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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]

Actually, COVID-19 and its variants present a big challenge for the public health security. COVID-19 is a new form of the coronaviruses characterized by a set of symptoms like laboratory and radiological symptoms, when the first case has confirmed in December 2019 in Wuhan City, as well as a new variant of this form has appeared in December 2020 in the United Kingdom. Internet of things (IoT) is a technological revolution employed in different areas in the aim to serve the asked purposes. The implementation of IoT solutions in healthcare area has several benefits such as reducing the cost of services and improving treatment results. In this paper, we present a review on the impact of IoT on this new health challenge (COVID-19 and its variants), we will focus this study on the impact of the use of IoT devices to reduce transmissions of COVID-19 and its variants. [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]

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]

Abstract: This paper reviews the statistics and economics of railway safety in Great Britain, the European Union and the United States, together with some results for Finland and Japan. In these countries railway safety has improved over recent decades. That finding applies both to train accidents and to personal accidents such as persons struck by trains. Fatal train collisions and derailments command most attention even though they are infrequent and account for only a small minority of railway fatalities. Great Britain, the EU and the USA formally espouse conventional cost benefit analysis for the appraisal of railway safety measures, using the same valuations for the prevention of casualties as are used in road safety appraisal. However there are often strong institutional, legal and political pressures towards adopting railway safety measures with safety benefit: cost ratios well below 1. The best-documented examples of this are automatic train protection systems, which are discussed in the paper. Apart from trespassers, the largest group of railway fatalities occur at level crossings, which the paper also discusses. Level crossing safety measures would seem to be an appropriate subject for cost benefit analysis, but there are few case-studies in the literature. Over the last few decades, the railways in many countries have been privatised or deregulated with the aim of improving their economic performance. Such changes have the potential to affect safety. The paper reviews evidence of the effects on safety of railway restructuring in Great Britain, Japan and the United State, and finds no evidence that safety deteriorated. [Copyright &y& Elsevier]

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]

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]

Abstract: The growing stream of municipal solid waste (MSW) requires a sustainable waste management strategy. At the same time, addressing climate change and security of energy supply concerns requires increased use of low-carbon and domestic sources of energy. This paper assesses the economic and environmental aspects of waste management options focusing on waste-to-energy (WtE) as a renewable resource. We discuss how WtE and recycling are compatible as waste treatment options. The paper then presents a social cost–benefit analysis of selected waste management scenarios for the UK focusing on specific waste management targets and carbon prices and compares them with coal-fired electricity. The results indicate that meeting the waste management targets of the EU Directive are socially more cost-effective than the current practice. The cost-effectiveness improves substantially with higher carbon prices. The findings show that WtE can be an important part of both waste management strategy and renewable energy policy although achieving the full potential of WtE requires development of heat delivery networks. [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]

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]

• 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]

Abstract: In order to reduce carbon emissions and alleviate fuel poverty, the UK Government has outlined proposals for a “Green Deal” to help provide financing for the installation of cost-effective retrofit measures to the existing UK housing stock. However, the Green Deal proposals have the potential to generate financial risk, due to a possible overestimation of the energy savings arising from retrofit measures. This paper proposes a framework for handling the uncertainties associated with the prediction of these energy savings, as well as demonstrating how decisions can be made in the face of the uncertainties involved in the retrofit analysis of a housing stock. The proposed framework is applied to a case study set of dwellings and it is seen that a limited range of measures will be cost-effective under the Green Deal proposals for these dwellings; as a result, subsidies will be required if higher impact measures are to be considered viable. Finally, however, it is also seen that the monetary value of additional societal benefits, such as reduced carbon emissions and improved thermal comfort, is likely to more than outweigh the cost of any subsidies. [Copyright &y& Elsevier]

Abstract: This paper develops multiple-pollutant marginal abatement cost curve analysis to identify an optimal set of greenhouse gas (GHG) mitigation measures considering the trade-offs and synergies with other environmental pollutants. The analysis is applied to UK agriculture, a sector expected to make a contribution to the national GHG mitigation effort. Previous analyses using marginal abatement cost curves (MACCs) have determined the sector''s GHG abatement potential based on the cost-effectiveness of a variety of technically feasible mitigation measures. Most of these measures have external effects on other pollution loads arising from agricultural activities. Here the monetary values of four of the most important impacts to water and air (specifically ammonia, nitrate, phosphorous and sediment) are included in the cost-effectiveness analysis. The resulting multiple-pollutant marginal abatement cost curve (MP MACC) informs the design of sustainable climate change policies by showing how the MP MACC for the UK agriculture can differ from the GHG MACC. The analysis also highlights research gaps, and suggests a need to understand the wider environmental effects of GHG mitigation options and to reduce the uncertainty in pollutant damage cost estimates. [Copyright &y& Elsevier]

