The document provides an overview of health technology assessment (HTA) in India. It discusses how HTA can help optimize resource allocation and ensure affordable access to essential healthcare as part of India's universal health coverage agenda. The HTAIn was established to conduct HTA studies to inform decision making. HTAIn's objectives include maximizing health outcomes while reducing costs and inequality. It has completed several studies that have informed policies on topics like safety engineered syringes, intraocular lenses for cataracts, and long acting contraceptives. Ongoing studies cover additional health technologies. HTAIn aims to support evidence-based policies to expand coverage and financial risk protection.
Presentation delivered by Dr Adham Ismail, Regional Adviser, Health Technologies at the 62nd Session of the WHO Regional Committee for the Eastern Mediterranean
> Why HEOR?
> Costs, Consequences and Perspectives
> Key Stakeholders in HEOR
> What is Health Economics and Pharmaco-economic Research?
> Economic Evaluations
> Incremental Cost Effectiveness Ratio (ICER)
> Concept of HRQoL
> Comparative Effectiveness Research (CER)
> Pragmatic Clinical Trials
> Observational Studies
> Systematic Reviews and Meta-Analysis
> Application of CER
> Health Technology Assessment (HTA)
> Real World Evidence (RWE)
> Patient Reported Outcomes (PROs)
> Patient Focused Drug Development (PFDD)
> Application of Health Economic Evaluations
> Challenges and Barriers
Presentation delivered by Dr Adham Ismail, Regional Adviser, Health Technologies at the 62nd Session of the WHO Regional Committee for the Eastern Mediterranean
> Why HEOR?
> Costs, Consequences and Perspectives
> Key Stakeholders in HEOR
> What is Health Economics and Pharmaco-economic Research?
> Economic Evaluations
> Incremental Cost Effectiveness Ratio (ICER)
> Concept of HRQoL
> Comparative Effectiveness Research (CER)
> Pragmatic Clinical Trials
> Observational Studies
> Systematic Reviews and Meta-Analysis
> Application of CER
> Health Technology Assessment (HTA)
> Real World Evidence (RWE)
> Patient Reported Outcomes (PROs)
> Patient Focused Drug Development (PFDD)
> Application of Health Economic Evaluations
> Challenges and Barriers
This describes the background problem, concept of health insurance, enrollment procedure, benefits,and implementation status of health insurance in Nepal, issues/concerns (discussion), take home message
HEALTH SECTOR REFORMS- INDIA
Slides contain;
Reforms & Health System
Definition- HSR
Introduction
Financial reforms
Structural re-organization
Communication
Quality Assurance
Convergence
Public Private Partnership
Ways forward for effective HSR
Conclusion and points for Consideration
End
Mode of Human Resource for Health Production in Nepal
Various Academic and Non Academic Institutes and Councils producing all sorts of Human Resource for Health in Nepal.
Universal Health Coverage (UHC) Day 12.12.14, NepalDeepak Karki
This presentation is made on the first ever Universal Health Coverage (UHC) Day 12.12.14 celebration in Nepal by Nepal Health Economics Association (NHEA).
Concept of Economic Evaluation in Health CarePrabesh Ghimire
Declaration: The materials incorporated in this document have come from variety of sources and compiler bears no responsibilities for any information contained herein. The compiler acknowledges all the sources although references have not been explicitly cited for all the contents in this document.
Health economics is a branch of economics concerned with issues related to efficiency, effectiveness, value and behavior in the production and consumption of health and healthcare.
This describes the background problem, concept of health insurance, enrollment procedure, benefits,and implementation status of health insurance in Nepal, issues/concerns (discussion), take home message
HEALTH SECTOR REFORMS- INDIA
Slides contain;
Reforms & Health System
Definition- HSR
Introduction
Financial reforms
Structural re-organization
Communication
Quality Assurance
Convergence
Public Private Partnership
Ways forward for effective HSR
Conclusion and points for Consideration
End
Mode of Human Resource for Health Production in Nepal
Various Academic and Non Academic Institutes and Councils producing all sorts of Human Resource for Health in Nepal.
Universal Health Coverage (UHC) Day 12.12.14, NepalDeepak Karki
This presentation is made on the first ever Universal Health Coverage (UHC) Day 12.12.14 celebration in Nepal by Nepal Health Economics Association (NHEA).
Concept of Economic Evaluation in Health CarePrabesh Ghimire
Declaration: The materials incorporated in this document have come from variety of sources and compiler bears no responsibilities for any information contained herein. The compiler acknowledges all the sources although references have not been explicitly cited for all the contents in this document.
