IMPACT OF HEALTH TECHNOLOGY ASSESSMENT REPORTS ON HOSPITAL DECISION MAKERS - 10-YEAR INSIGHT FROM A HOSPITAL UNIT IN SHERBROOKE, CANADA: IMPACT OF HEALTH TECHNOLOGY ASSESSMENT ON HOSPITAL DECISIONS.

OBJECTIVES: The overarching goal of this research was to (i) evaluate the impact of reports with recommendations provided by a hospital-based health technology assessment (HB-HTA) unit on the local hospital decision-making processes and implementation activities and (ii) identify the underlying factors of the nonimplementation of recommendations. METHODS: All reports produced by the HB-HTA unit between December 2003 and March 2013 were retrieved, and hospital decision makers who requested these reports were solicited for enrolment. Participants were interviewed using a mixed design survey. RESULTS: Twenty reports, associated with fifteen decision makers, fulfilled the study criteria. Nine decision makers accepted to participate, corresponding to thirteen reports and twenty-three recommendations. Of the twenty-three recommendations issued, 65 percent were implemented, 9 percent were accepted for implementation but not implemented, and 26 percent were declined. In terms of the utility of each report to guide decision makers, 92 percent of the reports were considered in the decision-making process; 85 percent had one or more recommendations adopted; and 77 percent had recommendations implemented. The most frequently mentioned reasons for nonimplementation were related to contextual factors (64 percent), production/diffusion process factors (14 percent), content/format factors (14 percent), or other factors (9 percent). Among the contextual factors, the complexity of the changes (i.e., administrative reasons), budget and resources constraints, failure to identify administrative responsibility to carry out the recommendation, and nonpriority status of the HTA recommendation, were provided. CONCLUSIONS: This study highlights that although HB-HTA reports are useful to hospital managers in their decision-making processes, certain barriers such as contextual factors need to be better addressed to improve HB-HTA efficiency and usefulness.

Is radiofrequency ablation of varicose veins a valuable option? A systematic review of the literature with a cost analysis.

BACKGROUND: Since the 1990s, new techniques for the treatment of varicose veins have emerged, including radiofrequency ablation (RFA) and laser treatment. We performed a study to compare the safety, efficacy and outcomes of RFA compared to those of open surgery and laser ablation for the treatment of varicose veins. We also carried out a cost analysis of RFA compared to open surgery to assess whether RFA could help free up operating room time by being performed in an outpatient context. METHODS: We conducted a systematic literature review (publication date May 2010-September 2013 for articles in English, January 1991-September 2013 for those in French). We used several checklists to measure the quality of the studies. We also collected data on costing. RESULTS: The literature search identified 924 publications, of which 38 were retained for analysis: 15 literature reviews, 1 good-practice guideline and 22 new primary studies. The overall level of evidence was low to moderate owing to the limited sample sizes, lack of information on patient characteristics and lack of standardization of the outcome measures. However, the results obtained are consistent from study to study. In the short and medium term, RFA is considered as effective as open surgery or laser treatment (moderate level of evidence) and presents fewer major and minor complications than open surgery (low level of evidence). Radiofrequency ablation can be performed on an outpatient basis. We calculated that RFA would be about $110-$220 more expensive per patient than open surgery. CONCLUSION: Radiofrequency ablation is a valuable alternative to open surgery and would free up operating room time in a context of low accessibility.

CONTEXTE: Depuis les années 1990, de nouvelles techniques pour le traitement des varices ont émergé, y compris l'ablation par radiofréquence (ARF) et le traitement au laser. Nous avons procédé à une étude afin de comparer l'innocuité, l'efficacité et les résultats de l'ARF à ceux de la chirurgie ouverte et de l'ablation par laser pour le traitement des varices. Nous avons aussi procédé à une analyse des coûts de l'ARF comparativement à la chirurgie pour vérifier si, en étant effectuée en consultation externe, l'ARF permet de libérer du temps de bloc opératoire. MÉTHODES: Nous avons réalisé une revue systématique de la documentation (articles publiés entre mai 2010 et septembre 2013 en langue anglaise, et entre janvier 1991 et septembre 2013 en langue française). Nous avons utilisé plusieurs séries de critères pour mesurer la qualité des études. Nous avons aussi recueilli des données sur l'estimation des coûts. RÉSULTATS: La recherche documentaire a permis de recenser 924 publications, dont 38 ont été retenues pour analyse : 15 examens documentaires, 1 directive de pratique optimale et 22 études principales. Le niveau de preuve global a été jugé de faible à modéré en raison de la taille limitée des échantillons, du manque d'information sur les caractéristiques des patients et de l'absence de normalisation des mesures paramétriques. Toutefois, les résultats obtenus concordent d'une étude à l'autre. À court et à moyen terme, l'ARF est considérée aussi efficace que la chirurgie ouverte ou que le traitement au laser (niveau de preuve modéré) et s'accompagne de moins de complications majeures et mineures que la chirurgie ouverte (faible niveau de preuve). L'ablation par radiofréquence peut être effectuée en consultation externe. Nous avons calculé que l'ARF couterait environ 110 à 220 $ de plus par patient comparativement à la chirurgie. CONCLUSION: L'ablation par radiofréquence est une solution de rechange valable à la chirurgie ouverte et pourrait libérer du temps de bloc opératoire dans un contexte d'accès restreint.

Are drug-coated balloons cost effective for femoropopliteal occlusive disease? A comparison of bare metal stents and uncoated balloons.

AIM: To perform a cost-effectiveness analysis to help hospital decision-makers with regard to the use of drug-coated balloons compared with bare metal stents and uncoated balloons for femoropopliteal occlusive disease. METHODS: Clinical outcomes were extracted from the results of meta-analyses already published, and cost units are those used in the Quebec healthcare network. The literature review was limited to the last four years to obtain the most recent data. The cost-effectiveness analysis was based on a 2-year perspective, and risk factors of reintervention were considered. RESULTS: The cost-effectiveness analysis indicated that drug-coated balloons were generally more efficient than bare metal stents, particularly for patients with higher risk of reintervention (up to CAD$1686 per patient TASC II C or D). Compared with uncoated balloons, results indicated that drug-coated balloons were more efficient if the reintervention rate associated with uncoated balloons is very high and for patients with higher risk of reintervention (up to CAD$3301 per patient). CONCLUSION: The higher a patient's risk of reintervention, the higher the savings associated with the use of a drug-coated balloon will be. For patients at lower risk, the uncoated balloon strategy is still recommended as a first choice for endovascular intervention.