The number and range of technologies that the National Institute for Health and Care Excellence (NICE) evaluates has never been greater, and with that comes an increasing requirement for capacity. However, not all technologies need the full intensity of the current standard evaluation process. This presents an opportunity to differentiate evaluation processes, and in doing so release capacity for more evaluations. NICE has embarked on a project to develop proportionate appraisal processes, allowing promising medicines to move through refined processes that better match the specific needs of individual evaluations.

The proportionate approach to technology appraisals (PATT) project was initiated in June 2022. Multiple work strands were established to develop and test potential proportionate approaches, focusing mainly on streamlined approaches for appraisals in which a lighter-touch approach is sufficient. By creating an accountability framework which empowered staff across NICE, new processes were developed using test-and-learn principles: piloting key concepts using retrospective reviews and live appraisals and adjusting the approach based on their findings. The impacts of each approach on NICE, on stakeholders and on the individual appraisals were monitored and assessed.

The project has identified a range of procedural, methodological and operational improvements across the NICE technology appraisal process. Substantial efficiencies have been found, including consolidation of activities, reducing duplication of effort and minimizing disproportionate steps. The test-and-learn approach has proved successful, both in rapidly identifying unsuccessful ideas and in refining and adjusting processes in light of new information and challenges.

The proportionate approach to technology appraisals project represents an important part of improving and streamlining NICE’s approach to health technology assessment, reflecting the increasing demands on the program. Developing proportionate approaches allows efficient use of limited evaluation resources to continue supporting rapid, evidence-based access to innovative technologies. The project also provides a valuable demonstration of an agile, flexible approach to process improvement, paving the way to rapid, dynamic updates in the future.

With the increasing popularity of enhanced recovery protocols and the growing opioid epidemic, recent pain management pathways have emphasized opioid-sparing measures. As a result, gabapentinoids are being used following surgery and have become one of the most common opioid-sparing analgesics prescribed. However, they are not without risk, with several cases of respiratory depression and oversedation being reported.

This systematic review and meta-analysis aimed to evaluate the impact of gabapentinoids on sedative complications following abdominal surgery in order to guide future clinical decisions. The Pubmed and Embase databases were searched according to PRISMA guidelines to identify randomized controlled trials comparing gabapentinoids with placebo following abdominal surgery with respect to sedation complications. The Cochrane Risk of Bias Tool was used to assess study quality. A comparative meta-analysis was performed on the data.

Of the 3,988 studies retrieved, 19 were eligible for meta-analysis. Eleven of the 19 studies assessed pregabalin (100 to 1,200 mg) and eight assessed gabapentin (300 to 1,200 mg). Postoperative sedation scores were higher in the gabapentinoid group (p<0.01) relative to placebo. Subgroup analyses demonstrated higher scores two hours after surgery for gabapentinoids (p=0.03), but no statistical difference at 24 hours (p=0.19). Different doses did not yield any differences on forest plot analyses.

Respiratory depression rates were higher in the gabapentinoid group, compared with placebo (p=0.02).

The preoperative use of gabapentinoids is associated with sedative complications, including respiratory depression. These results may help guide future perioperative pain protocols.

Up to 90 percent of inpatients require an intravenous catheter during their hospitalization. A closed, integrated peripheral intravenous catheter (PIVC) system has been shown to protect veins for longer and reduce the risk of complications and unnecessary restarts when compared with an open system. This study evaluated the annual clinical and economic outcomes of adopting a closed, integrated PIVC system, instead of an open system, for inpatients in a Japanese hospital.

A budget impact analysis was developed to estimate the clinical and economic impact for a 500-bed hospital with an 85 percent occupancy rate and a 96-hour catheter replacement protocol. For the analysis, the average length of stay for patients was 12 days and 90 percent of inpatients required a PIVC. Inputs such as catheter failure rate, complication rate, consumables costs, and complication management costs were informed by global and local data sources. The outcomes evaluated included consumables utilization, complication events, nurse time, and overall cost impact.

