Journal of human nutrition and dietetics : the official journal of the British Dietetic AssociationMonique Aucoin, Hainan Yu, Melissa Murphy, Nicole Yoannou, Laura LaChance, Kieran Cooley, Patricia M Herman
BACKGROUND: Nutrition is a significant modifiable risk factor for many illnesses. One often-cited barrier to diet change is the perceived cost of healthy food. While many diet diary templates exist, none have been developed to capture the data needed for calculating the cost of a diet consumed during a diet intervention study. METHODS: The objective of the present project was to develop and pilot test (1) a tailored diet diary template with instructions, and (2) alternative approaches for calculating diet cost. We created a draft diet diary and instructions which were used by participants. We used those data to test the feasibility of calculating weekly diet cost. Two methods were used: calculation of the cost of the actual price of the items purchased, and standardised prices. Acceptability was assessed by conducting participant interviews and the feedback that was provided was used to revise them. The methods to calculate costs were compared in terms of feasibility and researcher time needed. RESULTS: Of the 15 participants enrolled, 14 completed the interview. All participants reported that the process was acceptable or highly acceptable. Participant feedback was used to guide changes to the diet diary and instructions. Costs were calculated for 85.3% to 96.3% of food items. The researcher time needed to complete each method per participant, per week was 5 to 6.5 h. Participants who gave feedback confirmed that the edits addressed their previous concerns. CONCLUSIONS: Overall, the diet diary and instructions were acceptable to participants who are women and feasible for the collection and costing of diet data in Canada.
Applied health economics and health policyGillian Eaglestone, Charlotte Stoner, Rosana Pacella, Paul McCrone
BACKGROUND: This methodological paper reflects on how people with lived experience of dementia contributed to the development and refinement of a survey intended to identify priorities for future economic evaluation in dementia research. Although Patient and Public Involvement (PPI) is increasingly recognised as essential for producing relevant and ethical health research, people living with dementia are rarely included in PPI activities related to health economics, where outcomes are often predetermined by decision-making bodies. METHOD: To support the development and refinement of the survey, a small bespoke PPI group comprising four individuals with lived experience in England reviewed draft survey materials through online meetings and helped ensure the survey was accessible and meaningful through feedback on survey clarity, accessibility, and response options. RESULTS: PPI contributions led to important refinements, including simplifying terminology, removing ambiguous or burdensome items, and enhancing overall usability. DISCUSSION: The findings demonstrated the significant value of involving PPI contributors early and collaboratively, showing that co-design approaches enrich the relevance and sensitivity of research tools. The experience also highlighted the need for tailored support and an accessible introduction to health economic concepts for PPI contributors, alongside broader participation across study stages and engagement in dissemination activities.
JMIR research protocolsLillian Ofori Ward, Cate Bailey, Prai Wattanatakulchat, Benjamin Stone, Alexander Burger, Deanna Kaplan, Santiago Jose Arconada Alvarez, Cullan Joyce, Ana Ecla…
BACKGROUND: In recent decades, millions of people globally have taken up Buddhist spiritual and secularized meditation practices, such as mindfulness, with the aim of improving their quality of life and well-being. Practitioners are recommended to continue meditating regularly for the long term; however, the effects of regular meditation practice after introductory instruction remain scientifically underexplored. OBJECTIVE: This protocol aims to investigate whether regular meditation practice improves quality of life and mental well-being and whether its effects vary between secular and spiritual practitioners. We will also explore the cost-effectiveness of meditation in terms of quality of life and the incidence and functional impact of any adverse effects associated with the practice. METHODS: We will conduct a prospective longitudinal cohort study of 600 beginner meditators in Australia, New Zealand, the United States, and the United Kingdom over a 1-year period. Meditation practice frequency and duration will be reported weekly through the ambulatory assessment app Fabla (Emory University), with sampling of the primary outcome of quality of life and secondary outcome of mental well-being at monthly intervals. Practice characteristics, including secular versus spiritual practice, will also be reported monthly, as will the costs of meditation and mental health care and the incidence, severity, and duration of any adverse effects. Potential confounders, including baseline mental health symptoms, social support, and sociodemographics, will be controlled for in linear mixed models. An incremental cost-effectiveness ratio will be calculated, and sensitivity analyses will be conducted. RESULTS: Data collection began on October 28, 2025, after this study was first submitted on October 1, 2025. As of May 14, 2026, 341 participants have completed baseline measures. We expect results to be published in January 2028. CONCLUSIONS: Results of this investigation will illuminate the impact of meditation as it is currently practiced in natural contexts, and inform clinicians about whether and how regular meditation may be an effective tool for improving quality of life.
