Inclusion of Carer Health-Related Quality of Life in National Institute for Health and Care Excellence Appraisals.

OBJECTIVES: Health interventions for patients can have effects on their carers too. For consistency, decision makers may wish to specify whether carer outcomes should be included. One example is the National Institute for Health and Care Excellence (NICE), whose reference case specifies that economic evaluations should include direct health effects for patients and carers where relevant. We aimed to review the methods used in including carer health-related quality of life (HRQL) in NICE appraisals. METHODS: We reviewed all published technology appraisals (TAs) and highly specialized technologies (HSTs) to identify those that included carer HRQL and discussed the methods and data sources. RESULTS: Twelve of 414 TAs (3%) and 4 of 8 HSTs (50%) included carer HRQL in cost-utility analyses. Eight were for multiple sclerosis, the remainder were each in a unique disease area. Twelve of the 16 appraisals modeled carer HRQL as a function of the patient's health state, 3 modeled carer HRQL as a function of the patient's treatment, and 1 included family quality-adjusted life year (QALY) loss. They used 5 source studies: 2 compared carer EQ-5D scores with controls, 2 measured carer utility only (1 health utilities index and 1 EQ-5D), and 1 estimated family QALY loss from a child's death. Two used disutility estimates not from the literature. Including carer HRQL increased the incremental QALYs and decreased incremental cost-effectiveness ratios in all cases. CONCLUSIONS: The inclusion of carer HRQL in NICE appraisals is relatively uncommon and has been limited by data availability.

HTA Training for Healthcare Professionals: International Overview of Initiatives Provided by HTA Agencies and Organizations.

BACKGROUND: Health Technology Assessment (HTA) is a multidisciplinary process that synthesizes, with a systematic, transparent, impartial and robust methodological approach, the main information on the medical, economic, ethical and social implications of the use and dissemination of a health technology. Its aim is to support decision-makers in identifying safe, effective, patient-centered and best-value health policies, in order to promote an equitable, efficient, and high-quality health system. Given the continued application of innovative technologies into clinical practice, healthcare professionals need to be able to adequately evaluate these technologies using evidence-based approaches such as HTA. Therefore, the implementation of training in HTA is crucial. The aim of this study was to investigate existing HTA training initiatives for healthcare professionals provided by international HTA agencies and organizations around the world. METHODS: From March to November 2020, the websites of HTA agencies and organizations belonging to the European network for HTA (EUnetHTA) and to the International Network of Agencies for HTA (INAHTA), and the website of the HTA International (HTAi), were explored for identifying the HTA training initiatives directed to healthcare professionals. In addition, we screened the training initiatives proposed at European level by EUnetHTA as part of its Joint Actions and conducted in collaboration with its public-private partners. Specific keywords were searched in English and adapted to French, Portuguese, Spanish, Italian and German. Data extraction of the retrieved training initiatives was conducted from November 2020 to February 2021 and considered the following information: agency, country, website, coordinator, type of initiative, target, topic, main contents, and language. RESULTS: Out of 124 agencies/organizations/EUnetHTA public-private partners screened, only 21 provided training initiatives for healthcare professionals. A total of 55 training initiatives were analyzed, 85.5% of which were delivered at the European level and 14.5% at the international level. The countries with a greater number of courses were: Austria, Argentina, Spain, Portugal, and the United Kingdom. Twenty-one training initiatives focused on HTA application and methodology while 34 on specific HTA domains, particularly on the economic one. The technologies covered were mainly drugs. CONCLUSIONS: Our study revealed a limited number of HTA training programs targeting healthcare professionals. HTA supports the decision-making processes concerning the use and application of health technologies with scientific evidence. Indeed, training of healthcare professionals in this field should be a key driver in implementing evidence-based healthcare choices and through rigorous methodological approaches such as HTA, in order to ensure proper health governance and value-based application of technological innovations in clinical practice. Therefore, capacity building of healthcare professionals in this area should be enhanced by using appropriate and effective training initiatives and educational strategies.

Aprendizagem baseada em projetos como tecnologia educacional em saúde: vivências, possibilidades e desafios na formação e cotidiano de trabalho de residentes e facilitadores em um serviço de atenção primária à saúde / Project-based learning as health educational technology: experiences, possibilities and challenges in the training and daily work of residents and facilitators in a primary health care service

