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The quality of reporting of health economic evaluations for rehabilitation services has been questioned, limiting the ability to provide accurate recommendations for health decisions. To document current overall reporting quality of the published literature for economic evaluations of rehabilitation services using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS), and to identify factors that could influence the quality of reporting. Electronic literature searches were performed using MEDLINE and the NHS Economic Evaluations Database via the Cochrane Library. Prospective rehabilitation economic evaluation articles from 2013 to 2020 were selected. Data were extracted by one reviewer and independently verified by a second reviewer. Title and abstracts of 3,454 papers were reviewed. 204 papers were selected for a full text screening. From those, 129 potential papers were identified to be included in this study. Only two databases were used in data collection, and papers were selected from 2013 to 2020 only. Inconsistent reporting in health economic evaluations of rehabilitation services has continued, despite the availability of the CHEERS checklist. The methods of the analyzed studies were frequently under-reported, thereby creating challenges in determining whether the results reported were valid. Variable quality of reporting has been identified in rehabilitation research assessing cost-effectiveness. To grow as an area of expertise, the field of rehabilitation must produce research demonstrating its cost-effectiveness. Both rehabilitation clinicians and funders would benefit from full and transparent information to identify optimal solutions for effective and efficient care. [ABSTRACT FROM AUTHOR]

• The JCVI recently consulted on proposed changes to its CEA guidelines. • This a welcome opportunity to reconsider the JCVI's current and proposed methods. • Overall, the proposals represent a carefully thought-through methods update. • Some proposals require reconsideration, particularly those on uncertainty analysis. The UK Department of Health and Social Care recently held a consultation on proposals to revise the methods for the appraisal of cost-effectiveness of vaccines as applied by the Joint Committee on Vaccination and Immunisation (JCVI). This presents a useful opportunity to review the current methods applied by the JCVI and examine the proposals for their improvement. Reviewing such methods is timely as there is mounting evidence that key elements of the health economic appraisal of all healthcare interventions in the UK need to be revised. In particular, there is a need to reassess both the cost-effectiveness threshold used to judge if an intervention is cost-effective and the discount rates used to assess the present value of health gains that occur in the future. Accordingly, we critically appraise the methods and their proposed changes. Overall, the 27 recommendations made within the recent consultation on proposed changes indicate a sensible and carefully considered approach to methods reform. We identify 11 recommendations that deserve further comment or reconsideration. In particular, there are reasons to question the basis for the proposed reduction of the discount rate from 3.5% to 1.5%. We also find that aspects of the current methods for considering uncertainty in the cost-effectiveness of vaccines require revision. Both the discounting and uncertainty analyses recommendations do not appear to be well grounded in economic theory, empirically justified or consistent with the methods set out by the National Institute for Health and Care Excellence. [ABSTRACT FROM AUTHOR]

Recent evidence suggests that less frequent repositioning of long‐term care residents at moderate to high risk of developing pressure ulcers (PrUs) is noninferior to current repositioning standards in preventing PrUs, but the long‐term health and economic consequences of less frequent repositioning have not been adequately estimated. Our objective was to estimate the cost‐effectiveness of different repositioning strategies (2‐, 3‐, 4‐hour intervals). We conducted a cost‐utility analysis using a lifetime horizon based on data from a randomized clinical trial and the literature. We updated a published PrU decision model with resource usage, unit costs, and epidemiological estimates from the literature and from a small observational study. The Ontario Ministry of Health and Long‐Term Care perspective was taken. We estimated lifetime costs to be CAN$5,425 (95% credible interval (CrI)=$922–12,166) less per resident with 3‐hour repositioning than with 2‐hour repositioning and CAN$3,296 (95% CrI=$483–9,738) less than with 4‐hour repositioning. The gain in expected quality‐adjusted life years from a 3‐ to a 2‐hour repositioning strategy was 0.008, (95% CrI=0.005–0.016) and from a 3‐ to a 4‐hour repositioning strategy was 0.009 (95% CrI=0.007–0.018). Repositioning at 3‐hour intervals was the dominant strategy with respect to the incremental cost‐effectiveness ratio against the 2‐ and 4‐hour strategies. Sensitivity analysis showed a 99% probability that 3‐hour repositioning was a dominant strategy. We concluded that repositioning at 3‐hour intervals for residents at moderate or high risk of PrUs and who were cared for on high‐density foam mattresses appeared to be the most cost‐effective strategy. [ABSTRACT FROM AUTHOR]

