A Methodological Approach for Measuring the Impact of HTA

There is a lack of evidence concerning the link between HTA and outcomes in terms of health improvements. This work proposes a framework for assessing the impact of HTA. This impact assessment is a necessary step in then better understanding the value for money of HTA bodies. We emphasis that this is still a work in progress. iDSI has developed a theory of change-based framework in order to evaluate the impact the iDSI has on institutional strengthening – leading to ‘better decisions’ for ‘better health’. This framework recognises that there is a complex translation process between better decisions and better health dependent on many assumptions about local factors and systems, including linkage between decisions and budgets, delivery, implementation, and data accuracy. Work has been undertaken over the last 6 months developing a methodological approach for measuring the impact of health technology assessment (HTA). Two case studies are used to illustrate the approach. At the core of impact assessment is a requirement to link causes and effects, to explain ‘how’ and ‘why’ and to identify – and thus improve or adapt – mechanisms leading to impact. Policy makers also want to know ‘to what extent’ or ‘the magnitude of impact’. The framework developed adopts an economic approach nested in theory of change as a means of both quantifying the magnitude of impact (utilising economic models) as well as explaining why and how impact happens (drawing on theory based approaches) in order to reinforce learning as to how to improve our response and optimise the use of HTA to have the greatest impact in a given context. This should also enable us to capture and explain wider impact – perhaps more intangible aspects which cannot be easily quantified. This may also possibly increase policy-makers’ ‘buy-in’

Mobilization of Metals by Fungi in Historic Cemeteries

Interactions among fungi, soil, and metals are at the heart of nutrient cycling in terrestrial systems. Both major and trace elements are found in soils, but the degree to which they are biologically available is influenced by chemical weathering of soil minerals by fungi. In addition to contributing to weathering, mushrooms are known to bioaccumulate metals from soil, so edible mushrooms growing on soils contaminated with toxic metals can cause harm to those who eat them. This study focuses on metal content of mushrooms and soils from cemeteries that are suspected to be contaminated with arsenic as a result of late-19th Century embalming practices. Mushrooms and soil were collected from eight cemeteries and three control areas in Lewiston, Auburn, Sabattus, and Topsham, Maine and analyzed for metal content using acid digestion and ICP-OES. With particular focus on arsenic, concentrations of potassium, sodium, zinc, calcium, iron, magnesium, lead, and arsenic in mushrooms are compared to concentrations of those metals in the soil on which the mushrooms were growing

IDSI Reference Case work stream

This reports on the work undertaken by iDSI on each of the five objectives under the iDSI Reference Case (RC) work stream and on its future use by the Bill and Melinda Gates Foundation. The brief pilot studies’ report gives an overview of each of the pilots and extracts key issues for further RC development under iDSI going forward. The process of piloting the RC revealed that researchers found the RC challenging to fulfil every methodological and reporting standard, even those with substantial experience in economic evaluation in a low and middle income country (LMIC) context. Establishing a requirement that BMGF funded economic evaluation use of the RC ought to be accompanied by extensive efforts to build research capacity in modelling (mathematical, decision analytic) and cost-effectiveness analysis in LMICs

Economic evaluation of integrated new technologies for health and social care: suggestions for policy makers, users and evaluators

With an ageing population there is a move towards the use of assisted living technologies (ALTs) to provide social care and health care services, and to improve service processes. These technologies are at the forefront of the integration of health and social care. However, economic evaluations of ALTs, and indeed economic evaluations of any interventions providing both health benefits and benefits beyond health are complex. This paper considers the challenges faced by evaluators and presents a method of economic evaluation for use with interventions where traditional methods may not be suitable for informing funders and decision makers. We propose a method, combining economic evaluation techniques, that can accommodate health outcomes and outcomes beyond health through the use of a common numeraire. Such economic evaluations can benefit both the public and private sector, firstly by ensuring the efficient allocation of resources. And secondly, by providing information for individuals who, in the market for ALTs, face consumption decisions that are infrequent and for which there may be no other sources of information. We consider these issues in the welfarist, extra-welfarist and capabilities framework, which we link to attributes in an individual production model. This approach allows for the valuation of the health component of any such intervention and the valuation of key social care attributes and processes. Finally, we present a set of considerations for evaluators highlighting the key issues that need to be considered in this type of economic evaluation