Health economics is a branch of economics concerned with issues related to efficiency, effectiveness, value and behavior in the production and consumption of health and healthcare.
Detailing the overall profile of the Healthcare sector in India and Gujarat, this presentation makes a point for the immense business & investment opportunities present in the sector owing to government initiatives & schemes to achieve accessible, affordable & quality healthcare for all.
Seeking value: Experience from the UK's National Institute for Health and Car...OECD Governance
This presentation was made by Tommy Wilkinson, United-Kingdom, at the 4th meeting of the Joint DELSA/GOV-SBO Network on Fiscal Sustainability of Health Systems, held in Paris on 16-17 February 2015.
Clinical research plays a vital role in advancing medical knowledge, developing new treatments, and improving patient care. However, conducting clinical trials involves numerous ethical and regulatory considerations to ensure participant safety, data integrity, and compliance with applicable laws and guidelines.
Introduction to Clinical Research RegulationsClinosolIndia
Clinical research plays a vital role in advancing medical knowledge, developing new treatments, and improving patient care. However, conducting clinical trials involves numerous ethical and regulatory considerations to ensure participant safety, data integrity, and compliance with applicable laws and guidelines.
NATIONAL INITIATIVE FOR ALLIED HEALTH SCIENCES
A STUDY TO AUGMENT THE CAPACITY AND QUALITY OF ALLIED HEALTH PROFESSIONALS IN INDIA
From ‘Paramedics’ to Allied Health Professionals: Landscaping the Journey and Way Forward - 2012
The report commissioned by the MINISTRY OF HEALTH AND FAMILY WELFARE - Government of India
Once upon a time India's health care system was dominated by Ayurveda- the holistic health approach to keep persons disease free by adopting healthy life style.
With so many attacks on Indian heritage Ayurveda was pushed back for centuries. Indian government never promote this health system as main health delivery tool.
Now Prime Minister Shri Narendra Modi launches a much needed mission to make Ayush as one of main health delivery system in India.
Here are salient features of National Ayush Mission
This report highlights the main findings from the EIU assessment of value-based healthcare (VBHC) alignment in 25 countries. The study was commissioned by Medtronic, a global technology and medical devices company. As VBHC is an early-stage concept and model, this study was an effort to establish a standard of evaluation of value-based healthcare alignment and establish the core components of the enabling environment for VBHC.
ICH GCP guidelines for mpharmacy 2nd sem 204T subject.
topic include the brief description regarding ICH GCP
THE GOOD CLINICAL PRACTICES AND
THE INTERNATIONAL CONFERENCE OF HORMONIZATION.
THAT INCLUDE the regulation of all pharmaceutical industries.
Laws and Guidelines on Clinical Trials in India.pptxmehulsarathy
Diving into the Regulatory Framework: Navigating Clinical Trial Laws & Guidelines in India. This academic presentation offers an in-depth analysis of the legal landscape governing clinical research in India. Delve into the intricate web of regulations, ethical principles, and participant protection measures outlined by the Drugs and Cosmetics Act, ICMR guidelines, and recent amendments.
Ethiopia: Governing for Quality Improvement in the Context of UHCHFG Project
The government of Ethiopia launched the Health Sector Development Program (HSDP) in the 1990s. During the 2010 reform of the health sector, the Drug Administration and Control Agency was re-established to focus on regulating drugs and food, and expanded their scope by including the regulation of health facilities and personnel. They changed their name to the Ethiopian Food, Medicine and Healthcare Administration and Control Authority, and developed a list of minimum health facility requirements, regulating both public and private health facilities.
Presentation by David Wonderling, Head of Health Economics at National Guideline Centre, Royal College of Physicians and Lauren Ramjee, Senior Health Economist, Royal College of Physicians.
This workshop outlines the principles of health economic evaluation for the NHS.
Evidence-Based PracticeEvidence-based Practice Progra.docxelbanglis
Evidence-Based
Practice
Evidence-based Practice
Program
The Agency for Healthcare Research and
Quality (AHRQ), through its Evidence-
based Practice Centers (EPCs), sponsors
the development of evidence reports and
technology assessments to assist public-
and private-sector organizations in their
efforts to improve the quality of health
care in the United States. The reports
and assessments provide organizations
with comprehensive, science-based
information on common, costly
medical conditions and new health care
technologies. The EPCs systematically
review the relevant scientific literature
on topics assigned to them by AHRQ
and conduct additional analyses when
appropriate prior to developing their
reports and assessments.
