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Dr Matthew Taylor is the director of York Health Economics Consortium and leads the Consortium's health technology assessment program. The work of York Health Economics Consortium involves empirical research in health economics for both the private and public sectors. Dr Taylor is the scientific lead for the National Institute for Health and Care Excellence (NICE) Economic and Methodological Unit and a former member of NICE's Public Health Advisory Committee. He is also managing director (Europe) of Minerva, an international network of health economics consultancies.
A literature based study on the health impacts of three platinum anticancer drugs (cisplatin, carboplatin and oxaliplatin) was undertaken. The published evidence for health benefits is presented and assessed. A model was developed to quantify the health gain of adding platinum based drugs to cancer treatment at the population level for the UK and the USA. The economic value of using platinum drugs (in terms of quality-adjusted life year (QALY)) in addition to other cancer treatments can be estimated at over £556 million for the UK and over US$4.8 billion for the USA, depending on the scenario chosen.
BACKGROUND: It has been suggested that probiotics may improve gastrointestinal discomfort. Not all probiotics exhibit the same effects and consequently meta-analyses on probiotics should be confined to well-defined strains or strain combinations. The aim of this study was to evaluate the effectiveness of a probiotic fermented milk (PFM) that includes Bifidobacterium lactis (B. lactis) CNCM I-2494 and lactic acid bacteria on gastrointestinal discomfort in the general adult population.
METHODS: Double-blind randomized controlled trials in the general adult population comparing PFM with a control dairy product for at least 4 weeks were searched from multiple literature databases (up to February 2015). Meta-analyses using random-effects models, with individual participant data were undertaken to calculate an odds ratio (OR) or standard mean difference (SMD), with a 95% confidence interval (CI).
RESULTS: The search strategy identified 12,439 documents. Overall, three trials with a total of 598 adults (female = 96.5%) met the inclusion criteria. Consumption of the PFM product was associated with a significant improvement in overall gastrointestinal discomfort compared with the control product (OR = 1.48; 95% CI 1.07-2.05), with a number needed to treat (NNT) of 10.24 (95% CI 5.64-55.93). PFM was also superior to the control in reducing digestive symptoms, as measured using a composite score (SMD = -0.21; 95% CI -0.37 to -0.05). Sensitivity analyses produced similar results, and the heterogeneity between studies was minimal.
CONCLUSIONS: This meta-analysis shows that the consumption of PFM with B. lactis CNCM I-2494 and lactic acid bacteria is associated with a modest but consistent and significant improvement of outcomes related to gastrointestinal discomfort in healthy adults.
OBJECTIVES: To determine whether differential item functioning (DIF) was present in the EuroQol five-dimensional questionnaire (EQ-5D) used in cancer (non-small cell lung cancer and prostate cancer).
METHODS: The Partial Credit Model was applied to the three-level version of the EQ-5D with data obtained from four randomized controlled trials in prostate cancer and non-small cell lung cancer completed at baseline before treatment (N = 2213). DIF was assessed across cancer type (two levels), sex (two levels), and age group (three levels) using Mantel-Haenszel chi-square statistics and evaluated against the Educational Testing Service classification rules.
RESULTS: The presence of DIF was determined in 14 of 25 (56%) potential DIF contrasts in all the EQ-5D domains. Although mostly the DIF was categorized as either negligible (3 of 25 [12%]) or medium (7 of 25 [28%]), large DIF was observed in 4 of the 25 contrasts (16%). The mobility domain, in particular, showed consistently large DIF across cancer type, sex, and age.
CONCLUSIONS: Given the use of the instrument in health status assessments across conditions and interventions, these results may have significant implications for the EQ-5D in health economic evaluations. Further research is warranted to determine whether these results hold for other cancers.
BACKGROUND: In the UK, diabetes accounts for approximately 10% of the total UK National Health Service (NHS) resource expenditure, a figure that has been predicted to increase to 17% by 2035/2036. Meta-analysis of association studies indicate that yogurt consumption is potentially protective against type 2 diabetes (T2D). The purpose of this study was to explore the potential economic benefit to the UK NHS of a population increase in yoghurt consumption as a preventative measure against development of T2D.
METHODS: A patient simulation model was constructed for adults in the UK over the age of 25 years old using incidence rates for developing T2D with both current and increased yoghurt consumption. The reduction in risk in developing T2D associated with higher yoghurt consumption was taken from a meta-analysis of studies of dairy consumption on T2D risk. In each annual cycle of the model a patient could develop complications and comorbidities that are known to be more common in patients with T2D. Incidence rates for these conditions for diabetics and non-diabetics were taken from published studies. The model had a 25 year time horizon.
RESULTS: The model predicts that increasing average yoghurt consumption by adults over 25 years of age in the UK by 100g daily could result in 388,000 fewer people developing T2D over 25 years. This could save the UK NHS £2.3bn in direct T2D treatment costs and the costs of treating T2D associated complications. In addition, 267,000 QALYs would be generated. If the NHS values a QALY valued at £20,000, this would mean that the NHS should be prepared to pay £5.5bn for an intervention that generated the same number of QALYs.
CONCLUSIONS: Increasing yoghurt consumption in the adult population of the UK by 100g per day could generate substantial cost savings to the NHS as well as significant patient benefit through reductions in the incidence of T2D.
BACKGROUND: An evaluation was conducted to estimate the cost-effectiveness of insufflation of warmed humidified CO2 during open and laparoscopic colorectal surgery compared with usual care from a UK NHS perspective.
METHODS: Decision analytic models were developed for open and laparoscopic surgery. Incremental costs per quality-adjusted life year (QALY) were estimated. The open surgery model used data on the incidence of intra-operative hypothermia and applied risks of complications for hypothermia and normothermia. The laparoscopic surgery model utilised data describing complications directly. Sensitivity analyses were conducted.
RESULTS: Compared with usual care, insufflation of warmed humidified CO2 dominated. For open surgery, savings of £20 and incremental QALYs of 0.013 were estimated per patient. For laparoscopic surgery, savings of £345 and incremental QALYs of 0.001 per patient were estimated. Results were robust to most sensitivity analyses.
CONCLUSIONS: Considering the current evidence base, the intervention is likely to be cost-effective compared with usual care in patients undergoing colorectal surgery.
OBJECTIVES: To estimate the cost savings and health benefits in the UK NHS that could be achieved if human milk usage in the NICU was increased.
METHODS: A systematic review established the disease areas with the strong sources of evidence of the short, medium and long-term benefits of human milk for preterm infants as opposed to the use of formula milk. The analysis assessed the economic impact of reducing rates of necrotising enterocolitis, sepsis, sudden infant death syndrome, leukaemia, otitis media, obesity and neurodevelopmental impairment.
RESULTS: Based on the number of preterm babies born in 2013, if 100% of premature infants being fed mother's milk could be achieved in the NICU, the total lifetime cost savings to the NHS due to improved health outcomes is estimated to be £46.7 million (£30.1 million in the first year) with a total lifetime QALY gain of 10,594, There would be 238 fewer deaths due to neonatal infections and SIDS, resulting in a reduction of approximately £153.4 million in lifetime productivity. Sensitivity analyses indicated that results were robust to a wide range of inputs.
CONCLUSIONS: This analysis established that increasing the use of human milk in NICUs in the UK would lead to cost savings to the NHS. More research is needed on the medium and long term health and economic outcomes associated with breastfeeding preterm infants, and the differences between mother's own and donor breast milk.
