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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.
Statistical analyses are common practice in the modern world. While statistics is a discipline in its own right, statistical methods are employed across a vast and growing range of fields. It is, therefore, essential that the sharing of statistical information can be adapted to meet the needs of a range of audiences.
A web application (app) is an app that is accessed using a web browser. An advantage of web apps is their accessibility, allowing multiple users to access the same app from different locations, devices and software platforms. Shiny is a free, open-source R package for developing web apps. Shiny provides an excellent opportunity to share results from analyses with others in an interactive, easy-to-build web app.
A Shiny app contains a user interface (ui) and a server function. These two objects interact with each other to create an interactive Shiny app. The ui element controls the layout and appearance of your app whereas the server object performs the necessary computations. While Shiny dashboards can be built using the Shiny package alone, the Shinydashboard package can be used to make it much easier to create a more visually appealing dashboard. This package enables the use of complex dashboards with a variety of complex layouts.
While producing a web app in Shiny requires good knowledge of the R programming language, for those already conducting their analyses in R, Shiny offers the opportunity to create a bespoke, high-quality dashboard that is accessible to the end user.
No abstract available.
BACKGROUND: Highly active (HA) relapsing remitting multiple sclerosis (RRMS) is associated with frequent relapses and high burden of disease/disability. Natalizumab is licensed for HA RRMS, including rapidly evolving severe (RES) (=2 relapses in previous year) and sub-optimally treated (SOT) (=1 relapse in previous year despite treatment) populations. However, there is limited RCT evidence in the SOT subpopulation.
OBJECTIVE: To review the non-RCT evidence for natalizumab in SOT HA RRMS.
METHODS: Databases were searched to January 2023 for non-randomised studies of natalizumab in HA RRMS. Studies in patients with =1 relapse during previous treatment were eligible for inclusion. Meta-analyses were conducted to compare natalizumab with platform and higher efficacy disease-modifying therapies, with sensitivity analysis restricted to studies of low risk of bias.
RESULTS: Included comparative studies (n = 16) showed natalizumab had lower relapse rates, disease activity and MRI (radiological) outcomes compared with platform and higher efficacy therapy. Case series (n = 11) showed natalizumab was associated with high rates of freedom from relapse and clinical/radiological disease activity and reductions in annualised relapse rate and disability progression.
CONCLUSIONS: Literature reviewed indicates that natalizumab is more effective than other included treatments for SOT patients. Findings were consistent with studies in the broad HA RRMS population, suggesting that natalizumab may have similar efficacy for SOT and RES HA RRMS.
INTRODUCTION: Gastroesophageal reflux disease (GERD) is a common ailment associated with troublesome symptoms. The standard of care in Italy involves initial treatment with proton pump inhibitor (PPI)-based medical management or laparoscopic Nissen fundoplication (LNF) for patients unwilling to continue or intolerant of long-term PPI therapy. RefluxStop is a novel medical device, intended for laparoscopic implantation, that has recently proven to be an efficacious and cost-effective treatment option for patients with GERD. This analysis aims to describe the short-term budget impact of introducing RefluxStop as a GERD treatment option within the Italian National Health Service (SSN).
METHODS: A model adherent to international best practice recommendations was developed to estimate the budget impact of introducing RefluxStop over a 5-year time horizon. Two scenarios were considered: one without RefluxStop (i.e., comprising PPI therapy, LNF, and magnetic sphincter augmentation using the LINX system); and one with RefluxStop (i.e., addition of RefluxStop to the three treatment options previously mentioned). Clinical benefits and costs associated with each intervention were included in the analysis.
RESULTS: Over 5 years, the introduction of RefluxStop resulted in avoidance of 95 surgical failures, 11 reoperations, and 64 endoscopic esophageal dilations. Introduction of RefluxStop resulted in an almost neutral impact on the existing budget with a 0.316% increase in the annual Italian SSN spending on GERD treatment.
CONCLUSION: Introduction of RefluxStop as a GERD treatment option in Italy is likely to be associated with substantial clinical benefits and a marginal budget impact.
