Many population-based studies identify surgical complications using hospital discharge abstract databases (DAD). With DAD, however, complications occurring after the discharge date cannot be followed up. This study used physician claims data to identify the complications of partial nephrectomy, and to compare the rates of complications of open, laparoscopic, and robot-assisted nephrectomies.

Physician claims, DAD, and ambulatory care data from April 2003 to March 2016 were provided by Alberta Health. DAD and ambulatory care data were used to extract information on patients with kidney cancer who underwent partial nephrectomy. All physician claims within 30 days before and after surgery for the cohort were extracted. The numbers of the same International Classification of Diseases, Ninth Revision (ICD-9), codes before and after surgery were compared. If a number increased after surgery, this diagnosis was initially identified as a complication. All diagnoses with neoplasms were excluded. The incidence rates of complications for the three surgery groups were calculated. Chi-squared tests were conducted for the following nephrectomy comparisons: laparoscopic versus open; robot-assisted versus open; and robot-assisted versus laparoscopic.

A total of 1,890 kidney cancer patients had partial nephrectomies. Among them, 1,080, 411, and 399 had open, laparoscopic, and robot-assisted nephrectomies, respectively. One patient who had two different nephrectomies on the same day was excluded from analysis. The robot-assisted group had lower rates of digestive complications (ICD-9: 537–578, 787, 789, 998.6) and infections (ICD-9: 004–041, 998.5) than the open group, and higher rates of genitourinary complications (ICD-9: 584–599, 788, 997.5) than the laparoscopy group. The robot-assisted group had lower rates than the open group for most of the complication categories, but the differences were not statistically significant.

Robot-assisted surgery appears to be superior to open surgery, but no better than laparoscopic surgery, in terms of minimizing the risk of complications following partial nephrectomy.

For almost 20 years (1999–2017), the National Institute for Health and Care Excellence (NICE) focused primarily on cost utility analyses (CUA) for its health technology appraisals. This changed on the 01 April 2017, when a new fast track appraisal process was introduced for technologies that offer exceptional value for money. Under this process, a cost-comparison analysis can be included for technologies that are likely to provide similar or greater health benefits at a similar or lower cost to comparator technologies already recommended by NICE. This is in contrast to other jurisdictions (e.g. Scotland and Australia) that have long accepted cost-comparison analyses such as cost-minimization analyses (CMA) when a technology has comparable efficacy to relevant comparators. This research aimed to investigate if this new approach will have an impact on future appraisals

Publically available technology appraisal documents from NICE, Scottish Medicines Consortium (SMC), and Pharmaceutical Benefits Advisory Committee (PBAC) were screened (01/01/2016-01/12/2016), and the supportive economic analyses were identified and extracted.

In 2016, the proportion of CMA submissions that formed the basis of technology appraisals were 0/53 (0 percent), 17/55 (31 percent) and 25/82 (30 percent) for NICE, SMC and PBAC, respectively. The likelihood that a technology was recommended (with or without restrictions) for those technologies that were assessed using a CUA was 60 percent, 66 percent and 33 percent for NICE, SMC and PBAC, respectively, while technologies that were assessed using a CMA were associated with higher positive recommendation rates: 76 percent and 76 percent for SMC and PBAC, respectively.

Incorporating a cost-minimization approach may result in more technologies being recommended by NICE through the fast track appraisal process, whereby the likelihood of a technology having a positive recommendation is much greater than the standard appraisal process.

RedETS, created in 2006, is the Spanish network of health technology assessment agencies. The objective of this work is to describe and assess the quality of the full economic evaluation reports on medical devices (FEEMD) carried out by RedETS.

The FEEMD were identified through the RedETS website publications database. Assessments about screening technologies were not included. The characteristics of FEEMD were analyzed using a formal RedETS HTA quality checklist. The characteristics extracted were analyzed through a descriptive univariate analysis.

