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Health Technology Assessment and Public Health: Relation, Potentialities and Evidence Generation

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (28 February 2023) | Viewed by 17852

Special Issue Editors

Centre on Health Economics, Social and Health Care Management, LIUC Business School, LIUC-Università Cattaneo, 21053 Castellanza, Italy
Interests: health technology assessment
Department of Public Health, Experimental and Forensic Medicine University of Pavia, 27100 Pavia, Italy
Interests: immunization policies; vaccine hesitancy; digital health
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear colleagues,

Non-communicable diseases (NCDs) represent a threat to global health and socioeconomic development: NCDs, including heart disease, stroke, cancer, diabetes and chronic lung disease, are collectively responsible for almost 70% of all deaths worldwide (WHO, 2021), with a significant increase in the current COVID-19 era.

The sustainability of healthcare systems may be supported by investing more in health promotion, disease prevention, and early diagnosis rather than in disease treatment (Crisp et al., 2017). In this view, public health interventions (PHIs) have acquired a significant importance in NCDs management, with the institution of population-based interventions on health promotion or for the primary prevention of chronic or nonchronic diseases, thus developing personalized approaches that would place citizens at the core of healthcare systems (Ricciardi and Boccia, 2017). In addition, the COVID-19 pandemic has yet again reinforced the need to ensure health and social equity. While hospitals and healthcare authorities globally are appropriately focusing their resources and efforts to contain the pandemic, there is a consistent concern that the shifting of health, social and economic priorities will have long-lasting detrimental effects on NCD risk, especially amongst the most vulnerable subjects (Chang et al., 2020).

Therefore, considering the importance of correctly assessing the impact of innovative healthcare strategies, it is relevant to directly involve health professionals, service providers, policymaking authorities, and governmental agencies to strive for healthy communities while ensuring social justice and equity.

According to the above, health technology assessment (HTA) plays a key role in evaluating the feasibility of public health interventions devoted to NCDs, as a multi-disciplinary and multi-dimensional approach useful for deciding the efficient and equitable allocation of healthcare resources, by examining the relative value of interventions, to support and guide health policy decision making (Drummond et al., 2008; EUnetHTA, 2016).

Traditionally, the vast majority of HTAs have been concentrating on the assessment of drugs and medical devices. On the contrary, HTA on public health interventions is still a neglected area (Lavis et al., 2010; Stojanovic et al., 2020), thus requiring an in-depth analysis and a specific effort in evidence-based data generation.

Moving on from the aforementioned premises, the present Special Issue will try to cover the above knowledge gap, thus collecting HTA studies on public health topics, focusing on both methodological approaches and empirical studies conducted from real-life data, in the planning and evaluation of public health intervention, not only from an efficacy point of view, but providing a careful and in-depth analysis of organizational and economic impacts.

Scholars and practitioners are invited to share their latest research efforts about knowledge creation, exploration and exploitation in the healthcare sector, with respect to the role of HTA in supporting public health intervention planning, introduction, evaluation and decision.

As previously mentioned, this Special Issue welcomes conceptual, analytical, empirical or review research, conducted using qualitative and quantitative methods. The contributions may be focused (without being limited to) to different areas, considering (without being limited to) the following proposed topics.

  • Models, techniques and methodological approaches for assessing PHI.
  • The role of real-world data for creating PHI value.
  • Organizational antecedents and consequences of real-world data, in terms of the production of new roles and competencies.
  • The acceptability of PHI in promoting population health.
  • Understanding barriers to assessing/reaching a decision on and implementing a PH intervention.
  • The ability of real-world data to influence the communication process with patients, and population/citizen engagement.
  • Effective or ineffective management of innovative PHI in healthcare.
  • Investment strategies for healthcare organizations or healthcare companies.
  • The importance of monitoring healthcare delivery in terms of accessibility and appropriateness.
  • The evaluation of the performance of healthcare providers in terms of quality of care and value-for-money.
  • The role of PHI in supporting the healthcare planning process.

Dr. Emanuela Foglia
Prof. Dr. Anna Odone
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • HTA
  • health technology assessment
  • NCDs
  • chronic disease
  • real-world data
  • sustainability
  • acceptability
  • evidence-based information
  • public health intervention
  • public health program

Published Papers (9 papers)

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Research

Jump to: Review

14 pages, 348 KiB  
Article
Assessing the Social and Environmental Impact of Healthcare Technologies: Towards an Extended Social Return on Investment
by Maria Pinelli, Stefania Manetti and Emanuele Lettieri
Int. J. Environ. Res. Public Health 2023, 20(6), 5224; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20065224 - 22 Mar 2023
Viewed by 1496
Abstract
Stroke is the third leading cause of death and disability overall worldwide. Upper limb impairment is a common consequence for stroke survivors, having negative impact on their quality of life. Robotic rehabilitation, through repetitive and monitored movements, can improve their status. Developed by [...] Read more.
Stroke is the third leading cause of death and disability overall worldwide. Upper limb impairment is a common consequence for stroke survivors, having negative impact on their quality of life. Robotic rehabilitation, through repetitive and monitored movements, can improve their status. Developed by a team of researchers at Politecnico di Milano, AGREE is an exoskeleton for upper limb rehabilitation at the stage gate between translational research and clinical validation. Since the cost of this device is particularly high, the present study aimed to provide a framework for assessing its value. The Social Return on Investment (SROI) method, able to grasp the economic, social and environmental impact of an activity, was applied, using expert opinions of a pool of clinical engineers and healthcare professionals from different Italian hospitals to obtain information. Environmental impacts were estimated through Life Cycle Assessment in terms of CO2 emissions and incorporated in the analysis. Considering a 5-year period, the SROI for a single exoskeleton was 3.75:1, and the SROI for the number of exoskeletons projected to be sold was 2.868:1, thus resulting largely in value for money. This study provides a model for combining economic, social and environmental outcomes that, besides contributing to theory, could be useful for decision-making. Full article
17 pages, 711 KiB  
Article
Multidimensional Results and Reflections on CAR-T: The Italian Evidence
by Emanuela Foglia, Elisabetta Garagiola, Vito Ladisa, Alessandro Rambaldi, Roberto Cairoli, Simona Sammassimo, Emanuela Omodeo Salè, Pier Luigi Zinzani, Marco Esposti, Luisa Alberti, Maria Franca Mulas, Eleonora Melis, Stefania Onnis, Maurizio Marcias, Vittorio Satta and Davide Croce
Int. J. Environ. Res. Public Health 2023, 20(5), 3830; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20053830 - 21 Feb 2023
Cited by 2 | Viewed by 1651
Abstract
The present study aims at defining the economic and organizational impacts of the introduction of chimeric antigen receptor T-cell therapy (CAR-T) in Italy, for the management of diffuse large B-cell lymphoma (DLBCL) patients in third-line therapy, defining the overall level of sustainability for [...] Read more.
The present study aims at defining the economic and organizational impacts of the introduction of chimeric antigen receptor T-cell therapy (CAR-T) in Italy, for the management of diffuse large B-cell lymphoma (DLBCL) patients in third-line therapy, defining the overall level of sustainability for both hospitals and the National Healthcare System (NHS). The analysis focused on CAR-T and Best Salvage Care (in the following BSC), assuming the Italian hospital and NHS perspectives, over a 36-month time horizon. Process mapping and activity-based costing methodologies were applied to collect the hospital costs related to the BSC and CAR-T pathways, including adverse event management. Anonymous administrative data on services provided (diagnostic and laboratory examinations, hospitalizations, outpatient procedures, and therapies) to 47 third-line patients with lymphoma, as well as any organizational investments required, were collected, in two different Italian Hospitals. The economic results showed that the BSC clinical pathway required less resources in comparison with CAR-T (excluding the cost related to the therapy) (BSC: 29,558.41 vs. CAR-T: EUR 71,220.84, −58.5%). The budget impact analysis depicts that the introduction of CAR-T would generate an increase in costs ranging from 15% to 23%, without considering treatment costs. The assessment of the organizational impact reveals that the introduction of CAR-T therapy would require additional investments equal to a minimum of EUR 15,500 to a maximum of EUR 100,897.49, from the hospital perspective. Results show new economic evidence for healthcare decision makers, to optimize the appropriateness of resource allocation. The present analysis suggests the need to introduce a specific reimbursement tariff, both at the hospital and at NHS levels, since no consensus exists, at least in the Italian setting, concerning the proper remuneration for the hospitals who guarantee this innovative pathway, assuming high risks related to timely management of adverse events. Full article
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13 pages, 963 KiB  
Article
Negative Pressure Wound Therapy and Traditional Dressing: An Italian Health Technology Assessment Evaluation
by Dora Nicolazzo, Elena Rusin, Alessandra Varese and Margherita Galassi
Int. J. Environ. Res. Public Health 2023, 20(3), 2400; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20032400 - 29 Jan 2023
Cited by 5 | Viewed by 1945
Abstract
This evaluation shows the main advantages related to the introduction of negative pressure wound therapy (NPWT) in Italian clinical practice for the management of incisions in vascular surgery in patients suffering from peripheral arterial disease (PAD) and at risk of postoperative complications, compared [...] Read more.
This evaluation shows the main advantages related to the introduction of negative pressure wound therapy (NPWT) in Italian clinical practice for the management of incisions in vascular surgery in patients suffering from peripheral arterial disease (PAD) and at risk of postoperative complications, compared to treatment with traditional dressings. A health technology assessment (HTA) activity was conducted assuming the hospital perspective, within a 12-month time horizon. The nine EUnetHTA Core Model dimensions were deeply explored, using scientific evidence on the topic, real-life data, and healthcare professionals’ perceptions. The evaluation shows that the use of NPWT has had a positive impact in terms of higher clinical effectiveness and safety profile. The process mapping highlights how NPWT allows a reduction of 2.5 hospitalization days compared with standard dressing, with the consequent benefits considering economic, organizational, and social aspects. A significant economic saving per patient emerged, with an overall optimization of the patient’s clinical pathway, impacting positively on the hospital’s capacity. The budget impact analysis shows that the higher number of patients treated with NPWT, the higher the economic advantages. Furthermore, assuming the patient’s perspective, it would generate an overall reduction in social costs of 28%. In conclusion, the results of this study provide helpful evidence-based information to policymakers through examinations of the relative values of intervention, thus supporting the overall hospital and institutional decision-making process to define appropriate areas of investments, leading to the achievement of not only higher clinical outcomes, but also important social, economic, and organizational advantages. Full article
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14 pages, 500 KiB  
Article
HTA and Gastric Cancer: Evaluating Alternatives in Third- and Fourth-Line Patients
by Lucrezia Ferrario, Federica Asperti, Giuseppe Aprile and Jacopo Giuliani
Int. J. Environ. Res. Public Health 2023, 20(3), 2107; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20032107 - 24 Jan 2023
Viewed by 1370
Abstract
Metastatic gastric cancer (mGC) represents an economic and societal burden worldwide. The present study has two aims. Firstly, it evaluates the benefits and the added value of the introduction of trifluridine/tipiracil (FTD/TPI) in the Italian clinical practice, defining the comparative efficacy and safety [...] Read more.
Metastatic gastric cancer (mGC) represents an economic and societal burden worldwide. The present study has two aims. Firstly, it evaluates the benefits and the added value of the introduction of trifluridine/tipiracil (FTD/TPI) in the Italian clinical practice, defining the comparative efficacy and safety profiles with respect to the other available treatment options (represented by the best supportive care (BSC) and FOLFIRI (5-FU, irinotecan, and leucovorin) regimens). Secondly, it assesses the potential economic and organizational advantages for hospitals and patients, focusing on third- and fourth-line treatments. For the achievement of the above objective, a health technology assessment study was conducted in 2021, assuming the NHS perspective within a 3-month time horizon. The literature reported a better efficacy of FTD/TPI with respect to both BSC and FOLFIRI regimens. From an economic perspective, despite the additional economic resources that would be required, the investment could positively impact the overall survival rate for the patients treated with the FTD/TPI strategy. However, the innovative molecule would lead to a decrease in hospital accesses devoted to chemotherapy infusion, ranging from a minimum of 34% to a maximum of 44%, strictly dependent on FTD/TPI penetration rate, with a consequent opportunity to take on a greater number of oncological patients requiring drug administration for the treatment of any other cancer diseases. According to experts’ opinions, lower perceptions of FTD/TPI emerged concerning equity aspects, whereas it would improve both individuals’ and caregivers’ quality of life. In conclusion, the results have demonstrated the strategic relevance related to the introduction of FTD/TPI regarding the coverage of an important unmet medical need of patients with metastatic gastric cancer who were refractory to at least two prior therapies, with important advantages for patients and hospitals, thus optimizing the clinical pathway of such frail patients. Full article
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22 pages, 1760 KiB  
Article
Barriers and Enablers for the Use of Digital Interactive Television in Nursing Home Settings: An Interview Case Study with Older Adults and Professionals
by Bérangère Naudé, Anne-Sophie Rigaud, Laila Kamali and Maribel Pino
Int. J. Environ. Res. Public Health 2023, 20(3), 1813; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20031813 - 18 Jan 2023
Cited by 1 | Viewed by 1680
Abstract
Increasingly, public health programs are recommending the use of information and communication technologies to address the psychosocial needs of Older Adults (OAs). Recently, several applications that allow access to communication and stimulation functionalities using digital interactive television (DiTV) have been developed. The use [...] Read more.
Increasingly, public health programs are recommending the use of information and communication technologies to address the psychosocial needs of Older Adults (OAs). Recently, several applications that allow access to communication and stimulation functionalities using digital interactive television (DiTV) have been developed. The use of the television interface to access digital services seems to help meet several accessibility and usability needs of OAs. However, its use entails other challenges related to different dimensions (organizational, technological, ethical, etc.). This study aims to identify the factors that enable or hinder the use of DiTV by OAs living in geriatric institutions. A qualitative interview case study was conducted in three French geriatric facilities. A total of 25 semi-structured interviews were carried out with residents and care professionals, between February and April 2022, to identify enablers and barriers to DiTV use. Data were processed using a thematic deductive analysis inspired by a multidimensional Health Technology Assessment model. The analysis showed that DiTV use may be limited by organizational (e.g., workload), technological (e.g., ergonomic issues), human (e.g., health issues), ethical (e.g., privacy), and safety factors (e.g., frustration due to technical problems). A summary of these factors and five recommendations for DiTV implementation in geriatric settings are presented in this paper. Full article
