Gene Expression Profiling Tests for Early-Stage Invasive Breast Cancer: A Health Technology Assessment.
Conclusions: Gene expression profiling tests can likely prognosticate the risk of distant recurrence and some tests may also predict chemotherapy benefit. In people with breast cancer that is ER+, LN-, and human epidermal growth factor receptor 2 (HER2)-negative, GEP tests are likely cost-effective compared with no testing. The GEP tests are also likely cost-effective in LN+ and premenopausal people. Compared with funding GEP tests through the out-of-country program, publicly funding GEP tests in Ontario would cost an additional $1 million to $2 million annually, assuming a higher uptake of tests. GEP tests are valued by b...
Source: Ontario Health Technology Assessment Series - April 16, 2020 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

Extracorporeal Membrane Oxygenation for Cardiac Indications in Adults: A Health Technology Assessment.
Conclusions: For adults treated for refractory cardiac arrest, ECPR may improve survival and likely improves long-term neurological outcomes compared with conventional cardiopulmonary resuscitation. For patients treated for cardiogenic shock, ECMO may improve 30-day survival compared with intra-aortic balloon pump, but there is considerable uncertainty.For adults with refractory cardiac arrest, ECPR may be cost-effective compared with conventional CPR. We estimate that publicly funding ECMO for people with cardiac arrest and cardiogenic shock in Ontario over the next 5 years would cost about $845,000 to $2.2 million per ye...
Source: Ontario Health Technology Assessment Series - April 16, 2020 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

Cell-Free Circulating Tumour DNA Blood Testing to Detect EGFR T790M Mutation in People With Advanced Non-Small Cell Lung Cancer: A Health Technology Assessment.
Conclusions: As a minimally invasive test, liquid biopsy identifies a high proportion of people with the EGFR T790M resistance mutation. This identification could better guide treatment for people with advanced NSCLC. However, its relatively low negative predictive value means it is best used as a triage test (i.e., followed by tissue biopsy if the liquid biopsy does not identify a resistance mutation). Liquid biopsy as a triage test is likely more effective than tissue biopsy alone. However, owing to the high cost of treatment, liquid biopsy may not be cost-effective. We estimated that publicly funding liquid biopsy as a ...
Source: Ontario Health Technology Assessment Series - March 25, 2020 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

Implantable Devices for Single-Sided Deafness and Conductive or Mixed Hearing Loss: A Health Technology Assessment.
Authors: Ontario Health (Quality) Abstract Background: Single-sided deafness refers to profound sensorineural hearing loss or non-functional hearing in one ear, with normal or near-normal hearing in the other ear. Its hallmark is the inability to localize sound and hear in noisy environments. Conductive hearing loss occurs when there is a mechanical problem with the conduction of sound vibrations. Mixed hearing loss is a combination of sensorineural and conductive hearing loss. Conductive and mixed hearing loss, which frequently affect both ears, create additional challenges in learning, employment, and quality of...
Source: Ontario Health Technology Assessment Series - March 22, 2020 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

Genome-Wide Sequencing for Unexplained Developmental Disabilities or Multiple Congenital Anomalies: A Health Technology Assessment.
Conclusions: Genome-wide sequencing could have a higher diagnostic yield than standard testing for people with unexplained developmental disabilities or multiple congenital anomalies. Genome-wide sequencing can also prompt some changes to medications, treatments, and referrals to specialists for some people tested; however, we are very uncertain about this. Genome-wide sequencing could be a cost-effective strategy when used after standard testing to diagnose people with unexplained developmental disabilities or multiple congenital anomalies. It could also lead to cost savings when used earlier in the diagnostic pathway. Pa...
Source: Ontario Health Technology Assessment Series - March 22, 2020 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

Transcatheter Aortic Valve Implantation in Patients With Severe, Symptomatic Aortic Valve Stenosis at Intermediate Surgical Risk: A Health Technology Assessment.
Conclusions: In people with severe, symptomatic aortic valve stenosis at intermediate surgical risk, TAVI was similar to SAVR with respect to the composite endpoint of all-cause mortality or disabling stroke. However, the two treatments had different patterns of complications. The study authors also noted that longer follow-up is needed to assess the durability of the TAVI valve. Compared with SAVR, TAVI may provide good value for money, but publicly funding TAVI in Ontario would result in additional costs over the next 5 years. People with aortic valve stenosis who had undergone TAVI appreciated its less invasive nature a...
Source: Ontario Health Technology Assessment Series - March 22, 2020 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