The analysis estimated that 12,604 patients required PIVCs. Moving from an open to a closed, integrated PIVC system resulted in a 68 percent reduction in consumables (3,786 fewer catheters and 36,315 fewer connecting accessories). Complications (occlusion, extravasation, phlebitis, and bending) were reduced by 62 percent (3,682 fewer episodes). Blood exposure was reduced by 98 percent (3,565 fewer episodes), and nurse time decreased by 17 percent (786 fewer hours). This resulted in a potential overall cost saving of JPY3,955,140 (USD28,756) annually, after offsetting the acquisition cost of JPY888,247 (USD6,458) associated with the closed system.

PIVC is the most common vascular access device used in hospitals, and insertion and maintenance are often performed by nurses. Fewer complications can be expected with a closed system, leading to better patient outcomes. In addition, nurses spend less time managing complications and replacing PIVCs, and consumables utilization is reduced. This results in improved operational efficiency and potential cost savings for hospitals.

This study aimed to describe the type of evidence available for and the clinical benefit of cancer medicines assessed for funding in Australia by the Pharmaceutical Benefits Advisory Committee (PBAC). The evidence was assessed with the European Society of Medical Oncology Magnitude of Clinical Benefit Scale version 1.1 (ESMO-MCBS).

All data on applications submitted to PBAC between 2010 and 2020 were independently extracted in duplicate from PBAC Public Summary Documents available online. Any disagreements were resolved through discussion. ESMO-MCBS ratings were retrieved from the ESMO-MCBS website. Substantial benefit for the ESMO-MCBS was defined as a grade A or B for (neo)adjuvant intent and four or five for palliative intent.

In the study period, 182 cancer indications for 100 cancer medicines were examined by PBAC, including 124 (68%) for solid tumors (116 in the palliative setting) and 58 (32%) for hematological cancers. A total of 138 (76%) indications were recommended for public funding, 40 (22%) were rejected, and four (2%) were deferred. Randomized controlled trials (RCTs) were the main source of evidence in 154 indications (85%) and single-arm studies in 27 (15%) indications. RCTs were available in 113 (91%) and 41 (71%) of the solid tumor and hematological cancer indications, respectively. In submissions with RCTs, mature overall survival (OS) was reported in 81 (53%) indications. For indications with a statistically significant improvement in OS, the median gain was 3.0 months (range 0.9 to 17.0) for solid tumors and 8.2 months (range 1 to 9.1) for hematological cancers. The ESMO-MCBS score was available for 99 solid tumor indications. For indications in the palliative setting, 47 (52%) had substantial clinical benefit according to ESMO-MCBS v1.1, including 35 (51%) indications recommended by PBAC and six (35%) indications that were rejected.

These results show that only a minority of cancer medicine indications considered by PBAC are supported by a good level of evidence and provide a modest extension of patient survival.

Expert elicitation is often used in economic analyses to estimate uncertain or unobserved parameters for decision models. However, it has rarely been used in the context of local decision-making. A pragmatic elicitation process was used during a local economic evaluation to prompt local experts to assess the relevance of the published evidence to their setting, and to adjust the published effect estimates to better reflect the intervention effect expected in their setting.

Elicitation was undertaken for two interventions that targeted the prevention of hospital-acquired hypoglycemia. Six clinical experts from within the Southern Adelaide Local Health Network (SALHN) were systematically presented with information on the setting of the published evaluation and their local setting. This included information on the hospital and quality of care, patient characteristics, and the research context. After comparing the settings, the experts were asked to estimate the most realistic, most pessimistic, and most optimistic intervention effects for their local context.

The local intervention effect was estimated to be smaller than the published estimate for both interventions. For one intervention, this was driven by the lower complexity of the local patient cohort. For the other intervention, it was driven by differences in the scope of implementation, with hospital-wide local implementation expected to reduce staff buy-in relative to the targeted implementation used in the published evaluation. The elicited local intervention effects were used in a cost-consequence analysis to estimate the likely costs and effects of the interventions if they were implemented locally.

