walwyn, Sarayuth Khuntha and Jeremy C. Wyatts
BackgroundRigorous evaluations of mobile health (mHealth) behaviour change interventions for smoking cessation were reported to be mixed due to the diverse and complex nature of these interventions. The Multiphase Optimisation Strategy is an approach which aims to optimise and evaluate multicomponent interventions consisting of screening, refining, and confirming phases. This approach can be applied to develop and test complex interventions.
OBJECTIVEto systematically identify effective components of mHealth behaviour change interventions associated with improvements in smoking cessation, and to design and evaluate mHealth behaviour change interventions that contain effective components to support smoking cessation among Thai smokers.
METHODS A systematic review and a meta-regression of randomised controlled trials (RCT) of mHealth interventions for tobacco cessation were conducted to identify the effect sizes of mHealth interventions and to quantify the association of the characteristics of mHealth interventions with effect size. Mobile text messages were then designed to provide support for smokers aimed at three theory-based behaviour change components, namely: ‘Capability’, ‘Opportunity’, and ‘Motivation’. An RCT employing a 2×2×2 full factorial design was conducted to simultaneously assess the effectiveness of the BCT-enhanced text messages for smoking cessation individually, and in combination, among Thai smokers.
RESULTSOf 23 mHealth studies identified from the systematic reviews, interventions reported BCTs mapped onto all three theory-based behaviour change components (OR 1.30, 95% CI: 1.05 to 1.59) were also associated with an increased odds of smoking cessation. However, providing BCT-enhanced text messages aimed at supporting smokers’ capability to quit (OR 1.20, 95% CI: 0.77 to 1.86), smokers’ opportunity to quit (OR 1.05, 95% CI: 0.67 to 1.64), or smokers’ motivation to quit (OR 1.13, 95% CI: 0.73 to 1.77) did not significantly improve the 7-day smoking abstinence rate for Thai smokers (n=1,571) at 1-month follow-up. The additional components of BCT-enhanced text messages (two or more) showed a trend of decreasing the odds of quitting.
DISCUSSION AND CONCLUSIONSThis study optimised and evaluated multicomponent mHealth behaviour change interventions in a resource-limited country with emerging mHealth technology. Though a meta-regression suggested a promising result of combinations of BCT-contained mHealth interventions, the interventions failed to provide a significant improvement in cessation rates in a trial setting. Moreover, the addition of two or more behaviour change components decreased the effect size suggesting the importance of experimental studies for decision making. Understanding the effects of these fine-grained behaviour change components rather than a whole set of interventions as a ‘black box’ will advance knowledge in this field of research using a factorial design.
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Other07
Implications of Contraceptive Service on Health in China from 1990 to 2017
1,2Yu Zhang, 1,2Xiaoying Ma, 1,2,3Hong Jiang1 Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China2 Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China (Fudan University)3 Corresponding author. Mailbox 175, No. 138 Yi Xue Yuan Road, Shanghai, 200032, PR China
OBJECTIVEThe contraceptive service in China has made great achievements. The prevalence of contraceptive use among Chinese married women of reproductive age has reached 80.6% in 2017. We conduct this review to analyze the implications of the contraceptive service since 1990 in China to provide the evidence of policy making on contraceptive service in the future.
METHODS We conducted a literature search in PubMed, Web of Science, Guttmacher Institute website, WANFANG database, CNKI database, and WIP database. We collected, evaluated relevant studies and integrated the data regarding input and output of contraceptive service published between 1990 and 2018.
RESULTSMost studies in China focused on the outputs of a specific contraceptive drug or tool rather than the population health. Internationally, there were five most commonly used modeling approaches for estimating the impact of contraceptive use on averting adverse health outcomes. They are Adding It Up by the Guttmacher Institute; Impact 2 by Marie Stopes International; ImpactNow by the USAID-supported Health Policy Project; Reality Check by EngenderHealth's RESPOND Project supported by USAID; FamPlan and the Lives Saved Tool (LiST) by the Spectrum suite of models hosted by Avenir Health. Using the Reality Check estimation as the example, meeting the unmet need for modern contraception with the range from3.3% to 4.23% in China between1990 and 2017 would result in a total of 48.3 million decline in unintended pregnancies, 39.2 million decline in induced abortions, 5.3 million decline in live births and 1157 decline in maternal deaths. The results by three available models were comparable.
DISCUSSION AND CONCLUSIONSThe review showed inadequate studies and analysis on the implications of contraceptive service worldwide. Meeting unmet needs for contraception and increasing investment in contraceptive services has made significant impacts on the reproductive health.
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Other08
Health state valuation patterns and relations to religiosity
1Annushiah Vasan Thakumar, 1Ching Jou Lim, 2Nan Luo, 3Faridah Aryani Md Yusof, 3Asrul Akmal Shafie1 School of Pharmaceutical Sciences, Universiti Sains Malaysia, Malaysia2 Saw Swee Hock School of Public Health, National University of Singapore, Singapore3 Pharmaceutical Services Division, Ministry of Health, Malaysia
OBJECTIVETo assess the impact of religiosity on preference patterns in the Malaysian EQ-D-5L valuation study.
