Health technology assessment (HTA) is becoming more and more popular recently. For populations in China that share at least half of the global disease burden of liver cancer, it is extremely vital to give rise to an efficient secondary prevention strategy. The China central government launched liver cancer screening program in rural areas in 2005, and then extended to populations in urban in 2012. The studies of health technology assessment of liver cancer screening are based on available evidence, from an HTA perspective, aims to evaluate performance of liver screening, economic burden and cost-effectiveness and some other issues, in order to raise suggestions for possible directions in research and public health program related to liver cancer screening in China.
This paper used the application of health technology assessment (HTA) in medical insurance directory adjustment as an example, introduced NICE’s HTA in UK from seeking legislative support for HTA, established the system of HTA, improved the process of HTA and increasing awareness of using HTA among decision-maker, and provided suggestions for the development and advancement of HTA in China.
Objective To systematically review published methodological guidelines for health technology assessment (HTA) at home and abroad. Methods Common electronic databases, guideline databases, international networks of HTA agencies/organizations, representative national HTA networks and official websites of governmental health departments were extensively searched and screened to identify guidelines for conducting or reporting HTA from inception to April 24, 2023. Basic information on guidelines, HTA processes, assessment indicators, reporting checklists and other information was extracted, analyzed and described using a systematic review methodology. Results A total of 41 guidelines were included in this study, published from January 2002 to January 2023; the publishing institutions involved 23 countries/international organizations, and 6 languages; the assessments were mainly for all health technologies (n=23), pharmaceuticals (n=4), diagnostic/testing technologies (n=4), non-pharmaceutical health technologies (n=3), medical devices/equipment (n=3), hospital health technologies (n=2), medical and surgical interventions (n=1), and screening technologies (n=1); the assessment perspectives were mainly health system perspectives (n=16), societal perspectives (n=12), and hospital perspectives (n=3), while the rest did not provide information on the perspectives; 28 guidelines described the detailed HTA assessment process, involving 11 steps; there were 39 guidelines described the assessment domains and related assessment indicators in detail, ranging from 2 to 9 assessment domains and involving 10 first-level assessment indicators; a checklist for HTA reports listed in 10 guidelines, involving 18 report entries; 17 guidelines reported conflicts of interest, mostly no conflicts of interest (n=10), and 3 of the remaining 7 guidelines did not indicate a specific conflict of interest, while 4 guidelines in which possible sources of conflict of interest were indicated. Conclusion The development of HTA has formed a relatively perfect assessment system, but there is a need to unify the criteria for classification of health technologies and reporting checklist, improve the specificity indicators for different types of health technologies, and clarify the assessment perspectives. Combined with the current situation of HTA development in China, contextualized guidelines for HTA implementation and reporting should be formulated to provide scientific information and methodological basis for decision-making on rational allocation of health resources.
Objective To investigate the health technology assessment reports, analyze publication characteristics and report quality, and explore hot topics in health technology assessment. Methods Web of Science and CNKI databases were searched to collect complete health technology assessment reports from inception to January 2023. SPSS 26.0 software was used to analyze the publication journals, countries, number of authors, assessment types and assessment contents of the assessment reports. The report quality was assessed based on International Network of Agencies for Health Technology Assessment (INAHTA) report criteria (2007 edition). VOSviewer 1.6.11 was used to analyze keywords clustering. Results A total of 216 papers were included, with 158 published by Chinese authors, and a rapid growth trend in the number of reports over past four years. The rate of reports on health technology social adaptability assessment was only 17.13%. Among the Chinese reports, 25 were general health technology assessments, 35 were rapid assessments, and 3 were mini assessments. Among the English reports, 4 were rapid assessments, and 54 were regular healthcare technology assessments. For the 14 items in the INAHTA reporting criteria, the reporting rates were high for the brief summary (98.61%), problem description (94.91%), and results discussion entries (97.69%). However, the reporting rates were low for criteria such as personnel responsibilities, conflict of interest statements, and peer review statements, at 31.94%, 19.44%, and 3.24% respectively. English literature generally exhibited higher report quality. Conclusion In recent years, the volume of health technology assessment reports in China has been increasing, with developments in assessment types and application fields. However, there are also problems with standardization of reporting.
ObjectiveTo evaluate the efficacy, safety, and economics of omalizumab for the treatment of pediatric asthma through a rapid health technology assessment (HTA). MethodsThe search was conducted on INAHTA website and databases such as PubMed, Embase, Cochrane Library, SinoMed, CNKI, VIP, and WanFang Data from inception to August 2024. Literature screening, quality evaluation, and data extraction were conducted independently by two investigators. An interview was conducted to consult the medication and treatment opinions of doctors and patients to investigate its clinical application. ResultsA total of 28 articles, including HTA articles (4), SR/Meta analyses (18), and pharmacoeconomics articles (6) were included. Omalizumab could reduce the incidence of clinical exacerbations, decrease the number of asthma attacks/days with asthma symptoms, and improve the quality of life. The results of the safety evaluation showed that omalizumab could reduce the rate of serious adverse events, especially those related to worsening asthma. Foreign pharmacoeconomic studies showed ICER ranging from £30 109 to £78 009. A pharmacoeconomic study in China found an ICER of $211 217/QALY for omalizumab, which were both above the pre-set thresholds. ConclusionOmalizumab is a treatment for patients who suffer from moderate to severe persistent allergic asthma or moderate to severe allergic asthma. It has been found to improve disease symptoms without increasing serious adverse events. However, it is not considered cost-effective due to its high price.