10-kHz High-Frequency Spinal Cord Stimulation for Adults With Chronic Noncancer Pain: A Health Technology Assessment.
Conclusions: For adults with chronic noncancer pain that was refractory to medical management, 10-kHz high-frequency SCS was effective in relieving pain, reducing disability, and improving quality of life. Because there was limited evidence about the effectiveness of 10-kHz high-frequency SCS in people who had first tried and failed SCS at lower frequencies (up to 1.2 kHz), we were unable to determine whether 10-kHz high-frequency SCS is cost-effective in the Ontario context. We estimate that publicly funding 10-kHz high-frequency SCS in Ontario would result in cost savings of about $0.10 million to $0.21 million per year,...
Source: Ontario Health Technology Assessment Series - March 22, 2020 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

Continual Long-Term Physiotherapy After Stroke: A Health Technology Assessment.
Conclusions: We did not identify studies that addressed the specific research question. Based on the clinical evidence review, we are unable to determine the benefits of continual long-term compared with short-term physiotherapy after stroke. The cost-effectiveness of continual long-term physiotherapy after stroke in Ontario is unknown. We estimate that publicly funding continual long-term physiotherapy after stroke in Ontario would result in additional costs of between $445,000 and $888,000 annually over the next 5 years. Patients and caregivers who we spoke with felt that patients who have experienced a stroke should be ...
Source: Ontario Health Technology Assessment Series - March 22, 2020 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

5-Aminolevulinic Acid Hydrochloride (5-ALA)-Guided Surgical Resection of High-Grade Gliomas: A Health Technology Assessment.
Conclusions: 5-ALA-guided surgical resection appears to improve the extent of resection of high-grade gliomas compared with surgery using standard white-light microscopy (GRADE: Low). The evidence suggests 5-ALA-guided resection may improve overall survival; however, we cannot exclude the possibility of no effect (Grade: Low). 5-ALA may improve 6-month progression-free survival, although the results are highly uncertain (GRADE: Very low). There is an uncertain impact on overall or neurological adverse events (GRADE: Very low). We did not identify any economic studies conducted from the perspective of the Ontario or Canadia...
Source: Ontario Health Technology Assessment Series - March 22, 2020 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

Portable Normothermic Cardiac Perfusion System in Donation After Cardiocirculatory Death: A Health Technology Assessment.
Conclusions: Based on very low quality of evidence, the outcomes for recipients of DCD hearts preserved using a portable normothermic cardiac perfusion system appear to be similar to outcomes for recipients of NDD hearts. Owing to a lack of evidence relevant to the Ontario context, we were unable to determine whether a portable normothermic perfusion system may be cost-effective. We estimate that publicly funding a portable normothermic cardiac perfusion system for DCD heart transplantation over the next 5 years will cost about $5.6 million. The people we spoke with believe that the system may increase the number of hearts...
Source: Ontario Health Technology Assessment Series - March 21, 2020 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

Auditory Brainstem Implantation for Adults With Neurofibromatosis 2 or Severe Inner Ear Abnormalities: A Health Technology Assessment.
Conclusions: When compared with no intervention, auditory brainstem implantation provides some benefit for completely deaf adults with NF2 or severe inner ear abnormalities who are not candidates for cochlear implantation. Based on evidence of moderate to high quality, auditory brainstem implants allow any degree of improvement in sound recognition and in speech perception when used in conjunction with lip-reading for people with NF2. The quality of evidence on these outcomes was low to moderate for people with severe inner ear abnormalities. These functional outcomes lead to subjective benefits of hearing which are consis...
Source: Ontario Health Technology Assessment Series - March 21, 2020 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