Results : Twenty-six FEEMD were found. The publication years were distributed quite uniformly over time (approximately 2/year), although 7 were published in 2008 and 7 in 2013. Thirteen studies analyzed cost-utility, ten cost-effectiveness but not utility, and three both. The most frequent medical devices (MD) class analyzed were “In vitro diagnosis MD” (n = 8) and Class III products (8). The most frequent sources to analyze effectiveness were literature (22) and data collected through ad hoc studies (6). The main sources of unit costs were official public tariffs (14), manufacturers direct values (10) analytical accounting of one/more centers or regions (11) and DRGs (7). In relation to the modelling used, 14 evaluations performed Markov models and 7 decision trees. The perspective of 23 studies was that of the National Health System (NHS), and the rest corresponded to the perspective of a specific region (2) or social perspective (1). All studies analyzing time horizons greater than 1.5 years, except for 1, applied discount rates in the modelling. All studies included a sensitivity analysis.

The economic evaluations of MD published by the RedETS accomplish most of the quality checklist aspects and are therefore exhaustive. These FEEMD have been used in the framework of decision making for an efficient management of the NHS basic portfolio.

Total hip and knee arthroplasty (THKA) patients are at risk of venous thromboembolism (VTE). Guidelines recommend 10–35 days of pharmacoprophylaxis, but this may induce bleeding resulting in increased healthcare costs. This study assessed whether using intermittent pneumatic compression (IPC) for VTE prophylaxis is associated with reduced healthcare costs compared to anticoagulants.

Studies related to VTE and prophylaxis in THKA were identified by a structured search of the PubMed database. VTE incidence and cost data were Australia specific or, if not available, taken from other developed healthcare systems. A Markov model was used to estimate the incidence of deep vein thrombosis (DVT), pulmonary embolism (PE), death, post-thrombotic syndrome, as well as minor and major bleeding and heparin-induced-thrombocytopenia, to assess the budget impact of different VTE prophylaxis strategies. The time horizon was one year, low-molecular-weight-heparin (LMWH) was used as the reference intervention, and effectiveness data were obtained from meta-analyses.

A total of 102,459 THKA were performed in Australia in 2015. The twelve-day incidence of DVT and PE using LMWH prophylaxis were 4.48 percent and 0.25 percent, respectively, with minor and major bleeding occurred in 9.9 percent (within twelve days) and 1.9 percent (within 10 days) of the patients, respectively. The incidence of VTE was not different between LMWH and IPC after THKA. The model estimated that the total cost of post-operative care for THKA was AUD 101.7 million (USD 77 million) in 2015. A one percent-point change from LMWH to IPC prophylaxis (n=1025 patients) would reduce the total healthcare costs by AUD 317,361 (USD 240,274) per year (or AUD 310 (USD 235) per patient), primarily through reduced bleeding events (-72 minor and -3 major bleeds). Sensitivity analysis including 500 simulations demonstrated a likelihood of 100 percent for IPC to reduce both costs and bleeding events compared to LMWH. Similarly, a one percent-point change from dabigatran and rivaroxaban to IPC also resulted in total healthcare savings of AUD 320,580 (USD 242,711) and AUD 702,584 (USD 531,926) per year, respectively, with two-thirds and ninety-nine percent of the simulations favored IPC over dabigatran for bleeding and cost savings, respectively.

Using IPC for VTE prophylaxis after THKA has the potential to substantially reduce total healthcare costs compared to anticoagulants, primarily through reduced bleeding events. IPC is suitable for all patients, but may be particularly cost-effective in the immediate postoperative period or in patients at high-risk of bleeding.

Schizophrenia is a chronic debilitating condition characterized by disorders in thought, affect and behavior. The worldwide prevalence is around 0.3 to 1 percent. The pharmacological treatment is based on antipsychotic drugs, but their efficacy is limited, culminating in discontinuation of treatment, relapses, and readmissions to health services. Quetiapine was initially approved for use in the United States of America in 1997. The drug has moderate affinity for D2 and 5-HT2A receptors and high affinity for H1 receptors. This study aimed to conduct an assessment of the cost-utility of quetiapine for schizophrenia around the world.

Cost-utility studies of head-to-head comparisons of quetiapine against other antipsychotic drugs for the treatment of patients with schizophrenia and related disorders were included, irrespective of the diagnostic criteria used. An electronic search on Medline, Lilacs, Center for Reviews and Dissemination, The Cochrane Library and PsycINFO was conducted and complemented by references of included studies, Google Scholar and conference abstracts. Monetary values were converted to PPP-USD for the same base-year of the study.

