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Quantifying the market size for cannabis is important given vigorous policy debates about how to intervene in this market. We develop a new approach to measuring the size of the cannabis market using forensic economics. The key insight is that cannabis consumption often requires the use of complementary legal inputs: roll‐your‐own tobacco and rolling papers. The forensic approach specifies how legal and illegal inputs are combined in the production of hand‐rolled cigarettes and cannabis joints. These input relationships, along with market adding‐up conditions, can be used to infer the size of the cannabis market. We provide proof‐of‐concept that this approach can be readily calibrated using: (i) point‐of‐sale data on legal inputs of roll‐your‐own tobacco and rolling papers; (ii) input parameter estimates drawn from a wide‐ranging interdisciplinary evidence base. We implement the approach using data from 2008–9. For those years, the forensic estimates for the UK cannabis market are near double those derived from standard demand‐side approaches. We make precise what drives the measurement gap between methods by establishing the adjustments needed to match estimates from alternative approaches. Our analysis develops an agenda on measurement and data collection that allows for credible cost–benefit analysis of policy interventions in illicit drug markets. [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]

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]

Aims: Previous cost‐effectiveness analysis suggests that CardioMEMS is cost‐effective compared with usual care for patients with persistent New York Heart Association class III symptoms and at least one heart failure (HF) hospitalization within 12 months. The aim of the paper is to perform an update of the cost‐effectiveness analysis of CardioMEMS using the most recent data from the published literature. Methods and results: A Microsoft Excel Markov model from a previous UK cost‐effectiveness study of CardioMEMS was updated using the clinical effectiveness of pulmonary artery pressure (PAP)‐guided treatment derived from the pivotal trials. The model included the device costs (and the implantation procedure and related complications), costs of remote monitoring, costs of HF‐related hospitalizations, and costs of usual care. Quality‐adjusted life years (QALYs) were estimated based on utilities from pivotal trials and published literature. Cost‐effectiveness results were estimated as incremental cost per QALY gained of CardioMEMS compared with usual care. Scenario analyses were also performed using data from real‐world studies that showed a significant decrease in HF‐related hospitalizations. In the base case analysis over a time horizon of 10 years, PAP‐guided HF therapy increased cost compared with usual care by £6337 (i.e. from £22 770 in usual care to £29 107 in PAP‐guided HF therapy) and the QALYs per patient for usual care and PAP‐guided patients were 2.62 and 2.94, respectively, reflecting an increase of 0.32 QALYs with PAP‐guided treatment. The resultant incremental cost‐effectiveness ratio (ICER), the ratio between incremental costs and the QALYs, is estimated at £19 761/QALY. Scenario analyses suggest that the ICER for CardioMEMS can range from being dominant to £27 910/QALY. Probabilistic sensitivity analyses suggested that PAP‐guided HF therapy has 81.9% probability of being cost‐effective at a threshold of £30 000/QALY. Conclusions: Our model suggests that CardioMEMS is likely to be cost‐effective in the United Kingdom, at the currently considered thresholds of £20 000–30 000/QALY. [ABSTRACT FROM AUTHOR]

Substantial effort has been applied to researching government initiatives aimed at increasing efficiency and cost effectiveness within the U.K. healthcare system, particularly in terms of medical practice. However, little attention has been paid to the impact of these on the boundaries of authority within the setting of hospital pharmacies. This paper utilizes the sociology of the professions to analyze and report on hospital pharmacist prescribing in Scotland. The findings indicate a reduction in the authority of the medical profession and that medical practice can be subjected to rationalization in the same way as other occupations, which is of sociological importance. [ABSTRACT FROM AUTHOR]

In the UK, increased use of non-structural responses ( NSRs) in integrated urban flood risk management has been recommended since the flood of autumn 2000. Paralleling this change, the UK government are now strongly promoting a Whole Life Cycle Costing approach ( WLCC) to flood risk management economic appraisals. However, due to a relative lack of economic knowledge in relation to NSR, costing non-structural responses is still in its infancy. Thus, the feasibility of the WLCC approach to costing non-structural strategies has been brought into question. This paper describes a qualitative method to assess the feasibility of WLCC approach, i.e. a method designed to assess if enough expert-based knowledge and/or economic data are available to support an effective, robust economic appraisal for a scheme that includes NSRs. This conceptual method allows flood risk managers to identify if, and when, further efforts are required in relation to obtaining better cost data to underpin a cost-benefit test. A user-friendly interface has been developed to support decision makers faced with these new challenges. A schematic project has been presented in the text to illustrate the potential application of the method. [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]

Background: In the UK, tens of millions of working days are lost due to work‐related ill health every year, costing billions of pounds. The role of Occupational Health (OH) services is vital in helping workers to maintain employment when they encounter injury or illness. OH providers traditionally rely on a clinical workforce to deliver these services, particularly doctors and nurses with OH qualifications. However, the increasing demand for OH services is unlikely to be met in the future using this traditional model, due to the declining number of OH‐trained doctors and nurses in the UK. Multi‐disciplinary models of OH delivery, including a more varied range of healthcare and non‐healthcare professionals, could provide a way to meet this new demand for OH services. There is a need to identify collaborative models of OH service delivery and review their effectiveness on return‐to work outcomes. There is an existing pool of systematic review evidence evaluating workplace based, multi‐disciplinary OH interventions, but it is difficult to identify which aspects of the content and/or delivery of these interventions may be associated with improved work‐related outcomes. Objectives: The aim of this evidence and gap map (EGM) was to provide an overview of the systematic review evidence that evaluates the effectiveness and cost‐effectiveness of multi‐disciplinary OH interventions intending to improve work‐related outcomes. Search Methods: In June 2021 we searched a selection of bibliographic databases and other academic literature resources covering a range of relevant disciplines, including health care and business studies, to identify systematic review evidence from a variety of sectors of employment. We also searched Google Search and a selection of topically relevant websites and consulted with stakeholders to identify reports already known to them. Searches were updated in February 2023. Selection Criteria: Systematic reviews needed to be about adults (16 years or over) in employment, who have had absence from work for any medical reason. Interventions needed to be multi‐disciplinary (including professionals from different backgrounds in clinical and non‐clinical professions) and designed to support employees and employers to manage health conditions in the workplace and/or to help employees with health conditions retain and/or return to work following medical absence. Effectiveness needed to be measured in terms of return to work, work retention or measures of absence, or economic evaluation outcomes. These criteria were applied to the title and abstract and full text of each systematic review independently by two reviewers, with disagreements resolved through discussion. We awarded each systematic review a rating of 'High', 'Medium' or 'Low' relevance to indicate the extent to which the populations, interventions and their contexts synthesised within the review were consistent with our research question. We also recorded the number of primary studies included within each of the 'High' and 'Medium' reviews that were relevant to research question using the same screening process applied at review level. Data Collection and Analysis: Summary data for each eligible review was extracted. The quality of the systematic reviews, rated as 'High' or 'Medium' relevance following full text screening, was appraised using the AMSTAR‐2 quality appraisal tool. All data were extracted by one reviewer and checked by a second, with disagreements being settled through discussion. Summary data for all eligible systematic reviews were tabulated and described narratively. The data extracted from reviews of 'High' and 'Medium' relevance was imported into EPPI‐Mapper software to create an EGM. Stakeholder Involvement: We worked alongside commissioners and policy makers from the Department of Health and Social Care (DHSC) and Department of Work and Pensions (DWP), OH personnel, and people with lived experience of accessing OH services themselves and/or supporting employees to access OH services. Individuals contributed to decision making at all stages of the project. This ensured our EGM reflects the needs of individuals who will use it. Main Results: We identified 98 systematic reviews that contained relevant interventions, which involved a variety of professionals and workplaces, and which measured effectiveness in terms of return to work (RTW). Of these, we focused on the 30 reviews where the population and intervention characteristics within the systematic reviews were considered to be of high or medium relevance to our research questions. The 30 reviews were of varying quality, split evenly between High/Moderate quality and Low/Critically‐Low quality ratings. We did not identify any relevant systematic review evidence on any other work‐related outcome of interest. Interventions were heterogenous, both within and across included systematic reviews. The EGM is structured according to the health condition experienced by participants, and the effectiveness of the interventions being evaluated, as reported within the included systematic reviews. It is possible to view (i) the quality and quantity of systematic review evidence for a given health condition, (ii) how review authors assessed the effectiveness or cost‐effectiveness of the interventions evaluated. The EGM also details the primary studies relevant to our research aim included within each review. Authors' Conclusions: This EGM map highlights the array of systematic review evidence that exists in relation to the effectiveness or cost‐effectiveness of multi‐disciplinary, workplace‐based OH interventions in supporting RTW. This evidence will allow policy makers and commissioners of services to determine which OH interventions may be most useful for supporting different population groups in different contexts. OH professionals may find the content of the EGM useful in identifying systematic review evidence to support their practice. The EGM also identifies where systematic review evidence in this area is lacking, or where existing evidence is of poor quality. These may represent areas where it may be particularly useful to conduct further systematic reviews. [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]

The article presents a study which aims to compare the opinions of dairy farmers and farm veterinary surgeons on herd health plans (HHPs) and herd health and production management (HH&PM) in Great Britain to discover differences in their opinions. The study distributes two paper-based questionnaires, one for farm dairy farmers and one for farm veterinarians. The study reveals that cost-effectiveness is a major concern among farmers and veterinarians.

Medical Education 2011:: 741-747 Good examinations have a number of characteristics, including validity, reliable scores, educational impact, practicability and acceptability. Scores from the objective structured clinical examination (OSCE) are more reliable than the single long case examination, but concerns about its validity have led to modifications and the development of other models, such as the mini-clinical evaluation exercise (mini-CEX) and the objective structured long examination record (OSLER). These retain some of the characteristics of the long case, but feature repeated encounters and more structure. Nevertheless, the practical considerations and costs associated with mounting large-scale examinations remain significant. The lack of metrics handicaps progress. This paper reports a system whereby a sequential design concentrates limited resources where they are most needed in order to maintain the reliability of scores and practicability at the pass/fail interface. We analysed data pertaining to the final examination administered in 2009. In the complete final examination, candidates see eight real patients (the OSLER) and encounter 12 OSCE stations. Candidates whose performance is judged as entirely satisfactory after the first four patients and six OSCE stations are not examined further. The others - about a third of candidates - see the remaining patients and stations and are judged on the complete examination. Reliability was calculated from the scores of all candidates on the first part of the examination using generalisability theory and practicability in terms of financial resources. The functioning of the sequential system was assessed by the ability of the first part of the examination to predict the final result for the cohort. Generalisability for the OSLER was 0.63 after four patients and 0.77 after eight patients. The OSCE was less reliable (0.38 after six stations and 0.55 after 12). There was only a weak correlation between the OSLER and the OSCE. The first stage was highly predictive of the results of the second stage. Savings facilitated by the sequential design amounted to approximately GBP30 000. The overall utility of examinations involves compromise. The system described provides good perceived validity with reasonably reliable scores; a sequential design can concentrate resources where they are most needed and still allow wide sampling of tasks. [ABSTRACT FROM AUTHOR]

This paper reviews the literature on what the zero bound to nominal interest rates implies for the conduct of monetary policy. The aim is to evaluate the risks of hitting the zero bound; and to evaluate policies that are said to be able to reduce that risk, or policies that are proposed as means of helping the economy escape if it is in a zero bound ‘trap’. I conclude that policies aimed at ‘cure’ are arguably more uncertain tools than those aimed at ‘prevention’, so prevention is a less risky strategy for policymakers. But since the risks of hitting the zero bound seem quite small anyway, and the risks of encountering a deflationary spiral smaller still, it is conceivable that inflation objectives that typify modern monetary regimes already have more than enough insurance built into them to deal with the zero bound problem. [ABSTRACT FROM AUTHOR]

Operational analysis (OA) techniques are used extensively by the Ministry of Defence (MoD) to inform their decision-making process. One particular type of OA study frequently undertaken is a balance-of-investment (BoI) study. This paper focuses on a recent BoI study whose aim was to identify the optimum (i.e. most cost effective) mix of vehicles that should be procured to fill a large number of identified requirements/roles. There will be a description of the methodology employed, highlighting the formulation and application of mixed integer linear programming (MILP) techniques, alongside a brief discussion of the implication of the results and other issues associated with the complexity of the problem. [ABSTRACT FROM AUTHOR]

After highlighting some of the key issues and positions in the debate around appropriate preventive regulation, the paper presents a number of observations directed at the proponents of greater self-regulation. These observations confront directly a number of familiar, but often unchallenged, arguments for self-regulation. More centrally we address claims concerning, the extent to which the chemicals industries have a good and improving 'safety' record; and whether the sector consists of companies both motivated and capable in the context of effective crisis and disaster management. Lastly, the paper sets out some 'new directions' for the nature and role of regulation in the effective prevention of crises. Thus the paper indicates a number of regulatory developments which are distinct from any shift towards greater self-regulation, but which would result in more effective crisis and disaster prevention in the UK chemicals industries and, indeed, beyond that specific sector. [ABSTRACT FROM AUTHOR]

Objective: To develop an early economics evaluation (EEE) to assess the cost‐effectiveness of the GS in reducing the RoF and FoF. Methods: A cost‐effectiveness analysis (CEA) with a return on investment (RoI) estimation was performed. CEA used the most relevant parameters, such as increased gait speed and decreased FoF, to estimate the reduction in the RoF, the impact on health care resources used and financial implications for the National Health System in the United Kingdom. Outcomes were measured as incremental cost‐effectiveness ratio per quality‐adjusted life years (QALYs) gained based on the reduction of the RoF and FoF. Uncertainties around the main parameters used were evaluated by probabilistic sensitivity analysis. Results: The CEA results showed that the GS is a dominant strategy over the standard of care to improve the movements of older persons who have suffered a fall or are afraid of falling (incremental QALYs based on FoF = 0.77 and QALYs based on RoF = 1.07, cost of FoF = ‐£4479.57 and cost of RoF = ‐£2901.79). By implementing the GS, the ROI results suggest that every pound invested in the GS could result in cost savings of £1.85/patient based on the RoF reduction and £11.16/patient based on the FoF reduction. The probability of being cost saving based on the number of iterations were 79.4 percent (based on FoF) and 100 percent (based on RoF). Conclusion: The EEE supports the main hypothesis that the GS is an effective intervention to avoid falls and is potentially cost saving. [ABSTRACT FROM AUTHOR]

Aims: Heart failure is a chronic progressive condition, with considerable burden on patients' quality of life and economic burden for the healthcare systems. Before the approval of empagliflozin, there were no proven effective treatments for patients with heart failure with left ventricular ejection fraction (HF LVEF) > 40%. The aim of this study was to evaluate the cost‐effectiveness of empagliflozin + standard of care (SoC) compared with SoC alone for patients with HF LVEF > 40%, from the perspective of the healthcare systems of the United Kingdom (UK), Spain, and France, and to quantify the healthcare costs for these patients. Methods and results: A lifetime Markov cohort state‐transition model was developed based on discrete health states defined by Kansas City Cardiomyopathy Questionnaire‐Clinical Summary Score quartiles to track disease severity. Model inputs relied primarily on the EMPEROR‐Preserved trial data or obtained from published literature or country‐specific databases, as well as local guidelines for the requirements for the conduct of the economic evaluation of healthcare technologies. The total lifetime cost of receiving SoC per patient was £10 092, €15 765, and €14 958 in the UK, Spain, and France, respectively, which increased by £1407, €1148, and €1485, respectively, with the addition of empagliflozin to the SoC. Empagliflozin + SoC was associated with significantly reduced number of hospitalization for HF or cardiovascular death compared with SoC alone, which was a key driver offsetting its drug acquisition costs. The incremental cost‐effectiveness ratio per quality‐adjusted life year (QALY) gained was consistently favourable at £14 851, €11 706, and €15 447 in the UK, Spain, and France, respectively. Scenario analysis using the New York Heart Association functional class showed similar results. Probabilistic sensitivity analyses showed more than 50% probability for cost‐effectiveness for a willingness‐to‐pay (WTP) threshold of £/€20 000/QALY for the three countries. Conclusions: Empagliflozin was found to be the first targeted treatment option that is clinically effective and cost‐effective for patients with HF LVEF > 40%. Prescribing empagliflozin with SoC to patients with HF LVEF > 40% is expected to improve clinical outcomes and patients' quality of life and substantially below accepted WTP threshold for the healthcare systems in the UK, Spain, and France. [ABSTRACT FROM AUTHOR]

In the UK, patients with personality disorders presenting complex needs frequently experience an unhelpful pattern of acute treatment followed by community care—with associated high cost implications for services. With UK mental health resources under severe pressure, this leaves commissioners with difficult decisions to make. Yet studies on cost‐effectiveness in respect of personality disorder treatment are scarce, particularly for treatments taking place outside of major teaching hospitals in the USA. This paper studies the benefits of an intensive, holistic approach and finds that the Network achieved substantial reductions in health care usage and expenditure in the short to medium term. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

ABSTRACT Parenting programmes are widely used in the UK, promoted in policy documents as a cost-effective way for children's services to address behaviour problems and thereby the longer-term costs associated with conduct disorders, particularly antisocial behaviour and criminality. To explore whether these programmes are a cost-effective component of family intervention, this paper examines evidence from cost-effectiveness studies based on randomized controlled trials, modelling studies estimating longer-term costs and outcomes, and studies estimating costs of UK parenting programmes, including evidence from routine practice. Findings indicate that parenting programmes have the potential to be cost-saving in the long term; however, gaps in the evidence include: lack of follow-up of families who drop out of programmes, absence of control groups in longer-term follow-ups, and little information about costs and effects of programmes in routine practice. The size of savings resulting from implementation of effective parenting programmes will depend on the extent to which families likely to be most costly to society attend and experience lasting benefit. [ABSTRACT FROM AUTHOR]

Building on international insights into the complexity of public services' procurement and its outcomes, this paper reveals the contradictory influences that generated ambiguous, volatile, and variable commissioning practices in social care commissioning for older adults in a 2008/09 case survey of 14 English local authorities (LAs). Their commissioning practices ranged from cost minimizing to partnership-focused, with the more cost-focused practices associated with lower user satisfaction scores. Nevertheless, survey data show that LA measures such as more generous fees resulted in limited responses by the independent sector providers in improving employment practices. Overriding budget constraints, volatile national and local policy priorities, low trust relations, and an unwillingness among national providers to raise employment standards locally all limited the influence of local commissioning on actual practice. These findings point to the need for a stronger national framework for social care and for attention to be paid to how to improve providers' practices. [ABSTRACT FROM AUTHOR]

Experienced Carers Helping Others (ECHO) is a guided self-help intervention for carers of people with eating disorders to reduce distress and ameliorate interpersonal maintaining factors to improve patient outcomes. The aim of this paper is to describe the theoretical background and protocol of a randomised controlled trial that will establish whether ECHO has a significant beneficial effect for carers and the person they care for. Individuals with anorexia nervosa and carers will be recruited from eating disorder inpatient/day patient hospital services in the UK. Primary outcomes are time until relapse post-discharge (patient) and distress (carer) at 12 months post-discharge. Secondary outcomes are body mass index, eating disorder symptoms, psychosocial measures and health economic data for patients and carers. Carers will be randomised (stratified by site and illness severity) to receive ECHO (in addition to treatment as usual) or treatment as usual only. Potential difficulties in participant recruitment and delivery of the intervention are discussed. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Rainwater harvesting (RWH) can be used to reduce the demand for potable mains water. At the single-building scale, previous research has focused on water-saving potential, while financial assessment has either been omitted or considered in an ad hoc manner. This paper reports on the application of a more rigorous financial analysis of domestic RWH systems than had been conducted previously. Whole life costing was selected as the most appropriate financial assessment technique. A total of 3840 domestic system configurations were assessed at a daily time step, taking into account various stakeholder perspectives and future cost scenarios. In each case, it was found that harvesting rainwater was significantly less cost effective than relying solely on mains-only water. The domestic RWH systems generally resulted in financial losses approximately equal to their capital costs. Without significant financial support, domestic RWH is unlikely to be cost effective for all reasonably foreseeable scenarios. [ABSTRACT FROM AUTHOR]

Background: Despite a consensus on the need to expand and improve mental health care for older people, evidence on models of service development is limited. Objective: Referring to two case studies, this paper considers how evaluation of service innovations can inform policy and practice. Conclusions: Evaluation should entail a dual concern with measurement and meaning in judging the value of an intervention. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Petrou S, Taher S, Abangma G, Eddama O, Bennett P. Cost-effectiveness analysis of prostaglandin E2 gel for the induction of labour at term. BJOG 2011;118:726-734. To estimate the cost-effectiveness of prostaglandin E2 (dinoprostone) vaginal gel for the induction of labour at term from the perspective of the UK's National Health Service. Economic evaluation conducted as part of a randomised controlled trial. Maternity department at a major teaching hospital in London, UK. A cohort of 165 pregnant women presenting as cephalic between 36 and 41 weeks of gestation, for whom induction of labour was deemed necessary. Either 3-mg Prostin E2 vaginal tablets or 1- or 2-mg Prostin E2 vaginal gel were administered at 6-hourly intervals. Incremental cost per hour prevented between induction and delivery. The nonparametric bootstrap method was used to construct cost-effectiveness acceptability curves and estimate net benefits at alternative cost-effectiveness thresholds. Women receiving the gel accrued nonsignificantly higher costs (incremental cost £630; bootstrap 95% CI −£353, £2320; P = 0.43), and experienced a significantly reduced interval between induction and delivery (median of 1400 versus 1780 minutes; mean of 1711 versus 2765 minutes; P = 0.03). The incremental cost per hour prevented from induction of labour to delivery was estimated at £36. At a cost-effectiveness threshold of £100 per hour of care prevented, the probability that the gel is cost-effective was estimated at 0.83, and the mean net benefit to the health services was estimated at £1121 (bootstrap 95% CI −£1133, £3379). The results were sensitive to the inclusion of neonatal costs in the analysis and the value of the cost-effectiveness threshold. Notably, excluding neonatal costs increased the probability that the gel is cost-effective at a cost-effectiveness threshold of £100 per hour of care prevented to 0.99. This study suggests that prostaglandin E2 gel is probably more cost-effective than prostaglandin E2 tablets for the induction of labour at term. Given that the results are applicable to the general obstetric population requiring induction of labour at term, decision-makers should consider the likely economic impacts of their implementation. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Kaambwa B, Bryan S, Gray J, Milner P, Daniels J, Khan K, Roberts T. Cost-effectiveness of rapid tests and other existing strategies for screening and management of early-onset group B streptococcus during labour. BJOG 2010;117:1616-1627. To determine the cost-effectiveness of alternative screening and prevention strategies, including rapid intrapartum testing, for prevention of early-onset neonatal group B streptococcus (GBS) infection in the UK. A decision model was developed to investigate the cost-effectiveness of screening and prevention strategies for GBS. A strategy of doing nothing was also considered. Deterministic and probabilistic sensitivity analyses were carried out. Two large UK based obstetric units. Test accuracy data were obtained from a primary study of rapid tests at the onset of labour and risk factors from 1400 women. Incremental health sector costs per case of early-onset GBS death avoided. Compared with a strategy of do nothing, the incremental cost-effectiveness ratio was £32,000 per Early-Onset GBS Disease avoided and £427,000 per Early-Onset GBS Death avoided for the strategy of providing routine intrapartum antibiotic prophylaxis to all women without prior screening; Based on their current sensitivity, specificity and cost, screening using rapid tests was dominated by other more cost-effective strategies. The most cost-effective strategy was shown to be the provision of routine intrapartum antibiotic prophylaxis to all women without prior screening but, given broader concerns relating to antibiotic use, this is unlikely to be acceptable. In its absence, intrapartum antibiotic prophylaxis directed by screening with enriched culture becomes cost-effective. The current strategy of risk-factor-based screening is not cost-effective compared with screening based on culture. [ABSTRACT FROM AUTHOR]