Health economics reviewPablo Oscar Roza Miguel, Jorge Albareda Albareda, Nuria García-Rodríguez, Eduardo González Fidalgo, Daniel Hernández Vaquero, José Antonio Queiruga Dios, María…
BACKGROUND: Although several studies have evaluated the cost-effectiveness of total knee arthroplasty (TKA) compared with conservative treatment, few have explored how implant revision rates may influence its long-term cost-effectiveness. The objective of this study was to evaluate the impact of implant revision rates on quality of life and cost-effectiveness in patients undergoing TKA. METHODS: A cost-utility analysis from a healthcare system perspective was conducted using an individualized discrete-event simulation model parameterized with data from a Spanish cohort of patients undergoing TKA. Quality-adjusted life years were calculated with the SF-6D index, and implant alternatives were compared by assigning age- and sex-specific revision rates to each simulated patient while projecting long-term quality of life and life expectancy according to general population standards. The prosthetic models compared were those associated with the highest (WorstKnee) and lowest (BestKnee) revision rates in the UK National Joint Registry. The primary outcome was the incremental cost-effectiveness ratio. Secondary analyses included budget impact and deterministic sensitivity analyses. RESULTS: The projected quality-adjusted life expectancy over 15 years was 9.767 QALYs for WorstKnee, compared with 10.004 QALYs for BestKnee. The incremental cost-effectiveness ratio was €6,219/QALY, which remained below the cost-effectiveness thresholds commonly used in Spain. Use of BestKnee was associated with an additional cost of €332.3 M over 15 years; however, it also led to a substantial reduction in revision surgeries, with 27,878 fewer procedures performed, resulting in gradual cost savings over time. CONCLUSION: Within the price ranges currently observed in the Spanish National Health System, total knee prostheses associated with lower revision rates provide a favorable long-term cost-effectiveness profile and may reduce future revision burden despite their higher acquisition cost.
Journal of medical economicsPatrik Zamecnik, Jürgen Feuerstein, Michael Berghahn, Jelle Barentsz
BACKGROUND AND OBJECTIVE: Accurate nodal staging in intermediate- to high-risk prostate cancer (PCa) is crucial for treatment decisions. While extended pelvic lymph node dissection (ePLND) is the standard, it is invasive and has a low diagnostic yield. A 2019 analysis suggested that non-invasive imaging such as PSMA-PET/CT and ferumoxtran-enhanced macrophage-MRI (m-MRI) is cost-effective, but at the possible expense of a small QALY loss compared to ePLND, based on limited evidence. Recent Phase 3 trials have provided new data, prompting a reevaluation. Therefore, the aim of this article is to update a model with recent trial data to assess the cost-effectiveness of m-MRI and PSMA-PET/CT versus ePLND in Germany. MATERIAL AND METHODS: We adapted a Markov model to simulate lifetime outcomes for men with intermediate- to high-risk PCa from a German insurer's perspective, with costs updated to 2025 level. Diagnostic accuracy data were derived from recent multicenter trials. Costs and QALYs were calculated using a 3% discount rate. Sensitivity analyses tested uncertainties. A practical interactive online-tool is provided for clinical decision-making and research purposes, which can incorporate various input data (https://macrophage-mri.app). RESULTS: Both imaging options were dominant over ePLND (€37,855; 18.11 QALYs). PSMA-PET/CT was €7,869 cheaper and gained 0.800 QALYs; m-MRI was €9,985 cheaper and gained 0.990 QALYs. m-MRI was superior, saving €2,116 and gaining 0.19 QALYs over PSMA-PET/CT. The probabilistic analysis showed that m-MRI was optimal over 95% of the time at an €80,000/QALY threshold; the probability of PSMA-PET/CT being optimal was less than 5%. CONCLUSIONS: An imaging-first approach outperforms routine ePLND, with m-MRI as a cost-effective option. PSMA-PET/CT's low sensitivity limits its usefulness, though it is still cheaper than ePLND. These results support including m-MRI in guidelines for initial staging.
