Peer-reviewed publication

Comparative Efficacy of Blanket Versus Selective Dry-Cow Therapy: a Systematic Review and Pairwise Meta-Analysis

YHEC authors: Julie Glanville
Publication date: February 2020
Journal: Animal Health Research Reviews

Abstract

A systematic review and meta-analysis were conducted to determine the efficacy of selective dry-cow antimicrobial therapy compared to blanket therapy (all quarters/all cows). Controlled trials were eligible if any of the following were assessed: incidence of clinical mastitis during the first 30 DIM, frequency of intramammary infection (IMI) at calving, or frequency of IMI during the first 30 DIM. From 3480 identified records, nine trials were data extracted for IMI at calving. There was an insufficient number of trials to conduct meta-analysis for the other outcomes. Risk of IMI at calving in selectively treated cows was higher than blanket therapy (RR = 1.34, 95% CI = 1.13, 1.16), but substantial heterogeneity was present (I2 = 58%). Subgroup analysis showed that, for trials using internal teat sealants, there was no difference in IMI risk at calving between groups, and no heterogeneity was present. For trials not using internal teat sealants, there was an increased risk in cows assigned to a selective dry-cow therapy protocol, compared to blanket treatment, with substantial heterogeneity in this subgroup. However, the small number of trials and heterogeneity in the subgroup without internal teat sealants suggests that the relative risk between treatments may differ from the determined point estimates based on other unmeasured factors.

Peer-reviewed publication

Comparative Efficacy of Teat Sealants Given Prepartum for Prevention of Intramammary Infections and Clinical Mastitis: a Systematic Review and Network Meta-Analysis

YHEC authors: Julie Glanville
Publication date: February 2020
Journal: Animal Health Research Reviews

Abstract

A systematic review and network meta-analysis were conducted to assess the relative efficacy of internal or external teat sealants given at dry-off in dairy cattle. Controlled trials were eligible if they assessed the use of internal or external teat sealants, with or without concurrent antimicrobial therapy, compared to no treatment or an alternative treatment, and measured one or more of the following outcomes: incidence of intramammary infection (IMI) at calving, IMI during the first 30 days in milk (DIM), or clinical mastitis during the first 30 DIM. Risk of bias was based on the Cochrane Risk of Bias 2.0 tool with modified signaling questions. From 2280 initially identified records, 32 trials had data extracted for one or more outcomes. Network meta-analysis was conducted for IMI at calving. Use of an internal teat sealant (bismuth subnitrate) significantly reduced the risk of new IMI at calving compared to non-treated controls (RR = 0.36, 95% CI 0.25-0.72). For comparisons between antimicrobial and teat sealant groups, concerns regarding precision were seen. Synthesis of the primary research identified important challenges related to the comparability of outcomes, replication and connection of interventions, and quality of reporting of study conduct.

Peer-reviewed publication

Cost-Effectiveness of a Cardiac Contractlity Modulation Device in Heart Failure with Normal QRS Duration

YHEC authors: Michelle Green, Joe Moss, Stuart Mealing
Publication date: January 2020
Journal: ESC heart failure

Abstract

AIMS: The objective of this paper is to assess whether cardiac contractility modulation (via the Optimizer System) plus standard of care (SoC) is a cost-effective treatment for people with heart failure [New York Heart Association (NYHA) III, left ventricular ejection fraction of 25-45%, and narrow QRS] compared against SoC alone from the perspective of the English National Health Service.

METHODS AND RESULTS: We developed a regression equation-based cost-effectiveness model, using individual patient data from three randomized control trials (FIX-HF-5 Phases 1 and 2, and FIX-HF-5C) to populate the majority of parameters. A series of regression equations predicted NYHA class over time, mortality, all-cause hospitalization rates, and health-related quality of life. We conducted the analysis in line with the National Institute for Health and Care Excellence reference case, modelling costs from an English National Health Service perspective, and considering outcomes in quality-adjusted life years (QALYs) over a patient lifetime perspective. Our base case analysis produced an incremental cost per additional QALY of GBP22 988 (€25 750) when comparing Optimizer + SoC to SoC alone. This result was not sensitive to parameter uncertainty but was sensitive to the time horizon over which costs and QALYs were captured and the duration over which a survival benefit with Optimizer + SoC can be assumed to apply.

CONCLUSIONS: Cardiac contractility modulation is likely to be cost-effective in people with heart failure with reduced ejection fraction, NYHA III, and narrow QRS, provided that the treatment benefit can be maintained beyond the duration of the existing clinical trial follow-up. This analysis supports the current recommendations of the European Society of Cardiology that this therapy may be considered for such patients.

Peer-reviewed publication

A Systematic Review and Network Meta-Analysis of Bacterial and Viral Vaccines, Administered at or Near Arrival at the Feedlot, for Control of Bbovine Respiratory Disease in Beef Cattle

YHEC authors: Julie Glanville
Publication date: December 2019
Journal: Animal Health Research Reviews

Abstract

Vaccination against putative causal organisms is a frequently used and preferred approach to controlling bovine respiratory disease complex (BRD) because it reduces the need for antibiotic use. Because approximately 90% of feedlots use and 90% of beef cattle receive vaccines in the USA, information about their comparative efficacy would be useful for selecting a vaccine. We conducted a systematic review and network meta-analysis of studies assessing the comparative efficacy of vaccines to control BRD when administered to beef cattle at or near their arrival at the feedlot. We searched MEDLINE, MEDLINE In-Process, MEDLINE Daily Epub Ahead of Print, AGRICOLA, Cambridge Agricultural and Biological Index, Science Citation Index, and Conference Proceedings Citation Index - Science and hand-searched the conference proceedings of the American Association of Bovine Practitioners and World Buiatrics Congress. We found 53 studies that reported BRD morbidity within 45 days of feedlot arrival. The largest connected network of studies, which involved 17 vaccine protocols from 14 studies, was included in the meta-analysis. Consistent with previous reviews, we found little compelling evidence that vaccines used at or near arrival at the feedlot reduce the incidence of BRD diagnosis.

Peer-reviewed publication

Getting the Best out of Faecal Immunochemical Tests and Faecal Calprotectin

YHEC authors: Hayden Holmes, James Turvill
Publication date: December 2019
Journal: Frontline Gastroenterology

Abstract

Faecal calprotectin (FC) and the faecal immunochemical test for haemoglobin (FIT) are recommended for use in primary care where colorectal cancer (CRC) is not suspected.We are unclear how best to use these two biomarkers in younger patients where lower gastrointestinal symptoms are extremely common. Distinguishing irritable bowel syndrome from inflammatory bowel disease (IBD) from CRC on clinical grounds is often an uncertain exercise. Currently, there is no direct comparative evidence base on which to identify the optimal use of each biomarker. We undertook an illustrative comparison of the diagnostic accuracy of FC in a patient dataset at 'low risk' of CRC stratified by age and symptoms, and of FIT, from three existing published studies that included both CRC and IBD in their outcomes. From an existing dataset of patients using the York Faecal Calprotectin Care Pathway (YFCCP), we identified 1919 patients fulfilling National Institute for Health and Care Excellence (NICE) DG30 criteria. Patients were stratified based on age, symptomatology and diagnosis, either (1) CRC or (2) a composite of CRC, significant adenomatous polyps (=10 mm or high-grade dysplasia or =5 subcentimetre polyps) and IBD (organic enteric disease). Fishers' exact test was used to compare the data for FC of =100 µg/g faeces against the previously published data using FIT=10 µg Hb/g faeces.

Peer-reviewed publication

Systematic Literature Review for Utility Data in Acute Myeloid Leukemia

YHEC authors: Julie Glanville, Chris Bartlerr
Publication date: December 2019
Journal: Value in Health

Abstract

OBJECTIVES: A systematic literature review (SLR) was conducted to identify utilities in acute myeloid leukaemia (AML).

METHODS: SLR methods conformed to National Institute for Health and Care Excellence technology appraisal requirements. Eligible studies were economic evaluations (cost-effectiveness, cost-utility and cost-benefit analyses), utility studies, SLRs and health technology assessments. Nine bibliographic databases and 4 conferences were searched (November 2018) and retrieved 2,278 unique records. Two reviewers independently selected records and one extracted data.

RESULTS: Twenty-six studies (28 documents) met inclusion criteria. Data were derived using: EQ-5D (14 studies, including 2 using EQ-5D-5L), TTO (4), VAS (4), DCE (2), HUI2 (1), QLQ-PBM (1), EORTC-8D (1), standard gamble (1), as well as proxy data (1) and data mapped to utility (1, from QLQ-C30). Studies were conducted in Canada, Japan, the Netherlands, UK, USA, and one study was across Europe. Mean utility data were identified for these health states: induction chemotherapy (-0.15 to 0.706), consolidation chemotherapy (-0.11 to 0.71), maintenance (0.81 to 0.95 [median]), complete remission (0.62 to 0.99) [in transplant: 0.61 to 0.71; prior to transplant: 0.826], no relapse (0.83 to 0.90 [median]), temporary remission (0.66), partial remission (0.6574 to 0.7160), relapse (0.1 to 0.79), refractory (-0.1 to 0.568) and transplant (-0.21 to 0.94) [short-term: 0.4; recovery: 0.75 to 0.826; graft versus host disease (GVHD): 0.37 to 0.691; without GVHD: 0.79 to 0.864; long term: 0.94 to 1 [median]]. Disutilities were reported for chemotherapy (0.42) and transplant (0.57).

CONCLUSIONS: The SLR reported wide variations in utility values across AML health states, with most studies referring to first line treatment with induction/consolidation rather than relapse/refractory. Variations could be due to underlying disease activity within health states, differences utility elicitation methods, and health state definitions. Choice of utility values for decision analytic models should consider these differences to improve validity.

Report

Workplace Health: Long-Term Sickness Absence and Capability to Work

YHEC authors: Elizabeth Bell, Matthew Taylor
Publication date: November 2019

Abstract

No abstract available.

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