Ontario health technology assessment series
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Ont Health Technol Assess Ser · Jan 2009
Optical coherence tomography for age-related macular degeneration and diabetic macular edema: an evidence-based analysis.
The purpose of this evidence-based review was to examine the effectiveness and cost-effectiveness of spectral-domain (SD) optical coherence tomography (OCT) in the diagnosis and monitoring of patients with retinal disease, specifically age-related macular degeneration (AMD) and diabetic macular edema (DME). Specifically, the research question addressed was: What is the sensitivity and specificity of spectral domain OCT relative to the gold standard? ⋯ The conclusions for SD OCT based on Level 5 evidence, or expert consultation, are as follows: OCT is considered an essential part of the diagnosis and follow-up of patients with DME and AMD.OCT is adjunctive to FA for both AMD and DME but should decrease utilization of FA as a monitoring modality.OCT will result in a decline in the use of BM in the monitoring of patients with DME, given its increased accuracy and consistency.OCT is diffusing rapidly and the technology is changing. Since FA is still considered pivotal in the diagnosis and treatment of AMD and DME, and there is no common outcome against which to compare these technologies, it is unlikely that RCT evidence of efficacy for OCT will ever be forthcoming.In addition to the accuracy of OCT in the detection of disease, assessment of the clinical utility of this technology included a rapid review of treatment effects for AMD and DME. The treatment of choice for AMD is Lucentis®, with or without Avastin® and photodynamic therapy. (ABSTRACT TRUNCATED)
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Ont Health Technol Assess Ser · Jan 2009
Ultraviolet Phototherapy Management of Moderate-to-Severe Plaque Psoriasis: An Evidence-Based Analysis.
The purpose of this evidence based analysis was to determine the effectiveness and safety of ultraviolet phototherapy for moderate-to-severe plaque psoriasis. ⋯ The conclusions of the MAS evidence-based review are outlined in Table ES1. In summary, phototherapy provides good control of clinical symptoms in the short term for patients with moderate-to-severe plaque-type psoriasis that have failed or are unresponsive to management with topical agents. However, many of the evidence gaps identified in the NIHR 2000 evidence review on psoriasis management persisted. In particular, the lack of evidence on the comparative effectiveness and/or cost-effectiveness between the major treatment options for moderate-to-severe psoriasis remained. The evidence on effectiveness and safety of longer term strategies for disease management has also not been addressed. Evidence for the safety, effectiveness, or cost-effectiveness of phototherapy delivered in various settings is emerging but is limited. In addition, because all available treatments for psoriasis - a disease with a high prevalence, chronicity, and cost - are palliative rather than curative, strategies for disease control and improvements in self-efficacy employed in other chronic disease management strategies should be investigated. (ABSTRACT TRUNCATED)
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Ont Health Technol Assess Ser · Jan 2009
Community-based care for chronic wound management: an evidence-based analysis.
