An evaluation of the use of electronic monitoring as a condition of bail in Scotland

The aims of the evaluation were to assess the implementation of EM bail in replacing custodial remands, and to conduct a cost analysis of EM bail in contrast to those given custody. The study included the collection of qualitative and quantitative data, matched comparison data and cost analysis. Interviews were conducted with 10 Steering Group members and 45 professionals (comprising the police, social work, procurators fiscal, clerks of court, judges, sheriffs, defence agents, advocates, the electronic monitoring companies and victims' agencies). Interviews with 16 bailees and 15 household members were also undertaken. Quantitative data were collected from various sources, namely: court pro formas, Reliance/Serco databases, court files, social work files, police records, Scottish Criminal Record Office and data provided by the Scottish Executive Justice Statistics Branch, the Scottish Court Service and the Scottish Prison Service. Data from 3 comparison sheriff courts also provided a range of information on accused remanded in custody or bailed with or without conditions in areas outwith the pilot sites to ascertain whether EM bail is being used as a direct alternative to custodial remand and to explore differences in final sentences for the 2 groups

Health-related quality-of-life results from the phase 3 OPTIMISMM study: pomalidomide, bortezomib, and low-dose dexamethasone versus bortezomib and low-dose dexamethasone in relapsed or refractory multiple myeloma

This is an accepted manuscript of an article published by Taylor & Francis in Leukemia & Lymphoma on 09/04/2020, available online: https://www.tandfonline.com/doi/full/10.1080/10428194.2020.1747066 The accepted version of the publication may differ from the final published version.In the randomized phase-3 OPTIMISMM study, the addition of pomalidomide to bortezomib and low-dose dexamethasone (PVd) resulted in significant improvement in progression-free survival (PFS) in lenalidomide-pretreated patients with relapsed or refractory multiple myeloma (RRMM), including lenalidomide refractory patients. Here, we report health-related quality of life (HRQoL) results from this trial. Patients received PVd or Vd in 21-day cycles until disease progression or discontinuation. HRQoL was assessed using the EORTC QLQ-C30, QLQ-MY20, and EQ-5D-3L instruments on day 1 of each treatment cycle. Mean score changes for global QoL, physical functioning, fatigue, side effects of treatment domains, and EQ-5D-3L index were generally stable over time across treatment arms. The proportion of patients who experienced clinically meaningful worsening in global QoL and other domains of interest was similar. These HRQoL results with PVd along with previously demonstrated improvement in PFS vs Vd continue to support its use in patients with RRMM.This work was supported by Celgene Corporation.Published versio

Economic impact of services for first-episode psychosis: a decision model approach

Aim: To assess the impact of early intervention (EI) services on service costs for people with first-episode psychosis. Methods: A decision model was constructed to map the care pathways following input from EI services and from standard care. A Markov process was used to run the model over 18 2-month cycles. Probabilities and costs for the model of admissions, readmissions and use of community services were obtained from the literature, routine sources and expert opinion. One-way and probabilistic sensitivity analyses were conducted to address uncertainty around the parameter estimates. Results: The model estimated 1 year costs to be £9422 for EI and £14 394 for standard care. The respective figures over 3 years were £26 568 and £40 816. One-way sensitivity analyses revealed that the results were robust to changes in most parameters with the exception of the readmission rate. A relatively small decrease in the readmission rate for standard care patients would eliminate the cost saving. The probabilistic sensitivity analyses also showed that the results were robust to parameter changes. Conclusions: This study suggests cost savings associated with EI. However, caution is required as the model is relatively simple and relies on a number of assumptions

Lenalidomide as maintenance treatment for patients with multiple myeloma after autologous stem cell transplantation: A pharmaco-economic assessment

Objective: Autologous stem cell transplantation (ASCT) has improved progression-free survival (PFS) and overall survival in eligible patients with newly diagnosed multiple myeloma (NDMM); however, relapse occurs. Maintenance therapy with lenalidomide (Len-Mt) extends survival and delays relapse and the subsequent initiation of costly second-line regimens. Here, we report the cost-effectiveness of Len-Mt following ASCT from a Dutch healthcare service perspective. Methods: A partitioned survival model was developed to assess the lifetime costs and benefits for patients with NDMM. Efficacy was taken from a pooled meta-analysis of clinical trial data. Costs and subsequent therapy data were taken from sources appropriate for the Dutch market. Results: Lenalidomide produced a quality-adjusted life year gain of 2.46 and a life year gain of 2.79 vs no maintenance treatment. The cost of lenalidomide was partially offset by savings of EUR 77 462 in subsequent treatment costs. The incremental cost-effectiveness ratio of Len-Mt vs no maintenance treatment was EUR 30 143. Key model drivers included subsequent therapies, dosing schedule, and time horizon. Conclusion: Lenalidomide is cost-effective after ASCT vs no maintenance therapy in the Netherlands. By extending PFS, lenalidomide delays the cost burdens associated with relapse and subsequent treatment lines