Assessing the impact of health technology assessment in the Netherlands

Copyright © Cambridge University Press 2008Objectives: Investments in health research should lead to improvements in health and health care. This is also the remit of the main HTA program in the Netherlands. The aims of this study were to assess whether the results of this program have led to such improvements and to analyze how best to assess the impact from health research.Methods: We assessed the impact of individual HTA projects by adapting the "payback framework" developed in the United Kingdom. We conducted dossier reviews and sent a survey to principal investigators of forty-three projects awarded between 2000 and 2003. We then provided an overview of documented output and outcome that was assessed by ten HTA experts using a scoring method. Finally, we conducted five case studies using information from additional dossier review and semistructured key informant interviews.Results: The findings confirm that the payback framework is a useful approach to assess the impact of HTA projects. We identified over 101 peer reviewed papers, more than twenty-five PhDs, citations of research in guidelines (six projects), and implementation of new treatment strategies (eleven projects). The case studies provided greater depth and understanding about the levels of impact that arise and why and how they have been achieved.Conclusions: It is generally too early to determine whether the HTA program led to actual changes in healthcare policy and practice. However, the results can be used as a baseline measurement for future evaluation and can help funding organizations or HTA agencies consider how to assess impact, possibly routinely. This, in turn, could help inform research strategies and justify expenditure for health research.This research is funded by ZonMw, the Netherlands organization for health research and development (project 945-15-001)

Reforming the cancer drug fund focus on drugs that might be shown to be cost effective

The Cancer Drug Fund was originally conceived as a temporary measure, until value based pricing for drugs was introduced, to give NHS cancer patients access to drugs not approved by NICE. Spending on these drugs rose from less than the £50m (€63m; $79m) budgeted for the first year in 2010-11 to well over £200m in 2013-14, and the budget for the scheme—now extended for a further two years—will reach £280m by 2016.1 The recent changes to the fund recognise the impossibility, within any sensible budget limit, of providing all the new cancer drugs that offer possible benefit to patients. More radical changes are needed to the working of the fund, given the failure to introduce value based pricing, so that it deals with the underlying problem of inadequate information on the effectiveness and cost effectiveness of new cancer drugs when used in the NHS

A lattice spring model of heterogeneous materials with plasticity

A three-dimensional lattice spring model of a heterogeneous material is presented. For small deformations, the model is shown to recover the governing equations for an isotropic elastic medium. The model gives reasonable agreement with theoretical predictions for the elastic fields generated by a spherical inclusion, although for small particle sizes the discretization of the underlying lattice causes some departures from the predicted values. Plasticity is introduced by decreasing the elastic moduli locally whilst maintaining stress continuity. Results are presented for a spherical inclusion in a plastic matrix and are found to be in good agreement with the predictions of Wilner (1988 J. Mech. Phys. Solids 36 141-65).</p

Physical activity in England: Who is meeting the recommended level of participation through sports and exercise?

This article is available through the Brunel Open Access Publishing Fund. Copyright © 2012 Anokye et al.Background: Little is known about the correlates of meeting recommended levels of participation in physical activity (PA) and how this understanding informs public health policies on behaviour change. Objective: To analyse who meets the recommended level of participation in PA in males and females separately by applying ‘process’ modelling frameworks (single vs. sequential 2-step process). Methods: Using the Health Survey for England 2006, (n = 14 142; ≥16 years), gender-specific regression models were estimated using bivariate probit with selectivity correction and single probit models. A ‘sequential, 2-step process’ modelled participation and meeting the recommended level separately, whereas the ‘single process’ considered both participation and level together. Results: In females, meeting the recommended level was associated with degree holders [Marginal effect (ME) = 0.013] and age (ME = −0.001), whereas in males, age was a significant correlate (ME = −0.003 to −0.004). The order of importance of correlates was similar across genders, with ethnicity being the most important correlate in both males (ME = −0.060) and females (ME = −0.133). In females, the ‘sequential, 2-step process’ performed better (ρ = −0.364, P < 0.001) than that in males (ρ = 0.154). Conclusion: The degree to which people undertake the recommended level of PA through vigorous activity varies between males and females, and the process that best predicts such decisions, i.e. whether it is a sequential, 2-step process or a single-step choice, is also different for males and females. Understanding this should help to identify subgroups that are less likely to meet the recommended level of PA (and hence more likely to benefit from any PA promotion intervention).This study was funded by the Department of Health’s Policy Research Programme