This paper proposes a new model of consumer impulsivity, using type of good, a person's endorsement of materialistic values, and identity deficits as predictors. Traditional decision making and psychological accounts see impulsive behaviour as a general overweighing of short-term gratification (I want that dress now) relative to longer-term concerns, irrespective of consumer good. Our proposal is that consumers' impulsivity (a) differs according to type of good and (b) is linked systematically to a combination of materialistic values and high identity deficits. Beginning with Study 1, three experiments, using a temporal discounting paradigm, show consistently that discount rates are higher for goods that are seen as highly expressive of identity (e.g., clothes) than goods not expressive of identity (e.g., basic body care products). For materialistic consumers, identity deficits predict discount rates for identity-expressive goods (Study 2), and discount rates change for materialistic individuals when their identity deficits are made salient (Study 3). These findings support a conceptualization of consumer impulsivity as identity-seeking behaviour. [ABSTRACT FROM AUTHOR]

Distribution systems are inherent monopolies and therefore have generally been regulated in order to protect customers and to assure cost-effective operation. In the United Kingdom, this is one of the functions of the OFGEM (Office of Gas and Electricity Markets). Initially the regulation was based on the value of assets, but there is now a trend toward performance-based regulation. In order to achieve this, a methodology is needed that enables the reliability performance associated with alternative investment strategies to be compared with the investment cost of these strategies. At present there is no accepted approach for such assessments. Building on the concept of reference networks proposed in Refs. 1 and 2, this paper describes how these networks can be used to assess the impact that performance-driven investment strategies will have on the improvement of reliability indices. The method has been tested using the underground and overhead parts of a real system. © 2010 Wiley Periodicals, Inc. Electr Eng Jpn, 173(1): 24–31, 2010; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/eej.20945 [ABSTRACT FROM AUTHOR]

Clin. Otolaryngol. 2010, 35, 87–96 Objective: In the UK approximately 3% of over 50 years olds and 8% of over 70 year olds have severe (794–94 dBHL) to deafness. As deafness increased, hearing aids become increasingly ineffective. Cochelear implants can provide an alternative treatment. Objective of review: To bring together the research evidence through the robustness of a systematic review of the effectiveness of unilateral cochlear implants for adults. We also sought to systematically review the published literature on cost-effectiveness. Types of review: Systematic review. Search strategy: This examined 16 electronic databases, plus bibliographies and references for published and unpublished studies from inception to june 2009. Evaluation method: Abstracts were independently assessed against inclusion criteria by two researchers were compared and disagreements resolved. Included papers were then retrieved and further independently assessed in a similar way. Remaining studies had their data independently extracted by one of five reviewers and checked by another reviewer. Results: From 1,580 titles and abstracts nine studies were included. These were of variable quality; some study's results should be viewed with caution. The studies were too hetrogeneous to pool the data. However, overall the results firmly supported the use of unilateral cochler implants for severe to profoundly deaf adults. Additionally, four UK based economic evaluations found unilateral cochlear implants to be cost-effectivene in adults at UK implants centres. Conclusion: The methodologically weak but universally positive body of effectiveness evidence supports the use of unilateral cochlear implants in adults. Previous economic evaluations indicate that such implants are likely to be cost-effective. [ABSTRACT FROM AUTHOR]

This paper addresses Tier 4 services for children and young people whose needs require highly specialised services, and describes the range of provision which is currently available for this group. Although the evidence base is in its infancy, what is known about clinical outcomes, cost effectiveness and the views of users is summarised. The current shortfalls in tier 4 provision are highlighted, the drivers for change are identified and recommendations are made for future service improvements. [ABSTRACT FROM AUTHOR]

This paper summarizes and discusses the key findings of the evaluation of the English smoking treatment services, which were established in 1999 as part of the English National Health Service. Within 4 years these services existed throughout the country and were working at full capacity, a total of£76 million having been spent on them over this period, excluding medication costs. In the fourth year almost 235 000 people attended treatment and set a quit date, and the total budget, including medications, was approximately£50 million. At the end of the fourth year the government allocated£138 million for the services for the period April 2003–March 2006. The CO-validated 4-week abstinence rate was 53%, the validated 52-week abstinence rate was 15%, and the relapse rate from 4 to 52 weeks was 75%. There was no sex difference in cessation rates at long-term follow-up. The cessation results and relapse rate from weeks 4 to 52 are consistent with results from published studies, including clinical trials. The estimated cost per life-year saved was£684 and the figure is even lower if the potential future health care cost savings are taken into account at£438 per life-year saved. This compares with the benchmark of£20 000 per life-year saved, which the National Institute for Clinical Excellence (NICE) is using to recommend new health care interventions in the National Health Service. The services were also succeeding in reaching disadvantaged smokers. However, there have been problems, and other health care systems considering an initiative of this kind should: set national training standards and increase training capacitybeforelaunching the services; standardize the provision of pharmaceutical treatments and make them as accessible as possiblebeforelaunching the services; and give the services at least 5 years of central funding to allow them to become well established. Monitoring is extremely important but should not be so much of a burden that it detracts from developing a quality service and although cessation targets can be helpful, care needs to be taken that they are reasonable and do not promote throughput at the expense of quality. [ABSTRACT FROM AUTHOR]

