The possibility of referring to the medical literature to support technology assessments in perinatal care was studied by examining more than 40,000 references contained in the Index Medicus of Latin America for the period 1984–88. A total of 1,074 references addressed perinatal technologies, but with irregular distribution. Information on effectiveness, safety, costs, and social impact of perinatal technologies was extremely limited. These results led to the conclusion that immediate action needs to be taken to create the necessary conditions for health technology assessment in Latin America.

Collaboration within the European Community (EC) over health problems and their possible solutions has progressed significantly during the past decade. The pursuit of appropriate choices among a variety of issues has resulted in a growing demand for comparable health data. EC efforts to coordinate the health services research of the member states in the fourth Medical and Health Research Program (1987–1991) are discussed. Its contribution to the development of information relevant to the EC's health needs as well as financing, policies, and practices is outlined.

The efficacy of vaccines for prophylactic use is a function of the immune response elicited by activated lymphocytes. Based on the current understanding of these responses, their induction, and the most effective ways to obtain long-lived immunity, a novel protocol for the vaccination of children against seven childhood diseases, involving only two visits for vaccine administration, is proposed.

The practice of postoperative artificial nutrition (PAN) in elective surgery was covered by a consensus conference in France (December 16,1994). Artificial nutrition was defined as the intake of at least two macronutrients (protein, lipid, and carbohydrate) through an artificial pathway (enteral/parenteral). The guidelines resulting from the conference (2) recommended prescribing artificial nutrition for only malnourished patients, patients with insufficient postoperative nutrient intake lasting 7 or more days, and patients with severe postoperative complications. These were similar to American guidelines produced in 1993 (1).

Objectives: The aim of this study was to analyze the information needs of Spanish health technology assessment (HTA) agencies and units to facilitate access to the resources they require to substantiate their reports.

Methods: A questionnaire was designed and distributed among HTA bodies to ascertain the actual situation of subscriptions to information resources and what information specialists from these bodies considered would be the ideal subscription situation. Their information needs were then studied, and the resources that best met these needs were put forward. Following this definition, a subscriptions policy was adopted with suppliers and publishers.

Results: The survey showed that HTA bodies share a minimum of core subscriptions that includes open sources (MEDLINE, DARE) and sources that the government subscribes to for the health community (ISI Web of Science, Cochrane Library Plus). There was no common approach to determining which databases to subscribe to (UpToDate, EMBASE, Ovid EBMR, CINAHL, or ECRI). After identifying the information needs, a list of resources was proposed that would best cover these needs and, of these, subscription to the following was proposed: Scopus, Ovid EBMR, Clinical Evidence, DynaMed, ECRI, and Hayes.

Conclusions: There are differences in the way that HTA agencies and units access the different resources of biomedical information. Combined subscription to several resources for documentation services was suggested as a way of resolving these differences.

The Health Evidence Network (HEN) was established approximately 3 years ago as a service to the health policy makers in the fifty-two member states of World Health Organization (WHO) Europe. The objective of the HEN is to (i) make it easier for policy makers to access evidence-based studies in the field of health, and to (ii) provide synthesis of available evidence around specific policy issues in health.

Objectives: The aims of this study were, first, to define the main advantages and disadvantages of using bibliographic search protocols; second, to define a series of criteria that could aid in prioritizing the information resources to be consulted for each research project; and third, to rank these criteria.

Methods: First, a survey was e-mailed to the Spanish Health Technology Assessment Agencies (AUnETS) group, with the aim of evaluating the usefulness of using bibliographic search protocols. Second, a consensus group meeting with the information specialists of the AUnETS group was organized, where SWOT analysis technique (strengths, weaknesses, opportunities, and threats) was used, also to discuss the utility of using search protocols. Third, the same group designed a final prioritization criteria questionnaire intended for Health Technology Assessment International's Information Resources Group (HTAi IRG), based on a draft version written by the information specialist from the Basque Office for HTA. Finally, this questionnaire was e-mailed to the HTAi IRG experts, and their responses were analyzed.

Results: Some of the advantages defined were systematization of the searches and transparency and repeatability of the process. The perceived disadvantages were inflexibility to be adapted to some situations, inability to establish time frameworks and the difficulty of incorporating experts’ opinions into closed protocols. Five areas of prioritization criteria were defined: study topic; characteristics of the database and other information resources; database interface; characteristics of the organization; kind of research output for which the information is intended. A ranked list of prioritization criteria was established based on the responses of the HTAi IRG group.

Conclusions: The information specialists consulted agreed that search protocols are useful tools for guiding systematic searches. The twenty-one prioritization criteria defined will be used by the information specialists for determining, which databases to consult.

Objectives: The European Network for Health Technology Assessment (EUnetHTA) Joint Action Project Framework, 2010–12, Work Package 7B (WP 7B), was aimed at facilitating collaboration between HTA agencies to avoid duplication of assessment efforts. A major task of WP 7B was to collect information on planned and ongoing (POP) projects by EUnetHTA agencies and to incorporate this information in a POP Database. We analyzed whether the Database served its intended purpose.

