Welcome to the homepage of LBI-HTA !
The LBI-HTA is an acadmic non-profit institute and belongs to the Ludwig Boltzmann Society. At our website we wish to present our research and give support for health care decision-making. Here all of our reports are available for free. For further information please contact the LBI-HTA team.
Magnetic resonance imaging (MRI) is an essential component of medical care. Currently, however, the appropriateness of diagnostic imaging is increasingly debated. In a first report we identified via database screening, literature review and interviews with stakeholders recommendations against the use of MRI and opportunities and strategies to drive appropriate imaging relevant to the Austrian context. In the second part we aim to provide additional information (on evidence base, guideline recommendations, diagnostic algorithms/decision support tools and products) on already identified recommendations regarding a set of indications selected by a working group of HVB and WKÖ.
Publication: LBI-HTA Project report No. 80b: http://eprints.hta.lbg.ac.at/1090/
Contact: Agnes Kisser
We are pleased to introduce our new HSO report.
Involvement of Citizen and Patients in HTA-Processes – International Experiences and Good Practice Examples
There is consensus among HTA-experts that the involvement of patient and citizen perspectives can valuably complement health technology assessment (HTA) processes. Since the 1990s, scientific papers about different forms and models of participation have been published. Until now sound (cost-) benefit assessments are missing.
The project aims to summarize internationally published models, methods and experiences in a systematic overview. Furthermore it intends to identify and describe obstacles, facilitating factors and learnings for HTA in Austria by using examples of selected countries and models of good practice.
Publication: LBI-HTA Project report No. 86: http://eprints.hta.lbg.ac.at/1088/
Contact: Claudia Wild
We are pleased to introduce our two new HSO reports.
Thrombectomy for ischemic stroke: Patient characteristics, structural requirements and (differential) diagnostics
The results of recent studies suggest that mechanical thrombectomy combined with standard care is superior to standard care alone for the treatment of ischemic stroke in selected patients. The intention of this paper is to show under which circumstances and for which patients the mechanical thrombectomy could be a viable option for the treatment of stroke patients. Additionally, thrombectomy devices will be presented. Recent guidelines, systematic reviews, recent randomized controlled trials (RCTs) and information published by the manufacturers have been examined for this purpose. There is only evidence on the basis of RCTs for the efficacy of stent retriever available. At least noninvasive vascular imaging should be conducted prior the thrombectomy. The mechanical thrombectomy could be an option for patients with contraindications against systemic lysis and could allow treatment after 4.5 hours after symptoms onset. The number of potentially eligible patients is reduced because in all recent RCTs exclusively patients with anterior circulation occlusion have been treated. Additional patient selection criteria (e.g. NIHSS Score above a specific value) further limit this number.
Publication: Decision Support Document No. 95: http://eprints.hta.lbg.ac.at/1084/
Contact: Robert Emprechtinger
Mechanical thrombectomy devices for acute ischemic stroke: German version of the English EUnetHTA report
The benefit of the newly developed devices for mechanical thrombectomy for the treatment of patients with ischemic stroke was, so far, unclear. The intention of this paper is to sum up the currently available evidence to thrombectomy in combination with standard care regarding efficacy and security. A systematic search for randomized controlled trials to evaluate efficacy has been conducted. Additionally, prospective trials were considered to assess safety. The outcomes reported in the individual studies were combined and summarized using meta-analysis. The available evidence suggests that mechanical thrombectomy additionaly to standard care compared to standard care alone improves the morbidity and functionality of patients suffering from ischemic stroke. No proof of reduced overall mortality could be found. With regard to safety, the evidence suggests that the intervention is associated with a higher probability for asymptomatic intracerebral hemorrhage. The available evidence also suggests that mechanical thrombectomy in addition to standard care is, under specific circumstances, superior to standard care alone.
Publication: Decision Support Document No. 94: http://eprints.hta.lbg.ac.at/1081/
Contact: Claudia Wild
Effects of tangible and intangible incentives on health behavior, Part I: Definitions, theories and models – Part II: Overview of reviews covering 4 health issues
This project includes a theoretical part explaining concepts and models and potential mechanisms of incentives on health behaviour. The empirical part is based on an overview of systematic reviews (SRs), which examined the evidence of incentive effects for smoking, alcohol, nutrition and physical activity.
In general, there was a focus on material/ tangible incentives in the SRs. There is a considerable body of evidence for ‘smoking and incentives‘ (primarily for cessation and abstinence) (17 SRs) with clear evidence of a medium-term effectiveness (especially for pregnant women and women post partum). Regarding ‘alcohol and incentives’ (4 SRs), we found an insufficient evidence base, which does not allow putting forward statements about the effectiveness of incentives. Minor, positive effects could be detected regarding an improved nutritional behaviour due to incentives (14 SRs). Conflicting results have been reported for ‘incentives and physical activity’ (7 SRs).
Overall, the project shows that effects decrease once incentives were suspended. Bascially, incentives should be considered as part of an overall strategy seeking to influence health behaviour. Against the backdrop of social (and health) justice, the consideration of the policy-design of people’s social environments is of particular importance.
Additionally, an addendum provides a theoretical discussion of an issue that is closely linked to incentives: Nudging – stratgies (which can be primarily found on the policy-level) attempting to influence the health behavior of people by changing settings, (health) standards etc.
Publication: LBI-HTA Project report No. 83: http://eprints.hta.lbg.ac.at/1078/
Contact: Roman Winkler