Cost-effectiveness of buffered soluble alendronate 70 mg effervescent tablet for the treatment of postmenopausal women with osteoporosis in Italy

Summary: The use of buffered soluble alendronate 70 mg effervescent tablet, a convenient dosing regimen for bisphosphonate therapy, seems a cost-effective strategy compared with relevant alternative treatments for postmenopausal women with osteoporosis aged 60 years and over in Italy. Introduction: To assess the cost-effectiveness of buffered soluble alendronate (ALN) 70 mg effervescent tablet compared with relevant alternative treatments for postmenopausal osteoporotic women in Italy. Methods: A previously validated Markov microsimulation model was adjusted to the Italian healthcare setting to estimate the lifetime costs (expressed in €2019) per quality-adjusted life-years (QALY) of buffered soluble ALN compared with generic ALN, denosumab, zoledronic acid and no treatment. Pooled efficacy data derived from the NICE network meta-analysis were used for bisphosphonate treatments. Two treatment duration scenarios were assessed: 1 year using persistence data derived from an Italian prospective observational study including 144 and 216 postmenopausal osteoporotic women on buffered soluble ALN and oral ALN, respectively, and 3 years. Analyses were conducted for women 60–80 years of age with a bone mineral density T-score ≤ − 3.0 or with existing vertebral fractures. Results: In all simulated populations, buffered soluble ALN was dominant (more QALYs, lower costs) compared to denosumab. The cost per QALY gained of buffered soluble ALN compared to generic ALN and no treatment always falls below €20,000 per QALY gained. In the 1-year treatment scenario, zoledronic acid was associated with more QALY than buffered soluble ALN but the cost per QALY gained of zoledronic acid compared with buffered soluble ALN was always higher than €70,000, while buffered soluble ALN was dominant in the 3-year treatment scenario. Conclusion: This study suggests that buffered soluble ALN represents a cost-effective strategy compared with relevant alternative treatments for postmenopausal osteoporosis women in Italy aged 60 years and over. © 2021, The Author(s)

Preliminary characterization of residual biomass from Hibiscus sabdariffa Calyces

Hibiscus sabdariffa calyces are mainly used for different agro-food and beverages applications. The residual biomass generated contains various useful substances that were extracted and characterized. It contained 23% (w/w) soluble pectic material, a food additive, extracted with hot acidified water (80°C, pH = 1.5) and precipitated with ethanol. The molecular weight (28.5 and 109.7 kDa), the degree of methylation (70.6 and 44.3%) and the degree of acetylation (19.0 and 4.9%) were determined for two Senegalese cultivars (koor and vimto, respectively). The effect of the extraction method on these parameters was highlighted. The residual lignocellulosic material (LCM) was chemically degraded to monosaccharides and the amount of glucose and xylose (39% of dry LCM) determined to estimate its potential as feedstock for biofuels production. However, an enzymatic degradation test revealed a recalcitrant LCM, as only 50 to 55% of its polymeric glucose content was degraded to monosaccharides without pretreatment. Xylo-oligosaccharides (XOS) are functional foods with a real market potential as prebiotics, characterized by their degree of polymerization (DP). The production of XOS synthetized by the enzymatic degradation of LCM was monitored. The results of analyses performed showed that XOS produced had mainly DP3 and DP4 values.Key words: Pectin, lignocellulosic material, enzymatic degradation, xylo-oligosaccharides

Most Important Factors for Deciding Rehabilitation Provision for Severe Stroke Survivors Post Hospital Discharge: A Study Protocol for a Best–Worst Scaling Experiment

Copyright: © 2021 by the authors. Efficient decision-making is crucial to ensure adequate rehabilitation with optimal use of healthcare resources. Establishing the factors associated with making decisions concerning rehabilitation provision is important to guide clinical staff towards person-centred decisions for rehabilitation after severe stroke. In this study we conduct a best–worst scaling (BWS) experiment to identify the most important factors and their relative weight of importance for deciding the type of ongoing rehabilitation services a person with severe stroke might receive post hospital discharge. Fractional, efficient designs are applied regarding the survey design. Key multidisciplinary staff regularly involved in making decisions for rehabilitation in a stroke unit will be recruited to participate in an online BWS survey. Hierarchical Bayes estimation will be used as the main analysis method, with the best–worst count analysis as a secondary analysis. The survey is currently being piloted prior to commencing the process of data collection. Results are expected by the end of September 2021. The research will add to the current literature on clinical decision-making in stroke rehabilitation. Findings will quantify the preferences of factors among key multi-disciplinary clinicians working in stroke units in the UK, involved in decision-making concerning rehabilitation after stroke

