Objective We aimed to evaluate the comparative efficacy and cost-effectiveness of the ECMO versus mechanical ventilation through a rapid health technology assessment. Methods PubMed, EMbase, The Cochrane Library, CNKI, WanFang Data, and CBM databases were electronically searched to collect randomized controlled trials (RCTs), systematic reviews, meta-analyses, complete economic evaluations, and CRD database for HTA reports from inception to December 2020. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Descriptive analysis and summary were then performed. Results A total of 21 references were involved, including 2 HTA reports, 5 RCTs, 11 systematic reviews or meta-analyses, and 3 economic evaluations. The quality of the literature evidence was heterogenous, and only 2 RCTs of high quality were included for meta-analysis. The results showed that the difference of 60-day mortality between ECMO and mechanical ventilation was statistically significant (RR=0.73, 95%CI 0.57 to 0.92, P=0.007). The majority of recent meta-analysis literature showed that short-term mortality of ECMO treatment was lower than that of mechanically ventilated patients. The cost-effective literature from different countries all showed that it was cost-effective in their respective health system, however, the quality of the literature varied. Conclusions Current evidence shows that ECMO has better safety, effectiveness and cost-effectiveness for ARDS compared with mechanical ventilation. However, it still required to be verified by high-quality studies with a long-term follow-up. Validate conclusions are needed through rigorous health technology assessments.
Objective To assess the effectiveness and safety of nine lipid-lowing agents in the national essential drug list (2000) and provide evidence for the adjustment and selection of essential drugs. Methods Based on principles of health technology assessment (HTA) and evidence-based medicine, we searched for all published clinical studies about these drugs from the following databases: MEDLINE (1966-2002.8), The Cochrane Library, EMBASE (1974-2002), CBMdisk (1979-2002.8) and VIP (1989-2002.8), the database of National Center for Adverse Drug Reaction(ADR) Monitoring of China and the database of WHO Uppsala drug monitoring center. Included studies were appraised, analyzed and compared for the reduction of triglyceride (TC) or low density lipoprotein (LDL-C), the prevention for the coronary events and the incidence of ADR. Results The results from comparative trials for lipid-lowing agents showed that the equivalent dose of statins for 25% reduction of LDL-C was atorvastatin 10 mg/d, simvastatin 20 mg/d, pravastatin 40mg/d, lovastatin 40 mg/d, cerivastatin 0.3 mg/d and fluvastatin 80 mg/d. It was difficult to compare fenofibrate with gemfibrozil, acipimox with statins or fibrates based on available data. The study on the primary and secondary prevention of cardiovascular events showed that pravastatin and lovastatin were effective in primary prevention, and long-term use could reduce the incidence of cardiovascular disease.Gemfibrozil could reduce the mortality from coronary heart disease (CHD) but the overall mortality was not changed. Pravastatin, simvastatin, atorvastatin, fluvastatin, gemfibrozil and fenofibrate had a confirmed effect in secondary prevention. Data from large-scale clinical trials and the reports from ADR monitoring center of England, America, Canada and Australia suggested that the statins which had rare ADR were safe and tolerated. Rhabdomyolysis was rare but had a serious adverse reaction associated with statins. The rate of fatal rhabdomyolysis related to cerivastatin was the highest among 6 statins. The safety of simvastatin, lovastatin and atorvastatin was lower than cerivastatin but higher than simvastatin and atorvastatin. The number of ADR reports of fenofibrate was fewer than that of gemfibrozil. Conclusions At present, the best evidence focused on pravastatin, simvastatin and lovastatin are widely used and have a confirmed safety and efficacy. Atorvastatin, fluvastatin and fenofibrate still need more data to confirm their effects on coronary heart disease prevention. The drugs which were shown to be inferior or insufficient evidence are cerivastatin, gemfibrozil and acipimox.
