We are members of Students’ Education, Empowerment and Development in Mental Health, a group of medical students and psychiatrists from around the globe under the Psychiatry, Medicine and Primary Care Section of the World Psychiatric Association. In this article, we put forward recommendations to help improve the mental health response in disaster-prone regions such as Türkiye. We recommend a three-step multi-tiered mental health response system that could significantly help to address the immediate, short-term and long-term mental health needs of communities directly affected by a disaster. The recommendation draws from the relevant literature and, most importantly, from our lived experiences of living in earthquake-prone countries.

Objectives: Obsolescence is a natural phase of the lifecycle of health technologies. Given increasing cost of health expenditures worldwide, health organizations have little choice but to engage in health technology reassessment (HTR); a structured, evidence-based assessment of the medical, social, ethical, and economic effects of a technology, currently used within the healthcare system, to inform optimal use of that technology in comparison to its alternatives. This research was completed to identify and summarize international HTR initiatives for non-drug technologies.

Methods: A systematic review was performed using the terms disinvestment, obsolescence, obsolete technology, ineffective, reassessment, reinvestment, reallocation, program budgeting, and marginal analysis to search PubMED, MEDLINE, EMBASE, and CINAHL until November 2011. Websites of organizations listed as members of INAHTA and HTAi were hand-searched for gray literature. Documents were excluded if they were unavailable in English, if the title/abstract was irrelevant to HTR, and/or if the document made no mention of current practices. All citations were screened in duplicate with disagreements resolved by consensus.

Results: Sixty full-text documents were reviewed and forty were included. One model for reassessment was identified; however, it has never been put into practice. Eight countries have some evidence of past or current work related to reassessment; seven have shown evidence of continued work in HTR. There is negligible focus on monitoring and implementation.

Conclusions: HTR is in its infancy. Although health technology reassessments are being conducted, there is no standardized approach. Future work should focus on developing and piloting a comprehensive methodology for completing HTR.

Objectives: The aim of this study was to describe generally the development and present situation with health technology assessment (HTA) in the United Kingdom.

Methods: The methods used are a review of important materials that have described the development process and present situation, supplemented by some personal experiences.

Results: The United Kingdom has been characterized historically as a country with a strong interest in evidence in health care, both clinical trials for efficacy and cost-effectiveness analyses. However, this evidence was not well-linked to the needs of the National Health Services (NHS) before formation of the NHS R&D Programme in 1991, The R&D Programme brought substantial resources into HTA and related activities, with the central aim of improving health care in Britain and increasing value for money. However, policy makers as well as staff of the R&D Programme were dissatisfied with the use of the HTA results in clinical and administrative practice. Therefore, the National Institute of Clinical Excellence (NICE) was formed in 1999. NICE issues guidance intended to influence practical decision making in health care at the national and local levels, based on efficacy information and, in some cases, economic analyses. NICE is now also seeking ways to maximize impacts on practice.

Conclusions: The UK experience shows that information on clinical and cost-effectiveness may not be enough to change practice, at least in the short-run. Still, one may conclude that the United Kingdom now has one of the few most important and influential HTA programs in the world.

Objective: The aim of this report was to describe the history of health technology assessment (HTA) in the Netherlands.

Methods: This article is a descriptive review from two people who have been very much involved in the events described and is based on review of relevant policy documents and Web sites.

Results: HTA has been progressively developed in the Netherlands since (at least) the early 1980s. Beginning in 1985, there were progressive attempts to expand and institutionalized HTA in the Netherlands healthcare system. These attempts were generally successful, but did not result in a national agency for HTA. An important development in HTA in the Netherlands was a special fund (Ontwikkelingsgeneeskunde) designed to support prospective HTAs with the main purpose of affecting insurance coverage decisions. The administration of this fund moved progressively to broaden the subjects chosen for analysis to include such subjects as chronic illness and disability. A more-or-less hidden conflict developed in the question of the leadership and orientation of this fund, with the result that it was largely moved to a more research-oriented and less policy-oriented site.

Conclusions: The situation today is that HTA is visible and is used by the government in policy decisions, especially in the areas of prevention and screening. In addition, HTA is influential in insurance coverage decision making, especially in the field of pharmaceuticals. The principles of HTA and evidence-based medicine are generally familiar to physicians and other clinicians, however, the influence of HTA on clinical and administrative decisions is less than in some other countries.

Objectives: The aim of this study was to discuss the development of health technology assessment (HTA) in the Philippines.

Methods: A new national health insurance program began to be implemented in the Philippines in 1995 after passage of the Health Insurance Act.