Flash Glucose Monitoring System for People with Type 1 or Type 2 Diabetes: A Health Technology Assessment.
Conclusions: Based on an assessment of several glycemic outcomes, moderate-quality evidence shows that flash glucose monitoring improves diabetes management among adults with well-controlled type 1 diabetes and adults with type 2 diabetes requiring intensive insulin therapy. We estimate that publicly funding flash glucose monitoring in Ontario for people with type 1 diabetes and for people with type 2 diabetes requiring intensive insulin therapy who are eligible for coverage under the Ontario Drug Benefit program would result in additional costs of between $14.6 million and $38.6 million annually over the next 5 years. Adu...
Source: Ontario Health Technology Assessment Series - January 18, 2020 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

Minimally Invasive Glaucoma Surgery: A Budget Impact Analysis and Evaluation of Patients' Experiences, Preferences, and Values.
Conclusions: We estimate that publicly funding MIGS in Ontario would result in additional costs over the next 5 years; however, this may depend on the populations using MIGS and if uptake is restricted or controlled. For the people with glaucoma we spoke with, avoiding blindness was their paramount concern, and MIGS was perceived as an effective treatment option with minimal side effects and recovery time required. PMID: 31942228 [PubMed - in process] (Source: Ontario Health Technology Assessment Series)
Source: Ontario Health Technology Assessment Series - January 18, 2020 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

Osseointegrated Prosthetic Implants for People With Lower-Limb Amputation: A Health Technology Assessment.
Conclusions: In the studies included in the clinical evidence review, most people who received osseointegrated prosthetic implants were followed for only a few years. Studies showed that functional outcomes and physical ability improved with osseointegrated prosthetic implants (GRADE: Low), but there was uncertainty about the impact of these implants on people's emotional health (GRADE: Low). Osseointegrated prosthetic implants can lead to serious adverse events such as bone infection and bone fracture in some patients, which may require additional surgeries (GRADE: High). The reference case of the primary economic evaluat...
Source: Ontario Health Technology Assessment Series - January 10, 2020 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

Home-Based Subcutaneous Infusion of Immunoglobulin for Primary and Secondary Immunodeficiencies: A Health Technology Assessment.
Conclusions: The best available evidence suggests that home-based SC infusion is safe and effective, with clinical outcomes that are comparable to the clinical outcomes of hospital IV infusion. The quality of evidence is low, however, meaning that we cannot be certain about these findings. The shift from hospital-based IV to home-based SC has the potential to reduce the health care costs due to savings in nursing time in Ontario. Patients and caregivers expressed preference for home-based SC treatment as it reduces treatment burden and improves overall quality of life. PMID: 31210833 [PubMed] (Source: Ontario Health Te...
Source: Ontario Health Technology Assessment Series - June 21, 2019 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

Internet-Delivered Cognitive Behavioural Therapy for Major Depression and Anxiety Disorders: A Health Technology Assessment.
Conclusions: Compared with waiting list, guided iCBT is effective and likely results in symptom improvement in mild to moderate major depression and social phobia. Guided iCBT may improve the symptoms of generalized anxiety disorder and panic disorder compared with waiting list. However, we are uncertain about the effectiveness of iCBT compared with individual or group face-to-face CBT. Guided iCBT represents good value for money and could be offered for the short-term treatment of adults with mild to moderate major depression or anxiety disorders. Most people with mild to moderate depression or anxiety disorders with whom...
Source: Ontario Health Technology Assessment Series - March 16, 2019 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

Intermittent Catheters for Chronic Urinary Retention: A Health Technology Assessment.
Conclusions: Given the overall low quality of evidence in available studies, we are uncertain whether any specific type of IC (coated or noncoated, single- or multiple-use) significantly reduces symptomatic UTI, hematuria, or other serious adverse clinical events, or whether a specific type improves patient satisfaction. Therefore, the lowest-cost IC is likely the most cost-effective. PMID: 30847008 [PubMed - in process] (Source: Ontario Health Technology Assessment Series)
Source: Ontario Health Technology Assessment Series - March 10, 2019 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

Cervical Artificial Disc Replacement Versus Fusion for Cervical Degenerative Disc Disease: A Health Technology Assessment.
Conclusions: For carefully selected patients with cervical degenerative disc disease, C-ADR provides patient-important and statistically significant reductions in pain and disability. Further, unlike fusion, C-ADR allows people to maintain relatively normal cervical spine motion.Compared with fusion, C-ADR appears to represent good value for money for adults with one-level cervical degenerative disc disease ($11,607/QALY) and for adults with two-level disease ($16,782/QALY). In Ontario, publicly funding C-ADR could result in total additional costs of $916,326 for one-level procedures and $705,628 for two-level procedures o...
Source: Ontario Health Technology Assessment Series - March 10, 2019 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