AHRQ expects that the EPC evidence
reports and technology assessments will
inform individual health plans, providers,
and purchasers as well as the health care
system as a whole by providing important
information to help improve health care
quality.
The full report and this summary are
available at www.effectivehealthcare.
ahrq.gov/reports/final.cfm.
Background
The United States spends a greater proportion
of its gross domestic product on health care
than any other country in the world (17.6
percent in 2009),1 yet often fails to provide
high-quality and efficient health care.2-6 U.S.
health care has traditionally been based on a
solid foundation of primary care to meet the
majority of preventive, acute, and chronic
health care needs of its population; however,
the recent challenges facing health care in
the United States have been particularly
magnified within the primary care setting.
Access to primary care is limited in many
areas, particularly rural communities. Fewer
U.S. physicians are choosing primary care as
a profession, and satisfaction among primary
care physicians has waned amid the growing
demands of office-based practice.7 There has
been growing concern that current models
of primary care will not be sustainable for
meeting the broad health care needs of the
American population.
The patient-centered medical home (PCMH)
is a model of primary care transformation that
seeks to meet the variety of health care needs
of patients and to improve patient and staff
experiences, outcomes, safety, and system
efficiency.8-11 The term “medical home”
was first used by the American Academy of
Pediatrics in 1967 to describe the concept of a
single centralized source of care and medical
record for children with special health care
Evidence Report/Technology Assessment
Number 208
2. The Patient-Centered Medical Home
Closing the Quality Gap: Revisiting the State of the Science
Executive Summary
2
needs.12 The current concept of PCMH has been greatly
expanded and is based on 40 years of previous efforts to
redesign primary care to provide the highest quality of care
possible.13,14 The chronic care model,15,16 a conceptual
model for organizing chronic illness ...
Health technology assessment (HTA) is familiar as technique for gauging the value of specific medical technologies or approaches to care. As Adrian Towse points out, however, HTA has a much broader, ‘macro’ role in contributing to the efficiency of health care systems and supporting universal health coverage. This is particularly crucial in the face of increasing demands and limited budgets.
Medical Devices Rules 2017 Implementationshashi sinha
Medical Devices Rules are now enforced for all medical devices. It is important to know about the MDR 2017 and how it affects the Manufacturers, Importers and Distributors of Medical Devices and status of implementation.
Pharmacovigilance and Materiovigilance, Drugs and Cosmetics Act 1940shashi sinha
Pharmacovigilance and Materiovigilance monitors the adverse events arising out of use of Medicines and Medical Devices. This chapter also takes an overview of drugs and control act 1940. It is important to know about the side effects of medical devices and drugs and how to report the adverse events arising out of the usage of Drugs and Medical Devices
Pharmacovigilance and Materiovigilance, Drugs and Cosmetics Actshashi sinha
Due to side effects of Medicines and Medical Devices increasing day by day it is important to monitor the Adverse Events arising out of use of Medicines and Medical Devices. The Pharmacovigilance and Materiovigilance monitors adverse events arising our of usage of Drugs and Medical Devices respectively. This chapter also deals with Drugs and Cosmetics Act 1940 and their important provisions.
Medical Devices , regulations and e health solutionsshashi sinha
Medical Devices are now regulated in India. It is essential to know about the Medical Devices Regulations and how it is being implemented. Must know for all the manufacturers, importers and Distributors of Medical Devices.
Mechanical ventilators- Applications and Usageshashi sinha
The Medical Ventilators are also known as Mechanical Ventilators, Artificial Ventilators etc. We will henceforth refer all these as Ventilators.
When a patient breathes on its own it is known as Spontaneous Breathing and when the patient is unable to breathe on its own we use a device called Ventilator which helps the patient breathe artificially. This is called Mechanical Ventilation and is a method to mechanically assist the patient to breathe and in extreme cases replace the entire breathing process. Spontaneous breathing is done by a process called Respiratory System.
Suction machines- Applications and Maintenanceshashi sinha
Suction machines (also known as aspirators) are used to remove unwanted fluid from body cavities. They are found in operating theatres, delivery suites, ENT and emergency departments. Smaller specialised suctions are used in dental departments.
How it works
Suction is generated by a pump. This is normally an electrically powered motor, but manually powered versions are also often found. The pump generates a suction that draws air from a bottle. The reduced pressure in this bottle then draws the fluid from the patient via a tube. The fluid remains in the bottle until disposal is possible. A valve prevents fluid from passing into the motor itself.
