This timely presentation addresses the changes that are proposed under NICE's new value-based assessment (VBA) approach to assessing health technologies. It reviews NICE's current approach and decisions to date for all technologies and separately for orphan and cancer drugs. VBA's proposed calculations for burden of illness and societal impact use estimates of 'shortfall' are illustrated in the presentation. Also discussed are changes in QALY thresholds.
Pre conference workshop Economic Evaluations of Public Health Interventions
Amsterdam, EUPHA 2010
Public health economics was one of the themes of a pre conference at the 3rd European Public Health Conference in Amsterdam that took place from 10-13 November of 2010. Around 40 people participated at this pre conference. In four presentations the main topics in Public Health economics were introduced and illustrated. Economics is concerned with allocation of scarce resources in society over alternative uses. Some different types of evaluations were shown. The preference (utility) based health measure QALY (Quality Adjusted Life Years) was explained and discussed. In general methods for economic evaluations can be applied for evaluation of Public Health interventions. This was illustrated by a presentations on the economic impact of prevention strategies in tackling obesity. This study showed some good results in improving population health and decreasing health expenditure. However in many Public Health areas the effectiveness of public health interventions is still limited and should be assessed carefully concerning assumptions, costs calculated and models used.
More attention should be paid to inter-sectoral effects, equity considerations and a societal perspective in performing economic evaluations. Finally the involvement of relevant stakeholders is key to the success of Prevention.
The chair of this meeting concluded that Public Health and Economics could make a good couple. However for a longstanding relationship, we should put more effort in the evidence base of Public Health interventions. It is important that Public Health interventions demonstrate value for money!
Modeling an Integrated System for Obesity & Weight ManagementSIMUL8 Corporation
Worldwide obesity has more than doubled since 1980 (WHO; 2015). This is contributing to the growing number of patients living with chronic diseases and placing mounting pressure on health systems.
In 2013, part of the Public Health system in England transferred out of the NHS into local government. Responsibility for the prevention and management of obesity in adults and children transferred with these teams, while parts of the NHS primary and secondary care system remained responsible for aspects of treatment, including bariatric surgery.
This workshop explores the challenges in commissioning a healthcare organization to provide an integrated service for obesity, weight management, and treatment in Nottinghamshire County, UK. These challenges include:
- Estimating the health needs of overweight and obese people across the County
- Taking into account the fact that needs will change over time
- The lack of available evidence
Learn how out how Scenario Generator, a population health modeling and simulation tool, was used to test assumptions and develop the evidence to procure an integrated service
From effectively implementing electronic health records to reducing hospital readmissions to reporting more specific Medicare patient data, health care providers are reaping rewards from the Centers for Medicare and Medicaid Services for improving particular quality and safety measures. But many are also facing penalties, and the results for some institutions have been mixed. On the whole, the national readmission rate is dropping, but in 2014 a record 2,600-plus hospitals were fined for seeing too many patients return for care within 30 days, according to federal data.
This session will help attendees understand the range of CMS cuts and bonuses and a firsthand look at how the new regulations can help providers improve care.
This timely presentation addresses the changes that are proposed under NICE's new value-based assessment (VBA) approach to assessing health technologies. It reviews NICE's current approach and decisions to date for all technologies and separately for orphan and cancer drugs. VBA's proposed calculations for burden of illness and societal impact use estimates of 'shortfall' are illustrated in the presentation. Also discussed are changes in QALY thresholds.
Pre conference workshop Economic Evaluations of Public Health Interventions
Amsterdam, EUPHA 2010
Public health economics was one of the themes of a pre conference at the 3rd European Public Health Conference in Amsterdam that took place from 10-13 November of 2010. Around 40 people participated at this pre conference. In four presentations the main topics in Public Health economics were introduced and illustrated. Economics is concerned with allocation of scarce resources in society over alternative uses. Some different types of evaluations were shown. The preference (utility) based health measure QALY (Quality Adjusted Life Years) was explained and discussed. In general methods for economic evaluations can be applied for evaluation of Public Health interventions. This was illustrated by a presentations on the economic impact of prevention strategies in tackling obesity. This study showed some good results in improving population health and decreasing health expenditure. However in many Public Health areas the effectiveness of public health interventions is still limited and should be assessed carefully concerning assumptions, costs calculated and models used.
More attention should be paid to inter-sectoral effects, equity considerations and a societal perspective in performing economic evaluations. Finally the involvement of relevant stakeholders is key to the success of Prevention.
The chair of this meeting concluded that Public Health and Economics could make a good couple. However for a longstanding relationship, we should put more effort in the evidence base of Public Health interventions. It is important that Public Health interventions demonstrate value for money!
Modeling an Integrated System for Obesity & Weight ManagementSIMUL8 Corporation
Worldwide obesity has more than doubled since 1980 (WHO; 2015). This is contributing to the growing number of patients living with chronic diseases and placing mounting pressure on health systems.
In 2013, part of the Public Health system in England transferred out of the NHS into local government. Responsibility for the prevention and management of obesity in adults and children transferred with these teams, while parts of the NHS primary and secondary care system remained responsible for aspects of treatment, including bariatric surgery.
This workshop explores the challenges in commissioning a healthcare organization to provide an integrated service for obesity, weight management, and treatment in Nottinghamshire County, UK. These challenges include:
- Estimating the health needs of overweight and obese people across the County
- Taking into account the fact that needs will change over time
- The lack of available evidence
Learn how out how Scenario Generator, a population health modeling and simulation tool, was used to test assumptions and develop the evidence to procure an integrated service
From effectively implementing electronic health records to reducing hospital readmissions to reporting more specific Medicare patient data, health care providers are reaping rewards from the Centers for Medicare and Medicaid Services for improving particular quality and safety measures. But many are also facing penalties, and the results for some institutions have been mixed. On the whole, the national readmission rate is dropping, but in 2014 a record 2,600-plus hospitals were fined for seeing too many patients return for care within 30 days, according to federal data.
This session will help attendees understand the range of CMS cuts and bonuses and a firsthand look at how the new regulations can help providers improve care.
Eliciting societal preference for burden of illness, therapeutic improvement ...John Brazier
These slides are a short presentation of our work for the Department of Health for England on eliciting societal preferences for burden of illness. For full details our report at: seehttp://www.eepru.org.uk/VBP%20survey%20research%20report.pdf.
Thinking About Success and Failure in Obesity CareObesityHelp
Even though obesity has officially been classified as disease by important groups like the American Medical Association, many people – doctors included – put all the emphasis on the scale and on other measures like body mass index (BMI). In this talk we will look at how success is measured now and other ways to define success after bariatric surgery. Time allowing, we will also talk about some of the long-term issues related to health and nutrition after bariatric surgery, with a focus on things that contribute to weight regain.
Abdominal obesity : the risks factors .Redustim, a medical device solutionCOSMOSOFT SAS
Redustim is a class 2a medical device based on an innovative procedure that uses BioMagnetic action to gradually reduce harmful abdominal fat. The 100% hands-free treatment delivers visible results after 12 x 30 minute sessions. ReduStim is suitable for all patients who want to reduce their waist size. Clinical tests show an average reduction of more than 6 cm.
National Association of GPs Presentation 20 July 2013Oliver O'Connor
A presentation I gave at the EGM of Ireland's National Association of General Practitioners. Shows progress in some areas of health; payments to GPs since 2002; and argues that general practice should embrace measures which show its value and contribution to healthcare.
Eliciting societal preference for burden of illness, therapeutic improvement ...John Brazier
These slides are a short presentation of our work for the Department of Health for England on eliciting societal preferences for burden of illness. For full details our report at: seehttp://www.eepru.org.uk/VBP%20survey%20research%20report.pdf.
Thinking About Success and Failure in Obesity CareObesityHelp
Even though obesity has officially been classified as disease by important groups like the American Medical Association, many people – doctors included – put all the emphasis on the scale and on other measures like body mass index (BMI). In this talk we will look at how success is measured now and other ways to define success after bariatric surgery. Time allowing, we will also talk about some of the long-term issues related to health and nutrition after bariatric surgery, with a focus on things that contribute to weight regain.
Abdominal obesity : the risks factors .Redustim, a medical device solutionCOSMOSOFT SAS
Redustim is a class 2a medical device based on an innovative procedure that uses BioMagnetic action to gradually reduce harmful abdominal fat. The 100% hands-free treatment delivers visible results after 12 x 30 minute sessions. ReduStim is suitable for all patients who want to reduce their waist size. Clinical tests show an average reduction of more than 6 cm.
National Association of GPs Presentation 20 July 2013Oliver O'Connor
A presentation I gave at the EGM of Ireland's National Association of General Practitioners. Shows progress in some areas of health; payments to GPs since 2002; and argues that general practice should embrace measures which show its value and contribution to healthcare.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
2. 2
DISCLAIMER
• Views and opinions expressed are personal and not necessarily
those of UK government, NHS England, Public Health England or
other agencies
TITRE DE LA PRESENTATION (A MODIFIER SUR LE MASQUE)
3. 3
HTA: two questions
•How well does it work?
(compared to what we do now)
•What does it cost?
