Femtosecond Laser Versus Mechanical Microkeratome in Thin-Flap Laser in Situ Keratomileusis (Lasik) for Correction of Refractive Errors an Evidence-Based Effectiveness and Cost Analysis

INTRODUCTION: To compare the efficacy and cost-effectiveness of Femtosecond laser versus mechanical Microkeratome corneal flap creation in correction of refractive errors.METHODS: I this review, a comprehensive search of Medline, SCOPUS, Cochrane, TRIP database, supplemented by HTA and economic databases was performed. We searched for randomized controlled trials (RCTs) of Femtosecond laser which included mechanical Microkeratome in other arm. The quality of the retrieved studies was appraised by two independent reviewers and appropriate articles were finalized.RESULTS: A total of 1142 articles were identified, of which, 1059 were excluded after review of the titles and abstracts and 83 articles remained. Systematic reviews and RCTs were evaluated through CASP international worksheet. Eventually, 61 titles were excluded, leaving 22 articles to be reviewed.Safety: There was no individual evidence to cover all safety components about Femtosecond laser, but in summary, this modality seems a safe method for corneal flap creation.Effectiveness: No statistically significant difference was shown in visual acuity and refractive errors. The important secondary end point of this review was diffuse Lamellar keratitis in 17% of the femtosecond group versus 5% in mechanical Microkeratome. Inflammation was low-grade and improved during the first 3 months of follow-up period with a low dose medication without corneal scarring. The two groups was comparable in all clinical outcomes including Unorrected Visual Acuity (UCVA), Best Special Corrected Visual Acuity (BSCVA), manifest refraction, wave front aberrometry, Schirmer test, and Tear Break up time (TBUT).Cost Analysis: Results showed that marginal cost incurred due to Femtosecond technology adoption may vary from 27 to 117 € (resulted from sensitivity analysis). It is clear that additional cost may be a small proportion of LASIK procedure total cost.CONCLUSION: Although Femtosecond flap creation is a modern method with a good quality of corneal flap, but, there is no high-quality evidence to show superiority of Femtosecond laser in clinical outcomes. Although the efficacy and cost of the systems is almost equal, traditional method still remains as the standard approach.

Holmium Laser Prostate Enucleation (HOLEP) Versus Trans-Urethral Resection of Prostate (TURP) in Treatment of Symptomatic Prostatic Enlargement;A Health Technology Assessment

INTRODUCTION: Our aim was to compare the cost effectiveness of holmium laser prostate enucleation (HOLEP) versus trans-urethral resection of prostate.METHODS: We searched all available databases for any controlled trials comparing HOLEP and TURP from January 2000 to February 2009. Two independent reviewers studied and appraised the selected evidences. Then, effectiveness and cost effectiveness of HOLEP was evaluated.RESULTS: We identified four randomized controlled trials and one systematic review according to the inclusion criteria. Most of the studies had moderate quality of evidence with limited sample sizes. Overall success rate of HOLEP was comparable with TURP; but, some secondary outcomes such as pick flow rate twelve months after the surgery was better in HOLEP. A comparison between the original costs and those obtained from sensitivity analysis showed that the cost parameters were sensitive to the number of the patients treated. Increasing the number of the patients from 200 to 300 changed the study’s results in favor of the new techniques.CONCLUSION: Since the holmium and thulium laser sets are sensitive to the number of the patients and multipurpose, they potentially can be applied for stone fragmentation.Thus, utilization of these equipments will divide the costs between two groups of the services. In economic terms, these properties lower overhead costs and justify the purchasing of these equipments

Green Light Photo Selective Vaporization of the Prostate vs. Transurethral Resection of Prostate for Benign Prostatic Hyperplasia

