Doxycycline compared to prednisolone therapy for patients with bullous pemphigoid: cost-effectiveness analysis of the BLISTER trial

BACKGROUND: Bullous pemphigoid (BP) is an autoimmune blistering skin disorder associated with significant morbidity and mortality. Doxycycline and prednisolone to treat bullous pemphigoid were compared within a randomised controlled trial (RCT). OBJECTIVES: To compare the cost-effectiveness of doxycycline-initiated and prednisolone-initiated treatment for patients with BP. METHODS: a multicentre, parallel-group, investigator-blinded RCT. Within-trial analysis used bivariate regression of costs and QALYs, with multiple imputation of missing data, informing a probabilistic assessment of incremental treatment cost-effectiveness from a health service perspective RESULTS: In the base case, there was no robust difference in costs or QALYs per patient at 1 year comparing doxycycline-initiated therapy with prednisolone-initiated therapy (net cost: £959, 95% CI -£24 to £1941; net QALYs: -0.024, 95% CI -0.088 to 0.041). However, findings varied by baseline blister severity. For patients with mild or moderate blistering (≤30) net costs and outcomes were similar. For patients with severe blistering (>30) net costs were higher (£2558, 95% CI -£82 to £5198) and quality of life poorer (-0.090 QALYs, 95% CI-0.222 to 0.042) for patients starting on doxycycline. The probability that doxycycline would be cost-effective for those with severe pemphigoid was 1.5% at a willingness to pay of £20,000/QALY. CONCLUSIONS: Consistent with the clinical findings of the BLISTER trial, patients with mild or moderate blistering should receive treatment guided by the safety and effectiveness of the drugs and patient preference - neither strategy is clearly a preferred use of NHS resources. However, prednisolone-initiated treatment may be more cost-effective for patients with severe blistering

Weird exoskeletons: propositional politics and the making of home in underground Bucharest

The article explores the politics of life underground in Bucharest, Romania. It focuses on a tunnel passing under Bucharest's central train station, where a community of drug users and so‐called ‘homeless’ have made a long‐standing home, using a space that many others considered uninhabitable. Relying on extensive ethnographic observations and interviews undertaken within the tunnels, the article traces and illustrates the socio‐material entanglements characterizing life underground. It frames this assemblage of bodies, veins, syringes, substances and various relationships of power and affect, as a ‘propositional politics’ of home and life at the margins. Such a politics speaks of drug addiction and extreme marginalization, but also of a sense of belonging, reciprocal trust and care. In tracing such a politics, the article does not aim to romanticize the status of home in the underground or to treat it as the marginal antithesis of normative homeliness, but to reveal the ways in which an affirmative, self‐grounding politics of home emerges from the immanence of tunnel life within the fabric of the city. As such, the article contributes to debates around homing practices in conditions of uninhabitability and proposes a radical approach to the politics of life at the margins in the contemporary urban