In August 2008, the Medical Advisory Secretariat (MAS) presented a vignette to the Ontario Health Technology Advisory Committee (OHTAC) on a proposed targeted health care delivery model for chronic care. The proposed model was defined as multidisciplinary, ambulatory, community-based care that bridged the gap between primary and tertiary care, and was intended for individuals with a chronic disease who were at risk of a hospital admission or emergency department visit. The goals of this care model were thought to include: the prevention of emergency department visits, a reduction in hospital admissions and re-admissions, facilitation of earlier hospital discharge, a reduction or delay in long-term care admissions, and an improvement in mortality and other disease-specific patient outcomes.OHTAC approved the development of an evidence-based assessment to determine the effectiveness of specialized community based care for the management of heart failure, Type 2 diabetes and chronic wounds.PLEASE VISIT THE MEDICAL ADVISORY SECRETARIAT WEB SITE AT: www.health.gov.on.ca/ohtas to review the following reports associated with the Specialized Multidisciplinary Community-Based care series.Specialized multidisciplinary community-based care series: a summary of evidence-based analysesCommunity-based care for the specialized management of heart failure: an evidence-based analysisCommunity-based care for chronic wound management: an evidence-based analysisPlease note that the evidence-based analysis of specialized community-based care for the management of diabetes titled: "Community-based care for the management of type 2 diabetes: an evidence-based analysis" has been published as part of the Diabetes Strategy Evidence Platform at this URL: http://www.health.gov.on.ca/english/providers/program/mas/tech/ohtas/tech_diabetes_20091020.htmlPLEASE VISIT THE TORONTO HEALTH ECONOMICS AND TECHNOLOGY ASSESSMENT COLLABORATIVE WEB SITE AT: http://theta.utoronto.ca/papers/MAS_CHF_Clinics_Report.pdf to review the following economic project associated with this series:Community-based Care for the specialized management of heart failure: a cost-effectiveness and budget impact analysis. ⋯ The evidence supports that managing chronic wounds with a multidisciplinary wound care team significantly increases wound healing and reduces the severity of wound-associated pain and the required daily wound treatments compared to persons not managed by a wound care team. The quality of evidence supporting these outcomes is low to very low meaning that further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
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Ont Health Technol Assess Ser · Jan 2009
Intraocular lenses for the treatment of age-related cataracts: an evidence-based analysis.
The objective of the report is to examine the comparative effectiveness and cost-effectiveness of various intraocular lenses (IOLs) for the treatment of age-related cataracts. ⋯ The conclusions of the systematic review of IOLs for age-related cataracts are summarized in Executive Summary Table 1. CONSIDERATIONS FOR THE ONTARIO HEALTH SYSTEM: Procedures for crystalline lens removal and IOL insertion are insured and listed in the Ontario Schedule of Benefits.If a particular lens is determined to be medically necessary for a patient, the cost of the lens is covered by the hospital budget. If the patient chooses a lens that has enhanced features, then the hospital may choose to charge an additional amount above the cost of the usual lens offered.An IOL manufacturer stated that monofocal lenses comprise approximately 95% of IOL sales in Ontario and premium lenses (e.g., multifocal/accomodative) consist of about 5% of IOL sales.A medical consultant stated that all types of lenses are currently being used in Ontario (e.g., multifocal, monofocal, accommodative, tinted, nontinted, spheric, and aspheric). Nonfoldable lenses, rarely used in routine cases, are primarily used for complicated cataract implantation situations.ES Table 1:Conclusions for the Systematic Review of IOLs for Age-Related CataractsComparisonConclusionGRADE QualityMultifocal vs. monofocalObjective OutcomesSignificant improvement in BDCUNVANo significant difference in BCDVAInconclusive evidence for contrast sensitivityInconclusive evidence for glareSubjective OutcomesInconclusive evidence for visual satisfactionSignificant increase in glare/halosSignificant increase in freedom from spectaclesmoderatemoderatelowvery lowlowlow/moderatelow/moderateAccommodative vs. multifocal/monofocalInconclusive due to Insufficient limited evidence for any effectiveness outcomevery lowHydrophilic acrylic vs. other materials (hydrophobic acrylic, silicone)Significant increase in PCO scoreLowSharp edged compared to round edgedSignificant reduction in PCO scoreLowOne piece compared to three pieceNo significant difference in PCO scorelowHydrophobic acrylic compared to siliconeNo significant difference in PCO scoremoderateAspherical modified prolate anterior surface compared to sphericalNo significant difference in VASignificant reduction in contrast sensitivityvery lowvery lowBlue light filtering compared to non blue-light filteringNo significant difference in BCDVANo significant difference in contrast sensitivityNo significant difference in HRQLlowlowhigh/moderateBCDVA refers to best corrected distance visual acuity; BDCUNVA, best distance corrected unaided near visual acuity; HRQL, health related quality of life; PCO, posterior capsule opacification; VA, visual acuity.