The pragmatic elicitation process provides a feasible and acceptable way to assess and transparently adjust the published effect estimates to better reflect the expected intervention effect in the local setting.

Including this step in local economic evaluations can increase the relevance of these evaluations to local decision makers. Further development and application of these methods may facilitate greater use of economic evaluation in local settings.

Economic evaluation is infrequently used by local health services. To be useful to local decision makers, economic evaluations need to synthesize published evidence on effective interventions with local data and local stakeholder knowledge regarding patient and organizational contexts. A framework for local economic evaluation was applied by health economists working with a local health service to inform their decision-making regarding funding of health service delivery models to reduce hospital-acquired complications.

The framework engaged with local stakeholders to set priorities, assess the relevance of the published evidence, interpret local data, provide insight on the local context, and make recommendations to decision makers. It involved: (i) synthesizing the published evidence in a pragmatic review; (ii) determining local root causes and baseline incidence rates using local clinical and administrative data; and (iii) using expert elicitation to adjust published intervention effects to reflect the local context. This information was synthesized in a cost-consequence analysis that estimated the likely costs and effects of relevant interventions if they were implemented locally.

Local stakeholders selected hypoglycemia and urinary tract infections as targets for intervention. Tools and resources developed for each case study included: clinical audit tools and analysis files; pragmatic literature reviews with templates to present interventions to local stakeholders; an expert elicitation framework; and R code for cost-consequence analyses that apply published and elicited intervention effects to local data.

The framework provided a feasible and acceptable process for undertaking local economic evaluations. Engagement with local stakeholders ensured the evaluations produced were relevant and tailored to the local setting and were therefore useful to local decision makers. The tools and resources developed can be applied by other local health services. The framework itself can be used for other case studies. However, the time and cost associated with the evaluations was not sustainable and alternative models for applying the framework need to be explored.

In Brazil, the National Committee for Health Technology Incorporation of the Brazilian Public Health System (Conitec) defines the criteria for incorporating technologies into the public health system. However, all recommendations are submitted to public consultations to ensure transparency and public participation.

Contributions from the public consultation are analyzed and entered into Conitec’s final report and sometimes change the preliminary recommendation.

This descriptive, retrospective exploratory study aimed to gather qualitative and quantitative data on criteria considered by healthcare decision makers from Conitec and to identify which criteria most changed after reports were submitted to public consultation. Data from 2012 to November 2022 were collected from the Conitec website, entered into a specific extraction form, and analyzed using descriptive statistics.

Medicines (77%) were the most frequently evaluated type of technology, followed by procedures (15%), and products (8%). A total of 763 recommendations were analyzed. Of these, 70 percent did not change the decision criteria from the preliminary to the final published report, 9 percent did change, and 20 percent were simplified analyses of technologies of relevant public interest that were of low cost and low budget impact (these were not submitted to public consultation or public hearing). As pharmaceutical companies usually propose cost reductions or discounts during the Conitec public consultations, most of the recommendations (45%) were modified in the final report, with incremental budgetary reduction being the main criterion. This study identified that most of the changes occurred in neurology and were related to the high incremental budgetary impact of technologies for the care of rare diseases like spinal muscular atrophy.

Although different criteria are considered for Conitec recommendations, some of these are regarded as crucial for decision-making. Unfortunately, as there is no definition for the weight of each of these criteria, it is difficult to understand their influence on the recommendations made. Therefore, it is crucial to establish standardized criteria for proper decision-making.

The National Committee for Health Technology Incorporation of the Brazilian Public Health System (Conitec), which was created in 2011 by federal law, defines the criteria for incorporating and excluding health technologies in the Brazilian health system. For technology evaluation proposals a recommendation report is carried out, which finds the best scientific evidence about the efficacy, accuracy, effectiveness, and safety of the technology being analyzed. The report also provides a comparative economic evaluation of the technologies already in the health system to promote and protect public health, achieve the best allocation of resources, and reduce regional inequalities.