Preference of young adults for COVID-19 vaccination in the United Kingdom: a discrete choice experiment

Availability of materials: Available under request to the corresponding author.Supplemental material is available online at: https://www.tandfonline.com/doi/full/10.1080/14737167.2023.2223983#supplemental-material-section .Copyright © 2023 The Author(s).2023. Objectives: To determine preferences for COVID-19 vaccinations in the young adult population in the United Kingdom (UK). Method: A discrete choice experiment survey was conducted in UK young adults. Participants were asked to choose between two hypothetical vaccines the one they preferred the most. Vaccines were defined by five attributes (effectiveness, risk of side effects, duration of protection, number of doses, confidence in available evidence), identified following a systematic literature review and qualitative interviews with 13 young adults. A random parameters logit model, a latent class model, and subgroup analyses were used to identify preferences. Results: One hundred and forty-nine respondents were included (70% women, mean age 23 years). All five attributes significantly influenced respondents’ vaccination decisions. Respondents valued higher effectiveness, lower risk of side effects, longer protection duration, and a smaller number of doses. Based on the range of levels of each attribute, vaccine effectiveness was the most important attribute (relative importance 34%), followed by risk of side effects (32%), and duration of vaccine protection (22%). Conclusions: The five investigated vaccine attributes appear to play an important role in young adults’ decision-making process. Results of this study may help health authorities designing appropriate strategies in future vaccines campaigns in the younger UK population.This paper was not funded

PLOS

Data Availability: All relevant data are available from the figshare repository (https://doi.org/10.6084/m9.figshare.21548031).Supporting information: S1 File. Interview guide. https://doi.org/10.1371/journal.pone.0277109.s001 (DOCX); S2 File. Coding guide. https://doi.org/10.1371/journal.pone.0277109.s002 (DOCX); S3 File. Inclusivity in global research questionnaire. https://doi.org/10.1371/journal.pone.0277109.s003 (DOCX); S1 Fig. Awareness phase beliefs. https://doi.org/10.1371/journal.pone.0277109.s004 (TIF); S2 Fig. Motivation phase beliefs. https://doi.org/10.1371/journal.pone.0277109.s005 (TIF); S3 Fig. Action phase beliefs. https://doi.org/10.1371/journal.pone.0277109.s006 (TIF).Copyright: © 2022 van Bergen et al. Introduction: Young adults are considered one of the most hesitant groups towards getting vaccinated in the UK, which threatens the success of the vaccination program in ending the pandemic. Identifying and understanding the socio-cognitive beliefs is important to effectively design and implement health communication interventions. Therefore, the aim of this study was to identify the underlying beliefs regarding COVID-19 vaccinations among young adults in the UK. Methods: The study consisted of online, one-on-one interviews with 18 individuals (6 males, 12 females) aged between 18 and 29 years, conducted in June 2021. The guiding theoretical framework was the I-Change Model. Interviews were recorded and transcribed verbatim. The transcripts were independently coded by two researchers by using the constructs of the I-Change Model. Belief statements were elicited from the codes and the frequency of belief statements was recorded and compared between intenders and non-intenders. Results: Similar beliefs were observed in intenders and non-intenders for most constructs of the I-Change Model. However, non-intenders distinguished themselves from intenders by their higher perceived risks of side effects and higher perceived disadvantages of being vaccinated. Non-intenders expressed the belief that the risk of unknown or long-term side effects, such as blood clotting and impact on fertility, were the main reason for them not to be willing to vaccinate. In addition, in both groups, participants had mostly similar beliefs as their friends and family. Conclusion: This research provides insights in the specific beliefs of the young adult population of the UK regarding COVID-19 vaccinations, which could have implications for health communication interventions. The findings suggest that such interventions should focus on reducing the uncertainty regarding short- and long-term effects and potentially having a focus on the entire social environment of young adults.The author(s) received no specific funding for this work

Model-based economic evaluations in smoking cessation and their transferability to new contexts: A systematic review