METHODS Data from the recent Malaysian EQ-5D-5L valuation study was used. Quota-sampled respondents, representative of the Malaysian general population, were interviewed face-to-face. Valuation data were collected in addition to questions on socio-demographics and religiosity. Question on frequency of private (PRR) and public engagement (PUR) religious activities and self-rated religiosity were asked. Health state preference data from the 10 time-trade off questions answered by each respondent were analysed for patterns in number of worse-than-dead (WTD) and dead values, range of values respondents were comfortable placing. Associations between religiosity and patterns on health state valuations were tested using chi-square.
RESULTSAnalyses from 1125 respondents of the Malaysian EQ-5D-5L value set were included. Most respondents identified themselves as being religious, while only 2.31% did not feel religious at all. Preference patterns revealed 30.22% of the respondents not placing WTD values for any of the 10 health states while 61.33% did not have values equal to being dead (D). The range of values (of the 10 health states: highestvalue - lowestvalue) respondents were comfortable giving varied widely from 0.1 to 2, with a median of 1.5. Half of the respondents traded some life-years on all the health states while the rest were non-traders on at least one health state. In contrast, only 28.0% of the respondents valued a health state as the worst possible response of -1. Chi-square analysis revealed significant associations between PRR (PUR) with the presence of Dvalues (presence of -1 values) respectively (p-value<0.10).
DISCUSSION AND CONCLUSIONSRespondents were comfortable sacrificing life-years and placing WTD values. However, there were associations between religiosity and equating values as being dead. The concept of death is taboo in many religious countries and should be taken into consideration when designing health preference surveys.
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WP01
Literature Review of Cost-Effectiveness Studies of 9-valent Human Papillomavirus (HPV) Vaccination
Yaoling Wang, Wudong Guo, Xue Li, Kun Zhao1 China National Health Development Research Center
OBJECTIVEWith the recent licensing of the 9-valent vaccine in China, an update in the current recommendation of HPV vaccination is inevitable. Given the increasing number of economic evaluation studies on HPV vaccination, this review was conducted to update the economic evidence on HPV vaccination, by focusing on 9-valent vaccine, to provide relevant database for later economic evaluation and facilitate the evidence-based decisions making.
METHODS Searches were performed till November 2018 using several databases: CNKI, WANFANG, PubMed, EMBASE, and Cochrane Library. Reference lists of relevant published studies and grey literature were also included. The CHEERS list was used to evaluate the quality of included studies.
RESULTSAfter screening by title and abstract, 34 articles were selected for full-text review. Of those, 21 articles were included in the final review by inclusion criteria. When price for HPV9 was fall in certain range, the vaccination was cost-effectiveness when compared to existing vaccination. When vaccine coverage for female is above 80%, vaccinating additional boy is less favourable. Multiple age cohort vaccination was cost-effective, but the upper age limits was not explored. It still unknown if the life-long protection in model assumption was validated based on current evidence and how compliance affects the vaccine efficacy and duration of protection. Several key drivers of cost-effectiveness were identified in this review such as duration of vaccine protection, vaccine prices, coverage and discounting rate.
DISCUSSION AND CONCLUSIONSThe cost-effectiveness of HPV vaccination is contingent upon the vaccine coverage scale, compliance, cohort age group and vaccine price. It will be ideally adopting dynamic transmission model for consideration in the uptake of HPV vaccination. Also our findings are expected to support later economic evaluation and policy makers in making recommendation for HPV 9 national immunization program.
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WP02
Cost-effectiveness of 13-Valent Pneumococcal Conjugate Vaccine in the treatment of Invasive Pneumococcal Disease among Children Under 5 in China
1Kun Zhao(corresponding author), 1Yuzhao Li, 1Hao Hu, 1Rui Zhao, 1Chunping Liu1 China National Health Development Research Center
OBJECTIVEInvasive Pneumococcal Disease (IPD) is a leading cause of mortality and morbidity in China Under 5 in China, with such complications as otitis, meningitis, and etc. Due to the availability of 13-Valent Pneumococcal Conjugate Vaccinate (PCV13), the incidence of IPD has dropped significantly in Children under 5 in China. Thus, PCV13 is considered the main treatment of IPD world-wide through inhibiting streptococcus pneumonia, specifically for Children Under 5. Routine PCV13 immunization is recommended by World Health Organization and has been in the Expended Program on Immunization (EPI) in 176 countries. However, in China, PCV13 currently is costly and not in EPI in China. The aim of this research is to provide evidence on the effectiveness of the vaccination and support policymakers to decide whether or not to include PCV13 in the updated EPI to prevent from streptococcus pneumonia.
METHODS Through literature review, meta-analysis was applied to collect mortality rate, incident rate, case fatality rate, etc. To assess effectiveness, the Quality Adjusted Life Years (QALYs) were utilized as outcome indicator. A Markov model was constructed to evaluate the cost-effectiveness of different immunization strategies compared to no treatment. One-way sensitivity analysis was performed using the tornado analysis.
