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Background: Telehealth for paediatric speech and language therapy became one of the most salient modes of service delivery during the COVID‐19 pandemic. Evidence for speech and language therapy services via telehealth in comparison to face‐to‐face delivery demonstrates promising outcomes, and studies have begun to explore practitioner and client experiences. However, across the literature, many critical elements of services are overlooked, and there is a need to frame the evidence base within a theoretical model that can draw out practical implications that consider the range of factors having an impact on clinical implementation in real‐world contexts. The APEASE (Acceptability, Practicability, Effectiveness, Affordability, Side‐effects, and Equity) criteria offer such a model. The current study explored practising UK speech and language therapists' (SLTs) clinical experience of telehealth through the lens of the APEASE criteria and aimed to identify recommendations for future service provision from the practitioner perspective. Methods: An online survey structured using the APEASE criteria was developed in collaboration with the UK Royal College of Speech and Language Therapists. Quantitative data were analysed using descriptive statistics and qualitative data were analysed using reflexive thematic analysis. Results: Four hundred and thirty‐eight qualified and practicing UK paediatric SLTs completed the survey. Telehealth was broadly acceptable and practicable to SLTs yet there remains some uncertainty about its efficacy and cost‐effectiveness compared to face‐to‐face interventions and how equitable it is for different population groups. SLTs reported that effective implementation of telehealth services was dependent upon several contextual factors; affordability was a perceived barrier to clients having access to telehealth resources, intervention via telehealth was perceived as more acceptable than assessment, and whilst many SLTs welcomed aspects of telehealth, there were concerns about the physical and mental health consequences for practitioners. Six themes for the future development of telehealth in paediatric speech and language therapy were identified: (1) balanced and tailored services; (2) technology and equipment; (3) information and communication; (4) capacity building; (5) monitoring and evaluation; and (6) leadership and governance. Conclusions: Outcomes highlight promising, concerning and uncertain aspects of telehealth in paediatric speech and language therapy. SLTs value a flexible and tailored approach to service delivery and recommend that effective leadership, clear communication, ongoing policy and guidance development, upskilling of users and careful evaluation of impact are required to ensure optimal implementation. The APEASE criteria offer a valuable opportunity to enhance and streamline practice and research to ensure sustainable implementation of telehealth in the paediatric speech and language therapy services of tomorrow. WHAT THIS PAPER ADDS: What is already known on this subject: The COVID‐19 pandemic led to the increased use of telehealth as a main mode of service delivery in paediatric speech and language therapy. Pre‐COVID‐19, evidence for the use of telehealth in this field included small‐scale experimental studies that reported on children with particular disorders and explored telehealth outcomes in comparison to face‐to‐face delivery. The realities of at‐scale clinical practice were not well‐represented, and critical elements of service such as cost‐effectiveness were often overlooked in the paediatric literature. Furthermore, despite emerging global evidence for temporary telehealth responses to the crisis in speech and language therapy, the long‐term and future use of telehealth remains unclear. What this paper adds to existing knowledge: The current study applied the lens of the APEASE (Acceptability, Practicability, Effectiveness, Affordability, Side‐effects, and Equity) criteria, which were used in this case to consider socioeconomic, ecological and cultural factors to capture an overarching understanding of the use of telehealth in paediatric speech and language therapy, and to inform the role of telehealth in future, longer‐term and at‐scale service development. Results indicated emerging trends in UK paediatric speech and language therapists' (SLTs') perceptions of telehealth and SLTs perceived a hybrid approach to service delivery, combining mostly face‐to‐face services with some telehealth, was likely to continue in the future. We identified six themes to guide the future development of telehealth in paediatric speech and language therapy services: (1) balanced and tailored services; (2) technology and equipment; (3) information and communication; (4) capacity building; (5) monitoring and evaluation; and (6) leadership and governance. What are the potential or actual clinical implications of this work?: UK SLTs believe that speech and language therapy services using telehealth should be reflective, tailored and flexible to meet the requirements and circumstances of the children, young people and families served, as well as the physical and emotional needs of practitioners. SLTs recommend that this service development is clearly communicated to all stakeholders and suggested that those using telehealth should be supported through appropriate training, and ongoing effectiveness should be monitored. Telehealth is here to stay and the APEASE criteria offer a unique opportunity to ensure sustainable models of service delivery; to support co‐ordinated leadership at the local, national and international levels and the development of policy and clinical guidance. [ABSTRACT FROM AUTHOR]

Background: Influenza (flu) vaccination rates in UK care home staff are extremely low. Less than 40% of staff in care homes are vaccinated for influenza (flu), presenting risks to the health of frail residents and potential staff absence from cross-infection. Staff often do not perceive a need for vaccination and are unaware they are entitled to free flu vaccination. The FluCare study, a cluster randomised control trial (RCT), uses behavioural interventions to address barriers. Videos, posters, and leaflets are intended to raise awareness of flu vaccination benefits and debunk myths. On-site staff vaccination clinics increase accessibility. Financial incentives to care homes for improved vaccination rates and regular monitoring influence the environment. This paper outlines the planned process evaluation which will describe the intervention's mechanisms of action, explain any changes in outcomes, identify local adaptations, and inform design of the implementation phase. Methods/design: A mixed method process evaluation to inform the interpretation of trial findings. Objectives: • Describe the intervention as delivered in terms of dose and fidelity, including adaptations and variations across care homes. • Explore the effects of individual intervention components on primary outcomes. • Investigate the mechanisms of impact. • Describe the perceived effectiveness of relevant intervention components (including videos, leaflets, posters, and flu clinics) from participant perspectives (care home manager, care home staff, flu clinic providers). • Describe the characteristics of care homes and participants to assess reach. A purposive sample of twenty care homes (ten in the intervention arm, ten in the control arm) for inclusion in the process evaluation. Data will include (1) study records including care home site profiles, (2) responses to a mechanism of action questionnaire, and (3) semi-structured interviews with care home staff and clinic providers. Quantitative data will be descriptively reported. Interview data will be thematically analysed and then categories mapped to the Theoretical Domains Framework. Discussion: Adopting this systematic and comprehensive process evaluation approach will help ensure data is captured on all aspects of the trial, enabling a full understanding of the intervention implementation and RCT findings. Trial registration: ISRCTN ISRCTN22729870. Registered on 24 August 2022. [ABSTRACT FROM AUTHOR]

Currently in the UK and Ireland, after a hip fracture most patients do not receive bone protection medication to reduce the risk of refracture. Yet randomised controlled trial data specifically examining patients with hip fracture have shown that intravenous zoledronate reduces refracture risk by a third. Despite this evidence, use of intravenous zoledronate is highly variable following a hip fracture; many hospitals are providing this treatment, whilst most are currently not. A range of clinical uncertainties, doubts over the evidence base and practical concerns are cited as reasons. This paper discusses these concerns and provides guidance from expert consensus, aiming to assist orthogeriatricians, pharmacists and health services managers establish local protocols to deliver this highly clinically and cost-effective treatment to patients before they leave hospital, in order to reduce costly re-fractures in this frail population. [ABSTRACT FROM AUTHOR]