Steam inhalators- Usage and Maintenanceshashi sinha
Steam inhalation is one of the most widely used home remedies to soothe and open the nasal passages and get relief from the symptoms of a cold or sinus infection.
Also called steam therapy, it involves the inhalation of water vapor. The warm, moist air is thought to work by loosening the mucus in the nasal passages, throat, and lungs. This may relieve symptoms of inflamed, swollen blood vessels in your nasal passages.
While steam inhalation won’t cure an infection, like a cold or the flu, it may help make you feel a lot better while your body fights it off. But as with any home remedy, it’s important to learn best practices so you don’t hurt yourself in the process.
Spirometry which means “the measuring of breath,” is a routinely used pulmonary function test (PFT) that measures the amount and speed of air that a person can inhale and exhale. Results from the test can be used to estimate lung function and aid in the diagnosis of certain respiratory disorders.
A spirometer is an apparatus for measuring the volume of air inspired and expired by the lungs. A spirometer measures ventilation, the movement of air into and out of the lungs. The spirogram will identify two different types of abnormal ventilation patterns, obstructive and restrictive.
Pulse oximeters- Application and Maintenanceshashi sinha
A pulse oximeter is a painless and reliable way for clinicians to measure a person's blood oxygen levels.
When you breathe, oxygen enters your lungs, passes through thin membranes and enters your blood stream — where it's then picked up by red blood cells and carried around the body to various organs.
A pulse oximeter is a tiny device that usually slides over your fingertip or clips on your ear lobe and uses infrared light refraction to measure how well oxygen is binding to your red blood cells. Oximeters report blood oxygen levels via an oxygen saturation measurement called peripheral capillary oxygen saturation, or SpO2. It has been used extensively to detect COVID early
Oxygen Cylinders and Flowmeter- Uses and Maintenanceshashi sinha
Oxygen cylinders contain oxygen under pressure, and the pressure gauge gradually falls as the cylinder is depleted. A full-size E cylinder (the size fitted to most anaesthetic machines) contains approximately 680 l of gas. Manufacturers label the cylinders to confirm this. The medical gas flowmeter is a medical device for oxygen or medical air inhalation of first-aid and hypoxic patients in the hospital, including oxygen flowmeter, and medical air flowmeter. Oxygen flowmeter is mainly used to regulate the flow of oxygen, oxygen humidification.
Oxygen concentrator-Applications and Maintenanceshashi sinha
Oxygen Concentrator is a Medical Device used to produce Oxygen from Compressed Air . An oxygen concentrator takes in air and separates the oxygen and delivers it into a person via a nasal cannula. Air is 79% nitrogen and 21% oxygen and a concentrator that works by plugging into a source of electricity delivers air that is upto 95% oxygen. The Technology is known as Pressure Swing Adsorption technology or PSA Technology.
A nebulizer is a device used to administer medication in the form of a mist inhaled into the lungs. Nebulizers are commonly used for treatment of cystic fibrosis, asthma and other respiratory diseases. The reason for using a nebulizer for medicine to be administered directly to the lungs is that small aerosol droplets can penetrate into the narrow branches of the lower airways. Large droplets would be absorbed by the mouth cavity, where the clinical effect would be low.
Multipara monitor -Application and Maintenanceshashi sinha
A multiparameter monitor is a medical device for monitoring a patient's vital signs. It is mainly used in intensive care, hospitalization or Emergency Room.
It is also known as Vital Signs Monitor in its basic model. In general, basic models are used to monitor cardiac activity (ECG), blood pressure (NIBP), respiration (RESP), oxygen saturation (SpO2) and temperature (TEMP).
Infrared Thermometer-IR thermometer -Uses and Maintenanceshashi sinha
When the outbreak of COVID-19 took place the IR Thermometers have been of immense use. This device can measure the temperature without touching the patient and its measurement don't require a contact with the person. It provides fast temperature measurement and is highly accurate .
Humidifiers for Ventilators- Uses and Maintenanceshashi sinha
Humidification is done in respiration therapy to add moisture and sometimes heat to the inspiratory air as the air output coming of the Ventilator is dry. Humidification is done to maintain the normal physiological conditions in the body. The dry air more than 4 lpm if forced into the lungs cause immediate loss of water and heat. The unit of humidity is mg/litre.
Humidifier is a device that adds molecular water to the air.
