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OBJECTIVE: We aim to synthesize the available guidance with existing practices by Cochrane reviewers to generate an algorithm as a starting point in assisting reviewers reporting of registry records and published protocols (TRRs/PPs) use in systematic reviews of interventions.
STUDY DESIGN: We used existing guidance from major review bodies, assessed the current reporting of TRRs/PPs use in a sample of Cochrane reviews, and engaged in critical analysis. Independent reviewers identified and extracted textual excerpts reporting the use of trial registry records and published protocols and codes following a systematic review framework. Based on these elements, and our initial research, we created an algorithm/graphical aid to visualize initial direction.
RESULTS: We included 166 Cochrane systematic reviews published between August 2015 and 2016 from 48 review groups. Review authors' terminology (e.g., ongoing, terminated) varied between and within reviews. Reporting practices were diverse and inconsistent.
CONCLUSIONS: This is a timely investigation in an era where evidence synthesis informs health and health care decisions. Our proposed algorithm provides initial direction to systematize the reporting of TRR/PP use. We hope that the algorithm generates further discussion to enhance the transparency of TRR/PP reporting and methodological research into the complexities of using protocols in systematic reviews of interventions.
OBJECTIVE: The Cochrane Handbook of Systematic Reviews contains search filters to find randomized controlled trials (RCTs) in Ovid MEDLINE: one maximizing sensitivity and another balancing sensitivity and precision. These filters were originally published in 1994 and were adapted and updated in 2008. To determine the performance of these filters, the authors tested them and thirty-six other MEDLINE filters against a large new gold standard set of relevant records.
METHODS: We identified a gold standard set of RCT reports published in 2016 from the Cochrane CENTRAL database of controlled clinical trials. We retrieved the records in Ovid MEDLINE and combined these with each RCT filter. We calculated their sensitivity, relative precision, and f-scores.
RESULTS: The gold standard comprised 27,617 records. MEDLINE searches were run on July 16, 2019. The most sensitive RCT filter was Duggan et al. (sensitivity=0.99). The Cochrane sensitivity-maximizing RCT filter had a sensitivity of 0.96 but was more precise than Duggan et al. (0.14 compared to 0.04 for Duggan). The most precise RCT filters had 0.97 relative precision and 0.83 sensitivity.
CONCLUSIONS: The Cochrane Ovid MEDLINE sensitivity-maximizing RCT filter can continue to be used by Cochrane reviewers and to populate CENTRAL, as it has very high sensitivity and a slightly better precision relative to more sensitive filters. The results of this study, which used a very large gold standard to compare the performance of all known RCT filters, allows searchers to make better informed decisions about which filters to use for their work.
OBJECTIVE: To identify the factors that shape and characterise experiences of prehospital practitioners (PHPs), families and bystanders in the context of death and dying outside of the hospital environment where PHPs respond.
DESIGN: A scoping review using Arksey and O'Malley's five-stage framework. Papers were analysed using thematic analysis.
DATA SOURCES: MEDLINE; Embase; CINAHL; Scopus; Social Sciences Citation Index (Web of Science), ProQuest Dissertations & Theses A&I (Proquest), Health Technology Assessment database; PsycINFO; Grey Literature Report and PapersFirst were searched from January 2000 to May 2019.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Qualitative and mixed methods studies reporting the experiences of PHPs, families and bystanders of death and dying in prehospital settings as a result of natural causes, trauma, suicide and homicide, >18 years of age, in Europe, USA, Canada, Australia and New Zealand.
RESULTS: Searches identified 15 352 papers of which 51 met the inclusion criteria. The review found substantial evidence of PHP experiences, except call handlers, and papers reporting family and bystander experiences were limited. PHP work was varied and complex, while confident in clinical work, they felt less equipped to deal with the emotion work, especially with an increasing role in palliative and end-of-life care. Families and bystanders reported generally positive experiences but their support needs were rarely explored.
CONCLUSIONS: To the best of our knowledge this is the first review that explores the experiences of PHPs, families and bystanders. An important outcome is identifying current gaps in knowledge where further empirical research is needed. The paucity of evidence suggested by this review on call handlers, families and bystanders presents opportunities to investigate their experiences in greater depth. Further research to address the current knowledge gaps will be important to inform future policy and practice.
Matthew Taylor and Michelle Green provide a valuable insight into methods of vital cost-effectiveness analysis of combination inhalers for the management of chronic obstructive pulmonary disease.
