DyeVert™ PLUS EZ System for Preventing Contrast-Induced Acute Kidney Injury in Patients Undergoing Diagnostic Coronary Angiography and/or Percutaneous Coronary Intervention: A UK-Based Cost–Utility Analysis

Background: Contrast-induced acute kidney injury (CI-AKI) is a complication commonly associated with invasive angiographic procedures and is considered the leading cause of hospital-acquired acute kidney injury. CI-AKI can lead to a prolonged hospital stay, with a substantial economic impact, and increased mortality. The DyeVert™ PLUS EZ system (FDA approved and CE marked) is a device that has been developed to divert a portion of the theoretical injected contrast media volume (CMV), reducing the overall volume of contrast media injected and aortic reflux, and potentially improving long-term health outcomes. Objectives: To assess the long-term costs and health outcomes associated with the introduction of the DyeVert™ PLUS EZ system into the UK health care service for the prevention of CI-AKI in a cohort of patients with chronic kidney disease (CKD) stage 3–4 undergoing diagnostic coronary angiography (DAG) and/or percutaneous coronary intervention (PCI), and to compare these costs and outcomes with those of the current practice. Methods: A de novo economic model was developed based on the current pathway of managing patients undergoing DAG and/or PCI and on evidence related to the clinical effectiveness of DyeVert™ in terms of its impact on relevant clinical outcomes and health service resource use. Clinical data used to populate the model were derived from the literature or were based on assumptions informed by expert clinical input. Costs included in the model were from the NHS and personal social services perspective and obtained from the literature and UK-based routine sources. Probabilistic distributions were assigned to the majority of model parameters so that a probabilistic analysis could be undertaken, while deterministic sensitivity analyses were also carried out to explore the impact of key parameter variation on the model results. Results: Base-case results indicate that the intervention leads to cost savings (− £435) and improved effectiveness (+ 0.028 QALYs) over the patient’s lifetime compared with current practice. Output from the probabilistic analysis points to a high likelihood of the intervention being cost-effective across presented willingness-to-pay (WTP) thresholds. The overall long-term cost saving for the NHS associated with the introduction of the DyeVert™ PLUS EZ system is over £19.7 million for each annual cohort of patients. The cost savings are mainly driven by a lower risk of subsequent diseases and their associated costs. Conclusions: The introduction of the DyeVert™ PLUS EZ system has the potential to reduce costs for the health care service and yield improved clinical outcomes for patients with CKD stage 3–4 undergoing angiographic procedures

Habitat quality, configuration and context effects on roe deer fecundity across a forested landscape mosaic

Effective landscape-scale management of source-sink deer populations will be strengthened by understanding whether local variation in habitat quality drives heterogeneity in productivity. We related female roe deer Capreolus capreolus fecundity and body mass to habitat composition and landscape context, separately for adults and yearlings, using multi-model inference (MMI) applied to a large sample of individuals (yearlings: fecundity=202, body mass=395; adults: fecundity=908, body mass=1669) culled during 2002-2015 from an extensive (195 km2) heterogeneous forest landscape. Adults were heavier (inter-quartile, IQ, effect size=+0.5kg) when culled in buffers comprising more arable lands while contrary to our prediction no effects on body mass of grassland, young forest or access to vegetation on calcareous soil were found. Heavier adults were more fertile (IQ effect size, +12% probability of having two embryos instead of one or zero). Counter-intuitively, adults with greater access to arable lands were less fecund (IQ effect of arable: -7% probability of having two embryos, instead of one or zero), and even accounting for greater body mass of adults with access to arable, their modelled fecundity was similar to or lower than that of adults in the forest interior. In contrast, effects of grassland, young forest and calcareous soil did not receive support. Yearling body mass had an effect on fecundity twice that found in adults (+23% probability of having one additional embryo), but yearling body mass and fecundity were not affected by any candidate habitat or landscape variables. Effect of arable lands on body mass and fecundity were small, with little variance explained (Coefficient of Variation of predicted fecundity across forest sub-regions=0.03 for adults). More variance in fecundity was attributed to other differences between forest management sub-regions (modelled as random effects), suggesting other factors might be important. When analysing source-sink population dynamics to support management, an average value of fecundity can be appropriate across a heterogeneous forest landscape

Wintering habitat use by houbara bustard (Chlamydotis macqueenii) in steppes of Harat, central Iran