ECG machines -Operation and Maintenanceshashi sinha
ECG (or Electrocardiographs) machines are used to monitor the electrical activity of the heart and display it on a small screen or record it on a piece of paper. The recordings are used to diagnose the condition of the heart muscle and its nerve system.
BIPAP and CPAP are being used to support COVID patients for artificial respiratory support. This PPT Explains how the CPAP AND BIPAP Works and how to use and maintain these. equipment.
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
1. Health Technology Assessment in India
Department of Health Research
Ministry of Health and Family Welfare
Government of India
2. Introduction
1
• GoI is committed to extend healthcare services as part of India’s UHC agenda.
2
• Optimal utilization of existing resources to ensure that the greatest amount of health is bought
for every rupee spent.
3
• A challenge for the government is to devise ways to reduce catastrophic out of pocket health
expenditure and ensure affordable access to essential health care
4
• Health Technology Assessment (HTA), is a widely used methodology internationally for
optimization of resource allocation in health.
3. What is Health Technology Assessment
A multidisciplinary decision-making process that uses information about
the medical (clinical), social, economic, organizational and ethical
issues related to the use of a HT (such as medicines, vaccines,
biologicals, medical devices and clinical interventions) in a systematic,
transparent, unbiased, and robust manner. It aims to support the
formulation of safe and effective health policies that are patient
focused and seek to achieve best value of money and improved patients’
health outcomes.
A tool for evidence based decision making for health care benefits
4. Health Technology Assessment-Procedure
Choice A Choice B
Efficacy & Effectiveness
Equity & Budget Impact
Value for Money
Social, Legal & Ethical
Considerations
Systematic
Evaluation
Efficacy & Effectiveness
Equity & Budget Impact
Value for Money
Social, Legal & Ethical
Considerations
5. Model for HTA
Population
to be
included
Intervention Comparator Outcome
Time frame
for assessing
Setting of
Interest
6. Addressing Calls from User
Departments
Applications of HTA
Rationalizing Benefit Packages
Efficient Pricing & Procurement
Developing Standard Treatment
Workflows
Streamlining Reimbursement Process
UHC
7. HTA globally
In 2014, the World Health Assembly adopted a resolution on use of HTA to ensure
Universal Health Coverage.
8. Need for HTAIn
The need arose with the 12th
Five Year Plan for India by
Planning Commission - to
take into account 'cost
effectiveness studies to
frame clinical treatment
guidelines‘ and to assess
available therapies and
technologies
A commitment was made
in the Parliament in
response to a question
raised that 'the need to
establish such a board was
discussed and
recommended by 12th
Plan Working Group on
Health Research.
The Parliamentary
Standing Committee has
also commented that DHR
plans to focus on
programmes aimed at
making healthcare
affordable for the poor /
marginalized groups/
communities.
The draft National Health
Policy, 2015 and 2017 has
highlighted the importance
of HTA by stating `One
important capacity with
respect to introduction of
new technologies and their
uptake into public health
programmes is Health
Technology Assessment.
The concept note was
approved by Hon’ble
HFM on 09/09/2016 (F.
No. V-25011/476/2016-
HR). The board was
approved as MTAB
board and the division is
operational by the name
of Health Technology
Assessment in India
(HTAIn). .
9. Objectives of HTAIn
Maximising Health – Expanding coverage without
compromising the quality of healthcare services.
Reducing out of pocket expenditure - Achieving
reduction in proportion of catastrophic households
expenditures and consequent impoverishment.
Reducing Inequality - Minimizing disparity on account
of gender, poverty, caste, disability, other forms of social
exclusion and geographical barriers
10. HTAIn Structure
HTA
Project Appraisal Committee
HTA
Technical Appraisal Committee
HTAIn Secretariat
Technical Partners and Resource
Centre
HTAIn
BOARD
11.
12. Key Phases of the HTA Process
Topic Selection
Technical partner identification
Proposal development
Research and analysis
Appraisal of the evidence
Approval by the Board
Implementation by the User Departments
13. Progress of HTAIn from 2017 to August 2019:
16 Resource Centres approved and 8 centres
functional
10 Technical Partners established.
16 Technical Appraisal Committee Meetings
Conducted
2 Board Meetings Conducted
5 Studies completed and policy brief prepared for
disseminations of the recommendations
14. 24 ongoing Studies and 29 new topics received from Central
and State Governments of India
A multicentric Costing Study of Health Care Services in
India has been initiated in 16 States to support the
Ayushmann Bharat-PMJAY.