This exploratory, descriptive, and retrospective study aimed to identify the criteria considered for the exclusion of medicines within the Brazilian health system from 2012 to November 2022. Data were extracted from Conitec’s website into a specific extraction form and analyzed using descriptive statistics.

During the evaluation period, 763 technology recommendations by Conitec were identified, of which 75 (10%) related to the exclusion of medicines. Several criteria were identified among the exclusion recommendations, including protocol updates, expiry or lack of registration in the National Health Surveillance Agency, and drugs whose clinical indication was not included in the list of drugs registered for treatments in the health system.

Although there is no standardization of criteria in Conitec for recommendations on the exclusion of health technologies, this study contributes to a better understanding of these technologies. Disinvestment of technologies positively impacted the population because it resulted in better allocation of resources in the health system, and some of the excluded technologies presented a greater risk of interactions and undesirable adverse reactions.

Patients suspected of having a rare genetic disease often experience lengthy and costly diagnostic odysseys. The timing of whole exome sequencing (WES) in the testing sequence, its diagnostic yield and test costs in the sequence all factor into estimates of cost-effectiveness analysis for health technology assessment.

We modeled the diagnostic pathway using a discrete event simulation model, starting with the first test result. We defined and populated the simulation based on data from the electronic medical records of n=307 from the Care-for-Rare SOLVE multi-center Canadian observational cohort. Five alternative diagnostic pathways were modeled based on the observed data: no WES, and WES as the first, second, third or fourth test in the sequence. WES as the second test in the sequence is considered standard of care in medical genetic centers in Canada. We assessed effectiveness of WES in terms of diagnostic yield, time to diagnosis, and costs as patient-level overall test costs (2020 CAD/USD) across the diagnostic pathway.

Compared to molecular and specialized diagnostic tests only (i.e., no WES), WES increased diagnostic yield from 5 percent to 40 percent. The shortest time to diagnosis for those with a diagnosis was 1.82 years in the diagnostic pathway with WES as the second test. Test costs for each pathway were CAD2,800 (USD2,087, no WES), CAD2,700 (USD2,013, WES as first test), CAD3,500 (USD2,609, WES as second test), CAD4,500 (USD3,354, WES as third test), and CAD5,300 (USD3,951, WES as fourth test).

Placing WES earlier in the diagnostic pathway for patients suspected of having a rare disease is associated with an increased diagnostic yield, reduced time to diagnosis and lower overall test costs with the benefits being greater the earlier in the pathway that WES is implemented.

In consideration of the lessons learned from other jurisdictions and other ongoing work in the disease registry data space, an opportunity existed to investigate the current Canadian landscape and identify opportunities for a Canadian registry list. Previously, no national-level inventory of registries existed in Canada that could provide the necessary information to support awareness and use of available data for decision-making.

A literature search was conducted on key resources, including MEDLINE and a focused internet scan. No methodological filters were applied to limit retrieval by publication type. The search was limited to documents published in English or French.

Core characteristics of the identified registries were extracted and contextual information on the current landscape of disease registries in Canada was explored. A literature review and draft inventory list has been produced.

A CADTH environmental scan was undertaken to collect and report on existing Canadian disease registries and to identify key features, characteristics, and intersections. This information and analysis increase the potential of Canadian registries to inform decision-making and identifies opportunities for the optimal use of registry data in Canada more broadly.

The PRESS guideline and checklist provides a set of recommendations concerning the information that should be used by librarians and other information specialists when they are asked to evaluate electronic search strategies. CADTH and PRESS authors were approached for permission to translate this checklist into various languages.

The team from Fundação Oswaldo Cruz and the Universidade Federal do Rio de Janeiro asked CADTH for permission to translate the PRESS guideline and checklist for their research work. They translated PRESS following the steps advocated by the scientific literature on the translation of standardized questionnaires.

CADTH is now sharing and actively disseminating the PRESS translations in French and Portuguese (and a forthcoming version in Spanish) via the Finding the Evidence website and through related presentation activities.

