Role of centralized review processes for making reimbursement decisions on new health technologies in Europe

Tania Stafinski1, Devidas Menon2, Caroline Davis1, Christopher McCabe31Health Technology and Policy Unit, 2Health Policy and Management, School of Public Health, University of Alberta, Edmonton, Alberta, Canada; 3Academic Unit of Health Economics, Leeds Institute for Health Sciences, University of Leeds, Leeds, UKBackground: The purpose of this study was to compare centralized reimbursement/coverage decision-making processes for health technologies in 23 European countries, according to: mandate, authority, structure, and policy options; mechanisms for identifying, selecting, and evaluating technologies; clinical and economic evidence expectations; committee composition, procedures, and factors considered; available conditional reimbursement options for promising new technologies; and the manufacturers' roles in the process.Methods: A comprehensive review of publicly available information from peer-reviewed literature (using a variety of bibliographic databases) and gray literature (eg, working papers, committee reports, presentations, and government documents) was conducted. Policy experts in each of the 23 countries were also contacted. All information collected was reviewed by two independent researchers.Results: Most European countries have established centralized reimbursement systems for making decisions on health technologies. However, the scope of technologies considered, as well as processes for identifying, selecting, and reviewing them varies. All systems include an assessment of clinical evidence, compiled in accordance with their own guidelines or internationally recognized published ones. In addition, most systems require an economic evaluation. The quality of such information is typically assessed by content and methodological experts. Committees responsible for formulating recommendations or decisions are multidisciplinary. While criteria used by committees appear transparent, how they are operationalized during deliberations remains unclear. Increasingly, reimbursement systems are expressing interest in and/or implementing reimbursement policy options that extend beyond the traditional "yes", "no", or "yes with restrictions" options. Such options typically require greater involvement of manufacturers which, to date, has been limited.Conclusion: Centralized reimbursement systems have become an important policy tool in many European countries. Nevertheless, there remains a lack of transparency around critical elements, such as how multiple factors or criteria are weighed during committee deliberations.Keywords: reimbursement, centralized review, health technologies, Europ

Ageing, urban marginality, and health in Ghana

The world’s population is rapidly ageing. Global estimates for the next three decades indicate a two-fold increase in the population of older adults aged ≥60 years. Nearly 80% of this growth will occur in low and middle-income countries in Asia and sub-Saharan Africa, where population health is already under threat from poverty, degraded environments, and deficient healthcare systems. Although the world’s poorest region, sub-Saharan Africa, ironically, will witness the fastest growth in older populations, rising by 64% over the next 15 years. Indications are that the majority of this population will live in resource-poor settings, characterized by deficient housing and neighbourhood conditions. Yet, very little research has systematically examined the health and wellbeing of older adults in such settings. Drawing on the ecological theory of ageing, the present study explores the living conditions and quality of life of elderly slum dwellers in Ghana, a sub-Saharan African country with a growing population of older adults. Data collection was undertaken in two phases in two environmentally contrasting neighbourhoods in Accra, Ghana. In Phase 1, we carried out a cross-sectional survey of older adults in a slum community (n = 302) and a non-slum neighbourhood (n = 301), using the World Health Organization quality of life assessment tool (WHOQoL-BREF). The survey data were complemented in Phase 2 with qualitative interviews involving a sample of community dwelling older adults (N = 30), health service providers (N = 5), community leaders (N = 2), and policymakers (N = 5). Preliminary analysis of the survey data revealed statistically significant differences in the social and environment domains of quality of life, while the qualitative data identified multiple health barriers and facilitators in the two neighbourhoods. Insights from the research are expected to inform health and social interventions for older slum dwellers in Ghana

Effectiveness of photodynamic therapy for mammary and extra-mammary Paget's disease: a state of the science review

<p>Abstract</p> <p>Background</p> <p>Paget's disease is a rare skin disorder occurring in the breast (mammary) or in the groin, genital, peri-anal and axillary regions (extra-mammary). Typical treatment involves surgical excision, which in the case of extra-mammary Paget's disease, can lead to significant morbidity. Photodynamic therapy (PDT) which uses a topical or intravenous photosensitizing agent that is activated by a light source to ablate abnormal tissue, offers a minimally invasive alternative. The purpose of this study was to assess the effectiveness of photodynamic therapy in the treatment of Paget's disease.</p> <p>Methods</p> <p>Following Cochrane guidelines, a comprehensive systematic review of all clinical studies and reports examining the use of PDT for mammary and extra-mammary Paget's disease was conducted. Study quality was assessed using the Oxford Levels of Evidence Scale.</p> <p>Results</p> <p>21 retrospective and 2 prospective non-comparative studies were identified and included in the review: 9 case reports with 1-2 patients and 14 case series with 1-16 patients. These reports totalled 99 patients with 133 extra-mammary Paget's lesions and 3 patients (with 3 lesions) with mammary Paget's disease. Follow-up periods were typically one year or less, with 77/133 extra-mammary lesions exhibiting complete response to PDT. One recurrent mammary skin lesion and two mammary lesions treated concomitantly with surgery also exhibited complete responses.</p> <p>Conclusions</p> <p>Evidence of the effectiveness of PDT for Paget's disease is promising, but limited. This may, in part, be explained by the rarity of the condition, making controlled comparative clinical trials challenging.</p

White bait resources of the south west coast of India

The most important landing is that there exists in the sea between Ratnagiri and Tuticorin a sufficiently large resource of Anhoviella spp. (Whitebait), which 1s at present exploited to a small extent only. The estimates of the Pelagic Fishery Project reveal that the total resource of whitebait at the time of its highest availability is about 1/2 million tonnes (0 . 5 2 million) which is over 50%; of the total annual marine fish landing in India