A multi centric EURO-QOL study for obtaining Quality of
Life of Indian Population has been initiated in 8 States
A compendium for 2 year progress, A HTAIn manual and
Data repository have been prepared
A website designed for HTAIN (htain.icmr.org.in)
15. • To assess the cost information from different parts
of the country, the study utilises the
Multidisciplinary Research Units (MRUs) of DHR
functional in government medical colleges in
different states of India.
• This multistate costing study aims to collect cost
information from 15 public tertiary medical colleges,
30 district hospitals and 40 private hospitals from
across the above mentioned States.
• The Costing is used to revise the health benefit
packages of Ayushmann Bharat-PMJAY
packages.the study has been completed for 855
packages and Phase 2 has been initiated for 493
packagaes
Costing of Health Services in India:
16. Hospital
Direct Service
centre
Indirect Service
centre
Ancilliary service
centre
Site Management and
Service centre
Outpatient clinics
Inpatient wards
Intensive care unit
Operation theatre
Diagnostic centre Dietetics
Laundry
Medical Records
Water supply
Electricity
Administration
Maintenance
Training
Supervision
Care Service
centre
Support service
centre
Methodology: Bottom-up costing methods
Human
Resources
Capital Equipments Consumables Non-
consumables
Overhead
17. • The present study aims to develop EuroQol five-
dimensional (EQ-5D-5L) health states value set for
Indian population.
• A cross-sectional survey using the EuroQol Group’s
Valuation Technology (EQVT) software will be
undertaken in representative sample of 2700
respondents.
• The respondents will be selected from 12 districts in 6
different states of India using a multistage stratified
random sampling technique.
• The participants will be interviewed in a face to face
setting using CAPI (computer assisted personal
interviewing) technique. Time trade off (TTO)
valuation will be done using 10 composite (cTTO)
tasks and 7 discrete choice experiment (DCE) tasks.
• The demographic data will be analyzed by descriptive
statistics. TTO values will be modeled using main
effects model that will include constant and 20 main
effects derived from the EQ- 5D-5L descriptive
system, using ordinary least squares (OLS)and tobit
models.
• The study will give a Health Index Threshold for
India
EuroQoL-5-Quality of Life international Study
19. Topics Completed
Health Technology Assessment of
Intraocular Lenses for treatment
of Age-related Cataracts in India
– HTAIn Secretariat, Delhi.
Cost Effectiveness of Safety
Engineered Syringes for
Therapeutic Use In India –
PGIMER, Chandigarh.
Health Technology Assessment of
Strategies for Cervical Cancer
Screening in India – PGIMER,
Chandigarh.
Health Technology Assessment of
Long Acting Reversible
Contraceptives in India –
NIRRH, Mumbai.
Health Technology Assessment of
Hemoglobinometers-AIIMS
20. Recommendations
• Our recommendations are that RUP should replace disposable/conventional syringes for therapeutic care in India.
• The prices of these SES should be reduced either through price negotiation using bulk purchasing, or through price regulation by central
agencies such as NPPA.
• More future research could be done to assess the cost-effectiveness of SES in combination with behaviour change communication (BCC)
strategies which can impact the demand of injections with better sensitization among population.
Safety Engineered Syringes
21. School of Public Health, PGIMER, Chandigarh
December, 2017
Decision Model
22. Key Findings for Safety Engineered Syringes
1-Implementing RUP, SIP and RUP+SIP will prevent the new BBIS due to unsafe injections by 96%, 3.9% and 99%, respectively.
2-The introduction of RUP, SIP and RUP+SIP syringes in India will incur an incremental cost of INR 43,064, INR 7,219,687 and INR 209,398 per QALY
gained, respectively.
3-RUP has a 93% probability to be cost effective at a threshold of per capita gross domestic product(GDP)).
4-RUP syringe will become cost saving at a unit price of INR 1.9. Similarly, SIP and RUP+SIP syringes will be cost-effective at a unit price less than INR
1.8 and INR 5.9 respectively.
5-At the national level, annual cost of disposable syringes for therapeutic care is INR 3.34 billion (USD 52.6 million). Introduction of RUP, SIP and
RUP+SIP incurs an additional cost of INR 10.3 billion (USD 162 million), INR 32.3 billion (USD 509 million) and INR 32.4 billion (USD 511 million) per
year. Implementing SES will save INR 4.2 billion (USD 66.2 million), INR 3.07 billion (USD 48.4 million) and INR 4.9 billion (USD 77.2 million)
annually with use of RUP, SIP and RUP+SIP, respectively on account of treatment cost averted.