Aims: Assess effectiveness of a hybrid intervention targeting physical activity in women with prior gestational diabetes. Methods: Randomised controlled trial with parallel arms. 293 women (35.1 ± 5.1 years; 40% ethnic minority) recruited from two hospitals and randomised to routine care or hybrid lifestyle intervention comprising two group sessions and access to a mobile web app. Primary outcome was a change in objectively measured physical activity at 12 months. Secondary outcomes included self‐efficacy for exercise, quality of life and anxiety and depression. Linear regression compared outcome measures between groups. Results: 83% of intervention participants attended at least one group session, of who 66% registered to use the app. There was a non‐significant increase in physical activity at 12 months (between‐group difference of 0.95 mg [95% CI: −0.46 to 2.37]), equivalent to approximately 500 steps per day. Intervention participants reported higher self‐efficacy for exercise (0.54, 95% CI: 0.05 to 1.102; p = 0.029), lower anxiety (−0.91, 95% CI: −1.74 to −0.09; p = 0.031), and higher quality of life (0.05, 95% CI: 0.004 to 0.09; p = 0.032), compared to controls. Conclusions: The intervention improved confidence in exercise and quality of life. Further research is needed to improve participant engagement with physical activity interventions in multi‐ethnic populations with a history of gestational diabetes. [ABSTRACT FROM AUTHOR]

Summary1 Great spruce bark beetle Dendroctonus micans (Kug.) (Coleoptera: Scolytidae) has been subject to an Integrated Crop Management (ICM) regime in Great Britain since its first discovery in 1982. The elements of the ICM approach are sanitation felling of the initial infestations, restriction on movement of potentially infested conifers to prevent spread to uninfested parts of the country and biological control through rearing and release of the specific predatory beetle Rhizophagus grandis Gyll. (Coleoptera: Rhizophagidae). Such a programme carries costs that have to be evaluated against the benefits to the ICM strategy. 2 This paper presents a cost-effectiveness analysis of three options – (i) continue with the current policy of restriction on movement of infested timber and use of the imported predator R. grandis, (ii) do nothing (i.e. drop all attempts to reduce the spread of D. micans), or, (iii) introduce a new east–west Dendroctonus Micans Control Area (DMCA) to define the management area. Assumptions on rates of mortality and natural spread were based on research into D. micans in Britain’s spruce forests. 3 Appraisal indicated that the current policy was the most cost-effective, even when subject to sensitivity analysis to test the limits of the assumptions included in the models. It is concluded that the current policy should remain in force. [ABSTRACT FROM AUTHOR]

The New Labour government in Britain is the first post-deregulation regime in Europe and the first to attempt to re-regulate the labour market. In particular, its welfare-to-work programme and New Dealer Lorte Parents are aimed at shifting activities from the informal to the formal economy, and at enlarging labour market participation. Its commitment to social justice and inclusion is closely linked to increased employment opportunities and a responsibility for contributing to national prosperity. The new programmes must also reconcile these aims with the retention of the flexibility that it sees as giving Britain a competitive edge over other European economies. In order to combine efficiency and equity, increased participation must not involve excessive transaction and enforcement costs. The problem is that those at present engaged in the informal economy (and especially in undeclared cash work while claiming) do not have strong incentives to cooperate with the new schemes. This paper uses the example of the informal relations of taxi-driving in a small town to illustrate the paradoxes of this situation. It is a case study in the rational strategies of individual actors, which collectively frustrate each other; and in the difficulties of starting collective action for mutual restraint of competition. The New Labour government must solve many such problems if its policies are to succeed. [ABSTRACT FROM AUTHOR]

The article reports on the unlikeliness of badger culling to be considered a cost-effective control measure to treat bovine tuberculosis (TB), as conducted during the Randomized Badger Culling Trial (RCBT) in Great Britain. It mentions that the beneficial effects of badger culling would not sustain in the long term. The British Veterinary Association (BVA) argued that the method had an impact on bovine TB, and should be part of the control measures.

Aim: To measure the cost‐effectiveness of adding text message (TMB), exercise (EB) and abstinent‐contingent financial incentive‐based (CFIB) stop smoking interventions to standard smoking cessation support for pregnant women in England. Design: Modelling cost‐effectiveness outcomes by separately adding three cessation interventions to standard cessation care offered to pregnant women in England. English National Health Service Stop Smoking Services (NHS SSS) statistics from 2019 to 2020 were used for estimating the base quit rate. Intervention effectiveness and cost data for interventions were taken from trial reports. Cost‐effectiveness was derived using the economics of smoking in pregnancy (ESIP) model from a health service and personal social services perspective. Interventions were compared with each other as well as against standard cessation care. Setting English NHS SSS. Participants/cases: A total of 13 799 pregnant women who accessed NHS SSS. Interventions and comparator; comparator: standard stop smoking support comprising behavioural intervention and an offer of nicotine replacement therapy (NRT). Three additive interventions were TMB, EB and CFIB. Measurements Incremental cost‐effectiveness ratios per quality‐adjusted life‐years gained for both mothers and offspring over their life‐times; return on investment (ROI); and cost‐effectiveness acceptability curves (CEACs). Findings The addition of any of the interventions compared with standard care alone was preferred, but only significant for the addition of CFIB, with the CEAC suggesting an at least 90% chance of being favoured to standard care alone. When compared against each other CFIB appeared to yield the largest returns, but this was not significant. The estimated ROI for CFIB was £2 [95% confidence interval (CI) = £1–3] in health‐care savings for every £1 spent by the NHS on the cessation intervention. Conclusions: For a health system which currently provides behavioural support and an offer of nicotine replacement therapy as standard stop smoking support for pregnant women, the greatest economic gains would be provided by operating an abstinent‐contingent financial incentives scheme alongside this. [ABSTRACT FROM AUTHOR]

Although the possession of instrumentality (i.e., partner B being useful to partner A's goal pursuit) can facilitate relationship satisfaction, taking an instrumental approach (i.e., A focusing on B's usefulness and seeing B as a tool to facilitate personal goal attainment) is (often) considered as a callous and depersonalized approach to forming relationships. The current research examined whether adopting an exchange orientation amplifies the tendency for people to take an instrumental approach via the motive to maximize self‐gain. Four studies (N = 1446) utilizing samples across different countries, including the United Kingdom, the United States and China, supported this hypothesis. Specifically, during relationship initiation, an exchange (vs. non‐exchange) orientation made participants place higher importance on instrumentality rather than traits facilitating intimacy and bonding (Study 1). For established relationships, participants who chronically adopted an exchange orientation (Study 2) and who were temporarily induced to do so (vs. control; Study 3) were more likely to view their significant other as a tool. The final quasi‐experiment (Study 4) showed that requiring or being required to offer a bride price – an embodiment of exchange orientation – predicted instrumentality in marriage and subsequently impaired relationship satisfaction. Implications are discussed. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to an article about the cost-effectiveness of financial incentives for smoking cessation in pregnancy, which appeared in the previous issue.

