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Rationale, Aims, and Objectives: Several novel oral anticoagulants (NOACs) are licensed for atrial fibrillation (AF) treatment in the United Kingdom. We describe the incidence and mortality from ischaemic stroke and major bleeding in non-valvular atrial fibrillation (NVAF) patients in England, including treatment patterns before/following introduction of NOACs, healthcare resource utilization (HRU), and costs post-onset of these events. Method: Data were extracted from the UK Clinical Practice Research Datalink linked to Hospital Episode Statistics secondary care and Office for National Statistics mortality data. Results: Of 42 966 patients with a first AF record between 2011 and 2016, 9143 patients (21.3%) remained without AF (antiplatelets/antithrombotics) treatment post-index diagnosis. The proportion of patients receiving aspirin for ≥3 months post-index declined during the study (50.6%-5.5%), irrespective of CHA2DS2-VASc score, while the proportion prescribed NOACs increased (2.0%-70.1%). Rates of ischaemic stroke per 1000 patient-years (95% CI) were 9.4 (3.8-15.0) with NOACs, 10.4 (8.0-12.9) with warfarin, 20.1 (16.4-23.8) with aspirin, 21.3 (5.3-37.2) with other antiplatelets and 43.6 (39.3-47.8) in patients without AF prescription. Major bleeding occurred at a similar rate with different treatments. All-cause mortality rates were 42.8 (31.4-54.3) with NOACs, 46.3 (41.1-51.5) with warfarin, 56.5 (50.5-62.4) with aspirin, 102.2 (76.2-128.3) with other antiplatelets and 412.8 (399.6-426.0) with no AF prescription. Mean annual National Health Service healthcare costs up to 1 year post-index were lowest in patients receiving aspirin plus other antiplatelets without an event (£6152), and highest in patients with an event without AF prescriptions (£17 957). By extrapolation, national AF HRU in the United Kingdom in 2016 was estimated at £8-16 billion annually. Conclusions: These data provide temporal insights into AF treatment patterns and outcomes for NVAF patients in England and highlight the need to review higher stroke risk AF patients not receiving antiplatelet/antithrombotic prescriptions.

Supplemental material, sj-docx-1-mdm-10.1177_0272989X211016427 for Program Evaluation of Population- and System-Level Policies: Evidence for Decision Making by Simon Walker, Aimee Fox, James Altunkaya, Tim Colbourn, Mike Drummond, Susan Griffin, Nils Gutacker, Paul Revill and Mark Sculpher in Medical Decision Making

Supplemental material, Manuscript_expert_elicitation_HOC_MDM_4_Appendix5_online_supp for Health Opportunity Costs: Assessing the Implications of Uncertainty Using Elicitation Methods with Experts by Marta O. Soares, Mark J. Sculpher and Karl Claxton in Medical Decision Making

AIMS: To assist DH policy-makers to improve allocation of resources in health and social care policy throught the Unit's Work Programme. To provide a service with the flexibility to respond to rapid changes in the policy environment

In 2010 NICE released a clinical guideline recommending that natriuretic peptide (NP) testing in patients withsuspected heart failure without previous myocardial infarction can accelerate diagnosis of heart failure and alsoavoid unnecessary echocardiography. A framework for the evaluation of the value of implementation activities isapplied to this recommendation for NP testing.

In 2010 NICE released a clinical guideline recommending that natriuretic peptide (NP) testing in patients with suspected heart failure without previous myocardial infarction can accelerate diagnosis of heart failure and also avoid unnecessary echocardiography. A framework for the evaluation of the value of implementation activities is applied to this recommendation for NP testing.

Background: Limited evidence exists regarding the cost and health-related quality of life (HRQoL) impacts of non-muscle invasive bladder cancer (NMIBC) recurrence and progression to muscle invasive bladder cancer (MIBC). We examined these impacts using evidence from a recent randomised control trial. Material and Methods: Costs and HRQoL associated with bladder cancer were assessed using data from the Bladder COX-2 Inhibition Trial (BOXIT) (n=472). Cost and HRQoL impacts from clinical events were estimated using generalised estimating equations. Costs were derived from recorded resource usage and UK unit costs. HRQoL was assessed using the EQ-5D-3L with published UK preference tariffs. Events were categorised by TMN classification. Results: Grade 3 recurrences and progressions were associated with statistically significant -0.08 (95% confidence interval -0.13, -0.03) and -0.10 (-0.17, -0.03) HRQoL decrements, respectively. The three year average cost per NMIBC patient was estimated at £8,735 (£8,325, £9,145) with grade 1, 2 and 3 recurrences associated with annual cost impacts of £1,218 (£403, £2033), £1,677 (£920, £2433) and £3,957 (£2,332, £5,583), respectively, and £5,407 (£2,663, £8,152) for a progression to MIBC. Conclusion: Evidence from the BOXIT trial suggests NMIBC patients will incur both decrements in HRQoL and significant costs, especially in the event of a grade 3 recurrence or a progression to MIBC.