Deploying a spreadsheet tool for early economic value assessment of medical device innovations with healthcare decision makers

Early stage evaluation of medical device innovations is important for healthcare decision-makers as much as for manufacturers, meaning that a wider application of a basic cost-effectiveness analysis is becoming necessary outside the usual expert base of health technology assessment specialists. Resulting from an academic-industry-healthcare professional collaboration, a spreadsheet tool is described that was designed to be accessible both to professionals in healthcare delivery organisations and to innovators in the healthcare technology industry who are non-experts in the field of health economics. The tool enables a basic cost-effectiveness analysis to be carried out, using a simplified decision-tree model to compare costs and patient benefit for a new device-related procedure with that of standard care employing an incumbent device or other alternative. Such a tool is useful to healthcare professionals because it enables them to rapidly elucidate the cost-effectiveness of heterogeneous innovations by means of the standard quality adjusted life year (QALY) measure of clinical outcome, which is intended to be broadly comparable across treatments. For the innovator or manufacturer it helps them focus on what is required for future stages of development, in order to fill gaps in the input data and so further strengthen their case from a health economics perspective. Results are presented of first experiences from deploying the tool on three medical device exemplars, in face-to-face meetings of the NHS National Innovation Centre (NIC) along with the innovator or clinical champion. The results show that mapping of device-related innovations to the tool is achievable in a short meeting between the NIC and the innovator using expected costs, outcomes data from the literature and estimates of ranges for unknown input data. Whilst the result of a simplified analysis is not expected to be definitive, the process of reasoning is found to be illuminating for the parties involved, enabling innovators to articulate the benefits of their innovations and for all parties to highlight gaps in data and evidence that will be required to take the innovation forward. The partnership model of the authors’ organisation supports the kind of cooperative design approach that is necessary to produce the kind of tool described.---------------------------7dd39101208fa Content-Disposition: form-data; name="c14_creators_1_name_family" Crave

Cuff-less continuous blood pressure monitoring system using pulse transit time techniques

This paper describes the development of a continuous cuff-less blood pressure system based on the pulse transit time (PTT) technique. In this study, PTT is defined by two different approaches denoted as PTT1 and PTT2. PTT1 is the time difference between the R-wave peak of the Electrocardiogram (ECG) and the peak of the Photoplethysmogram (PPG). PTT2 is the time difference between two peak PPG signals on same cardiac cycle at different positions on the body. The ECG is acquired on the chest using 3 lead electrodes and a reflection mode optical sensor is deployed on brachial artery and fingertip to monitor the PPGs. These data were synchronized using a National Instruments data acquisition card along with Matlab software for subsequent analysis. A wrist-type cuff-based blood pressure device was used to measure blood pressure on the right hand. Brachial blood pressure was measured on the upper left arm using oscillometric blood pressure monitor. Experiments were conducted by elevating the right hand at different position to investigate variability of PTT under the effects of hydrostatic pressure. Next the variability of PTT due to blood pressure changes during a Valsalva maneuver was investigated. The result shows that the PTT1 is inversely proportional to blood pressure in both experiments. Meanwhile, there is weak correlation between PTT2 and blood pressure measurement which suggests that by excluding the pre-ejection period (PEP) time in PTT calculation may reduce the accuracy of PTT for blood pressure measurement. In conclusion, PTT measurement between ECG and PPG signals has potential to be a reliable technique for cuff-less blood pressure measurement

Development of tubular cardiovascular phantom system for pulse transit time simulation

This paper presents on the development of a tubular cardiovascular phantom system to simulate pulse transit time (PTT). The PTT defined as the delay time between two pulses in one cardiac cycle has been shown to be promising method for cuffless continuous blood pressure (BP) measurement. However most of the PTT measurement was performed on human subjects, thus giving a difficulty in validating sensor performance due to variability of BP. Therefore, a cardiovascular phantom system was proposed for simulate the PTT measurement. An electronic controlled module was developed to control pump operation for pulse generation. Plastic optical fibre (POF) sensors were used to measure the pulse signal on the flexible tube and the results were compared with an in-line pressure sensor. In this experiment, the delay time between two pulses were calculated offline using Matlab software and correlated with pulse pressure. The result demonstrate that the pulse delay time recorded by both sensors decreased with increase of pulse rate and pulse pressure. These results on the phantom study showed similar pattern to the human model, thus indicating that the system is able to simulate PTT for sensor validation purposes

