Over the past few years, there has been an increasing recognition of the value of public involvement in health technology assessment (HTA) to ensure the legitimacy and fairness of public funding decisions [Street J, Stafinski T, Lopes E, Menon D. Defining the role of the public in Health Technology Assessment (HTA) and HTA-informed decision-making processes. Int J Technol Assess Health Care. 2020;36:87–95]. However, important challenges remain, in particular, how to reorient HTA to reflect public priorities. In a recent international survey of thirty HTA agencies conducted by the International Network of Agencies for HTA (INAHTA), public engagement in HTA was listed as one of the “Top 10” challenges for HTA agencies [O'Rourke B, Werko SS, Merlin T, Huang LY, Schuller T. The “Top 10” challenges for health technology assessment: INAHTA viewpoint. Int J Technol Assess. 2020;36:1–4].

Historically, Australia has been at the forefront of the application of HTA for assessing the effectiveness and cost-effectiveness of new health technologies to inform public funding decisions. However, current HTA processes in Australia lack meaningful public inputs. Using Australia as an example, we describe this important limitation and discuss the potential impact of this gap on the health system and future directions.

Malaria is a major public health problem in Burkina Faso. Statistics from health facilities in 2006 show that 40.1 percent of medical consultations, 53.4 percent of hospital admissions, and 45.8 percent of deaths are malaria related (2). Malaria among children under 5 years of age accounted for 46 percent of all cases in 2004, 49 percent in 2005 and 48 percent in 2006. In the same age group, malaria was the cause of 66.4 percent of deaths in 2004, 62.0 percent in 2005 and 62.7 percent in 2006.

The HTA Core Model (HTACM) of EUnetHTA and the INTEGRATE-HTA Model (IHTAM) both provide HTA experts with advanced guidance on how to assess health technologies. In this study, we examine the similarities and differences of the two models, identifying synergies and opportunities for future collaboration. We also consider how such an alignment of the HTACM and IHTAM might be done in practice and present some alternative practical approaches. Overall the two models share several similarities, primarily the perception of HTA as a multidisciplinary analysis that needs to be adjusted according to the properties of the technology under assessment.

This article first examines data bases available to assess the risk of vaccine-preventable diseases (VPD). In the second part, immunization recommendations and practices are briefly evaluated in view of the risk of exposure to VPD and of the efficacy and safety of available vaccines.

Objectives: The aim of this study was to assess the evidence of diagnostic accuracy of the wireless capsule for endoscopy (WCE) for the diagnosis of obscure gastrointestinal bleeding (OGIB) and small bowel disease in adults and translate it to the context of the Italian National Health Service.

Methods: We performed a systematic review of secondary and primary literature. We reviewed WCE diagnostic accuracy, safety, economic evaluations for OGIB. Context-specific data about WCE diffusion, costs, appropriateness of WCE use were collected by means of a national survey involving all Italian gastroenterological departments.

Results: We updated the systematic review of the most recent health technology assessment report (2006). Our review shows lack of robust comparative evidence of diagnostic accuracy of WCE. The studies' design do not allow collection of reliable evidence due to the uncertainty surrounding morphological variability of bleeding vascular gut lesions. The national survey reported widespread WCE use and data on appropriateness and costs.

Conclusions: Evidence of WCE diagnostic accuracy is of low quality, and there is a requirement for randomized comparisons. Our findings raise the issue of technology governance and show the importance of an assessment before the technology being widely commercialized.

KDTD (Turkish Evidence-Based Medicine Association) hosted a conference on the subject of health technology assessment (HTA)-emerging countries in Ankara, Turkey on March 4–6, 2009.

Since 1982, the Medical Research Council of the Academy of Finland, together with other interested parties, has tried to develop systematically the evaluation research of medical technology. The broadly based working group set up by the Council is preparing a program dealing with this issue to promote research work and the training of researchers. The arrangement of consensus development conferences, held on various topics in many countries, is another means of reaching these goals. In Finland, the arrangement of such conferences has been the responsibility of the Medical Research Council.

Policy makers in the United States have increasingly recognized the deficiencies in information related to technology assessment and quality assessment. This growing consensus resulted in the passage of legislation in 1989 to create a new Agency for Health Care Policy and Research and to expand substantially funding for assessment activities.

The first consideration must be an agreed-upon definition of asphyxia. We cannot determine outcome of a condition if some observers are referring to apples and others to pears. Asphyxia is a pathophysiological event comprising both hypoperfusion and hypoxia, and these events result in compromise at a cellular level with the production of metabolic acids. This can be due to a wide number of insults, but a complication of the birth process is the most important cause. Asphyxia is not like intraventricular hemorrhage (IVH) or periventricular leukomalacia (PVL), as these are conditions that can be diagnosed with a reasonable degree of precision with imaging techniques.

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.

The majority of technologies in use in perinatal care were organized into 45 technological functions. Forty-six experts from 19 different regions of Brazil and other Latin American countries then selected a “basic package” (BP) of 15 technological functions. Considering the 12 main causes of perinatal mortality in Brazil, the experts estimated the number of preventable deaths, assuming universal coverage by the BP and the additional reductions that could be obtained by gradually adding other technological functions to the BP. A simulation was performed for the 26 states of Brazil to identify regional priorities for the diffusion of technological functions. For most regions, the BP appears to be the most effective intervention, with the potential of reducing perinatal mortality by 33%, followed by “coordination of services and referral of pregnant women” (14%), and “treatment of respiratory conditions” (11.8%).

