As a methodological tool, evidence-based management can assess the technological advantages and economical value of medical consumables scientifically, and select the most cost-effective products into the hospital access directory with guarantees of the development of clinical disciplines. Now this method has been widely used for consumable access management in our hospital. Policies and processes have been established to normalize the assess, allocation, and usage, and the management mode is transformed from experience-based management into evidence-based management. With clinical nominalism being changed, the method of evidence-based management can be used for every link of comsumble management, to reduce the costs and ensure the safety and quality of medical consumables at the same time, so as to promote the rational cost of medical consumables.
ObjectivesThe primary objectives of this rapid health technology assessment (RHTA) were to assess the safety and effectiveness of Da Vinci surgical system compared with traditional e surgeries, so as to provide the currently-available best evidence for health decision makers and clinical workers. MethodsA comprehensive search of electronic databases (EMbase, PubMed, The Cochrane Library, Web of Science, CNKI, VIP, CBM and WanFang Data) and relevant professional HTA websites were conducted from inceptionto October 9, 2012. Two reviews independently screen literature according to the inclusion and exclusion criteria, extracted data, and assess the quality of included studies. The data based on secondary studies were reported, and a final recommendation and its level was made based on assessment outcome. ResultsA total of 21 studies were included, encompassing 7 HTAs and 14 systematic reviews/metaanalyses. The included studies involved radical prostatectomy, hysterectomy, nephrectomy, coronary artery bypass graft, and gastric fundoplication. Though the included HTAs and systematic reviews/meta-analyses focus on different diseases, the outcomes showed significant differences existed between Da Vinci surgical system and other routine surgery in clinical effectiveness and safety of different diseases. Compared with routine surgery, Da Vinci surgical system shortened hospital stay; decreased operation conversion rates, blood loss and blood transfusion rates during surgery; but it increased operative time. Besides, compared with traditional laparoscopic surgery, Da Vinci surgical system shortened operation time and hospital stay, and decreased operation conversion rates, blood loss and blood transfusion rates during surgery. ConclusionCurrent evidence shows that the clinical effectiveness and safety outcomes of Da Vinci surgical system differ in diseases. Currently, most included HTAs and systematic reviews/meta-analyses are based on observational studies, relevant prospective randomized controlled trials lack, and the evidence is graded as low quality, health decision makers are suggested to apply this evidence with caution on the basis of comprehensive consideration.
ObjectiveTo utilize a rapid health technology assessment to evaluate the efficacy, safety and cost-effectiveness of the MitraClip device for patients with severe mitral regurgitation (MR). MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data, CBM and the CRD databases were electronically searched to collect clinical evidence and economic evaluations on the efficacy, safety and cost-effectiveness of the MitraClip device for patients with severe MR from inception to May 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; then, descriptive analyses and data summaries were performed. ResultsA total of 33 studies, involving 4 HTA reports, 3 RCTs, 16 systematic reviews or meta-analyses, and 10 economic evaluations were included. In the evidence comparing MitraClip and surgery, most of the literature showed that the MitraClip group had higher postoperative residual MR, fewer blood transfusion events, and fewer hospital days. We found no significant treatment effects on 30-day adverse events and mortality, and the 1-year and above survival rate. In the evidence of MitraClip versus medical therapy alone, all included studies showed that MitraClip benefited mid-term and long-term survival and reduced the incidence of subsequent cardiac hospitalizations. Economic evaluations showed that the clinical benefits were cost-effective in the setting of their health service systems. ConclusionThe available high-grade clinical evidence shows that MitraClip is effective and safe to some extent, and has cost-effectiveness compared with traditional treatment in other countries. However, the real-world effectiveness and cost-effectiveness of the MitraClip need to be tested in the Chinese population and health-care setting.
Health technology assessment is a systematic assessment of the nature and impact of health technology. It is a science that solves the problems of health intervention or health technology on society, economy, organization and ethics. Aiming at the current issues of availability, accessibility, affordability, rationality and safety in the field of medical devices, health technology assessment can systematically evaluate the characteristics, effects and impact of medical devices, and provide evidence-based basis for scientific decision-making. Starting from the current status and challenges of medical device management, this paper introduces the origin and development, basic scope, assessment process and main assessment content of health technology assessment, and introduces the application of health technology assessment in medical device management through case studies, so as to promote development of health technology assessment in the field of medical device management and make medical device management more scientific and standardized.
Hospital-based health technology assessment (HB-HTA) refers to the practice of health technology assessment for hospital management decision-making based on the actual situations in hospitals. It includes processes and methods of health technology assessment carried out in and for hospitals. Under the background of comprehensively promoting the reform of public hospitals in China, HB-HTA is undoubtedly an important scientific method to enhance the fine management of public hospitals and implement the policy of medical reform. This paper introduced the concept, the international and domestic development status, the characteristics of HB-HTA, and put forward the scheme of development of HB-HTA macroscopically, so as to promote the popularization and applications of HB-HTA in China.