The coordinated translation of key health technology assessment (HTA) tools provides an avenue for international uptake and improvement of best practice in information retrieval, which is a foundational feature of HTA work. With the absence of formal translation guidelines on the translation of protocols such as PRESS, CADTH would benefit from developing guidance for HTA teams requesting to translate our tools. CADTH is currently conducting research on the uptake and use of PRESS, which will inform future knowledge mobilization strategies such as translation standards and communications.

Decisions to adopt health technologies rely, in part, on judgements about cost effectiveness. Cost effectiveness is commonly assessed against a willingness-to-pay threshold for health gains. Building an evidence base on the marginal productivity of health spending to inform the value of the threshold is increasingly of interest for resource allocation decision-making and technology implementation. We report on an in-progress analysis to inform a threshold for policy purposes in British Columbia, Canada.

We developed a ten-year panel-data model with instrumental variables, which lessens the degree of time-invariant confounding and addresses biased causal inferences caused by unobserved factors, to provide estimates of the marginal cost per health unit measured using quality-adjusted life-years (QALYs). We use the Johns Hopkins Adjusted Clinical Group (ACG) system and a British Columbia Health System Matrix to classify patients into six resource use bands (RUBs) ranging from ‘healthy’ to ‘very high morbidity’. Patients are also classified by chronic conditions and types of services. Place of residence and geographical region of health authorities are considered. Variables included age, gender, mortality and comorbidity rates, costs of hospitalizations, emergency department and physician visits, residential and home care, laboratory services, diagnosis and medications, and quality of life. Instrumental variables included sociodemographic characteristics as reported in the Canadian census.

The largest RUB was ‘moderate’ morbidity (39.3%), while the smallest was ‘healthy’ (1.5%). The youngest was the ‘low’ morbidity (mean 31, standard deviation [SD] 21) and the oldest was ‘very high’ (mean 69, SD 17). The healthy group had the smallest mean costs (CND563, SD CND4,121; equivalent to USD421, SD USD3,083). In contrast, the ‘very high’ group had the largest (CND20,398, SD CND36,188; equivalent to USD15,258, SD USD27,069). Age and gender standardized comorbidity index scores ranged from 0.05 to 6.41 (median 0.98). Additional analyses (e.g., costs per QALY) are ongoing and the results will be reported at the conference.

Our empirical approach is robust and flexible, allowing estimates of marginal productivity according to factors such as disease, geographical region, service type, and care sector. This work has applications at the provincial and national levels and adds to methodological literature in the field.

The challenge to health systems is sustainability, not only in the economic and financial sense of compatibility of spending with allocated resources, but also in terms of equity in access to services and care, quality, safety, innovation and research, that is, in terms of the effectiveness of the right to health. Some countries, such as Italy, do not have formal health technology assessment (HTA) or other similar processes that take into account views outside the decision maker.

In the Italian national context, there is currently no single tariff for the reimbursability and pricing of genomic technologies. In fact, although genomic tests have been in clinical practice for many years now, to date they have not yet been included in the LEA (Minimum healthcare provision), especially in view of the fact that a defined and transparent process for updating the Essential Levels of Care has been operational since 2018. With the goal of structuring guidelines for the adaptability of economic evaluations to currently available and developing genomic technologies, a literature review was conducted.

The literature review showed that there are some methodological and practical issues that need to be carefully considered when designing and conducting economic evaluations of genomic tests. In more detail, five key concepts were identified in order to implement the most comprehensive economic evaluation of the technologies under study: the PICO model, the survey perspective, the costs included in the analysis, the effectiveness analysis, the time horizon, and the discount rate.

Adequate definition of these concepts appears to be of paramount importance in view of the fact that genomic testing may have important consequences for future generations as well. For the purpose of sustainability of access of genomic technologies, the use of Budget Impact Analysis (BIA) is recommended in all analysis settings being essential for the regulator to tie access to its available budget capacity.