Background: Due to high survival rates and the relatively small benefit of adjuvant therapy, the application of personalized medicine (PM) through risk stratification is particularly beneficial in early breast cancer (BC) to avoid unnecessary harms from treatment. The new 21-gene assay (OncotypeDX, ODX) is a promising prognostic score for risk stratification that can be applied in conjunction with Adjuvant!Online (AO) to guide personalized chemotherapy decisions for early BC patients. Our goal was to evaluate risk-group specific cost effectiveness of adjuvant chemotherapy for women with early stage BC in Austria based on AO and ODX risk stratification.Methods: A previously validated discrete event simulation model was applied to a hypothetical cohort of 50-year-old women over a lifetime horizon. We simulated twelve risk groups derived from the joint application of ODX and AO and included respective additional costs. The primary outcomes of interest were life-years gained, quality-adjusted life-years (QALYs), costs and incremental cost-effectiveness (ICER). The robustness of results and decisions derived were tested in sensitivity analyses. A cross-country comparison of results was performed.Results: Chemotherapy is dominated (i.e., less effective and more costly) for patients with 1) low ODX risk independent of AO classification; and 2) low AO risk and intermediate ODX risk. For patients with an intermediate or high AO risk and an intermediate or high ODX risk, the ICER is below 15,000 EUR/QALY (potentially cost effective depending on the willingness-to-pay). Applying the AO risk classification alone would miss risk groups where chemotherapy is dominated and thus should not be considered. These results are sensitive to changes in the probabilities of distant recurrence but not to changes in the costs of chemotherapy or the ODX test.Conclusions: Based on our modeling study, chemotherapy is effective and cost effective for Austrian patients with an intermediate or high AO risk and an intermediate or high ODX risk. In other words, low ODX risk suggests chemotherapy should not be considered but low AO risk may benefit from chemotherapy if ODX risk is high. Our analysis suggests that risk-group specific cost-effectiveness analysis, which includes companion prognostic tests are essential in PM. [ABSTRACT FROM AUTHOR]

The authors discuss the implications of the 2015 proposed revision of the Cancer Drugs Fund (CDF), established to provide a means by which National Health Service (NHS) patients could get cancer drugs that are not available on the NHS in Great Britain. They argues against the threats of the revised scheme on public health. They describe how the revised CDF could maximize the value of the benefit to cancer patients while minimizing its negative impact on the equity and efficiency of the NHS.

Background Context: Whiplash-associated disorders (WAD) and neck pain and associated disorders (NAD) are prevalent conditions that impact society and impose a significant economic burden on health-care systems. Health economic evidence on WAD and NAD interventions has been sparse: only three economic evaluations of interventions for NAD were identified by the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders (NPTF). An updated overview is needed to inform health-care policy and guidelines.Purpose: This study aimed to determine the cost-effectiveness of interventions for grades I-III WAD and NAD in children and adults.Study Design: Systematic review of health economic literature, best-evidence synthesis.Methods: We systematically searched CINAHL, the Cochrane economic databases (Health Technology Assessment, NHS Economic Evaluation Database), EconLit, EMBASE, MEDLINE, PsycINFO, and Tufts CEA Registry from 2000 to 2015 for economic evaluations of WAD and NAD interventions. We appraised relevant evaluations using the Scottish Intercollegiate Guidelines Network Methodology Criteria for Economic Evaluations. We extracted data, including mean costs (standardized to 2013 Canadian dollars [CAD]) and quality-adjusted life years (QALYs), from studies with adequate methodological quality. We recalculated cost-effectiveness statistics based on the standardized currency using a willingness-to-pay of CAD $50,000 per additional QALY. Funding was provided by the Ministry of Finance.Results: Our search identified 1,616 citations. Six studies fulfilled our selection criteria, including three studies previously reviewed by the NPTF. Structured education appears cost-effective for adults with WAD. For adults with NAD, acupuncture added to routine medical care; manual therapy; multimodal care that includes manual therapy; advice and exercise; and psychological care using cognitive-behavioral therapy appear cost-effective. In contrast, adding manual therapy or diathermy to advice and exercise; multimodal care by a physiotherapist or physician; and behavioral-graded activity do not appear cost-effective for adults with NAD.Conclusions: Our review adds to the findings of the NPTF. Recent evidence suggests that structured education is cost-effective for WAD, whereas advice and exercise and multimodal care that include manual therapy are cost-effective for NAD. Obtaining more robust health economic evidence for non-invasive interventions for WAD and NAD in children and adults remains an essential research priority. [ABSTRACT FROM AUTHOR]