6-The study estimated that if the current injection practices are continued for next 20 years, there will be 99,557, 47,618 and 5,650 new cases of HBV,
HCV and HIV, respectively which are attributable to NSI and reuse.
23.
24. HTA on Intraocular Lens for Cataract Surgery in India
• On the basis of clinical efficacy, cost, accessibility, availability and
feasibility, MSICS with rigid lens is most appropriate intervention to treat
cataract patients in India in current scenario.
• Phacoemulsification cataract surgery can be provided in those areas where
infrastructure and experts are available for Phaco. surgery.
• The benefit packages for Phaco with foldable lens and Small Incision
Cataract Surgery with rigid PMMA lenses may cost as 9606 INR and
7405 INR, respectively.
• The package is inclusive of initial OPD consultation, diagnostic
tests(optometry, vision test etc.), counselling, pre-surgery/ anesthetics,
surgery, ward, drugs, medical consumables, lens, food for patient and one
attendant and one follow-up visit cost.
25. HTA on Long Acting Reversible Contraceptives
• Addition of Nexplanon to current Family planning scenario in the public health sector of India
is found to be cost-effective. It could be considered for program introduction to improve the
contraceptive basket of choice in a phased manner. The model shows that larger the proportion
of method users, the higher is the cost-effectiveness.
• The pre-requisites recommended for Nexplanon introduction into the public health sector of
India are to be:
Conducting feasibility and acceptability studies before introducing Nexplanon with due
consideration to ethical issues of autonomy and coercion.
Program introduction could be phased top-down from Medical Colleges to 24X7 PHC level
manned by Medical Officers (MBBS), as Nexplanon requires surgical removal.
Effective pre-insertion counselling and preparedness for management of side-effects by
trained health personnel.
Efficient follow-up and tracking mechanism for users of Nexplanon
26. Health Technology Assessment of Strategies for Cervical Cancer Screening
• Screening with VIA every 5 years among the women of age 30-65 years is
recommended for India.
• A minimum 30% of screened positive patients are needed to be treated for VIA
every 5 years to remain cost effective. Similarly, lifetime risk of cervical cancer of at
least 0.7 is required for VIA 5 yearly to be cost effective.
• In terms of equity considerations and specifically considering the screening
strategy of VIA every 5 years, it was seen that there was around 30% more reduction
in cervical cancer cases and subsequent mortality in the bottom1/3rd of the income
population group as compared to upper 2/3rd of the income group in India. Similarly,
in terms of financial risk protection, bottom 1/3rd of the income group had greater
reduction in OOP expenditure (INR 1073 vs INR 770respectively) and more
households averted catastrophic health expenditure(520 vs 245 respectively) as
compared to upper 2/3rd in the cohort of 1 lakh women screened with VIA 5 yearly.
28. Diagnostic efficacy of digital hemoglobinometer (TrueHb), HemoCue and non- invasive
devices for screening patients for anemia in the field settings
• Invasive devices shows overall better performance than Non-invasive devices in the field
settings.
• For screening of Anemia, HemoCue (AUC 0.92, 95% CI 0.88-0.94) and True Hb (AUC
0.85, 95% CI 0.83-0.89) are comparable with no statistically significant difference
between the two.
• For screening of Severe Anemia, TrueHb (AUC 0.91, 95% CI 0.85-0.97) fares better than all
other devices including HemoCue (AUC 0.73, 95% CI 0.67-0.79)
• Overall it appears that TrueHb is better than HemoCue in estimating Hb including
severe anemia
• The cost of True Hb device is less, but the running cost is high as compared to HemoCue. The
cost of true Hb device is less but it's running cost is more than hemocue. The running cost to
the health system for measuring each test is RS 24.4 in rural areas for hemocue while it is RS
38.7 for true Hb. Considering operational issues, and accuracy across different weather
conditions true Hb seems to fare better than hemocue
29. Studies Approved by TAC
• Rapid Health Technology Assessment for incorporating TrueNat as a diagnostic tool for
tuberculosis under RNTCP in India
• Evaluation of Pulse Oximeter as the Tool to Prevent Childhood Pneumonia related
Mortality and Morbidity
• Cost effectiveness analysis Hypothermia detection devices (BEPMU, Thrmospot and fever
Watch) for pre-mature and low birth weight neonates in India.