BMJ openSita Saunders, Kim Seemann, Tobias Muench, Rhodri Saunders, Nady Sfeir, Finn M Radtke, Basak C Meco, Joana Berger-Estilita
STUDY TYPE: Mixed-methods observational implementation and economic evaluation study. BACKGROUND: Perioperative care bundles have the potential to improve patient outcomes but their successful implementation depends on staff engagement and the resources required. Data on implementation costs and staff perceptions are limited for perioperative brain health initiatives. OBJECTIVES: To estimate the resource use and costs of implementing a perioperative brain healthcare bundle in a Swiss hospital and to explore staff perceptions relevant to sustainable adoption. DESIGN: Retrospective mixed-methods study combining semi-structured interviews with economic modelling. SETTING: Single tertiary-level Swiss hospital. Cost estimates were expressed in 2024 Swiss Francs (CHF). PARTICIPANTS: Five anaesthesiologists and five nurses involved in perioperative care and bundle implementation were interviewed using semi-structured interviews. Postoperative delirium incidence was assessed in patients admitted to the post-anaesthesia care unit (PACU). INTERVENTIONS: Implementation of a perioperative brain healthcare bundle, including staff training, workflow adaptation and routine postoperative delirium screening. MAIN OUTCOME MEASURES: Primary outcomes were total implementation time and costs, and postoperative delirium incidence in the PACU measured using the Nursing Delirium Screening Scale. Secondary outcomes included staff perceptions of workload and feasibility, hospital length of stay and net cost impact. RESULTS: Staff perceptions of the care bundle were generally positive, with initial concerns about workload decreasing over time. Implementation required an estimated 803 hours (695-912) and cost CHF 326 612 (275 370-374 781). The economic model estimated a reduction of 300 (270-330) PACU-detected postoperative delirium cases, corresponding to 421 (341-509) hospital days saved and net cost savings of CHF 389 523 (159 209-688 988) within 12 months. Scenario and probabilistic sensitivity analyses projected cumulative net savings exceeding CHF 2 million over 5 years, with a breakeven point at approximately 2 months. CONCLUSIONS: Implementation of a perioperative brain healthcare bundle was well accepted by staff and associated with substantial cost savings in this single-centre model-based analysis, supporting its potential scalability as a perioperative quality improvement intervention.
Community mental health journalRichard Stenmark, Erik Jedenius, Gunnar Edman, Fiona Gaughran, Jonas Eberhard
Severe mental illness (SMI), such as schizophrenia, is associated with high physical health morbidity, extensive healthcare utilization, and substantial economic costs. This naturalistic study examined changes in resource utilization, measured as direct costs, following a psychosocial health promotion program (MINT) across social services and physical and psychiatric healthcare. Resource utilization patterns for 77 participants were assessed using the Resource Utilization of Mental Illness (RUMI) instrument during the 6-month intervention and a 6-month follow-up. Data were collected on physical and psychiatric care, social services, and contacts with the justice system. We observed significant changes in both costs and patterns of resource utilization. As anticipated, costs related to social services were unchanged. Total costs increased during the intervention period and decreased at follow-up. Costs associated with physical and psychiatric healthcare decreased during the intervention and continued to decrease during follow-up. At a profession-specific level, significant differences were observed in primary care visits: costs associated with physician visits decreased during the intervention and increased at follow-up, whereas costs related to nurse visits increased during both the intervention and follow-up. Overall, these findings suggest that the MINT intervention may modify patients' patterns of resource utilization across services in ways that better align with patients' needs.