INTRODUCTION: Green light photo selective vaporization of the prostate (PVP) is a minimally invasive method of treatment for clinical benign prostatic hyperplasia with fewer side effects. The aim of this study is to evaluate the safety, effectiveness and cost analysis of PVP compared with transurethral resection of prostate.METHODS: A systematic search was done in Cochrane, TRIP database, MEDLINE, NHS EED, NIHR HTA, CRD, Health star database, Pro Quest, Psycoinfo and Google Scholar to find randomized control trials, systematic reviews and HTA reports. The searched keywords were Green light laser (PVP or KTP) and prostate. The cost analysis was done by the perspective of society and providers.RESULTS: Complication rate in 12 included evidences ranged from 0-9.3%. The complication rate of TUR-P (Transurethral Resection of Prostate) was more than PVP. Changing in flow rate reducing residual urine, improving patients’ symptoms and QOL (Quality of life), and operative outcome length of operation varied from no significant to significant differences in favor of TURP. Unit cost in both social and provider view was significantly high in PVP in comparison with TURP. Increasing the number of patients did not change the cost analysis.CONCLUSION: PVP is a safe method for treatment of clinical BPH, but there is a lack of evidence for the evaluation of effectiveness. Overall, the unit cost for PVP was significantly more than TURP; for this reason this method could not be conducted in very wide indications, because of high cost

Family Members’ Attitudes Regarding Family Presence During Resuscitation of Adults: A Systematic Review and Meta Analysis

Context: Family presence during resuscitation (FPDR) is a controversial debate throughout the world. Experts believe that FPDRis a cultural and ethnical issue and that countries have different views regarding this matter. The aim of this study is a systematicreview and meta-analysis of all available studies assessing patient families’ views regarding their presence during resuscitation.Evidence Acquisition: Studies reported attitudes of the patients’ relatives toward FPDR were eligible for inclusion. Case reports,letters, opinion pieces, and reviews were excluded from the study. A systematic search was conducted in Medline, Embase, CINAHL,Cochrane library,Web of Science, SCOPUS, PsycInfo, and other related databases based on selected keywords. The qualities of studieswere assessed using Critical Appraisal Skills Programme (CASP) and STROBE statement. Comprehensive meta-analysis (version-2)was used for data analysis. Heterogeneity was assessed using the Cochrane Q-statistic and the I2 statistic. Publication bias was detectedthrough funnel plot.Results: A total of 18 studies were selected, including 10 cross-sectionals and 8 control trials. The results were categorized in threeitems: tendency for being present, satisfaction, and coping. A meta-analysis was done for 9 descriptive cross-sectional studies. Theevent rate of being present was 0.73 (95% CI: 0.60 - 0.83), which was statistically significant (P = 0.001), whereas the event rate ofcoping was 0.62 (95% CI: 0.48 - 0.73) and was not statistically significant.Conclusions: The results of this study showed that the patients’ families tend to be present during resuscitation and believe thatsome rules should support FPDR. In terms of anxiety disorders and PTSD, when there were more intervals, family’s presence andtheir emotional supports had a positive effect on them. However, the role of the medical staff cannot be ignored in this regard

effectiveness of endovascular versus open surgical repair for thoracic aortic aneurysm:a systematic review and meta-analysis

iNTroduCTioN: since the approval, the thoracic endovascular aortic repair (TeVar) is widely used for the repair of thoracic aortic aneurysm. however, the long-term mortality and re-intervention rates compared to open surgical repair (osr) are unclear. We aimed to compare the effectiveness of TEVAR with OSR specifically for thoracic aortic aneurysms. eVideNCe aCQuisiTioN: We conducted a comprehensive search in MedliNe, PubMed, eMBase, CiNahl, ProsPero, Centre for reviews and dissemination, and the Cochrane library up to November 2020. The main outcomes were early mortality, mid-to-long-term survival, and re-intervention. The quality of the evidence was assessed using the grade methodology. all analyses were performed using revMan with the random effect model and Comprehensive Meta-analysis software. eVideNCe syNThesis: one systematic review and 15 individual studies were included. Pooled analysis showed that 30-day mortality, stroke, renal failure, and pulmonary complications were significantly lower in TEVAR versus open surgery. The pooled rate of re-intervention significantly favored the OSR. The long-term survival and mortality favored TEVAR and OSR in one and two studies, respectively, but was non-significant in seven analyzes. CONCLUSIONS: Early clinical outcomes including the 30-day mortality, stroke, renal failure, and pulmonary complications significantly favored the TeVar. however, the mid-to-long-term re-intervention rate favored the osr and long-term survival was inconsistent among the studies. The quality of evidence was very low. More studies with longer follow-ups are needed. The use of TeVar should be decided by taking into account other factors including patient characteristics and preferences, cost, and surgeon expertise.</p

