Abstract

OBJECTIVES: Differences in the process of using liver imaging technologies might be important to patients. This study aimed to investigate preferences for scanning modalities used in diagnosing focal liver lesions.

METHODS: A discrete choice experiment was administered to 504 adults aged 25 =years. Respondents made repeated choices between two hypothetical scans, described according to waiting time for scan and results, procedure type, the chance of minor side-effects, and whether further scanning procedures were likely to be required. Choice data were analyzed using mixed-logit models with respondent characteristics used to explain preference heterogeneity.

RESULTS: Respondents preferred shorter waiting times, the procedure to be undertaken with a handheld scanner on a couch instead of within a body scanner, no side-effects, and no follow-up scans (p=.01). The average respondent was willing to wait an additional 2 weeks for the scan if it resulted in avoiding side-effects, 1.5 weeks to avoid further procedures or to be told the results immediately, and 1 week to have the scan performed on a couch with a handheld scanner. However, substantial heterogeneity was observed in the strength of preference for desirable imaging characteristics.

CONCLUSIONS: An average individual belonging to a general population sub-group most likely to require imaging to characterize focal liver lesions in the United Kingdom would prefer contrast-enhanced ultrasound over magnetic resonance imaging or computed tomography. Insights into the patient perspective around differential characteristics of imaging modalities have the potential to be used to guide recommendations around the use of these technologies

Abstract

BACKGROUND: This is an updated version of a Cochrane review first published in Issue 3, 2006 (Perry 2006). The review represents one in a family offour reviews focusing on the effectiveness of interventions in reducing drug use and criminal activity for offenders. This specific reviewconsiders interventions for female drug-using offenders.

OBJECTIVES: To assess the effectiveness of interventions for female drug-using offenders in reducing criminal activity, or drug use, or both.

SEARCH METHODS: We searched 14 electronic bibliographic databases up to May 2014 and five additional Website resources (between 2004 and November2011). We contacted experts in the field for further information.

SELECTION CRITERIA: We included randomised controlled trials (RCTs) designed to reduce, eliminate or prevent relapse of drug use or criminal activity in femaledrug-using offenders. We also reported data on the cost and cost-effectiveness of interventions.

DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by The Cochrane Collaboration.

MAIN RESULTS: Nine trials with 1792 participants met the inclusion criteria. Trial quality and risks of bias varied across each study. We rated the majorityof studies as being at 'unclear' risk of bias due to a lack of descriptive information. We divided the studies into different categories forthe purpose of meta-analyses: for any psychosocial treatments in comparison to treatment as usual we found low quality evidence thatthere were no significant differences in arrest rates, (two studies; 489 participants; risk ratio (RR) 0.82, 95% confidence interval (CI) 0.45to 1.52) or drug use (one study; 77 participants; RR 0.65, 95% CI 0.20 to 2.12), but we found moderate quality evidence that there was asignificant reduction in reincarceration, (three studies; 630 participants; RR 0.46, 95% CI 0.34 to 0.64). Pharmacological intervention usingbuprenorphine in comparison to a placebo did not significantly reduce self reported drug use (one study; 36 participants; RR 0.58, 95% CI0.25 to 1.35). No cost or cost-effectiveness evidence was reported in the studies.

AUTHORS' CONCLUSIONS: Three of the nine trials show a positive trend towards the use of any psychosocial treatment in comparison to treatment as usualshowing an overall significant reduction in subsequent reincarceration, but not arrest rates or drug use. Pharmacological interventions incomparison to a placebo did not significantly reduce drug use and did not measure criminal activity. Four different treatment comparisonsshowed varying results and were not combined due to differences in the intervention and comparison groups. The studies overall showeda high degree of heterogeneity for types of comparisons and outcome measures assessed, which limited the possibility to pool the data.Descriptions of treatment modalities are required to identify the important elements for treatment success in drug-using female offenders.More trials are required to increase the precision of confidence with which we can draw conclusions about the effectiveness of treatmentsfor female drug-using offenders.

Abstract

No abstract available

Abstract

Scoliosis-structural lateral curvature of the spine-affects around four children per 1,000. The MAGEC system comprises a magnetically distractible spinal rod implant and an external remote controller, which lengthens the rod; this system avoids repeated surgical lengthening. Rod implants brace the spine internally and are lengthened as the child grows, preventing worsening of scoliosis and delaying the need for spinal fusion. The Medical Technologies Advisory Committee at the National Institute for Health and Care Excellence (NICE) selected the MAGEC system for evaluation in a NICE medical technologies guidance. Six studies were identified by the sponsor (Ellipse Technologies Inc.) as being relevant to the decision problem. Meta-analysis was used to compare the clinical evidence results with those of one conventional growth rod study, and equal efficacy of the two devices was concluded. The key weakness was selection of a single comparator study. The External Assessment Centre (EAC) identified 16 conventional growth rod studies and undertook meta-analyses of relevant outcomes. Its critique highlighted limitations around study heterogeneity and variations in baseline characteristics and follow-up duration, precluding the ability to draw firm conclusions. The sponsor constructed a de novo costing model showing that MAGEC rods generated cost savings of £9,946 per patient after 6 years, compared with conventional rods. The EAC critiqued and updated the model structure and inputs, calculating robust cost savings of £12,077 per patient with MAGEC rods compared with conventional rods over 6 years. The year of valuation was 2012. NICE issued a positive recommendation as supported by the evidence (Medical Technologies Guidance 18).

Abstract

OBJECTIVES: To evaluate the cost-effectiveness of everolimus plus exemestane (EVE+EXE) versus chemotherapy agents [docetaxel (DOC), vinorelbine (VIN), doxorubicin (DOX) and capecitabine (CAPE) ] for the treatment of hormone receptor positive (HR+) HER2 negative (HER2-) advanced or metastatic breast cancer in the United Kingdom (UK).

METHODS: A partitioned survival model was developed to compare treatment with EVE+EXE versus DOC, VIN, DOX and CAPE in patients with ER+ HER2- metastatic breast cancer over a 10-year time horizon from a UK NHS perspective. Progression-free survival and overall survival for EVE+EXE were taken from the BOLERO-2 trial. Log-logistic functions were used to extrapolate trial data beyond the follow-up period. In the absence of head-to-head evidence comparing EVE+EXE versus chemotherapy a naïve chained comparison was conducted with the link between EVE+EXE established via tamoxifen using the Bucher method. A class effect was assumed for the four chemotherapy agents. Background health state and terminal care resource use were derived from NICE Clinical Guideline 81. Drug costs were taken from the British National Formulary. Utilities for stable and progressive states were obtained from the literature (Lloyd et al. 2006).

RESULTS: Over a ten year time horizon, EVE+EXE led to a life expectancy of 3.55 years, compared to 1.88 for chemotherapy agents (DOC, VIN, DOX and CAPE). EVE+EXE resulted in 2.06 QALYs, compared to 0.95 for chemotherapy agents. Total costs were £48,085 for EVE+EXE compared to £31,835 vs. DOC, £25,021 vs. VIN, £23,743 vs. DOX and £21,851 vs. CAPE. The incremental costs per QALY were £14,550 vs. DOC, £20,653 vs. VIN, £21,797 vs. DOX and £23,491 vs. CAPE. Results were most sensitive to changes in PFS for chemotherapy and disease related costs.

CONCLUSIONS: Everolimus in combination with exemestane is a cost effective option compared with commonly used chemotherapeutic agents (docetaxel, vinorelbine, doxorubicin and capecitabine) in UK clinical practice.

Abstract

OBJECTIVE: The aim of this study was to determine the budget impact of everolimus (in combination with letrozole/anastrozole) as a second-line treatment for ER+ HER2- negative advanced and metastatic breast cancer in post-menopausal women.

RESEARCH DESIGN & METHODS: A cumulative cohort model was developed to estimate the 5-year costs associated with introducing everolimus to the Kazakh healthcare system. Two alternative market share scenarios were compared: with everolimus and without everolimus. PFS and OS data were taken from the trial and extrapolated. The background costs of the pre-progressed and post-progressed health states, drug costs and costs associated with adverse events were included in the model.

RESULTS: The 5-year results from the budget impact analysis demonstrate that the introduction of everolimus leads to a 12% increase in drug costs, a 2% reduction in pre-progression health state costs, a 1% increase in post-progression health state costs, and a 2% reduction in adverse event costs. The net result is only a modest increase in total costs; a 2.69% increase of T201 million, from T7.5 billion to T7.7 billion over a period of 5 years.

CONCLUSIONS: The analysis estimated that, if everolimus were to be introduced to the Kazakh healthcare market for the treatment of ER+ HER2- advanced breast cancer, there would be minimal impact upon overall healthcare expenditure. An increase in drug acquisitions costs was almost exactly offset by a reduction in other healthcare costs, due to improved management of the disease.

Abstract

OBJECTIVES: This study evaluated the cost-effectiveness of everolimus plus exemestane (EVE+EXE) versus exemestane (EXE) and fulvestrant (FUL) in the treatment of postmenopausal women with ER+ HER2- metastatic breast cancer in the United Kingdom (UK) from a societal perspective.

METHODS: A partitioned survival model was developed to compare treatment with EVE+EXE versus EXE and FUL over a 10-year time horizon. Progression-free survival and overall survival for EVE+EXE and EXE were estimated from the BOLERO-2 trial. Log-logistics functions were used to extrapolate trial data beyond the follow-up period. In the absence of head-to-head evidence vs. FUL an indirect treatment comparison was conducted using a Bayesian fixed effect model. Background health state and terminal care resource use were derived from NICE Clinical Guideline 81. Drug costs were taken from the British National Formulary. Productivity loss, defined as working days lost due to disease, was included in the analysis. Utilities from published sources were combined with trial data to calculate quality-adjusted life years (QALYs) for the model health state.

RESULTS: EVE+EXE led to an incremental gain in life years of 0.20 vs. EXE and 0.19 vs. FUL. The incremental QALY gain was 0.31 vs. EXE and 0.27 vs. FUL. The cost of lost productivity was £66,163 in the EVE+EXE compared to £75,067 in the EXE arm and £73,434 in the FUL arm. The incremental cost per QALY was £27,644 vs. EXE and £14,030 vs. FUL. Probabilistic sensitivity analysis demonstrated that, at a threshold of £30,000 per QALY gained, EVE+EXE had a 51.6% likelihood of being cost-effective vs. EXE and 59.0% vs. FUL.

CONCLUSIONS: Patients receiving EVE+EXE experienced an improvement in survival which translated into health gains in terms of both LYs and QALYs. EVE+EXE was associated with savings in productivity costs compared to both EXE and FUL.