BMJ public healthBethany A Caruso, Madeleine Patrick, Sonia Shahid, Ashraful Islam, Ramkrishna Paul, Abul K Shoab, Mahbub-Ul Alam
INTRODUCTION: Regular collection and reporting of gender data is critical for informing water, sanitation and hygiene (WASH)-related policies, programmes and investments that benefit all. Priority gender-specific indicators for WASH monitoring were identified and published in March 2024. However, the indicators need testing and there is a lack of understanding about what may enable or prevent governments from adopting them. This study aims to test and report against the priority gender indicators in Bangladesh and identify barriers and enablers to national-level indicator adoption. ANALYSIS AND METHODS: Four primary activities were identified to achieve the study aims: stakeholder meetings, cognitive interviews, survey data collection and key-informant interviews (KIIs). First, stakeholder meetings engage those involved in work related to gender, WASH and/or monitoring to discuss and solicit feedback on the proposed data collection plan, including if any additional Bangladesh-specific indicators should be tested. Second, 48 cognitive interviews (24 men and 24 women) assess face validity of the survey questions that generate indicator data. Findings are then used to strengthen survey question wording. Third, survey data collection with 600 participants (300 men, 300 women) generates data to test indicator performance. Finally, KIIs with 20-30 individuals engaged in WASH, gender and/or monitoring seek to gain impressions of the indicator data produced and to identify barriers and facilitators of indicator adoption. Qualitative data will be analysed thematically. Quantitative analyses will follow the approach used by the Bangladesh National Hygiene Survey. ETHICS AND DISSEMINATION: Institutional Review Boards at the University of Dhaka Institute of Health Economics and Emory University reviewed and approved the study. Indicator data will be shared with stakeholders during KIIs and more broadly through a learning workshop and via policy briefs. We aim to present at conferences and publish results in peer-reviewed journals. Data will be publicly available on publication of key findings.
The International journal of pharmacy practiceAnisha Patel, Jessica Gadsby, Harshil Dhutia, Helen Knight, Julian Barwell, Hussain Mulla
OBJECTIVES: To evaluate whether point-of-care (POC) CYP2C19 genotyping streamlines mavacamten initiation. METHODS: Pre-post service evaluation in a tertiary cardiology service; 10 consecutive patients underwent parallel laboratory and POC genotyping. Outcomes were concordance, turnaround time, number of appointments, patient preference, and costs. KEY FINDINGS: Concordance was 100%. Laboratory turnaround was 10 days; POC run time 63 min. Appointments fell from three to one. Costs decreased by £245.76 per patient for the health service and £118 for patients; break-even was about 3-4 patients per year. CONCLUSIONS: POC genotyping is feasible, improves efficiency and experience, and offers a credible economic case.
BMJ global healthMartilord Ifeanyichi, Johnson Ezema Nchege, Ebikabowei Biedomo Aduku, Meskerem Aleka Kebede, Maeve Bognini, Rachel Hargest, Rocco Friebel
INTRODUCTION: While health improvements drive economic growth, the specific macroeconomic impact of surgery remains unknown. Previous studies have quantified economic losses from unmet need but have not established whether surgery generates economic returns. This study investigates the association between surgical activity and economic growth across low- and middle-income countries (LMICs). METHODS: We analysed panel data from 95 LMICs (2000-2022) using System Generalised Method of Moments (GMM) estimation. Surgical volume was proxied by per capita suture consumption in kilograms (kg) measured by per capita suture imports (in kg), with gross domestic product (GDP) per capita adjusted for purchasing power parity as the outcome variable. We controlled for education, labour force, infrastructure, quality of governance, health expenditure, and credit availability while addressing endogeneity through internal instrumentation. RESULTS: Each 1% increase in per capita suture consumed corresponded to a 0.0083% increase in per capita GDP (p<0.05). Associations were concentrated and larger in middle-income countries (0.013%; p<0.05) and countries with surgical activity above the 75th percentile in a piecewise spline model (0.016%; p<0.05). No significant associations were found in low-income countries (-0.0039%; p>0.05) or below the 75th percentile surgical activity settings (0.0049%; p>0.05). In a secondary (non-log-transformed) model, a 1-kg increase in per capita sutures consumption corresponded to an increase of 89 international dollars in per capita GDP (p<0.05). CONCLUSION: Surgical activity is positively associated with economic growth in LMICs, particularly in higher capacity settings. This provides novel empirical evidence suggesting that surgical investments may yield macroeconomic returns, supporting integration of surgical system strengthening into economic development strategies. Low-income countries may require coordinated investments to build capacity to levels where economic benefits become visible.
PURPOSE: To determine whether the clinical characteristics of IRD patients are associated with the positive molecular diagnosis. METHODS: This multi-center cross-sectional study analyzed 492 IRD patients in Taiwan enrolled between January 2018 and May 2022. Patients with clinical IRD suspicion aged between 0 and 96 years with no previous genetic diagnosis were enrolled. RESULTS: Among the 492 patients recruited, 274 (55.7%) received a molecular diagnosis. The mean age at first visit was 49.5 years, and 245 patients (49.8%) were male. Positive genetic results were observed in 67 of 72 patients (93.1%) with onset age < 10 years, compared with 18 of 28 (64.3%) in those with onset age ≥ 50 years. Positive results were also more common in patients with a positive IRD family history, 136 of 162 (84.0%), compared with those without a family history, 138 of 179 (77.1%). In addition, patients with a previous genetic diagnosis in one family member had a higher diagnostic yield. In univariate analysis, male sex (OR 1.83; p < .01), age of onset 0-9 years (OR 3.00; p < .01), a positive IRD family history (OR 4.18; p < .05), and a previous genetic diagnosis in one family member (OR 4.24; p < .001) were associated with higher odds of a positive result. For worse-seeing-eye BCVA, diagnostic yield ranged from 68.6% in patients with normal vision to 87.5% in those with moderate visual impairment and 85.1% in those with no light perception. In the multivariate model, only worse-seeing-eye logMAR BCVA > 2.0 remained independently associated with positive testing (OR 4.80; p < .001). No negative predictors of panel-based molecular diagnosis were identified. CONCLUSION: We discovered key patient-level demographic and clinical factors associated with increased odds of obtaining a molecular diagnosis. This study supports further evaluations of clinical characteristics that can improve the cost-benefit of panel-based genetic testing for IRD, paving the way for efficient genetic diagnostics and identifying high-risk panel-undiagnosable patients to pursue more advanced sequencing platforms.
Journal of Alzheimer's disease : JADMateo Montes-Martinez, Luisa S Welter, Paul Boon, Claudio L A Bassetti, Thomas Berger, Günther Deuschl, Elena Moro, Christopher Kruse, Maria Lolich, Maria Kont…
BackgroundDementia, with Alzheimer's disease as its most common underlying cause, is a major contributor to disability, dependency, and death, imposing significant societal and economic burdens across Europe. Despite its growing prevalence, cross-country cost estimates remain scarce and highly heterogeneous, limiting comparability.ObjectiveTo estimate country-level societal costs of dementia in Europe and to derive aggregate European cost estimates, including direct costs, indirect costs (productivity losses), and informal care costs.MethodsA standardized review of dementia cost assessments conducted in Europe was performed. Heterogeneous cost-estimation approaches were harmonized using pooling and health-economic imputation techniques to address data gaps and generate country-level estimates. All cost estimates were converted to 2019 euros using Consumer Price Indices and Purchasing Power Parities (PPP). Informal care costs were analyzed separately to reflect their complexity and substantial contribution to total costs.ResultsForty-five studies were identified. Annual societal costs of dementia in high-income European countries totaled €221.4 billion (€PPP, 2019; €25,218 per patient) for 8.8 million people with dementia. Informal care and direct costs accounted for 58% and 42% of total costs, respectively. Indirect costs contributed minimally to total costs. Substantial variation in per patient costs across countries was observed.ConclusionsDementia care imposes substantial societal burdens, largely driven by informal care. Owing to data availability, estimates were limited to high-income European countries. Future research should focus on standardizing cost assessment methods, improving informal care valuation, expanding evidence from low- and middle-income countries, and evaluating the financial impact of emerging treatments and prevention strategies.
