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International Journal of Technology Assessment in Health Care ; 37(S1):18-19, 2021.
Article in English | ProQuest Central | ID: covidwho-1550202


IntroductionHealth technology reassessment (HTR) is a structured evidence-based assessment of an existing technology in comparison to its alternatives. The process results in the following four outputs: (i) increased use;(ii) decreased use;(iii) no change;or (iv) de-adoption. However, implementing these outputs remains a challenge. Knowledge translation (KT) can be applied to implement findings from the HTR process. This study sought to identify which characteristics of KT theories, models, and frameworks (TMFs) could be useful, specifically for decreasing the use of or de-adopting a technology.MethodsA qualitative descriptive approach was used to ascertain the perspectives of international KT and HTR experts on the characteristics of KT TMFs for decreasing the use of or de-adopting a technology. One-to-one semi-structured interviews were conducted. Interviews were audio recorded and transcribed verbatim. Themes and sub-themes were deduced from the data through framework analysis using the following five distinctive steps: familiarization;identifying an analytic framework;indexing;charting;and mapping and interpretation. Themes and sub-themes were also mapped to existing KT TMFs.ResultsThirteen experts participated. The following three themes emerged as ideal characteristics of a KT TMF: (i) principles foundational for HTR: evidence-based, high usability, patient-centered, and ability to apply to micro, meso, and macro levels;(ii) levers of change: characterized as positive, neutral, or negative influences for changing behavior;and (iii) steps for knowledge to action: build the case for HTR, adapt research knowledge, assess context, select, tailor, and implement interventions, and assess impact. The Consolidated Framework for Implementation Research had the greatest number of ideal characteristics.ConclusionsApplication of KT TMFs to the HTR process has not been clearly established. This is the first study to provide an understanding of characteristics within KT TMFs that could be considered by users undertaking projects to decrease or de-adopt technologies. Characteristics to be considered within a KT TMF for implementing HTR outputs were identified. Consideration of these characteristics may guide users in choosing which KT TMF(s) to use when undertaking HTR projects.

Sci Rep ; 11(1): 17787, 2021 09 07.
Article in English | MEDLINE | ID: covidwho-1397899


Despite COVID-19's significant morbidity and mortality, considering cost-effectiveness of pharmacologic treatment strategies for hospitalized patients remains critical to support healthcare resource decisions within budgetary constraints. As such, we calculated the cost-effectiveness of using remdesivir and dexamethasone for moderate to severe COVID-19 respiratory infections using the United States health care system as a representative model. A decision analytic model modelled a base case scenario of a 60-year-old patient admitted to hospital with COVID-19. Patients requiring oxygen were considered moderate severity, and patients with severe COVID-19 required intubation with intensive care. Strategies modelled included giving remdesivir to all patients, remdesivir in only moderate and only severe infections, dexamethasone to all patients, dexamethasone in severe infections, remdesivir in moderate/dexamethasone in severe infections, and best supportive care. Data for the model came from the published literature. The time horizon was 1 year; no discounting was performed due to the short duration. The perspective was of the payer in the United States health care system. Supportive care for moderate/severe COVID-19 cost $11,112.98 with 0.7155 quality adjusted life-year (QALY) obtained. Using dexamethasone for all patients was the most-cost effective with an incremental cost-effectiveness ratio of $980.84/QALY; all remdesivir strategies were more costly and less effective. Probabilistic sensitivity analyses showed dexamethasone for all patients was most cost-effective in 98.3% of scenarios. Dexamethasone for moderate-severe COVID-19 infections was the most cost-effective strategy and would have minimal budget impact. Based on current data, remdesivir is unlikely to be a cost-effective treatment for COVID-19.

COVID-19/drug therapy , COVID-19/therapy , Health Care Costs/statistics & numerical data , Health Care Rationing/economics , Adenosine Monophosphate/analogs & derivatives , Adenosine Monophosphate/economics , Adenosine Monophosphate/therapeutic use , Alanine/analogs & derivatives , Alanine/economics , Alanine/therapeutic use , COVID-19/diagnosis , COVID-19/economics , COVID-19/mortality , COVID-19/virology , Clinical Decision-Making/methods , Computer Simulation , Cost-Benefit Analysis , Dexamethasone/economics , Dexamethasone/therapeutic use , Health Care Rationing/organization & administration , Humans , Intensive Care Units/economics , Intensive Care Units/statistics & numerical data , Middle Aged , Oxygen/administration & dosage , Oxygen/economics , Quality-Adjusted Life Years , Respiration, Artificial/economics , SARS-CoV-2 , Severity of Illness Index , Treatment Outcome , United States/epidemiology