Abstract: This work assesses the main regulatory responses to the changes in the capital structure of the utilities firms. It examines the different means of influencing the capital structure and the various concerns related to high gearing; particularly in relation to the cost of capital and risk. The paper argues that several of those concerns are unfounded and that the effectiveness of various aspects of the regulation of capital structure and the setting of the cost of capital are highly questionable. [Copyright &y& Elsevier]

Abstract: In the context of ambitious commitments to reduce CO2 emissions in industrialised countries, the domestic sector will play a crucial role as one of the biggest sources of end-use emissions. In the past, several studies have aimed to analyse the costs and the technical feasibility of CO2 emissions reduction in the domestic stock. This paper addresses the issue of abatement costs and potentials in the housing stock from a systems perspective in order to capture interactions and interdependencies with the wider energy system. Marginal abatement cost (MAC) curves for the UK residential sector are derived based on the energy systems model UK MARKAL in combination with decomposition analysis. The results indicate that it is cost-effective to implement conservation measures, as well as increase the share of district heat and biomass for space and water heating. The decarbonisation of electricity and heat dominates the lower part of the residential sector MAC curve up to £50/t CO2. The MAC curve is found to be robust to fossil fuel prices, while more expensive electricity and limited availability of biomass significantly reduce the abatement potential. The results underline the need to assess emissions reduction from a systems perspective to capture system-wide interactions. [Copyright &y& Elsevier]

The J-value technique allows an objective determination to be made of the resources that should be applied cost effectively to improve heath and safety. This is essential if capabilities are to be employed optimally and risks reduced in a way that reflects their severity. Although other considerations such as good practice and socio-political influences may affect a final decision on the resources to be sanctioned, the incorporation of these additional factors should be made transparent if the decision is no longer to be based on cost effectiveness. The J-value provides an objective criterion by which to judge when "reasonable practicability" has been achieved in committing resources for safety improvement, which is the legal requirement under health and safety law in the UK. Moreover, the J-value methodology also allows other related issues to be addressed objectively. Regulatory bodies apply different limits for workers and the general public, with higher risks being permitted for workers. Although a factor of about 10 has been used in several contexts, no objective rationale has been developed for this particular figure until now. However, it is shown that application of the J-value analysis can provide a justification for a ratio of workers' risk to public risk of approximately this size if certain reasonable assumptions are made. Thus the paper provides the first quantitative explanation for the different levels of protection demanded by regulators nationally and internationally for workers and public. [ABSTRACT FROM AUTHOR]

Abstract: Despite significant conservation efforts, global biodiversity continues to decline. A key contributing factor has been a failure to fully recognise the range of ecosystem service benefits provided by biodiversity. In this paper, we use a case study relating to Sites of Special Scientific Interest (SSSI) in England and Wales to demonstrate the potential ecosystem service benefits that can be derived from biodiversity conservation policies. Our approach involved three stages: (1) a choice experiment to assess the economic value of ecosystem services delivered by SSSI sites; (2) a ‘weighting matrix’ to (a) assign ecosystem services to the different SSSI habitats and (b) identify the contribution that conservation management on SSSIs has on the delivery of these services; (3) estimation of the aggregated economic value of ecosystem services directly attributable to conservation management on SSSI sites. The public are willing to pay £956m annually to secure the levels of services and benefits currently delivered by SSSI conservation activities, and a further £769 million to secure the benefits that would be delivered if SSSIs were all in favourable condition. These benefit estimates significantly exceed the annual £111 million costs of managing SSSIs, demonstrating that investing in biodiversity conservation can be cost effective. [Copyright &y& Elsevier]

Abstract: This paper analyzes the cost efficiency of UK airports over the period 1998–2008, using a Bayesian dynamic frontier model. This model provides a more structural explanation for the variation in airports inefficiency than has been presented by previous models, and also allows for cost inefficiency effects. On average, the dynamic frontier results, estimated via the Markov Chain Monte-Carlo simulation, indicate that UK airports improved their efficiency over time. Factors found to be important determinants of cost efficiency include airport size, price regulation, price cap variations and airport competition. Policy implications of the results are derived. [Copyright &y& Elsevier]

