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Introduction: Detail on a technology's projected therapeutic use is required for horizon scanning. The International Horizon Scanning Initiative (IHSI) database will utilize natural language processing (NLP) augmented by human curation to generate an estimated indication for technologies in development. We compared the estimated indication, generated as a test-set for NLP, with health technology developers' (HTDs) proposed indications identified from Ireland's horizon scanning system (HSS). Methods: Eight oncology technologies common to both Ireland's HSS and the IHSI database were analyzed. The analysis included unlicensed technologies in late-stage development that have not submitted a European marketing authorization application. Ireland's HSS receives data on proposed indications for technologies from HTDs. IHSI database curators extract and convert terms from clinical trials into structured inputs (condition, combination therapy, stage of disease, place in treatment, patient/disease-specific subgroups) to produce an estimated indication for a technology. We sought to identify, by structured input, the degree of alignment between HTDs' proposed indications with the IHSI database's estimated indication. Results: There was 100 percent alignment between the HTD's proposed indication and the estimated indication generated in the IHSI database for five of the eight included technology records. There was 83 percent alignment for two records and 67 percent alignment for one record. Across all records there was full alignment on condition, combination therapy details, patient-specific subgroup, disease-specific subgroup, and place in treatment. Stage of disease was the only element where data was either not generated for the IHSI database's estimated indication, not aligned with the HTD's proposed indication, or reported in an incorrect field. Conclusions: There is a high degree of alignment between an HTD-proposed indication and the IHSI-estimated indication. The processes for generating an estimated indication will involve both NLP-generation and human co-curation. The current (curator-selected) elements are being used to train the NLP engine. Thereafter, the engine will process clinical trial data to surface tags for human selection to generate the structured inputs. [ABSTRACT FROM AUTHOR]

Introduction: In 2021, approximately 15,000 men in Germany died from prostate cancer (PCa). The national health policy is considering shifting from annual digital rectal examination (DRE)-based screening to an age-related prostate-specific antigen (PSA)-based risk-adapted and organized screening strategy. Our research investigated the cost–utility of the current DRE-based strategy versus organized age-related PSA-based risk-adaptive PCa screening strategies in Germany. Methods: We adapted the Swedish Prostata model to the German context, recalibrating it with PCa clinical and epidemiological data from the national and state registries. The model includes preclinical and clinical disease health states defined by tumor, nodal, and metastatic stages and Gleason scores, and assumes that the benefits of screening arise from stage shift. We assessed the cost–utility of 14 strategies, ranging from no screening to DRE, and age-related, PSA-based, risk-adapted screening. Health state utility values and test characteristics were sourced from the literature. Inpatient and outpatient care costs were derived from the German diagnostic-related groups and uniform-based valuation systems. Results: Among all strategies evaluated and compared with no screening, the "DRE only" strategy led to substantial overdiagnosis, the highest incremental cost, and minimal quality-adjusted life years (QALY) gains. PSA testing starting at 50 to 60 years with reflex MRI for PSA greater than 3 ng/mL cases followed by combined systemic and targeted biopsy reduced the number of biopsies and overdiagnosis by 75 percent and 26 percent, albeit for fewer QALYs and higher costs (dominated) than the same strategy without reflex MRI. The PSA-based risk-adaptive strategy, starting at 50 to 60 years without reflex MRI, demonstrated an 85 percent probability of being cost effective within the EUR30,000 (USD32,211) to EUR100,000 (USD107,369)/QALY willingness-to-pay range. Conclusions: While Germany's HTA emphasizes clinically added benefits and health-related quality of life, cost-effectiveness analysis substantiates this evidence. As a standalone early detection tool, DRE leads to substantial overdiagnosis, unnecessary biopsies, and increased healthcare costs. Overall, this study demonstrated the importance of age-related PSA risk-adaptive PCa screening. The value of MRI deserves further investigation, considering MRI's positive effect on screening acceptability. [ABSTRACT FROM AUTHOR]

Introduction: Innovative public procurement (IPP) is a driver of innovation across sectors. IPP involves the strategic acquisition of cutting-edge technologies and solutions by public entities in collaboration with the private sector. This approach aims to leverage the potential of "omics" technologies, such as genomics and proteomics, within the public sector to advance healthcare solutions. Methods: The IPP process comprises key phases such as needs identification, solicitation preparation, execution, evaluation and awarding, and impact and assessment. The methodology applied was based on the Rapid Assessment Tool for Omics Technologies developed by the Andalusian Agency for Health Technology Assessment, accompanied by clinical validity reports from the impact and evaluation phase of the Technical Office for IPP of Andalusia. The aim was to assess the clinical validation results of two omics technologies, that is, two diagnostic tests. A systematic review was performed to identify existing evidence. We also addressed the challenges associated with implementing the Rapid Assessment Tool in the IPP process. Results: Systematic reviews identifying evidence on the clinical validity and utility of omics technologies provided a foundation for the subsequent evaluation of two technologies in development, once the clinical trials had finished. An analysis of scientific evidence, together with the compilation of information provided by industry, was conducted through a questionnaire and clinical data derived from the company's studies. The analysis of clinical and diagnostic validity was not conclusive. We delivered the final assessment report to support decision-making in the public health system of Andalusia. Conclusions: Both assessed technologies presented a high degree of innovation, but different challenges and issues were identified during the application of the Rapid Assessment Tool for Omics Technologies. Further improvement in IPP procedures for innovative technologies in Andalusia, including integration of our methodological approach at the start the IPP process, could facilitate the acquisition of cutting-edge technologies in collaboration with public entities. [ABSTRACT FROM AUTHOR]

