Budgeting and health technology assessment: First evidence obtained from proposal forms used to submit the adoption of new technology

Objectives: The aim of this study was to benchmark the proposal forms used by a sample of Italian hospitals to inform the budget process for the adoption of new technology to understand the relationship with the guidelines provided by the Health Technology Assessment (HTA) literature. Methods: A literature review was first undertaken to identify the frameworks developed to support decision making regarding new technology at a hospital level. A checklist of criteria drawn up according to five main perspectives (technology, patient, organization, economics, and level of evidence) has been formalized to review and compare the collected proposal forms. Results: The “technology” perspective appears to have been broadly covered. The “patient” perspective has focused to clinical issues and partially neglects other dimensions such as patient satisfaction and potential adverse events. The “organization” dimension has paid little attention to change management. The “economics” dimension has been broadly covered, even though a sensitivity analysis has not been considered. The “level of evidence” that is required for submitting the proposal form is little. Conclusions: The proposal forms used to inform the budget process regarding the adoption of new technology are accountable for a limited set of dimensions from among those proposed in literature. Further research is required to understand how to render technology assessment multidimensional, multidisciplinary, evidence-based, and accountable at a hospital leve

Why laparoscopists may opt for three-dimensional view: a summary of the full HTA report on 3D versus 2D laparoscopy by S.I.C.E. (Società Italiana di Chirurgia Endoscopica e Nuove Tecnologie)

Background: Three-dimensional view in laparoscopic general, gynaecologic and urologic surgery is an efficient, safe and sustainable innovation. The present paper is an extract taken from a full health technology assessment report on three-dimensional vision technology compared with standard two-dimensional laparoscopic systems. Methods: A health technology assessment approach was implemented in order to investigate all the economic, social, ethical and organisational implications related to the adoption of the innovative three-dimensional view. With the support of a multi-disciplinary team, composed of eight experts working in Italian hospitals and Universities, qualitative and quantitative data were collected, by means of literature evidence, validated questionnaire and self-reported interviews, applying a final MCDA quantitative approach, and considering the dimensions resulting from the EUnetHTA Core Model. Results: From systematic search of literature, we retrieved the following studies: 9 on general surgery, 35 on gynaecology and urology, both concerning clinical setting. Considering simulated setting we included: 8 studies regarding pitfalls and drawbacks, 44 on teaching, 12 on surgeons’ confidence and comfort and 34 on surgeons’ performances. Three-dimensional laparoscopy was shown to have advantages for both the patients and the surgeons, and is confirmed to be a safe, efficacious and sustainable vision technology. Conclusions: The objective of the present paper, under the patronage of Italian Society of Endoscopic Surgery, was achieved in that there has now been produced a scientific report, based on a HTA approach, that may be placed in the hands of surgeons and used to support the decision-making process of the health providers

A new method for the quantitative analysis of gated SPECT polar scintigraphic maps

We have developed a software, which allows to do non conventional percent quantitative analysis on scintigraphic polar map obtained from conventional processing of gated-SPECT acquisitions. Polar maps are 8 bit images of perfusion, motion, ejection fraction (EF) and thickening, of the heart The software is written in Matlab, analyses the whole polar map and four ROIs corresponding to the theoretical LAD, LCX, RCA territories (perfused by these arteries) and extra-ROIs region. An intensity segmentation is performed. The area corresponding to pixels lower and higher than a varying cut-off are calculated on the whole image and for each ROI. The software calculates an intensity-area histogram, which is the analogous of the Dose-Volume Histogram used in radiation therapy: in this case, the histogram has the meaning of a Perfusion- or a Motion-Volume histogram. Then, the software applies the Lyman-Wolbarst algorithm, to calculate the area equivalent histogram reduction (e.g. the perfused area in the hypothesis that all pixels are perfused at 100%.). The makes a direct comparison between two different polar maps by choice. The comparison between the numerical quantification of motion and perfusion maps, allows the physicians to get a clinical evaluation of the stunned myocardium

How High to Fly? Mapping Evapotranspiration from Remotely Piloted Aircrafts at Different Elevations

Recent advancements in remotely piloted aircrafts (RPAs) have made frequent, low-flying imagery collection more economical and feasible than ever before. The goal of this work was to create, compare, and quantify uncertainty associated with evapotranspiration (ET) maps generated from different conditions and image capture elevations. We collected optical and thermal data from a commercially irrigated potato (Solanum tuberosum) field in the Wisconsin Central Sands using a quadcopter RPA system and combined multispectral/thermal camera. We conducted eight mission sets (24 total missions) during the 2019 growing season. Each mission set included flights at 90, 60, and 30 m above ground level. Ground reference measurements of surface temperature and soil moisture were collected throughout the domain within 15 min of each RPA mission set. Evapotranspiration values were modeled from the flight data using the High-Resolution Mapping of Evapotranspiration (HRMET) model. We compared HRMET-derived ET estimates to an Eddy Covariance system within the flight domain. Additionally, we assessed uncertainty for each flight using a Monte Carlo approach. Results indicate that the primary source of uncertainty in ET estimates was the optical and thermal data. Despite some additional detectable features at low elevation, we conclude that the tradeoff in resources and computation does not currently justify low elevation flights for annual vegetable crop management in the Midwest USA

How High to Fly? Mapping Evapotranspiration from Remotely Piloted Aircrafts at Different Elevations

Recent advancements in remotely piloted aircrafts (RPAs) have made frequent, low-flying imagery collection more economical and feasible than ever before. The goal of this work was to create, compare, and quantify uncertainty associated with evapotranspiration (ET) maps generated from different conditions and image capture elevations. We collected optical and thermal data from a commercially irrigated potato (Solanum tuberosum) field in the Wisconsin Central Sands using a quadcopter RPA system and combined multispectral/thermal camera. We conducted eight mission sets (24 total missions) during the 2019 growing season. Each mission set included flights at 90, 60, and 30 m above ground level. Ground reference measurements of surface temperature and soil moisture were collected throughout the domain within 15 min of each RPA mission set. Evapotranspiration values were modeled from the flight data using the High-Resolution Mapping of Evapotranspiration (HRMET) model. We compared HRMET-derived ET estimates to an Eddy Covariance system within the flight domain. Additionally, we assessed uncertainty for each flight using a Monte Carlo approach. Results indicate that the primary source of uncertainty in ET estimates was the optical and thermal data. Despite some additional detectable features at low elevation, we conclude that the tradeoff in resources and computation does not currently justify low elevation flights for annual vegetable crop management in the Midwest USA

Could fluorescence‑guided surgery be an efficient and sustainable option? A SICE (Italian Society of Endoscopic Surgery) health technology assessment summary

Indocyanine green fluorescence vision is an upcoming technology in surgery. It can be used in three ways: angiographic and biliary tree visualization and lymphatic spreading studies. The present paper shows the most outstanding results from an health technology assessment study design, conducted on fluorescence-guided compared with standard vision surgery