In patients with non-valvular atrial fibrillation (NVAF), left atrial appendage closure (LAAC) has demonstrated non-inferior efficacy and safety relative to life-long oral anticoagulation therapy (OAT) in a four-year randomized controlled trial (RCT) (PRAGUE-17). Sub-optimal compliance to OAT in the real-world setting (Simmons 2016) has been associated with increased risk of stroke (Ozaki 2020) and may alter efficacy estimates derived from RCTs in which compliance is generally higher. The study aims to model disease outcomes in NVAF patients treated with LAAC versus lifelong OAT when applying trial versus real world compliance to OAT.

Real-world compliance to OAT in the Australian setting was investigated in a 10 percent Pharmaceutical Benefits Schedule (PBS) sample scripts analysis which measured treatment adherence and persistence to new oral anticoagulants (NOACs) and warfarin. Design of the 10 percent PBS analysis was informed by the compliance to medicine working group report and included the longest follow-up of any OAT compliance study identified in the literature. A Markov cohort model was developed to estimate the expected numbers of strokes and major bleeding events in NVAF patients.

Rates of NOAC discontinuation in PRAGUE-17 was higher at 20 months median follow-up (6.5%) versus compliance in the Australian setting (35.4% and 30.0% according to 3 and 6 month ceasing rules at 20 months follow-up). Applying sub-optimal compliance to lifelong OAT demonstrated in the Australian setting resulted in higher numbers of strokes over a life time modelled time horizon compared with LAAC.

Real world compliance to medicines should be a consideration in economic analysis comparing lifelong medications to one-off surgical interventions.

Cervical artificial disc replacement (C-ADR) is not a new technology but one that has seen many technological advances in the past 10 years. Indeed, a recent review described total disc arthroplasty as the most innovative development in the history of spinal surgery. The primary goals of C-ADR are to reduce or eliminate pain, and restore normal segmental motion. The aim of this analysis was to identify, extract and examine key health outcomes and economic data from published health technology assessment (HTA) reports on C-ADR, with the aim of understanding how the evolution of this technology has influenced assessments internationally.

A comprehensive search of over 90 HTA organization websites and the INAHTA HTA database using key terms for C-ADR surgical procedures was coupled with a literature search of recent systematic reviews. No language restrictions were applied.

Twenty HTA reports of C-ADR surgery published from 2005 to 2022 were included for review. Several HTAs (4/20) were updates or reassessments by the same agency and one was an update across agencies (Italy update of Belgian HTA). While many of the HTAs concluded C-ADR is as effective as standard care and superior in certain outcomes, there was no pattern or consistency in the conclusions or recommendations from these assessments, even as the evidence base expanded over time. Our analysis found this was largely due to variations in HTA approaches among agencies including: differences in research questions asked, PICO (Population, Intervention, Comparator, Outcomes) criteria and methods performed, such as: rapid versus full systematic reviews; inclusion of economic evaluations and/or budget impact analyses.

Indeed, one of the only predictive factors for a positive HTA was a favorable cost-effectiveness analysis.

C-ADR is an established technology with extensive HTA investigation internationally. The lack of a consistent approach taken by HTA bodies made prediction of successful HTA outcomes difficult. Future alignment of key evaluation processes and methods may help address current international variations and support consistent decision making on patient access.

Canada’s National Advisory Committee on Immunization (NACI) makes recommendations on the use of human vaccines. Provinces and territories subsequently use the advice to make decisions on public funding and program implementation. Traditionally, NACI reviewed vaccine characteristics and burden of illness.

With its recent expanded mandate, NACI now considers cost-effectiveness via economic evaluations, among other decision determinants. As such, new processes and guidelines were needed to formalize the incorporation of economic evidence into federal vaccine decision-making.

Two task groups were convened respectively to develop NACI’s “Economic Process” and “Guidelines for the Economic Evaluation of Vaccination Programs in Canada”. The groups conducted environmental scans to inform their work, as well as engaged with government partners, decision-makers, academics, national immunization technical advisory groups from other countries, health technology assessment agencies, industry, patient groups, among others.

