Mini-HTA for above cuff vocalization was released in Norway

Norway established in 2013 a framework for the introduction of innovations into the health care system through either a national or hospital-based health technology assessment. This framework is called the “New Method.”

In this framework, all innovations should undergo HTA before being funded. If the method concerns only one or two hospitals, the assessment shall be initiated by clinicians and ran at the hospital level. The final report is disseminated via a mini-HTA database. If the method is of national concern, it undergoes Single Technology Appraisal at national level followed by the funding decision by the group of payers (Decision Forum, Beslutningsforum).

Above cuff vocalization (ACV) is a technique with the use of the subglottic suction port of specialized tracheostomy tubes to deliver a low flow of gas (air or oxygen) backward, up to the subglottic suction port, to exit above the cuff. This gas flow can then travel upwards through the trachea, pass through the vocal cords, and exit via the mouth. This can result in audible vocalization in around 80% of patients who would otherwise not be able to speak. ACV is particularly useful for those patients who cannot tolerate or be managed with a deflated tracheostomy tube cuff. In June 2019, a completed mini-method assessment for ACV was released.

The following conclusions were provided:

• The good level of efficacy was shown by the method on patients with a tracheostomy who otherwise could not speak in comparison with those patients who was not able to speak at all
• The method was determined as safe considering that ACV was carried out in the intensive care unit (ICU) under supervision
• The method should be introduced as part of the clinical routine in the hospital and offered to those ICU patients who may benefit from verbal communication under controlled conditions during other procedures related to tracheostomy
• The method should be followed up through monitoring. The existing UK protocols can be used

See the full details in Norwegian here.

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