Does responsibility affect the public valuation of health care interventions? A relative valuation approach to health care safety

This article is available open access through the publisher’s website at the link below. Copyright © 2012, International Society for Pharmacoeconomics and Outcomes Research (ISPOR).Objective - Health services often spend more on safety interventions than seems cost-effective. This study investigates whether the public value safety-related health care improvements more highly than the same improvements in contexts where the health care system is not responsible. Method - An online survey was conducted to elicit the relative importance placed on preventing harms caused by 1) health care (hospital-acquired infections, drug administration errors, injuries to health care staff), 2) individuals (personal lifestyle choices, sports-related injuries), and 3) nature (genetic disorders). Direct valuations were obtained from members of the public by using a person trade-off or “matching” method. Participants were asked to choose between two preventative interventions of equal cost and equal health benefit per person for the same number of people, but differing in causation. If participants indicated a preference, their strength of preference was measured by using person trade-off. Results - Responses were obtained from 1030 people, reflecting the sociodemographic mix of the UK population. Participants valued interventions preventing hospital-acquired infections (1.31) more highly than genetic disorders (1.0), although drug errors were valued similarly to genetic disorders (1.07), and interventions to prevent injury to health care staff were given less weight than genetic disorders (0.71). Less weight was also given to interventions related to lifestyle (0.65) and sports injuries (0.41). Conclusion - Our results suggest that people do not attach a simple fixed premium to “safety-related” interventions but that preferences depend more subtly on context. The use of the results of such public preference surveys to directly inform policy would therefore be premature.Brunel University

Discovery of a supernova associated with GRB 031203: SMARTS Optical-Infrared Lightcurves from 0.2 to 92 days

Optical and infrared monitoring of the afterglow site of gamma-ray burst (GRB) 031203 has revealed a brightening source embedded in the host galaxy, which we attribute to the presence of a supernova (SN) related to the GRB ("SN 031203"). We present details of the discovery and evolution of SN 031203 from 0.2 to 92 days after the GRB, derived from SMARTS consortium photometry in I and J bands. A template type Ic lightcurve, constructed from SN 1998bw photometry, is consistent with the peak brightness of SN 031203 although the lightcurves are not identical. Differential astrometry reveals that the SN, and hence the GRB, occurred less than 300 h_71^-1 pc (3-sigma) from the apparent galaxy center. The peak of the supernova is brighter than the optical afterglow suggesting that this source is intermediate between a strong GRB and a supernova.Comment: 11 pages, 3 figures, submitted to ApJ Letter

The "universal" radio/X-ray flux correlation : the case study of the black hole GX 339-4

The existing radio and X-ray flux correlation for Galactic black holes in the hard and quiescent states relies on a sample which is mostly dominated by two sources (GX 339-4 and V404 Cyg) observed in a single outburst. In this paper, we report on a series of radio and X-ray observations of the recurrent black hole GX 339-4 with the Australia Telescope Compact Array, the Rossi X-ray Timing Explorer and the Swift satellites. With our new long term campaign, we now have a total of 88 quasi-simultaneous radio and X-ray observations of GX 339-4 during its hard state, covering a total of seven outbursts over a 15--year period. Our new measurements represent the largest sample for a stellar mass black hole, without any bias from distance uncertainties, over the largest flux variations and down to a level that could be close to quiescence, making GX 339-4 the reference source for comparison with other accreting sources (black holes, neutrons stars, white dwarfs and active galactic nuclei). Our results demonstrate a very strong and stable coupling between radio and X-ray emission, despite several outbursts of different nature and separated by a period of quiescence. The radio and X-ray luminosity correlation of the form L_X ~L_Rad^0.62 +/-0.01 confirms the non-linear coupling between the jet and the inner accretion flow powers and better defines the standard correlation track in the radio-X-ray diagram for stellar mass black holes. We further note epochs of deviations from the fit that significantly exceed the measurement uncertainties, especially during the formation and destruction of the compact jets ...[abridged]. We incorporated our new data in a more global study of black hole candidates strongly supporting a scale invariance in the jet-accretion coupling of accreting black holes, and confirms the existence of two populations of sources in the radio/X-ray diagram.Comment: Paper accepted in MNRAS. 18 pages, 9 figure