• Health Technology Assessment of Uterine Balloon Tamponade for Management of
Postpartum Haemorrhage in India”
• Health Technology Assessment of Portable automated ABR Neonatal Hearing Screening
Device-Soham
30. Ongoing Studies
1.Breast Cancer Screening
2.Screening of Hypertension & Diabetes
3.Mobile Application based health program (TeCHO-plus) In
Gujarat State
4.Sickle-Scan For Diagnosis Of Sickle Cell Anaemia
5.Real Time RT-PCR For H1N1
6.Urine Analyzer (Right Biotic)
7.Automated Portable Blood Analyzer (Shonit/ i-STAT)
8.Cost Effectiveness Of Community Based Screening Under NACP
31. 14. Screening Of Hepatitis B & C At PHC In Tamil Nadu
15. Low Cost Portable Ventilator
16. Neonatal Resuscitator
17. PCI Vs CABG For LM Or TVD and PCI Vs. Optimal Medical Therapy For half Vessel Disease
18. VVI Vs. DDD Pacemakers For Patients With CHB
19. Inclusion Of Medtronic's ENTraview Device Under The National Programme For Prevention And Control Of
Deafness (NPPCD)
20. Portable ECG Facility at PHCs Of Ahmedabad District Of Gujarat
21. Burden Of HIV/Patient Load In Private Sector & How To Improve Private Sector Reporting
22. Home Based New Born Care (HBNC) By ASHA Workers In Select States –An Exploratory Study-ICMR,
NIMS, PHFI
23. Validation Of Optometrists And Cost Analysis Of Glaucoma Screening In Community Based Setting -
RPC, AIIMS, New Delhi
24. Screening for Dengue
25. HTA for high end equipments
26. Price Regulation & Value-Based Pricing for Anti-Cancer Drugs: Implications for Patients, Industry, Insurer &
Regulator
27. HTA for Techo +
28. HTA on portable ECG
29 Cost-effectiveness of administering parenteral iron therapy through Iron-sucrose and Ferrous Carboxyl Maltose
for first line management of iron deficiency anemia among pregnant women in a natural program setting at
Sabarkantha, Gujarat
32. RUP Syringes for
Therapeutic Use
Intra Ocular Lenses for
Cataract
Selecting Efficient
Delivery Platforms
Developing Standard
Treatment Guidelines
Regulatory:
Pricing and
Procurement
Inclusion of Interventions
in Benefit Package
Screening for Cervical
Cancer with VIA at the
Frequency of 5 years
Use of Directly Acting
Antivirals (SOF/VAL)
for Hepatitis C
Safety Engineered
Syringes
Value Based Pricing of
Anti Cancer Drugs
Applications of HTA
33. Safety Engineered Syringes
HTA outcome report on
Safety Engineered
Syringes has been
implemented in Punjab
and Andhra Pradesh &
under the guidelines for
National prevention
against Hepatitis program
34. Central/State Participation
22 States have appointed Nodal officers for HTA
Topics Received from States-Maharastra, Kerala, Punjab, Tamil Nadu,
Meghalaya, Gujarat
MoU signed with 9 States
Programs like NPCB ,NACO,NPPCD,NPPA have also sent topics
38. Need for the Act
• An Act to institutionalise the structure and function of the HTAIn body.
• It would not only make innovative health tools reach patients faster, but also boost
innovation and improve competitiveness of the healthcare sector, which accounts for 10 %
of the GDP.
• Health technology assessment will inform prioritisation, selection, distribution, management
and introduction of interventions for health promotion, disease prevention, diagnosis,
treatment and rehabilitation
• an opportunity to develop a comprehensive HTA strategy based on an existing foundation.
• The establishment of a functioning system will create a policy demand for HTA outputs
• HTA outputs may be linked with the explicit decision-making needs of UHC policies
• a central finding of gap analysis in the health research domains based on disease burden
• New program may be rolled out in priority areas
• Introduction on new technologies after due validation at different levels
• Budget impact analysis and budget allocation
All points are based on the international best practices
39. Salient Features of the Bill
The ACT has 5 chapters and 22 sections elaborating
the structure and its functions
the functions and powers of the Board,
Duties of the Technical Appraisal Committees and
Secretariat,
procedure for sanction of financial assistance, finance
audit/ accounts and miscellaneous.
The power to make rules and regulations
AD: Auto-disable- Auto-disabling, single-use needle permanently fixed to a plastic syringe, designed to prevent inadvertent or intentional reuse.,
RUP: Reuse prevention, SIP:
