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Objective: To systematically review and critically appraise the economic evaluations of one to one interventions to reduce sexually transmitted infections (STIs) and teenage conceptions. Design: Systematic review. Data Sources: Search of four electronic bibliographic databases from 1990 to January 2006. Search keywords included teenage, pregnancy, adolescent, unplanned, unwanted, cost benefit, cost utility, economic evaluation, cost effectiveness and all terms for STIs, including specific diseases. Review Methods: We included studies that evaluated a broad range of one to one interventions to reduce STIs. Outcomes included major outcomes averted, life years and quality adjusted life years (QALY). All studies were assessed against quality criteria. Results: Of 3,190 identified papers, 55 were included. The majority of studies found one to one interventions to be either cost saving or cost effective, although one highlighted the need to target the population to receive post-exposure prophylaxis to reduce transmission of HIV. Most studies used a static approach that ignores the potential re-infection of treated patients. Conclusion: One to one interventions have been shown to be cost saving or cost effective but there are some limitations in applying this evidence to the UK policy context. More UK research using dynamic modelling approaches and QALYs would provide improved evidence, enabling more robust policy recommendations to be made about which one to one interventions are cost effective in reducing STIs in the UK setting. The results of this review can be used by policy makers, health economists and researchers considering further research in this area. [ABSTRACT FROM AUTHOR]

Objective To determine the cost-effectiveness of a physical activity programme (Be Active) aimed at city-dwelling adults living in Birmingham, UK. Methods Very little is known about the cost-effectiveness of public health programmes to improve city-wide physical activity rates. This paper presents a cost-effectiveness analysis that compares a physical activity intervention (Be Active) with no intervention (usual care) using an economic model to quantify the reduction in disease risk over a lifetime. Metabolic equivalent minutes achieved per week, quality-adjusted life years (QALYs) gained and healthcare costs were all included as the main outcome measures in the model. A cost-benefit analysis was also conducted using 'willingness-to-pay' as a measure of value. Results Under base-case assumptions--that is, assuming that the benefits of increased physical activity are sustained over 5 years, participation in the Be Active programme increased quality-adjusted life expectancy by 0.06 years, at an expected discounted cost of £3552, and thus the cost-effectiveness of Be Active is £400 per QALY. When the start-up costs of the programme are removed from the economic model, the cost-effectiveness is further improved to £16 per QALY. The societal value placed on the Be Active programme was greater than the operation cost therefore the Be Active physical activity intervention results in a net benefit to society. Conclusions Participation in Be Active appeared to be cost-effective and cost-beneficial. These results support the use of Be Active as part of a public health programme to improve physical activity levels within the Birmingham-wide population. [ABSTRACT FROM AUTHOR]

Background Systematic reviews suggest school-based mindfulness training (SBMT) shows promise in promoting student mental health. Objective The My Resilience in Adolescence (MYRIAD) Trial evaluated the effectiveness and cost-effectiveness of SBMT compared with teaching-as-usual (TAU). Methods MYRIAD was a parallel group, cluster-randomised controlled trial. Eighty-five eligible schools consented and were randomised 1:1 to TAU (43 schools, 4232 students) or SBMT (42 schools, 4144 students), stratified by school size, quality, type, deprivation and region. Schools and students (mean (SD); age range=12.2 (0.6); 11-14 years) were broadly UK population-representative. Forty-three schools (n=3678 pupils; 86.9%) delivering SBMT, and 41 schools (n=3572; 86.2%) delivering TAU, provided primary end-point data. SBMT comprised 10 lessons of psychoeducation and mindfulness practices. TAU comprised standard social-emotional teaching. Participant-level risk for depression, social-emotional-behavioural functioning and well-being at 1 year follow-up were the co-primary outcomes. Secondary and economic outcomes were included. Findings Analysis of 84 schools (n=8376 participants) found no evidence that SBMT was superior to TAU at 1 year. Standardised mean differences (intervention minus control) were: 0.005 (95% CI -0.05 to 0.06) for risk for depression; 0.02 (-0.02 to 0.07) for social-emotional-behavioural functioning; and 0.02 (-0.03 to 0.07) for well-being. SBMT had a high probability of cost-effectiveness (83%) at a willingness-to-pay threshold of £20 000 per quality-adjusted life year. No intervention-related adverse events were observed. Conclusions Findings do not support the superiority of SBMT over TAU in promoting mental health in adolescence. Clinical implications There is need to ask what works, for whom and how, as well as considering key contextual and implementation factors. Trial registration Current controlled trials ISRCTN86619085. This research was funded by the Wellcome Trust (WT104908/Z/14/Z and WT107496/Z/15/Z). [ABSTRACT FROM AUTHOR]

Objective To estimate the carbon footprint of behavioural support services for smoking cessation: text message support, telephone counselling, group counselling and individual counselling. Design Carbon footprint analysis. Data source Publicly available data on National Health Service Stop Smoking Services and per unit carbon emissions; published effectiveness data from the txt2stop trial and systematic reviews of smoking cessation services. Main outcome measures Carbon dioxide equivalents (CO2e) per 1000 smokers, per lifetime quitter, and per quality-adjusted life year gained, and cost-effectiveness, including social cost of carbon, of smoking cessation services. Results Emissions per 1000 participants were 8143 kg CO2e for text message support, 8619 kg CO2e for telephone counselling, 16 114 kg CO2e for group counselling and 16 372 kg CO2e for individual counselling. Emissions per intervention lifetime quitter were 636 (95% CI 455 to 958) kg CO2e for text message support, 1051 (95% CI 560 to 2873) kg CO2e for telephone counselling, 1143 (95% CI 695 to 2270) kg CO2e for group counselling and 2823 (95% CI 1688 to 6549) kg CO2e for individual counselling. Text message, telephone and group counselling remained cost-effective when costeffectiveness analysis was revised to include the environmental and economic cost of damage from carbon emissions. Conclusions All smoking cessation services had low emissions compared to the health gains produced. Text message support had the lowest emissions of the services evaluated. Smoking cessation services have small carbon footprints and were cost-effective after accounting for the societal costs of greenhouse gas emissions. [ABSTRACT FROM AUTHOR]

Objective To assess the cost-effectiveness of transcatheter aortic valve implantation (TAVI) compared with medical management in patients with severe aortic stenosis who are ineligible for conventional aortic valve replacement (SAVR) from the perspective of the UK National Health Service Design Probabilistic decision analytical model Methods A decision analytical model was developed to assess the costs and benefits associated with both interventions over a 10-year time horizon. A literature review was performed to identify relevant clinical evidence. Health-related quality of life and mortality were included using data from the PARTNER clinical trial (cohort B). Unit costs were taken from national databases. Costs and benefits were discounted at 3.5% per year, and extensive sensitivity analyses (probabilistic and deterministic) were performed to explore the impact of uncertainty on the cost-effectiveness estimates Main outcome measure Incremental costeffectiveness ratio (ICER) with benefits expressed as quality-adjusted life years (QALYs Results The base case ICER was approximately £16 100 per QALY gained. At a cost-effectiveness threshold of £20 000 per QALY gained, the probability that TAVI was cost-effective compared with medical management was 1.00. The results were robust to changes in key clinical parameters as well as choice of baseline survival data. The observed PARTNER survival data only have to be extrapolated for 2 years to generate an ICER below £30 000 per QALY gained, which is the upper value of the threshold range used by the National Institute for Health and Clinical Excellence in the UK. Conclusions TAVI is highly likely to be a cost-effective treatment for patients with severe aortic stenosis who are currently ineligible for SAVR [ABSTRACT FROM AUTHOR]

Objective To undertake a cost-effectiveness analysis that compares pulse oximetry as an adjunct to clinical examination with clinical examination alone in newborn screening for congenital heart defects (CHDs). Design Model-based economic evaluation using accuracy and cost data from a primary study supplemented from published sources taking an NHS perspective. Setting Six large maternity units in the UK. Patients 20 055 newborn infants prior to discharge from hospital. Intervention Pulse oximetry as an adjunct to clinical examination. Main outcome measure Cost effectiveness based on incremental cost per timely diagnosis. Results Pulse oximetry as an adjunct to clinical examination is twice as costly but provides a timely diagnosis to almost 30 additional cases of CHD per 100 000 live births compared with a modelled strategy of clinical examination alone. The incremental cost-effectiveness ratio for this strategy compared with clinical examination alone is approximately £24 000 per case of timely diagnosis in a population in which antenatal screening for CHDs already exists. The probabilistic sensitivity analysis suggests that at a willingness-to-pay (WTP) threshold of £100 000, the probability of 'pulse oximetry as an adjunct to clinical examination' being cost effective is more than 90%. Such a WTP threshold is plausible if a newborn with timely diagnosis of a CHD gained just five quality-adjusted life years, even when treatment costs are taken into consideration. Conclusion Pulse oximetry as an adjunct to current routine practice of clinical examination alone is likely to be considered a cost-effective strategy in the light of currently accepted thresholds. [ABSTRACT FROM AUTHOR]

Objective: Economic evaluation of computerised decision-support software intended to assist in the interpretation of a cardiotocography (CTG) during birth.Design: Individual patient level data from the INFANT study (an unmasked randomised controlled trial).Setting: Maternity units in the UK and Ireland.Population: Singleton or twin pregnancy women of 35 weeks' gestation or more and receiving continuous electronic fetal monitoring during labour.Intervention: Computerised decision-support software.Methods: Cost-consequence analysis presenting costs and outcomes with a time horizon of 2 years from a government healthcare perspective. Unit cost data collected from a combination of primary and secondary sources.Main Outcome Measures: Primary clinical outcomes were (i) composite 'poor neonatal outcome' and (ii) developmental assessment at age 2 years in a subset of surviving children. Mean cost per mother and infant dyad from birth to hospital discharge, and from hospital discharge to 24 months follow-up. Maternal health-related quality of life was assessed at 12 and 24 months follow-up using the EuroQol three-level health-related quality of life instrument (EQ-5D-3L).Results: Data were analysed for 46 042 women and 46 614 infants. No statistically significant differences were detected between trial arms in any of the primary clinical outcomes or maternal quality of life. No statistically significant differences in costs were detected in maternal or infant costs from trial entry to hospital discharge or overall from hospital discharge to 2-year follow-up.Conclusions: Decision-support software during labour is not associated with additional maternal or infant benefits and over a 2-year period the software did not lead to additional costs or savings to the National Health Service.Trial Registration Number: ISRCTN98680152. [ABSTRACT FROM AUTHOR]

Objectives: Transvenous lead extraction (TLE) poses a significant economic and resource burden on healthcare systems; however, limited data exist on its true cost. We therefore estimate real-world healthcare reimbursement costs of TLE to the UK healthcare system at a single extraction centre.Methods: Consecutive admissions entailing TLE at a high-volume UK centre between April 2013 and March 2018 were prospectively recorded in a computer registry. In the hospital's National Health Service (NHS) clinical coding/reimbursement database, 447 cases were identified. Mean reimbursement cost (n=445) and length of stay (n=447) were calculated. Ordinary least squares regressions estimated the relationship between cost (bed days) and clinical factors.Results: Mean reimbursement cost per admission was £17 399.09±£13 966.49. Total reimbursement for all TLE admissions was £7 777 393.51. Mean length of stay was 16.3±15.16 days with a total of 7199 bed days. Implantable cardioverter-defibrillator and cardiac resynchronisation therapy defibrillator devices incurred higher reimbursement costs (70.5% and 68.7% higher, respectively, both p<0.001). Heart failure and prior valve surgery also incurred significantly higher reimbursement costs. Prior valve surgery and heart failure were associated with 8.3 (p=0.017) and 5.5 (p=0.021) additional days in hospital, respectively.Conclusions: Financial costs to the NHS from TLE are substantial. Consideration should therefore be given to cost/resource-sparing potential of leadless/extravascular cardiac devices that negate the need for TLE particularly in patients with prior valve surgery and/or heart failure. Additionally, use of antibiotic envelopes and other interventions that reduce infection risk in patients receiving transvenous leads should be considered. [ABSTRACT FROM AUTHOR]

Background: In January 2016, clinical TB guidance in the UK changed to no longer recommend screening contacts of non-pulmonary, non-laryngeal (ETB) index cases. However, no new evidence was cited for this change, and there is evidence that screening these contacts may be worthwhile. The objective of this study was to estimate the cost-effectiveness of screening contacts of adult ETB cases and adult pulmonary or laryngeal TB (PTB) cases in London, UK.Methods: We carried out a cross-sectional analysis of data collected on TB index cases and contacts in the London TB register and an economic evaluation using a static model describing contact tracing outcomes. Incremental cost-effectiveness ratios (ICERs) were calculated using no screening as the baseline comparator. All adult TB cases (≥15 years old) in London from 2012 to 2015, and their contacts, were eligible (2465/5084 PTB and 2559/6090 ETB index cases were included).Results: Assuming each contact with PTB infects one person/month, the ICER of screening contacts of ETB cases was £78 000/quality-adjusted life-years (QALY) (95% CI 39 000 to 140 000), and screening contacts of PTB cases was £30 000/QALY (95% CI 18 000 to 50 000). The ICER of screening contacts of ETB cases was £30 000/QALY if each contact with PTB infects 3.4 people/month. Limitations of this study include the use of self-reported symptomatic periods and lack of knowledge about onward transmission from PTB contacts.Conclusions: Screening contacts of ETB cases in London was almost certainly not cost-effective at any conventional willingness-to-pay threshold in England, supporting recent changes to National Institute for Health and Care Excellence national guidelines. [ABSTRACT FROM AUTHOR]

The National Institute for Health and Care Excellence (NICE) was established in 1999 to provide evidence-based guidance. The task of producing guidance by reviewing primary research data and using an advisory committee to develop evidence-based recommendations, is not straightforward. Guidance production is, however, less challenging than the task of putting evidence-based recommendations into practice.NICE is very sensitive to this challenge as, since 1999, over 1500 pieces of NICE guidance have been published. A number of pieces of guidance relate to heart disease, including pharmaceutical agents, new medical technologies and clinical guidelines. Examples include guidelines on acute heart failure and atrial fibrillation, and advice on technologies including edoxaban and implantable cardioverter defibrillators.The research evidence is clear that a change in practice rarely comes about as a result of simply disseminating guidance on best practice. Simple dissemination is particularly ineffective if the guidance has not been produced by a well-respected, credible organisation. It is also clear from the literature that implementation is more successful when more than one approach is taken, and when there is alignment between efforts at organisational, local and national levels.At an organisational level, there should be support from the Board for quality improvement, with ongoing measurement of progress. Resources should be provided for targeted change programmes, particularly where new guidance suggests improvements are required. A systematic process for putting change in place should include identifying barriers to change, agreeing interventions to overcome the barriers and drive forward improvement and planning for implementation and evaluation. [ABSTRACT FROM AUTHOR]

Objectives: To determine health and equity benefits and cost effectiveness of policies to reduce or eliminate trans fatty acids from processed foods, compared with consumption remaining at most recent levels in England.Design: Epidemiological modelling study.Setting: Data from National Diet and Nutrition Survey, Low Income Diet and Nutrition Survey, Office of National Statistics, and health economic data from other published studiesParticipants: Adults aged ≥25, stratified by fifths of socioeconomic circumstance.Interventions: Total ban on trans fatty acids in processed foods; improved labelling of trans fatty acids; bans on trans fatty acids in restaurants and takeaways.Main Outcome Measures: Deaths from coronary heart disease prevented or postponed; life years gained; quality adjusted life years gained. Policy costs to government and industry; policy savings from reductions in direct healthcare, informal care, and productivity loss.Results: A total ban on trans fatty acids in processed foods might prevent or postpone about 7200 deaths (2.6%) from coronary heart disease from 2015-20 and reduce inequality in mortality from coronary heart disease by about 3000 deaths (15%). Policies to improve labelling or simply remove trans fatty acids from restaurants/fast food could save between 1800 (0.7%) and 3500 (1.3%) deaths from coronary heart disease and reduce inequalities by 600 (3%) to 1500 (7%) deaths, thus making them at best half as effective. A total ban would have the greatest net cost savings of about £265m (€361m, $415m) excluding reformulation costs, or £64m if substantial reformulation costs are incurred outside the normal cycle.Conclusions: A regulatory policy to eliminate trans fatty acids from processed foods in England would be the most effective and equitable policy option. Intermediate policies would also be beneficial. Simply continuing to rely on industry to voluntary reformulate products, however, could have negative health and economic outcomes. [ABSTRACT FROM AUTHOR]

Presents an editorial on the issuance of a sixth coronary heart disease drug. Thoughts on how zero risk for disease is not possible; Belief that no health care system has the resources to deliver every test and treatment that offers even minimal potential benefit to every patient; Citing of the paper by Marshall in this issue on the national treatment guidelines; Conclusion that national guideline should be amended to offer preventive measures in order of cost effectiveness.

The article offers information on a study that aimed to re-evaluate the public health impact and cost effectiveness of universal vaccination against meningitis. Topics discussed includes infant immunization, effects of different introductory Bexsero vaccination programmes and results of sensitivity analysis.

When thinking about population level healthcare priority setting decisions, such as those made by the National Institute for Health and Care Excellence, good medical ethics requires attention to three main principles of health justice: (1) cost-effectiveness, an aspect of beneficence, (2) non-discrimination, and (3) priority to the worse off in terms of both current severity of illness and lifetime health. Applying these principles requires consideration of the identified patients who benefit from decisions and the unidentified patients who bear the opportunity costs. [ABSTRACT FROM AUTHOR]

Objectives: To investigate ethnic differences in the cost-effectiveness of targeted and mass screening for high cardiovascular risk. Design: Simulation of two screening strategies (targeted screening of most deprived areas and mass screening) using cross-sectional data from Health Survey for England. Setting: England. Subjects: 9407 adults aged 40-74 years (493 Black Caribbean, 532 Indian, 516 Pakistani/Bangladeshi, 617 Irish and 7249 general population of whom 6633 were White). Main outcome measures: Coverage of high-risk population, number needed to screen to identify one person at high cardiovascular risk and cost-effectiveness of targeted screening, with incremental analysis of expanding targeted to mass screening. Results: Coverage, number needed to screen and costeffectiveness of targeted screening were better in all ethnic minority groups compared with the White group and general population. Targeted screening would identify 19.2% of high-risk individuals in the general population, and require 4.1 people to be screened to identify one person at high cardiovascular risk at a cost of £98. In the Pakistani/Bangladeshi group, 68.7% of the high-risk population would be identified, and only 2.5 people would need to be screened at a lower cost of £59. In comparison with targeted screening, mass screening was less cost-effective overall but the cost per additional high-risk individual detected was the lowest among the South Asian groups (Indian £130 and Pakistani/Bangladeshi £94). Conclusions: Irrespective of whether cardiovascular screening is targeted or universal, it is more costeffective in South Asian ethnic groups than in the general population. Therefore, cardiovascular screening has the potential to reduce ethnic health inequalities. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the effectiveness of mobile phone based self-monitoring of patients from primary care with poorly controlled asthma in Great Britain. The study has conducted a parallel group randomised controlled trial and an analysis of costs. The results of the study have revealed that the paper based model of asthma care is less expensive than the mobile phone supported model.

Objective To assess the cost-effectiveness of dabigatran etexilate, a new oral anticoagulant, versus warfarin and other alternatives for the prevention of stroke and systemic embolism in UK patients with atrial fibrillation (AF). Methods A Markov model estimated the costeffectiveness of dabigatran etexilate versus warfarin, aspirin or no therapy. Two patient cohorts with AF (starting age of <80 and ≥80 years) were considered separately, in line with the UK labelled indication. Modelled outcomes over a lifetime horizon included clinical events, quality-adjusted life years (QALYs), total costs and incremental cost-effectiveness ratios (ICERs). Results Patients treated with dabigatran etexilate experienced fewer ischaemic strokes (3.74 dabigatran etexilate vs 3.97 warfarin) and fewer combined intracranial haemorrhages and haemorrhagic strokes (0.43 dabigatran etexilate vs 0.99 warfarin) per 100 patient-years. Larger differences were observed comparing dabigatran etexilate with aspirin or no therapy. For patients initiating treatment at ages <80 and $80 years, the ICERs for dabigatran etexilate were £4831 and £7090/QALY gained versus warfarin with a probability of cost-effectiveness at £20 000/QALY gained of 98% and 63%, respectively. For the patient cohort starting treatment at ages <80 years, the ICER versus aspirin was £3457/QALY gained and dabigatran etexilate was dominant (ie, was less costly and more effective) compared with no therapy. These results were robust in sensitivity analyses. Conclusions This economic evaluation suggests that the use of dabigatran etexilate as a first-line treatment for the prevention of stroke and systemic embolism is likely to be cost-effective in eligible UK patients with AF. INSET: Key messages. [ABSTRACT FROM AUTHOR]

Aims To assess the cost-effectiveness of installing thermostatic mixer valves (TMVs) in reducing risks of bath water scalds and estimate the costs of avoiding bath water scalds. Methods The evaluation was undertaken from the perspective of the UK public sector, and conducted in conjunction with a randomised control trial of TMVs installed in social housing in Glasgow. Installation costs were borne by the social housing organisation, while support materials were provided by the UK NHS. Effectiveness was represented by the number of families with at-risk bath water temperatures pre- and post-installation, and the number of bath scalds avoided as a result of installation. Differences in the number of families with at-risk temperatures between groups were derived from the RCT. Cost-effectiveness was assessed and a series of one-way sensitivity analyses were conducted. Results Unit costs associated with installation were calculated to be £13.68, while costs associated with treating bath water scalds ranged from £25 226 to £71 902. The cost of an avoided bath water scald ranged from net savings to public purse of £1887 to £75 520 and at baseline produced a net saving of £3 229 008; that is, £1.41 saved for every £1 spent. Conclusion It is very likely that installing TMVs as standard in social housing in new buildings and major refurbishments accompanied by educational information represents value for money. [ABSTRACT FROM AUTHOR]

Objective: To assess the cost effectiveness of primary angioplasty, compared with medical management with thrombolytic drugs, to achieve reperfusion after acute myocardial infarction (AMI) from the perspective of the UK NHS. Design: Bayesian evidence synthesis and decision analytic model. Methods: A systematic review was conducted and Bayesian statistical methods used to synthesise evidence from 22 randomised control trials. Resource utilisation was based on UK registry data, published literature and national databases, with unit costs taken from routine NHS sources and published literature. Main outcome measure: Costs from a health service perspective and outcomes measured as quality-adjusted life years (QALYs). Results: For the base case, the incremental cost-effectiveness ratio of primary angioplasty was £9241 for each additional QALY, with a probability of being cost effective of 0.90 for a cost-effectiveness threshold of £20 000. Results were sensitive to variations in the additional time required to initiate treatment with primary angioplasty. Conclusions: Primary angioplasty is cost effective for the treatment of AMI on the basis of threshold cost- effectiveness values used in the NHS and subject to a delay of up to about 80 minutes. These findings are mainly explained by the superior mortality benefit and the prevention of non-fatal outcomes associated with primary angioplasty for delays of up to this length. [ABSTRACT FROM AUTHOR]

Background: The EUropean trial on Reduction Of cardiac events with Perindopril in stable coronary Artery disease (EUROPA) trial has recently reported. Objective: To assess the cost effectiveness of perindopril in stable coronary heart disease in the UK. Methods: Clinical and resource use data were taken from the EUROPA trial. Costs included drugs and hospitalisations. Health-related quality of life values were taken from published sources. A cost-effectiveness analysis is presented as a function of the risk of a primary event (non-fatal myocardial infarction, cardiac arrest or cardiovascular death) in order to identify people for whom treatment offers greatest value for money. Results: The median incremental cost of perindopril for each quality-adjusted life year (QALY) gained across the heterogeneous population of EUROPA was estimated as £9700 (interquartile range £6400-£14 200). Overall, 88% of the EUROPA population had an estimated cost per QALY below £20 000 and 97% below £30 000. For a threshold value of cost effectiveness of £30 000 per QALY gained, treatment of people representing the 25th, 50th (median) and 75th centiles of the cost effectiveness distribution for perindopril has a probability of 0.999, 0.99 and 0.93 of being cost effective, respectively. Cost effectiveness was strongly related to higher risk of a primary event under standard care. Conclusions: Whether the use of perindopril can be considered cost effective depends on the threshold value of cost effectiveness of healthcare systems. For the large majority of patients included in EUROPA, the incremental cost per QALY gained was lower than the apparent threshold used by the National Institute for Health and Clinical Excellence in the UK. [ABSTRACT FROM AUTHOR]

Background The imminent publication of a randomised controlled trial from the USA that suggests CT screening reduces mortality from lung cancer by more than 20%, may potentially lead to one of the most important developments in lung cancer care. However, there remain important questions about the applicability of the results to the UK and the clinical effectiveness of this intervention, including its feasibility and costeffectiveness. Objective To describe the remaining questions that need to be answered by further research and to comment on the use of CT screening in the UK outside a clinical trial. Methods The detailed design process of the UKLS protocol and international discussions were used to identify the research questions that remain to be answered and to inform those who may choose to consider offering CT screening, before these questions are answered. Results A series of research imperatives have been identified and we advise that CT screening should be part of the ongoing clinical trial in the UK, currently in the pilot phase (UKLS). UKLS is randomising 4,000 individuals for the pilot and a total of 32,000 for the main study. Conclusion There remain unresolved issues with respect to CT screening for lung cancer. These include its feasibility, psychosocial and cost-effectiveness in the UK, harmonisation of CT acquisition techniques, management of suspicious screening findings, the choice of screening frequency and the selection of an appropriate risk group for the intervention. UKLS is aimed at resolving these issues. [ABSTRACT FROM AUTHOR]

A review is presented of the article "Estimating the Population Impact of Screening Strategies for Identifying and Treating People at High Risk of Cardiovascular Disease: Modelling Study" by P. Chamnan, R. K. Simmons, K. T. Khaw et al., which appeared in a 2010 issue of the "British Medical Journal".