ObjectiveCapsule endoscopy (CE) has been widely used in the diagnosis of small bowel disease (SBD) in the world. To bring CE into the national health insurance directory, and intensify its popularization in primary hospitals, the government needs high quality health technology assessment (HTA) evidence for decision making. This study was aimed to comprehensively evaluate the effectiveness, safety, applicability and economics of CE in the diagnosis of SBD based on global review, to providing the best currently-available evidence for decision making. MethodsWe electronically searched The Cochrane Library (Issue 8, September 2013), PubMed, EMbase, INAHTA, VIP, CBM, CNKI and WanFang Data. We screened studies, extracted data, and evaluated quality independently, according to inclusion and exclusion criteria; and then we made final conclusion after comprehensive analysis. ResultsWe finally included 4 HTAs, 11 systematic reviews (SRs)/ Meta-analyses, 2 randomized controlled trials (RCTs), 5 guidelines, and 10 economics studies for assessment. The results of HTAs, SRs/ meta-analyses and RCTs all showed that, the disease detection rate of CE was higher than that of many other traditional technologies, and that the main adverse event for CE was retention (0.7% to 3.0%), which were consistent with those of the guidelines' recommendations. Besides, the comprehensive results of economics studies showed the superiority of CE compared with other technologies. As the first choice, CE could significantly decrease potential costs, especially when used in outpatients. Conclusiona) Compared with similar technologies, CE indeed has advantages in diagnostic yield, safety and potential costs in the diagnosis of SBD. However, its application has certain limitations, which still needs to be verified by more high quality evidence about CE diagnosis accuracy. b) It is sug gested that, when the government approves the introduction of CE to hospitals, many factors must be considered, such as local disease burden, clinical demands, ability to pay, and staff configuration. At the same time, it is necessary to standardize training for medical technicians, to reduce economic loss caused by poor technical abilities of medicaltechnicians.
Objective According to health technology assessment (HTA) methodology, to assess the efficacy and safety of different doses of metoprolol in the treatment of atrial fibrillation (AF). Methods Based on the principles of HTA, we searched some important medical databases including MEDLINE, EMBASE, The Cochrane Library and CMCC, as well as several national special heart disease databases and side effect centers. We selected eligible studies based on the inclusion and exclusion criteria and critically assessed their quality. Results Intravenous metoprolol 10 mg - 15 mg could control rapid ventricular rate in patients with chronic AF. On either rest or exercise, oral metoprolol 150 mg/d had a better control of rapid ventricular rate than 50 mg/d in patients with chronic AF. For preventing postoperative AF (POAF), the intravenous metoprolol 20 mg group and the 30 mg group could decrease the incidence of POAF compared to the 10 mg group. Oral metoprolol 150 mg/d was more effective than 100 mg/d in preventing POAF. In addition, intravenous metoprolol therapy was well-tolerated and more effective than oral metoprolol therapy in preventing atrial fibrillation after cardiac surgery. Results from several national side effect centers demonstrated that the incidence of adverse reactions associated with metoprolol was low. Conclusion Present evidence showed that high dose of metoprolol was superior to low dose in treating AF, however, the evidence available is insufficient. It is suggested that adequate evidence through further studies are needed. The safety profile of different doses of metoprolol is similar.