Six economic evaluations were included, representing four countries and a multicentric analysis. Comparisons between quetiapine and twelve other antipsychotic drugs were identified. Three studies found quetiapine to be dominated by risperidone and the remaining three found it to be more expensive and more effective with incremental cost-effectiveness ratio (ICER) values of USD 36,535, 8,786 and USD 127,600 per quality-adjusted life-year (QALY). Three studies found quetiapine, in comparison to olanzapine, to be inferior, one found it to be superior and two studies found it to be more expensive and more effective with ICER values of USD 139,699 and USD 224,000 per QALY. The reports were considered to be of reasonable quality. Yet the mixture of contexts might influence the results.

In general, there seems to be a trend favoring olanzapine and risperidone over quetiapine. None of the studies favored quetiapine over all the other drugs.

Since 2011, the process of incorporation of technologies into the Brazilian public health system (SUS) has been assisted by the National Commission for the Incorporation of Technologies in SUS (Conitec). The present work collected data of effectiveness, safety, cost-effectiveness, budget impact and other criteria from Conitec's reports to determine the influence of economic evaluations on issued recommendations.

Data was collected from drug recommendation reports published by Conitec between 2012 and 2016 and organized in a Microsoft Excel® spreadsheet. The association of the incremental cost-effectiveness ratio (ICER) and the chance of incorporation was assessed through a binary logistic regression in R®.

Two hundred and sixty-six reports were issued by Conitec between 2012 and 2016. Data were collected from 169 reports evaluating requisitions of incorporation of new medicines. Of these, there were ninety-nine which recommended the incorporation. The most common ATC classes analyzed were immunosuppressants (34 drugs), other antineoplastic agents (16 drugs) and direct-acting antivirals (15 drugs). Of the seventy negative recommendations, thirty-five were due to cost-effectiveness, thirty-one due to efficacy, twenty-nine due to safety, forty due to the budget impact, and thirty-two due to other reasons. In general, the reports were considered to be of poor quality. Only 21.9 percent of the reports had ICERs. The binary logistic regression analysis did not present a statistically significant difference for the influence of the ICER on the recommendation decision with outcomes reported in life years gained (OR = 0.9999732; 95% Confidence Interval [CI] = 0.9999304 to 1.000016) or quality-adjusted life years (OR = 0.9999789; 95% CI = 0.9999321 to 1.000026).

Economic evaluations appear to be a secondary criterion for Conitec's recommendations. Despite this, they are commonly used to justify non-incorporation of drugs into the public system.

Maintaining people's ability to work is a priority in many European countries. Through healthier and more motivated employees, companies should benefit from lower absenteeism and increased productivity. The public sector expects savings in health care costs, an increase in the employment rate and avoidance of early retirement. Employees benefit from improving their health and well-being. The aim of the study is to investigate whether there is empirical economic evidence for the benefit of workplace health promotion.

Systematic literature search in electronic databases and handsearch for systematic reviews, meta-analyses and economic studies with predefined inclusion and exclusion criteria.

Literature search provided two meta-analyses (with 84 primary studies), three systematic reviews (with 36 primary studies) and one model calculation (with 6 primary studies). There are relatively few empirical studies available to prove the economic benefit, often with inadequate methodological quality. Most of them are conducted in the United States of America. Only a few are from Europe, and those are mainly from Scandinavia. The available studies show a positive return on investment for companies however with a width range. Benefits for the health and social services have also been proven in a model calculation.

The positive results must be interpreted with caution. Firstly, there is a lack of good primary studies on the effectiveness of measures on which economic analyses could be based; secondly, the methodological quality and comparability of economic analyses can still be improved and thirdly, the transferability of the results is often limited due to differences in health care systems.

Pulmonary Hypertension is a silent disease and its diagnosis often occurs when it is already at an advanced stage. Pharmacological treatment of Pulmonary Arterial Hypertension (PAH) can be performed with: calcium channel blockers; phosphodiesterase-5 inhibitors; prostanoids; endothelin-receptor antagonists; and, soluble guanylate cyclase stimulators. The use of Riociguat was approved in Brazil by the National Sanitary Surveillance Agency on October 5, 2015 for use in patients with PAH. The objective was to perform a systematic review (SR) of the efficacy of pharmacological treatment of Pulmonary Arterial Hypertension comparing Riociguat with other available medications or with placebo.