Abstract: The successful provision of Demand Responsive Transport (DRT) in Europe, Australia, UK and the US has been addressed in several substantial studies and projects. The general finding of these studies is that DRT is a suitable transport solution in particular areas and can deliver social inclusion and community building objectives. Existing research confirms that DRT is particularly useful for connecting isolated communities and population groups to essential services such as healthcare and is cost-effective in terms of contributing greatly to community wellbeing. However, many existing DRT services are still not performing to their true potential, and many of them could not be viable as commercial services. The aim of this study is to develop greater understanding of DRT services from the passengers’ perspective using a case study of LinkUp in Tyne and Wear, one of the most successful DRT schemes in the UK. The paper has two key objectives: (a) to critically review, in the context of the detailed case study the general characteristics of the selected DRT scheme; and (b) to analyse and interpret the findings from a detailed survey of users (who are predominately elderly and female) with regard to passenger characteristics, their attitudes and perception of the service and their suggestions for improvement. [Copyright &y& Elsevier]

Abstract: Background: The rise in the number of patients with arthritis coupled with understaffing of medical services has seen the deployment of Clinical Nurse Specialists in running nurse-led clinics alongside the rheumatologist clinics. There are no systematic reviews of nurse-led care effectiveness in rheumatoid arthritis. Few published RCTs exist and they have shown positive results for nurse-led care but they have several limitations and there has been no economic assessment of rheumatology nurse-led care in the UK. Objective: This paper outlines the study protocol and methodology currently being used to evaluate the outcomes and cost effectiveness for patients attending rheumatology nurse-led clinics. Design and methods: A multi-centred, pragmatic randomised controlled trial with a non-inferiority design; the null hypothesis being that of ‘inferiority’ of nurse-led clinics compared to physician-led clinics. The primary outcome is rheumatoid arthritis disease activity (measured by DAS28 score) and secondary outcomes are quality of life, self-efficacy, disability, psychological well-being, satisfaction, pain, fatigue and stiffness. Cost effectiveness will be measured using the EQ-5D, DAS28 and cost profile for each centre. Power calculations: In this trial, a DAS28 change of 0.6 is considered to be the threshold for clinical distinction of ‘inferiority’. A sample size of 180 participants (90 per treatment arm) is needed to reject the null hypothesis of ‘inferiority’, given 90% power. Primary analysis will focus on 2-sided 95% confidence interval evaluation of between-group differences in DAS28 change scores averaged over 4 equidistant follow up time points (13, 26, 39 and 52 weeks). Cost effectiveness will be evaluated assessing the joint parameterisation of costs and effects. Results: The study started in July 2007 and the results are expected after July 2011. Trial registration: The International Standard Randomised Controlled Trial Number ISRCTN29803766. [Copyright &y& Elsevier]

Abstract: Currently, a wide range of strategies is implemented in different countries to increase the share of electricity from renewable energy sources (RES-E). A still controversial discussion is whether quantity-driven (like Tradable Green Certificates (TGCs) based on quotas) or price-driven (like feed-in-tariffs (FIT)) instruments lead to preferable solutions for society. The core objective of this paper is to compare the perspectives of quota-based certificate trading systems for an efficient and effective increase of RES-E with FIT. The major results of this analysis are: (i) The success stories of growth in RES-E in EU member states in recent years has been triggered by FIT implemented in a technology-specific manner at modest costs for European citizens; (ii) At present, TGC systems in most countries applied show a low effectiveness with respect to RES-E deployment of less mature technologies such as solar PV (with improving tendencies in e.g. the UK or Italy with respect to certain technologies); (iii) Compared to short term trading in TGC markets the intrinsic stability of FIT systems appears to be a key element for success; (iv) Hence, currently a well-designed (dynamic) FIT system provides a certain deployment of RES-E in the shortest time and at lowest costs for society. [Copyright &y& Elsevier]

