Public health (PH) interventions are crucial for ensuring sustainable healthcare infrastructures. Nevertheless, they represent a neglected area in HTA due to various methodological issues and their complex design that goes beyond clinical setting. Our study provides an environmental scan of HTA initiatives related to the assessment of PH technologies on a global level.

The Initiative for Public Health Outcomes Research and Measurement (INPHORM) interest group has conducted a survey among European and international societies, health bodies and networks during September 2018. The questionnaire evaluates what kind of PH technologies and/or interventions have been evaluated in the last five years, or are planned for the future.

Our preliminary findings from November 2018 indicate a total of 94 initiated and 44 completed surveys. Among the completed ones, the majority of respondents came from European countries (36%), followed by North (30%) and South America (16%) countries. Sixty-eight percent of institutions reported engagement in any aspect of HTA in the area of PH (N = 30). Medical aspects of the PH technology are considered by 83 percent of the institutions, followed by organizational impact (67%), economic evaluation (60%) and societal consequences (60%). An average of four PH technologies has been evaluated by the responding institutions in the last five years. In reference to methodological aspects, 90 percent of institutions used a classical HTA approach for evaluating PH interventions, while 40 percent used budget impact analyses. Among the barriers for reaching a decision, conflicting stakeholder priorities, lack of data and clear methodological frameworks were most commonly cited.

Data analysis is currently on-going and final results will be presented during the Cologne meeting. This study will allow to raise awareness about the importance of PH interventions in HTA, identify existing gaps and propose future methodological developments.

Iron Deficiency Anemia (IDA), a common cause of anemia in the world, is a frequently neglected disease that represents the main extraintestinal manifestation affecting patients with inflammatory bowel disease (IBD) (1). The release of new intravenous (IV) iron compounds represents a great opportunity for both physicians and patients, but the higher costs might hold back their optimal diffusion. A Health Technology Assessment (HTA) approach was used to provide insights on the sustainability of the IV iron formulations in a hospital setting, with a special focus on ferric carboxymaltose.

Epidemiology of IBD, as well as IDA associated with these conditions, was assessed with a systematic appraisal of the published literature. Data on efficacy and safety of IV iron formulations currently used in Italy were retrieved from the available medical electronic databases. A hospital based cost-analysis of the outpatient delivery of IV iron treatments was performed. Organizational and ethical implications were discussed.

The reported prevalence of anemia in patients with IBD varies markedly from 10 to 73 percent for Crohn's Disease and from 9 to 67 percent for Ulcerative Colitis. Although there are no studies on direct comparison of different IV iron preparations, the literature indicates good efficacy and safety profiles of these formulations. However, ferric carboxymaltose seemed to provide a better and faster correction of hemoglobin and serum ferritin levels in iron-deficient patients (2,3). Our analyses indicated that ferric carboxymaltose, in spite of a greater price, would have positive benefits for the hospital, in terms of reduced costs related to individual patient management, and for the patients themselves, by reducing the number of infusions and accesses to health facilities.

This hospital-based HTA reports an overall positive organizational, economic and ethical evaluation for the sustainable introduction of ferric carboxymaltose in the Italian outpatient setting.