ObjectiveTo construct rapid health technology assessment (RHTA) reporting norms, with a view to providing methodological references for RHTA research and reporting. MethodsBased on the preliminary pool of entries constructed by the literature research results, and taking into account the characteristics of RHTA, a Delphi expert correspondence questionnaire was designed, and 25 experts in the field of HTA were selected to conduct multiple rounds of expert correspondence. By calculating the expert authority coefficient and opinion coordination coefficient, combined with the average value of the entry score, coefficient of variation and full score ratio, the entries were selected to form the list of RHTA report specifications. ResultsThe positive coefficient of experts in both rounds of investigation was 100%, the expert authority coefficient in the first round was 0.858, and the expert authority coefficient in the second round was 0.838. The Kendall coordination coefficient in the first round was 0.169, and in the second round it was 0.081. According to the correspondence of 2 rounds of investigation, the final formation included 8 aspects, 26 first-level entries and 18 second-level entries in the list of RHTA report specifications. ConclusionThis study constructed the RHTA report specification, which is both scientific and operable, providing a reference for RHTA report writing.
Health insurance system has been proved to be an effective way to promote the quality of health service in many countries. However, how to control health expenditure under health insurance system remains a problem to be resolved. Some developed countries like UK, Canada and Sweden linked their health technology assessment results with decision making and health insurance management, and made prominent achievements in both expenditure control and quality improvement. China is carrying out its health system reform and running a new health insurance project. Using the experiences of other countries is undoubtedly of great importance in developing and managing our health insurance system.
Objective To comprehensively summarize and analyze the status quo, assessing contents and problems of the assessment studies on appropriate health technology in China. Methods With the search terms and strategies predefined by repeated discussion and pre-retrieval, all literature on appropriate health technology assessment in China published from October 1949 to March 2012 were searched in the following databases: CBM, VIP, CNKI and WanFang Data. According to the inclusion and exclusion criteria, two reviewers independently screened literature, and extracted and cross-checked data. Disagreements were resolved by discussion or by involving a third researcher. The qualitative synthesis method was used to analyze the studies. Results Among total 174 included studies, 117 were cross-sectional. Targeted populations were patients and community residents who had received the service or treatment of appropriate health technology, as well as the grassroots medical staffs and workers from marketing organization who had used or carried out the appropriate health technologies. Appropriate health technologies mainly contained four fields of appropriate health technology: traditional Chinese medicine, western medicine, family planning services and community health services. Most types of diseases involved in those technologies were circulatory system diseases, and high blood pressure was highly concerned. The contents of appropriate health technology assessment mainly included 6 aspects: effectiveness, acceptability, economic characteristics, requirements, safety and technical specific property. The results of the included studies indicated that, most assessments focused on just one aspect, and were lack of comprehensive evaluation. The indexes used in each assessment covered a far too wide range, and was lack of unified index and standards. Conclusion Current studies show that the fields of appropriate health technology assessment distribute widely; the assessment content is simple and lack of comprehensive evaluation; the assessment index system has no unified standard; and the study design methods are different and lack of high quality study design. So it is necessary to conduct high quality assessment studies, establish scientific assessment index system, and systematically assess appropriate health technology, so as to provide more scientific basis for health decision makers.
Health technological innovation has helped to improve health care delivery and patient outcomes. However, the proliferation of health care technology has accompanied burgeoning health care costs and evoked social, ethical, legal, and political concerns. Health technology assessment (HTA) is the systematic evaluation of properties, effects and/or other impacts of health care technology. The main purpose of HTA is to inform persons of technology-related policy making in health care. There is great variation in the scope, selection of methods and level of detail in the practice of HTA. This paper will introduce the basic concepts and methods of HTA in order to help those who are interested in conducting HTA.
ObjectivesTo explore the using status of psychological assessment instruments including checklists, questionnaires and scales after earthquake, so as to provide baseline data for establishing a standard method and process in developing earthquake-related population psychological screening and assessment instruments in future. MethodsWe searched WanFang Data, CNKI, VIP, PubMed, EMbase, The Cochrane Library and CiNii databases, as well as special websites about earthquake and disaster management from inception to July 30th, 2014 to collect studies evaluating the population psychological health conditions with assessment instruments after earthquakes. The earthquake countries/regions, the main assessment institutions, the time of assessment, the objects of assessment, and the instruments used were analyzed. ResultsA total of 794 studies were included, of which 87.4% were from mainland China, and 78.0% were related to the Wenchuan earthquake. Most of assessments were conducted by universities (47.9%) and hospitals (46.9%) in Sichuan, Beijing and Guangdong provinces of China. The psychological assessments conducted in the first year after quake were found in 537 studies (67.6%), of which 244 studies (45.4%) reported the psychological assessments results in the first month after quake. The top five assessment objects were children/teenagers, survivors, wounded, military rescuers, and medical staff. In the 794 included studies, a total of 217 instruments were used. In the 244 studies reported the assessment results in the first month after quake, a total of 73 instruments were used. 122 of the 244 studies reported only one instrument was used, and the other 122 of the 244 studies reported two or more instruments were used. Most of the instruments were translation versions and developed for mental disorders. The top 5 instruments were Symptom Checklist 90, Self-Rating Depression Scale, Self-Rating Anxiety Scale, PTSD Checklist-Civilian Version and Impact of Event Scale Revised, respectively. ConclusionAll the psychological assessment instruments are not developed for assessing earthquake-related psychological health problem, so a simple, economic, feasible and specialized instrument for earthquake-related population should be developed. It's needed to organize professionals to design a local guideline and training material for earthquake survivors and rescuers, and to establish a standardized, sustainable normal training base and trainer's team, so as to standardize the psychological aid work.