Abstract: Discounting has been a long-established intertemporal efficiency tool in cost-benefit analysis which focuses on project selection at communal level with a view to maximising the social welfare. However, with the relentless growth in environmental stress that, in good parts, stems from investment projects the established criterion in discounting appears to be inadequate especially when environmental issues are taken into consideration. This paper looks at how dual focus on efficiency and sustainability can be achieved by using dual discounting, i.e. discounting environmental benefits separately and differently from other costs and benefits and applies this alternative criterion to an afforestation scheme in the United Kingdom which contains carbon sequestration in addition to timber benefits. [Copyright &y& Elsevier]

Abstract: This paper reviews current methodologies for measuring the moisture content of straw bale walls in buildings. It discusses the development of an affordable and accurate moisture probe that has been designed to be easily assembled by the builder or owner of a straw bale building from items readily available in the United Kingdom (UK). The probe uses a timber block inserted into the wall, relying upon the measurable moisture variances of the timber and relating this to the surrounding straw. The probes are designed to be used in pairs of varying length, taking measurements at different depths to give an estimate of the moisture gradient through the wall. In order to properly calibrate this device, a full set of sorption and desorption isotherms were established for both Oat and Wheat straw and three different timber species. The results from an environmental chamber have been compared to readings from specimens of the new probe installed in a straw bale house in the south west of the UK. The results were found to be consistent, to within 2%, with the laboratory findings. [ABSTRACT FROM AUTHOR]

Abstract: With the UK Marine Bill promoting the creation of a network of marine protected areas and similar commitments in other countries there is a need for tools to assist in their design and management. Although physical science often drives designation, the implementation of marine protected areas also encompasses political and socio-economic issues. This paper focuses on one tool in the armoury of decision-makers: choice experiments. It illustrates its application to the quantification of aspects of socio-economic value not readily incorporated into the evaluation of the costs and benefits of marine protected areas utilising cold-water deep coral reefs off the Republic of Ireland. [Copyright &y& Elsevier]

Abstract: Objective: To assess the long-term cost effectiveness of treatment for 1 month, and for 1 year with clopidogrel in addition to standard therapy (including aspirin) compared with standard therapy alone, in patients diagnosed with ST elevation acute myocardial infarction (STEMI) in the UK. Design: Cost utility analysis using a cohort Markov model, incorporating clinical data from two pivotal clinical trials (the COMMIT/CCS-2 and CLARITY-TIMI 28 trials) and data from UK and non-UK observational studies. Setting: Health economic evaluation carried out from the perspective of the UK NHS. Patients: A representative cohort of 1000 UK patients aged 60 years, diagnosed with STEMI. Interventions: 75 mg/day clopidogrel, with and without a 300 mg loading dose, in addition to standard therapy (including aspirin, 75–325 mg/day) for 1 month, and for 1 year, followed by standard therapy alone for their remaining lifetime, or standard therapy alone (including aspirin, 75–325 mg/day) for their remaining lifetime. Main outcome measures: Incremental cost per quality-adjusted life-year (QALY) gained (ICER). Results: For the 1-month treatment option both the COMMIT/CCS-2 and CLARITY-TIMI 28 trials have ICERs below £2500. For the 1-year treatment option both trials have ICERs below £4000. Extensive univariate and probabilistic sensitivity analyses showed these results to be robust. Conclusions: In combination with previous economic analyses of clopidogrel in NSTEMI patients, this paper demonstrates that clopidogrel appears to offer a cost-effective treatment option for all ACS patients. [Copyright &y& Elsevier]

Abstract: This paper presents the technical and economic performance of energy-from-waste (EfW) fluidized bed combustion and gasification processes and reports on the implications of different scales and technologies on costs and efficiencies. Mass and energy balances of the processes were performed and the cost effectiveness of the different waste treatment options, for the generation of electric power, was assessed using a discounted cash flow analysis. For the different waste treatment options, the study concludes that gasification processes have higher overall system efficiencies than combustion processes. In particular, fluidized bed gasification with combined cycle gas turbine (CCGT) is the most attractive treatment option in terms of cost and efficiency. Although fluidized bed gasification has limited commercial operation in the UK, they are compatible with high levels of source segregation and, therefore, have the potential to contribute towards integrated waste management practices. The operational reliability of the systems will be further improved as more facilities are commissioned and operated at commercial scales. Furthermore, financial incentives, such as Renewable Obligation Certificates (ROCs), supportive policies and active R&D by major industry players and research institutions are important factors for the full commercialisation of the gasification processes, especially, for plant scales larger that 50ktpa. [Copyright &y& Elsevier]

Objective: This article assesses the cost-effectiveness of pentostatin compared with cladribine in the management of hairy cell leukemia (HCL) in the United Kingdom. Methods: A systematic literature search for papers on HCL was performed using MEDLINE, EMBASE, Current Contents, NHS Economic Evaluation Database, and the Cochrane computerized database. Search terms were HCL plus 1 of the following: incidence, prevalence, epidemiology, cladribine, interferon, pentostatin, rituximab, splenectomy, utility, quality of life, cost-effectiveness, cost-utility, resource utilization, economic, or cost. Published clinical outcomes and estimates of health care resource use obtained from 10 consultant hematologists across the United Kingdom were used to construct a 5-year Markov model depicting the current management of HCL in the United Kingdom. Utilities for health states in the model were obtained from the general public using standard gamble, time tradeoff, and visual analog scale techniques. The model was used to consider the decision by a clinician to initially treat an HCL patient with either pentostatin or cladribine and to estimate the relative cost-effectiveness of pentostatin over 5 years (at 2007/2008 prices) from the perspective of the UK''s National Health Service (NHS). Results: According to the model, 64% of all pentostatin-treated patients are expected to be in relapse-free remission at 5 years compared with 49% of cladribine-treated patients (P = 0.04). Repeat treatment of initial partial responders, nonresponders, and those who relapse during the 5 years is expected to result in complete remission in 92% of pentostatintreated patients and 90% of cladribine-treated patients at 5 years. Using pentostatin instead of cladribine is expected to lead to a minimal cost increase (from £21,325 to £21,609) and an improvement in health status (from 3.64 to 3.77 quality-adjusted life-years [QALYs]) over 5 years. Hence, the cost per QALY gained from using pentostatin is expected to be £5000. Moreover, pentostatin has a 0.90 probability of being cost-effective for a threshold of £20,000 per QALY. Accordingly, using pentostatin as a first-line treatment for patients with HCL is an effective use of NHS resources. Conclusion: Based on current practice, this model predicts that pentostatin is a cost-effective treatment compared with cladribine in the management of HCL from the perspective of the UK''s NHS. [Copyright &y& Elsevier]

Summary The problem of managing demand: Most healthcare systems have 'third-party payers' who face the problem of keeping within budgets despite pressures to increase resources due to the ageing population, new technologies and patient demands to lower thresholds for care. This paper uses the UK National Health Service as a case study to suggest techniques for system-based demand management, which aims to control demand and costs whilst maintaining the cost-effectiveness of the system. Technique for managing demand: The technique for managing demand in primary, elective and urgent care consists of managing treatment thresholds for appropriate care, using a whole-systems approach and costing the care elements in the system. It is important to analyse activity in relation to capacity and demand. Examples of using these techniques in practice are given. Conclusion: The practical effects of using such techniques need evaluation. If these techniques are not used, managing demand and limiting healthcare expenditure wilt be at the expense of clinical outcomes and unmet need, which wilt perpetuate financial crises. [ABSTRACT FROM AUTHOR]

Policymakers and public health researchers alike have demanded better evidence of the effects of interventions on health inequalities. These calls have been repeated most recently in the UK in the final Wanless report, which spoke of the "almost complete lack of an evidence base on the cost-effectiveness of public health interventions", and pointed more generally to the limited evidence base for public health policy and practice. Wanless and others have suggested that the gaps may be partially filled by exploiting the opportunities offered by "natural experiments", such as changes in employment opportunities, housing provision, or cigarette pricing. Natural experiments have an important contributions to make within the health inequalities agenda. First, they can play an important role in investigating the determinants of health inequalities. Second, they can assist in the identification of effective interventions, an area where it is widely acknowledged that the evidence-base is currently sparsely populated. This paper discusses some of the benefits and limitations of using this type of evidence, drawing on two ongoing quasi-experimental studies as examples. [ABSTRACT FROM AUTHOR]

Cost-sharing rules for paying physicians have been advanced as a way of generating incentives for the provision of quality care, while recognizing their potential negative effects on production efficiency. However, the optimal sharing rate typically depends on the degree to which the physician acts in the interest of the patient, what we identify as the physician's altruism. Since the degree of altruism is likely to vary across physicians, and to be private information, the standard rules for setting the cost-sharing rate are unlikely to be optimal. This paper derives conditions for the optimal non-linear cost-sharing mechanism in the presence of asymmetric information about altruism, and shows how it can sometimes be implemented through a menu of linear cost-sharing schemes. The model can be used to rationalize the design of the fund-holder system for general practictioners that operated in the 1990s in the United Kingdom. [ABSTRACT FROM AUTHOR]