Hypertension in pregnancyAdili Adilan, Haoran Zhan, Yanan Hu, Lana McClements, Emily J Callander
OBJECTIVE: Preeclampsia is a serious pregnancy complication associated with substantial maternal and infant morbidity worldwide. The adverse outcomes related to preeclampsia increase healthcare costs, highlighting the importance of quantifying its economic burden to inform healthcare policy and resource allocation. This systematic review aimed to synthesize evidence on the economic burden of preeclampsia and identify key cost drivers. METHODS: MEDLINE, PubMed, Web of Science, and the Cochrane Library were searched for English-language studies published between 2014 and 2024. Studies reporting healthcare resource utilization or costs associated with preeclampsia were included. The review followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD42025650091). RESULTS: Of 3,107 records identified, 12 studies were included; most were conducted in high-income countries. All cost estimates were converted to 2024 US dollars for comparability. Direct medical costs ranged from US$109.84 to US$87,339.71, with a mean cost of US$33,585.48 per patient. National healthcare system costs were estimated at €6.5-€9.1 million in Ireland and US$2.18 billion in the United States. CONCLUSION: Preterm birth was identified as a major driver of economic burden, with earlier gestational age significantly increasing maternal and infant costs. Indirect costs and regional disparities remain underexplored, highlighting important gaps for future research.
Journal of the American College of Emergency Physicians openNoah Williams, Aswathy Geetha Manukumar, Hensley H Mariathas, Hai Van Nguyen, Christopher Patey, Shabnam Asghari
OBJECTIVES: To examine patient-reported non-disease-specific out-of-pocket costs (OOPCs) among emergency department (ED) visitors in a publicly funded health care system, including factors associated with OOPC and to explore patient experiences related to these costs. METHODS: This convergent parallel mixed-method study used data collected through telephone surveys and semistructured interviews from March 1, 2021, to July 27, 2023. All patients who visited the 4 EDs (2 rural and 2 urban EDs) in Newfoundland and Labrador, Canada, were randomly selected to participate based on when they visited the ED (date and time). OOPC was defined as the total amount patients incurred from food, transportation, missed work hours, and other related expenses. Quantitative analyses included multivariable binomial and multinomial regression models adjusting for age, gender, ED location, and patient self-reported length of stay (LOS). Sensitivity analyses using multiple imputation assessed the impact of missing data. Qualitative data were analyzed using thematic analysis. RESULTS: Among the final sample of 818 patients, 24% (199/818) reported OOPC for an ED visit. An ED length of stay of 4+ hours was associated with higher odds of incurring OOPC (adjusted odds ratio [aOR], 2.26; 95% CI, 1.29-4.15) and OOPC of ≥$200 Canadian dollars (CAD; aOR, 3.68; 95% CI, 1.21-11.19). Patients who visited urban EDs were more likely to report OOPC of ≥$200 CAD (aOR, 2.55; 95% CI, 1.09-5.99). Qualitative analysis showed 4 OOPC themes: (1) ED visits are expensive; (2) missing work hours; (3) being forced to choose between care and necessities; and (4) ongoing costs of care. CONCLUSION: These findings demonstrate that OOPC persist even within a publicly funded health system and underscore the importance of improving ED efficiency to reduce the financial burden on individuals seeking care.
