Current service organization is not adapted for youth with or at risk of mental illness. Access, engagement and continuity of care are notorious challenges, particularly during transition from adolescence to adulthood, when youths are transferred to adult services. An HTA was initiated to evaluate the efficacy of programs for which admission is not a function of the legal age of majority.

A systematic review of systematic reviews identified literature published between 2000 and 2017 in 4 databases. To be selected, studies had to focus on specialised mental healthcare early intervention (EI) programs targeting both adolescents and young adults. Contextual and experiential data were collected through interviews with local leading experts. Article selection and quality assessment using ROBIS were conducted with inter rater agreement. The analytical framework developed includes 4 domains: access, engagement and continuity, recovery as well as meaningfulness and acceptability.

1841 references were identified. Following inclusion/exclusion criteria, 5 studies were selected, 3 of which focused on EI for psyschosis. EI programs alone do not seem to decrease duration of untreated psychosis. EI including a multi focus campaign were more successful. EI does, however, seem to decrease hospitalisation for psychosis. The experience of service users and professionals with inter agency collaboration and person-centred care models were analysed to identify facilitating and inhibiting implementation factors.

Healthcare policies need to support further research and development of EI where admission is not a function of the legal age of majority and diagnostic, particularly for youths at risk.

In low- and middle-income countries (LMICs) striving to achieve universal health coverage, the involvement of different stakeholders in formal or informal ways in health technology assessment (HTA) must be culturally and socially relevant and acceptable. Challenges may be different from those seen in high-income countries. In this article, we aimed to pilot a questionnaire for uncovering the context-related aspects of patient and citizen involvement (PCI) in LMICs, collecting experiences encountered with PCI, and identifying opportunities for patients and citizens toward contributing to local decision- and policy-making processes related to health technologies.

Through a collaborative, international multi-stakeholder initiative, a questionnaire was developed for describing each LMIC's healthcare system context and the emergence of opportunities for PCI relating to HTA. The questionnaire was piloted in the first set of countries (Brazil, Indonesia, Nigeria, and South Africa).

The questionnaire was successfully applied across four diverse LMICs, which are at different stages of using HTA to inform decision making. Only in Brazil, formal ways of PCI have been defined. In the other countries, there is informal influence that is contingent upon the engagement level of patient and citizen advocacy groups (PCAGs), usually strongest in areas such as HIV/AIDS, TB, oncology, or rare diseases.

The questionnaire can be used to analyze the options for patients and citizens to participate in HTA or healthcare decision making. It will be rolled out to more LMICs to describe the requirements and opportunities for PCI in the context of LMICs and to identify possible routes and methodologies for devising a more systematic and formalized PCI in LMICs.

Principal component analysis (PCA) is important to summarize data or reduce dimensionality. However, one disadvantage of using PCA is the interpretability of the principal components (PCs), especially in a high-dimensional database. This study aims to analyze the patterns of variance accumulation according to PCA loadings and to approximate PCs with input variables from sample data sets.

There were three data sets of various sizes used to understand the performance of PC approximation: Hitters; SF-12v2 subset of the 2004 to 2011 Medical Expenditure Panel Survey (MEPS); and, the full set of 1996 to 2011 MEPS data. The variables in three data sets were first centered and scaled before PCA. PCs approximation was studied with two approaches. First, the PC loadings were squared to estimate the variance contribution by variables to PCs. The other method was to use forward-stepwise regression to approximate PCs with all input variables.

The first few PCs represented large portions of total variances in each data set. Approximating PCs using stepwise regression could more efficiently identify the input variables that explain large portions of PC variances than approximating according to PCA loadings in three data sets. It required few numbers of variables to explain more than eighty percent of the PC variances.

Approximating and interpreting PCs with stepwise regression is highly feasible. Approximating PCs can help i) interpret PCs with input variables, ii) understand the major sources of variances in data sets, iii) select unique sources of information and iv) search and rank input variables according to the proportions of PC variance explained. This is an approach to systematically understand databases and search for variables that are highly representative of databases.

This study sought to explore main barriers and facilitators to implementing health technology assessment (HTA) in Kuwait from the perspective of key stakeholders.

Semi-structured qualitative interviews were conducted with ten key stakeholders: seven healthcare providers working at various departments of the Kuwaiti Ministry of Health (MOH), and three academics with substantial experience in teaching HTA or related fields. Interviews were conducted face-to-face, audio-recorded, and transcribed verbatim. Data were analyzed using an inductive thematic approach.

Participating stakeholders reported several factors that might act as a barrier to building HTA in Kuwait: minimal awareness of HTA, lack of institutional and human capacity, a fragmented healthcare system, poor communication between researchers and policy makers, the country's wealth, politics, as well as data quality, availability, and sharing. Institutionalizing HTA as a politically empowered body, enforcing its recommendation by law, and benefiting from neighboring countries' experiences were suggested as possible ways to move forward.

Studies exploring the unique challenges that high-income developing countries may face in implementing HTA are still scarce. The results of this study are consistent with evidence coming from other developing countries, while also suggesting that the abundance of financial resources in the country is a double-edged sword; it has the potential to facilitate the development of HTA capacity, but also hinders recognizing the need for it.

Systematic reviews (SRs) are usually conducted by a highly specialized group of researchers. The routine involvement of methodological experts is a core methodological recommendation. The present commentary describes the qualifications required for information specialists and statisticians involved in SRs, as well as their tasks, the methodological challenges they face, and potential future areas of involvement.

Information specialists select the information sources, develop search strategies, conduct the searches, and report the results. Statisticians select the methods for evidence synthesis, assess the risk of bias, and interpret the results. The minimum requirements for their involvement in SRs are a suitable university degree (e.g., in statistics or librarian/information science or an equivalent degree), methodological and content expertise, and several years of experience.

The complexity of conducting SRs has greatly increased due to a massive rise in the amount of available evidence and the number and complexity of SR methods, largely statistical and information retrieval methods. Additional challenges exist in the actual conduct of an SR, such as judging how complex the research question could become and what hurdles could arise during the course of the project.

SRs are becoming more and more complex to conduct and information specialists and statisticians should routinely be involved right from the start of the SR. This increases the trustworthiness of SRs as the basis for reliable, unbiased and reproducible health policy, and clinical decision making.

This paper aims to describe the development of a flowchart to guide the decisions of researchers in the Spanish Network for Health Technology Assessment of the National Health System (RedETS) regarding patient involvement (PI) in Health Technology Assessment (HTA). By doing so, it reflects on current methodological challenges in PI in the HTA field: how best to combine PI methods and what is the role of patient-based evidence.

A decisional flowchart for PI in HTA was developed between March and April 2019 following an iterative process, reviewed by the members of the PI Interest Group and other RedETS members and validated during an online deliberative meeting. The development of the flowchart was based on a previous methodological framework assessed in a pilot study.

The guidelines on how to involve patients in HTA in the RedETS were graphically represented in a flowchart. PI must be included in all HTA reports, except those that assess technologies with no relevant impact on patients’ experiences, values, and preferences. Patient organizations or expert patients related to the topic of the HTA report must be identified and invited. These patients can participate in protocol development, outcomes' identification, assessment process, and report review. When the technology assessed affects in a relevant way patient experiences, values, and preferences, patient-based evidence should be included through a systematic literature review or a primary study.

The decisional flowchart for PI in HTA contributes to the current methodological challenges by proposing a combination of direct involvement and patient-based evidence.