In the UK, local authority transport departments are being encouraged to implement transport schemes that can contribute cost-effectively to achieving a wide range of corporate policy objectives. The ‘Civilising Cities’ initiative, funded by the UK''s RAC Foundation and the Department for Transport, seeks to identify—through a set of Pilot Projects—how packages of transport measures (usually in partnership with initiatives from other agencies) can contribute to improving local quality of life. One key feature of the project has been the development of a comprehensive Indicator Framework for cross-sector evaluation, that has defined a set of indicators covering nine areas of quality of life: neighbourhood, environment, transport, health, education, local economy, crime, participation and lifestyle. The paper outlines the philosophy behind the project, the range of policy instruments being examined and describes the Indicator Framework and its application. [Copyright &y& Elsevier]

This paper aims to evaluate the energy-saving potential, affordability and thermal comfort performance of various passive building retrofit measures for a historical building (late nineteenth-century Victorian house) renovation. Three types of interior passive retrofit measures (i.e. internal wall insulation, glazing upgrade and airtightness improvement), classified as traditional and advanced measures, are further grouped into 63 retrofit combinations. In order to evaluate the performance of these defined retrofit combinations, five assessment indicators are proposed, including energy reduction rate, specific initial cost, discounted payback period, space volume reduction rate, and indoor thermal comfort. Under three internal space reduction scenarios with a space reduction rate of 5.2%, 2.6% and 1.3%, these combinations are evaluated and compared, and the most favourable combinations are determined to achieve multiple objectives (maximum energy saving, most cost-effective and most energy-efficient). The influence of the most favourable retrofit combinations on the internal thermal comfort level improvement is also dynamically evaluated using the EnergyPlus simulation tool. The final recommended passive retrofit combination consists of vacuum insulation windows, gypsum air infiltration reduction, and 2 cm thickness of Polyisocyanurate (PIR) panels, with 51.8% of primary energy reduction, a specific initial investment of £144.71/m2 and a discounted payback period of 18 years. • Traditional and advanced passive retrofit combinations were evaluated in historical building renovation. • Space volume reduction rate is introduced to evaluate the building interior renovation. • A bi-objective optimal approach was proposed considering the effectiveness of energy and cost. • Indoor thermal comfort analysis of overheating was evaluated for risk of passive retrofit combinations. • This holistic approach facilitates the passive retrofit design and decision-making process. [ABSTRACT FROM AUTHOR]

Radon, a gaseous radioactive decay product of naturally-occurring uranium is widely distributed in the environment in rocks and soils and, in certain circumstances, can accumulate in the built environment. Initial studies confirmed a direct link between exposure to both radon gas and its short-lived radioactive progeny, and increased lung-cancer incidence, and demonstrated that radon levels in domestic housing can be sufficiently high to expose occupants to increased risk of lung-cancer. Subsequent studies worldwide have shown that it is cost-effective to detect and reduce domestic radon levels in order to reduce this risk. Recent advances in the early detection of lung-cancer, coupled with the development of improved treatment procedures, have progressively improved survival from the disease, with the numbers surviving at 5 years doubling over recent years, during which period the real costs of lung cancer treatment have risen by around 30%. In the meantime, however, in addition to radon and tobacco-smoke, other airborne pollutants have been identified as risk-factors for lung-cancer. This paper reviews both these actual developments and anticipated future trends, and concludes that since these advances in diagnosis and treatment of lung-cancer have had only a modest effect on cost-effectiveness, it is still important to conduct radon monitoring and remediation programmes. While the general increase in life-expectancy improves the cost-effectiveness of radon remediation programmes significantly, reducing tobacco-smoking incidence reduces that cost-effectiveness but with the overall benefit of reducing radon-related lung-cancers. The challenge remains of encouraging affected householders to remediate their homes to reduce radon levels. Image 1 • Review of Cost Effectiveness of Domestic Radon Remediation. • Review of developments and future trends in Lung Cancer Diagnosis, Treatment and Survival. • Domestic Radon Remediation Programmes remain cost effective, despite improvements in Lung cancer diagnosis and treatment. • Public Participation in Radon Remediation Programmes remains key. [ABSTRACT FROM AUTHOR]