Unequal Distribution of Innovation Efforts for Neglected Tropical Diseases: The Role of Funding Evaluation Criteria

Background: International research and innovation efforts for neglected tropical diseases have increased in recent decades due to disparities in overall health research funding in relation to global burden of disease. However, within the field of neglected tropical diseases some seem far more neglected than others. In this research the aim is to investigate the distribution of resources and efforts, as well as the mechanisms that underpin funding allocation for neglected tropical diseases. Methodology: A systematic literature review was conducted to establish a comprehensive overview of known indicators for innovation efforts related to a wide range of neglected tropical diseases. Articles were selected based on a subjective evaluation of their relevance, the presence of original data, and the breadth of their scope. This was followed by thirteen in-depth open-ended interviews with representatives of private, public and philanthropic funding organizations, concerning evaluation criteria for funding research proposals. Results: The findings reveal a large difference in the extent to which the individual diseases are neglected with notable differences between absolute and relative efforts. Criteria used in the evaluation of research proposals relate to potential impact, the probability of success and strategic fit. Private organizations prioritize strategic fit and economic impact;philanthropic organizations prioritize short-term societal impact;and public generally prioritize the probability of success by accounting for follow-up funding and involvement of industry. Funding decisions of different types of organizations are highly interrelated. Conclusions: This study shows that the evaluation of funding proposals introduces and retains unequal funding distribution, reinforcing the relative neglect of diseases. Societal impact is the primary rationale for funding but application of it as a funding criterion is associated with significant challenges. Furthermore, current application of evaluation criteria leads to a primary focus on short-term impact. Through current practice, the relatively most neglected diseases will remain so, and a long-term strategy is needed to resolve this.

Adopting Health Apps, What’s Hindering Doctors and Patients?

There are high expectations for Mobile Health to transform health into a sustainable and prevention-based system. Unfortunately it has not reached its scale of adoption many had hoped for, due to the existence of adoption barriers. More insight into these barriers fosters adoption of mHealth and the innovation it can bring to worldwide healthcare. This study investigates the main barriers in the adoption of mHealth, their underlying causes and their breakthrough possibilities. All the data are gathered from an international and multi-stakeholder point of view. First of all we tried to identify the main barriers by doing an international literature study. Second of all we asked Dutch mHealth Key Opinion Leaders (KOLs) to rank the barriers to importance. These KOLs were from different stakeholder groups;policy-makers, users and developers. At last we asked the KOLs in interviews for underlying causes and breakthrough opportunities of the barriers. Eventually twelve main adoption barriers emerged. According to literature and to the KOLs the most important barriers are “Integration and interoperability” and “Business case”. An underlying cause for the barrier “Integration and interoperability” might be the active closed power system of technology suppliers, which exists in the Netherlands. Furthermore there seems to be a difference in the importance of the barriers “Privacy and security” and “Conservative culture” when perceptions of Dutch KOLS and international literature are compared. Within the stakeholders-groups, the KOLs think differently about the importance of the barriers “Visionless development” and “Competing payment mechanism”. The Dutch healthcare insurers could take a more leading role in the fragmented landscape of mHealth in the Netherlands, by strategically funding new initiatives that use open standards and deliver better value for end-users. Other chances might lie in the international cooperation between countries to overcome certain barriers.

Low utilization of skilled birth attendants in Ngorongoro Conservation Area, Tanzania: A complex reality requiring action

Limited integration of contextual factors in maternal care contributes to slow progress towards achieving MDG5 in sub-Sahara Africa. In Ngorongoro, rural Tanzania, the maternal mortality ratio is high with 642 maternal deaths/100,000 live births. Skilled birth attendants (SBAs) assist only 7% of deliveries. This study, undertaken from 2009 to 2011, used Participatory Action Research involving local stakeholders (Maasai women and men, traditional birth attendants (TBAs), hospital staff) to examine reasons for low utilization of SBAs and moreover to develop proposals how to integrate contextual factors and local needs in the health care system. Interviews, observations and literature study were also conducted. Thaddeus and Maine’s Three Delays model is used to structure the analysis. Delaying factors in decision making at home: negative perceptions by the community on availability and quality of care in the hospital;discontinuity of care by TBAs;food and financial insecurity;desired nearness to cattle and family;limited recognition of maternal deaths;limited male health education and suboptimal birth preparedness. Delaying factors in reaching the hospital: vehicle and road limitations. Delaying factors in receiving hospital care: limited (human) resources and limited knowledge sharing at the hospital. Community members and health workers proposed: increasing food/financial security;tailoring male health education;combining TBA/SBA care to provide continuous, culturally appropriate labour support;creating separate maternity wards;increasing the number and training of staff;ensuring continuous availability of Emergency Obstetric Care. Applying solutions to increase hospital utilization seems complex as collaborative actions by multiple actors and institutions are needed to create both a needs based and clinically sound continuum of maternal care. To follow-up this process of integrating local solutions into the maternal care system, we suggest to adapt the WHO Strategic Approach—a top-down framework for the implementation of innovations—to fit this bottom-up approach.

