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BACKGROUND: There is limited guidance on which biologic therapies should be prioritised for the treatment of moderate-to-severe psoriasis, amongst the many available options. New mode-of-action biologics, as well as recently available biosimilars for existing biologics, continue to be developed making the choice of treatment sequence increasingly complex.
OBJECTIVES: The aim of this analysis was to develop a cost-effectiveness model to determine the optimal placement of biologic therapies on the treatment pathway for psoriasis in the UK.
METHODS: A cohort-based Markov model was developed in Microsoft Excel, from the perspective of the National Health Service and Personal and Social Services in the UK. The model followed a hypothetical cohort of patients over a lifetime. The health states in the model were defined by Psoriasis Area and Severity Index response. In the model, patients could receive a total of four separate treatments, including three active interventions and best supportive care.
RESULTS: A fully incremental analysis was undertaken on a subset of commonly used treatment sequences. The results of the list price analyses determined the most cost-effective sequence to be adalimumab biosimilar followed by ustekinumab, secukinumab, then best supportive care. This sequence is associated with total costs of £78,731 and total quality-adjusted life-years of 14.74 over a patient's lifetime.
CONCLUSIONS: This research suggests that the optimal first-line treatment in the UK is adalimumab biosimilar. The optimal second-line and third-line treatments depend on the magnitude of confidential discounts applied to the biologic treatments.
This systematic review and network meta-analysis aimed to estimate the relative efficacy of dry cow antimicrobial therapies, registered in Canada and/or the United States, to cure existing intramammary infections (IMI) in dairy cattle. The controlled trials examining all-cause cures of existing IMI present at dry-off were eligible. Five databases and four conference proceeding platforms were searched. The risk of bias at the level of the outcome was assessed using the Cochrane 2.0 risk of bias instrument (Cochrane, Denmark), and the overall confidence in the findings from the network meta-analysis was assessed using the Confidence in Network Meta-Analysis (CINeMA) platform. Of 3,743 articles screened for eligibility by the two independent reviewers, 58 trials were included in the Bayesian network meta-analysis for the all-cause cure of existing IMI from dry-off to calving. No antimicrobial treatment (non-active control) was associated with a decreased risk of a cure compared with all other currently labeled antimicrobials in Canada and the United States; however, lack of replication trials for some antimicrobial products created large credibility intervals and, therefore, we were unable to identify meaningful comparisons between the products. Poor reporting of trial features, heterogeneity in outcome measurements, and high risk of bias in some domains further contributed to this inability to compare antimicrobials. Continued improvement in the reporting of animal trials is required to make recommendations for antimicrobial products on the basis of efficacy.
The growing recognition of the importance of the natural environment, and in particular of green and blue spaces, for mental and physical health has led to numerous scientific studies that provide evidence on a wide range of health outcomes. Among the health effects of green and blue spaces, mental health is one of the most investigated outcomes. WHO recognizes the substantial importance of the benefits related to green and blue spaces, and the critical need to support these spaces to protect and promote health and well-being. This report presents the main results of two systematic reviews on types and characteristics of green and blue spaces and mental health, conducted by the Expert Working Group (EWG) on Biodiversity and Mental Health of the EKLIPSE project. By focusing on mental health, and how various kinds of mental disorders are impacted by green and blue spaces, the analysis synthesizes evidence in an understanding of the interactions between environment and health. Information from earlier WHO reports and activities has also been provided so that the results of the EKLIPSE systematic reviews presented here can be put into the context of the general public health framework of which they are part.
The COVID-19 pandemic has highlighted the importance of contact with green and blue spaces in fostering the ability of communities to cope with the stress of the threat of the virus and the physical restrictions imposed in response to it, and also the role of such spaces as alternative places for physical activity and social interaction.
The results and conclusions of the EKLIPSE reviews are of relevance to the health sector, where policies and programmes generally target specific health issues. Besides direct or immediate health and well-being benefits, interventions on green and blue spaces can generate other benefits, related to ecosystem services such as climate adaptation and reduction of air pollution, and can improve opportunities for social interaction. A deeper understanding of the beneficial and restorative impacts of various types and characteristics of green and blue spaces can help guide policy-makers in designing cities that not only support mental health, but also reduce costs to the health-care system. The findings are also relevant to non-health sectors, whose activities influence the planning, design and maintenance of green and blue spaces and, thereby, indirectly affect health and well-being.