Sensitive protein detection using an optical fibre long period grating sensor anchored with silica core gold shell nanoparticles

Copyright ©2014 Society of Photo-Optical Instrumentation Engineers. This paper was published in the Proceedings of SPIE and is made available with permission of SPIE. One print or electronic copy may be made for personal use only. Systematic electronic or print reproduction and distribution, duplication of any material in this paper for a fee or for commercial purposes, or modification of the content of the paper are prohibited.An optical fibre long period grating (LPG), modified with a coating of silica gold (SiO2:Au) core/shell nanoparticles (NPs) deposited using the layer-by-layer (LbL) method, was employed for the development of a bio-sensor. The SiO2:Au NPs were electrostatically assembled onto the LPG with the aid of a poly(hydrochloride ammonium) (PAH) polycation layer. The LPG sensor operates at the phase matching turning point to provide the highest sensitivity. The SiO2:Au NPs were modified with biotin, which was used as a ligand for streptavidin (SV) detection. The sensing mechanism is based on the measurement of the refractive index change induced by the binding of the SV to the biotin. The lowest detected concentration of SV was 19 nM using an LPG modified with a 3 layer (PAH/SiO2:Au) thin film

Investigating the role of Hedgehog/GLI1 signaling in glioblastoma cell response to temozolomide.

Resistance to chemotherapy substantially hinders successful glioblastoma (GBM) treatment, contributing to an almost 100% mortality rate. Resistance to the frontline chemotherapy, temozolomide (TMZ), arises from numerous signaling pathways that are deregulated in GBM, including Hedgehog (Hh) signaling. Here, we investigate suppression of Hh signaling as an adjuvant to TMZ using U87-MG and T98G cell lines as in vitro models of GBM. We found that silencing GLI1 with siRNA reduces cell metabolic activity by up to 30% in combination with TMZ and reduces multidrug efflux activity by 2.5-fold. Additionally, pharmacological GLI inhibition modulates nuclear p53 levels and decreases MGMT expression in combination with TMZ. While we surprisingly found that silencing GLI1 does not induce apoptosis in the absence of TMZ co-treatment, we discovered silencing GLI1 without TMZ co-treatment induces senescence as evidenced by a significant 2.3-fold increase in senescence associated β-galactosidase staining, and this occurs in a loss of PTEN-dependent manner. Finally, we show that GLI inhibition increases apoptosis in glioma stem-like cells by up to 6.8-fold in combination with TMZ, and this reduces the size and number of neurospheres grown from glioma stem-like cells. In aggregate, our data warrant the continued investigation of Hh pathway inhibitors as adjuvants to TMZ chemotherapy and highlight the importance of identifying signaling pathways that determine whether co-treatment will be successful

Can health economics aid decision making in healthcare innovation in academia?

Health economics is extensively used by reimbursement agencies to make decisions on whether to adopt new medical technologies. It is also used by the healthcare industry as an aid to decision making during product development. This paper proposes that academic healthcare technology transfer could also benefit from adopting health economics. The study investigated the knowledge and attitudes of academic staff involved in developing and transferring healthcare technologies. The participants had little or no prior knowledge of health economics; however, the majority reported that this method had the potential to aid development and commercialisation. The innovations developed by the workshop attendees and their commercialisation plans were of a type that could potentially benefit from cost-effectiveness calculations. Health economics has the potential to make valuable contribution to academic healthcare innovation. Research is required to develop this method further and ensure that it can be successfully applied in academia

Carbon dioxide measurements using long period grating optical fibre sensor coated with metal organic framework HKUST-1

