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Hip Protectors: A Review of the Comparative Clinical and Cost-Effectiveness [Internet]

There are several different commercially available hip protectors the comparative effectiveness of each type is unclear. This Rapid Response report aims to review the comparative clinical and cost-effectiveness of HipSaver, Safe Hip, and Secure brands of hip protectors.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: February 11, 2015
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Prophylactic Treatment for Contacts of Patients with Invasive Meningococcal Disease on Sports Teams: A Review of the Clinical Effectiveness, Cost-Effectiveness, and Guidelines [Internet]

The purpose of this review was to assess the evidence of the clinical effectiveness and cost-effectiveness of prophylactic treatment for contacts of patients with invasive meningococcal disease (IMD) who are members of sports teams, and to identify and appraise any relevant evidence-based guidelines.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: February 10, 2015
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Holkira (Ombitasvir/Paritaprevir/ Ritonavir with Dasabuvir) and Harvoni (Ledipasvir/Sofosbuvir) for Chronic Hepatitis C: A Review of the Clinical Evidence [Internet]

The treatment of chronic hepatitis C (CHC) using the all oral, interferon-free regimen has potential advantages compared with interferon-based regimens. This report reviews the evidence of clinical effectiveness and safety of Harvoni and Holkira Pak for the management of CHC genotype 1, which may assist in healthcare funding decision-making in the context of the publicly funded healthcare system. Due to the complex generic names, the trade names of these therapies will be used in the review for clarity.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: January 16, 2015
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Excimer Laser and Stenting in Patients with Distal Peripheral Arterial Disease: A Review of the Clinical Effectiveness, Safety, and Guidelines [Internet]

Since lower extremities affected by peripheral arterial disease (PAD) are hard to treat and usually occur in high-risk patients, percutaneous transluminal angioplasty (PTA) (or balloon dilatation) and PTA with stenting are not always successful or possible. In addition, patients may not be suitable for the currently acceptable surgical bypass intervention. Therefore, there remains a need for a different method of PAD management. The purpose of this report is to examine the clinical effectiveness and safety of excimer laser atherectomy for use in patients with distal PAD in order to ascertain whether it is a viable option to PTA or PTA plus stenting. In addition, evidence-based guidelines associated with the use of excimer laser use in patients with distal PAD were of interest.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: January 26, 2015
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Vitamin D Testing in the General Population: A Review of the Clinical and Cost-Effectiveness and Guidelines [Internet]

Rising awareness about the potential link between vitamin D deficiency and adverse health outcomes has seen an increase in the rate of vitamin D testing in developed countries. The cost of a single vitamin D test is moderate (e.g., $61.32 in British Colombia) but the elevated testing rate contributes to substantial healthcare costs. Concern over rising costs led to reform in testing coverage in 2010 in Ontario, followed by other provinces. The changes in Ontario were based on a 2010 report by the Ontario Health Technology Advisory Committee (OHTAC) on the clinical utility of vitamin D testing (reviewed in this report). Despite a lack of direct evidence on testing, a recommendation was made against providing testing for the general population. Tests are now indicated only for individuals with specific conditions (i.e., osteoporosis, rickets, osteomalacia, malabsorption syndromes, renal disease, and individuals taking medications that may affect vitamin D status). The Endocrine Society and Osteoporosis Canada also recommend against screening for low risk individuals. There is a lack of evidence to suggest that the rise in test frequency has translated into improved healthcare practices. For example, the temporal increase in testing in Australia has not resulted in improved osteoporosis detection in women aged 45 to 74. There is also a lack of evidence on the cost-effectiveness of testing. In light of the rise in test frequency, assay and cut-off inconsistency, and the lack of evidence for the utility of testing, this report will investigate the clinical and cost-effectiveness of testing in the general population.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: January 16, 2015
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Icatibant for Patients with Type III Hereditary Angioedema: A Review of Clinical Effectiveness and Harms [Internet]

Icatibant, a selective bradykinin B2 receptor antagonist, has been approved in many countries worldwide for the symptomatic treatment of acute attacks of types I and II hereditary angioedema (HAE) in adults since 2008. It was reported that icatibant was successful in the prevention of angioedema after thyroid biopsy in HAE type I. Icatibant has also reportedly been used for type III HAE, although it is not licensed for this indication. The objective of this report is to review the therapeutic and prophylactic effectiveness and harms of icatibant in the treatment of type III HAE.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: February 6, 2014
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Next Generation DNA Sequencing: A Review of the Cost Effectiveness and Guidelines [Internet]

Next generation sequencing (NGS) approaches have been used over the past decade in research settings and now are the focus of concerted effort to make them standard practice in clinical settings. Focus has been given to their use in various medical diagnoses such as cardiomyopathy, noninvasive prenatal diagnosis, inherited cancers, and various inherited Mendelian diseases. This movement into a clinical setting has created many questions and concerns in the medical community and with interest groups. Chief among these concerns are: what is the proven cost effectiveness of this type of approach, and what procedural guidelines should be followed in regard to experimental methodology, data storage, report generation, and communication of results.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: February 6, 2014
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Non-invasive Prenatal Testing: A Review of the Cost Effectiveness and Guidelines [Internet]