Following the steps described in the PRISMA guideline, a search for randomized controlled clinical trials was conducted, in which Riociguat was used alone or in combination with other therapies, in databases MEDLINE, LILACS, Web of Science, Science Direct, Cochrane Library Wiley and in the gray literature (Google Scholar, Capes Bank of Theses and Clinical Trials). EndNote and Mendeley were used as reference managers. Outcomes analyzed were: death; six-minute walk distance (6MWD); World Health Organization (WHO) functional class (improvement, stabilization or worsening); hemodynamic variables (pulmonary vascular resistance, cardiac index and pulmonary-artery pressure); clinical worsening; hospitalization; and, quality of life.

Four hundred and sixty-seven articles were obtained which reduced to 379 after the duplicated articles were removed. After exclusion by title and abstract by two independent reviewers, forty-seven studies remained. Through the gray literature, six studies were obtained, resulting in fifty-three articles being retrieved for full-text review. Five studies were selected to compose the SR. Compared with placebo, Riociguat showed improvements in 6MWD, pulmonary vascular resistance, WHO functional class and time to clinical worsening. Efficacy was maintained after one year of use. Subgroup analysis was performed comparing of treatment-naive patients and patients on background PAH-targeted therapy.

This work may be used as a management and decision support tool, based on the same methodology of a Health Technology Assessment, and may contribute to quality decisions to be taken in relation to the incorporation of new technology.

Venoarterial extracorporeal life support (ECLS) is increasingly used in patients during cardiogenic shock, due to favorable results in this very high-risk scenario. However, it is a costly intervention that requires heavy financial investment and specialized human resources.

Cost-effectiveness analysis to evaluate ECLS in the perspective of the Brazilian public health system (SUS) in the population of adult patients with cardiogenic shock. A decision tree comparing ECLS and usual care was built, using efficacy data from a systematic review of literature, and cost data from SUS reimbursement values. Impact of parameter variability and uncertainty were ascertained with deterministic and probabilistic sensitivity analysis.

Usual care resulted in thirty percent probability of survival, at an average cost of 3,000 international dollars (Int$/USD); the strategy that includes ECLS resulted in sixty-two percent survival rate, and average cost of Int$ 23,000, with incremental cost-effectiveness ratio (ICER) of Int$ 62.215 per averted in-hospital death. Results were sensitive to device cost, and survival difference between strategies. In probabilistic sensitivity analysis, ECLS was consistently more costly and more effective than usual care; based on a willingness-to-pay of three times Brazilian gross domestic product (GDP) per capita (Int$ 45,000), there was twenty-seven percent probability of ECLS being cost-effective.

ECLS has the potential to increase survival for cardiogenic shock, but would significantly increase costs. In the Brazilian public health system, the cost per averted in-hospital death is 4.1 times the domestic GDP per capita.

Patient and social aspects form a key domain within health technology assessments (HTAs) but are less well established in rapid HTA. Patient aspects can add value to HTAs by aiding in interpretation of variations in intervention effectiveness or providing context on the impact of interventions on patients’ lives. This poster describes initial experience of incorporating patient aspects into a rapid HTA for the Scottish National Health Service.

A rapid review explored using qualitative literature to understand patient issues relating to transoral robotic surgery (TORS) for head and neck cancer. Literature searches identified qualitative studies or systematic reviews of qualitative studies using two search filters: one for patient perspectives and another for qualitative study designs.

No qualitative literature specific to the exact question posed in the HTA was identified. Instead the project focused on patient experiences of alternative treatments (radiotherapy or open surgery) and identifying patient-important outcomes, such as speech function or lack of facial disfigurement. Pragmatic decisions on study selection were required in the TORS review due to the large volume of literature identified: we only included the most recent studies and limited our selection to patients with specific forms of head and neck cancer. Selecting studies from a large volume of literature may be an issue for future rapid HTAs attempting to incorporate qualitative evidence. The qualitative studies were summarised and used to inform advice issued to NHSScotland by the Scottish Health Technologies Group (SHTG).