RESULTSThe incremental cost effectiveness ratio (ICER) was 957800 RMB/ QALYs, indicating PCV13 on the treatment of IPD was less cost-effective at Willingness To Pay at 162,000 RMB/QALYs. Meanwhile, One-way sensitivity analysis revealed that the most four influential factors affecting the ICER are QALYs of AOM, QALYs of pneumonia, the incident rate of pneumonia, and price of PCV13. Finally, if PCV13 is included in the Chinese EPI, the increase of budget on public health investment by government would range from 1.21 billion to 4.82 billion RMB.
DISCUSSION AND CONCLUSIONSThere are two recommendations on PCV13 treatment. First, decrease in the price of PCV13 would significantly yield higher return on public investment, especially below the cut-off point of 112 RMB per dose (including vaccine administration cost). Second, because of the limitation of incident rate of PDs in other age group, herd immunity effect was not taken into account in the current study. Strengthening the population-based monitoring system of PDs would make incident rate of PDs of other age group accessible, therefore would significantly make results of vaccine economic evaluation more accurate to decision makers.
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WP03
Developing a streamlined Health Technology Assessment framework to assess diagnostic imaging for staging of uncommon cancers
1David Tivey, 1Ning Ma & 1Tom Vreugdenburg1 Royal Australasian College of Surgeons, Research & Evaluation inc. ASERNIP-S, Australia.
OBJECTIVEThe current Health Technology Assessment (HTA) methods of the Medical Services Advisory Committee are limited when reviewing technologies or services for uncommon health conditions. For example, in Australia, this hasprevented the approval of fluorodeoxyglucose F18 (FDG) PET imaging for staging of rare and uncommon cancers. A new approach is required, and this project investigates an evidence framework that focuses on the clinical utility of PET imaging when compared with other imaging modalities to improve cancer staging regardless of cancer type. The framework allows the comparison of PET use in uncommon to common cancers, with the latter approved through a full HTA review. If results are qualitatively similar to common cancers and they demonstrate strong clinical plausibility, then funding is approved for uncommon cancers. The framework has two components; the first is to select between full versus facilitated assessments and the second is an expedited method for facilitated assessments. With a completion date of October 2019, this project aims to develop and test the framework for facilitated assessments, which represents a paradigm shift in the approach to assessing imaging for cancer.
METHODS A Systematic Review will identify potential selection criteria to categorize assessments as facilitated, the methods for facilitated assessments and generate a data set to validate the selection process. A multidisciplinary Delphi panel will determine the core selection criteria and assessments methods of the framework. Following this, both elements will be tested and refined, by conducting two facilitated assessments to determine the value of the framework in decision-making
POTENTIAL IMPACT The validated framework will allow appropriate, timely and cost-effective evidence reviews of FDG PET for cancer staging of uncommon cancers. The framework will have a broad application including other FDG PET indications (diagnosis, recurrence), other PET radionuclides, and imaging modalities, and translate to all healthcare jurisdictions.
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Moderator
DAY 3 Friday 26 April 2019
EEProfessor Anthony Culyer, Universigty of YorkProfessor Iñaki Gutiérrez-Ibarluzea, HTAiMr. Kwong Hoe Ng, ACE of Singapore MOHDr. Jasmine Pwu, Ministry of Health and Welfare in Taiwan
HSRAssociate Prof. Wendy Babidge, RACSProfessor Eunyoung Bae, Gyeongsang National UniversityProfessor Nam-Kyong Choi, Ewha Womans University Professor Alec Morton, University of StrathclydeDr. Jinnie Rhee, NECADr. Ah Ram Sul, NECADr. Teo Yik Ying, School of Public Health SingaporeProfessor Kun Zhao, CNHDRC
OtherAssociate Prof. Thunyarat Anothaisintawee, Mahidol UniversityDr. Insun Choi, NECA Dr. Junainah Sabirin, MaHTASAssociate Prof. Pattarawalai Talungchit, Mahidol University
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Commentator
DAY 3 Friday 26 April 2019
EEProfessor Jeonghoon Ahn, Ewha Womans UniversityDr. Somsak Chunharas, HITAPProfessor Jeffrey Hoch, University of California, DavisDr. Wanrudee Isaranuwatchai, HITAPProfessor Mark Jit, London School of Hygiene & Tropical MedicineProfessor Kun Zhao, CNHDRC
HSRDr. Melanie Bertram, World Health OrganizationPhD. YingYao Chen, NHC Key Lab of Health Technology Assessment, Fudan UniversityProfessor Nam-Kyong Choi, Ewha Womans UniversityDr. Tessa Edejer, World Health OrganizationDr. Pwee Keng Ho, IJTAHC / SMJProfessor Brendon Kearney, HealthPactDr. Sukyeong Kim, NECADr. Joongyub Lee, NECADr. Ryan Li, Global Health and Development Group, Imperial College LondonDr. Ryota Nakamura, Hitotsubashi UniversityAssociate Prof. Dr. Asrul Akmal Shafie, School of Pharmaceutical Sciences, Universiti Sains MalaysiaDr. Chae-Min Shin, NECA
OtherDr. Usa Chaikledkaew, Mahidol University Mr. Dechen Choiphel, Ministry of Health, Royal Govefnment of BhutanDr. Takashi f*ckuda, National Institute of Public HealthDr. Pritap*rn Kingkaew, HITAPDr. Wee Hwee Lin, Saw Swee Hock School of Public Health, National University of SingaporeDr. Montarat Thavorncharoensap, Mahidol University