Recent advances in genomic sequencing and bioinformatics have led to development of noninvasive detection methods with detection rates approaching those obtained with amniocentesis and chorionic villus sampling (CVS). Recently, a novel prenatal testing method has become available. This method, known as non-invasive prenatal testing (NIPT), is a molecular approach for assessing fetal aneuploidy using cell-free fetal deoxyribonucleic acid (cffDNA) from the plasma of pregnant women. NIPT has a false positive rate of about 0.2% and detection rate of about 98% for Down syndrome. NIPT has been used for assessing abnormalities such as trisomy 21, trisomy 18, and trisomy 13. Approximately 10% to 15% of the cell free deoxyribonucleic acid (DNA) in maternal blood comprises of cffDNA. The half-life of cffDNA is short and clears from maternal circulation soon after delivery. Hence, there is no risk of fetal DNA persisting from one pregnancy to the next and confounding test results. The cost of NIPT ranges from US$800 to US$2000 in the USA and from US$500 to US$1500 elsewhere. A Canadian economic study reported a cost range of C$600 to C$800 for NIPT. Among other factors, cost implications for introducing this new technology in clinical practice will need to be considered. At present there is some uncertainty around the incorporation of NIPT into current strategies for prenatal screening and diagnosis.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: February 10, 2014
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Suboxone Versus Methadone for the Detoxification of Patients Addicted to Prescription Opioids: A Review of Comparative Clinical Effectiveness, Safety, and Guidelines [Internet]

The purpose of this review to examine the comparative clinical effectiveness of Suboxone versus methadone for the detoxification of patients addicted to prescription opioids. In addition, guidelines on the length of detoxification time using Suboxone in patients addicted to prescription opioids will be examined.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: February 13, 2014
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Nutritional Supplementation for Patients with Cancer: A Review of the Clinical Effectiveness and Guidelines [Internet]

People with cancer who are well nourished and who are capable of maintaining a healthy body weight may have better outcomes than patients who are undernourished or underweight. Survival is generally shorter for those patients who lose weight prior to starting cancer treatment. Maintaining a healthy diet through cancer treatment may help maintain the immune system and the general well-being of patients. Weight and nutrition can be managed by eating more protein, eating more calories, drinking more water, and reducing alcohol consumption. Calories and protein may come from foods that would regularly be consumed in the diet or through high-calorie and high-protein shakes or beverages. When ingesting adequate nutrition by mouth is not a possibility due to nausea, swallowing difficulty, or a very sore mouth or throat, alternative feeding methods could be necessary. These methods may include providing fluids and nutrition through a feeding tube (enteral nutrition) or intravenous line (parenteral nutrition).

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: February 12, 2014
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Oncotype DX in Women and Men with ER-Positive, HER2-Negative Early Stage Breast Cancer who are Lymph Node Negative: A Review of Clinical Effectiveness and Guidelines [Internet]

For patients with estrogen receptor-positive (ER+) and lymph node-negative (LN−) early stage breast cancer (ESBC), the decision to initiate adjuvant chemotherapy (ACT) after surgery has traditionally been guided by clinical and pathological factors (i.e., characteristics of the patient and the tumour), in conjunction with clinician and patient preferences. In the absence of ACT, 15% of these patients will have a cancer recurrence within 5 years yet up to 90% receive ACT. Unfortunately, many patients are therefore exposed to ACT toxicity and cost with little or no clinical benefit, and identifying those who do benefit remains a challenge. The dilemma has pushed researchers to seek additional methods to evaluate cancer recurrence risk in order to support better decision-making about ACT. Gene-expression profiling (GEP) is an emerging clinical strategy which proposes to meet this need by using genomic information to inform risk prediction and treatment selection one patient at a time.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: February 20, 2014
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Immediate Osseointegrated Implants for Cancer Patients: A Review of Clinical and Cost-Effectiveness [Internet]

Oral cancers can develop in any part of the mouth, but most oral cancers start within the tongue or the floor of the mouth. They can also spread or originate from the bony structures of the mandibles. Oral cancers are commonly treated with ablative surgery alone or in combination with radiation and/or chemotherapy. Ablative surgeries may range from minor soft tissue trimming to a major resection of the tongue and jaw and face bones. Ablative surgeries of the face and mouth can introduce significant defects in the orofacial region. If not restored, these defects can compromise essential functions such as mastication, speech, and even breathing. Therefore, prosthetic rehabilitation is planned along with the ablative surgery. Oral prosthetics are usually constructed for edentulous patients, and they are stabilized and retained over the jaw bones. However, their stability and retention can be compromised due to the ablative surgery conducted on oral soft tissues and bone. The use of osseointegrated implants is suggested to improve the stability and retention of oral prosthetics in oral cancer patients. Osseointegrated implants are metallic, or even ceramic, structures which can be fixed within the jaw bones. They are connected to external structures which can be used to anchor oral prostheses. Classically, oral prostheses are put directly on the defective area and rely on the remaining oral structure for retention and stability. The purpose of this report is to review the evidence of the clinical effectiveness and cost-effectiveness of immediate osseointegrated implants for cancer patients.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: January 13, 2015
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Transoral Robotic Surgery: A Review of Clinical and Cost-Effectiveness [Internet]