AIMS: In the COMPASS trial, rivaroxaban 2.5 mg twice daily (bid) plus acetylsalicylic acid (ASA) 100 mg once daily (od) performed better than ASA 100 mg od alone in reducing the rate of cardiovascular disease, stroke, or myocardial infarction (MI) in patients with coronary artery disease (CAD) and peripheral artery disease (PAD). A Markov model was developed to assess the cost-effectiveness of rivaroxaban plus ASA vs. ASA alone over a lifetime horizon, from the UK National Health System perspective.
METHODS AND RESULTS: The base case analysis assumed that patients entered the model in the event-free health state, with the possibility to experience =2 events, transitioning every three-month cycle, through acute and post-acute health states of MI, ischaemic stroke (IS), or intracranial haemorrhage (ICH), and death. Costs, quality-adjusted life-years (QALYs), life years—all discounted at 3.5%—and incremental cost-effectiveness ratios (ICERs) were calculated. Deterministic and probabilistic sensitivity analyses were conducted, as well as scenario analyses. In the model, patients on rivaroxaban plus ASA lived for an average of 14.0 years with no IS/MI/ICH, and gained 9.7 QALYs at a cost of £13 947, while those receiving ASA alone lived for an average of 12.7 years and gained 9.3 QALYs at a cost of £8126. The ICER was £16 360 per QALY. This treatment was cost-effective in 98% of 5000 iterations at a willingness-to-pay threshold of £30 000 per QALY.
CONCLUSION: This Markov model suggests that rivaroxaban 2.5 mg bid plus ASA is a cost-effective alternative to ASA alone in patients with chronic CAD or PAD.
BACKGROUND: The winter pressure often experienced by NHS hospitals in England is considerably contributed to by severe cases of seasonal influenza resulting in hospitalisation. The prevention planning and commissioning of the influenza vaccination programme in the UK does not always involve those who control the hospital budget. The objective of this study was to describe the direct medical costs of secondary care influenza-related hospital admissions across different age groups in England during two consecutive influenza seasons.
METHODS: The number of hospital admissions, length of stay, and associated costs were quantified as well as determining the primary costs of influenza-related hospitalisations. Data were extracted from the Hospital Episode Statistics (HES) database between September 2017 to March 2018 and September 2018 to March 2019 in order to incorporate the annual influenza seasons. The use of international classification of disease (ICD)-10 codes were used to identify relevant influenza hospitalisations. Healthcare Resource Group (HRG) codes were used to determine the costs of influenza-related hospitalisations.
RESULTS: During the 2017/18 and 2018/19 seasons there were 46,215 and 39,670 influenza-related hospital admissions respectively. This resulted in a hospital cost of £128,153,810 and £99,565,310 across both seasons. Results showed that those in the 65+ year group were associated with the highest hospitalisation costs and proportion of in-hospital deaths. In both influenza seasons, the HRG code WJ06 (Sepsis without Interventions) was found to be associated with the longest average length of stay and cost per admission, whereas PD14 (Paediatric Lower Respiratory Tract Disorders without Acute Bronchiolitis) had the shortest length of stay.
CONCLUSION: This study has shown that influenza-related hospital admissions had a considerable impact on the secondary healthcare system during the 2017/18 and 2018/19 influenza seasons, before taking into account its impact on primary health care.
INTRODUCTION: Lung cancer is accountable for 35 000 deaths annually, and prognosis is improved when the cancer is diagnosed early. CT-guided biopsy (transthoracic needle aspiration, TTNA) and electromagnetic navigation bronchoscopy (ENB) can be used to investigate indeterminate pulmonary nodules if the patient is unfit for surgery. However, there is a paucity of clinical and health economic evidence that directly compares ENB with TTNA in this population group. This cost-effectiveness study aimed to explore potential scenarios whereby ENB may be considered cost-effective when compared with TTNA.
METHODS: A cohort decision analytic model was developed using a UK National Health Service perspective. ENB was assumed to have equal sensitivity to TTNA at 82%. Lifetime costs and quality-adjusted life-year (QALY) gain were calculated to estimate the net monetary benefit at a £20 000 per QALY threshold. Sensitivity analyses were used to explore scenarios where ENB could be considered a cost-effective intervention.
RESULTS: Under the assumption that ENB has equal efficacy to TTNA, ENB was found to be dominant (less costly and more effective) when compared with TTNA, due to having a reduced risk and cost of adverse events. This conclusion was most sensitive to changes in the cost of intervention, estimates of effectiveness and adverse event rates.
DISCUSSION: ENB is expected to be cost-effective when the likelihood of an accurate diagnosis is equal to (or better than) TTNA, which may occur in certain subgroups of patients in whom TTNA is unlikely to accurately diagnose malignancy or when an experienced practitioner achieves a high accuracy with ENB.