A systematic review of effectiveness and economic evaluation of Cardiohelp and portable devices for extracorporeal membrane oxygenation (ECMO)

In recent years, there have been substantial advancements in the development of different technologies for extracorporeal membrane oxygenation (ECMO) for in-hospital and out of hospital applications. However the effectiveness of these devices is not clearly known. The objective of this study was to evaluate the cost-effectiveness of Cardiohelp compared to other portable ECMO devices. In this systematic review, we searched Medline (via Ovid), Embase, Pubmed, Cochrane Library, SCOPUS, CRD and NICE. Articles were assessed by two independent reviewers for eligibility and quality of the evidence. Studies which compared Cardiohelp to other ECMO devices were included. Seven out of 1316 publication were included in this review, three of them were clinical trials and four were observational studies. The majority of the studies had limited quality. According to the measures of safety, Cardiohelp had safer technological features, but on the other hand, was more complex to use. Considering the effectiveness, Cardiohelp was not statistically different from other technologies. Cardiohelp showed slightly better performance than Centrimag in terms of cost per patient and cost-effectiveness. However, when clinical criteria were used to select the patients with good prognosis to administer the ECMO, incremental cost utility ratios (ICURs) for both Cardiohelp and Centrimag were below the level of willingness-to-pay threshold. According to the measures of safety and effectiveness, ECMO with Cardiohelp was not considerably different from other evaluated technologies. Moreover, ECMO with Cardiohelp or Centrimag can be considered cost-effective, provided that the patients are selected carefully in terms of neurological outcomes.</p

The use of Holmium and Tolmium YAG Laser-assisted technologies in benign prostatic hyperplasia surgery: A health technology assessment study

Background & Objectives: Current study aimed to compare effectiveness and cost effectiveness of laser devices in BPH surgery. This study could provide clear evidences which could be used in prior approval and funding of such new emerging technologies. Methods: A systematic search of related databases was performed to find Randomized clinical trials, systematic reviews, Meta analyses and health technology assessment studies which had been published up to 2008.key words are: Laser، Holmium YAG laser (HOLEP)، Tolmium Laser، Transurethral Resection of the Prostate (TURP) and prostate. Data for clinical effectiveness was retrieved from the literature. Two Laser Assisted Technologies were analyzed in terms of efficacy, effectiveness and cost-effectiveness and compared with Trans-Urethral Resection of the Prostate (TURP) method from the perspective of Iran Ministry of Health. We used standard costing for analysis of costs. One-way sensitivity analysis was performed for the examination of calculated ICER in different probable scenarios. Results: Literature review stressed that there is no statistically significant difference in clinical effectiveness of Lasers assisted devices and TURP technique. The length of hospital stay and severity of side effects are clinically and statistically lower in Laser Assisted devices. Estimated unit-cost of treatment for Tolmium, Holmium and TURP was 3403541, 3019261 and 2455794 (RLS) from MOH perspective and 340354, 4719261 and 4325794 from societal perspective. Conclusion: Sensitivity analysis showed that, in most of the study scenarios TURP was dominant intervention because of low treatment costs. Tolmium laser only with the assumption of dual applicability and 200 patients per year would be considered as a cost-effective technology

Additional file 2 of How are ontologies implemented to represent clinical practice guidelines in clinical decision support systems: protocol for a systematic review

Additional file 2. Search strategy MEDLIN