Systematic review of economic evaluations of primary caries prevention in 2- to 5-year-old preschool children

Objectives: To describe and summarize evidence on economic evaluations (EEs) of primary caries prevention in preschool children aged 2 to 5 years and to evaluate the reporting quality of full EE studies using a quality assessment tool. Methods: A systematic literature search was conducted in several databases. Full and partial EEs were included. The reporting quality of full EE studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Results: A total of 808 studies were identified, and 39 were included in the review. Most papers were published between 2000 and 2017 and originated in the United States and the United Kingdom. The most common type of intervention investigated was a complex multicomponent intervention, followed by water fluoridation. Cost analysis and cost-effectiveness analysis were the most frequently used types of EE. One study employed cost-utility analysis. The proportion of full EEs increased over time. The parameters not reported well included study perspective, baseline year, sensitivity analysis, and discount rate. The CHEERS items that were most often unmet were characterizing uncertainty, study perspective, study parameters, and estimating resources and costs. Conclusions: Within the past 2 decades, there has been an increase in the number of EEs of caries prevention interventions in preschool children. There was inconsistency in how EEs were conducted and reported. Lack of preference-based health-related quality-of-life measure utilization in the field was identified. The use of appropriate study methodologies and greater attention to recommended EE design are required to further improve quality

Role of home visiting in improving parenting and health in families at risk of abuse and neglect : results of a multicentre randomised controlled trial and economic evaluation

Objectives – To evaluate the effectiveness and cost-effectiveness of an intensive home visiting programme in improving outcomes for vulnerable families. Design – Multicentre randomised controlled trial in which eligible women were allocated to receive home visiting (n=67) or standard services (n=64). Incremental cost analysis. Setting – 40 GP practices across two counties in the UK Participants – 131 vulnerable pregnant women. Intervention: Selected health visitors were trained in the Family Partnership Model to provide a weekly home visiting service from 6-months antenatally to 12 months postnatally. Main outcome measures – mother-child interaction, maternal psychological health attitudes and behaviour, infant functioning and development, and risk of neglect or abuse. Results – At 12-months differences favouring the home visited group were observed on an independent assessment of maternal sensitivity (p<0.04) and infant cooperativeness (p<0.02). No differences were identified on any other measures. There was a non-significant increase in the likelihood of intervention group infants being the subject of child protection proceedings, or being removed from the home, and one death in the control group. The mean incremental cost per infant of the home visiting intervention was £3,246 (bootstrapped 95% confidence interval for the difference: £1,645 - £4,803). Conclusion – This intervention may have the potential to improve parenting and increase the identification of infants at risk of abuse and neglect in vulnerable families. Further investigation is needed together with long term follow up to assess possible sleeper effects

Protocol for the economic evaluation of a complex intervention to improve the mental health of maltreated infants and children in foster care in the UK (The BeST? services trial)