Introduction: As part of the prehabilitation of elderly frail or pre-frail patients prior to elective surgery (PRAEP-GO) randomized controlled trial (NCT04418271), we are investigating the approach of multimodal prehabilitation (e.g., physiotherapy) combined with frailty screening and a shared decision-making conference for frail elderly patients prior to elective surgery. The aim of this analysis was to identify strengths, weaknesses, opportunities, and risks of the PRAEP-GO intervention to inform its implementation within the German healthcare system. Methods: This strengths, weaknesses, opportunities, and threats (SWOT) analysis was based on two expert interview studies and a realist review aiming to identify factors that might facilitate or hinder the implementation of prehabilitation from the perspectives of health service providers and patients. As part of the SWOT analysis, one author categorized these factors into external and internal factors, assessed their importance (scale of one [no/barely] to five [very high] points) and visualized it using radar plots, and assigned them to the categories of strengths, weaknesses, opportunities, or threats. Strategies were then developed to address the following combinations of the categories: strengths/opportunities, strengths/threats, weaknesses/opportunities, and weaknesses/threats. Results: In the expert interviews and the realist review, 45 facilitating and 28 hindering factors focusing on health service provision, patients, and the implementation of prehabilitation for frail patients in general were identified. In the SWOT analysis these factors were assigned to 60 internal (resource analysis) and 13 external factors (environmental analysis), and were further sorted into eight and five categories, respectively; for example, "equipment" and "staff" (these two categories were assigned the highest importance [5 points]). Strategies for utilizing strengths and opportunities included, for example, promotion of interdisciplinary cooperation between service providers. The weaknesses and risks of PRAEP-GO might be mitigated, for example, by improving infrastructures. Conclusions: A variety of factors in different categories may facilitate or hinder the implementation of PRAEP-GO. Based on preliminary results from this analysis, the identified strengths of prehabilitation outweigh its weaknesses, but when analyzing the external factors, the identified risks outweigh the benefits. Thus, the implementation of prehabilitation should be prepared by optimizing framework conditions (e.g., transportation for patients and allocation of personnel). [ABSTRACT FROM AUTHOR]

Introduction: Multimodal prehabilitation, including interventions like physiotherapy, combined with frailty screening and a shared decision-making conference for frail elderly patients before elective surgery is an innovative approach currently under investigation (PRAEP-GO RCT, NCT04418271). The PRAEP-GO intervention aims to enhance postoperative outcomes and prevent care dependency. Our aim is to systematically assess the scale-up potential of PRAEP-GO within the German healthcare system. Methods: We are conducting a scalability analysis using the Intervention Scalability Assessment Tool (ISAT). The ISAT questionnaire comprises two parts: (A) "Setting the scene," describing the current health service situation (e.g., intervention characteristics, political context), and (B) "Intervention implementation planning," outlining future requirements (e.g., workforce, infrastructure), with open-ended questions and a scalability readiness assessment using a scale. Our analysis involves three stages: (i) health economists from the PRAEP-GO research team individually answering ISAT questions, (ii) trialists from the PRAEP-GO research team interviewed in a group, and (iii) external experts representing relevant stakeholders for future implementation interviewed in an advisory board meeting. Results: Data collection for stage (i) and (ii) has been completed, while data collection for stage (iii) is expected to be completed in February 2024. The preliminary findings for part (A) highlight the need for a sustainable approach to manage an aging and increasingly frail patient population requiring surgery. There is no clinical guideline available for the management of this population group. Regarding part (B), the current infrastructure (e.g., therapy facilities) and personnel structures might need to be adapted and should be expanded for large-scale application. Employing professionals to coordinate the patient pathway was recommended, along with adjustments to reimbursement structures. Conclusions: In PRAEP-GO, we are pursuing a multidisciplinary process with the aim of supporting health decisions that promote an equitable, efficient, and high-quality healthcare system meeting the challenges of an aging population due to demographic change. The PRAEP-GO trial is currently exploring this approach on a small scale. Existing infrastructure and personnel structures would need to be adapted and expanded for scale-up. [ABSTRACT FROM AUTHOR]