The purpose of this report is to summarize the clinical and cost-effectiveness for the use of transoral robotic surgery (TORS) in the management of early stage oral and oropharyngeal cancer and obstructive sleep apnea (OSA) compared to open surgical techniques, increased doses of chemoradiation, or no treatment.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: January 12, 2015
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Stool Antigen Tests for Helicobacter pylori Infection: A Review of Clinical and Cost-Effectiveness and Guidelines [Internet]

There are two types of stool antigen tests for the diagnosis of H. pylori infection, one based on enzyme immunoassay (EIA) and the other based on immunochromatography (ICA). Both types of tests can be operated using either monoclonal antibody or polyclonal antibodies. Although both are highly sensitive and specific, the EIA-based tests appears to be more accurate than the ICA-based tests. However, the ICA-based tests do not required specialized equipment, are easy to use, and are useful for rapid diagnosis of H. pylori infection.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: January 8, 2015
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Protein Testing in Patients with Multiple Myeloma: A Review of Clinical Effectiveness and Guidelines [Internet]

Protein manifestations characteristic of multiple myeloma (MM) include increases of monoclonal (M)-protein concentrations (IgG, IgA, IgA, IgD), light chain concentrations (including kappa [κ] and lambda[λ]), abnormal β2-microglobulin, serum albumin, creatinine, and hemoglobin levels, and findings of bone marrow plasma cells (of greater than or equal to 5%). Measurement of the protein manifestations produced by patients can be achieved by numerous methods. Traditional tests that measure M-proteins are the 24-hour urine collection test, urine protein electrophoresis (UPEP), serum protein electrophoresis (SPEP), and immunofixation electrophoresis (IFE). One newer test (developed in 2001) is the serum free light chain (sFLC) assay. The frequency with which to test using any of the tests along with the clinical utility of the newer tests remains in question. It is for this reason that a review of the clinical effectiveness, clinical utility, and guidelines of repeat testing for protein abnormalities in patients with MM was undertaken.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: January 9, 2015
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Junctional Tourniquets for Controlling Hemorrhage from Wounds in Adults: A Review of Clinical Effectiveness, Cost-Effectiveness, Safety, and Guidelines [Internet]

Until recently, three junctional tourniquet models were available on the market: the Junctional Emergency Treatment Tool (JETT), the SAM Junctional TQ, and the Combat Ready Clamp (CRoC). The Abdominal Aortic & Junctional Tourniquet (AAJT), previously only indicated for truncal use to prevent inguinal bleeding, can be now added to this list since it has recently received FDA clearance for junctional use. According to the American Committee on Tactical Combat Casualty Care (TCCC), the desirable traits of junctional tourniquets include: effective control of hemorrhage from junctional areas, safety, amenable to battlefield and tactical situations, low weight, low cost, ease of use, speed of application and stability.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: April 10, 2014
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Long-term Use of Ondansetron, Dolasetron and Granisetron for the Prevention of Nausea and Vomiting: A Review of the Clinical Effectiveness and Safety [Internet]

The purpose of this review is to provide evidence on the comparative clinical effectiveness and safety of the long-term use (> 5 days) of serotonin receptor antagonists (5-HT3RAs) for the prevention of nausea and vomiting.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: April 23, 2014
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Antiemetics For Adults Experiencing Opioid-Induced Nausea: A Review of Clinical and Cost-Effectiveness, Benefits and Harms, and Guidelines [Internet]

The purpose of this report is to retrieve and review existing evidence comparing the efficacy of different antiemetics for treatment of opioid-induced nausea. This report also aims to retrieve and review the evidence regarding the clinical effectiveness, benefits and harms, cost-effectiveness and evidence-based guidelines regarding the use of dimenhydrinate and ondansetron for adult patients experiencing opioid-induced nausea.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: April 9, 2014
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Ketamine for Adult Patients who Have Suffered Painful and Traumatic Injuries: A Review of Clinical Effectiveness, Cost-Effectiveness, Safety and Guidelines [Internet]

This report will review the evidence surrounding the clinical effectiveness, safety, and cost-effectiveness of ketamine and guidelines for its use in adult patients who have suffered painful and traumatic brain or eye injury. This report will also review the evidence around the optimal dose of ketamine and its safety in adults with moderate to severe pain from traumatic injury who are conscious, and the comparative safety of ketamine against fentanyl and morphine in this population.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: March 6, 2014
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Plasma Vaporization of the Prostate for Treatment of Benign Prostatic Hypertrophy: A Review of Clinical and Cost-Effectiveness, and Safety [Internet]

This review aims to review the clinical efficacy, safety and cost-effectiveness of bipolar plasma vaporization of the prostate (BPVP) for the treatment of benign prostatic hyperplasia (BPH) as compared to transurethral resection of the prostate (TURP).

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: March 5, 2014
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