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.
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
The LBI-HTA/ Ludwig-Boltzmann Institute for HTA has the pleasure to announce that the Austrian Ministry of Health appointed it to be a partner institute in the EUnetHTA Joint Action 3 (2016-2020).
We are pleased to introduce our new HSO report.
By law NIS need to be registered. The research question underlying this systematic analysis was primarily to learn about the scientific objectives of these. On the cutoff date (Aug. 7th, 2015) information available through the public database was systematically evaluated. It comprised 251 NIS on 581 pharmaceuticals with a total planned patient enrollment of 406,831. Of 33 final reports available only 8 conformed to the formal requirements. For at least 14 (and possibly up to 31) additional NIS such reports should already have been posted online. The most common research questions a NIS addressed were effectiveness in practice (efficacy) and drug safety. The addressed pharmaceuticals were mostly patented me-too drugs and generic drugs/biosimilars. In 31 of the 33 reports the respective research questions were answered with a positive result for the NIS. Due to deficits in reporting requirements for the public database and due to modest reporting morale and accountability the informed public is in no position to make well-founded statements on completed and ongoing NIS.
Publication: Rapid Assessment No. 7c: http://eprints.hta.lbg.ac.at/1080
Contact: Claudia Wild
Robot-assisted surgery: A systematic review of effectiveness and safety for elected indications and accumulating costs
Robot-assisted surgery is already performed in many disciplines, especially in urology and gynaecology.
The report assessed the efficacy and safety of robot-assisted surgery, compared to laparoscopic and open surgery for partial nephrectomy, adrenalectomy, radical prostatectomy, radical cystectomy, hysterectomy and ovariectomy.
Furthermore, the costs (acquisition, maintenance, instruments) of robot-assisted surgery from the perspective of hospitals were calculated and the future of robotic surgery was evaluated.
Publication: LBI-HTA Project report No. 84: http://eprints.hta.lbg.ac.at/1077/
Contact: Stefan Fischer