Patient aspects can be incorporated into rapid HTAs using systematic and pragmatic approaches to identifying and summarizing qualitative literature. Future rapid HTAs by SHTG may include syntheses of qualitative studies rather than summaries. Patient submissions are also being piloted as a method of collating patient experiences.

China has the largest obese population in the world and its prevalence is increasing faster and faster. The researchers are investigating the association between the socioeconomic status (SES) and obesity in several ways. However, SES may not only play a direct impact on obesity but influences health behaviors which, in turn, affect obesity. The mediating factors have rarely been studied. This study investigates the association between SES and obesity mediated by behavioral factors among adults in China.

The longitudinal data including 110,449 individuals were obtained from the eight waves of the China Health and Nutrition Survey from 1991–2011. The outcome of obesity was measured using Body Mass Index (BMI). The SES factors include education and income (low, medium and high). Mediating factors include alcohol consumption, smoking status, diet and physical activity. A variety of statistical models were used to investigate the association between SES and obesity. Age/gender-adjusted prevalence of obesity was calculated and multiple-logistic regression was used.

To some extent, SES influenced BMI directly, positively in men and inversely in women, respectively. SES may also operate through behavioral factors. These associations were not always straightforward, and changes in SES might create some offsetting risks. Behavioral factors including alcohol consumption, smoking status, diet and physical activity were associated with SES indicators in all groups. In addition, the prevalence was higher in urban areas than rural areas in China. Several pathways for different SES groups leading to obesity were simulated.

Higher SES groups are more likely to have higher BMI compared to lower SES groups. Different SES groups have different significant mediating risk factors. The pathways between SES and obesity are complex. This study suggests that it is necessary to apply different interventions to different SES individuals especially focused on the disadvantaged populations according to their different behaviors and preference.

The Canadian Agency for Drugs and Technologies in Health (CADTH) Common Drug Review and pan-Canadian Oncology Drug Review programs incorporate perspectives and experiences from patients and family members who might be affected by the resulting funding recommendation. Perspectives are provided by patient groups who use different approaches to gather patient input.

We analyzed a random sample of ninety-three patient input submissions, drawn from a sampling frame of 532 submissions given to CADTH between June 2010 and June 2016. We looked at how groups described their information gathering methods in the original submissions or the published Clinical Guidance Reports.

Approaches were categorized according to whether they involved primary (n = 86) or secondary data collection (n = 130) and further sub categorized according to how data was collected. Primary data included: personal experiences, as described by the submission's author (n = 16); surveys conducted specifically for the submission (n=34); and new interviews of patients and family members on disease and drug experiences (n = 36). Half (forty-seven of ninety-three) of the patient input submissions included experiences of one or more patients who had received the drug under review. Secondary data included: published literature (n = 31); existing surveys (n = 27); past conversations with patients and family members (n = 36); experiences of patient group staff interacting with patients and family members (n = 19); and advice from clinical experts (n = 17). Many patient input submissions (sixty-eight out of ninety-three) reported multiple approaches to collect data. Use of two approaches was most common (thirty-seven out of ninety-three) with five or six approaches used in three of ninety-three submissions.

Despite resource and timing challenges, many patient groups gather primary data to share with CADTH and find individuals with experience of the drug under review.

Principal component analysis (PCA) is important to summarize data or reduce dimensionality. However, one disadvantage of using PCA is the interpretability of the principal components (PCs), especially in a high-dimensional database. This study aims to analyze the patterns of variance accumulation according to PCA loadings and to approximate PCs with input variables from sample data sets.

There were three data sets of various sizes used to understand the performance of PC approximation: Hitters; SF-12v2 subset of the 2004 to 2011 Medical Expenditure Panel Survey (MEPS); and, the full set of 1996 to 2011 MEPS data. The variables in three data sets were first centered and scaled before PCA. PCs approximation was studied with two approaches. First, the PC loadings were squared to estimate the variance contribution by variables to PCs. The other method was to use forward-stepwise regression to approximate PCs with all input variables.

The first few PCs represented large portions of total variances in each data set. Approximating PCs using stepwise regression could more efficiently identify the input variables that explain large portions of PC variances than approximating according to PCA loadings in three data sets. It required few numbers of variables to explain more than eighty percent of the PC variances.

