Developing core economic outcome sets for asthma studies: a protocol for a systematic review

Introduction Core outcome sets are standardised lists of outcomes, which should be measured and reported in all clinical studies of a specific condition. This study aims to develop core outcome sets for economic evaluations in asthma studies. Economic outcomes include items such as costs, resource use or quality-adjusted life years. The starting point in developing core outcome sets will be conducting a systematic literature review to establish a preliminary list of reporting items to be considered for inclusion in the core outcome set. Methods and analysis We will conduct literature searches of peer-reviewed studies published from January 1990 to January 2017. These will include any comparative or observational studies (including economic models) and systematic reviews reporting economic outcomes. All identified economic outcomes will be tabulated together with the major study characteristics, such as population, study design, the nature and intensity of the intervention, mode of data collection and instrument(s) used to derive an outcome. We will undertake a ‘realist synthesis review’ to analyse the identified economic outcomes. The outcomes will be summarised in the context of evaluation perspectives, types of economic evaluation and methodological approaches. Parallel to undertaking a systematic review, we will conduct semistructured interviews with stakeholders (including people with personal experience of asthma, health professionals, researchers and decision makers) in order to explore additional outcomes which have not been considered, or used, in published studies. The list of outcomes generated from the systematic review and interviews with stakeholders will form the basis of a Delphi survey to refine the identified outcomes into a core outcome set. Ethics and dissemination The review will not involve access to individual-level data. Findings from our systematic review will be communicated to a broad range of stakeholders including clinical guideline developers, research funders, trial registries, ethics committees and other regulators

Healthcare resource utilisation and cost analysis associated with opioid analgesic use for non-cancer pain: A case-control, retrospective study between 2005 and 2015

ObjectiveTo examine differences in healthcare utilisation and costs associated with opioid prescriptions for non-cancer pain issued in primary care.MethodA longitudinal, case-control study retrospectively examined Welsh healthcare data for the period 1 January 2005–31 December 2015. Data were extracted from the Secure Anonymised Information Linkage (SAIL) databank. Subjects, aged 18 years and over, were included if their primary care record contained at least one of six overarching pain diagnoses during the study period. Subjects were excluded if their record also contained a cancer diagnosis in that time or the year prior to the study period. Case subjects also received at least one prescription for an opioid analgesic. Controls were matched by gender, age, pain-diagnosis and socioeconomic deprivation. Healthcare use included primary care visits, emergency department (ED) and outpatient (OPD) attendances, inpatient (IP) admissions and length of stay. Cost analysis for healthcare utilisation used nationally derived unit costs for 2015. Differences between case and control subjects for resource use and costs were analysed and further stratified by gender, prescribing persistence (PP) and deprivation.ResultsData from 3,286,215 individuals were examined with 657,243 receiving opioids. Case subjects averaged 5 times more primary care visits, 2.8 times more OPD attendances, 3 times more ED visits and twice as many IN admissions as controls. Prescription persistence over 6 months and greater deprivation were associated with significantly greater utilisation of healthcare resources. Opioid prescribing was associated with 69% greater average healthcare costs than in control subjects. National Health Service (NHS) healthcare service costs for people with common, pain-associated diagnoses, receiving opioid analgesics were estimated to be £0.9billion per year between 2005 and 2015.ConclusionReceipt of opioid prescriptions was associated with significantly greater healthcare utilisation and accompanying costs in all sectors. Extended prescribing durations are particularly important to address and should be considered at the point of initiation

Effectiveness and cost-effectiveness of a universal parenting skills programme in deprived communities : multicentre randomised controlled trial

