Direct and indirect costs of paediatric asthma in the UK : a cost analysis

We thank all the children who took part in the study and their families, and the staff at recruitment sites who facilitated identification, recruitment and follow-up of study participants. We acknowledge Jessica Wood, Victoria Bell and Andrea Fraser from the RAACENO trial office. We also thank Aileen Neilson who initially led the health economic aspects of the RAACENO trial.Peer reviewe

Cost-effectiveness and value of information analysis of multiple frequency bioimpedance devices for fluid management in people with chronic kidney disease having dialysis

Acknowledgements The authors would like to thank the Thomas Walker and Rebecca Albrow (National Institute for Health and Care Excellence) for comments on earlier versions of the model. We also wish to thank the NICE expert committee members who provided information and data to support the development of the model: Dr Andrew Davenport (Royal Free Hospital, London), Dr Simon Roe (Nottingham University Hospitals NHS Trust), Dr Elizabeth Lindley (St James’s University Hospital), Dr Wesley Hayes (Great Ormond Street Hospital), Ms Joanne Prince (Central Manchester University Hospitals NHS Foundation Trust), Mr Nick McAleer (Royal Devon & Exeter NHS Foundation Trust), Dr Kay Tyerman (Leeds General Infirmary), Dr Graham Woodrow (St James’s University Hospital) and Mr Paul Taylor (lay specialist committee member). Funding This paper presents independent research funded by the National Institute for Health Research (NIHR), commissioned through the NICE Diagnostic Assessment Programme (Project no 15/17/07). The views expressed are those of the authors and not necessarily those of NICE, the NHS, the NIHR or the Department of Health. The Health Economics Research Unit and the Health Services Research Unit, University of Aberdeen, are funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates.Peer reviewedPublisher PD

Cost of fertility treatment and live birth outcome in women of different ages and BMI

Acknowledgements We thank the Aberdeen Fertility Centre Database Committee and the Aberdeen Maternal and Neonatal Databank Committee for giving us approval to use their databases. We thank the Data Management Team for extracting the required information from these databases. The views expressed in this paper represent the views of the authors and not necessarily the views of the funding bodies. Funding This study was partly funded by an NHS endowment grant (Grant Number 12/48) and DM by a Chief Scientist Office Postdoctoral Fellowship (Ref PDF/12/06).Peer reviewedPostprin

Pre-hospital and emergency department treatment of convulsive status epilepticus in adults : an evidence synthesis

Acknowledgements The authors are grateful to Robert Silbergleit, Department of Emergency Medicine, University of Michigan, MI, USA, for providing the individual participant data set of RAMPART. Patient and public involvement The Plain English summary was shared with the Health Services Research Unit (HSRU) Public Partnership Group at the University of Aberdeen, which consists of 11 patient and public involvement partners (seven men, four women; three working age, eight retired). Communication with the Public Partnership Group was facilitated by the HSRU patient and public involvement co-ordinator. The Group consists of members of the public, who meet regularly to discuss aspects of HSRU research and provide a public perspective. Six members of the group provided comments on the language and general meaning of the summary Funding This project was funded by the National Institute for Health Research (NIHR) Evidence Synthesis programme and will be published in full in Health Technology Assessment; Vol. 26, No. 20. See the NIHR Journals Library website for further project information.Peer reviewedPublisher PD