Objective To assess the effectiveness and safety of nine lipid-lowing agents in the national essential drug list (2000) and provide evidence for the adjustment and selection of essential drugs. Methods Based on principles of health technology assessment (HTA) and evidence-based medicine, we searched for all published clinical studies about these drugs from the following databases: MEDLINE (1966-2002.8), The Cochrane Library, EMBASE (1974-2002), CBMdisk (1979-2002.8) and VIP (1989-2002.8), the database of National Center for Adverse Drug Reaction(ADR) Monitoring of China and the database of WHO Uppsala drug monitoring center. Included studies were appraised, analyzed and compared for the reduction of triglyceride (TC) or low density lipoprotein (LDL-C), the prevention for the coronary events and the incidence of ADR. Results The results from comparative trials for lipid-lowing agents showed that the equivalent dose of statins for 25% reduction of LDL-C was atorvastatin 10 mg/d, simvastatin 20 mg/d, pravastatin 40mg/d, lovastatin 40 mg/d, cerivastatin 0.3 mg/d and fluvastatin 80 mg/d. It was difficult to compare fenofibrate with gemfibrozil, acipimox with statins or fibrates based on available data. The study on the primary and secondary prevention of cardiovascular events showed that pravastatin and lovastatin were effective in primary prevention, and long-term use could reduce the incidence of cardiovascular disease.Gemfibrozil could reduce the mortality from coronary heart disease (CHD) but the overall mortality was not changed. Pravastatin, simvastatin, atorvastatin, fluvastatin, gemfibrozil and fenofibrate had a confirmed effect in secondary prevention. Data from large-scale clinical trials and the reports from ADR monitoring center of England, America, Canada and Australia suggested that the statins which had rare ADR were safe and tolerated. Rhabdomyolysis was rare but had a serious adverse reaction associated with statins. The rate of fatal rhabdomyolysis related to cerivastatin was the highest among 6 statins. The safety of simvastatin, lovastatin and atorvastatin was lower than cerivastatin but higher than simvastatin and atorvastatin. The number of ADR reports of fenofibrate was fewer than that of gemfibrozil. Conclusions At present, the best evidence focused on pravastatin, simvastatin and lovastatin are widely used and have a confirmed safety and efficacy. Atorvastatin, fluvastatin and fenofibrate still need more data to confirm their effects on coronary heart disease prevention. The drugs which were shown to be inferior or insufficient evidence are cerivastatin, gemfibrozil and acipimox.
Objectives To evaluate the effectiveness, safety, applicability and economy of psychological assessment instruments including checklists, questionnaires and scales used in population exposed to earthquake. MethodsWe searched PubMed, EMbase, The Cochrane Library, CBM, CNKI, VIP, WanFang Data, and CiNii databases, as well as special websites about earthquake and disaster management from inception to July 30th, 2014 to collect studies related to psychological assessment of population exposed to earthquake in the first month after quake. A descriptive analysis was conducted to analyze the positive detection rate of psychological problems, rate of informed consent, and effective response rate in population exposed to earthquake, as well as the cost of psychological assessment. ResultsA total of 67 studies were included which involved 4 instruments including Symptom Checklist 90 (SCL-90), Self-Reporting Questionnaire-20 (SRQ-20), Chinese Psychosomatic Health Scale-134 (CPSHS-134) and 12-item General Health Questionnaire (GHQ-12). SCL-90 was the most commonly used scale. Forty-five studies reported the positive detection rate of psychological problems in population exposed to earthquake. The positive detection rates by using SCL-90, GHQ-12 and SRQ-20 were 8.6% to 77.8%, 65.6% to 89.9% and 65.6% to 89.9%, respectively. Informed consent was reported in 27 studies, and effective response rate was reported in 20 studies with the highest one 99.56% for CPSHS-134. No study reported the cost of psychological assessment. ConclusionSCL-90, RQ-20, CPSHS-134 and GHQ-12 are mainly used instruments for assessing psychological problems in population exposed to earthquake in the first month after quake. The reporting of important information related to effectiveness, safety, applicability and economy of psychological assessment instruments is insufficient and not standardized. A concise and authoritative psychological assessment instrument for population exposed to earthquake is warranted.
ObjectivesTo explore the using status of psychological assessment instruments including checklists, questionnaires and scales after earthquake, so as to provide baseline data for establishing a standard method and process in developing earthquake-related population psychological screening and assessment instruments in future. MethodsWe searched WanFang Data, CNKI, VIP, PubMed, EMbase, The Cochrane Library and CiNii databases, as well as special websites about earthquake and disaster management from inception to July 30th, 2014 to collect studies evaluating the population psychological health conditions with assessment instruments after earthquakes. The earthquake countries/regions, the main assessment institutions, the time of assessment, the objects of assessment, and the instruments used were analyzed. ResultsA total of 794 studies were included, of which 87.4% were from mainland China, and 78.0% were related to the Wenchuan earthquake. Most of assessments were conducted by universities (47.9%) and hospitals (46.9%) in Sichuan, Beijing and Guangdong provinces of China. The psychological assessments conducted in the first year after quake were found in 537 studies (67.6%), of which 244 studies (45.4%) reported the psychological assessments results in the first month after quake. The top five assessment objects were children/teenagers, survivors, wounded, military rescuers, and medical staff. In the 794 included studies, a total of 217 instruments were used. In the 244 studies reported the assessment results in the first month after quake, a total of 73 instruments were used. 122 of the 244 studies reported only one instrument was used, and the other 122 of the 244 studies reported two or more instruments were used. Most of the instruments were translation versions and developed for mental disorders. The top 5 instruments were Symptom Checklist 90, Self-Rating Depression Scale, Self-Rating Anxiety Scale, PTSD Checklist-Civilian Version and Impact of Event Scale Revised, respectively. ConclusionAll the psychological assessment instruments are not developed for assessing earthquake-related psychological health problem, so a simple, economic, feasible and specialized instrument for earthquake-related population should be developed. It's needed to organize professionals to design a local guideline and training material for earthquake survivors and rescuers, and to establish a standardized, sustainable normal training base and trainer's team, so as to standardize the psychological aid work.