Aims To identify different types of models used in economic evaluations of smoking cessation, analyse the quality of the included models examining their attributes and ascertain their transferability to a new context. Methods A systematic review of the literature on the economic evaluation of smoking cessation interventions published between 1996 and April 2015, identified via Medline, EMBASE, NHS EED, and HTA. Checklist-based quality of the included studies and transferability scores were based on European Network of Health Economic Evaluation Databases (EURONHEED) criteria. Studies that were not in smoking cessation, not an original research, not a model-based economic evaluation, that did not consider adult population and not from a high income country were excluded. Findings Among the 64 economic evaluations included in the review, state-transition Markov model was the most frequently used method (n = 30/64) with Quality Adjusted Life Years (QALYs) being the most frequently used outcome measure in a lifetime horizon. A small number of the included studies (13/64) were eligible for EURONHEED transferability checklist. The overall transferability scores ranged from 0.50 to 0.97 with an average score of 0.75. The average score per section was 0.69 (range 0.35-0.92). Relative transferability of the studies could not be established due to a limitation present in the EURONHEED method. . Conclusion All existing economic evaluations in smoking cessation lack in one or more key study attributes necessary to be fully transferable to a new context.SP and PK’s time in this research was partly funded by the European Union’s Seventh Framework Programme for research, technological development and demonstration under grant agreement No. 602270 (EQUIPT)

Recommendations for The Conduct of Economic Evaluations in Osteoporosis: Outcomes of An Experts’ Consensus Meeting Organized by The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) And the US Branch of The International Osteoporosis Foundation

Summary Economic evaluations are increasingly used to assess the value of health interventions, but variable quality and heterogeneity limit the use of these evaluations by decision-makers. These recommendations provide guidance for the design, conduct, and reporting of economic evaluations in osteoporosis to improve their transparency, comparability, and methodologic standards. Introduction This paper aims to provide recommendations for the conduct of economic evaluations in osteoporosis in order to improve their transparency, comparability, and methodologic standards. Methods A working group was convened by the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis to make recommendations for the design, conduct, and reporting of economic evaluations in osteoporosis, to define an osteoporosis-specific reference case to serve a minimum standard for all economic analyses in osteoporosis, to discuss methodologic challenges and initiate a call for research. A literature review, a face-to-face meeting in New York City (including 11 experts), and a review/approval by a larger group of experts worldwide (including 23 experts in total) were conducted. Results Recommendations on the type of economic evaluation, methods for economic evaluation, modeling aspects, base-case analysis and population, excess mortality, fracture costs and disutility, treatment characteristics, and model validation were provided. Recommendations for reporting economic evaluations in osteoporosis were also made and an osteoporosis-specific checklist was designed that includes items to report when performing an economic evaluation in osteoporosis. Further, 12 minimum criteria for economic evaluations in osteoporosis were identified and 12 methodologic challenges and need for further research were discussed. Conclusion While the working group acknowledges challenges and the need for further research, these recommendations are intended to supplement general and national guidelines for economic evaluations, improve transparency, quality, and comparability of economic evaluations in osteoporosis, and maintain methodologic standards to increase their use by decision-makers

Value of information analysis of an early intervention for subthreshold panic disorder: Healthcare versus societal perspective

Background Panic disorder is associated with high productivity costs. These costs, which should be included in cost-effectiveness analyses (CEA) from a societal perspective, have a considerable impact on cost-effectiveness estimates. However, they are often omitted in published CEAs. It is therefore uncertain whether choosing a societal perspective changes priority setting in future research as compared to a healthcare perspective. Objectives To identify research priorities regarding the cost-effectiveness of an early intervention for subthreshold panic disorder using value of information (VOI) analysis and to investigate to what extent priority setting depends on the perspective. Methods We calculated the cost-effectiveness of an early intervention for panic disorder from a healthcare perspective and a societal perspective. We performed a VOI analysis, which estimates the expected value of eliminating the uncertainty surrounding cost-effectiveness estimates, for both perspectives. Results From a healthcare perspective the early intervention was more effective at higher costs compared to usual care (€17,144 per QALY), whereas it was cost-saving from a societal perspective. Additional research to eliminate parameter uncertainty was valued at €129.7 million from a healthcare perspective and €29.5 million from a societal perspective. Additional research on the early intervention utility gain was most valuable from a healthcare perspective, whereas from a societal perspective additional research would generate little added value. Conclusions Priority setting for future research differed substantially according to the perspective. Our study underlines that the health-economic perspective of CEAs on interventions for panic disorder must be chosen carefully in order to avoid inappropriate choices in research priorities