Noninvasive Prenatal Testing for Trisomies 21, 18, and 13, Sex Chromosome Aneuploidies, and Microdeletions: A Health Technology Assessment.
Conclusions: NIPT is an effective and safe prenatal screening method for trisomies 21, 18, and 13 in the average-risk or general population. Compared with traditional prenatal screening, second-tier NIPT improved the overall performance of prenatal screening and slightly decreased costs. Compared with second-tier NIPT, first-tier NIPT detected more chromosomal anomalies, but resulted in a considerable increase in the total budget. Interviewees were generally positive about NIPT, but they raised concerns about the lack of good informed-choice conversations with primary care providers and the quality of the information they ...
Source: Ontario Health Technology Assessment Series - March 10, 2019 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

Perspectives of Pregnant People and Clinicians on Noninvasive Prenatal Testing: A Systematic Review and Qualitative Meta-synthesis.
Conclusions: Noninvasive prenatal testing offers significant benefit for pregnant people but may also be associated with potential harms related to informed decision-making, inequitable use, social pressure to test, and reduced support for people with disabilities. PMID: 30838086 [PubMed - in process] (Source: Ontario Health Technology Assessment Series)
Source: Ontario Health Technology Assessment Series - March 8, 2019 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

Compression Stockings for the Prevention of Venous Leg Ulcer Recurrence: A Health Technology Assessment.
Conclusions: The available evidence shows that, compared with usual care, compression stockings are effective in preventing venous leg ulcer recurrence and likely to be cost-effective. In people with a healed venous leg ulcer, wearing compression stockings helps to reduce the risk of recurrence by about half. Publicly funding compression stockings for people with venous leg ulcers would result in additional costs to the Ontario health care system over the next 5 years. Despite concerns about cost and the daily chore of wearing compression stockings, most people interviewed felt that compression stockings provided important...
Source: Ontario Health Technology Assessment Series - March 6, 2019 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

Cognitive Behavioural Therapy for Psychosis: A Health Technology Assessment.
The objectives of this report were to assess the effectiveness, harms, cost-effectiveness, and lived experience of CBT for psychosis in improving outcomes for adults with a primary diagnosis of schizophrenia. Methods: We performed literature searches on March 28 and April 5, 2017, and undertook a qualitative synthesis of systematic reviews of the clinical and economic literature comparing CBT for psychosis with any comparator interventions (e.g., usual care, waitlist control, or pharmacotherapy) in adults with a diagnosis of schizophrenia as defined by any criteria (including related disorders such as schizoaffective d...
Source: Ontario Health Technology Assessment Series - November 18, 2018 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

Bilateral Cochlear Implantation: A Health Technology Assessment.
Conclusions: Based on evidence of moderate to high quality, we found that bilateral cochlear implantation improved hearing in adults and children with severe to profound sensorineural hearing loss. Bilateral cochlear implantation was potentially cost-effective compared to unilateral cochlear implantation in adults and children. Patients with sensorineural hearing loss reported the positive effects of cochlear implants, and patients with unilateral cochlear implants generally expressed a desire for bilateral implants. PMID: 30443278 [PubMed - in process] (Source: Ontario Health Technology Assessment Series)
Source: Ontario Health Technology Assessment Series - November 18, 2018 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

Remote Monitoring of Implantable Cardioverter-Defibrillators, Cardiac Resynchronization Therapy and Permanent Pacemakers: A Health Technology Assessment.
Conclusions: Remote monitoring of ICDs, CRT-Ds, and pacemakers plus clinic visits resulted in improved outcomes without increasing the risk of major adverse events compared with clinic visits alone. Remote monitoring is a cost-effective option for patients implanted with cardiac electronic devices. Patients reported positive experiences using remote monitoring, and perceived that the device provided important medical and safety benefits. PMID: 30443279 [PubMed - in process] (Source: Ontario Health Technology Assessment Series)
Source: Ontario Health Technology Assessment Series - November 18, 2018 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