(compared to what we do now)
4. 4
Aim of session
• To understand basic concepts in health technology
assessment
• To know that assessment provides information not a
decision: committee judgement is still needed
• To understand common terms used in HTA reports:
§ Health states
§ Disease models
§ Discounting
TITRE DE LA PRESENTATION (A MODIFIER SUR LE MASQUE)
12. 12
Assessing effects – longer life
•Treatment X cures a fatal disease of
childhood
•Extends life by 80 years
TITRE DE LA PRESENTATION (A MODIFIER SUR LE MASQUE)
13. 13
IMPROVED QUALITY OF LIFE
•Improves quality of life
‘I no longer need to use a
wheelchair’
‘I’m not in pain’
‘I can do more’
14. 14
Measuring effects on quality of life
•How to MEASURE improvement in
quality of life?
•Standard method – describe health state
TITRE DE LA PRESENTATION (A MODIFIER SUR LE MASQUE)
15. 15
Assessing quality of life: the EQ5D
•Mobility
•Self Care – wash and dress
•‘Usual activities’
•Pain
•Anxious or depressed
TITRE DE LA PRESENTATION (A MODIFIER SUR LE MASQUE)
16. 16 TITRE DE LA PRESENTATION (A MODIFIER SUR LE MASQUE)
17. 17
Improvement in health state
Health state before:
•Extreme pain
•Moderately
depressed
•Some problem with
usual activity
Health state after:
•No pain
•No depression
•Some problem with
usual activity
TITRE DE LA PRESENTATION (A MODIFIER SUR LE MASQUE)
18. 18
Health gain
•20 years in health state A (without
treatment)
•20 years in health state B (with
treatment)
•Gain = 20 x QA gain
TITRE DE LA PRESENTATION (A MODIFIER SUR LE MASQUE)
19. 19
Growth hormone (simplified)
•Extra height as adult: extra utility = 0.1
•Adult life span 50 years
5 QALY gain
•Cost = £100 000
•£20 000 per QALY – cost is justified
TITRE DE LA PRESENTATION (A MODIFIER SUR LE MASQUE)
21. 21
ICER
•Incremental costs £100 000 more
•Incremental effects 5 QALY more
•Ratio £20 000 per QALY
•Incremental cost effectiveness ratio ICER
TITRE DE LA PRESENTATION (A MODIFIER SUR LE MASQUE)
22. 22
Incremental
•Incremental cost £10 000 more
•Incremental effect 5 QALY more
•More than what? – must specify comparator
§ usually what you’re doing now: ‘standard of care’
§ May differ from country to country
TITRE DE LA PRESENTATION (A MODIFIER SUR LE MASQUE)
23. 23
A note on ‘dominates’
•If the new treatment is better AND
cheaper it is said to ‘dominate’ the
comparator J
•… usually it’s better but costs more L
TITRE DE LA PRESENTATION (A MODIFIER SUR LE MASQUE)
24. 24
EXERCISE
NHS England budget for ‘specialised
services’
£ 17 000 000 000 per annum
How much of this should we spend on
cystic fibrosis?
TITRE DE LA PRESENTATION (A MODIFIER SUR LE MASQUE)
25. 25
RULES FOR WISE SPENDING?
TITRE DE LA PRESENTATION (A MODIFIER SUR LE MASQUE)
29. 29
SEVERITY
A proposal in Norway:
•Basic threshold c 30k / QALY
•Pay more for severe disease, but only up to x3
the normal limit.
•Severity – Absolute QALY shortfall of 30 QALY
or more
•Rarity – 1 in 100 000 or less
•Benefit – minimum 2 QALY
TITRE DE LA PRESENTATION (A MODIFIER SUR LE MASQUE)
41. 41
How models are used
• Patient move from one state to another
• Model usually assumes change every six months
• Model run for 20 years (or 50 years or…) – the ‘time horizon’
• Patients move from each state to another with a probability – the
‘transition probability’ for that transition
• Treatments change the transition probability – make it less likely
to transition from a healthy state to an ill state
• Patients should give the model a common sense check – are all
states included? Are the results obviously wrong after 20 years?
TITRE DE LA PRESENTATION (A MODIFIER SUR LE MASQUE)
44. 44
Summary – top tips
TITRE DE LA PRESENTATION (A MODIFIER SUR LE MASQUE)
45. 45
Top tips
§ THE COSTS
• Lobby for societal perspective (…you won’t win this one)
§ THE BENEFIT
• Ensure the quality of life measure covers all relevant problems –
EQ5D probably doesn’t
§ THE MODEL
• Check all relevant states included
• Check utility score for each state
§ THE TIME HORIZON
• Ask for an undiscounted analysis
TITRE DE LA PRESENTATION (A MODIFIER SUR LE MASQUE)
46. 46
Change the system?
§ Which spending rule:
» cost / QALY
» budget impact
» multi criterion
§ Special categories?
§ Spend more?
TITRE DE LA PRESENTATION (A MODIFIER SUR LE MASQUE)
47. 47 TITRE DE LA PRESENTATION (A MODIFIER SUR LE MASQUE)