Screening for type 2 diabetes : literature review and economic modelling

Objectives: To reconsider the aims of screening for undiagnosed diabetes, and whether screening should be for other abnormalities of glucose metabolism such as impaired glucose tolerance (IGT), or the ‘metabolic syndrome’. Also to update the previous review for the National Screening Committee (NSC) on screening for diabetes, including reviewing choice of screening test; to consider what measures would be taken if IGT and impaired fasting glucose (IFG) were identified by screening, and in particular to examine evidence on treatment to prevent progression to diabetes in these groups; to examine the cost-effectiveness of screening; and to consider groups at higher risk at which screening might be targeted. Data sources: Electronic databases were searched up to the end of June 2005. Review methods: Literature searches and review concentrated on evidence published since the last review of screening, both reviews and primary studies. The review of economic studies included only those models that covered screening. The new modelling extended an existing diabetes treatment model by developing a screening module. The NSC has a set of criteria, which it applies to new screening proposals. These criteria cover the condition, the screening test or tests, treatment and the screening programme. Screening for diabetes was considered using these criteria. Results: Detection of lesser degrees of glucose intolerance such as IGT is worthwhile, partly because the risk of cardiovascular disease (CVD) can be reduced by treatment aimed at reducing cholesterol level and blood pressure, and partly because some diabetes can be prevented. Several trials have shown that both lifestyle measures and pharmacological treatment can reduce the proportion of people with IGT who would otherwise develop diabetes. Screening could be two-stage, starting with the selection of people at higher risk. The second-stage choice of test for blood glucose remains a problem, as in the last review for NSC. The best test is the oral glucose tolerance test (OGTT), but it is the most expensive, is inconvenient and has weak reproducibility. Fasting plasma glucose would miss people with IGT. Glycatedhaemoglobin does not require fasting, and may be the best compromise. It may be that more people would be tested and diagnosed if the more convenient test was used, rather than the OGTT. Five economic studies assessed the costs and short-term outcomes of using different screening tests. None examined the long-term impact of different proportions of false negatives. All considered the costs that would be incurred and the numbers identified by different tests, or different cut-offs. Results differed depending on different assumptions. They did not give a clear guide as to which test would be the best in any UK screening programme, but all recognised that the choice of cut-off would be a compromise between sensitivity and specificity; there is no perfect test. The modelling exercise concluded that screening for diabetes appears to be cost-effective for the 40–70-year age band, more so for the older age bands, but even in the 40–49-year age group, the incremental cost-effectiveness ratio for screening versus no screening is only £10,216 per quality-adjusted life-year. Screening is more cost-effective for people in the hypertensive and obese subgroups and the costs of screening are offset in many groups by lower future treatment costs. The cost-effectiveness of screening is determined as much by, if not more than, assumptions about the degree of control of blood glucose and future treatment protocols than by assumptions relating to the screening programme. The very low cost now of statins is also an important factor. Although the prevalence of diabetes increases with age, the relative risk of CVD falls, reducing the benefits of screening. Screening for diabetes meets most of the NSC criteria, but probably fails on three: criterion 12, on optimisation of existing management of the condition; criterion 13, which requires that there should be evidence from high-quality randomised controlled trials (RCTs) showing that a screening programme would reduce mortality or morbidity; and criterion 18, that there should be adequate staffing and facilities for all aspects of the programme. It is uncertain whether criterion 19, that all other options, including prevention, should have been considered, is met. The issue here is whether all methods of improving lifestyles in order to reduce obesity and increase exercise have been sufficiently tried. The rise in overweight and obesity suggests that health promotion interventions have not so far been effective. Conclusions: The case for screening for undiagnosed diabetes is probably somewhat stronger than it was at the last review, because of the greater options for reduction of CVD, principally through the use of statins, and because of the rising prevalence of obesity and hence type 2 diabetes. However, there is also a good case for screening for IGT, with the aim of preventing some future diabetes and reducing CVD. Further research is needed into the duration of undiagnosed diabetes, and whether the rise in blood glucose levels is linear throughout or whether there may be a slower initial phase followed by an acceleration around the time of clinical diagnosis. This has implications for the interval after which screening would be repeated. Further research is also needed into the natural history of IGT, and in particular what determines progression to diabetes. An RCT of the type required by NSC criterion 13 is under way but will not report for about 7 years

Early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma:An economic evaluation based on data from the EAGLE trial

