4 research outputs found
Cost-effectiveness of a community-delivered multicomponent intervention compared with enhanced standard care of obese adolescents: cost-utility analysis alongside a randomised controlled trial (the HELP trial)
Objective To undertake a cost-utility analysis of a motivational multicomponent lifestyle-modification intervention in a community setting (the Healthy Eating
Lifestyle Programme (HELP)) compared with enhanced standard care.
Design Cost-utility analysis alongside a randomised controlled trial. Setting Community settings in Greater London, England. Participants 174 young people with obesity aged 12ā19 years. Interventions Intervention participants received 12 one to-one sessions across 6months, addressing lifestyle behaviours and focusing on motivation to change and self esteem
rather than weight change, delivered by trained graduate health workers in community settings. Control participants received a single 1-hour one-to-one nurse delivered
session providing didactic weight-management
advice. Main outcome measures Mean costs and quality adjusted life years (QALYs) per participant over a 1-year period using resource use data and utility values collected during the trial. Incremental cost-effectiveness ratio (ICER) was calculated and non-parametric bootstrapping was conducted to generate a cost-effectiveness acceptability curve (CEAC).
Results Mean intervention costs per participant were Ā£918 for HELP and Ā£68 for enhanced standard care. There were no significant differences between the two
groups in mean resource use per participant for any type of healthcare contact. Adjusted costs were significantly higher in the intervention group (mean incremental costs
for HELP vs enhanced standard care Ā£1003 (95% CI Ā£837 to Ā£1168)). There were no differences in adjusted QALYs between groups (mean QALYs gained 0.008 (95% CI ā0.031 to 0.046)). The ICER of the HELP versus enhanced standard care was Ā£120 630 per QALY gained. The CEAC shows that the probability that HELP was cost-effective relative to the enhanced standard care was 0.002 or 0.046, at a threshold of Ā£20 000 or Ā£30 000 per QALY gained.
Conclusions We did not find evidence that HELP was more effective than a single educational session in improving quality of life in a sample of adolescents with
obesity. HELP was associated with higher costs, mainly due to the extra costs of delivering the intervention and therefore is not cost-effective
Quality assessment of included studies based on Drummond et al (1997).
<p>Quality assessment of included studies based on Drummond et al (1997).</p
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Effectiveness of rapid SARSāCoVā2 genome sequencing in supporting infection control for hospitalāonset COVIDā19 infection: multicenter, prospective study
Background Viral sequencing of SARSāCoVā2 has been used for outbreak investigation, but there is limited evidence supporting routine use for infection prevention and control (IPC) within hospital settings. Methods We conducted a prospective nonārandomised trial of sequencing at 14 acute UK hospital trusts. Sites each had a 4āweek baseline dataācollection period, followed by intervention periods comprising 8 weeks of ārapidā (<48h) and 4 weeks of ālongerāturnaroundā (5ā10 day) sequencing using a sequence reporting tool (SRT). Data were collected on all hospital onset COVIDā19 infections (HOCIs; detected ā„48h from admission). The impact of the sequencing intervention on IPC knowledge and actions, and on incidence of probable/definite hospitalāacquired infections (HAIs) was evaluated. Results A total of 2170 HOCI cases were recorded from October 2020āApril 2021, corresponding to a period of extreme strain on the health service, with sequence reports returned for 650/1320 (49.2%) during intervention phases. We did not detect a statistically significant change in weekly incidence of HAIs in longerāturnaround (incidence rate ratio 1.60, 95%CI 0.85ā3.01; P=0.14) or rapid (0.85, 0.48ā1.50; P=0.54) intervention phases compared to baseline phase. However, IPC practice was changed in 7.8% and 7.4% of all HOCI cases in rapid and longerāturnaround phases, respectively, and 17.2% and 11.6% of cases where the report was returned. In a āperāprotocolā sensitivity analysis there was an impact on IPC actions in 20.7% of HOCI cases when the SRT report was returned within 5 days. Capacity to respond effectively to insights from sequencing was breached in most sites by the volume of cases and limited resources. Conclusion While we did not demonstrate a direct impact of sequencing on the incidence of nosocomial transmission, our results suggest that sequencing can inform IPC response to HOCIs, particularly when returned within 5 days