The Economic Process outlines when and how NACI incorporates economic evidence for vaccine recommendation. For instance, it describes how policy questions are prioritized given institutional capacity constraints for generating economic evidence. It also describes how policy questions are assessed to determine the appropriate type of economic evidence required (i.e., systematic review, economic evaluation, multi-model comparison of external models).

The Economic Guidelines provide recommendations in 15 chapters on how to conduct economic evaluations (i.e., from defining the decision problem to reporting). Unlike other health technologies, vaccines have the potential to affect both vaccinated and unvaccinated individuals. Hence, the Guidelines consider population-level impacts such as externalities (e.g., herd immunity, age-shifting of disease) and spillover effects. They also discuss equity considerations and non-health impacts of vaccines such as to productivity, consumption and education.

The Economic Process and Economic Guidelines promote the generation and use of credible and standardized economic evidence. They advocate for transparency, allowing evidence to be used across jurisdictions beyond Canada. Next steps include documentation of user feedback, incorporation of Indigenous considerations, and formal evaluations.

Decision-making for vaccination programs requires additional consideration on broader effects. The cost-effectiveness guidelines published by the Professional Society for Health Economics and Outcomes Research (ISPOR) working group recommends considering broader effects such as herd protection. Whilst difficulty to produce robust data for such factors might hinder quicker decisions, they are important features of vaccination programs and some of them were the narratives that dominated over the COVID-19 pandemic. In this systematic literature review, the perspectives taken and inclusion of broader effects were investigated for recent influenza vaccine economic evaluations.

The search strategy based on the terms influenza vaccination and cost-effectiveness was carried out on Embase and PubMed. Considering the publication date of the ISPOR guidelines, articles since 2019 were searched. The review focus was the perspectives taken and inclusion of broader benefits in the analysis. A link between perspective and inclusion of broader effects was tested with a Chi-square test.

The total number of full cost-effectiveness articles screened was 48. Of those, the number of articles performed from both the perspectives was 18 (37.5%), and 13 articles (27.1%) considered the perspective of payer only. For those that had both perspectives considered, the ICER reported from the societal perspective was consistently lower than that from the payer perspective. Thirty-one articles (65%) included any of the broader effects. However, broader effects considered were limited to indirect protection (17 articles, 35.4%) and productivity loss (22 articles, 45.8%). The relation between perspective and inclusion of broader effects was significant (p=0.04).

This review highlights that studies performed using both payer and societal perspectives as recommended by the ISPOR research guidelines are not many, while more favorable outcomes were presented when the societal perspective was adapted. Broader effects included are productivity loss and indirect protection.

For other broader effects specified in the research guidelines, there are not many attempts to include those in economic evaluations.

Hospitals in England experience extremely high levels of bed occupancy in the winter. In these circumstances, vaccine-preventable hospitalizations due to seasonal respiratory infections, have a high cost because of the missed opportunity to treat other patients on the waiting list.

This study sought to generate evidence on the hospitalizations that vaccines for older adults against seasonal influenza (flu), pneumococcal disease (PD), respiratory syncytial virus (RSV) and COVID-19 may prevent during the winter season (October-March) in England. The monetary value of the vaccine-preventable hospitalizations was estimated using a conventional reference costing method and a novel opportunity costing approach.

Based on retrospective analysis of Hospital Episode Statistics data on hospitalizations in England, and efficacy and observed coverage rates per vaccination program, we estimated the number of bed-days that current vaccines against flu, PD and COVID-19, and a hypothetical RSV vaccine, could free up by preventing hospitalizations in the winter among older adults. We valued the freed-up bed-days (1) as the cost of prevented hospitalizations (reference cost); (2) as the Net Monetary Benefit (NMB) generated by alternative uses of the freed-up bed-days. The opportunity cost of vaccines-preventable hospitalizations is (2) when they would be an optimal use of beds or (1)+(2) when they would be a suboptimal use.