A systematic literature review (SLR) of economic evaluations (EE) conducted for interventions to screen, treat, and manage retinopathy of prematurity (ROP) in the United States (US), United Kingdom (UK), and Canada was performed. The SLR accessed the MEDLINE, Embase, Cochrane, Web of Science, Health Business Elite, Econ. Lit, NHS EED, and Google Scholar databases over the period 1st January 2000 to 4th August 2021. The key Medical Subject Heading (MeSH) search terms used included: Retinopathy of prematurity, Cost-effectiveness analysis, Cost-utility analysis, Cost of illness, Cost-benefit analysis, Cost minimization analysis, Incremental cost-effectiveness ratio, Quality adjusted life years, return on investment, burden of illness, disability adjusted life years, and Economic evaluation. Screening was conducted using Covidence, and the risk of bias was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Data extraction was performed using MS Excel. 1,527 articles were examined with nine (9) papers identified, one (1) from the UK; two (2) from Canada and six (6) from the US. Cost-effectiveness analysis was the main form of EE conducted (n = 5) and telemedicine screening (n = 3) was found to be highly cost-effective for ROP with the ICER values ranging from £446 to £4,240 per Quality Adjusted Life Year (QALY) in 2021 figures. 73% of included studies complied with the CHEERS checklist for EE. ROP screening and treatment strategies reviewed were highly cost-effective. This review may assist eye health policymakers in planning nationwide screening and treatment programs to combat vision loss and blindness due to ROP. [ABSTRACT FROM AUTHOR]

Historically, consent for treatment in the United Kingdom's National Health Service has been collected using traditional paper forms. For public health services, such as immunizations, this process involved significant time, space, paper, and staff resources. In a bid to provide a more modern, secure, cost‐effective and paperless service, an electronic consent (eConsent) form for the routine school aged immunization program was designed and successfully piloted for the HPV 1 vaccine in 25 schools during the summer of 2019, with an average of 80% return rate. This was not only significantly higher than paper consent returns, there was also a significantly quicker return rate. These factors resulted in the clinical record being updated more quickly than ever before which reduced clinical risk. Following the pilot, the program was launched countywide for all school aged immunizations in September 2020. Since its launch some minor issues have been identified but resolved quickly and efficiently. Although still in its early days it is felt that the eConsent system has promoted a more informed and easier collaboration across sectors and has reduced operating costs. Although the use of electronic consent needs to be used more widely, it is felt that this new practice is a success. [ABSTRACT FROM AUTHOR]

Purpose: Loneliness and social isolation can occur at all stages of the life course and are recognized as a global health priority. The aim of this study was to review existing literature on the economic costs associated with loneliness and social isolation as well as evidence on the cost-effectiveness of interventions to prevent or address loneliness and social isolation.Methods: A bibliographic database search was undertaken in Medline, PsycINFO, CINAHL, and Embase, supplemented by a grey literature search and a reference list search. Papers were included that were published in English language in peer-reviewed literature in the past 10 years, reporting costs of loneliness and/or social isolation or economic evaluations of interventions whose primary purpose is to reduce loneliness and/or social isolation, including return on investment (ROI) or social return on investment (SROI) studies.Results: In total, 12 papers were included in this review, consisting of four cost-of-illness studies, seven economic evaluations and five ROI or SROI studies. Most studies were conducted in the UK and focused on older adults. Due to the inconsistent use of the terms loneliness and social isolation, as well as their measurement, the true economic burden can only be estimated to a certain extent and the comparability across economic evaluations and ROI studies is limited.Conclusions: The paucity of evidence that is available primarily evaluating the economic costs of loneliness indicates that more research is needed to assess the economic burden and identify cost-effective interventions to prevent or address loneliness and social isolation. [ABSTRACT FROM AUTHOR]

Background: The E-Freeze trial is a multi-centre randomised controlled trial of fresh versus frozen embryo transfer for women undergoing in vitro fertilisation. This paper describes the statistical analysis plan for the E-Freeze trial.Methods and Design: E-Freeze is a two-arm parallel-group, multi-centre, individually randomised controlled trial to determine if a policy of freezing embryos, followed by thawed frozen embryo transfer, results in a higher healthy baby rate when compared with the current policy of transferring fresh embryos. Couples undergoing their first, second or third cycle of in vitro fertilisation at fertility centres in the UK were randomised to either fresh or frozen embryo transfer. The primary outcome is a healthy baby, defined as a live singleton baby born at term with an appropriate weight for gestation. This paper describes the statistical analysis plan for the trial, including the analysis principles, definitions of outcomes, methods for primary analysis, pre-specified subgroup analysis and sensitivity analysis. This plan was finalised prior to completion of recruitment to the trial.Trial Registration: ISRCTN registry: ISRCTN61225414 . Registered on 29 December 2015. [ABSTRACT FROM AUTHOR]

This paper presents a study on the impacts of an inter-urban road development in the UK through a comprehensive investigation and clarification of the relationship between road-user benefits as a primary impact and changes in land values (CLVs) as a secondary impact. It seeks to offer a methodology aiming at coupling the conventional cost–benefit analysis (CBA) with aspects of economic impact analysis by avoiding double-counting of the results. The CBA model of an existing highway management tool was used to calculate road-user cost savings (RUCSs) of generated traffic, while CLVs were calculated over the same period using a statistical model newly developed for the purpose. A comparison of a 30-year time span was used to test similarities in trends of road-user benefits and CLVs. The main factors affecting the degree of similarity were found to be traffic and its prediction and, in particular, the traffic generated by the new road. It appears that over a 30-year period, a new road project has a positive effect on land values but a negative effect on RUCSs in the first years after construction. The latter increases for about 15 years and then follows a decreasing pattern in the last 10 years or so. [ABSTRACT FROM AUTHOR]

Integrated working can be a means of providing efficient and cost-effective care, which benefits both service users and health professionals. However, it does require readiness of practitioners to work in new and innovative ways to achieve integration. This paper describes the findings of a qualitative study exploring the nature of practice-based education and training underpinning successful integrated care teams using an ecological systems theory lens. Nine teams in the West Midlands region of the United Kingdom (UK) participated in this study. A total of 27 participants were involved in semi-structured interviews during which they shared their views and experiences of learning in practice. Thematic analysis of interview transcripts highlighted the shifting context of working in integrated teams impacting on learning, the influence of leadership on education and training, the nature of in-service training, and the knowledge-sharing culture. The findings highlight that the learning climate is highly dependent on the leadership ethos in the practice context, which influences the allocation of time and resources for training and clinical supervision. Whilst formal education and training has an important role to play in fostering integrated working, informal learning is pivotal to successful integration and potentially has greater impact making it worthy of further study. [ABSTRACT FROM AUTHOR]

Background: Up to 20% of UK children experience socio-emotional difficulties which can have serious implications for themselves, their families and society. Stark socioeconomic and ethnic inequalities in children's well-being exist. Supporting parents to develop effective parenting skills is an important preventive strategy in reducing inequalities. Parenting interventions have been developed, which aim to reduce the severity and impact of these difficulties. However, most parenting interventions in the UK focus on early childhood (0-10 years) and often fail to engage families from ethnic minority groups and those living in poverty. Strengthening Families, Strengthening Communities (SFSC) is a parenting programme designed by the Race Equality Foundation, which aims to address this gap. Evidence from preliminary studies is encouraging, but no randomised controlled trials have been undertaken so far.Methods/design: The TOGETHER study is a multi-centre, waiting list controlled, randomised trial, which aims to test the effectiveness of SFSC in families with children aged 3-18 across seven urban areas in England with ethnically and socially diverse populations. The primary outcome is parental mental well-being (assessed by the Warwick-Edinburgh Mental Well-Being Scale). Secondary outcomes include child socio-emotional well-being, parenting practices, family relationships, self-efficacy, quality of life, and community engagement. Outcomes are assessed at baseline, post intervention, three- and six-months post intervention. Cost effectiveness will be estimated using a cost-utility analysis and cost-consequences analysis. The study is conducted in two stages. Stage 1 comprised a 6-month internal pilot to determine the feasibility of the trial. A set of progression criteria were developed to determine whether the stage 2 main trial should proceed. An embedded process evaluation will assess the fidelity and acceptability of the intervention.Discussion: In this paper we provide details of the study protocol for this trial. We also describe challenges to implementing the protocol and how these were addressed. Once completed, if beneficial effects on both parental and child outcomes are found, the impact, both immediate and longer term, are potentially significant. As the intervention focuses on supporting families living in poverty and those from minority ethnic communities, the intervention should also ultimately have a beneficial impact on reducing health inequalities.Trial Registration: Prospectively registered Randomised Controlled Trial ISRCTN15194500 . [ABSTRACT FROM AUTHOR]