Human vaccines & immunotherapeuticsPeter S Nyasulu, Jacques L Tamuzi, Chinwe Iwu-Jaja, Ritika Tiwari, Doris Y Sakala, Charles S Wiysonge, Rene English, Usuf Chikte
Mapping current vaccinology courses is critical for identifying educational gaps, refining program content, and increasing international cooperation to achieve a competent and well-coordinated global vaccination effort. This scoping review investigates the availability and content of vaccinology courses throughout the world, with a focus on Africa where there is a need for strengthened immunization systems and workforce capacity. Eight vaccinology courses, including short professional training and university certificate programs, were offered in Africa, including Morocco, Senegal, Uganda, Kenya, Ethiopia, Rwanda, Ghana, South Africa, and Zimbabwe. Our findings indicated that the percentages of vaccinology modules significantly vary between Africa and other continents, specifically: introduction to immunology, epidemiology, biology of pathogens, vaccine types, vaccine pharmacology, clinical research methodology, pharmacovigilance and vaccine safety, health economics, immunization programs, vaccine manufacture, the role of international organizations in vaccine development, vaccine advocacy, and vaccine cold chain management. By analyzing and comparing specific characteristics of the courses, our results also found multiple gaps and potential challenges related to target population, course objectives, method of course delivery, course contents, duration of course, training, practical sessions delivery, course costs, and funding constraints.
Diabetic medicine : a journal of the British Diabetic AssociationMaria-Eleni Syleouni, Tara T M Lee, Federica Carrieri, Eleanor M Scott, Aesha Khan Mirón, Helen R Murphy
AIMS: The Automated Insulin Delivery among Pregnant women with Type 1 diabetes (AiDAPT) trial demonstrated that using the CamAPS FX automated insulin delivery (AID) was associated with improved glycaemic outcomes. This study aimed to assess the clinical and economic impact of improving third-trimester HbA1c. METHODS: Using the AiDAPT data, a health economics model was built to estimate clinical outcomes and healthcare resource utilisation associated with third-trimester HbA1c categories (<42 mmol/mol, 42-53 mmol/mol, ≥53 mmol/mol). AiDAPT HbA1c distribution and associated clinical outcomes (obstetric: pre-eclampsia, delivery method; neonatal: length of stay in normal/critical/intensive care) were used to estimate perinatal complications. UK-specific healthcare costs were extracted from the NHS National Schedule and other published sources. Total costs to the UK healthcare system were estimated using an incremental 3.3 mmol/mol (0.3%) HbA1c reduction observed with CamAPS FX AID over Standard Care in AIDAPT. RESULTS: In the model, HbA1c improvement with CamAPS FX AID was associated with projected reductions in pre-eclampsia risk (-13%), high dependency neonatal care days (-16%), neonatal intensive care unit days (-12%) and clinic visits. The model projected cost reduction for the NHS healthcare system of £6,696,636 under conservative modelling assumptions, being cost saving at 96.8% of the simulations. The projected incremental cost difference per woman treated with CamAPS FX AID was -£1016, mainly derived from a modelled shift in the distribution of neonatal care, with reduced length of stay in high dependency neonatal intensive care. CONCLUSION: CamAPS FX AID improves third-trimester HbA1c with projected cost reductions for the UK healthcare system.
SeizureP Boon, B Schmitz, P House, L M'Rabet, A Marcellusi, J Poza, F Sofia, P Tittensor, I Pavisic, C Vázquez Álvarez, S Sgarbi, E Stamuli, M C Walker
BACKGROUND: Seizure freedom (SF) is widely recognized as a key goal in epilepsy treatment, yet its value is inconsistently defined, applied, and communicated in both clinical and research contexts. This lack of consensus limits the alignment of clinical care, trial design, and patient-centered outcomes. OBJECTIVE: To generate expert consensus on the definition, relevance, and value of SF in epilepsy, and to inform its future integration into treatment guidelines, health policy, and economic evaluations. METHODS: A three-round Delphi panel was conducted involving 28 stakeholders, including epileptologists, neurologists, patient advocacy representatives, nurses, and Health Economics and Outcomes Research (HEOR) experts from EU countries and the UK. Participants responded to structured questionnaires covering clinical, social, and economic aspects of seizure freedom. Consensus thresholds were pre-defined based on question type. RESULTS: High consensus was reached on the definition of SF as "no seizures for 1 year or more" and its importance as a primary endpoint in studies involving newly diagnosed patients and surgical interventions. In studies and clinical practice involving drug-resistant patients, consensus was also reached, on SF not being the sole primary endpoint. Patient-centered priorities, including improved quality of life, psychological well-being, and functional independence, were identified as key benefits of SF. Economic and societal impacts of uncontrolled seizures were also rated as highly significant and impactful. CONCLUSION: The Delphi panel findings highlight SF as a clinically meaningful, patient-prioritized, and economically valuable outcome. These insights should guide the standardization of SF definitions, support its broader use in health technology assessment (HTA), and inform shared decision-making in clinical practice in resource-rich environments in Europe.