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Area No. Title Country
HSR PS2-01 The status of the Medical Assistance for low incomes in China: on the case of Hebei Province from 2016 to 2018 China
HSR PS2-02 Evidence-based quality standards for preventing pre-term labor Thailand
HSR PS2-03 Whole body computed tomography (WBCT) in adult with major blunt trauma injuries: A systematic review Malaysia
HSR PS2-04 Adherence and impact of Clinical Practice Guidelines (CPG) Management of Dengue in adults: result of a mixed method evaluation Malaysia
HSR PS2-05 Development and Implementation of Screening Programme in Malaysia. Role of HTA Malaysia
HSR PS2-06 Meta-Analysis Approach on Iron Fortification and its Effect on Pregnancy and its Outcome through Randomized, Controlled Trials India
Other PS2-07 Cost of Adverse Drug Reaction (ADR) Among Hospitalized Patients: A Systematic Review Malaysia
EE PS2-08 Operation simplifying and Time saving by implementation of 200-ml contrast China
EE PS2-09 Budget Impact analysis of Anti-Vascular Endothelial Growth Factor in Patients with Diabetic Macular Edema Republic of Korea
W/P PS2-10 Cost effectiveness and budget impact of implementing nucleic acid test screening of blood donations for hepatitis B, hepatitis C, and human immunodeficiency virus in the Philippines Philippines
W/P PS2-11 Economic Evaluation of Molecular Diagnostic Technologies for Pulmonary Tuberculosis (TB) in China China
W/P PS2-12 Cost Effectiveness Analysis of Cervical Cancer Screening in Shanghai China
W/P PS2-13 Cost-Effectiveness Evaluation of 9-valent Human Papillomavirus (HPV) Vaccination in China China
W/P PS2-14 The Development of Patient Safety Culture Instrument for Acute Care Hospitals in South Korea Republic of Korea
W/P PS2-15 An Update Systematic review and meta-analysis of non-invasive prenatal China
W/P PS2-16 A Cross-Country Survey of HTA Policies and Guidelines in Asia Singapore
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PS2-01
Analysis on disease spectrum and health expenditures of the low incomes: the practice of Poverty Alleviation Project in Hebei Province of China
1Zhang Ruilin, 2Du Tiantian, 1Zhang Fan, 1Liu Zhao, 1Wang Yitong, 1Liu Yuehua1 China National Health Development Research Center2 Institute for Hospital Management of Tsinghua University
BACKGROUNDThe low-income population are especially vulnerable when suffering the serious illness with high medical cost. To provide financial protection for these people against unaffordable expenses, China has developed the Poverty Alleviation Project including Medical Assistance based on the current multiple health insurance coverage system in 2016. This study is to analyze the Medical Assistance expenses for the leading diseases among the low incomes involved in the Poverty Alleviation Project in Hebei Province from 2016 to 2018 and to propose recommendation to improve the effectiveness of the Medical Assistance program.
METHODS Data is supplied by the Multiple Healthcare Coverage for the Low Incomes Program based on the Targeted Poverty Alleviation Register System. Descriptive analysis was conducted for the total medical expenses by Hebei Government and the per capita medical cost for each disease. The analysis was conducted using Stata 13.0.
RESULTSFrom 2016 to 2018 June, 469,219 low-income people have received the Medical Assistance in the Poverty Alleviation Project in Hebei Province. The leading 5 diseases among these people are cerebrovascular disease, hypertension, diabetes, malignant tumor, chronic obstructive emphysema. The diseases with high per capita cost (more than 17,000 CNY) of these population are end-stage kidney disease, severe sepsis, lymphoma, aplastic anemia and chronic hemocytopenia, hemophilia, and malignant tumor. Additionally, nearly 80% of the total expenses of medical assistance by Hebei Government were spent on the Medical Assistance of 10 diseases (including cerebrovascular disease, malignant tumor, end-stage renal disease, chronic obstructive emphysema, and diabetes).
DISCUSSION AND CONCLUSIONSThe high-cost and high-prevalence diseases should be the priority to be insured in the Medical Assistance. Meanwhile, the reimbursem*nt ratio should be adjusted according to different conditions of disease to improve the rational utilization of the Medical Assistance funds.
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PS2-02
Evidence-based quality standards for preventing pre-term labor
1Sonvanee Uansri, 1Roongnapa Khampang, 1Suthasinee Kumluang, Thunyarat Anothaisintawee, 1Sarayuth Khuntha, 1Phorntida Hadnorntun, 1Sripen Tantivess, 1Yot Teerawattananon1 Health Intervention and Technology Assessment Program (HITAP), Thailand2 Mahidol University, Faculty of Medicine, Ramathibodi Hospital, Thailand
OBJECTIVEPreterm labor is one of the main causes of morbidity and mortality in mothers and infants. The condition also leads to high healthcare costs. Current variations in practices to prevent preterm labor and uptake of services were reported. Therefore, this study aims to develop quality standards (QS) – a concise set of evidence-informed quality statements designed to drive and measure quality improvements – to reduce the variation in healthcare providers’ practices on preventing preterm labor in Thailand. Moreover, this study aims to explore the feasibility of implementing the developed QS in practice.
