Injury Epidemiology in Female Netball Players during the 2016/2017 Season in the United Kingdom.

Netball is ranked second behind football for female sports participation in the United Kingdom. The epidemiology of netball injuries has been reported at elite level but not amateur (Best and Gledhill 2017, IOC Conference on the Prevention of Injury and Illness in Sport, 16 March 2017 - 18 March 2017, Monaco). The aim of this study was to report the prevalence and incidence of injury in amateur female netball players during the 2016/2017 UK season. Following ethical approval from the Leeds Beckett University research ethics committee, 134 Female netball players (mean (range): age 23y (16-54), height 170cm (140-190cm), weight 66kg (50 – 100kg) provided electronic informed consent. Players completed a retrospective injury history questionnaire adapted from a football consensus statement on injury reporting (Fuller et al., 2006, Scandinavian journal of medicine & science in sports, 16(2), 83-92). Severity of injury was categorised using a time loss definition: slight (1-3 days), minor (4-7 days), moderate (1-4 weeks) and major (4 weeks plus). The one season prevalence of injury in this sample was 54%. The overall (match and training) incidence of injury was 5.72/1000h. More injuries occurred during match play (9.14/1000h) than in training (3.00/1000h). Injuries to the ankle (36%), knee (22%) and the wrist/hand/fingers (24%) were the most common. Ligaments were the most commonly injured tissues (53% of all injuries). The most commonly reported mechanism was landing from a jump (33% of all injuries). The majority of injuries were first-time injuries (81%). Moderate injuries were most common (47%), followed by major (35%) and minor injuries (18%). This is the first data set to retrospectively analyse netball injures at amateur level. We report a lower injury incidence than that found at the elite level (5.72 vs. 9.08/1000h). At elite and amateur level, a similar relative percentage of injuries occur during match and training. The nature and mechanism of injury also remain common to both playing standards. Insufficient neuromuscular control when landing from a jump appears to stress ligaments beyond their physiological load tolerance in female netball players. Prospective studies are required to confirm these findings

Valuing Health Gain from Composite Response Endpoints for Multisystem Diseases

Objectives: This study aimed to demonstrate how to estimate the value of health gain after patients with a multisystem disease achieve a condition-specific composite response endpoint. Methods: Data from patients treated in routine practice with an exemplar multisystem disease (systemic lupus erythematosus) were extracted from a national register (British Isles Lupus Assessment Group Biologics Register). Two bespoke composite response endpoints (Major Clinical Response and Improvement) were developed in advance of this study. Difference-in-differences regression compared health utility values (3-level version of EQ-5D; UK tariff) over 6 months for responders and nonresponders. Bootstrapped regression estimated the incremental quality-adjusted life-years (QALYs), probability of QALY gain after achieving the response criteria, and population monetary benefit of response. Results: Within the sample (n = 171), 18.2% achieved Major Clinical Response and 49.1% achieved Improvement at 6 months. Incremental health utility values were 0.0923 for Major Clinical Response and 0.0454 for Improvement. Expected incremental QALY gain at 6 months was 0.020 for Major Clinical Response and 0.012 for Improvement. Probability of QALY gain after achieving the response criteria was 77.6% for Major Clinical Response and 72.7% for Improvement. Population monetary benefit of response was £1 106 458 for Major Clinical Response and £649 134 for Improvement. Conclusions: Bespoke composite response endpoints are becoming more common to measure treatment response for multisystem diseases in trials and observational studies. Health technology assessment agencies face a growing challenge to establish whether these endpoints correspond with improved health gain. Health utility values can generate this evidence to enhance the usefulness of composite response endpoints for health technology assessment, decision making, and economic evaluation