Objective: To evaluate the effectiveness and cost utility of a universally provided early years parenting programme. Design: Multicentre randomised controlled trial with cost-effectiveness analysis. Setting: Early years centres in four deprived areas of South Wales. Participants: Families with children aged between 2 and 4 years. 286 families were recruited and randomly allocated to the intervention or waiting list control. Intervention: The Family Links Nurturing Programme (FLNP), a 10-week course with weekly 2 h facilitated group sessions. Main outcome measures: Negative and supportive parenting, child and parental well-being and costs assessed before the intervention, following the course (3 months) and at 9 months using standardised measures. Results: There were no significant differences in primary or secondary outcomes between trial arms at 3 or 9 months. With ‘+’ indicating improvement, difference in change in negative parenting score at 9 months was +0.90 (95%CI −1.90 to 3.69); in supportive parenting, +0.17 (95%CI −0.61 to 0.94); and 12 of the 17 secondary outcomes showed a non-significant positive effect in the FLNP arm. Based on changes in parental well-being (SF-12), the cost per quality-adjusted life year (QALY) gained was estimated to be £34 913 (range 21 485–46 578) over 5 years and £18 954 (range 11 664–25 287) over 10 years. Probability of cost per QALY gained below £30 000 was 47% at 5 years and 57% at 10 years. Attendance was low: 34% of intervention families attended no sessions (n=48); only 47% completed the course (n=68). Also, 19% of control families attended a parenting programme before 9-month follow-up. Conclusions: Our trial has not found evidence of clinical or cost utility for the FLNP in a universal setting. However, low levels of exposure and contamination mean that uncertainty remains. Trial registration: The trial is registered with Current Controlled Trials ISRCTN13919732

‘For All of Your Protection Needs’: Tracing the witch-bottle from the Early Modern Period to TikTok

© 2023 TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA. This is the accepted manuscript version of an article which has been published in final form at https://doi.org/10.1353/mrw.2023.a906600In the Early Modern Period, witch-bottles were a magical-medical remedy for bewitchment, prescribed by cunning-folk. Filled with pins, nails, and the victim’s urine, the bottles were then heated or buried, counteracting the suspected curse. Today, witch-bottles have taken on new meanings and new physical specifications. It is no longer seventeenth-century cunning-folk instructing on how to make them, but contemporary Wiccans on social media. This paper traces the shift in the purpose and perceptions of the witch-bottle over time, its adaptation key to our understanding of the custom itself and of how people today engage with the practices of the past.Peer reviewe

Assessing cost-effectiveness in the management of multiple sclerosis

Multiple sclerosis (MS) is one of the most common causes of neurological disability in young and middle-aged adults, with current prevalence rates estimated to be 30 per 100,000 populations. Women are approximately twice as susceptible as males, but males are more likely to have progressive disease. The onset of the disease normally occurs between 20 and 40 years of age, with a peak incidence during the late twenties and early thirties, resulting in many years of disability for a large proportion of patients, many of whom require wheelchairs and some nursing home or hospital care. The aim of this study is to update a previous review which considered the cost-effectiveness of disease-modifying drugs (DMDs), such as interferons and glatiramer acetate, with more up to date therapies, such as mitaxantrone hydrochloride and natalizumab in the treatment of MS. The development and availability of new agents has been accompanied by an increased optimism that treatment regimens for MS would be more effective; that the number, severity and duration of relapses would diminish; that disease progression would be delayed; and that disability accumulation would be reduced. However, doubts have been expressed about the effectiveness of these treatments, which has only served to compound the problems associated with endeavors to estimate the relative cost-effectiveness of such interventions

Using Q methodology to Evaluation a Day Service for Younger Adult Stroke Survivors

Q methodology was used in programme evaluation of the Cardiff Day Service, which was launched in July 1995 specifically for adult stroke survivors 18-55 years of age. The aim of the Service was to offer participants an opportunity to identify and pursue meaningful and realistic situations within the community that would enable them to meettheir personal aspiration, and develop their full potential. The purpose of this student is its application as a tool for understanding, evaluating, and extending or redirecting this Day Service. A 41-item Q set pertaining to perceived benefits of the Cardiff Day Service were sorted by 18 Helpers, yielding five factors (psychological gains, socialconfidence, encourages communication, respite for careers, and sense ofpurpose). The Q set sorted by Users was reduced to 33 items, after pilot testing indicated that users could not concentrate long enough to complete the longer sort. Seventeen User Q sorts resulted in six factors(new experiences, feeling valued, social recovery, security, prevents isolation, and general recovery). The evidence from this aspect of the programme evaluation suggests that the Service is a welcome initiative, Reconsideration of its structure led to a suggestion to establish two distinct branches, one to provide social support and another for rehabilitation support., Q methodology can continue to provide importantinput into the evolution of the Service by addressing questions about how best to meet the needs of pre-retirement individuals after stroke