METHODS QS development is an iterative process involving several steps and relevant stakeholders. A technical working group that consisted of researchers, policymakers, experts, and health professionals with expertise in maternal and child care was appointed to facilitate the development process. The group started with reviewing and selecting national and international clinical guidelines on the prevention of preterm labor; identifying relevant recommendations; prioritizing recommendations; devising statements and measures; conducting in-depth interviews with key stakeholders (e.g. 9 policymakers at national and regional levels and 44 health professionals) to explore the feasibility of using the QS in practice; and presenting the results of QS development and feasibility study to relevant stakeholders
RESULTSThe QS statements included providing information on symptoms and signs, assessing risk and management of the risks, referral services to other hospitals for receiving specialist care, and prescribing corticosteroids. Results from the feasibility study showed that 5 quality statements were considered useful for preventing preterm labor; however, there were some limitations. First, some QS statements could not be applied to district or health-promoting hospitals. Second, healthcare providers working at district hospitals still lacked knowledge and skills related to service provision. Third, the QS provided excessive detail and its content was difficult to understand.
DISCUSSION AND CONCLUSIONSThe QS should be tested and tailored to different levels of healthcare facilities. Training to build capacity of healthcare providers related to service delivery should be arranged prior to the implementation of the QS.
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PS2-03
Whole body computed tomography (WBCT) in adult with major blunt trauma injuries: A systematic review
1Syful Azlie MF, 1Aidatul Azura AR, 2Sabariah Faizah J, 2Sii Ing Y1 Ministry of Health Malaysia2 Sungai Buloh Hospital
OBJECTIVEIn Malaysia, WBCT is not widely practice as routine imaging procedure due to lack of clear guidelines. Hence, to ascertain the benefit of using WBCT as part of assessment in benefiting blunt polytrauma patients.
METHODS Electronic databases such as PubMed, Medline, OVID EBM Reviews, and US FDA website were searched. Studies were selected based on inclusion/exclusion criteria, critically appraised, and evidence graded using US/Canadian Preventive Services Task Force.
RESULTSA total of 443 records were identified whereby 25 articles which consist of systematic reviews and meta-analysis, randomised controlled trial (RCT), cohort, cross-sectional, diagnostic, non-RCT, and cost-utility analysis were included. WBCT compared to conventional/selective CT scanning early in the management of major blunt trauma injuries reduced overall mortality rate (odds ratio [OR] 0.21 to 0.75) and increases the chance of survival among patients in moderate shock (OR 0.73) and severe shock (OR 0.67). It was highly specific in detecting injuries to different body regions (97.5-99.8%) but sensitivity varies (79.6-86.7%). Although patients underwent WBCT were exposed to higher radiation dose (>20 mSv), the position of both arms not only reduced the radiation but produced highest imaging quality. WBCT was superior to conventional CT scan in reducing/shortening time spent in ED, from admission to injury diagnosis and operating room, length of hospital stay but no different in the ICU stay. WBCT was found to be a cost-effective strategy in United States.
DISCUSSION AND CONCLUSIONSWBCT is useful as part of assessment for adult with major blunt trauma injuries. However, proper selection criteria of patients that will benefit the most and discussion with patient or caregiver before undergoing the procedure are advocated. Hence, findings from this review may be used as technical input in decision/policy making, particularly in developing a guideline related to management of trauma care using WBCT as routine imaging procedure.
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PS2-05
DEVELOPMENT AND IMPLEMENTATION OF SCREENING PROGRAMME IN MALAYSIA. ROLE OF HTA.
1Erni Zurina Romli, 1Junainah Sabirin1 Malaysian Health Technology Assessment Section, Medical Development Division, Ministry of Health, Putrajaya, Malaysia
OBJECTIVEOver the years, MAHTAS had many assessment on screening programmes. Hence, this study was conducted to review the role of HTA in development and implementation of screening programmes in Malaysia.
METHODS Databases on HTA and Mini-HTA produced by MaHTAS from 1997 to 2018 were reviewed. Titles related to health screening were identified and analysed in term of report types, disease types and recommendations. Impacts were analysed from survey report, policy documents and guidelines.
RESULTSSince 1997 to 2018, MaHTAS has produced 71 HTA and 353 mini-HTA reports whereby 15 HTA (21.1%) and 17 mini-HTA (4.8%) were pertaining to screening programmes. The majority of the titles were on screening of non-communicable disease (87.5%) and communicable disease (12.5%). Out of this, 19 (59.4%) were recommended for routine or selected use (for example School Scoliosis Screening Programme), four (12.5%) were recommended for research purpose or use in a research environment ( example; Low Dose CT Scan for Lung Cancer Screening) and nine (28.1%) were not recommended, either due to lack of high quality evidence on effectiveness, ethical and legal issue or due to ineffective screening tools. Majority of the health screening titles assessed (87.5%) follows the recommendation given in term appropriateness of screening programme implementation, with the exception of four titles (12.5%) for research purpose. To date, only two titles had further research done.