ObjectiveTo evaluate the efficacy, safety, and economics of omalizumab for the treatment of pediatric asthma through a rapid health technology assessment (HTA). MethodsThe search was conducted on INAHTA website and databases such as PubMed, Embase, Cochrane Library, SinoMed, CNKI, VIP, and WanFang Data from inception to August 2024. Literature screening, quality evaluation, and data extraction were conducted independently by two investigators. An interview was conducted to consult the medication and treatment opinions of doctors and patients to investigate its clinical application. ResultsA total of 28 articles, including HTA articles (4), SR/Meta analyses (18), and pharmacoeconomics articles (6) were included. Omalizumab could reduce the incidence of clinical exacerbations, decrease the number of asthma attacks/days with asthma symptoms, and improve the quality of life. The results of the safety evaluation showed that omalizumab could reduce the rate of serious adverse events, especially those related to worsening asthma. Foreign pharmacoeconomic studies showed ICER ranging from £30 109 to £78 009. A pharmacoeconomic study in China found an ICER of $211 217/QALY for omalizumab, which were both above the pre-set thresholds. ConclusionOmalizumab is a treatment for patients who suffer from moderate to severe persistent allergic asthma or moderate to severe allergic asthma. It has been found to improve disease symptoms without increasing serious adverse events. However, it is not considered cost-effective due to its high price.
Objectives Re-evaluation the clinical evidence of. anti-virus medicines for virosis communicable respiratory disease on the effectiveness, safety and health economy. Methods To search CL (2003 Issue 1), Medline (1966-2003.5), CCOHTA, SBU, NICE and NCCHTA and collect all CSRs and HTA with computer . The quality of evaluation partly based on QUOROM will be done before results analysed. If heterogeneity does not exist in CSRs and HTA, a Meta-analysis will be re-conducted. Results 4 CSRs (38 RC, n=22 835) and 5 HTA (28 RCT, n=139 281) were included. Due to the significant heterogeneity between these studies, further Meta-analysis could not be conducted, and descri ptive conclusions were conducted only. Conclusions Neuraminidase inhibitors (zanamivir and oseltamivir) are more effective than placebo in reducing the duration of symptoms of patients with basic disease, and have limited effectiveness in health adults. But, both are well tolerated and reduce the rate of contracting influenza in all individuals. For prevention, neuraminidase inhibitors cost more and are not suitable as first-line drug. 2. Diamantane is more effective than placebo in reducing the duration of having fever, and effectively prevents the influenza A. Amantadine and rimantadine have comparable effectiveness in the prevention, although rimantadine induces fewer adverse effects than amantadine. 3. The number of the childrenpatients of upper respiratory tract infection prevented and treated by ribavirin is too small to draw any conculsion now.
Mini health technology assessment (mini-HTA) is a decision support tool based on the principle and method of evidence-based medicine and traditional HTAs. It systematically reviews healthy technologies and provides references for decision makers at the hospital level in terms of introducing relevant health technologies. In order to provide a new insight to the decision makers, this paper briefly introduces the features of mini-HTA.
ObjectiveTo comprehensively review the status quo, contents, and problems of health technology assessments (HTAs) on cardiovascular and cerebrovascular diseases in Chinese rural. MethodsThe CNKI, VIP, WanFang Data and CBM databases were searched for the HTAs on cardiovascular and cerebrovascular diseases in Chinese rural up to October 31st, 2013. Two reviewers independently screened literatures and extracted data, and then the qualitative method was used to systematically analyze the literatures' information and results. ResultsA total of 34 studies were included. Of which, 23 were descriptive studies and 11 were experimental studies. The studied populations were patients and ordinary residents who had received the service of cardiovascular and cerebrovascular diseases health technology in rural, as well as the grassroots medical technical personnel and promotion staffs who had developed the health technologies. HTAs on cardiovascular and cerebrovascular diseases in rural mainly included western medicine health technologies and traditional Chinese medicine (TCM) health technologies. The contents of HTA of the included literatures mainly included:effectiveness, acceptability, requirements, economic characteristics, safety and technical specific property. The results of the included literatures showed that the type of diseases involved in cardiovascular and cerebrovascular diseases in rural were not widely enough, the fields involved in assessment contents were single, lack of rigorous and comprehensive study design. ConclusionWe need more HTAs of cardiovascular and cerebrovascular diseases in rural, we also need to strengthen early prevention, promote a wider range of cardiovascular and cerebrovascular diseases health technology, strengthen promotion and application of both TCM health technologies and the combination of TCM and western medicine health technologies in cardiovascular and cerebrovascular diseases.
