Abstract

BACKGROUND: Transcatheter aortic valve implantation (TAVI) has shown similar or improved clinical outcomes compared with surgical aortic valve replacement (SAVR) in patients with symptomatic severe aortic stenosis at low risk for surgical mortality. This cost-utility analysis compared TAVI with SAPIEN 3 versus SAVR in symptomatic severe aortic stenosis patients at low risk of surgical mortality from the perspective of the Swedish healthcare system.

METHODS: A published, two-stage, Markov-based cost-utility model that captured clinical outcomes from the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated according to Recommended Therapies (SWEDEHEART) registry (2018-2020) was adapted from the perspective of the Swedish healthcare system using local general population mortality, utility and costs data. The model had a lifetime horizon. Model outputs included changes in direct healthcare costs and health-related quality of life from using TAVI as compared with SAVR.

RESULTS: TAVI with SAPIEN 3 resulted in lifetime costs per patient of 940,541 Swedish krona (SEK) and lifetime quality-adjusted life years (QALYs) per patient of 7.16, whilst SAVR resulted in lifetime costs and QALYs per patient of 821,380 SEK and 6.81 QALYs, respectively. Compared with SAVR, TAVI offered an incremental improvement of +0.35 QALY per patient at an increased cost of +119,161 SEK per patient over a lifetime horizon, resulting in an incremental cost-effectiveness ratio of 343,918 SEK per QALY gained.

CONCLUSION: TAVI with SAPIEN 3 is a cost-effective option versus SAVR for patients with symptomatic severe aortic stenosis at low risk for surgical mortality treated in the Swedish healthcare setting. These findings may inform policy decisions in Sweden for the management of this patient group.

Abstract

BACKGROUND AND AIMS: The NICE Highly Specialised Technology (HST) programme evaluates interventions for very rare conditions within the UK. This review aimed to analyse previous NICE HST appraisals and determine commonly used methods to overcome uncertainties relating to health-related quality of life (HRQoL) and disease burden for people with rare diseases and their caregivers. The review also aimed to identify areas where further methodological development is required.

APPROACH AND RESULTS: A targeted review of all previous NICE HST appraisals published by the 28th February 2022, in which at least one committee meeting had taken place, was conducted. A total of 24 appraisals were included (17 fully completed and seven ongoing). Data were extracted by one reviewer. The evidence review group (ERG) and committee comments were compared against the NICE reference case and synthesised to identify the following methodological uncertainties that occurred most commonly: using alternatives to the EuroQol-5 Dimension (EQ-5D), sourcing HRQoL data from single-arm studies, measuring caregiver disutilities and estimating disease burden.

CONCLUSIONS: This review has highlighted the need for new methodology to reflect the impact of the diseases on people with rare diseases and their families. The review identified the following methodological requirements: alternative approaches that should be used when EQ-5D is not appropriate, methods to evaluate paediatric HRQoL and methods to quantify disease burden. This review also highlights the need to establish clear recommendations on the estimation of utilities across different rare diseases.

Abstract

A vision-based patient monitoring system (VBPMS), Oxevision, has been introduced in approximately half of National Health Service (NHS) mental health trusts in England. A VBPMS is an assistive tool that supports patient safety by enabling non-contact physiological and physical monitoring. The system aims to help staff deliver safer, higher-quality and more efficient care. This paper summarises the potential health economic impact of using a VBPMS to support clinical practice in two inpatient settings: acute mental health and older adult mental health services. The economic model used a cost calculator approach to evaluate the potential impact of introducing a VBPMS into clinical practice, compared with clinical practice without a VBPMS. The analysis captured the cost differences in night-time observations, one-to-one continuous observations, self-harm incidents, and bedroom falls at night, including those resulting in A&E visits and emergency service callouts. The analysis is based on before and after studies conducted at five mental health NHS trusts, including acute mental health and older adult mental health services. Our findings indicate that the use of a VBPMS results in more efficient night-time observations and reductions in one-to-one observations, self-harm incidents, bedroom falls at night, and A&E visits and emergency service callouts from night-time falls. Substantial staff time in acute mental health and older adult mental health services is spent performing night-time observations, one-to-one observations, and managing incidents. The use of a VBPMS could lead to cost savings and a positive return on investment for NHS mental health trusts. The results do not incorporate all of the potential benefits associated with the use of a VBPMS, such as reductions in medication and length of hospital stay, plus the potential to avoid adverse events which would otherwise have a detrimental impact on a patient's quality of life.

Abstract

INTRODUCTION
Single use medical devices' environmental impact is known to generate sizable carbon emissions over a life cycle compared to a reusable equivalent. The SHTG have recognised the need to evaluate this health technology carbon hotspot as part of the HTA. Specifically, this environmental assessment was appropriate for parallel evaluation alongside a health economic analysis to support the decision-making process.

METHODS
Through the application of HTA and environmental management principles and reporting, the Greenhouse Gas (GHG) Protocols, ISO14040 and Publicly Available Specification 2050, a carbon footprint of single use rhinolaryngoscopes was compared with a reusable equivalent. Process activity data, real world data and secondary data were used to quantify carbon intensity. Data were extrapolated to estimate national GHG emissions and waste volumes. The technologies were categorized using thresholds based on the functional unit, to strengthen support for the HTA decision making process. Sensitivity analyses were performed. Further recommendations were made to promote the use of more sustainable health technologies.

RESULTS
The carbon emissions of a single use flexible rhinolaryngoscope compared to its reusable equivalent was 6.03kgCO2e and 3.26kgCO2e respectively. Data extrapolation (2264 procedures per annum) reveals the annual environmental impact of this technology, throughout NHS Scotland, to be 13,652kgCO2e and 7,381kgCO2e, for the single use and reusable devices, respectively. Raw material acquisition, the use of personal protective equipment and transportation were health technology carbon hotspots. The estimated waste volumes are 12.58 tonnes and negligible volumes of clinical waste per annum for the single use versus reusable equivalent, respectively. This pilot study recommends the use a reusable equivalent in this setting.

CONCLUSIONS
Aligned with NHS net zero targets, these findings confirm the need to perform a parallel environmental assessment of technologies alongside a HTA. LCA is a useful framework to comprehensively assess environmental impact of health technology. Data constraints can be overcome through the use of hybrid methodologies, aligned with HTA principles including transparency and reproducibility to enable sustainable HTA decision making.