DISCUSSION AND CONCLUSIONSThe HTA has played an important role in healthcare decision making towards development and implementation of screening programme in Malaysia. Only evidence-based screening programmes that have been proven to be safe, effective and cost effective, are been implemented.
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PS2-06
Meta-Analysis Approach on Iron Fortification and its Effect on Pregnancy and its Outcome through Randomized, Controlled Trials
Ramesh Athe*1, Anindita Mazumder2, Rinshu Dwivedi1, Sanghamitra Pati1
1 HTA Indian Hub, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha-751023, India2 Indian Statistical Institute, North East Centre, Tezpur, Guwahati-754028, India.
OBJECTIVEMicronutrients deficiency (MD) is a common phenomenon among majority of the population residing in Low and Middle Income Countries (LMIC) especially among the women and children. Present study aims to provide evidences on the impact of iron fortification on hemoglobin (Hb) concentration during pregnancy and also evaluates the specific maternal and pregnancy outcomes.
METHODS the steps in this process were conducted according to the PRISMA guidelines. A systematic review was conducted by using search engines such as PubMed, Cochrane Library, Medline, EMbase, and secondary references. Meta-analyses were performed to calculate summary estimates on Hb concentration during pregnancy, low birth weight (LBW), and preterm births. The standard mean difference (SMD) and Relative Risk (RR) were calculated by using random-effects model. Sources of heterogeneity were explored through meta-regression analysis.
RESULTSEight studies were included for the final analysis. The overall pooled estimates showed a significant increase in the Hb concentration among fortification group as compared with the control group (n 3872 SMD 0.43g/l; 95% confidence intervals (CI) 0.26, 0.60g/l; I2 82 %; τ2 0.06; ρ<0.00001).
DISCUSSION AND CONCLUSIONSThere has been a notable reduction in IDA among the pregnant women due to substantial heterogeneity in the duration of iron fortification. Meta-regression analysis reveals that duration of feeding was positively associated with the effect size. This review provides evidence on the substantial benefits of iron fortification during pregnancy for reducing the preterm births and risk of LBW. However, the effectiveness of iron fortification needs further research.
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PS2-07
Cost of Adverse Drug Reaction (ADR) Among Hospitalized Patients:A Systematic Review
1Siti Fauziah Abu, 1Asrul Akmal Shafie, 1Haarathi Chandriah1 School of Pharmaceutical Sciences, Universiti Sains Malaysia
OBJECTIVEThe study aimed to systematically review the cost of ADRs among hospitalized patients with specific objectives of identifying the prevalence, cost of and factors associated with risk and cost in managing ADR.
METHODS Literature search was conducted in MEDLINE, EMBASE, CINAHL, Cochrane Library and Google Scholar databases. Search restricted to English studies published from year 2000-2017. Studies included if met the following criteria, i.e. fitted definition by WHO, not addressing specific ADR, and provided sufficient data on incidence and cost per case of ADR related-to hospitalization. Two review authors independently selected trials, assessed risk of bias and extracted data.
RESULTSThe search yielded 676 potentially relevant references with final sample of 11 studies eligible for inclusion. Most studies were conducted prospectively (n=7) comprising 558,188 patients. Mean age ranged from 40 to 71 years with more male patients included (n=6). Four studies were from Asian and others from United States (n=3), France, Switzerland, Spain and Germany. Percentage admission due to ADR ranged between 0.03 to 7.1% with mean length of hospital stay ranging from 6 to 11 days. Drugs commonly causing ADR were cardiovascular agents, anti-infectives and anticoagulants. All studies estimated ADR cost according to health sector (provider’s perspective, n=8) using micro-costing (n=5), DRG system-based costing (n=3) and average-per-diem costing (n=3) respectively. Cost per ADR case (adjusted for year 2016) ranged between USD65 to USD12,129 where lowest ADR costs were reported by studies from India.
DISCUSSION AND CONCLUSIONSADR among hospitalized patients are significant public health problem leading to economic burdens. Our findings showed, the cost per ADR case for high-income countries (US, n=2; Europe, n=4 and Taiwan, n=1) were more than 10 times higher compared to studies from a lower-income country (India, n=3). However, the methodological heterogeneities among included studies such as study design, ADR characteristics, type and structure of costs resulted in varied ADR cost estimates.
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PS2-08
Operation simplifying and Time saving by implementation of 200-ml contrast
Chen Zhang, Yan Wei, Zhilei Fan, Feng Ma1 School of Public Health, Fudan University2 Key Lab of Health Technology Assessment, National Health Commission
OBJECTIVEIn China, 100-ml single-use contrast is usually given to the patients who need CT enhanced scanning, which increases the workloads for radiology nurses and prolongs the waiting time of patients. This study aims to assess the operation simplifying and time savings by implementation of 200-ml contrast.