Aim: Optimal airway management during out-of-hospital cardiac arrest (OHCA) is uncertain. Complications from tracheal intubation (TI) may be avoided with supraglottic airway (SGA) devices. The AIRWAYS-2 cluster randomised controlled trial (ISRCTN08256118) compared the i-gel SGA with TI as the initial advanced airway management (AAM) strategy by paramedics treating adults with non-traumatic OHCA. This paper reports the trial cost-effectiveness analysis.Methods: A within-trial cost-effectiveness analysis of the i-gel compared with TI was conducted, with a six-month time horizon, from the perspective of the UK National Health Service (NHS) and personal social services. The primary outcome measure was quality-adjusted life years (QALYs), estimated using the EQ-5D-5L questionnaire. Multilevel linear regression modelling was used to account for clustering by paramedic when combining costs and outcomes.Results: 9296 eligible patients were attended by 1382 trial paramedics and enrolled in the AIRWAYS-2 trial (4410 TI, 4886 i-gel). Mean QALYs to six months were 0.03 in both groups (i-gel minus TI difference -0.0015, 95% CI -0.0059 to 0.0028). Total costs per participant up to six months post-OHCA were £3570 and £3413 in the i-gel and TI groups respectively (mean difference £157, 95% CI -£270 to £583). Based on mean difference point estimates, TI was more effective and less costly than i-gel; however differences were small and there was great uncertainty around these results.Conclusion: The small differences between groups in QALYs and costs shows no difference in the cost-effectiveness of the i-gel and TI when used as the initial AAM strategy in adults with non-traumatic OHCA. [ABSTRACT FROM AUTHOR]

Cost effectiveness of different visual screening modalities cannot be calculated without long-term outcome data. This paper reports detailed outcomes from a gold-standard UK recommended orthoptist-delivered screening (ODS) at 4–5 years in school, compared to a neighboring school-nurse delivered screening (SNDS), both feeding into the same treatment pathway. The target condition was reduced visual acuity (VA) of worse than logMAR 0.2 in either eye. Available records from screening databases and hospital records were analyzed, comparing the two services wherever possible. More screening data was available from the ODS. ODS: 5706 screened, 3.5% referred. False positives 6.5%, PPV 91.4%, sensitivity 97.9%, and specificity 99.8% for reduced VA. Cost per child with reduced vision detected £195.22, and per amblyope detected £683.28. The mean treatment cost per child with reduced VA was £331.68 and for amblyopia treatment was £458.65. SNDS: 5630 screened and 3.8% referred (plus some referrals to local optometrists lost to follow up). False positives 34%, PPV 53.2%, sensitivity and specificity estimated as 89.3% and 98.67%. Costs to secondary services of false positives were seven times greater. The cost per child with confirmed reduced vision seen at the hospital was 46% more; and per amblyope detected was 39% more. Outcomes for treatment post referral in both groups were similar and excellent. 86% of genuine referrals improved to within normal limits with glasses alone. Of 221 genuine referrals with final outcome data, all now have better than 0.2logMAR acuity in the better eye and only two (0.9%) have residual amblyopia in one eye worse than 0.4logMAR. About 14–18% of children with reduced VA would have passed AAPOS photoscreening referral criteria. An orthoptist-delivered single VA screen at 4–5 years is highly cost effective with good outcomes. The main contributing factors to success appear to be training and experience in accurate VA testing, the opportunity to rescreen equivocal results, and monitoring, audit, and feedback of outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Several forces are contributing to an increase in the number of people living with and surviving colorectal cancer (CRC). However, due to the lack of available data, little is known about the implications of these forces. In recent years, the use of administrative records to inform research has been increasing. The aim of this paper is to investigate the potential contribution that administrative data could have on the health economic research of CRC. Methods: To achieve this aim, we conducted a systematic review of the health economic CRC literature published in the United Kingdom and Europe within the last decade (2009–2019). Results: Thirty‐seven relevant studies were identified and divided into economic evaluations, cost of illness studies and cost consequence analyses. Conclusions: The use of administrative data, including cancer registry, screening and hospital records, within the health economic research of CRC is commonplace. However, we found that this data often come from regional databases, which reduces the generalisability of results. Further, administrative data appear less able to contribute towards understanding the wider and indirect costs associated with the disease. We explore several ways in which various sources of administrative data could enhance future research in this area. [ABSTRACT FROM AUTHOR]

The most widespread approach to transport appraisal is to combine cost-benefit analysis (CBA) with environmental assessments and public consultations. However, large-scale transport projects such as the HS2 high-speed rail system in the UK seem to have pushed this approach beyond its limits, leading to broad discontent with the appraisal process. There is a need both to develop new methods capable of integrating a wide range of perspectives in a systematic manner and to test these for large-scale projects. Multicriteria analysis (MCA) has proven useful in supporting transport decision-making by including a broader set of criteria in the appraisal process. Multiactor multicriteria analysis (MAMCA) has extended this approach to include multiple actors and stakeholders in the judgment and decision-making process. This paper builds on the MAMCA method and demonstrates its practicability and usability by applying it to the case of HS2. The purpose of this paper is not to reach a definitive conclusion on the desirability of various project options, but to complement existing transport appraisal methods by making different perspectives explicit. For example, the results for this case show contrasting views for different groups of transport professionals: a favorable assessment of HS2 among transport planners employed in government, but an unfavorable assessment among transport researchers with a background in sustainability. In terms of contribution to the development of data collection methods, this research demonstrates the usefulness of conducting semistructured interviews in conjunction with an online questionnaire for the assessment and weighting process within MCA. Because MCA results are expressed in terms of relative desirability of projects, the approach also effectively systematizes the inclusion and assessment of multiple options. Overall, the proposed method enhances the capacity to analyze conflicting views in large-scale transport project appraisal processes. [ABSTRACT FROM AUTHOR]

Objectives: The prevalence of hepatitis is high in emergency department (ED) attendees in the United Kingdom, with a prevalence of up to 2% for hepatitis B (HBV) HBsAg, and 2.9% for hepatitis C (HCV) RNA. The aim of this paper is to perform an economic evaluation of opt-out ED-based HCV and HBV testing.Methods: A Markov model was developed to analyze the cost-effectiveness of opt-out HCV and HBV testing in EDs in the UK. The model used data from UK studies of ED testing to parameterize the HCV and HBV prevalence (1.4% HCV RNA, 0.84% HBsAg), test costs, and intervention effects (contact rates and linkage to care). For HCV, we used an antibody test cost of £3.64 and RNA test cost of £68.38, and assumed direct-acting antiviral treatment costs of £10 000. For HBV, we used a combined HBsAg and confirmatory test cost of £5.79. We also modeled the minimum prevalence of HCV (RNA-positive) and HBV (HBsAg) required to make ED testing cost-effective at a £20 000 willingness to pay per quality-adjusted life-year threshold.Results: In the base case, ED testing was highly cost-effective, with HCV and HBV testing costing £8019 and £9858 per quality-adjusted life-year gained, respectively. HCV and HBV ED testing remained cost-effective at 0.25% HCV RNA or HBsAg prevalence or higher.Conclusions: Emergency department testing for HCV and HBV is highly likely to be cost-effective in many areas across the UK depending on their prevalence. Ongoing studies will help evaluate ED testing across different regions to inform testing guidelines. [ABSTRACT FROM AUTHOR]

Objectives: To describe and summarize evidence on economic evaluations (EEs) of primary caries prevention in preschool children aged 2 to 5 years and to evaluate the reporting quality of full EE studies using a quality assessment tool.Methods: A systematic literature search was conducted in several databases. Full and partial EEs were included. The reporting quality of full EE studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.Results: A total of 808 studies were identified, and 39 were included in the review. Most papers were published between 2000 and 2017 and originated in the United States and the United Kingdom. The most common type of intervention investigated was a complex multicomponent intervention, followed by water fluoridation. Cost analysis and cost-effectiveness analysis were the most frequently used types of EE. One study employed cost-utility analysis. The proportion of full EEs increased over time. The parameters not reported well included study perspective, baseline year, sensitivity analysis, and discount rate. The CHEERS items that were most often unmet were characterizing uncertainty, study perspective, study parameters, and estimating resources and costs.Conclusions: Within the past 2 decades, there has been an increase in the number of EEs of caries prevention interventions in preschool children. There was inconsistency in how EEs were conducted and reported. Lack of preference-based health-related quality-of-life measure utilization in the field was identified. The use of appropriate study methodologies and greater attention to recommended EE design are required to further improve quality. [ABSTRACT FROM AUTHOR]

Phase imbalance widely exists in the UK's low voltage (415 V, LV) distribution networks. The imbalances not only lead to insufficient use of LV network assets but also cause energy losses. They lead to hundreds of millions of British pounds each year in the UK. The cost-benefit analyses of phase balancing solutions remained an unresolved question for the majority of the LV networks. The main challenge is data-scarcity – these networks only have peak current and total energy consumption that are collected once a year. To perform a cost-benefit analysis of phase balancing for data-scarce LV networks, this paper develops a customized cluster-wise Gaussian process regression (CGPR) approach. The approach estimates the total cost of phase imbalance for any data-scarce LV network by extracting knowledge from a set of representative data-rich LV networks and extrapolating the knowledge to any data-scarce network. The imbalance-induced cost is then translated into the benefit from phase balancing and this is compared against the costs of phase balancing solutions, e.g., deploying phase balancers. The developed CGPR approach assists distribution network operators (DNOs) to evaluate the cost-benefit of phase balancing solutions for data-scarce networks without the need to invest in additional monitoring devices. [ABSTRACT FROM AUTHOR]

Food waste is a significant contemporary issue in the UK, with substantial environmental, social and economic costs to the nation. Whilst efforts to reduce food waste are laudable, a significant proportion of food and drink manufacturer waste is unavoidable. On the one hand, there is a drive from industry to reclaim as much value from this waste as possible, for example, by conversion to valuable products in what is known as "valorisation". At the same time, growing social and legislative pressures mean that any attempts to valorise food waste must be performed in a sustainable manner. However, for every company and its specific food wastes, there will be multiple valorisation possibilities and few tools exist that allow food and drink manufacturers to identify which is most profitable and sustainable for them. Such a decision would need to not only consider environmental, social and economic performance, but also how ready the technology is and how well it aligns with that company's strategy. In response, this paper develops and presents a hybrid framework that guides a company in modelling the volumes/seasonality of its wastes, identifying potential valorisation options and selecting appropriate indicators for environmental, social and economic performance as well as technological maturity and alignment with company goals. The framework guides users in analyzing economic and environmental performance using Cost-Benefit Analysis and Life Cycle Assessment respectively. The results can then be ranked alongside those for social performance, technological maturity and alignment with company goals using a weighted sum model variant of Multi-Criteria Decision Analysis to facilitate easy visual comparison. This framework is demonstrated in the form of a case study with a major UK fruit consolidator to identify the optimal strategy for managing their citrus waste. Possibilities identified included sale of imperfect but still edible waste via wholesale at a significantly reduced profit and the investment in facilities to extract higher value pectin from the same waste stream using a microwave assisted pectin extraction process. Results suggest that continued sale of waste to wholesale markets is currently the most beneficial in terms of economic viability and environmental performance, but that in the medium to long term, the projected growth in the market for pectin suggests this could become the most viable strategy. • When food waste cannot be avoided, valorisation can increase company resilience. • Valorisation strategies must try to avoid negative supply chain ramifications. • The SWaVI pragmatic framework allows companies to identify their optimal valorisation route. • The SWaVI pragmatic framework facilitates initial selection, not implementation of valorisation. [ABSTRACT FROM AUTHOR]

The National Institute for Health and Care Excellence (NICE), as part of the institute's single technology appraisal (STA) process, invited the company that makes obinutuzumab (Roche Products Limited) to submit evidence of the clinical and cost effectiveness of the drug in combination with chemotherapy, with or without obinutuzumab as maintenance therapy for adult patients with untreated, advanced follicular lymphoma (FL) in the UK. Kleijnen Systematic Reviews Ltd (KSR), in collaboration with Erasmus University Rotterdam, was commissioned to act as the Evidence Review Group (ERG). This paper describes the company's submission, the ERG review, and NICE's subsequent decisions. The clinical evidence was derived from two phase III, company-sponsored, randomised, open-label studies. Most evidence on obinutuzumab was based on the GALLIUM trial that compared obinutuzumab in combination with chemotherapy as induction followed by obinutuzumab maintenance monotherapy with rituximab in combination with chemotherapy as induction followed by rituximab maintenance monotherapy in previously untreated patients with FL (grades 1-3a). Long-term clinical evidence was based on the PRIMA trial, studying the benefit of two years of rituximab maintenance after first-line treatment in patients with FL. The cost-effectiveness evidence submitted by the company relied on a partitioned survival cost-utility model, implemented in Microsoft® Excel. The base-case incremental cost-effectiveness ratio (ICER) presented in the company submission was <£20,000 per quality-adjusted life-year (QALY) gained. Although the ERG concluded that the economic model met the NICE reference case to a reasonable extent, some errors were identified and several assumptions made by the company were challenged. A new base-case scenario produced by the ERG suggested an ICER that was higher than the company base case, but still below £30,000 per QALY gained. However, some ERG scenario analyses were close to or even above the threshold. This was the case in particular for assuming a treatment effect that did not extend beyond trial follow-up. These results led to an initial negative recommendation by the appraisal committee. Subsequently, the company submitted a revised base case focusing on patients at intermediate or high risk of premature mortality. Simultaneously, a further price discount for obinutuzumab was granted. In addition to the company's revised base case, the ERG suggested a restriction of the treatment effect to 5 years and implemented biosimilar uptake and cheaper prices for rituximab. All of these adjustments did not exceed £30,000 per QALY gained and therefore the use of obinutuzumab for patients with advanced FL and a Follicular Lymphoma International Predictive Index (FLIPI) score of two or more could be recommended. [ABSTRACT FROM AUTHOR]

Background: Childhood obesity is a serious public health challenge and schools have been identified as an ideal place to implement prevention interventions. The aim of this study was to measure the cost-effectiveness of a multi-faceted school-based obesity prevention intervention targeting children aged 6–7 years when compared to ‘usual activities’. Methods: A cluster randomised controlled trial in 54 schools across the West Midlands (UK) was conducted. The 12-month intervention aimed to increase physical activity by 30 minutes per day and encourage healthy eating. Costs were captured from a public sector perspective and utility-based health related outcomes measured using the CHU-9D. Multiple imputation using chained equations was used to address missing data. The cost effectiveness was measured at 30 months from baseline using a hierarchical net-benefit regression framework, that controlled for clustering and prespecified covariates. Any uncertainty in the results was characterised using cost-effectiveness acceptability curves. Results: At 30 months, the total adjusted incremental mean cost of the intervention was £155 (95% confidence interval [CI]: £139, £171), and the incremental mean QALYs gained was 0.006 (95% CI: -0.024, 0.036), per child. The incremental cost-effectiveness at 30 months was £26,815 per QALY and using a standard willingness to pay threshold of £30,000 per QALY, there was a 52% chance that the intervention was cost-effective. Conclusions: The cost-effectiveness of the school-based WAVES intervention was subject to substantial uncertainty. We therefore recommend more research to explore obesity prevention within schools as part of a wider systems approach to obesity prevention. Trial registration: This paper uses data collected by the WAVES trial: Controlled trials (registered May 2010). [ABSTRACT FROM AUTHOR]

Abstract This paper reflects on the impact of a decade of austerity measures on children in the UK, with a particular focus on the growing emphasis on cost benefit analysis (CBA) as a public rationing device. The argument points to the dangers of the now widespread use of this mechanism in the context of resourcing children's services, not just by state bodies, but by civil society organisations and others charged with the protection of children's rights. It considers why CBA is so appealing, and points to its potential in creating persuasive economic arguments in favour of investment in children; but it also points to the need for more principled, critical engagement with this device to prevent some of the mischiefs for which it has been used to date. The discussion proposes that a more robust rights-based approach, grounded firmly in the UN Convention on the Rights of the Child, would help to achieve a more fruitful correspondence between economic and children's rights-related objectives. Highlights • Cost benefit analysis • Children's rights • Socio-economic rights • Children's services, poverty [ABSTRACT FROM AUTHOR]

Objective: To examine the impact and cost associated with mental illness. Methods: A rapid review of the literature from Australia, New Zealand, UK and Canada was undertaken. The review included literature pertaining to the cost-of-illness and impact of mental illness as well as any modelling studies. Included studies were categorised according to impact on education, labour force engagement, earlier retirement or welfare dependency. The well-accepted Drummond 10-point economic appraisal checklist was used to assess the quality of the studies. Results: A total of 45 methodologically diverse studies were included. The studies highlight the significant burden mental illness places on all facets of society, including individuals, families, workplaces and the wider economy. Mental illness results in a greater chance of leaving school early, a lower probability of gaining full-time employment and a reduced quality of life. Research from Canada suggests that the total economic costs associated with mental illness will increase six-fold over the next 30 years with costs likely to exceed A$2.8 trillion (based on 2015 Australian dollars). Conclusions: Mental illness is associated with a high economic burden. Further research is required to develop a better understanding of the trajectory and burden of mental illness so that resources can be directed towards cost-effective interventions. What is known about the topic?: Although mental illness continues to be one of the leading contributors to the burden of disease, there is limited information on the economic impact that mental illness imposes on individuals, families, workplaces and the wider economy. What does this paper add?: This review provides a summary of the economic impact and cost of mental illness. The included literature highlights the significant burden mental illness places on individuals, families, workplaces, society and the economy in general. The review identified several areas for improvement. For example, only limited information is available on the impact of attention deficit hyperactivity disorder, anxiety, cognitive function, conduct disorder, eating disorder and psychological distress. There was also a dearth of evidence on the intangible elements of pain and suffering of people and their families with depressive disorders. More research is required to better understand the full extent of the impact of mental illness and strategies that may be implemented to minimise this harm. What are the implications for practitioners?: Knowing the current and future impact of mental illness highlights the imperative to develop an effective policy response. [ABSTRACT FROM AUTHOR]

Background: Exercise referral schemes are recommended by the National Institute for Clinical Excellence (NICE) for physical activity promotion among inactive patients with health conditions or risk factors. Whilst there is evidence for the initial effectiveness and cost-effectiveness of such schemes for increasing physical activity, evidence of long-term effects is limited. Techniques such as goal setting, self-monitoring and personalised feedback may support motivation for physical activity. Technologies such as activity monitoring devices provide an opportunity to enhance delivery of motivational techniques. This paper describes the PACERS study protocol, which aims to assess the feasibility and acceptability of implementing an activity monitor within the existing Welsh National Exercise Referral Scheme (NERS) and proposed evaluation methodology for a full-scale randomised controlled trial. Methods/design: The PACERS study consists of a pilot randomised controlled trial, process evaluation and exploratory economic analyses. Participants will be recruited from the generic pathway of the Welsh NERS and will be randomly assigned to receive the intervention or usual practice. Usual practice is a 16-week structured exercise programme; the intervention consists of an accelerometry-based activity monitor (MyWellnessKey) and an associated web platform (MyWellnessCloud). The primary outcomes are predefined progression criteria assessing the acceptability and feasibility of the intervention and feasibility of the proposed evaluation methodology. Postal questionnaires will be completed at baseline (time 0: T0), 16 weeks after T0 (T1) and 12 months after T0 (T2). Routinely collected data will also be accessed at the same time points. A sub-sample of intervention participants and exercise referral staff will be interviewed following initiation of intervention delivery and at the end of the study. Discussion: The PACERS study seeks to assess the feasibility of adding a novel motivational component to an existing effective intervention in order to enhance effects on physical activity and support longer-term maintenance. The study will provide insight into the acceptability of activity-monitoring technologies to an exercise referral population and delivery staff. Data from this study will be used to determine whether and how to proceed to a full-scale trial of effectiveness of the intervention, including any necessary refinements to intervention implementation or the proposed evaluation methodology. [ABSTRACT FROM AUTHOR]

Abstract: Thirty years ago, Adams (1981) depicted a future UK where everyone was a millionaire lorry driver, simply by extrapolating from contemporary official transport growth assumptions. These assumptions underpinned the ‘predict and provide’ approach which then characterised transport planning. Twenty years later, the New Deal for Transport White Paper (1998) abandoned ‘predict and provide’ as unsustainable. This paper argues that the same growth assumptions that Adams took to their logical (absurd) conclusion have re-emerged to define both transport and the drivers of transport demand. While non-aviation transport is supposed to be carbon-neutral by 2050, the implied reductions in emissions rely on an absolute decoupling of transport demand and its drivers for which there is no evidence in current planning. Targets rely on optimistic, narrowly framed technology forecasts and behaviour change assumptions which appear highly unlikely in the present socio-political climate. Moreover, such is the cost of mitigating these tensions between economic growth and other concerns, it is argued that the targeted outcomes of current policy are as undesirable as they are unlikely. The paper concludes by calling for a transport policy which considers mobility in an integrated, holistic fashion, rather than merely as a dimension of economic growth. [Copyright &y& Elsevier]

Purpose – The purpose of this paper is to discuss the economic pressures on long-term care systems, and describe how an economic case might be made for better care, support and preventive strategies. Design/methodology/approach – Discussion of recent developments and research responses, with illustrations from previous studies. Findings – Economics evidence is highly relevant to decision makers in health, social care, and related systems. When resources are especially tight, economics evidence can sometimes persuade uncertain commissioners and others to adopt courses of action that improve the wellbeing of individuals, families, and communities. Originality/value – The paper uses long-established approaches in economic evaluation to discuss preventive and other strategies in today's challenging context. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to review the management of the (accessible) social housing stock as a means to achieve a cost effective solution to meeting the needs of an ageing population. The paper examines the costs and effectiveness of an accessible housing register (AHR) as the primary means social landlords have to utilise accessible housing stock efficiently. Design/methodology/approach – The paper examines the cost effectiveness of the most advanced AHR in the UK. The data for the study was collected in 2009 (costs/expenditure quoted relate to that year) and is derived from a combination of interrogating computerised allocation records and the collection of information on costs through interviews with local authority staff. Findings – The concept of an AHR can involve substantial set up costs. The financial analysis to assess their cost effectiveness proves complex but suggests that an efficient full register could be more than justified in these terms if it led to a reduction in costs, through the removal of the need for a relatively small number of adaptations in the first years of a tenancy. Originality/value – This is the first study that assesses the financial case for AHRs. [ABSTRACT FROM AUTHOR]

Purpose – This paper seeks to suggest that social housing can and should be the local hub for cost-effective, human-scale health and wellbeing. It aims to explore the way that community-based housing providers can help health and social care services to deliver long-term wellbeing. Design/methodology/approach – The argument is illustrated with examples of constructive practice drawn from membership of the PlaceShapers Group of housing associations, across different parts of England. Findings – Localism and promotion of public health lie at the roots of social housing, dating back more than 150 years. Because of their physical stake and presence in communities, social landlords are able to offer combined homes and support in a way and on a scale that few private operators can match. So social housing providers are in a prime position to add value and recast the relationship between health, wellbeing, social care and housing. But social housing organisations and their leaders will need to be highly inventive, enterprising and determined to reap the full rewards for service users and neighbourhoods. Practical implications – Changes to the health, wellbeing and social care landscape, coming into effect in England and Wales from April 2013, present a unique opportunity to bridge the "parallel worlds" of housing and health. Local housing providers now have the chance to bond their long-term presence, commitment and investment in communities to the new outcomes required for health and social care. Originality/value – The lead author is chair of a grouping of community-based housing associations working throughout England and is especially well placed to identify examples of innovative practice, such as those described in the paper. [ABSTRACT FROM AUTHOR]

This paper estimates the effects of human capital skills largely created through education on life's chances over the life cycle. Qualifications as a measure of these skills affect earnings, and schooling affects private and social non-market benefits beyond earnings. Private non-market benefits include better own-health, child health, spousal health, infant mortality, longevity, fertility, household efficiency, asset management and happiness. Social benefits include increased democratisation, civil rights, political stability, reduced crime, lower prison, health and welfare costs, and new ideas. Individual benefits enhance community-wide development. New ‘narrow’ social rates of return using UK Labour Force earnings correct for institutional costs, longitudinal trends and ability. The paper's objective, however, is to estimate these earnings plus non-market outcomes comprehensively without overlaps and also relative to costs. Non-market outcomes are measured by averaging regression coefficients from published studies that meet scientific standards. New UK ‘narrow’ social rates of return average 12.1 per cent for short-cycle and 13.6 per cent for bachelor's programmes. Augmented with non-market effects on life chances, they are over twice that. Short degrees are found effective for regional development and have potential for developing countries. [ABSTRACT FROM PUBLISHER]

AimAge UK Lancashire received Big Lottery funding to deliver an active lives programme from January 2012 to December 2014 to the population of West Lancashire aged over 50 years. The overall aims of the associated evaluation were to measure older people’s experiences of participating in the programme, identify the impacts on their health and well-being and their suggestions for services development, and establish the costs and benefits of the programme.BackgroundThe World Health Organisation recommends older people should be able to achieve physical, social and mental well-being throughout their lives, and that international, national and local policies should be developed to support older adults, promote their independence and well-being, and encourage physical exercise. Consequently, the West Lancashire programme was to establish preventative community support for older people to assist in improving their well-being and physical and mental health, particularly those isolated due to age-related illness or disability. It was to provide interventions not available from local social care providers.MethodsA mixed methods approach was adopted, with the qualitative evaluation utilising focus groups to establish people’s experiences, identify impacts on their health and well-being, and suggestions for services development. This paper describes the quantitative evaluation, which involved three surveys and a costs analysis. The surveys were scheduled to give timely feedback to management about programme delivery and content, and overall benefits of participation.FindingsThe active lives programme and groups offered a wide range of flexible and local activities that provided benefits for older people in terms of health and well-being, social well-being and quality of life, and reducing social isolation. There was interconnectivity between these benefits. The programme was delivered in an affordable and flexible manner. Such programmes should be made more widely available. [ABSTRACT FROM PUBLISHER]

This paper outlines an econometric analysis of business planning data examining the scope for efficiency improvements of regulated firms in regulatory price reviews. Historical data may not fully reflect current industry cost structures, whereas forecast data offers evidence on cost evolution. Business Plans can provide useful information on planned elimination of inefficiencies in response to regulatory pressure. Network Rail submitted such data to the British railway regulator at the last Periodic Review (2013). Using a cost frontier model, the organisation's business units are analysed to determine the extent of their plans to eliminate internal inefficiencies and response to regulatory incentives. [ABSTRACT FROM AUTHOR]

Equity, efficiency and effectiveness are three key criteria use to assess environmental policy instruments. Part 1 of this survey shows that, in terms of equity, Tradable Energy Quotas (TEQs) – a widely discussed personal carbon trading (PCT) scheme - cannot be differentiated from Cap and Dividend (C&D) or Cap and Share (C&S). Hence, Part 2 explores whether they can be differentiated in terms of efficiency and/or effectiveness. The paper reviews two studies that compare the efficiency of TEQs and C&D. Whilst their estimates of the costs and abatement potential of TEQs differ, neither study considers that there is a case, on efficiency grounds, for its implementation. The paper goes on to sketch two arguments for the implementation of PCT that might, nevertheless, be made on efficiency grounds and one – relating to public acceptability – that might be made on effectiveness grounds. Exploring the various public surveys conducted on the acceptability of PCT, the paper concludes that support for PCT is not obviously greater than for alternative instruments and notes a methodological limitation in the work reviewed. The paper concludes that, to date, the case against implementation of PCT is stronger than the case for. [Copyright &y& Elsevier]

This is a paper reviewing the National Health Service (NHS) agenda in relation to the use of Negative Pressure Wound Therapy (NPWT) in chronic wound management and assesses the evidence behind it, its cost effectiveness and the outcome it has on patients' satisfaction and life style. Multiple studies over the last 10 years looking at clinical efficacy of NPWT with its cost effectiveness and the implementation of this service in the UK were reviewed. NPWT has showed a reasonable body of evidence to support its usage in chronic wounds with potential positive outcomes on finance and patients' satisfaction. However, the NHS system shows significant variations in the availability and implementation of this useful tool, depending on care providers and resources availabilities. The paper concluded that the NPWT can be a useful source of cutting down costs of chronic wound managements and saving money by its effect on expediting wound healing, which can address a part of the financial crises facing the NHS, however, has to be considered according to specific case needs. There should also be a national standard for the availability and indication of this tool to assure equal opportunities for different patients in different areas in the country. [ABSTRACT FROM AUTHOR]

Conduct disorder (CD) places huge costs on the individual, family and society. Parenting programmes can reduce CD symptomatology, but economic evaluations of their cost-effectiveness are rarely undertaken. The objective of this paper was to conduct the first specific systematic review of the published economic evidence of parenting programmes as a means to support families with children with or at risk of developing CD. A systematic search of 12 electronic databases was conducted. We identified 93 papers, of which six fulfilled the inclusion criteria. The search found one review article, mainly focusing upon clinical evidence with secondary focus on cost-effectiveness, one cost-effectiveness study, two partial economic evaluations and two cost studies. The costs of group parenting programme delivery ranged from £629.00 to £3839.00. Cost-effectiveness was influenced by intervention type and delivery method, i.e. individual versus group programme. The review highlights a need for a more standardized approach towards the comparison of the cost-effectiveness of parent programmes. In future studies it may be helpful to adopt a 'complex intervention approach', exploring in detail the attribution of cause and effect, the role of socio-economic setting and ripple effects, e.g. benefits to other family members. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to provide information about cost-effectiveness analysis and the roles of clinical pharmacologists generally in providing efficient health care. The paper highlights the potential consequences of ‘off-label prescribing’ and ‘indication creep’ behaviour given slower growth (or potential cuts) in the NHS budget. This paper highlights the key roles of clinical pharmacologists in delivering an efficient health care system when resources are allocated using cost-effectiveness analyses. It describes what cost-effectiveness analysis (CEA) is and how incremental cost-effectiveness ratios (ICERs) are used to identify efficient options. After outlining the theoretical framework within which using CEA can promote the efficient allocation of the health care budget, it considers the place of disinvestment within achieving efficient resource allocation. Clinical pharmacologists are argued to be critical to providing improved population health under CEA-based resource allocation processes because of their roles in implementation and disinvestment. Given that the challenges facing the United Kingdom National Health Service (NHS) are likely to increase, this paper sets out the stark choices facing clinical pharmacologists. [ABSTRACT FROM AUTHOR]

Abstract: International cost efficiency benchmarking played a central role in informing the Office of Rail Regulation''s (ORR) determination of Network Rail''s future funding during the 2008 periodic review (PR08) of the company''s finances. This paper sets out how international benchmarking can inform a regulator''s decisions on efficiency and, in particular, how international econometric studies can be used alongside other evidence in the regulatory context. We start by reviewing the use of previous international benchmarking work. We then set out the data, methodology and results in respect of the two separate econometric studies carried out as part of PR08. The further work that was done in support of the econometric results is then described. The paper shows that top-down econometric techniques, combined with bottom-up engineering analysis produced a robust comparison between Network Rail and its peers. We conclude by outlining how the econometric results were used, in conjunction with other evidence, to reach a final efficiency determination, and how we consider that international benchmarking can be applied by other regulators. [Copyright &y& Elsevier]

Since 1999, the National Institute for Health and Clinical Excellence (NICE) Technology Appraisal Programme has been charged with producing guidance for the NHS in England and Wales on the appropriate use of new and existing healthcare programmes. Guidance is based on an assessment of a number of factors, including cost effectiveness. The identification, measurement and valuation of costs are important components of any cost-effectiveness analysis. However, working through these steps raises a number of important methodological questions. For example, how should ‘future’ resource use be estimated, and is there a need to consider all ‘future’ costs? Given that NICE produces national guidance, should national unit cost data be used to value resources or should local variations in negotiated prices be taken into account? This paper was initially prepared as a briefing paper as part of the process of updating NICE’s 2004 Guide to the Methods of Technology Appraisal for a workshop on ‘costs’. It outlines the issues that were raised in the original briefing paper and the subsequent questions that were discussed at the workshop. [ABSTRACT FROM AUTHOR]

This article reports major themes emerging from 41 semi-structured interviews conducted with staff from one ‘old’ and one ‘new’ university in England about the use of the web in teaching and learning for campus-based students. The research set out to explore real-life instances of the use of the web in teaching and learning to determine the relationship between this reality and the rhetoric surrounding the use of information and communication technologies (ICTs) in universities. The focus of this paper is the motivations and/or barriers to adopting the WWW in teaching and learning at the institutional and individual staff level. The paper concludes by stressing that while there may be great potential for the use of ICTs for some aspects of teaching and learning, adoption of these new technologies is not straightforward; and, in the cases studied here, the use of the web in teaching and learning neither appears to be radically transforming teaching and learning within the university, nor to be providing (or even regarded as) a ready solution to the problems the sector currently encounters. [ABSTRACT FROM AUTHOR]

There is little in the literature describing hospital specialist palliative care units (PCUs) within the NHS. This paper describes how specialist PCUs can be set up within and be entirely funded by the NHS, and outlines some of the challenges and successes of the units. Having PCUs within hospitals has offered patients increased choice over their place of care and death; perhaps not surprisingly leading to a reduced death rate in the acute hospital. However, since the opening of the PCUs there has also been an increased home death rate. The PCUs are well received by patients, families and other staff within the hospital. We believe they offer a model for excellence in cost-effective inpatient specialist palliative care within the NHS. [ABSTRACT FROM AUTHOR]

Background: Rising cancer incidence, the cost of cancer pharmaceuticals and the introduction of the Cancer Drugs Fund in England, but not other United Kingdom(UK) countries means evidence of 'postcode prescribing' in cancer is important. There have been no systematic reviews considering access to cancer drugs by geographical characteristics in the UK.Methods: Studies describing receipt of cancer drugs, according to healthcare boundaries (e.g. cancer network [UK]) were identified through a systematic search of electronic databases and grey literature. Due to study heterogeneity a meta-analysis was not possible and a narrative synthesis was performed.Results: 8,780 unique studies were identified and twenty-six included following a systematic search last updated in 2015. The majority of papers demonstrated substantial variability in the likelihood of receiving chemotherapy between hospitals, health authorities, cancer networks and UK countries (England and Wales). After case-mix adjustment, there was up to a 4-5 fold difference in chemotherapy utilisation between the highest and lowest prescribing cancer networks. There was no strong evidence that rurality or distance travelled were associated with the likelihood of receiving chemotherapy and conflicting evidence for an effect of travel time.Conclusions: Considerable variation in chemotherapy prescribing between healthcare boundaries has been identified. The absence of associations with natural geographical characteristics (e.g. rurality) and receipt of chemotherapy suggests that local treatment habits, capacity and policy are more influential. [ABSTRACT FROM AUTHOR]

The remit of the National Institute for Health Research Public Health Research (PHR) Programme is to evaluate public health interventions, providing new knowledge on the benefits, costs, acceptability and wider impacts of interventions, set outside of the National Health Service, intended to improve the health of the public and reduce inequalities. This paper illustrates how the PHR Programme is providing new knowledge for public health decision makers, based on the nine key areas for local authority public health action, described by the King's Fund. Many funded PHR projects are evaluating interventions, applied in a range of settings, across the identified key areas for local authority influence. For example, research has been funded on children and young people, and for some of the wider determinants of health, such as housing and travel. Other factors, such as spatial planning, or open and green spaces and leisure, are less represented in the PHR Programme. Further opportunities in research include interventions to improve the health of adolescents, adults in workplaces, and communities. Building evidence for public health interventions at local authority level is important to prioritise and implement effective changes to improve population health. [ABSTRACT FROM AUTHOR]

This paper uses a 'case in sector' analysis to investigate the extent to which the success criteria imposed by cost accounting constrains the ability of engineers to acquire and make effective use of computer aided design (CAD). The paper examines two periods of CAD investment in a sample of UK manufacturers. In the first 'early adoption' period CAD proposals were made by junior engineers on a locally initiated 'bottom up' basis. Proposals were made according to the dictates of conventional cost benefit analysis, engineering and accounting priorities were separate, and senior management were not involved. In the second 'general adoption' period there was a general uptake of CAD throughout the sector. The paper demonstrates that the evaluation of CAD was influenced not just by the rival claims of accountants and engineers, but also by long run changes in the operating environment, and by the control devices employed by senior management. The findings bear out the view of technological change as a socially negotiated process. However, it would appear that the oranizational practices associated with CAD evaluation are continually re-negotiated in the light of dynamic organizational interests and changes in the broader sectoral context. [ABSTRACT FROM AUTHOR]

This paper considers the term evidence-based practice by way of its relationship to empirically supported therapies and NICE guidance, before critiquing the randomised control trial methodology. We feel psychologists need to engage in such debates to inform those who commission services. [ABSTRACT FROM AUTHOR]

• A market-based approach to procure reactive power is analysed. • Reactive power support from network assets and DER is considered. • The analysis is done in the context of an innovation project. • Savings are given by the difference between the NVP of BAU costs and alternative solutions. • Actual prices from the live trial are used. This paper quantifies the benefits of introducing reactive power markets that promote the participation of distributed energy resources (DER) in a coordinated way, between the electricity system operator and the electricity distribution utilities. The contribution that DER could make by displacing conventional network assets in supplying reactive power support is evaluated in the context of a case study, the Power Potential (PP) project in Great Britain. We discuss the rising need for absorptive (leading) reactive power in the PP trial area, driven by the rapid connection of renewable generation in an area of low demand growth. A social cost benefit analysis (SCBA) is performed to quantify the net benefits, with sensitivities regarding bid prices, % of DER participation, time horizons. Price information from the PP live trial conducted between January and March 2021 is also used to evaluate the robustness of the SCBA and to estimate benefits using actual prices. Our results suggest that energy consumers could save from 8 to 21% of business as usual asset costs by 2050. The introduction of actual bid prices increases these savings by around 3% of business as usual asset costs out to 2050. Potential sources of additional benefits on top of those identified in the SCBA are also discussed. [ABSTRACT FROM AUTHOR]

The Midland Metro light rail system began running between Wolverhampton and Birmingham in 1999. Despite initial problems of reliability, it now has a stable patronage of around 5 million passenger journeys per year and is one of the most reliable transport services in the West Midlands. Centro, as owner of Midland Metro, has long been keen to expand the system and has battled to obtain funding. Over the last 3 years, the company has made significant progress towards delivery of the line's expansion, including a major structure required to put trams back onto the streets of Birmingham, finalising a funding package and placing the order for a new tram fleet. This paper examines Centro's successful approach to obtaining the necessary funding for the Metro expansion and the benefits it will deliver for the West Midlands; how the company is ensuring - through its procurement strategy, programme management approach and risk management - that the scheme is cost effective; and the longer term strategy for growth of the system that will result from delivery of this first phase of expansion. [ABSTRACT FROM AUTHOR]

Background: Resources for supporting children and adolescents with psychiatric disorders continue to be scarce. Economics research can identify current patterns of expenditure, and help inform allocation of treatment and support resources between competing needs or uses. Scope and methods: The aim was to identify the costs of supporting children and adolescents, the economic impacts of childhood psychiatric disorders in adulthood and any new evidence on the cost-effectiveness of interventions. An electronic search of databases (including PubMed, Medline and Psychinfo) identified peer-reviewed journal articles published between 2005 and 2012. Findings: Sixty-seven papers provided data on support and treatment costs now or in the future, or cost-effectiveness analyses of services. Half the articles came from the United States. Most articles focussed on autism spectrum disorder (ASD; 23 articles), attention deficit hyperactivity disorder (ADHD; n = 15), conduct disorder (CD; n = 7), and anxiety or depression (n = 8). Conclusion: Only 14 studies used a cost perspective wider than health care; most included education costs (n = 11), but only five included costs to the justice system. The number of studies estimating costs to the family has increased, particularly for children with autism spectrum disorder (ASD). In the United Kingdom, support costs for children and adolescents with conduct disorder (CD) appear to be lower than for those with attention deficit hyperactivity disorder (ADHD), although for the United States, the opposite may be true. Support costs for children and adolescents with ASD may be higher than both CD and ADHD. However, there were many differences between the samples and the methods employed making comparisons between studies difficult. Outcomes in adulthood include negative impacts on (mental) health, quality of life, public sector services, employment status and income. The evidence base is improving for child and adolescent psychiatric disorders, although only one full cost-effectiveness analysis was identified since the previous review published in 2012. However, we still do not know enough about the economic implications of support and treatment for specific disorders. [ABSTRACT FROM AUTHOR]

Purpose – There has been a significant increase in flooding in the UK over the past ten years. During this time, Government policy has moved from investment in flood defences towards encouraging property owners to take responsibility for reducing the impact of flooding. One of the ways in which this can be achieved is for homeowners to adapt their properties to flood risk by implementing property level flood risk adaptation (PLFRA) measures. While there has been some attempt to develop an understanding of the benefits of such measures, these previous studies have their limitations in that the intangible benefits have not been fully considered. As such, there remains a need for further development of these studies towards developing a more comprehensive understanding of PLFRA measures. It is against this background the purpose of this paper is to present a conceptual cost benefit analysis (CBA) framework for PLFRA measure. This framework brings together the key parameters of the costs and benefits of adapting properties to flood risk including the intangible benefits, which have so far been overlooked in previous studies. Design/methodology/approach – A critical review of the standard methods and existing CBA models of PLFRA measures was undertaken. A synthesis of this literature and the literature on the nature of flooding and measures to reduce and eliminate their impacts provides the basis for the development of a conceptual framework of the costs and benefits of PLFRA measures. Within the developed framework, particular emphasis is placed on the intangible impacts, as these have largely been excluded from previous studies in the domain of PLFRA measures. Findings – The framework provides a systematic way of assessing the costs and benefits of PLFRA measures. A unique feature of the framework is the inclusion of intangible impacts, such as anxiety and ill health, which are known to be difficult to measure. The study proposes to implement one of the stated preference methods (SPM) of valuation to measure these impacts, known as the willingness to pay method, as part of a survey of homeowners. The inclusion of these intangible impacts provides the potential to develop a more comprehensive understanding of the benefit cost ratio (BCR) for different stakeholders. The newly developed CBA conceptual framework includes four principal components: the tangible benefits to insurers; the tangible benefits to the government; the tangible benefits to homeowners; and the intangible benefits to homeowners. Originality/value – This tool offers the potential to support government policy concerned with increasing the uptake of PLFRA measures through increasing the information available to homeowners and thereby supporting the decision-making process. [ABSTRACT FROM AUTHOR]

Background A number of published economic evaluations of elective endovascular aneurysm repair ( EVAR) versus open repair for abdominal aortic aneurysm ( AAA) have come to differing conclusions about whether EVAR is cost-effective. This paper reviews the current evidence base and presents up-to-date cost-effectiveness analyses in the light of results of four randomized clinical trials: EVAR-1, DREAM, OVER and ACE. Methods Markov models were used to estimate lifetime costs from a UK perspective and quality-adjusted life-years ( QALYs) based on the results of each of the four trials. The outcomes included in the model were: procedure costs, surveillance costs, reintervention costs, health-related quality of life, aneurysm-related mortality and other-cause mortality. Alternative scenarios about complications, reinterventions and deaths beyond the trial were explored. Results Models based on the results of the EVAR-1, DREAM or ACE trials did not find EVAR to be cost-effective at thresholds used in the UK (up to £30 000 per QALY). EVAR seemed cost-effective according to models based on the OVER trial. These results seemed robust to alternative model scenarios about events beyond the trial intervals. Conclusion These analyses did not find that EVAR is cost-effective compared with open repair in the long term in trials conducted in European centres. EVAR did appear to be cost-effective based on the OVER trial, conducted in the USA. Caution must be exercised when transferring the results of economic evaluations from one country to another. [ABSTRACT FROM AUTHOR]