In the absence of head-to-head trials of first-line treatments for metastatic non-small cell lung cancer (NSCLC), synthesis of available evidence is needed. We conducted a systematic literature review and network meta-analysis of randomized controlled trials in patients with stage IV NSCLC and high programmed death-ligand 1 (PD-L1) expression. Patients with other-stage NSCLC or without PD-L1 expression and populations with < 80% stage IV NSCLC were excluded. Outcomes included overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and treatment-related adverse events. English records from MEDLINE and Embase published through October 2020 were eligible, supplemented by hand searches of other sources. Three evidence networks were constructed based on histology (mixed, squamous, non-squamous). OS and PFS results were analyzed applying Bayesian fractional polynomial random-effects models. Hazard ratios over time with 95% credible intervals (CrIs) and expected differences in OS and PFS between each cancer immunotherapy regimen and the chemotherapy common comparator were generated. Seventeen clinical trials were included after screening 32,527 records. Heterogeneity and risk of bias were generally low across trials. In the mixed-histology network of PD-L1-high patients, expected OS was significantly longer with atezolizumab (estimated difference: 10.4 months [95% CrI: 1.9, 18.2]), pembrolizumab (7.2 [2.2, 12.3]), and cemiplimab (13.0 [4.2, 21.0]) versus chemotherapy but not with nivolumab (3.5 [-2.5, 10.6]) or nivolumab plus ipilimumab (6.7 [-0.5, 14.2]) versus chemotherapy. OS improvements were not significant compared with chemotherapy for any regimen in the squamous and non-squamous networks, except pembrolizumab plus chemotherapy in the non-squamous network. All regimens showed significantly longer expected PFS versus chemotherapy in the non-squamous network, whereas the increases were not significant in the mixed or squamous networks. ORR was significantly higher with pembrolizumab and cemiplimab versus chemotherapy in the mixed-histology network, with sintilimab in the non-squamous network, and with combination regimens, including pembrolizumab or atezolizumab, in the squamous and non-squamous networks, except with atezolizumab plus carboplatin, paclitaxel, and bevacizumab. Survival and safety versus chemotherapy were generally similar across cancer immunotherapies and histology networks. These findings may support treatment decisions for patients with high PD-L1 status receiving first-line treatment for NSCLC.
OBJECTIVES: To model the cost-effectiveness of the TYRX Absorbable Antibacterial Envelope when used in patients at increased risk of cardiac implantable electronic device (CIED) infection in the context of 3 European healthcare systems: Germany, Italy, and England.
METHODS: A decision tree model with a lifetime horizon was populated using data from the Worldwide Randomized Antibiotic Envelope Infection Prevention Trial, a large multicenter randomized controlled trial. Use of the antibacterial envelope adjunctive to standard of care was compared to standard of care infection prevention alone. Patients in the model were divided into subgroups based on presence of factors known to increase infection risk.
RESULTS: The antibacterial envelope had the most favorable cost-effectiveness profile when patients had previously experienced CIED infection, had a history of immunosuppressive therapy, or had a Prevention of Arrhythmia Device Infection Trial (PADIT) score indicating high risk of infection (scores =6) at cost-effectiveness thresholds of €50 000 in Germany (assumed in the absence of an official threshold), €40 000 in Italy, and £30 000 in England. Probabilistic sensitivity analysis indicated that the antibacterial envelope was likely to be cost-effective in patients with other risk factors (including replacement of high power CIEDs, generator replacement with lead modification, and PADIT scores indicating intermediate risk of infection) when used with some device types and in some countries.
CONCLUSIONS: The absorbable antibacterial envelope was associated with cost-effectiveness ratios below European benchmarks in selected patients at increased risk of infection, suggesting the envelope provides value for European healthcare systems by reducing CIED infections.
BACKGROUND: Ventilator-associated pneumonia (VAP) is an important diagnosis in critical care. VAP research is complicated by the lack of agreed diagnostic criteria and reference standard test criteria. Our aim was to review which reference standard tests are used to evaluate novel index tests for suspected VAP.
METHODS: We conducted a comprehensive search using electronic databases and hand reference checks. The Cochrane Library, MEDLINE, CINHAL, EMBASE, and web of science were searched from 2008 until November 2018. All terms related to VAP diagnostics in the intensive treatment unit were used to conduct the search. We adopted a checklist from the critical appraisal skills programme checklist for diagnostic studies to assess the quality of the included studies.
RESULTS: We identified 2441 records, of which 178 were selected for full-text review. Following methodological examination and quality assessment, 44 studies were included in narrative data synthesis. Thirty-two (72.7%) studies utilised a sole microbiological reference standard; the remaining 12 studies utilised a composite reference standard, nine of which included a mandatory microbiological criterion. Histopathological criteria were optional in four studies but mandatory in none.
CONCLUSIONS: Nearly all reference standards for VAP used in diagnostic test research required some microbiological confirmation of infection, with BAL culture being the most common reference standard used.
No abstract available.