INTRODUÇÃO: Esta dissertação é resultado do trabalho desenvolvido no Mestrado Profissional em Avaliação e Produção de Tecnologias para o SUS da Escola GHC. OBJETIVOS: teve como objetivo analisar a tecnologia educacional da Aprendizagem Baseada em Projetos (ABP) a partir da ótica de ex-residentes e facilitadores que vivenciaram o espaço denominado Seminário de Campo (SC) dos programas de residência Médica em Medicina de Família e Comunidade e de Residência Multiprofissional em Saúde da Família e Comunidade do Serviço de Saúde Comunitária do GHC. Também se propõe a analisar a utilização de aspectos da metodologia da ABP no cotidiano atual de trabalho dos participantes. MATERIAL E MÉTODO: O desenho metodológico escolhido foi a pesquisa qualitativa com abordagem de estudo de caso. Os dados foram coletados por meio de questionário sociodemográfico e entrevista semiestruturada. O tratamento dos achados pautou-se na análise temática proposta por Minayo (2008). RESULTADOS: Dentre os principais resultados destaca-se que a ABP constitui um processo pedagógico participativo que promove a elaboração de um projeto de intervenção que pode ser aplicado nos serviços de Atenção Primária à Saúde (APS). CONCLUSÃO: Podemos então concluir que a ABP demonstra ser uma potente ferramenta metodológica, ampliando as possibilidades de integração dos conhecimentos adquiridos teoricamente, aplicando-os na prática dos processos de trabalho em saúde, especificamente no âmbito da APS e, consequentemente, no Sistema Único de Saúde.

INTRODUCTION: This thesis results from the research developed in the Professional Masters Course in Health Technology Assessment and Production for the National Health System, Grupo Hospitalar Conceição, Brazil. OBJECTIVE: It was aimed to assess the Project-based Learning (PBL) as an educational technology based on the Perspective of former residents and facilitators who experienced the teaching-learning scope of the Field Seminaries within the Family and Community Medical Residence Program and the Multiprofessional Residence Program ­ emphasis on Family Health, both developed in a Primary Health Care service of Porto Alegre/Brazil. It was also aimed to analyze the use of aspects of this technology in the current daily work of the participants. MATERIALS AND METHODS: This is a qualitative case study. Data were collected by means of a social-demographic questionnaire and semi-structured interviews. RESULTS: The findings were examined according to Minayo's thematic analysis (2008). Among the main results, it is emphasized that PBL is a participatory pedagogical tool that promotes the elaboration of an intervention project that can be applied to primary health care (PHC) services. CONCLUSION: It can also be concluded that PBL proved to be a powerful methodological tool, expanding the possibilities of the theoretically acquired knowledge, applying them to the work processes in health, specifically within the PHC scope and, consequently in the National Unified Health System.

Evaluación económica de tecnologías sanitarias: una introducción para médicos / Economic evaluation of healthcare technologies: an introduction for physicians

Resumen. La evaluación económica de tecnologías sanitarias está logrando un papel importante en la agenda de los responsables sanitarios interesados en tomar decisiones más eficientes y que aseguren la maximización de la salud de la población. Por ello es necesario que los profesionales sanitarios entiendan en qué consiste el análisis económico para poder leer, evaluar y criticar este tipo de estudios. El siguiente artículo presenta una introducción al análisis económico de tecnologías sanitarias y describe los conceptos básicos en una evaluación económica en salud. Los autores utilizan principios económicos fundamentales y el concepto de eficiencia para defender el uso de esta herramienta en la toma de decisiones sanitarias. El artículo introduce el plano coste-efectividad como instrumento principal para presentar los resultados de estos estudios y explica cómo se deben medir los costes y beneficios en el análisis económico. Para facilitar la lectura y comprensión de esta introducción, se utilizan ejemplos de estudios económicos en el área del ictus (AU)

Summary. Economic evaluation of healthcare interventions is becoming increasingly important and are seen by decision makers as a useful tool on how best to allocate scarce resources efficiently by maximising the health of the population. It is therefore important that health care professionals understand the fundamentals of an economic analysis so that they can understand, evaluate and critically appraise published economic evaluations. This article presents an introduction to the economic analysis of health care interventions and describes the basic concepts of an economic evaluation. The authors introduce the concept of efficiency to defend the use of economic tools to guide or help decisions in healthcare. The article presents the cost-effectiveness plane as a useful instrument when presenting the results of an economic evaluation, and summarises the main ways on how costs and outcomes are measured. To help readers understand the concepts presented in this introduction, we draw on published examples of economic analyses undertaken in the field of stroke (AU)

Avaliaçäo tecnologica em saude / Health Tecnology Assessment: a contribuition to medical practice medical aducation end to organization of health services in Brazil

O autor discute a Avaliacao Tecnologica em Saude (ATS) buscando contextualiza-la no processo de decisao medica e em suas interfaces com a formacao medica e a pratica profissional.Discute a insuficiencia do paradigma biomedico quer seja como poder explicativo para o processo saude-doenca, quer seja para responder com equidade e integralidade as necessidades humanas e sociais de saude. Reconhece finalidade e intencionalidade na escolha e no uso de tecnologias em saude. Conclui pela necessidade de que a ATS se constitua em um programa integrante da politica cientifica do setor saude, nos marcos dos direitos e necessidades individuais e sociais e dos principios eticos da sociedade