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Social values for health technology assessment in Canada: a scoping review of hepatitis C screening, diagnosis and treatment.
BMC Public Health ( IF 4.5 ) Pub Date : 2020-01-20 , DOI: 10.1186/s12889-020-8190-2
Caroline O'Keefe-Markman 1 , Kristina Dawn Lea 2 , Christopher McCabe 3, 4 , Elaine Hyshka 1, 5 , Tania Bubela 6
Affiliation  

BACKGROUND Health care system decision makers face challenges in allocating resources for screening, diagnosis and treatment of hepatitis C. Approximately 240,000 individuals are infected with the hepatitis C virus (HCV) in Canada. Populations most affected by HCV include Indigenous people, people who inject drugs, immigrants and homeless or incarcerated populations as well as those born between 1946 and 1965. Curative but expensive drug regimens of novel direct acting antivirals (DAAs) are available. We aim to identify social values from academic literature for inclusion in health technology assessments. METHODS We conducted a scoping review of academic literature to identify and analyze the social values and evidence-based recommendations for screening, diagnosis and treatment of HCV in Canada. After applying inclusion/exclusion criteria, we abstracted: type of intervention(s), population(s) affected, study location, screening methods, diagnostics and treatments. We then abstracted and applied qualitative codes for social values. We extracted social value statements and clustered them into one of 4 categories: (1) equity and justice, (2) duty to provide care, (3) maximization of population benefit, and (4) individual versus community interests. RESULTS One hundred and eighteen articles met our inclusion criteria on screening, diagnosis and treatment of HCV in Canada. Of these, 54 (45.8%) discussed screening, 4 (3.4%) discussed diagnosis and 60 (50.8%) discussed treatment options. Most articles discussed the general population and other non-vulnerable populations. Articles that discussed vulnerable populations focused on people who inject drugs. We coded 1243 statements, most of which fell into the social value categories of equity and justice, duty to provide care and maximization of population benefit. CONCLUSION The academic literature identified an expanded set of social values to be taken into account by resource allocation decision makers in financially constrained environments. In the context of hepatitis C, authors called for greater consideration of equity and justice and the duty to provide care in making evidence-based recommendations for screening, diagnosis and treatment for different populations and in different settings that also account for individual and community interests.

中文翻译:

加拿大卫生技术评估的社会价值:丙型肝炎筛查,诊断和治疗的范围回顾。

背景技术卫生保健系统的决策者在分配用于丙型肝炎的筛查,诊断和治疗的资源方面面临挑战。在加拿大,大约有240,000个人感染了丙型肝炎病毒(HCV)。受HCV影响最大的人群包括土著人民,注射毒品的人,移民和无家可归者或被监禁的人口,以及1946年至1965年之间出生的人群。可以使用新颖但直接作用的抗病毒药物(DAA)进行治疗,但费用昂贵。我们旨在从学术文献中确定社会价值,以纳入卫生技术评估。方法我们对学术文献进行了范围界定性审查,以鉴定和分析在加拿大进行HCV筛查,诊断和治疗的社会价值和基于证据的建议。应用纳入/排除条件后,我们摘要:干预类型,受影响人群,研究地点,筛查方法,诊断和治疗。然后,我们为社会价值抽象并应用了定性代码。我们提取了社会价值表述并将其分为以下四类之一:(1)公平与正义;(2)提供照顾的义务;(3)最大化人口利益;(4)个人利益与社区利益。结果在加拿大,有118篇文章符合我们对HCV的筛查,诊断和治疗的纳入标准。其中54(45.8%)个讨论筛查,4(3.4%)个讨论诊断,60(50.8%)个讨论治疗选择。大多数文章讨论了普通人群和其他非弱势人群。讨论弱势人群的文章集中于注射毒品的人。我们编码了1243条语句,其中大多数属于公平和正义,提供照料的义务和人口利益最大化的社会价值类别。结论学术文献确定了在经济拮据的环境中,资源分配决策者应考虑的一套广泛的社会价值。在丙型肝炎的背景下,作者呼吁更多地考虑公平与正义,并有责任在提出循证建议时针对不同人群和不同环境进行筛查,诊断和治疗,这也应考虑个人和社区的利益。结论学术文献确定了在经济拮据的环境中,资源分配决策者应考虑的一套广泛的社会价值。在丙型肝炎的背景下,作者呼吁更多地考虑公平与正义,并有责任在提出循证建议时针对不同人群和不同环境进行筛查,诊断和治疗,这也应考虑个人和社区的利益。结论学术文献确定了在经济拮据的环境中,资源分配决策者应考虑的一套广泛的社会价值。在丙型肝炎的背景下,作者呼吁更多地考虑公平与正义,并有责任在提出循证建议时针对不同人群和不同环境进行筛查,诊断和治疗,这也应考虑个人和社区的利益。
更新日期:2020-01-21
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