Methods: A survey was sent to all fifty-seven EUnetHTA partners, complemented by telephone interviews with the Ludwig Boltzmann Institute of HTA in Austria (lead institution). Furthermore, detailed documentation on the activities of the POP Database was provided to the research team at CAST (University of Southern Denmark) by the lead institution.

Results: Forty-two of fifty-seven agencies (74 percent) responded to the survey. Eleven collaborations initiated by agencies themselves were reported. The scope of these collaborative activities was usually limited to information exchange on for example literature search protocols. A slight reduction of duplication of effort was documented. In addition, twelve collaborations at the full report level were initiated by the lead institution.

Conclusion: While the POP Database has the potential to reduce duplication of effort, this has not been realized during the 3-year period of the EUnetHTA Joint Action Project Framework, 2010–12. Further evidence needs to be gathered to determine whether the POP Database is effective and whether the benefits outweigh the resources required to maintain it.

Objectives: Single-vessel bypass can often be accomplished through less invasive techniques than conventional coronary artery bypass graft (CABG) at substantially lower cost. We undertook a study to empirically determine the cost savings associated with one such technique, left anterior small thoracotomy (LAST).

Methods: Reviewing medical and billing records, we measured the difference in hospitalization costs between two methods of coronary bypass surgery. The study groups consisted of 50 patients who underwent LAST and 28 who underwent single-vessel conventional CABG during 1995 and 1996. A subsequent validation sample of 50 patients who underwent LAST was also analyzed. Hospitalization costs were estimated using a relative value unit methodology and were risk-adjusted for both perioperative risk factors and changes in operating room technology.

Results: Risk-adjusted hospitalization costs for those undergoing LAST were $9,510 and $12,546 for the CABG control subjects (p < .01), with differences in surgical costs reflecting over 62% of this overall difference. Differences in average length of stay were under a half-day (10.0 for LAST vs. 10.46 for CABG). Only one inpatient fatality was reported; therefore, no inference regarding mortality differences could be made.

Conclusions: LAST is substantially less costly than conventional surgery, and the savings are potentially greater if hospital length of stay is reduced to a clinically recommended time of 2 days.

Objectives: This review aims to assess the state of the science around the potential impact of certain patient characteristics on the safety and effectiveness of in vitro fertilization (IVF).

Methods: Following Cochrane Collaboration guidelines and the PRISMA statement, a comprehensive systematic review of reviews and recent primary studies examining the impact of paternal age and maternal age, smoking, and body mass index (BMI) on the safety and effectiveness of IVF was performed. Papers, published between January 2007 and June 2014, were independently reviewed and critically appraised by two researchers using published quality assessment tools for reviews and primary studies. Due to heterogeneity across papers (different study designs and patient selection criteria), a qualitative analysis of extracted information was performed.

Results: Seventeen papers (ten systematic reviews and seven primary studies) were included. They comprised evidence from retrospective observational studies in which maternal age, BMI, and smoking status were explored as part of secondary analyses of larger studies. The majority of papers found that the likelihood of achieving a pregnancy was lower among women who were >40 years, had a BMI ≥ 25 and smoked. Advanced maternal age and BMI were also associated with higher rates of preterm birth and low birth weight.

Conclusions: Based on available evidence, it may be appropriate to consider “maternal age” and “morbid obesity” in public funding policies that aim to maximize the effectiveness of IVF. However, given inconsistencies in the effect of smoking across different pregnancy-related outcomes, support for incorporating it into funding conditions appears weak.

Objectives: Companion diagnostic tests (CDx) are used to measure an individual's protein or gene expression (biomarkers) to inform choice of therapy. The increasing number of drugs requiring CDx poses challenges for regulatory and reimbursement policies. To better understand this issue, an environmental scan was conducted by the Canadian Agency for Drugs and Technologies in Health (CADTH).

Methods: The environmental scan was based on a focused literature search and feedback solicited from targeted stakeholders.

Results: The global market for CDx is expected to grow considerably until the end of this decade, with compound annual growth rate around 20 percent. Several factors may impact the adoption of CDx, including the potential cost-savings associated with reduced treatment failures and adverse reactions. Anticipating an expansion in drugs with CDx, some countries have updated their regulatory frameworks, including the United States where the FDA released new guidance in 2014. With respect to reimbursement, both the United Kingdom and Australia updated their evaluation frameworks to inform reimbursement decisions; however, several countries, including Canada, have not published policies for co-dependent technology.

Conclusion: The market size for CDx is expected to considerably expand in the future. The drive in uptake may be influenced by many factors including an increased knowledge of biomarkers and molecular drivers of disease and the potential cost-savings associated with fewer treatment failures and adverse reactions. Assessing whether such benefits materialize is important. Health technology assessment will play an important role in informing policies regarding the clinical use and funding of pharmaceuticals with CDx.