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Background: Transradial access (TRA) for percutaneous coronary intervention (PCI) is associated with a reduced risk of mortality compared with transfemoral access, access site-related bleeding complications, and shorter length of stay. The budget impact from a healthcare system that has largely transitioned to TRA for PCI has not been previously published., Methods and Results: Data from 323 656 patients undergoing PCI between 2010 and 2014 were obtained from the British Cardiovascular Intervention Society database. Costs for TRA and transfemoral access PCI were estimated based on procedure cost, length of stay, and differences in the rates of complications (major bleeding and vascular complications). In the base case, a propensity-matched data set between transfemoral access and TRA was used to directly compare the cost per PCI, whereas in the real-world analysis, the full data set was used. Across all indications and all years, TRA offered an average cost saving of £250.59 per procedure (22% reduction) versus transfemoral access with the majority of cost saving derived from reduced length of stay (£190.43) rather than direct costs of complications (£3.71). In the real-world analysis, adoption of TRA was estimated to have provided cost savings of £13.31 million across England between 2010 and 2014; however, if operators in all regions had adopted TRA at the rate of the region with the highest utilization, cost savings of £33.40 million could have been achieved., Conclusions: The transition to TRA in England has been associated with significant cost savings across the national healthcare system, in addition to the well-established clinical benefits., (© 2018 American Heart Association, Inc.)

Background: Prevention of sexually transmitted infection (STI) incidence in England is a high priority, particularly among young people, men who have sex with men (MSM) and black ethnic minorities. An economic evaluation of condom distribution programmes (CDPs) to reduce STI transmission is presented., Methods: An economic model using a Bernoulli process estimated the number of people acquiring an STI as a function of its prevalence, transmission rate, condom use, condom failure rate and number of sexual contacts. Models were developed for young people (13-24 years), black ethnic minorities, MSM and the general English population. Effectiveness evidence came from a recent systematic review. For young people, a CDP was modelled (relative risk for condom use=1.23), along with an exploratory analysis of the impact on unintended pregnancies. For other populations, threshold analyses were used to identify the combination of costs and effect size required to make a programme cost-effective., Results: The base case predicted that CDP for all young people in England could avert 5123 STI cases per annum, with an incremental cost-effectiveness ratio of £17 411. In addition, it could avert 118 pregnancies and 82 abortions and save £333 000 in associated costs. Schemes for black ethnic minorities and MSM could also be cost-effective even with relatively high costs and small effect sizes., Conclusion: CDPs for young people are likely to be cost-effective or cost-saving. CDPs for other high-risk populations may also be cost-effective if they can increase condom use, since high HIV prevalence in these groups imposes a considerable health and cost burden., Competing Interests: Competing interests: RP is considered to be a government employee since she works for the National Institute of Health and Care Excellence (NICE), a publicly funded body sponsored by the UK government's Department of Health. Rest of the authors have no competing interests to declare., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

The Sheffield RA health economic model has been used in several published cost-effectiveness analyses in both the UK and internationally to evaluate different treatments for patients with RA. This article presents the key methods and assumptions that underpin the model, including justifications for using an individual patient sampling methodology, and why the model has used the HAQ to track disease activity. The article also details how trial and observational data are used in the model to address specific questions. The model has been used to support health policy in both the UK and internationally, although the limited evidence still provides a challenge when using an economic model to determine the cost-effectiveness of RA treatments. The results of analyses using the Sheffield RA model are presented. The limitations of the model are discussed, and improvements are continually required to provide a model that is appropriate to address health economic questions in the future. The Sheffield RA model continues to be used and refined, and allows health economic questions to be answered using a transparent and flexible modelling methodology.