The article analyzes research conducted in Great Britain that focuses on employee layoffs, shareholder wealth, and firm performance. Particular attention is paid to firms in Britain that have experienced layoffs in the 2000s, as well as the meaning behind layoffs, which include cost cutting, improving performance, refocusing on core activities, and improving employee efficiency. Additional article topics include factors that motivate managers to undertake employee layoffs, data and sampling strategies, stock price reactions to employee layoffs, as well as the outcomes of layoff decisions.

The author discusses several studies published in the journal "Diabetic Medicine" between 2016 and 2019 related to people living with diabetes. Highlights include the psychological impact of technology during pregnancy, the positive psychometric validation of the hypoglycaemia awareness questionnaire HypoA-Q in adults with type 1 diabetes, and dietary associations with type 2 diabetes risk in children in the Child Heart and Health Study in England.

This paper provides a recursive empirical analysis of the scope for cost minimization in public debt management when the debt manager faces a given short-term interest rate dictated by monetary policy as well as risk and market impact constraints. It simulates the ‘real-time’ interest costs of alternative portfolios for UK government debt between April 1985 and March 2000. These portfolios are constructed using forecasts of return spreads based on a recursive modelling procedure. While we find statistically significant evidence of predictability, the interest cost savings are quite small when portfolio shares are constrained to lie within historical bounds. [ABSTRACT FROM AUTHOR]

Aim: Parastomal hernia (PSH) is a common problem following colostomy. Using prophylactic mesh during end colostomy creation may reduce PSH incidence, but concerns exist regarding the optimal type of mesh, potential long‐term complications, and cost‐effectiveness of its use. We evaluated the cost‐effectiveness of mesh prophylaxis to prevent PSH in patients undergoing end colostomy creation for rectal cancer. Methods: We developed a decision‐analytical model, stratified by rectal cancer stages I–IV, to estimate the lifetime costs, quality‐adjusted life‐years (QALYs) and net monetary benefits (NMBs) of synthetic, biologic and no mesh from a UK NHS perspective. We pooled the mesh‐related relative risks of PSH from 13 randomised controlled trials (RCTs) and superimposed these on the baseline (no mesh) risk from a population‐based cohort. Uncertainty was assessed in sensitivity analyses. Results: Synthetic mesh was less costly and more effective than biologic and no mesh to prevent PSH for all rectal cancer stages. At the willingness‐to‐pay threshold of £20,000/QALY, the incremental NMBs (95% CI) ranged between £1,706 (£1,692 to £1,720) (stage I) and £684 (£678 to £690) (stage IV) for synthetic versus no mesh, and £2,038 (£1,997 to £2,079) (stage I) and £1,671 (£1,653 to £1,689) (stage IV) for synthetic versus biologic mesh. Synthetic mesh was more cost‐effective than no mesh unless the relative risk of PSH was ≥0.95 for stages I–III and ≥0.93 for stage IV. [Correction added on 05 October 2021 after first online publication: The estimation of health outcomes (QALYs) for all three interventions evaluated (synthetic mesh; biologic mesh; no mesh) have been corrected in this version.] Conclusions: Synthetic mesh was the most cost‐effective strategy to prevent the formation of PSH in patients after end colostomy for any rectal cancer stage; however, conclusions are dependent on which subset of RCTs are considered to provide the most robust evidence. [ABSTRACT FROM AUTHOR]

Modelling suggests hepatitis C virus (HCV) elimination is possible among men who have sex with men (MSM), with key screening groups including HIV‐diagnosed MSM and MSM using pre‐exposure prophylaxis (PrEP). Mathematical modelling was used to determine the cost‐effectiveness of HCV case‐finding strategies among MSM from the provider perspective, and to determine which interventions could achieve a 90% reduction in HCV incidence over 2015–2030. At baseline, we assumed symptomatic screening in HIV‐negative MSM (including PrEP users) and 12‐monthly screening among HIV‐diagnosed MSM. Improved case‐finding strategies included screening alongside HIV testing in HIV‐negative MSM not using PrEP (PrEP non‐users); 12/6/3‐monthly screening in PrEP users; and 6‐monthly screening in HIV‐diagnosed MSM, with the cost‐effectiveness being compared incrementally. Costs (GBP) and quality‐adjusted life years (QALYs) were assessed to estimate the mean incremental cost‐effectiveness ratio (ICER) with a time horizon to 2050, compared to a willingness‐to‐pay threshold of £20,000/QALY. From the baseline, the most incrementally cost‐effective strategy is to firstly undertake: (1) 12‐monthly HCV screening of PrEP users (gaining 6715 QALYs with ICER £1760/QALY), followed by (2) HCV screening among PrEP non‐users alongside HIV testing (gaining 7048 QALYs with ICER £4972/QALY). Compared to the baseline, this combined strategy would cost £46.9 (95%CrI £25.3–£66.9) million and achieve the HCV elimination target in 100% of model runs. Additional screening incurs ICERs >£20,000/QALY compared to this combined strategy. In conclusion, HCV elimination can be achieved cost‐effectively among UK MSM. Policymakers should consider scaling‐up HCV screening in HIV‐negative MSM, especially PrEP users, for achieving this target. [ABSTRACT FROM AUTHOR]

The article investigates a dynamic cost function, capable of generating the dynamic demand system in Great Britain. It shows that the derivation of an effective underlying cost function allows identifying the full set of parameters of the underlying process. In the production case, in contrast, ignoring the underlying objective function loses much information. Here, total costs are generally observed, and indeed it has become standard in the static cost function literature to estimate the objective function along with the factor demand functions. The direct derivation of factor demand functions from the underlying objective function means that the factor demands are evaluated, conditional on the technology, even in the short run. It is apparent from the empirical results that our dynamic error correction representation of the estimable short-run cost function and its derived share equations do provide a clear interpretation of the underlying economic theory of producer behavior.