Structured Education and Neuromuscular Exercise Program for Hip and/or Knee Osteoarthritis: A Health Technology Assessment.
Conclusions: There is moderate-quality evidence that, compared with usual care, a structured education and neuromuscular exercise program improves physical function, quality of life, and the ability to perform activities of daily living. There is low-quality evidence that, compared with usual care, this type of program improves pain. Low-quality evidence suggests that, compared with patient education, a structured education and neuromuscular exercise program improves pain and physical function.A group-based structured education and neuromuscular exercise program may be cost-effective for the nonsurgical management of knee ...
Source: Ontario Health Technology Assessment Series - November 18, 2018 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

Electronic Monitoring Systems to Assess Urinary Incontinence: A Health Technology Assessment.
Conclusions: The effectiveness of using the electronic monitoring system to assess urinary incontinence is uncertain because of the very low quality of the evidence. Introducing electronic monitoring systems would result in incremental costs, and there would be savings only if the systems substantially reduced incontinence. PMID: 29844845 [PubMed - in process] (Source: Ontario Health Technology Assessment Series)
Source: Ontario Health Technology Assessment Series - June 4, 2018 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

Magnetic Resonance-Guided Focused Ultrasound Neurosurgery for Essential Tremor: A Health Technology Assessment.
Conclusions: MRgFUS neurosurgery is an effective and generally safe treatment option for moderate to severe, medication-refractory essential tremor. It provides a treatment option for people ineligible for invasive neurosurgery and offers a noninvasive option for all people considering neurosurgery.For people ineligible for invasive neurosurgery, MRgFUS neurosurgery is cost-effective compared with no surgery. In people eligible for invasive neurosurgery, MRgFUS neurosurgery may be one of several reasonable options. Publicly funding MRgFUS neurosurgery for the treatment of moderate to severe, medication-refractory essential...
Source: Ontario Health Technology Assessment Series - May 31, 2018 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

Continuous Monitoring of Glucose for Type 1 Diabetes: A Health Technology Assessment.
Conclusions: Continuous glucose monitoring was more effective than self-monitoring of blood glucose in managing type 1 diabetes for some outcomes, such as time spent in the target glucose range and time spent outside the target glucose range (moderate certainty in this evidence). We were less certain that continuous glucose monitoring would reduce the number of severe hypoglycemic events. Compared with self-monitoring of blood glucose, the costs of continuous glucose monitoring were higher, with only small increases in health benefits. Publicly funding continuous glucose monitoring for the type 1 diabetes population in Ont...
Source: Ontario Health Technology Assessment Series - March 18, 2018 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

Portable Ultraviolet Light Surface-Disinfecting Devices for Prevention of Hospital-Acquired Infections: A Health Technology Assessment.
Conclusions: We are unable to make a firm conclusion about the effectiveness of this technology on HAIs given the very low to low quality of evidence. The budget impact estimates are sensitive to assumptions made about the number of UV disinfecting devices purchased per hospital, frequency of daytime use, and staff time required per use. PMID: 29487629 [PubMed - in process] (Source: Ontario Health Technology Assessment Series)
Source: Ontario Health Technology Assessment Series - March 2, 2018 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

Psychotherapy for Major Depressive Disorder and Generalized Anxiety Disorder: A Health Technology Assessment.
Conclusions: Compared with usual care, treatment with CBT, interpersonal therapy, or supportive therapy significantly reduces depression symptoms posttreatment. CBT significantly reduces anxiety symptoms posttreatment in patients with generalized anxiety disorder.Compared with usual care, treatment with structured psychotherapy (CBT or interpersonal therapy) represents good value for money for adults with major depressive disorder and/or generalized anxiety disorder. The most affordable option is group structured psychotherapy provided by nonphysicians, with the selective use of individual structured psychotherapy provided...
Source: Ontario Health Technology Assessment Series - December 9, 2017 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