Approximating and interpreting PCs with stepwise regression is highly feasible. Approximating PCs can help i) interpret PCs with input variables, ii) understand the major sources of variances in data sets, iii) select unique sources of information and iv) search and rank input variables according to the proportions of PC variance explained. This is an approach to systematically understand databases and search for variables that are highly representative of databases.

Principal component analysis (PCA) is used for dimension reduction and data summary. However, principal components (PCs) cannot be easily interpreted. To interpret PCs, this study compares two methods to approximate PCs. One uses the PCA loadings to understand how input variables are projected to PCs. The other uses forward-stepwise regression to determine the proportions of PC variances explained by input variables.

Two data sets derived from the Canadian Health Measures Survey (CHMS) were used to test the concept of PC approximation: a spirometry subset with the measures from the first trial of spirometry; and, full data set that contained representative variables. Variables were centered and scaled. PCA were conducted with 282 and twenty-three variables respectively. PCs were approximated with two methods.

The first PC (PC1) could explain 12.1 percent and 50.3 percent of total variances in respective data sets. The leading variables explained 89.6 percent and 79.0 percent of the variances of PC1 in respective data sets. It required one and two variables to explain more than 80 percent of the variances of PC1, respectively. Measures related to physical development were the leading variables to approximate PC1 and lung function variables were leading to approximate PC2 in the full data set. The leading variable to approximate PC1 of the spirometry subset were forced expiratory volume (FEV) 0.5/forced vital capacity (FVC) (percent) and FEV1/FVC (percent).

Approximating PCs with input variables were highly feasible and helpful for the interpretation of PCs, especially for the first PCs. This method is also useful to identify major or unique sources of variances in data sets. The variables related to physical development are the variables related to the most variations in the full data set. The leading variable in the spirometry subset, FEV0.5/FVC (percent), is not well studied for its application in clinical use.

Equity is the core of primary care. The issue of equity in health has become urgent and China has attached increasing attention to it. With rapid economic development and great change of the policy on medical insurance, the pattern of equity in health has changed a lot. Reform of healthcare in Zhejiang province is at the forefront of China; studies on Zhejiang are of great significance to the whole country. This paper aims to measure the equity in health from the perspectives of health needs and health seeking behavior, and provides suggestions for decision making.

A household survey was conducted in August 2016. A sample of 1000 households, 2807 individuals in Zhejiang was obtained with the multi-stage stratified cluster sampling method. Descriptive analysis and Chi-square test were adopted in the analysis. The value of concentration index was used to measure the equity.

This study finds that the poor have more urgent health needs and poorer health situation compared with the rich. The utilization of outpatient services was almost equal, whilst the utilization of hospitalization was pro-rich (the rich use more).Individuals with employer-based medical insurance use more outpatient services than those with rural and urban medical insurance. Compared to the rich, there were more people in the poorer income groups who didn't use inpatient services due to financial difficulties.

The issue of equity in health has attracted broad attention in the world, and China is no exception. We measured and analyzed the equity of health needs and absent rate of health services. We find that the poor have more urgent health needs and high absent rate of inpatient services compared with the rich. Income level and medical insurance may well explain the equity of outpatient and inequity of hospitalization. In view of the pro-rich inequity of hospitalization, more financial protection should be provided for the poor.

Stereo-electroencephalography (SEEG) has been shown to be a valuable tool for the anatomo-electroclinic definition of the epileptogenic zone (EZ) in some patients with medically refractory epilepsy considered for surgery. In Spain, many of those patients are not offered this diagnostic procedure. The objective of our health technology assessment (HTA) report was to evaluate the effectiveness, safety and cost-effectiveness of SEEG to define the EZ in patients with refractory epilepsy considered for surgery compared to no SEEG intervention (i.e. remaining with further antiepileptic drugs).

We undertook a systematic review with meta-analyses on the effectiveness and safety of SEEG. A cost-effectiveness analysis was conducted using a Markov model which simulates the costs and health outcomes of individuals for a lifetime horizon from the perspective of the Spanish National Health Service (NHS). The effectiveness measure was quality-adjusted life years (QALYs). We ran extensive sensitivity analyses, including a probabilistic sensitivity analysis.