Objectives About 12.9-50% patients of SARS (Severe Acute Respiratory Syndrome), require brief mechanical ventilation (MV) to save life. All the reported principles and guidelines for therapy SARS were based on experiences from clinical treatments and facts of inadequacy. Neither prospective randomized controlled trials (RCT) nor other high quality evidences were in dealing with SARS. Our objective is to seek safe and rational non-drugs interventions for patients with severe SARS by retrospectively reviewing clinical studies about MV all over the world, which include clinical guidelines, systematic reviews (SR), Meta-analysis, economic researches and adverse events. Methods To search MEDLINE and Cochrane Library with computer. According to the standards of inclucion or exclusion, the quality of the article which as assessed, and relevant data which were extracted double checked. The Meta-analysis was conducted if the studies had no heterogeneity. Results 14 papers were eligible. Due to the significant heterogeneity between these studies, further Meta-analysis could not be conducted, and the authors’ conclusions were described only. Conclusions The outcome of PPV is better than that of VPV. Patients who underwent PPV had a significantly lower mortality than that of VPV. Of course, the volutrauma should be watched. With low tidal volume and proper PEEP, or decreased FiO2, even permissive hypercapnia, the mortality and length of stay were cut down. Non-invasive mechanical ventilation (NIMV) was effective in treating haemodynamical stable patients, minimizing complications and reducing medical staff infection. Patients with serious dyspnea with PaO2/FiO2lt;200, no profit of NIMV, or couldn’t tolerance hypoxaemia were unlikely to benefit from this technique and needed ventilation with endotracheal intubation. Prone position could improve PaO2/FiO2, NO maybe increased pulmonary perfusion, improved V/Q, and raised oxygenation. Furthermore, Inhaled NO sequentially (SQA) was better than Inhaled NO continuouly (CTA). Some studies implied that practice of protocol-directed weaning from mechanical ventilation implemented by nurses excelled that of traditional physician-directed weaning.
Objective To investigate the feasibility of health technology permission (HTP) for widely used, high cost and risk technologies based on evidence of health technology assessment (HTA) from the perspective of Ministry of Health (MOH). Method With reference to experiences of HTA and evidence-based health administration in developed countries, four HTA and EBM entities have been established in China, which promoted and disseminated HTA. Three technologies-Bank of Haematopoietic Stem Cell from Umbilical Cord, Assisted Reproductive Technology (ART) and Sperm Bank-were piloted to assess, which provided quality evidence to assist MOH in formulating the Regulation for Permission on Health Technology. Results A set of technologies such as medical equipment, clinical techniques and screening technology for disease prevention and control have been assessed. Several regulations for permission on individual health technologies have been prepared to guide certification of professionals and health institutes. These include Regulation of Bank of Haematopoietic Stem Cell from Umbilical Cord, Regulation of Assisted Repreduction Technology and Management of Human Sperm Bank. Conclusions Although we have possessed a pre-requisite to establish a set of managing system for evidence-based permission of health technologies, an efficient infrastructure to run this system should be established and improved.
Objective To investigate present status of health care in peri-brain-death and analyze its effectiveness and health economic characteristics. Method Retrospective analysis of case series was conducted and a total of 940 patients from surgical intensive care unit (SICU) were reviewed on treatment and part of direct medical expenditure. The patients admitted from Jun. 1999 to Dec. 2000 and Nov. 2001 to Jun. 2002 were included in this study. Data were processed by SPSS 10.0. Results Patients were included if they had two of the three symptoms for at least one hour: deep coma, pupillar light reflex disappear, and no autonomic respiratory. Ultimately 115 patients were included, with a total cost of ￥2 515.9 per day for each case, whereas mortality was 99.10%. Mortality increased with the state of peri-brain-death prolonged. Eighty percent of patients included were dead within 72 hours after admission. Conclusions Attempts to resuscitate patients of peri-brain-death have been the most widely applied in China, however, it resulted in great unnecessary consumption of health resources. It is of great importance to promote legislation of brain death in China.