METHODS A multicenter perspective study was developed to measure the operating time of nursing staff in tertiary hospitals in six regions in China. A total of 1169 operations were observed and recorded by the stopwatch between September 2018 and November 2018 and total operation process is divided into different parts to record. T-test, Pearson χ2 test and partial correlation analysis ware used to compare the operating time and frequency of two packages of contrast through STATA software.
RESULTSA total of 787 patients were examined using the 100-ml contrast, and 382 with the 200-ml contrast. Partial correlation analysis showed that the implementation of larger contrast package can save operating time (r=-0.43, p<0.01). The total operating time for 100-ml contrast versus 200-ml contrast, which was adjusted according to the market share of two different power injectors (PIs), were 80.67s and 63.81s and about 16.86s were saved (P<0.01). Besides, the frequency of contrast agent exchanging operation for 100-ml contrast versus 200-ml contrast of different types of PIs were 1 time per examination versus 0.45 time per examination for dual-syringe PIs (χ2 =183.44, p<0.01) and 1 time per examination versus 0.30 time per examination for syringeless PIs respectively (χ2 =429.59, p<0.01).
DISCUSSION AND CONCLUSIONSNo matter what type of PI, it is obvious that the use of 200-ml contrast can shorten the operating time of nursing staff and queuing time of patients. Thus, it can improve the working efficiency of nursing staff and improve the service capacity of medical institutions.
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PS2-09
Budget Impact analysis of Anti-Vascular Endothelial Growth Factor in Patients with Diabetic Macular Edema
1Jangmi Yang, 1Sang Jin Shin, 1Jae Kyung Suh, 1Songhee Cho, 1Hajin Tchoe, 1Min Joo Kang, 1, 2Donghyun Jee1 National Evidence based Health Care Collaborating Agency, Seoul, Korea2 Department of Ophthalmology and Visual Science, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
OBJECTIVEThis study aimed to investigate the optimal strategy to give more diabetic macular edema (DME) patients anti-vascular endothelial growth factors (anti-VEGFs) therapy with less burden impact on National Health Insurance (NHI) to the hypothetical reimbursem*nt condition and the change of environment
METHODS The budget impacts by changes of reimbursem*nt condition and environment in anti-VEGF treatments for DME patients were estimated over the next five years (2018-2022). Four scenarios were assumed based on the change of Anti-VEGF treatment patterns by the current reimbursem*nt condition (scenario 1), the hypothetical reimbursem*nt condition (scenario 2), the introduction of biosimilar of anti-VEGF (scenario 3) or the prescription of off-label drug bevacizumab (scenario 4).. The number of patients, anti-VEGF treatments and medical costs of each scenario were calculated by claims data of the Korea National Health Insurance (NHI) and the anti-VEGF prescription data in a hospital.
RESULTSThe budget impact of Anti-VEGF injection in patients with DME over the next 5 years was estimated to about 97.7 billion or 106.2 billion KRW in scenario 1 or 2 respectively. Under a supposition of using biosimilar products of Anti-VEGF since 2020 (scenario 3), the estimated budget of NIH was approximately 98.4 billion KRW (scenario 3). If the off-label drug, bevacizumab is reimbursed, roughly 79.5 billion KRW will be required for NHI’s budget (scenario 4).
DISCUSSION AND CONCLUSIONSIf the newly revised reimbursem*nt condition of anti-VEFG for Age Related Macular Degeneration (AMD) patients is applied to DME patients, the financial burden of NHI of anti-VEGF for DME patients will be increased more than in the case of the current reimbursem*nt condition will be maintained over the next 5 years. Thus, considering of the continuous growth of DME patients, the prescription of biosimilar or off-label drug can be an alternative option to reduce the financial burden on NIH.
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PS2-12
Cost Effectiveness Analysis of Cervical Cancer Screening in Shanghai
Jun-qin Jie1, Dan-ni Chen1,2,Chong-yang Jiang1,Ying Xu1, Ping Zhou1
1 Key Lab of Health Technology Assessment, National Health Commission (Fudan University), Shanghai 200032, China2 Shanghai Center for Health and Wellness Development, Shanghai 200030, China
OBJECTIVECervical cancer is the fourth most common cancer in women worldwide [1]. In China, about 90,000 women were newly diagnosed of and 30,500 were died of cervical cancer every year [2]. Various screening strategies have been applied to reduce morbidity and mortality from cervical cancer following international or national guidelines in China. The objective of this study is to compare the cost-effectiveness of 6 primary cervical cancer screening strategies in China aiming to help related decision makings to promote organized screening programs and reduce the burden of cervical cancers.
METHODS Based on our well-calibrated Markov cohort model, cost effectiveness of 6 primary cervical cancer screening strategies were evaluated from the governmental perspective. The strategies are the following: S1: pap cytology screening (once every 3 years); S2: liquid-based cytology screening (once every 3 years); S3: liquid-based cytology combined with HPV screening (once every 5 years); S4: pap cytology combined with HPV screening (once every 5 years); S5: HPV high-risk subtype screening (once every 5 years); S6: HPV high-risk classification screening (once every 5 years). Moreover, sensitivity analyses including patient adherence, cost and technology parameters were assessed. TreeAge pro 2018 software was applied for data analyses.