The Value of Health Technology Assessment: a mixed methods framework

Whilst much research has been undertaken on establishing what factors influence improved decision-making including good governance structures, expertise, political and institutional factors, resources and participation, how such influences on decision-making interact with local context and health systems, leading to impact on health outcomes, is less understood. The focus of our research is on the impact of Health Technology Assessment (HTA) as a tool for priority-setting with its explicit consideration of costs and benefits. Where evaluations have been undertaken, they mainly focus on processes or outcomes at the decision-making level, with impact on health outcomes rarely measured. Even in countries where HTA programmes are well established, evidence which identifies their outcomes and impact in terms of health gains is limited. For countries with greater capacity constraints, how decision-making interacts with ‘context’ leading to health outcomes is even less explored and arguably of critical importance. This research aims to provide a methodological framework and evidence base to: quantify the returns on investment in HTA; and produce explanatory programme theory that considers individual, interpersonal, institutional and systems-level components and their interactions on the mechanisms by which HTA impact can be optimised

Within-trial cost and 1-year cost-effectiveness of the DiRECT/Counterweight-Plus weight-management programme to achieve remission of type 2 diabetes

No abstract available

UK guideline for the use of HIV Post-Exposure Prophylaxis Following Sexual Exposure, 2015.

We present the updated British Association for Sexual Health and HIV guidelines for HIV post-exposure prophylaxis following sexual exposure (PEPSE). This document includes a review of the current data to support the use of PEPSE, considers how to calculate the risks of infection after a potential exposure, and provides recommendations on when PEPSE should and should not be considered. We also review which medications to use for PEPSE, provide a checklist for initial assessment, and make recommendations for monitoring individuals receiving PEPSE. Special scenarios, cost-effectiveness of PEPSE, and issues relating to service provision are also discussed. Throughout the document, the place of PEPSE within the broader context of other HIV prevention strategies is considered

Intelligent autonomous treatment of bedwetting using non-invasive wearable advanced mechatronics systems and MEMS sensors

Post-void alarm systems to monitor bed wetting in Nocturnal Enuresis (NE) have been deemed unsatisfactory. The aim in this study is to develop a safe, comfortable and non-invasive pre-void wearable alarm and associated technology using advanced mechatronics. Each stage of development includes patient and public involvement and engagement (PPI). The early stage of the development involved children with and without nocturnal enuresis (NE) (and parents) who were tested at a hospital under the supervision of physicians, radiologists, psychologists, and nurses. The readings were simultaneously compared to B-mode images and measurements, acquired from a conventional ultrasound device, and were found to correlate highly. The results showed that determining imminent voiding need is viable using non-invasive sensors. Following on from "proof of concept", a bespoke advanced mechatronics device has been created. The device houses custom electronics, an ultrasound system, intelligent software, a user-friendly smartphone application, bedside alarm box and a dedicated undergarment, along with a self-adhesive gel pad - designed to keep the MEMS sensors aligned with the abdomen. Testing of the device with phantoms and volunteers has been successful in determining bladder volume and associated voiding need. Five miniaturized, and therefore more ergonomic, versions of the device are being developed, with an enabled connection to the cloud platform for location independent control and monitoring. Thereafter, the enhanced device will be tested with children with NE at their homes for 14 weeks, to gain feedback relating to wearability and data collection involving the cloud platform

Separation of oil/water emulsions in continuous flow using microwave heating

This work studies a continuous flow microwave system to enhance gravity settling of water-in-oil emulsions. Settling times were found to be dependent upon the applied power, flowrate and energy input. Power and energy input are linked to liquid flowrate within the flow system used in this study, so a key objective of this work was to understand the effect of turbulence on the heating and separation of the flowing emulsion. At high flowrates (9 – 12 L/min) it was found that turbulence dominates, with settling times largely independent of energy input. At lower flowrates (1 - 6 L/min), when turbulence was decreased, it was found that the settling time decreased as the power density was increased. Settling times have the potential to be less than half that of untreated emulsions, and can be reduced further if turbulence can be minimised between the microwave heating zone and the settling zone in the process equipment