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19 pages, 615 KiB  
Article
Health Technology Assessment for the Prevention of Peri-Operative Hypothermia: Evaluation of the Correct Use of Forced-Air Warming Systems in an Italian Hospital
by Giulia Zucconi, Anna Maria Marchello, Camilla Demarco, Elisabetta Fortina and Ljdia Milano
Int. J. Environ. Res. Public Health 2023, 20(1), 133; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20010133 - 22 Dec 2022
Cited by 2 | Viewed by 1550
Abstract
This study investigates the implications of using a system for the maintenance of normothermia in the treatment of patients undergoing surgery, determining whether the FAW (Forced-Air Warming) systems are more effective and efficient than the non-application of appropriate protocols (No Technology). We conducted [...] Read more.
This study investigates the implications of using a system for the maintenance of normothermia in the treatment of patients undergoing surgery, determining whether the FAW (Forced-Air Warming) systems are more effective and efficient than the non-application of appropriate protocols (No Technology). We conducted Health Technology Assessment (HTA) analysis, using both real-world data and the data derived from literature, assuming the point of view of a medium-large hospital. The literature demonstrated that Inadvertent Perioperative Hypothermia (IPH) determines adverse events, such as surgical site infection (FAW: 3% vs. No Technology: 12%), cardiac events (FAW: 3.5% vs. No Technology: 7.6%) or the need for blood transfusions (FAW: 6.2% vs. No Technology: 7.4%). The correct use of FAW allows a medium saving of 16% per patient to be achieved, compared to the non-use of devices. The Cost Effectiveness Value (CEV) is lower in the hypothesis of FAW: it enables a higher efficacy level with a contextual optimization of patients’ path costs. The social cost is reduced by around 30% and the overall hospital days are reduced by between 15% and 26%. The qualitative analyses confirmed the results. In conclusion, the evidence-based information underlines the advantages of the proper use of FAW systems in the prevention of accidental peri-operative hypothermia for patients undergoing surgery. Full article
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17 pages, 1031 KiB  
Article
An Empirical Framework for Assessing the Balanced Scorecard Impact on Sustainable Development in Healthcare Performance Measurement
by Anca Antoaneta Vărzaru
Int. J. Environ. Res. Public Health 2022, 19(22), 15155; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph192215155 - 17 Nov 2022
Cited by 2 | Viewed by 2393
Abstract
Performance appraisal has become an essential tool for healthcare managers due to the frequent and rapid changes in the healthcare sector. Sustainable performance management implies increasing organizations’ efficiency and effectiveness while considering all vectors of sustainability. This study examines the impact of digital [...] Read more.
Performance appraisal has become an essential tool for healthcare managers due to the frequent and rapid changes in the healthcare sector. Sustainable performance management implies increasing organizations’ efficiency and effectiveness while considering all vectors of sustainability. This study examines the impact of digital transformation, accounting information systems, and strategic human resource management improvements on organizational performance and sustainable development. The paper uses the balanced scorecard (BSC) for organizational performance assessment. The paper proposes a theoretical model that integrates the traditional and digital information systems and human resources engagement with the BSC dimensions for sustainable organizational development. The theoretical model is tested in an empirical study involving a questionnaire-based survey of 387 employees with management experience in the healthcare sector. Based on structural equation modeling, the research results showed that the efficiency and effectiveness of strategic human resources management and the accounting information system significantly positively affect the BSC dimensions. Furthermore, the use of BSC in measuring organizational performance has significant effects on sustainable development, with the internal process dimension being the most influential. Full article
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17 pages, 1368 KiB  
Article
Using the Dynamic SWOT Analysis to Assess Options for Implementing the HB-HTA Model
by Barbara Więckowska, Monika Raulinajtys-Grzybek and Katarzyna Byszek
Int. J. Environ. Res. Public Health 2022, 19(12), 7281; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19127281 - 14 Jun 2022
Cited by 3 | Viewed by 2360
Abstract
This paper is aimed at exploring the role of the HB-HTA ecosystem as an important pathway for popularizing the implementation of innovations in healthcare organizations. The scientific debate has largely been focused on the rising importance of HB-HTA and the principles guiding the [...] Read more.
This paper is aimed at exploring the role of the HB-HTA ecosystem as an important pathway for popularizing the implementation of innovations in healthcare organizations. The scientific debate has largely been focused on the rising importance of HB-HTA and the principles guiding the process. Solutions implemented by individual countries differ, which may be rooted in historical, cultural, and institutional differences. Our understanding of the impact of individual countries’ healthcare systems on HB-HTA solutions and infrastructure still lacks a basis in interpretative studies. A conceptual framework is proposed to assess the aptness of the HB-HTA model designed for hospitals operating in a country or region, focused on the concepts of adaptiveness and responsiveness to features of the healthcare system present there. A tool is proposed for investigating factors that are likely to assist the successful implementation of the HB-HTA ecosystem. A dynamic SWOT analysis on the case of the HB-HTA model designed for Poland provides interesting insights into the building of the conceptual framework. The results of this study help explain how to create an HB-HTA model that is best adapted to the regional or national healthcare system, including potential risks and opportunities. Full article
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Review