Retinal Prosthesis System for Advanced Retinitis Pigmentosa: A Health Technology Assessment Update.
Conclusions: Based on evidence of moderate quality, the Argus II retinal prosthesis system improved visual function, real-life functional outcomes, and quality of life in patients with advanced retinitis pigmentosa. The Argus II system is expensive, but the cost to publicly fund it would be low, because of the small number of eligible patients. The Argus II system can only enable perception of light/dark and shapes/objects, but these advancements represent important gains for people with retinitis pigmentosa in terms of mobility and quality of life. PMID: 29201260 [PubMed - in process] (Source: Ontario Health Technology Assessment Series)
Source: Ontario Health Technology Assessment Series - December 6, 2017 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

Electrical Stimulation for Pressure Injuries: A Health Technology Assessment.
Conclusions: While electrical stimulation is safe to use (GRADE quality of evidence: high) there is uncertainty about whether it improves wound healing (GRADE quality of evidence: low). In Ontario, publicly funding electrical stimulation for pressure injuries could result in extra costs of $0.77 to $3.85 million yearly for the next 5 years. PMID: 29201261 [PubMed - in process] (Source: Ontario Health Technology Assessment Series)
Source: Ontario Health Technology Assessment Series - December 6, 2017 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

Fibreglass Total Contact Casting, Removable Cast Walkers, and Irremovable Cast Walkers to Treat Diabetic Neuropathic Foot Ulcers: A Health Technology Assessment.
CONCLUSIONS: Ulcer healing improved with total contact casting, irremovable cast walkers, and removable cast walkers, but total contact casting and irremovable cast walkers had higher rates of ulcer healing than removable cast walkers. Increased access to offloading devices could result in cost savings for the health system because of fewer amputations. Patients with diabetic foot ulcers reported a preference for total contact casting over removable cast walkers, largely because they perceived wound healing to be improved with total contact casting. However, cost, comfort, and convenience are concerns for patients. PMI...
Source: Ontario Health Technology Assessment Series - October 12, 2017 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

Lumbosacral Dorsal Rhizotomy for Spastic Cerebral Palsy: A Health Technology Assessment.
CONCLUSIONS: Lumbrosacral dorsal rhizotomy and physical therapy effectively reduces lower-limb spasticity in children with spastic cerebral palsy and significantly improves their gross motor function and functional independence. Major peri-operative complications were infrequently reported. Families reported perceived improvements with dorsal rhizotomy, and surgery and post-operative rehabilitation were intensive and demanding. PMID: 28757906 [PubMed - in process] (Source: Ontario Health Technology Assessment Series)
Source: Ontario Health Technology Assessment Series - August 2, 2017 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

Robotic Surgical System for Radical Prostatectomy: A Health Technology Assessment.
CONCLUSIONS: There is no high-quality evidence that robot-assisted radical prostatectomy improves functional and oncological outcomes compared with open and laparoscopic approaches. However, compared with open radical prostatectomy, the costs of using the robotic system are relatively large while the health benefits are relatively small. PMID: 28744334 [PubMed - in process] (Source: Ontario Health Technology Assessment Series)
Source: Ontario Health Technology Assessment Series - July 28, 2017 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

Left Atrial Appendage Closure Device With Delivery System: A Health Technology Assessment.
CONCLUSIONS: Moderate-quality evidence suggests that the LAAC device is as effective as novel oral anticoagulants in preventing stroke in people with nonvalvular atrial fibrillation. However, our results indicate that the LAAC device is cost-effective only in patients with contraindications to oral anticoagulants. People with nonvalvular atrial fibrillation with whom we spoke reported positive support for the LAAC device. PMID: 28744335 [PubMed - in process] (Source: Ontario Health Technology Assessment Series)
Source: Ontario Health Technology Assessment Series - July 28, 2017 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

Effect of Early Follow-Up After Hospital Discharge on Outcomes in Patients With Heart Failure or Chronic Obstructive Pulmonary Disease: A Systematic Review.
CONCLUSIONS: Based on low- and very low-quality evidence, follow-up within 7 days and within 30 days of discharge from hospitalization for heart failure or COPD-compared with usual care or no follow-up-were both associated with a reduced risk of all-cause readmission, emergency department visits, and mortality. Overall, there is a lack of large, methodologically robust studies specifically focusing on the effectiveness of 7-day follow-up after discharge in improving patient outcomes. PMID: 28638496 [PubMed - in process] (Source: Ontario Health Technology Assessment Series)
Source: Ontario Health Technology Assessment Series - June 25, 2017 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