This study investigated the validity of an assessment centre (AC) used to choose serving policemen and policewomen for places on an accelerated promotion scheme. Two samples of successful applicants, totalling 223 and 157, were followed up over 1-19 years. Three types of criteria-training grades, rank attained and supervisory ratings-were regressed on a variety of AC measures. In a subsidiary investigation, supervisory ratings were factor analysed. The principal conclusion is that AC selection decisions were valid, but only for supervisory rating criteria. Relatively low validity overall is interpreted in terms of questionable job-relatedness of the AC procedure. Nevertheless the AC appears to be cost beneficial. Other issues discussed are the dimensionality of supervisory ratings, the validity of peer nominations, the invalidity of pencil-and-paper ability tests used, the distinction between AC predictions of performance and potential, and the amount of redundancy in AC measurements. [ABSTRACT FROM AUTHOR]

The article discusses a study designed to determine the extent of geographical variations in industrial costs in Great Britain. The study involved an analysis to understand and evaluate differences in industrial costs between mainly urban areas and mainly rural areas. It also evaluated the differences between areas that qualified for assistance in regional policy and those that did not. The study revealed that unit input costs in large urban areas tended to be higher than their surrounding undeveloped areas.

The sale of public sector industry has become a central plank of UK public policy. This paper concentrates upon the most contentious area of the opportunity cost of share sales. The nature of these costs is related to the revealed objectives of the policy, and the extent to which they differ from expected costs is identified. The nature of the benefits forecast for privatization is explored and questions posed concerning the balance of costs and benefits in current policy. Particular attention is paid to the distribution of returns on the share issues in privatized businesses and parallels are drawn with issues in the private sector. [ABSTRACT FROM AUTHOR]

Studies of policy-making and management in health and related fields have generally been confined to England even when professing to embrace Britain or the United Kingdom. The assumption of a unitary state in which the policy lead is given by Westminster/Whitehall is shown to be grossly misleading in the case of community care policy. Considerable variations exist not only in policy means but also in policy ends. The paper demonstrates the limitations of studying health and personal social services adopting a unitary state perspective, It argues for more intra-Britain comparative work aimed at evaluating the costs and benefits of service variations in different policy fields. [ABSTRACT FROM AUTHOR]

The article informs about of British Infection Association adult HIV testing guidelines 2020 about in areas of high seroprevalence to increase testing uptake and frequency. Topics include target all individuals living with undiagnosed HIV will need to be offered testing and commenced on antiretroviral therapy (ART); and elimination of human immunodeficiency virus (HIV) transmission in the Great Britain.

Climate change has been described as the biggest global health threat of the 21st century. As a result, governments around the world are committing to legislative change in order to reduce greenhouse gas emissions (GHGEs). The healthcare sector makes a significant contribution to GHGEs and in line with national legislation in the UK, the NHS has recently committed to achieving net zero emissions by 2050. The management of asthma and COPD largely depends on the prescribing of medications that are delivered through inhalers. In the UK, the use of pressurized metered dose inhalers (pMDIs), which rely on hydrofluorocarbon (HFC) propellants accounts for 3.5% of the NHS's total carbon footprint. In contrast, dry powder inhalers (DPIs) have a much lower carbon footprint due to the absence of a HFC propellant. Here we review evidence of the impact of inhaler choices across four domains: environmental impact, clinical effectiveness, cost effectiveness and patient preferences. We find that as well as a lower global-warming potential, DPIs have additional benefits over pMDIs in other domains and should be considered first line where clinically appropriate. [ABSTRACT FROM AUTHOR]

Aims: We examined the effectiveness of a service innovation, Three Dimensions for Diabetes (3DFD), that consisted of a referral to an integrated mental health, social care and diabetes treatment model, compared with usual care in improving biomedical and health economic outcomes. Methods: Using a non‐randomized control design, the 3DFD model was offered in two inner‐city boroughs in London, UK, where diabetes health professionals could refer adult residents with diabetes, suboptimal glycaemic control [HbA1c ≥ 75 mmol/mol (≥ 9.0%)] and mental health and/or social problems. In the usual care group, there was no referral pathway and anonymized data on individuals with HbA1c ≥ 75 mmol/mol (≥ 9.0%) were collected from primary care records. Change in HbA1c from baseline to 12 months was the primary outcome, and change in healthcare costs and biomedical variables were secondary outcomes. Results: 3DFD participants had worse glycaemic control and higher healthcare costs than control participants at baseline. 3DFD participants had greater improvement in glycaemic control compared with control participants [−14 mmol/mol (−1.3%) vs. −6 mmol/mol (−0.6%) respectively, P < 0.001], adjusted for confounding. Total follow‐up healthcare costs remained higher in the 3DFD group compared with the control group (mean difference £1715, 95% confidence intervals 591 to 2811), adjusted for confounding. The incremental cost‐effectiveness ratio was £398 per mmol/mol unit decrease in HbA1c, indicating the 3DFD intervention was more effective and costed more than usual care. Conclusions: A biomedical, psychological and social criteria‐based referral system for identifying and managing high‐cost and high‐risk individuals with poor glycaemic control can lead to improved health in all three dimensions. What's new?: There are few evidence‐based models of diabetes care that include mental health and social care.The Three Dimensions for Diabetes (3DFD) model integrated social care, mental health and diabetes care into one service.This non‐randomized, observational study, set in three diverse boroughs in London, UK, recruited adults with suboptimal glycaemic control and mental health and/or social problems.3DFD was associated with clinically significant reductions in glycaemic control but because they were already a very expensive and high‐risk group, there was no evidence of reduction in costs compared with the control group. [ABSTRACT FROM AUTHOR]