PHP97 Use of Paediatric “Observation Status” and Effect on in-Patient Admission Rate in Accident and Emergency (A&E) Departments

Abstract

Health Technology Assessment in Poland) for orphan oncology drugs are based. The role of AHTAPol is to prepare for the Minister of Health recommendations on financing all medical technologies from public funds. Orphan oncology drugs undergo pharmacoeconomic evaluations and coverage decision processes similar to other molecules. AHTAPol's reimbursement recommendations are based on evidence of clinical benefit and efficacy/safety ratio, cost-effectiveness, costs and their impact on the payer's budget. METHODS: Among recommendations of AHTAPol published until the end of May 2011, we identified all related to orphan oncology drugs. Having categorized into types of recommendations then we analyzed rational for granted decision. RESULTS: Among 420 AHTAPol decisions analyzed, 32 (21,7%) applied to non-drugs technologies, 91 (21,7%) to health care programs and 297 (70,7%) to drugs technologies. Among 297 drugs recommendations only 15 (5%) was related to oncology orphan molecules. Granted were 10 (out of 15) positive recommendations. For 3 out of 15 drugs AHTAPol issued conditional recommendations (with restriction related to reducing the cost-effectiveness outcomes). Only two orphan oncology drugs were assessed negatively. In both cases main criteria on which recommendations were based refer to low clinical efficacy and safety. CONCLUSIONS: Neither cost-effectiveness nor costs and budget impact were significant arguments in negative recommendations of AHTAPol. As a matter of fact, lack of clinical efficacy and insufficient safety profile were the key issues for orphan oncology drugs negatively assessed by AHTAPol. OBJECTIVES:Methadone maintenance programs (MMP) offer the best treatment for opioid dependence. In Spain, methadone hydrochloride is prepared as a magistral formulation. Despite the organization and the management of the MMP is in hands of the Delegación del Gobierno para el Plan Nacional sobre Drogas, each autonomous region (AR) is responsible for its planning and financing. The aim of this study was to identify planning MMP differences among AR in Spain. METHODS:A structured literature review on the IME, SciELO, Doyma, Medline, national and AR official bulletins and health web pages, and general and specialised press, up to July 1, 2010. RESULTS: Planning differences were found around four areas. First, in 13 AR the regional health department establishes the health care provision and legal framework for MMP, whereas in 4 AR this is a shared responsibility between health and social security regional departments. Second, three health care networks for the provision of MMP coexist in Spain. Andalusia has drug care centers, 6 AR specialized or mental health centers and 10 AR combine both structures. Third, in 11 AR methadone prescribing and dispensing is performed in one center, in 6 AR in separate centers and in Cantabria coincide both systems. Fourth, in the majority of AR a central laboratory or the hospitals elaborate the greater part of the methadone; however, in 2 AR it is elaborated in pharmacies and in 2 ...