Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for the treatment of rheumatoid arthritis not previously treated with disease-modifying antirheumatic drugs and after the failure of conventional disease-modifying antirheumatic drugs only: systematic review and economic evaluation.

OBJECTIVES: Rheumatoid arthritis (RA) is a chronic inflammatory disease associated with increasing disability, reduced quality of life and substantial costs (as a result of both intervention acquisition and hospitalisation). The objective was to assess the clinical effectiveness and cost-effectiveness of seven biologic disease-modifying antirheumatic drugs (bDMARDs) compared with each other and conventional disease-modifying antirheumatic drugs (cDMARDs). The decision problem was divided into those patients who were cDMARD naive and those who were cDMARD experienced; whether a patient had severe or moderate to severe disease; and whether or not an individual could tolerate methotrexate (MTX). DATA SOURCES: The following databases were searched: MEDLINE from 1948 to July 2013; EMBASE from 1980 to July 2013; Cochrane Database of Systematic Reviews from 1996 to May 2013; Cochrane Central Register of Controlled Trials from 1898 to May 2013; Health Technology Assessment Database from 1995 to May 2013; Database of Abstracts of Reviews of Effects from 1995 to May 2013; Cumulative Index to Nursing and Allied Health Literature from 1982 to April 2013; and TOXLINE from 1840 to July 2013. Studies were eligible for inclusion if they evaluated the impact of a bDMARD used within licensed indications on an outcome of interest compared against an appropriate comparator in one of the stated population subgroups within a randomised controlled trial (RCT). Outcomes of interest included American College of Rheumatology (ACR) scores and European League Against Rheumatism (EULAR) response. Interrogation of Early Rheumatoid Arthritis Study (ERAS) data was undertaken to assess the Health Assessment Questionnaire (HAQ) progression while on cDMARDs. METHODS: Network meta-analyses (NMAs) were undertaken for patients who were cDMARD naive and for those who were cDMARD experienced. These were undertaken separately for EULAR and ACR data. Sensitivity analyses were undertaken to explore the impact of including RCTs with a small proportion of bDMARD experienced patients and where MTX exposure was deemed insufficient. A mathematical model was constructed to simulate the experiences of hypothetical patients. The model was based on EULAR response as this is commonly used in clinical practice in England. Observational databases, published literature and NMA results were used to populate the model. The outcome measure was cost per quality-adjusted life-year (QALY) gained. RESULTS: Sixty RCTs met the review inclusion criteria for clinical effectiveness, 38 of these trials provided ACR and/or EULAR response data for the NMA. Fourteen additional trials contributed data to sensitivity analyses. There was uncertainty in the relative effectiveness of the interventions. It was not clear whether or not formal ranking of interventions would result in clinically meaningful differences. Results from the analysis of ERAS data indicated that historical assumptions regarding HAQ progression had been pessimistic. The typical incremental cost per QALY of bDMARDs compared with cDMARDs alone for those with severe RA is > £40,000. This increases for those who cannot tolerate MTX (£50,000) and is > £60,000 per QALY when bDMARDs were used prior to cDMARDs. Values for individuals with moderate to severe RA were higher than those with severe RA. Results produced using EULAR and ACR data were similar. The key parameter that affected the results is the assumed HAQ progression while on cDMARDs. When historic assumptions were used typical incremental cost per QALY values fell to £38,000 for those with severe disease who could tolerate MTX. CONCLUSIONS: bDMARDs appear to have cost per QALY values greater than the thresholds stated by the National Institute for Health and Care Excellence for interventions to be cost-effective. Future research priorities include: the evaluation of the long-term HAQ trajectory while on cDMARDs; the relationship between HAQ direct medical costs; and whether or not bDMARDs could be stopped once a patient has achieved a stated target (e.g. remission). STUDY REGISTRATION: This study is registered as PROSPERO CRD42012003386. FUNDING: The National Institute for Health Research Health Technology Assessment programme

Patient electronic record Information and consent (PERIC) : public attitudes to protection and use of personal health information

Available from British Library Document Supply Centre- DSC:8088. 675275(no 7) / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo

Lifestyle Matters Study, 2011-2015

Abstract copyright UK Data Service and data collection copyright owner.Background: Healthy, active ageing is strongly associated with good mental wellbeing which in turn helps to prevent mental illness. However, more investment has been made into research into interventions to prevent mental illness than into those designed to improve mental wellbeing. This applied research programme provided high quality evidence for an intervention designed to improve and sustain mental wellbeing in older adults. Methods/Design: This study was a multi-centre, pragmatic, two-arm, parallel group, individually randomised controlled trial to determine the population benefit of an occupational therapy based intervention for community living people aged 65 years or older. Participants (n = 268) were identified in one city in the North of England and in North Wales through GP mail-outs, signposting by local authority, primary care staff and voluntary sector organisations and through community engagement. Participants were randomised to one of two treatment arms: an intervention (Lifestyle Matters programme); or control (routine access to health and social care). All participants were assessed at baseline, 6 and 24 months post-randomisation. The primary outcome was the SF-36 Mental Health dimension at six months post randomisation. Secondary outcome measures were selected to measure psychosocial, physical and mental health outcomes. They included other dimensions of the SF36, EQ-5D-3L, Brief Resilience Scale, General Perceived Self Efficacy Scale, PHQ-9, de Jong Gierveld Loneliness Scale, Health and Social Care Resource Use and the wellbeing question of the Integrated Household Survey 2011. A cost effectiveness analysis investigated the incremental cost per Quality Adjusted Life Years (QALYs) of the Lifestyle Matters intervention compared with treatment as usual. Further information can be found on the Sheffield University Lifestyle Matters webpage. Main Topics:Topics covered include the health and wellbeing issues of adults aged 65 and over who volunteered to participate in the Lifestyle Matters study, half of which were randomly allocated to receive the Lifestyle Matters intervention, and half of which were randomised to receive usual care

Comparing the cost of elective surgical procedures in thirteen European countries

Includes bibliographical referencesAvailable from British Library Document Supply Centre- DSC:8088. 675275(no 1) / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo

Family Practices during Life-Threatening Illness: Exploring the Everyday, 2007-2008

Abstract copyright UK Data Service and data collection copyright owner.This is a qualitative data collection. These data were collected as part of a PhD project which explored the experiences of individuals living in a family where a member was dying or had a life-threatening illness. This was an ethnographic study which combined informal, in-depth interviews with nine families and participant observation on a hospice ward. Participant observations and the interviews from one family have not been archived due to consent restrictions; therefore the collection comprises data from eight families. Broadly the research aims were: to explore how everyday family life is pursued when someone in the family has a life-threatening or terminal illnessto ask what families are doing at this timeto examine how relationships, family practices, familial identities and everyday family lives are experienced - particularly how they are sustained and/or changed when families encounter illness, dying and deathto also consider how family lives are experienced in a less every day and familiar context, by asking what might be significant about a hospice inpatient ward as a setting for family life during the illness process and especially nearing the end-of-life These data are under embargo until October 31st 2014 at the request of the depositor. After that, the data will be available only with the express permission of the depositor. Main Topics:The data collection deposited includes 37 in-depth interviews with members from eight different families. The consistent themes covered in the interviews include: facing deathliving with life-threatening illnesseveryday routinesfamily life and relationships</ul

Reducing barriers to health care A study to measure and understand inequalities in health resulting from an inequitable balance between health service use and the need for health services : phase two (RBG 99XX8)

Includes bibliographical referencesAvailable from British Library Document Supply Centre- DSC:8088. 675275(no 9) / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo

A review of community nursing in Doncaster West PCT The agenda, the current position, resource allocation and involving the public : a compilation of research-based reports to inform the modernisation of community nursing services

Includes bibliographical referencesAvailable from British Library Document Supply Centre- DSC:8088. 675275(no 3) / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo

A review of community nursing in North Kirklees The agenda, the current position, resource allocation and involving the public : a compilation of research-based reports to inform the modernisation of community nursing services

SIGLEAvailable from British Library Document Supply Centre- DSC:8088. 675275(no 2) / BLDSC - British Library Document Supply CentreGBUnited Kingdo

SHELL Sheffield Health and Ethnicity in Later Life : a pilot project investigating primary care among older people from Sheffield's Pakistani and African-Caribbean communities

Includes bibliographical referencesAvailable from British Library Document Supply Centre- DSC:m03/14676 / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo

Drug prevention or reduction Early findings

Includes bibliographical referencesAvailable from British Library Document Supply Centre- DSC:7762. 74087(9) / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo