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Aims To determine whether the provision of contingencymanagement using financial incentives to improve hepatitis B vaccine completion in people who inject drugs entering community treatment represents a cost-effective use of healthcare resources. Design A probabilistic cost-effectiveness analysis was conducted, using a decision-tree to estimate the short-term clinical and health-care cost impact of the vaccination strategies, followed by a Markov process to evaluate the long-term clinical consequences and costs associated with hepatitis B infection. Settings and participants Data on attendance to vaccination from a UK cluster randomized trial. Intervention Two contingency management options were examined in the trial: fixed versus escalating schedule financial incentives. Measurement Life-time health-care costs and quality-adjusted life years discounted at 3.5% annually; incremental cost-effectiveness ratios. Findings The resulting estimate for the incremental life-time health-care cost of the contingency management strategy versus usual care was £21.86 [95% confidence interval (CI) = -£12.20 to 39.86] per person offered the incentive. For 1000 people offered the incentive, the incremental reduction in numbers of hepatitis B infections avoided over their lifetime was estimated at 19 (95% CI = 8-30). The probabilistic incremental cost per quality adjusted life-year gained of the contingency management programmewas estimated to be £6738 (95% CI = £6297-7172),with an 89% probability of being considered cost-effective at a threshold of £20 000 per quality-adjusted life years gained (97.60% at £30 000). Conclusions Using financial incentives to increase hepatitis B vaccination completion in people who inject drugs could be a cost-effective use of health-care resources in the UK as long as the incidence remains above 1.2%. [ABSTRACT FROM AUTHOR]

Objectives To determine whether use of the Screening Tool of Older Persons' Prescriptions ( STOPP) and Screening Tool to Alert to Right Treatment ( START) criteria reduces incident hospital-acquired adverse drug reactions ( ADRs), 28-day medication costs, and median length of hospital stay in older adults admitted with acute illness. Design Single-blind cluster randomized controlled trial ( RCT) of unselected older adults hospitalized over a 13-month period. Setting Tertiary referral hospital in southern Ireland. Participants Consecutively admitted individuals aged 65 and older (N = 732). Intervention Single time point presentation to attending physicians of potentially inappropriate medications according to the STOPP/ START criteria. Measurements The primary outcome was the proportion of participants experiencing one or more ADRs during the index hospitalization. Secondary outcomes were median length of stay ( LOS) and 28-day total medication cost. Results One or more ADRs occurred in 78 of the 372 control participants (21.0%; median age 78, interquartile range ( IQR) 72-84) and in 42 of the 360 intervention participants (11.7%; median age 80, IQR 73-85) (absolute risk reduction = 9.3%, number needed to treat = 11). The median LOS in the hospital was 8 days ( IQR 4-14 days) in both groups. At discharge, median medication cost was significantly lower in the intervention group (€73.16, IQR €38.68-121.72) than in the control group (€90.62, IQR €49.38-162.53) (Wilcoxon rank test Z statistic = −3.274, P < .001). Conclusion Application of STOPP/ START criteria resulted in significant reductions in ADR incidence and medication costs in acutely ill older adults but did not affect median LOS. [ABSTRACT FROM AUTHOR]