Introduction: Children who have experienced abuse and neglect are at increased risk of mental and physical health problems throughout life. This places an enormous burden on individuals, families and society in terms of health services, education, social care and judiciary sectors. Evidence suggests that early intervention can mitigate the negative consequences of child maltreatment, exerting long-term positive effects on the health of maltreated children entering foster care. However, evidence on cost-effectiveness of such complex interventions is limited. This protocol describes the first economic evaluation of its kind in the UK. Methods and analysis: An economic evaluation alongside the Best Services Trial (BeST?) has been prospectively designed to identify, measure and value key resource and outcome impacts arising from the New Orleans intervention model (NIM) (an infant mental health service) compared with case management (CM) (enhanced social work services as usual). A within-trial economic evaluation and long-term model from a National Health Service/Personal Social Service and a broader societal perspective will be undertaken alongside the National Institute for Health Research (NIHR)–Public Health Research Unit (PHRU)-funded randomised multicentre BeST?. BeST? aims to evaluate NIM compared with CM for maltreated children entering foster care in a UK context. Collection of Paediatric Quality of Life Inventory (PedsQL) and the recent mapping of PedsQL to EuroQol-5-Dimensions (EQ-5D) will facilitate the estimation of quality-adjusted life years specific to the infant population for a cost–utility analysis. Other effectiveness outcomes will be incorporated into a cost-effectiveness analysis (CEA) and cost-consequences analysis (CCA). A long-term economic model and multiple economic evaluation frameworks will provide decision-makers with a comprehensive, multiperspective guide regarding cost-effectiveness of NIM. The long-term population health economic model will be developed to synthesise trial data with routine linked data and key government sector parameters informed by literature. Methods guidance for population health economic evaluation will be adopted (lifetime horizon, 1.5% discount rate for costs and benefits, CCA framework, multisector perspective). Ethics and dissemination: Ethics approval was obtained by the West of Scotland Ethics Committee. Results of the main trial and economic evaluation will be submitted for publication in a peer-reviewed journal as well as published in the peer-reviewed NIHR journals library (Public Health Research Programme). Trial registration number: NCT02653716; Pre-results

Exploring the feasibility of implementing a supervised exercise training and compression hosiery intervention in patients with venous ulceration: a case study

Study background and context (please read poster for more information) Over 180,000 people in the UK suffer from venous leg ulcers; it is a major health problem (Whiteley, 2013). A leg ulcer is defined as a break in the skin of the leg which has not healed after 4-6 weeks (Morris & Sander, 2007). Treatment of venous ulcers costs the NHS between £400,000 - £600,000 annually (Whiteley, 2013). Exercise training offers a financially viable adjunct to compression hosiery in the prevention and treatment of venous ulcers, via favourable effects on lower-limb blood flow and vascular function (Davies et al, 2008). Despite the potential benefits, the combined effect of exercise and compression has not yet been examined and the Royal College of Nursing is requesting for more studies to be undertaken in this area

What is the extent and distribution of evidence on effectiveness of systematic conservation planning around the globe? A systematic map protocol

Background: Systematic conservation planning involves the prioritisation of conservation actions to optimise biodiversity conservation outcomes whilst considering implementation challenges such as minimising costs. Thousands of systematic conservation plans have been developed around the globe (a popular software package, 'Marxan', has over 4200 active users from more than 180 countries). However, the effects of systematic approaches on conservation actions and outcomes are not generally known, nor are the factors which distinguish effective from ineffective plans. Previous reviews of conservation planning outcomes have been limited in scope and to narrow time intervals, and have revealed very few formal evaluations of plans. Given systematic approaches are widely perceived to offer the best chance to rapidly and efficiently achieve biodiversity protection targets, a thorough, up-to-date synthesis of the evidence is required. Methods: This protocol outlines the methodology for a systematic mapping exercise to identify retrospective studies measuring the effects of systematic conservation planning on biodiversity conservation at regional, national and subnational scales. Our primary research question is: what is the extent and distribution of evidence on the conservation outcomes of systematic conservation planning? Outcomes will be categorised according to types of capital: natural, financial, social, human and institutional, given the range of potential direct and indirect effects of systematic conservation planning on conservation outcomes. A comprehensive and repeatable search strategy will be undertaken, utilising a wide range of sources including grey literature sources and targeted searches of organisational websites and databases. Sources will be restricted to English language publications between 1983 and 2016. The resultant studies will be screened using standardised inclusion and exclusion criteria and data from included studies will be categorised according to a standardised data extraction form. Information about the study design of relevant articles will be recorded to determine study robustness. A searchable database of studies will be made publicly accessible and available for updating in future. The results will be published in this journal and also presented as an interactive online resource to aid conservation planners in identifying impacts and outcomes of conservation plans

Impact of legislation to reduce the drink-drive limit on road traffic accidents and alcohol consumption in Scotland: a natural experiment study

Background : It is widely recognised that drink driving is a leading cause of road traffic accidents (RTAs). There is evidence that changing the drink-drive limit from a blood alcohol concentration of 0.08 to 0.05 g/dl is effective in reducing RTAs. Scotland changed the blood alcohol concentration limit to 0.05 g/dl on 5 December 2014. Aims : To assess whether or not the numbers and rates of RTAs and per capita alcohol consumption in Scotland were reduced because of the 2014 drink-drive legislation. To assess whether or not the 2014 change in legislation provided good value for money. Design : A natural experimental, quantitative study. The control group was England and Wales, that is, the other countries in Great Britain, where the drink-drive legislation remained unchanged. Setting : Great Britain. Participants : The entire population of Scotland, England and Wales for the period of January 2013– December 2016. Intervention : The change to drink-drive legislation in Scotland. Outcome measures : The counts and rates of RTAs; and per capita alcohol consumption. Methods : For the numbers and rates of RTAs (both traffic flow and population denominators were used), and separately for the intervention and control trial groups, negative binomial regression models were fitted to panel data sets to test for a change in outcome level after the new 2014 legislation was in place. To obtain a ‘difference-in-differences’ (DiD)-type measure of effect, an interaction term between the intervention group indicator and the binary covariate for indicating pre and post change in legislation (‘pseudo’-change for the control group) was assessed. For off- and on-trade per capita alcohol sales, and separately for the intervention and control trial group, seasonal autoregressive integrated moving average error models were fitted to the relevant time series. Results : The change to drink-drive legislation was associated with a 2% relative decrease in RTAs in Scotland [relative risk (RR) 0.98, 95% CI 0.91 to 1.04; p = 0.53]. However, the pseudo-change in legislation was associated with a 5% decrease in RTAs in England and Wales (RR 0.95, 95% CI 0.90 to 1.00; p = 0.05). For RTA rates, with traffic flow as the denominator, the DiD-type estimate indicated a 7% increase in ratesfor Scotland relative to England and Wales (unadjusted RR 1.07, 95% CI 0.98 to 1.17; p = 0.1). The change to drink-drive legislation was associated with a 0.3% relative decrease in per capita off-trade sales (–0.3%, 95% CI –1.7% to 1.1%; p = 0.71) and a 0.7% decrease in per capita on-trade sales (–0.7%, 95% CI –0.8% to –0.5%; p < 0.001).  Conclusion : The change to drink-drive legislation in Scotland in December 2014 did not have the expected effect of reducing RTAs in the country, and nor did it change alcohol drinking levels in Scotland. This main finding for RTAs was unexpected and the research has shown that a lack of enforcement is the most likely reason for legislation failure.  Future work : Investigations into how the public interpret and act on changes in drink-drive legislation would be welcome, as would research into whether or not previous change in drink-drive legislation effects on RTAs in other jurisdictions are associated with the level of enforcement that took place

Using Nominal Group Technique to Identify Key Attributes of Oncology Treatments for a Discrete Choice Experiment.

Background. Responding to rising oncology therapy costs, multiple value frameworks are emerging. However, input from economists in their design and conceptualization has been limited, and no existing framework has been developed using preference weightings as legitimate indicators of value. This article outlines use of the nominal group technique to identify valued treatment attributes (such as treatment inconvenience) and contextual considerations (such as current life expectancy) to inform the design of a discrete choice experiment to develop a preference weighted value framework for future decision makers. Methods. Three focus groups were conducted in 2017 with cancer patients, oncology physicians, and nurses. Using the nominal group technique, participants identified and prioritized cancer therapy treatment and delivery attributes as well as contextual issues considered when choosing treatment options. Results. Focus groups with patients (n = 8), physicians (n = 6), and nurses (n = 10) identified 30 treatment attributes and contextual considerations. Therapy health gains was the first priority across all groups. Treatment burden/inconvenience to patients and their families and quality of evidence were prioritized treatment attributes alongside preferences for resource use and cost (to patients and society) attributes. The groups also demonstrated that contextual considerations when choosing treatment varied across the stakeholders. Patients prioritized existence of alternative treatments and oncologist/center reputation while nurses focused on administration harms, communication, and treatment innovation. The physicians did not prioritize any contextual issues in their top rankings. Conclusions. The study demonstrates that beyond health gains, there are treatment attributes and contextual considerations that are highly prioritized across stakeholder groups. These represent important candidates for inclusion in a discrete choice experiment seeking to provide weighted preferences for a value framework for oncology treatment that goes beyond health outcomes

Valuing mobile health: an open-ended contingent valuation survey of a national digital health program

Background: Changing population demographics and technology developments have resulted in growing interest in the potential of consumer-facing digital health. In the United Kingdom, a £37 million (US $49 million) national digital health program delivering assisted living lifestyles at scale (dallas) aimed to deploy such technologies at scale. However, little is known about how consumers value such digital health opportunities. Objective: This study explored consumers’ perspectives on the potential value of digital health technologies, particularly mobile health (mHealth), to promote well-being by examining their willingness-to-pay (WTP) for such health solutions. Methods: A contingent valuation study involving a UK-wide survey that asked participants to report open-ended absolute and marginal WTP or willingness-to-accept for the gain or loss of a hypothetical mHealth app, Healthy Connections. Results: A UK-representative cohort (n=1697) and a dallas-like (representative of dallas intervention communities) cohort (n=305) were surveyed. Positive absolute and marginal WTP valuations of the app were identified across both cohorts (absolute WTP: UK-representative cohort £196 or US$258 and dallas-like cohort £162 or US $214; marginal WTP: UK-representative cohort £160 or US$211 and dallas-like cohort £151 or US $199). Among both cohorts, there was a high prevalence of zeros for both the absolute WTP (UK-representative cohort: 467/1697, 27.52$39,642 (0.21, 95% CI 0.14 to 0.4) and increased spending on existing phone and internet services (0.52, 95% CI 0.30 to 0.74). The amount spent on existing health apps was shown to be a positive indicator of WTP across cohorts, although the effect was marginal (UK-representative cohort 0.01, 95% CI 0.01 to 0.01; dallas-like cohort 0.01, 95% CI 0.01 to 0.02). Conclusions: This study demonstrates that consumers value mHealth solutions that promote well-being, social connectivity, and health care control, but it is not universally embraced. For mHealth to achieve its potential, apps need to be tailored to user accessibility and health needs, and more understanding of what hinders frequent users of digital technologies and those with long-term conditions is required. This novel application of WTP in a digital health context demonstrates an economic argument for investing in upskilling the population to promote access and expedite uptake and utilization of such digital health and well-being apps

Activating Equitable Engagement: from research to policy (and back again): a report on dissemination activities for 'NIHR Global Health Research Group on estimating the prevalence, quality of life, economic and societal impact of arthritis in Tanzania'

This report details the dissemination outputs, stakeholder engagement events (herein referred to as ‘Engagement Activities’) and their underlying principles conducted by the NIHR Funded Project: NIHR Global Health Research Group on estimating the prevalence, quality of life, economic and societal impact of arthritis in Tanzania. Engagement activities were designed acknowledging that inequalities and injustices are writ large in the field of Global Health. Just as social, economic, political, racial and gendered inequalities impact individuals’ health experiences, we also recognise that these same inequalities can be reproduced and reinforced by institutions, organisations and (most pertinent to us) research groups purporting to tackle health issues (Büyüm et al. 2020). Engagement activities were therefore designed from a commitment to make Global Health more equitable, with the following interrelated principles underpinning all engagement efforts: i) the ethics of dissemination ii) valuing knowledges iii) decentering western voices iv) nurturing equitable relationships. As such, we paid close attention not only to what we did but how we did it, striving towards a goal of activating equitable engagement