Hyperbaric Oxygen Therapy for the Treatment of Diabetic Foot Ulcers: A Health Technology Assessment.
CONCLUSIONS: The evidence makes it difficult to draw any definitive conclusions on the clinical and cost effectiveness of standard wound care plus HBOT versus standard wound care alone for the treatment of diabetic foot ulcers. PMID: 28572866 [PubMed - in process] (Source: Ontario Health Technology Assessment Series)
Source: Ontario Health Technology Assessment Series - June 4, 2017 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

Prolaris Cell Cycle Progression Test for Localized Prostate Cancer: A Health Technology Assessment.
CONCLUSIONS: We found no evidence to demonstrate the impact of the Prolaris CCP test on patient-important clinical outcomes. The limited evidence available shows that the test appears to provide information that, when considered in addition to clinical risk stratification, may change the treatment plan or actual treatment for some low- and intermediate-risk prostate cancer patients. As a result, there is insufficient data to inform the cost-effectiveness of the CCP test. Publicly funding the CCP test would result in a large incremental cost to the provincial budget. PMID: 28572867 [PubMed - in process] (Source: Ontario...
Source: Ontario Health Technology Assessment Series - June 4, 2017 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

Prostate Cancer Patient Perspectives on the Use of Information in Treatment Decision-Making: A Systematic Review and Qualitative Meta-synthesis.
CONCLUSIONS: Although each prostate cancer patient is unique, studies suggest that most patients seek extensive information to help inform their treatment decisions. This may happen before, during, and after the treatment choice is made. Given the amount of information patients may access, it is important that they also establish the trustworthiness of the various types and sources of information. When information conflicts, patients may be unsure about how to proceed. Open collaboration between patients and their health care providers can help patients manage and navigate their concerns so that their values and perspectiv...
Source: Ontario Health Technology Assessment Series - June 4, 2017 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

Pharmacogenomic Testing for Psychotropic Medication Selection: A Systematic Review of the Assurex GeneSight Psychotropic Test.
CONCLUSIONS: There is uncertainty about the use of GeneSight Psychotropic pharmacogenomic genetic panel to guide medication selection. It was associated with improvements in some patient outcomes, but not others. As well, our confidence in these findings is low because of limitations in the body of evidence. PMID: 28515818 [PubMed - in process] (Source: Ontario Health Technology Assessment Series)
Source: Ontario Health Technology Assessment Series - May 19, 2017 Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research

Patient Safety Learning Systems: A Systematic Review and Qualitative Synthesis.
CONCLUSIONS: The design of a patient safety learning system can be optimized by an awareness of the barriers to and facilitators of successful adoption and implementation identified by health care professionals. Evaluation of the effectiveness of a patient safety learning system is needed to refine its design. PMID: 28326148 [PubMed - in process] (Source: Ontario Health Technology Assessment Series)
Source: Ontario Health Technology Assessment Series - March 24, 2017 Category: Journals (General) Tags: Ont Health Technol Assess Ser Source Type: research

Percutaneous Ventricular Assist Devices: A Health Technology Assessment.
CONCLUSIONS: On the basis of evidence of low to very low quality, Impella 2.5 devices were associated with improved hemodynamic stability, but had mortality rates and safety profile similar to IABPs in high-risk PCI and cardiogenic shock. Our cost-effectiveness analysis indicated that Impella 2.5 is likely associated with greater costs and fewer quality-adjusted life years than IABP. PMID: 28232854 [PubMed - in process] (Source: Ontario Health Technology Assessment Series)
Source: Ontario Health Technology Assessment Series - February 27, 2017 Category: Journals (General) Tags: Ont Health Technol Assess Ser Source Type: research

Long-Term Continuous Ambulatory ECG Monitors and External Cardiac Loop Recorders for Cardiac Arrhythmia: A Health Technology Assessment.
CONCLUSIONS: Although both longterm continuous ambulatory ECG monitors and external cardiac loop recorders were more effective than a 24-hour Holter monitor in detecting symptoms of cardiac arrhythmia, we found no evidence to suggest that these two devices differ in effectiveness. Assuming that the use of longterm continuous monitors will continue to increase in the next 5 years, the public health care system in Ontario can expect to see added costs of $130,000 to $370,000 per year. PMID: 28194254 [PubMed - in process] (Source: Ontario Health Technology Assessment Series)
Source: Ontario Health Technology Assessment Series - February 16, 2017 Category: Journals (General) Tags: Ont Health Technol Assess Ser Source Type: research

Levonorgestrel-Releasing Intrauterine System (52 mg) for Idiopathic Heavy Menstrual Bleeding: A Health Technology Assessment.
CONCLUSIONS: The 52-mg LNG-IUS is an effective and cost-effective treatment option for idiopathic heavy menstrual bleeding. It improves quality of life and menstrual blood loss, and is well tolerated compared with endometrial ablation, hysterectomy, or usual medical therapies. PMID: 27990196 [PubMed - in process] (Source: Ontario Health Technology Assessment Series)
Source: Ontario Health Technology Assessment Series - December 21, 2016 Category: Journals (General) Tags: Ont Health Technol Assess Ser Source Type: research

Transcatheter Aortic Valve Implantation for Treatment of Aortic Valve Stenosis: A Health Technology Assessment.
CONCLUSIONS: Moderate quality evidence showed that TAVI and SAVR had similar mortality rates in patients who were eligible for surgery. Information about quality of life showed similar results for TAVI and SAVR in the first year, but was based on low quality evidence. Moderate quality evidence also showed that TAVI was associated with higher rates of adverse events than SAVR. In patients who were not suitable candidates for surgery, moderate quality evidence showed that TAVI improved survival compared with balloon aortic valvuloplasty. When TAVI was compared with SAVR, the incremental cost-effectiveness ratio was $51,988 p...
Source: Ontario Health Technology Assessment Series - December 21, 2016 Category: Journals (General) Tags: Ont Health Technol Assess Ser Source Type: research

Magnetic Resonance Imaging as an Adjunct to Mammography for Breast Cancer Screening in Women at Less Than High Risk for Breast Cancer: A Health Technology Assessment.
CONCLUSIONS: It remains uncertain if the use of adjunct screening breast MRI in women at less than high risk (average or higher than average risk) for breast cancer will reduce breast cancer-related mortality without significant increases in unnecessary follow-up testing and treatment. PMID: 27990198 [PubMed - in process] (Source: Ontario Health Technology Assessment Series)
Source: Ontario Health Technology Assessment Series - December 21, 2016 Category: Journals (General) Tags: Ont Health Technol Assess Ser Source Type: research

Fecal Microbiota Therapy for Clostridium difficile Infection: A Health Technology Assessment.
CONCLUSIONS: In patients with recurrent C. difficile infection, fecal microbiota therapy improves outcomes that are important to patients and provides good value for money. PMID: 27516814 [PubMed - in process] (Source: Ontario Health Technology Assessment Series)
Source: Ontario Health Technology Assessment Series - August 16, 2016 Category: Journals (General) Tags: Ont Health Technol Assess Ser Source Type: research

Composite Tissue Transplant of Hand or Arm: A Health Technology Assessment.
CONCLUSIONS: Composite tissue transplant of the hand or arm may improve a patient's ability to function, but because the overall quality of evidence is of very low quality, there is considerable uncertainty as to whether benefits outweigh harms. Compared with standard care, both single- and double-hand transplants are not cost-effective. PMID: 27468324 [PubMed - in process] (Source: Ontario Health Technology Assessment Series)
Source: Ontario Health Technology Assessment Series - July 30, 2016 Category: Journals (General) Tags: Ont Health Technol Assess Ser Source Type: research

Retinal Prosthesis System for Advanced Retinitis Pigmentosa: A Health Technology Assessment.
CONCLUSIONS: Based on evidence of moderate quality, patients with advanced retinitis pigmentosa who were implanted with the Argus II retinal prosthesis system showed significant improvement in visual function, real-life functional outcomes, and quality of life, but there were complications associated with the surgery that could be managed through standard ophthalmologic treatments. The costs for the technology are high. PMID: 27468325 [PubMed - in process] (Source: Ontario Health Technology Assessment Series)
Source: Ontario Health Technology Assessment Series - July 30, 2016 Category: Journals (General) Tags: Ont Health Technol Assess Ser Source Type: research