Critical care and resuscitation : journal of the Australasian Academy of Critical Care MedicineKristen S Gibbons, Sainath Raman, Lalitha Av, Marino Festa, Shane George, Renate Le Marsney, Paula Lister, Debbie A Long, Karthi Nallasamy, Anton Pak, Daniela …
BACKGROUND: The Resuscitation in Paediatric Septic Shock using Vitamin C and Hydrocortisone (RESPOND) trial is a multicentre randomised controlled trial exploring whether the use of hydrocortisone alone, or in combination with vitamin C, increases time alive and free of vasopressors for critically ill children. OBJECTIVE: To present the prespecified statistical analysis plan (SAP) for the RESPOND trial prior to finalising recruitment and locking the trial dataset. DESIGN SETTING AND PARTICIPANTS: The RESPOND trial is a three-arm, parallel group, open-label, randomised controlled trial, recruiting in paediatric intensive care units in Australia, New Zealand, India, and Brazil. The planned sample size is 384 participants. MAIN OUTCOME MEASURES: The primary outcome is time alive and free of inotropes/vasopressors, censored at 7 days post-randomisation. Secondary outcomes include clinical (e.g. alive and free of multi-organ dysfunction, length of stay), safety, health economics (e.g. incremental costs, quality-adjusted life years), and long-term outcomes (measured at 6 months post-randomisation; e.g. health-related quality of life). RESULTS AND CONCLUSIONS: The SAP was designed by the Chief Investigators and approved by the RESPOND Steering Committee. Statistical analyses are summarised. The primary outcome will be analysed using quantile regression adjusted for stratification variables. Appropriate statistical comparisons between groups were planned and described in a way that is transparent, available to the public, verifiable, and predetermined before completion of data collection. The trial statistician, RESPOND Steering Committee members, and SAP authors remain blind to treatment allocation throughout the study. Data Safety and Monitoring Board members were provided with safety data with masked group identifiers during interim analyses. The RESPOND trial commenced recruitment in December, 2021, and aims to complete recruitment by mid-2026. TRIAL REGISTRATION: ACTRN12621000247875.
JID innovations : skin science from molecules to population healthChristian L Bailey-Burke, David M Brizel, Peter A Ubel, Shelby D Reed, Meenal K Kheterpal
Cutaneous squamous cell carcinoma occurs with increasing incidence in the aging United States population and, depending on the tumor stage, can require multimodal treatment. Neoadjuvant cemiplimab has shown promise in improving pathological response and event-free survival, but its cost effectiveness compared with starting with upfront wide local excision has not been explored. This health economics evaluation aims to determine whether adding neoadjuvant cemiplimab may be a more economically valuable intervention in the management of head and neck locoregionally advanced cutaneous squamous cell carcinoma using a decision tree combined with a state-transition Markov model over a 10-year horizon. In the model's base-case analysis, the expected long-term cost per patient was $19,021 lower with the addition of neoadjuvant immunotherapy than with upfront wide local excision alone and yielded 0.11 more quality-adjusted life years, with adjusted time horizon and health utilities leading to the greatest differences in mean costs and quality-adjusted life years, respectively. In this model, neoadjuvant immunotherapy followed by wide local excision was associated with lower expected costs and modestly higher quality-adjusted life years over a 10-year horizon, although the results were sensitive to modeling parameters and assumptions. Future research is needed to clarify long-term costs, outcomes, and corresponding health state utilities.