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14 pages, 355 KiB  
Review
Suture-Mediated Patent Foramen Ovale Closure Using the NobleStitch EL: Results from a Hospital-Based HTA
by Giovanni Gaetti, Alessandro Beneduce, Dario La Fauci, Alessandro Scardoni, Federica Chiappa, Lorenzo Bellini, Michela Franzin, Anna Maria Natale, Paola Marras, Paolo Ranieri, Carlo Signorelli, Eleonora Bossi, Lucrezia Ferrario, Emanuela Foglia, Matteo Montorfano and Anna Odone
Int. J. Environ. Res. Public Health 2022, 19(13), 7863; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19137863 - 27 Jun 2022
Cited by 4 | Viewed by 2022
Abstract
(1) Background: Patent foramen ovale (PFO) is a congenital abnormality present in up to 25% of the general population, and it is a relevant cause of cryptogenic stroke. We applied the hospital-based HTA model (AdHopHTA) to conduct a multidimensional assessment of NobleStitch EL, [...] Read more.
(1) Background: Patent foramen ovale (PFO) is a congenital abnormality present in up to 25% of the general population, and it is a relevant cause of cryptogenic stroke. We applied the hospital-based HTA model (AdHopHTA) to conduct a multidimensional assessment of NobleStitch EL, an innovative suture-mediated PFO closure device. We compared it to Amplatzer PFO Occluder (APO) to provide evidence to inform technologies’ governance in hospital settings. (2) Methods: For each AdHopHTA dimension we: systematically retrieved available evidence from the literature applying the PRISMA guidelines and then analyzed original clinical and cost data of a NobleStitch EL device at San Raffaele research hospital in Milan (Italy). The economic dimension was analyzed through activity-based costing and a cost analysis. We conducted semi-structured interviews with selected healthcare professionals to explore the organizational, legal, social, and ethical impact. (3) Results: A single study was included for the NobleStitch EL, with 10 for APO. Both literature data and original data showed comparable safety. Efficacy data analysis found that the PFO closure was at 89% for NobleStitch EL vs. 89–97% for APO. APO has a better impact on the budget and minor process costs. Consulted experts reported that the organizational impact of NobleStitch EL in the short and the long run as null, albeit a better impact under the social and the ethical aspects. (4) Conclusion: We suggest that there is inadequate evidence to conclude the relative efficacy of NobleStitch EL as compared to APO. Nevertheless, this report shows a good safety profile and higher costs for NobleStitch EL, with no organizational or legal impact. Further studies in selected population are recommended. Full article
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