The development and assessment, over a 10-year period, of a technology for group treatment of patients with chronic pain and anxiety is described. Positive results, such as a decrease of symptoms and improved self-confidence, have stimulated diffusion of the technology to colleagues and have increased our own involvement in the organization of services.

Objectives: Information on the impact of computed tomography coronary angiography (CTCA) on patterns of care is scarce. In particular, it is not clear if, and to what extent, its adoption actually leads to a reduction in the use of other diagnostics tools. The aim of this study was to evaluate whether the adoption of CTCA in Emilia-Romagna (an Italian region with a population of 4.4 million) had any effect on utilization rates of myocardial perfusion scintigraphy (MPS) and coronary angiography (CA).

Methods: Interrupted time series (ITS) were applied to monthly volumes of MPS and CA tests performed from 2003 to 2010, to assess trends in usage rates for those procedures before and after CTCA was adopted by all the healthcare organizations operating in the region.

Results: After an increase in the first year of CTCA introduction, its use remained stable over the study period. After September 2006, a significant decrease in MPS volumes (31 percent; p < .0001) and a much less tangible decrease in CA volumes (5 percent; p < .0001), were detected by ITS analyses.

Conclusions: This study demonstrates that the use of CTCA had a greater impact on MPS usage rates than on CA.

We analyzed the cost-effectiveness of nonemergent treatment for esophageal varices commonly used in Japan (endoscopic injection sclerotherapy, nonshunting direct interruption procedure, and selective shunt). We assessed the cost per survivor from the perspective of the Japanese government and other payors. Epidemiologic and economic data from published Japanese literature and from Japanese hospital-cost information were applied in decision analysis. While sclerotherapy is the most cost-effective treatment, the popular surgical procedures save the most lives, thus raising difficult ethical issues regarding trade-offs of cost and quality.

Cochlear prostheses are beginning to be implanted regularly to restore hearing in profoundly deaf patients, but there is little agreement on the relative merits of the many different designs and rehabilitative procedures. We report on the responses to a technology assessment questionnaire that was sent to 120 researchers and clinicians worldwide who have been at the forefront of research in this field.

The author examines the Australian health care system by surveying the financing techniques, physical organization, and government activity. He explains the impact of the public and private sectors and comments on the effectiveness of current evaluation procedures. While the author believes that the system is relatively healthy and cost effective, he recognizes a need for more comprehensive and scientific oversight. Using regression analysis and focusing on the installation of medical technology in hospitals, the author attempts to determine the specific factors that influence technology diffusion. He concludes by stressing that further studies analyzing the actual use of specific technologies are vital.

Objectives: The aim of this prospective study was to perform a cost and outcome comparison between two alternative operative techniques (osteosynthesis and hemiarthroplasty) used in the treatment of elderly patients with unstable trochanteric hip fracture.

Materials and Methods: One hundred seventy-three trochanteric hip fracture patients were followed-up for 1 year after surgery. For each operative technique, hospital treatment's cost per patient was computed. Mortality and complication rate in-hospital and at specific time points after surgery were used as outcome measures. Patients' functional level before and after hip fracture was estimated according to their mobility and ability to perform basic and instrumental activities of daily living.

Results: The cost for patients undergoing osteosynthesis reached €1,931 per case, whereas for those treated with hemiarthroplasty reached €3,719 per case (2001 rates). There was no statistically significant difference regarding in-hospital mortality and complication rate, as well as mortality and complication rate 1 year after surgery, between the two patient groups.

Conclusions: The quite similar performance of the two operative techniques suggests that cost could be the key factor for choosing between them. However, it is critical that many more randomized studies, with larger sample sizes and wider follow-up time periods should be conducted.

Surfactant deficiency has come to be understood as equivalent clinically to lung immaturity, except in situations of extreme prematurity or lung hypoplasia. Thus, surfactant deficiency and the diagnosis respiratory distress syndrome (RDS) have been applied quite uniformly to preterm infants with respiratory distress who have no other identifiable problems. While the diagnosis can be made more specific by assay of surfactant phospholipid composition (12), such measurements are seldom made in clinical practice. Perinatal discussions of the premature with respiratory distress also have been focused toward surfactant by the availability of multiple tests of “lung maturation” based on the assay of surfactant components in amniotic fluid (19). While surfactant is necessary for normal lung function, adequate surfactant is not sufficient to assure normal gas exchange in the preterm. There are no simple ways to separate surfactant deficiency states clearly from other aspects of lung development, such as airway development, alveolarization, and the development of the pulmonary vasculature in the preterm infant. The anatomic data of Hislop et al. (13) and Langston et al. (22) indicate a considerable variability in the number of alveoli in the preterm infant at each gestational age, resulting in large differences in potential gas exchange surfaces in different infants. Airway development also differs between infants of comparable gestational ages, as is evident clinically by susceptibility to the development of pulmonary interstitial emphysema. Assuming that surfactant treatments for RDS fully correct the surfactant deficiency, a realistic expectation based on animal studies (16), surfactant treatments should be useful in the near future to eliminate the surfactant deficiency component of lung immaturity syndromes. Any residual lung disease can then be better characterized.