Over the last few decades, Asiatic houbara bustard (Chlamydotis macqueenii) has declined in numbers throughout its geographic range. In Iran, houbaras occur in arid and semi-arid deserts, with the highest population densities in the central steppes. Wintering habitat selection of houbara bustards was studied from December 2006 to March 2007 in Harat, central Iran. To compare houbara population densities in different habitats within the study area, the number of houbara fecal pellets were quantified within strip transects in two habitat types. Houbara population density was higher in bush-steppe habitat, which had lower plant height and greater vegetation cover, than shrub-steppe. In contrast, houbaras selected sites within each habitat where vegetation cover was significantly lower compared with control sites. Distance to farmlands and plant species richness were also important determinants of the habitat use of bustards in the study area. We suggest that agricultural development strategies may influence the abundance of local populations of houbara in their wintering grounds

The influence of wood land size and shape on bird Species richness and diversity in Karkas protected area

Determining landscape parameters influencing species richness of habitat patches is one of the most important issues in conservation biology. Many previous studies have investigated the influence of habitat parameters on bird assemblages in forest patches, but studies seeking effects of oasis parameters on bird assemblages are very scarce. Karkas Protected Area is located in semi-arid zone in   the central Iran, comprising a number of woodland patches supporting different groups of birds. We studied the influence of patch size and shape on bird species richness and diversity of woodland patches in Karakas Protected Area. Bird census was conducted in spring and summer 2007 within 15 woodland patches using established line transects (TL = 17.1 km). Rarefied species richness and Shannon-Wiener diversity index were respectively used as measures of species richness and diversity. Patch parameters (area and circumference) were quantified using satellite images. Linear regression analysis revealed positive effect of patch area and negative effect of patch shape (the ratio of patch perimeter to patch area) on bird species richness and diversity. These results can be applied in management programs for biodiversity conservation, in particular, for maintaining bird species diversity

A corticosteroid-eluting sinus implant following endoscopic sinus surgery for chronic rhinosinusitis: a UK-based cost-effectiveness analysis.

BACKGROUND: Chronic rhinosinusitis (CRS) is one of the commonest chronic health problems among adults in the UK. Around 15% of CRS patients undergo functional endoscopic sinus surgery (FESS) annually after failing medical treatment. However, as incomplete resolution of symptoms or complications post-operatively is common, the post-operative management is considered to be as important as the surgery itself. A bioabsorbable corticosteroid-eluting sinus implant (CESI) (Propel®, mometasone furoate 370 µg) has been used as an alternative post-FESS treatment. OBJECTIVE: The objective of this study was to assess the cost effectiveness of the corticosteroid-eluting implant versus non-corticosteroid-eluting spacer following FESS for treatment of patients with CRS. METHODS: A decision tree model was developed to estimate the cost and effectiveness in each strategy. Costs and effects were estimated from a UK National Health Service (NHS) and personal social services perspective over a 6-month time horizon. Model pathways and parameters were informed by existing clinical guidelines and literature and sensitivity analyses were conducted to explore uncertainties in base-case assumptions. RESULTS: Over a 6-month time horizon, inserting CESI at the end of FESS is less costly (£4646 vs. £4655 per patient) and is the more effective intervention [total quality-adjusted life-years (QALYs) over 6 months 0.443 vs. 0.444] than non-corticosteroid-eluting spacers; hence, it is a dominant strategy. The probabilistic analysis results indicate that CESI following FESS has a 62% probability of being cost effective at the £20,000/per QALY willingness-to-pay threshold and 56% probability of being a cost-saving intervention. CONCLUSIONS: The use of CESI after FESS results in fewer post-operative complications than non-corticosteroid-eluting implants and may be a cost-saving technology over a 6-month time horizon. Although the cost of initial treatment with the CESI is greater, cost savings are made due to a reduction in the number of complications experienced

The disappearance of muntjac (Muntiacus reevesi) and roe deer (Capreolus capreolus) pellet groups in a pine forest of lowland England

Reliable knowledge of the disappearance rate of faecal pellets is essential for converting pellet density to deer density when using standing-crop pellet-group counts. Disappearance of muntjac and roe deer pellet groups was monitored in four growth stages of a pine forest of lowland England over a 15-month period. Time to disappearance of the pellet groups (days) of both species significantly differed between habitats and months; it was shorter in late summer to early autumn and in habitats with more ground vegetation. Muntjac pellet groups disappeared more quickly than roe deer pellet groups. Time to disappearance of roe deer pellet groups was negatively correlated with air and grass temperature in pre-thicket and pre-fell habitats, while time to disappearance of muntjac pellet groups was negatively correlated with frequency of rainfall and positively correlated with the run of wind (air passage over a site within a 24-h period measured in km) in pre-thicket habitats. It is the time of the standing-crop pellet-group counts and the disappearance rate of pellet groups deposited in different months and habitats that determine the appropriate method for conversion of pellet-group density to deer density