The EZ was found in 92 percent of patients who underwent SEEG, 72 percent were eligible for epilepsy surgery and 33 percent were free of seizures after surgery (47 percent of those who received surgery). Any complications related to insertion and monitoring of SEEG and the subsequent intervention occurred in 1.3 percent of patients. In the base case analysis, SEEG led to higher QALYs and healthcare costs with an estimated incremental cost-effectiveness ratio of EUR 10,368 (USD 12,217) per QALY. The sensitivity analyses showed that the results of the study were robust.

SEEG is a cost-effective technology in patients with refractory epilepsy considered for surgery when compared to no SEEG intervention.

The therapy using molecular-targeted (MTT) and monoclonal antibodies (MA) are examples of new therapeutic technologies in search of greater clinical effectiveness and reduction of adverse effects in the fight against frequent diseases. Generally, new technologies have a high cost impact on the health system. The objective of this study was to evaluate the financial impact generated by the use of MTT and MA therapies in the teaching Hospital de Clínicas, Porto Alegre, Brazil.

The first 60 higher monetary spending drug items of the last 12 months were analyzed. From them, drugs which fit in the categories under study, and have been regularly used, were identified. The monthly expenditures with each item were tabulated and compared with the total expenditures on drugs, in order to calculate the budgetary impact. The major groups of diseases treated with each agent were analyzed.

Two MTT agents (gefitinib and infliximab) and three MAs (rituximab, basiliximab and abciximab) were identified. The highest expenditure items, respectively, per year, were the oncological medicines rituximab (USD127,890) and gefitinib (USD96,923), followed by the immunosuppressive basiliximab (USD88,998) and the immunomodulatory infliximab (USD68,642), and the platelet aggregation inhibitor abciximab (USD47,886). These values corresponding to, respectively, 1.1 percent, 0.8 percent, 0.8 percent, 0.6 percent and 0.4 percent of total drug expenditure per year (USD11,866,124). Trastuzumab, bortezomib and imatinib were often used, but directly supplied by the public system, in a way that didn't impact the hospital budgetary management.

MTT and MA have an important impact on health budgets, and are mainly used to treat some types of cancer, cardiovascular disease and autoimmune disorders. These aspects should be considered in the management of drugs in hospitals of high complexity.

Health Technology Assessment (HTA) is important to the rational decision in healthcare systems. In Brazil, HTA is carried out by the national commission for the incorporation of technologies in the public system (Conitec), which issues reports with recommendations. This work aims to describe these recommendations and the factors influencing them.

A descriptive analysis was conducted on Conitec's reports of incorporation of medicines between 2012 and 2016. The medicines were classified according to the Anatomical Therapeutic Chemical system (ATC).

One hundred and twenty-eight reports were assessed. Most requests were issued by the pharmaceutical industry (n=72; 47 percent), followed by the Ministry of Health (n=63; 41 percent). More reports issued by the Ministry of Health had positive recommendations compared to manufacturers (n=22 vs. n=50; χ2=30.231, df=1, p<0.001). Other antivirals were the most common class with requisitions (n=16), followed by TNF-α inhibitors (n=14) and selective immunosuppressants (n=12). Other antivirals had the most positive recommendations (n=12; 75 percent), followed by TNF-α inhibitors (n=7; 50 percent) and selective immunosuppressants (n=7; 58 percent). The difference was significant (χ2=88.65, df=63, p=0.02). TNF-α inhibitors was the class with the most negative recommendations (n=7; 50 percent), followed by monoclonal antibodies (n=6; 67 percent). Sixty-two reports contained economic assessments. Fifty-four presented incremental cost-effectiveness ratio (ICER) data and 57 presented the budget impact. Twenty-three reports showed data indicating dominance of the medicine, but only five of these were recommended for incorporation. Drugs for cancer have been recommended despite high ICER values. Decision makers accepted all the recommendations issued by Conitec.

Data suggest that the economic evaluation is secondary to the decision of incorporation. The pharmaceutical industry is the largest applicant for the incorporation of medicines, but these requests are significantly less accepted than those made by the Ministry of Health. Conitec's recommendations are well-accepted by policy-makers. It was not possible to determine an implicit cost-effectiveness threshold.