This study was funded by the UK Medical Research Council (ref G0701604), and managed by the National Institute for Health Research (NIHR-EME 09-800-26) on behalf of the MRC-NIHR partnership, Efficiency and Mechanism Evaluation Programme. The Health Services Research Unit and the Health Economics Research Unit are both funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates. The funders had no role in the study design; collection, analysis, and interpretation of data; the writing of the report; or in the decision to submit the article for publication. The views expressed in this article are those of the authors and do not necessarily reflect the views of the MRC, National Institute for Health Research, the Department of Health, or the Scottish Government.Peer reviewedPublisher PD

Intelligent policy making? Key actors' perspectives on the development and implementation of a national early years' initiative

Increased political enthusiasm for evidence-based policy and action has re-ignited interest in the use of evidence within political and practitioner networks. Theories of evidence-based policy making and practice are being re-considered in an attempt to better understand the processes through which knowledge translation occurs. Understanding how policy develops, and practice results, has the potential to facilitate effective evidence use. Further knowledge of the factors which shape healthcare delivery and their influence in different contexts is needed.<p></p> This paper explores the processes involved in the development of a complex intervention in Scotland's National Health Service (NHS). It uses a national oral health programme for children (Childsmile) as a case study, drawing upon key actors' perceptions of the influence of different drivers (research evidence, practitioner knowledge and values, policy, and political and local context) to programme development. Framework analysis is used to analyse stakeholder accounts from in-depth interviews. Documentary review is also undertaken.<p></p> Findings suggest that Childsmile can be described as an ‘evidence-informed’ intervention, blending available research evidence with knowledge from practitioner experience and continual learning through evaluation, to plan delivery. The importance of context was underscored, in terms of the need to align with prevailing political ideology and in the facilitative strength of networks within the relatively small public health community in Scotland. Respondents' perceptions support several existing theoretical models of translation, however no single theory offered a comprehensive framework covering all aspects of the complex processes reported. Childsmile's use of best available evidence and on-going contribution to knowledge suggest that the programme is an example of intelligent policy making with international relevance.<p></p&gt

Economic evaluation of Medically Assisted Reproduction : an educational overview of methods and applications for healthcare professionals

Acknowledgements Medical writing support was provided by Steven Goodrick of in Science Communications, Springer Healthcare Ltd, UK, and was funded by Merck Healthcare KGaA, Darmstadt, GermanyPeer reviewedPostprin

Biomarkers for assessing acute kidney injury for people who are being considered for admission to critical care : a systematic review and cost-effectiveness analysis

This study is registered as PROSPERO CRD42019147039. Funding This project was funded by the National Institute for Health Research (NIHR) Evidence Synthesis programme and will be published in full in Health Technology Assessment; Vol. 26, No. 7. See the NIHR Journals Library website for further project information.Peer reviewedPublisher PD

Cost-effectiveness and value of information analysis of NephroCheck and NGAL tests compared to standard care for the diagnosis of acute kidney injury

Acknowledgements We are grateful to Thomas Walker and Rebecca Albrow at NICE for their thoughtful comments on earlier versions of the economic model and to the NICE Diagnostic Committee for their critical review of our identifed evidence. We are also grateful for the advice and clinical guidance received from the NICE Specialist Advisory Group for DG19 and to Peter S Hall and Alison F Smith (on behalf of the team) for providing early versions of their economic model that was instrumental in the development and structuring of the model used in this study. A big thank goes also to Lara Kemp for her secretarial support and patience throughout the study. The results presented in this paper have not been published previously in any academic journals, nor have they been submitted elsewhere. This work has informed the development of NICE guidance for diagnostic testing for AKI (https://www.nice.org.uk/guidance/dg39) and a full report to the funder describing the totality of this work will be published in the NIHR, HTA mono‑ graph series in due course. Funding The fndings presented in this manuscript are part of a broader research project funded by the National Institute for Health Research (NIHR) and com‑missioned through the NICE Diagnostic Assessment Programme (project no 12/88/97). The views expressed are those of the authors and not necessarily those of NICE, the NHS, the NIHR or the Department of Health. The Health Economics Research Unit and the Health Services Research Unit, University of Aberdeen, are funded by the Chief Scientist Ofce of the Scottish Government Health and Social Care Directorates.Peer reviewedPublisher PD