In the winter months, vaccination programs targeting flu, PD and RSV for older adults could collectively prevent 72,813 bed days and save over £45million (USD56 million) in hospitalization costs. The COVID-19 vaccine could prevent over 2 billion bed days and save GBP1.3 billion. Importantly, the value of hospital beds freed up by vaccination is likely to be 1.1–2 times larger (£48–£93 million [USD60-116 million] for flu, PD and RSV; £1.4–£2.8 billion [USD1.8-3.5 billion] for COVID-19) when quantified in opportunity cost terms. Scenario analysis replacing the current vaccine used in the adult PD program with the newly licensed pneumococcal conjugate 20-valent vaccine (PCV20), would increase the impact of each modelled outcome for this program by approximately 38 times.

Vaccines for flu, PD, RSV and COVID-19 could prevent a significant number of hospitalizations in the winter. The value of the associated freed-up bed capacity is likely to be underestimated by conventional reference costing methods.

Patient involvement has become increasingly integral to health technology assessment (HTA) processes globally due to greater recognition of the important contribution patients make to address uncertainties in the scientific evidence base and interpret results for real-world implementation. To align with best practices and encourage meaningful patient input in HTAs in Singapore, patient involvement processes were established by the Agency for Care Effectiveness (ACE) in 2021. This presentation discusses how patient groups were identified in Singapore and describes the new patient involvement processes.

In the absence of a centralized database, a stakeholder mapping exercise was undertaken in 2021 to identify all relevant patient and volunteer groups in Singapore. A comprehensive search of the Singapore Charity Portal, hospital websites, standard search engines and social media platforms was conducted.

Identified groups were screened in line with specific inclusion criteria and contacted via email and cold calling to find out more about their remits. Plain English resources, targeted training materials and a process guide to encourage patient involvement in ACE’s work were co-developed with local patient organizations by drawing upon best practices from overseas HTA agencies contextualized to local patients’ needs. Supporting resources and processes were revised in 2022 based on ACE’s experience receiving inputs from patients and caregivers to inform drug HTAs.

One hundred and six patient groups covering 20 conditions were identified including registered organizations and informal support groups. In the first half of 2022, ACE received responses from 82 patients from ten patient organizations to inform seven drug HTAs for cancer, diabetes, HIV, and other conditions in line with the new patient involvement processes. Patient organizations viewed the opportunity to submit testimonials of their lived experience with different conditions as a meaningful and important activity for their members.

Patient involvement processes have improved the legitimacy and acceptance of ACE’s work and will be continuously revised to ensure that they remain relevant and meet patients’ expectations and needs.

In recent years, several efforts have been initiated by health technology assessment (HTA) agencies to increasingly incorporate patient involvement (PI) into their assessment processes. The rationale behind PI in HTA is that patients can give their perspective and experiences about health, illness and the use of health technologies, complementing clinical and healthcare system standpoints.

A recent systematic review summarized current evidence on the barriers and facilitators of PI in HTA. Barriers and facilitators were classified according to the context in which they appear, as organizational, decision-making, political and community-related.

Digital health technologies offer a singular opportunity to address some challenges faced by healthcare systems. However, we hypothesized that their intrinsic characteristics may have some implications for PI in digital HTA. We conducted a survey to gain knowledge about barriers in PI in digital HTA.

The survey was elaborated using Microsoft Forms and consisted of 31 questions divided into four blocks (organizational, decision-making, political and community-related). It was sent to three Spanish, one Catalan and one International patient umbrella organizations. The results were analysed using Microsoft Excel.

A total of four responses were received from three Spanish and one Catalan patient umbrella organizations. Results showed high, partial, and low concordance among organizations in 65 percent, 19 percent and 16 percent of the answers received, respectively. According to the results, most of the barriers for PI seem to be the same for HTA of digital health technologies as for other types of health technologies. However, two or three of the four umbrella organizations consider that HTA of digital health technologies might pose greater challenges in terms of achieving significant patient participation, sufficient patient training and knowledge of HTA processes, proper preparation and tools of the HTA experts and logistics during the HTA process.

Barriers in PI are mostly the same for digital or other types of health technologies. Few differences are related to patient training, tools, and logistics during HTA process.