Death from congenital heart disease (CHD) can be avoided, contributing to reduced infant mortality. The objective of this study was to identify the profile of patients undergoing surgical correction for CHD in three São Paulo State hospitals, and to determine factors that contribute to morbidity and mortality.

The Voluntary Pediatric Cardiovascular Surgery Multicenter Registry (ASSIST) was created in 2014 through a Research Grant Program for the Public Healthcare System (Pesquisas para o Sistema Único de Saúde, PPSUS)* project, a federal-state joint strategic public policies research grant, coordinated by the Hospital das Clínicas of Faculdade de Medicina of Universidade de São Paulo (InCor-HCFMUSP-SP) and Ribeirão Preto's Hospital das Clínicas, both linked to the São Paulo University Medical School.

We analyzed 1,842 patients, with an average age of 1.2 (range 0.4–8.6) years, 50.9 percent were male. Procedural complexity was classified as “Risk Adjustment in Congenital Heart Surgery” version 1 score, RACHS-1: 18.2 percent RACHS1, 25.5 percent RACHS2, 41.2 percent RACHS3, 9.6 percent RACHS4 and 5.4 percent RACHS5–6. Overall hospital mortality was 12.2 percent, and preoperative risk factors included: age <30 days (Odds Ratio, OR = 1.7 p = 0.012), prolonged ICU admission (OR = 3.3 p = 0.001). Other significant factors were RACHS score >4 (OR = 5.3 p < 0.001), heart dysfunction (OR = 3.4 p = 0.001), sepsis (OR = 3 p = 0.001), hemodynamic or surgical re-intervention required (OR = 6.2 p < 0.001), cardiorespiratory arrest (CPR, OR = 24.9 p < 0.001) and renal failure (OR = 5.4 p<0.001). The frequency of related morbidity was 16.2 heart failure, 7.1 percent arrythmia, 5.9 percent pneumonia, 5.9 percent pneumotórax, 4.2 percent pleural and pericardial effusion, 10 percent mechanical ventiation > 7 days, 13.2 percent late sternal closure, 2.8 percent had wound infection, 3.7 percent neurological alterations, 2.3 percent diaphragmatic dysfunction, 11.5 percent CPR, 3.2 percent renal failure, 4.5 percent sepsis, 55.1 percent length of hospital stay longer than 5 days with 45.8 percent postoperative hospital admission longer than 15 days and 6.1 percent needed surgical or hemodynamic re-intervention.

The information collected in the ASSIST registry was of great importance in the São Paulo State CHD surgical practice evaluation. Morbi-mortality related factors elicited critical points and allowed improvement actions. Excluding age and intrinsic procedure complexity, identified outcome modifier factors can be manageable, aiming to increase patient safety and program resolubility or performance.

In 2016, Global Burden of Disease (GBD) data was used to identify the top twenty percent of disease causes in the Philippines, which happened to account for eighty percent of the burden, following the Pareto principle. This study follows from that initial work, aimed at creating a list of cost-effective interventions recommended for priority-setting to achieve universal health coverage (UHC).

A comprehensive literature review search was done, from global sources such as the Disease Control Priorities (DCP) for Developing Countries Project and World Health Organization's (WHO) Choosing Interventions that are Cost-Effective (CHOICE), and local sources such as clinical practice guidelines (CPGs). Forty-seven local experts from thirty-eight medical societies were also consulted on the applicability, appropriateness, adaptability, feasibility of implementation, ability to maintain fidelity, ease of dissemination, and sustainability of selected interventions in the Philippine setting. Resource requirements were then derived using the WHO OneHealth Tool, CPGs, and key informant interviews.

A list of 745 interventions categorized by life stages and by level of intervention with estimates of cost-effectiveness was produced. From these, fifty seven percent had cost-effectiveness studies. Primary interventions were found to be the least costly for the pregnant women, newborn, infant, adolescents, adults, and elderly life stages, while tertiary interventions were found to be the least costly for children.

The interventions are potential targets for inclusion by policymakers. Additional factors to consider include the appropriateness of the context in which the cost-effectiveness study was conducted, the feasibility of conducting primary HTA locally, the local costs of the intervention, and the need to act quickly before the policy window closes.