RESULTSCompared to no screening, S3 achieved the best effectiveness (reduced 283 CC cases), while the strategy 6 had lowest cost-effectiveness (¥ 215953.67/case). Compared to S1, the lowest incremental cost-effectiveness ratios were S6 (¥ 134220.03/case) and 5 (¥ 157632.95/case). Taken S 6 as an example, women participation rate, colposcopy referral rate, the proportion of HPV16/18 infection had positive associations with its cost-effectiveness, while the screening cost had negative association.
DISCUSSION AND CONCLUSIONSAmong the 6 screening strategies, HPV high-risk classification screening (Once every 5 years) has the best cost-effectiveness, and this screening strategy is a priority when performing population-based cervical cancer screening. It is preferable to adopt HPV DNA testing in combination with cytology screening when economic conditions permit.
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PS2-14
The Development of Patient Safety Culture Instrument for Acute Care Hospitals in South Korea
1Jessie Lee, 2Haerim Han, 3Seunggyeong Jang, 4Sang-il Lee, 3Won Lee, 1Eunji Park, 1Eunjung Park, 1Ji Eun Choi1 National Evidence-based Healthcare Collaborating Agency, South Korea2 Departement of Physical Therapy, Yonsei University, South Korea3 Departement of Medical Law & Ethics, Yonsei University, South Korea4 Departement of Preventive Medicine, Ulsan University, South Korea
OBJECTIVEWith the rapidly changing healthcare environment in South Korea, which includes the implementation of the Patient Safety Act and the National Patient Safety Reporting and Learning System, it is the key to accurately measure patient safety culture of hospitals by using an adequate tool in order to monitor change in patient safety culture from patients, healthcare providers, institutions, and system’s perspectives. The aim of this study is to develop a patient safety culture instrument that properly reflects the health care environment and system in South Korea.
METHODS Interview prompts and a preliminary questionnaire were developed through a literature review, followed by individual in-depth interviews and four focus groups with doctors and nurses from acute care hospitals with over two hundred beds. The preliminary questionnaire was evaluated on content validity by 11 healthcare professionals including professors, doctors, nurses, and staff specially tasked with patient safety and healthcare quality. To pilot the preliminary questionnaire, the questionnaire will be administered to 30 healthcare professionals to find problems in the instrument and measure the time to complete it. To conduct reliability validity and criterion validity analyses, the preliminary questionnaire will be administered to hundreds of doctors and nurses currently working in acute care hospitals with over two hundred beds located in various regions of South Korea.
POTENTIAL IMPACT The development of the patient safety culture instrument which adequately reflects healthcare system and environment in South Korea may enable Korean acute care hospitals to accurately measure and assess change in patient safety culture over time. It will also be possible for hospitals to recognize the constituent of patient safety culture on an individual, institutional, and social level and consider measures to improve patient safety. The completed questionnaire will be collected and analyzed, and the final questionnaire will be available by the end of March 2019.
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PS2-15
5Pregnant women’s experiences and perceptions of non-invasive prenatal screening (NIPS) in prenatal screening and diagnosis: systematic review of qualitative evidence
Wenru Shang1, Yanqiu Du1, Wenjun Zhu1, Jiayan Huang1*1 Department of Hospital Management School of Public Health, Fudan University
OBJECTIVEIt is critical that the perspectives of users and other stakeholders were considered in the process of HTA and policy-making. Important source of information can be provided that relate to the needs and wishes of the people which may be neglected when decision-makers focus on clinical efficacy and cost. This study systematically reviews the pregnant women’s experiences and perceptions of non-invasive prenatal screening (NIPS) in prenatal screening and diagnosis to inform health decision-making regarding how best to implement NIPS in the prenatal care and how to reasonably handle the growing number of clinical applications for NIPS.
METHODS A comprehensive literature search, limited to English language, was undertaken on seven databases (Medline, EMBASE, PubMed, CINAHL, PsycINFO, Web of science, SCOPUS) for studies using qualitative methods and reporting pregnant women’s experiences and perceptions of NIPS. We also critically evaluated the included studies using the Critical Appraisal Skills Program (CASP) quality assessment tool which used to appraise qualitative studies for credibility, integrity and trustworthiness. Qualitative data were analysised using thematic synthesis in NVivo.
POTENTIAL IMPACT The development and implication of NIPT from commercialization to national screening programmes offered via public services shows a great influence on pregnant women and other stakeholders. Especially, women who have had personal experience with NIPT have concerns and priorities which will inform making-decision on supervision and implementation of the non-invasive prenatal screening test.
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Poster Session
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ReviewerProfessor John Cairns, LSHTMPhD. YingYao Chen, NHC Key Lab of Health Technology Assessment, Fudan University Dr. Seok-Hyun Kim, NECADr. Ryota Nakamura, Hitotsubashi University
https://htasialink2019.org/program/program.htmlContact. [emailprotected]
