Article type
Year
Abstract
Background: Healthcare systems are offered with a wide range of technologies and services, but they have to cope with decreasing resources and the uncertainty about what is effective and more appropriate. Making decisions about healthcare interventions is complex. Decisions should be informed by the best available evidence, which, in order to be comprehensive needs to take into account all the relevant aspects (e.g. efficacy, safety, equity, costs), and gathered within a limited time period. DECIDE (www.decide-collaboration.eu) is a project funded by the European Community that, using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology (www.gradeworkinggroup.org), aims at implementing strategies to enhance dissemination and communication of scientific evidence to support on-time evidence-based decision making.
Objectives: To prepare an informative and exhaustive evidence synthesis to help a Regional Commission taking a coverage decision using the GRADE/DECIDE Evidence to Decision (EtD) Framework (see attached file).
Methods: We performed a systematic review of the available evidence about the efficacy and safety of trans-aortic valve implantation (TAVI) for aortic stenosis in high risk patients. We also searched for information about economic evaluations, patients’ preferences, feasibility and equity. We used the EtD Framework to present the information to the members of the Regional Commission.
Results: We identified 4072 records: four Health Technology Assessment (HTA) reports, 13 systematic reviews (SR), three randomised controlled trials and 15 observational studies were eligible for our topic (the single studies were not included in the SRs). We prepared two different EtD Frameworks for the two questions of interest: 1) TAVI versus surgery and 2) TAVI versus medical therapy.
Conclusions: The relevance of this experience lies in the opportunity to pilot test the GRADE/DECIDE EtD Framework for real world coverage decisions. Feedbacks about its usefulness and usability will be collected from the members of the Regional Commission.
Objectives: To prepare an informative and exhaustive evidence synthesis to help a Regional Commission taking a coverage decision using the GRADE/DECIDE Evidence to Decision (EtD) Framework (see attached file).
Methods: We performed a systematic review of the available evidence about the efficacy and safety of trans-aortic valve implantation (TAVI) for aortic stenosis in high risk patients. We also searched for information about economic evaluations, patients’ preferences, feasibility and equity. We used the EtD Framework to present the information to the members of the Regional Commission.
Results: We identified 4072 records: four Health Technology Assessment (HTA) reports, 13 systematic reviews (SR), three randomised controlled trials and 15 observational studies were eligible for our topic (the single studies were not included in the SRs). We prepared two different EtD Frameworks for the two questions of interest: 1) TAVI versus surgery and 2) TAVI versus medical therapy.
Conclusions: The relevance of this experience lies in the opportunity to pilot test the GRADE/DECIDE EtD Framework for real world coverage decisions. Feedbacks about its usefulness and usability will be collected from the members of the Regional Commission.