Results: The program is known as the Philippine Health Insurance Corporation (PhilHealth). HTA was introduced to the Philippines in 1998. PhilHealth began to develop an HTA program subsequently.

Conclusions: As a developing country struggling to provide comprehensive health care to all citizens, PhilHealth sees HTA as an essential part of assuring that only effective and cost-effective care is provided for the public sector.

Objectives: The aim of this study was to describe the developing health technology assessment (HTA) activities in Brazil, both historically and in the present day.

Methods: This report is a descriptive analysis based on personal experiences of the authors and on selected literature.

Results: Interest in HTA in Brazil began in the mid-1980s. Several seminars and consultations were held, often with invited foreign participants. A cadre of people with knowledge and expertise in HTA was gradually developed. In 2003, several policies were developed by the federal government of Brazil to encourage HTA and base clinical, management, and policy decisions on HTA. During the past 5 years, institutional development has been rapid in government, private companies (mainly prepaid health plans), academia, and research institutes. Further policy changes are needed to maximize the impact of these developments. Nevertheless, although the growing network of HTA programs will have a considerable impact on Brazilian health care, further institutional development could stimulate this change.

Conclusions: It would be desirable if the Federal Ministry of Health of Brazil were to proceed to develop a national agency for HTA.

This study summarizes the experience with health technology assessment (HTA) at the European level. Geographically, Europe includes approximately fifty countries with a total of approximately 730 million people. Politically, twenty-seven of these countries (500 million people) have come together in the European Union. The executive branch of the European Union is named the European Commission, which supports several activities, including research, all over Europe and in many other parts of the world. The European Commission has promoted HTA by several policy positions and has funded a series of projects aimed at strengthening HTA in Europe. Around fifteen of the European countries now have formal national programs on HTA and some also have regional public programs. All countries that are members of the European Union and do not have a national approach to HTA have an interest in becoming more involved. The HTA projects sponsored by the European Commission have focused on networking and collaboration among established agencies and institutions for HTA, however, also on capacity building, support, and facilitation in creating mechanisms for HTA in European countries that still do not have any program in the field.

The aim of the present study was to compare the factual results with the perception of results by the expert investigators involved in a major epidemiological study on risk factors for hip fracture, the Mediterranean Osteoporosis Study (MEDOS), and to do so before the actual results were known. A selection of 30 questions were used from the original MEDOS questionnaire to obtain estimates of selected key risk factors from the 14 participating experts. Ten investigators participated, six of whom filled out the questionnaire completely; these six questionnaires were used for the analysis. The population was estimated to be younger, to have better functional capacity, and to be more subjected to preventive activities than the actual survey data showed. Several methodological problems are explored.

Objectives: The aim of this study was to develop a methodology for calculating the need for positron emission tomography (PET) scanners in a country and illustrate this methodology for Belgium.

Methods: First, levels of evidence were assigned to PET in different indications according to a standard hierarchical classification system. The level reached depends on whether there is evidence on diagnostic accuracy, impact on diagnostic thinking, therapeutic impact, impact on patient outcomes, or cost-effectiveness. Second, the number of patients eligible for PET for each indication was derived from a registry of PET. Third, the number of PET scanners needed in Belgium was estimated for different baseline hypotheses about maximum annual capacity of a scanner and the minimally required level of evidence.

Results: The number of PET scanners needed crucially depends on the level of evidence considered acceptable for the implementation of PET: the higher the level of evidence required, the lower the number of PET scanners needed. Belgium needs at least three and at most ten PET scanners. This contrasts with the thirteen currently approved.

Conclusions: Scientific evidence and information on the eligible population for a specific procedure are crucial elements for policy makers who wish to make evidence-based decisions about programming and planning of heavy medical equipment.

Obesity is a serious public health problem that has important social, economic and health consequences. The prevalence of obesity is rising rapidly throughout the world in both rich and poor countries, and it affects all sections of society. There are several important reasons for addressing the prevention of obesity, rather than its treatment or management. The prevention of weight gain (or the reversal of small gains) and the maintenance of a healthy weight are likely to be easier, less expensive and potentially more effective than the treatment of obesity after it has fully developed. A structured planning framework for the identification of potential interventions for the promotion of healthy weight and the prevention of weight gain is clearly required. However, detailed reviews of the scientific literature have revealed that the body of research is too small to provide firm guidance on consistently-effective interventions for adults or children. Ultimately, a broader approach to evidence of effectiveness needs to be adopted. The present paper proposes a structured planning approach that utilises the portfolio model and allows the selection of interventions to be based on the best available evidence, while not excluding untried but promising strategies.