An economic evaluation of vagus nerve stimulation as an adjunctive treatment to anti-seizure medications for the treatment of drug-resistant epilepsy in England.

INTRODUCTION: Anti-seizure medications (ASMs) are commonly used to prevent recurring epileptic seizures, but around a third of people with epilepsy fail to achieve an adequate response. Vagus nerve stimulation (VNS) is clinically recommended for people with drug-resistant epilepsy (DRE) who are not suitable for surgery, but the cost-effectiveness of the intervention has not recently been evaluated. The study objective is to estimate costs and quality-adjusted life-years (QALYs) associated with using VNS as an adjunct to ongoing ASM therapy, compared to the strategy of using only ASMs in the treatment of people with DRE, from an English National Health Service perspective. METHODS: A cohort state transition model was developed in Microsoft Excel to simulate costs and QALYs of the VNS + ASM and ASM only strategies. Patients could transition between five health states, using a 3-month cycle length. Health states were defined by an expected percentage reduction in seizure frequency, derived from randomized control trial data. Costs included the VNS device as well as its installation, setup, and removal; ASM therapy; adverse events associated with VNS (dyspnea, hoarseness, and cough); and health-state costs associated with epilepsy including hospitalizations, emergency department visits, neurologist visits, and primary care visits. A range of sensitivity analyses, including probabilistic sensitivity analysis, were run to assess the impact of parameter and structural uncertainty. RESULTS: In the base case, VNS + ASM had an estimated incremental cost-effectiveness ratio (ICER) of £17,771 per QALY gained compared to ASMs alone. The cost-effective ICER was driven by relative reductions in expected seizure frequency and the differences in health care resource use associated therewith. Sensitivity analyses found that the amount of resource use per epilepsy-related health state was a key driver of the cost component. CONCLUSIONS: VNS is expected to be a cost-effective intervention in the treatment of DRE in the English National Health Service

A cost-effectiveness analysis of endoscopic eradication therapy for management of dysplasia arising in patients with Barrett's oesophagus in the United Kingdom

BACKGROUND AND AIMS: Endoscopic eradication therapy (EET) is the first line approach for treating Barrett's Esophagus (BE) related neoplasia globally. The British Society of Gastroenterology (BSG) recommend EET with combined endoscopic resection (ER) for visible dysplasia followed by endoscopic ablation in patients with both low and high grade dysplasia (LGD and HGD). The aim of this study is to perform a cost-effectiveness analysis for EET for treatment of all grades of dysplasia in BE patients. METHODS: A Markov cohort model with a lifetime time horizon was used to undertake a cost effectiveness analysis. A hypothetical cohort of United Kingdom (UK) patients diagnosed with BE entered the model. Patients in the treatment arm with LGD and HGD received EET and patients with non-dysplastic BE (NDBE) received endoscopic surveillance only. In the comparator arm, patients with LGD, HGD and NDBE received endoscopic surveillance only. A UK National Health Service (NHS) perspective was adopted and the incremental cost effectiveness ratio (ICER) was calculated. Sensitivity analysis was conducted on key input parameters. RESULTS: EET for patients with LGD and HGD arising in BE is cost-effective compared to endoscopic surveillance alone (lifetime ICER £3,006 per QALY gained). The results show that as the time horizon increases, the treatment becomes more cost-effective. The five year financial impact to the UK NHS of introducing EET is £7.1m. CONCLUSIONS: EET for patients with low and high grade BE dysplasia, following updated guidelines from the BSG has been shown to be cost-effective for patients with BE in the UK

Evaluation of the silver species nature in Ag-ITQ2 zeolites by the CO oxidation reaction

The authors thank the Spanish Ministry of Economy and Competitiveness through RTI2018-101784-B-I00 (MINECO/FEDER) and SEV-2016-0683 projects for the financial support. We gratefully acknowledge ALBA synchrotron for allocating beamtime (proposal 2015091414) and the CLAESS beamline staff for their help and technical support during our experiment. CG and NB thank the TUW Innovative Project GIP165CDGC. CG, SP, VT, NB and GR are thankful for financial support from the Austrian Science Fund (FWF) through projects DK+ Solids4Fun (W1243) and ComCat (I 1041-N28). I. Lopez Hernandez is grateful to Generalitat Valenciana and European Social Fund for the pre doctoral grant ACIF2017.López-Hernández, I.; García Yago, CI.; Truttmann, V.; Pollit, S.; Barrabés, N.; Rupprechter, G.; Rey Garcia, F.... (2020). Evaluation of the silver species nature in Ag-ITQ2 zeolites by the CO oxidation reaction. 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Towards screening Barrett’s Oesophagus: current guidelines, imaging modalities and future developments

Barrett’s oesophagus is the only known precursor to oesophageal adenocarcinoma (OAC). Although guidelines on the screening and surveillance exist in Barrett’s oesophagus, the current strategies are inadequate. Oesophagogastroduodenoscopy (OGD) is the gold standard method in screening for Barrett’s oesophagus. This invasive method is expensive with associated risks negating its use as a current screening tool for Barrett’s oesophagus. This review explores current definitions, epidemiology, biomarkers, surveillance, and screening in Barrett’s oesophagus. Imaging modalities applicable to this condition are discussed, in addition to future developments. There is an urgent need for an alternative non-invasive method of screening and/or surveillance which could be highly beneficial towards reducing waiting times, alleviating patient fears and reducing future costs in current healthcare services. Vibrational spectroscopy has been shown to be promising in categorising Barrett’s oesophagus through to high-grade dysplasia (HGD) and OAC. These techniques need further validation through multicentre trials

Early management of head injury: Summary of updated NICE guidance

Head injury is the commonest cause of death and disability in people aged 1-40 years in the UK. Each year, 1.4 million people attend emergency departments in England and Wales with a recent head injury. The National Institute for Health and Care Excellence (NICE) published guidance on managing head injury in 2003 (clinical guideline 4)1 and updated this in 2007 (clinical guideline 56),2 which resulted in computed tomography (CT) replacing skull radiography as the primary imaging modality for assessing head injury. Key changes driving this update include the introduction of regional trauma networks with prehospital major trauma triage in England; the extension of indications for anticoagulation therapy; the establishment of local safeguarding boards in the UK, requiring front-line clinical staff to assess not only the severity of the head injury but also why it occurred; and new evidence on the initial assessment and early management of head injury. This article summarises the most recent recommendations from the National Institute for Health and Care Excellence (NICE). © BMJ Publishing Group Ltd 2014

Making better use of information to drive improvement in local public services: A report for the Audit Commission

This report on making better use of information to drive improvement in local public services was commissioned from the School of Public Policy at the University of Birmingham, by the Audit Commission. It explores how decision makers use information when making decisions. These decision makers can be politicians, top managers, operational managers, planners etc. The focus of this report is not on the use of performance indicators sensu stricto, but on the use of information more generally. Rather than studying how existing information is used or not used in decision making, this report is looking at how decision makers go about searching, analysing, summarising, processing and interpreting information when they need to make a decision. The report consists of three main chapters. - A summary of key government policy initiatives in the UK to stimulate the use of information in decision making - A review of the relevant research literature. This is the main section of the report. In it, we review the role of information in decision making theories, the organisational and structural context of information use, and psychological factors in the use of information in decision making - A presentation of a number of international perspectives on the use of information in public sector decision makin