An optical fibre long period grating (LPG) based carbon dioxide (CO2) sensor coated with HKUST-1, a material from the metal organic framework family, functional coating is presented. In-situ crystallization and layer by layer (LbL) techniques of HKUST-1 thin film synthesis are compared in terms of the feasibility of the deposition procedure (time and cost efficiency) and the sensitivity of the film to carbon dioxide. The sensing mechanism is based on the measurement of the change of the refractive index (RI) of the coating that is induced by the penetration of CO2 molecules into the HKUST-1 pores. The HKUST-1 film was characterized by scanning electron microscopy (SEM). The thickness and refractive index (RI) of the 10, 20 and 40 layers thick films were determined using ellipsoetry. The crystallinity of the films was examined by X-ray diffraction pattern (XRD). While no response to CO2 was observed for the sensor coated using the in-situ crystallization technique, an LPG modified with 10, 20 and 40 layers of HKUST-1 films using LbL method upon exposure to CO2 in the range of 500 ppm to 40,000 ppm showed good sensitivity. The film containing 40 layers exhibited the highest sensitivity to CO2 with an obtained detection limit of 401 ppm

Multi-exposure laser speckle contrast imaging using a high frame rate CMOS sensor with a field programmable gate array

A system has been developed in which multi-exposure Laser Speckle Contrast Imaging (LSCI) is implemented using a high frame rate CMOS imaging sensor chip. Processing is performed using a Field Programmable Gate Array (FPGA). The system allows different exposure times to be simulated by accumulating a number of short exposures. This has the advantage that the image acquisition time is limited by the maximum exposure time and that regulation of the illuminating light level is not required. This high frame rate camera has also been deployed to implement laser Doppler blood flow processing enabling direct comparison of multi-exposure laser speckle contrast imaging and Laser Doppler Imaging (LDI) to be carried out using the same experimental data. Results from a rotating diffuser indicate that both multi-exposure LSCI and LDI provide a linear response to changes in velocity. This cannot be obtained using single-exposure LSCI unless an appropriate model is used for correcting the response

Strategic placement of automated external defibrillators (AEDs) for cardiac arrests in public locations and private residences

Aim: The aim of our study was to determine whether businesses can be identified that rank highly for their potential to improve coverage of out-of-hospital cardiac arrests (OHCAs) by automated external defibrillators (AEDs), both in public locations and private residences. Methods: The cohort comprised 10,422 non-traumatic OHCAs from 2014 to 2020 in Perth, Western Australia. We ranked 115 business brands (across 5,006 facilities) for their potential to supplement coverage by the 3,068 registered public-access AEDs in Perth, while accounting for AED access hours. Results: Registered public-access AEDs provided 100 m coverage of 23% of public-location arrests, and 4% of arrests in private residences. Of the 10 business brands ranked highest for increasing the coverage of public OHCAs, six brands were ranked in the top 10 for increased coverage of OHCAs in private residences. A public phone brand stood out clearly as the highest-ranked of all brands, with more than double the coverage-increase of the second-ranked brand. If all 115 business brands hosted AEDs with 24–7 access, 57% of OHCAs would remain without 100 m coverage for public arrests, and 92% without 100 m coverage for arrests in private residences. Conclusion: Many businesses that ranked highly for increased coverage of arrests in public locations also rank well for increasing coverage of arrests in private residences. However, even if the business landscape was highly saturated with AEDs, large gaps in coverage of OHCAs would remain, highlighting the importance of considering other modes of AED delivery in metropolitan landscapes

Polymeric optical fibre sensor coated by SiO2 nanoparticles for humidity sensing in the skin microenvironment

The sensitivity of a low-cost polymeric optical fibre humidity sensor based on transmittance changes due to evanescent wave absorption is reported using test measurements in an environmental chamber and of the skin. The layer-by-layer method was used to coat 30mm of the central unclad section of a multimode polymeric optical fibre with 7 layers of a hydrophilic film consisting of bilayers of poly(allylamine hydrochloride) and SiO2 mesoporous nanoparticles. Sensor characterisation shows a decrease in light transmission as relative humidity increases as a result of refractive index changes of the coating deposited onto the optical fibre which correlates with a commercial capacitive humidity sensor. The sensitivity obtained for the sensor coated with an optimum 7 layers was approximately -3.87x10-3 and -9.61x10-3 in transmittance percentage per RH percentage for the range of ~10% to ~75% RH and 90% to 97% RH, respectively. In addition, a response time of 1.5s can be seen for breath monitoring with the polymeric optical fibre humidity sensor. The proof of concept measurements made on the skin indicate that this sensor has the potential to be used to monitor humidity of the skin microenvironment within a wound dressing which can be used to provide better prognosis of healing