Market Knowledge and Stakeholder Considerations for the Biopharmaceutics Sector—Incorporating User Value and Societal Needs in Therapeutic Interventions

Purpose: Many health systems are considered ill-equipped to adequately meet future demand. Although academic entrepreneurs and small and medium-sized enterprises (SMEs) drive health technology innovation, they often suboptimally consider important market and stakeholder requirements. This can result in missed opportunities to improve health system performance, address demand-supply gaps, and achieve financial rewards. Market intelligence can provide crucial information in this regard, but scientifically sourced guidance on how to perform market research for biopharmaceutics is scarce. Our objective was, therefore, to create and provide an easily accessible biopharmaceutics market research toolbox that can be perused by academic entrepreneurs and SMEs to improve the alignment of their developments with stakeholder needs. Design: Guided by market orientation theory, we interviewed senior managers and commercialisation experts from the biopharmaceutics sector. We asked them which information they consider most relevant, and how they collect, analyse and respond to new information to align product features, positioning and stakeholder-relationship management with market needs. Findings: Our innovator toolbox consists of a high-level overview of market intelligence considerations mapped against a novel innovation framework, a stakeholder reasoning and value model, and detailed considerations (checklists) per stakeholder of biopharmaceutics interventions. Originality: We provide here the first market orientation-based overview of market intelligence considerations for the biopharmaceutics sector. Although primarily collated for academic entrepreneurs and SMEs, our innovator toolbox for the biopharmaceutics sector can help all stakeholders better understand their orientation towards markets.

Intrahepatic Cholangiocarcinoma and Thermal Ablation:Long-term Results of An Italian Retrospective Multicenter Study

Background and Aims: Despite resection being considered the treatment of choice for intrahepatic cholangiocarcinoma(ICC),percutaneous thermal ablation can be an alter-native treatment for patients unfit for surgery.Our aim was to compare long-term results of percutaneous sonographi-cally-guided radiofrequency ablation(RFA)with high-powered microwave ablation(MWSA)in treatment of ICC.Methods: Results of 71 ICC patients with 98 nodules treated with RFA(36 patients)or MWSA(35 patients)between January 2008 and June 2018 in 5 Interventional Ultrasound centers of Southern Italy were retrospectively reviewed.Cu-mulative overall survival curves were calculated with the Ka-plan-Meyer method and differences with the log-rank test.Eleven possible factors affecting survival were analyzed.Results: Overall survival of the entire series was 88%,65%,45%and 34%at 12,36,60 and 80 months,respec-tively.Patients treated with MWSA survived longer than pa-tients treated with RFA(p < 0.005).The MWSA group with ICC nodules ≤3 cm or nodules up to 4 cm survived longer than the RFA group(p < 0.0005).In patients with nodules>4 cm,no significant difference was found.Disease-free sur-vival and progression-free survival were better in the MWSA group compared to the RFA group(p < 0.005).Diameter of nodules and MWSA were independent factors predicting a better survival.No major complications were observed.Conclusions: MWSA is superior to RFA in treating ICC unfit for surgery,achieving better long-term survival in small(≤3 cm)ICC nodules as well as nodules up to 4 cm of neo-plastic tumors and should replace RFA.

Contrast-enhanced ultrasound with sulphur-hexafluoride in diagnosis of early HCC in cirrhosis

Contrast-enhanced ultrasound(CEUS)with pure blood stream contrast agents allow the study of blood supply of focal liver lesions and especially of hepatocellular carcinoma(HCC)in cirrhosis.Its sensitivity and specificity in diagnosis of small tumors is very high.This review summarizes the recent results on CEUS with SonoVue,which is one of the second generation contrast agents,in the diagnosis of early HCC in cirrhosis emphasizing its increasing role in routine clinical practice.

Editorial on "Role of thermal ablation in the management of colorectal liver metastasis"

The last 30 years have shown the increasing role of Ablation in the treatment of malignant liver tumors. By the introduction of percutaneous ethanol injection (PEI) as first ablation tool for percutaneous treatment of hepatocellular carcinoma (HCC) in cirrhosis that firstly showed very high efficacy (1), several ablation techniques (mainly thermal) have been introduced in clinical practice aimed at destroying primary and secondary hepatic tumors as alternative or substitute tools to surgery. Radiofrequency ablation (RFA) was the first thermal technique that showed a good efficacy to ablate liver metastases (2). Among the secondary liver tumors, colorectal liver metastases (CRLM) represent the unique indication for ablation (2). Unlike HCC in cirrhosis where the role of RFA is well defined as first line therapy for HCC nodules < or equal to 2 cm or as alternative to surgery in 1-3 HCC nodules with the maximum diameter<3 cm (3), in the case of CRLM it is not possible to reproduce the same paradigm. Liver resection remains the standard of care for CRLM and the indications to ablation remain confined to nonresectable patients (4). The review article by Takahashi and Berber recently published in HBSN wells illustrates the current role of ablation in treatment of CRLM (5).