Search

Current cost-effectiveness analyses (CEA) emphasize drug costs as the differentiator between NICE recommended anti-VEGF treatments but may neglect real-world non-drug costs of running nAMD services in the UK. To address this, this study identified real-world non-drug service cost items relevant to UK NHS nAMD clinics, including costs arising from operational strain (demand exceeding capacity). Cost items were identified by a structured literature review of peer-reviewed and grey literature, and an expert panel of 10 UK-based ophthalmologists with relevance to real-world practice. These items underwent meta-synthesis and were then determined in a consensus exercise. Of 237 cost items identified, 217 (91.6%) met the consensus threshold of >0.51 and were included in the nAMD Service Non-Drug Cost Instrument (nAS). Sensitivity of cost items taken from UK Health Technology Assessment (HTA) using the nAS as the reference standard was low (HTAmin: 1.84%, 95% CI 0.50–4.65%; HTAmax: 70.51%, 95% CI 63.96–76.49%). False negative rates showed variable likelihood of misclassifying a service by cost burden depending on prevalence. Scenario analysis using cost magnitudes estimated annual per-patient clinic cost at £845 (within capacity) to £13,960 (under strain) compared to an HTAmin estimate of £210. Accounting for cost of strain under an assumed 50% increase in health resource utilization influenced cost-effectiveness in a hypothetical genericisation scenario. Findings suggested that HTA underestimates UK NHS nAMD clinic cost burden with cost of strain contributing substantial additional unmeasured expense with impact on CEA. Given potential undertreatment due to strain, durability is suggested as one of the relevant factors in CEA of nAMD anti-VEGF treatments due to robustness under limited capacity conditions affecting UK ophthalmology services. When considering how well treatments work versus how much they cost, the focus is usually only on the price of the medicine itself. However, other real-world costs exist. In the UK, when treating certain eye problems such as neovascular age-related macular degeneration (nAMD), there are additional expenses related to running clinics and managing treatments that often go unnoticed. To get a better understanding of these hidden costs, the study examined factors like clinic workload and the extra expenses that come with it. Ten eye doctors in the UK were consulted for their expert opinions and numerous research papers were reviewed to identify these additional costs. The study grouped different costs in a tool called the nAMD Service Non-Drug Cost Instrument (nAS). When the findings of the nAS tool were compared to the usual methods of calculating costs, it was found that the conventional approach overlooked many of the actual expenses. Busy clinics face unique challenges, such as higher operational costs associated with staffing for extended hours, emergency appointments, extended waiting times and the potential to miss optimal treatment windows. This can lead to disease progression and the onset of comorbidities, which require more complex and costly treatments. Recognizing these real costs is crucial when making decisions about treatments, especially when treatments require more frequent visits to eye clinics. This study emphasizes the importance of considering all expenses, not just the obvious ones like medication and doctor visits when determining the most effective way to manage eye conditions like nAMD in the UK. [ABSTRACT FROM AUTHOR]

Evidence reviews, commonly confused with literature reviews, are a crucial method not only for collating and synthesising the evidence base, but also for determining what the quality of previous evidence is and extracting the most amount of value from previous studies using systematic techniques. The paper focuses on the use of evidence reviews to inform the development of energy and climate policies, using the UK as a case study. A framework is proposed for understanding the different types of evidence reviews based on government resource constraints. Although the application of evidence reviews is growing, the method has received much less attention in the energy and climate policy field in comparison to other policy areas, such as health policy and social policy. This paper argues that the method (particularly systematic scoping reviews and Rapid Evidence Assessments) is resource-efficient, delivers good value-for-money and is comprehensive for informing the development of energy and climate policy within the timescales and resources of governments. They ensure that only high quality evidence is used (through the use of quality assessment scales), thus helping to ensure that policies maximise positive societal impacts, minimise any negative impacts, are defendable from an expert perspective, and that they learn from past experiences, both domestically and internationally. The paper discusses the practical challenges associated with the four main types of evidence review, and draws on the experiences of four evidence reviews commissioned in 2016-2017 by the UK Government's Department for Business, Energy & Industrial Strategy (BEIS).

(1) Background: Immune cells infiltrate the tumor microenvironment and secrete inflammatory cytokines, including interferons (IFNs), to drive antitumor responses and promote tumor clearance. However, recent evidence suggests that sometimes, tumor cells can also harness IFNs to enhance growth and survival. The essential NAD+ salvage pathway enzyme nicotinamide phosphoribosyltransferase (NAMPT) gene is constitutively expressed in cells during normal homeostasis. However, melanoma cells have higher energetic demands and elevated NAMPT expression. We hypothesized that interferon gamma (IFNγ) regulates NAMPT in tumor cells as a mechanism of resistance that impedes the normal anti-tumorigenic effects of IFNγ. (2) Methods: Utilizing a variety of melanoma cells, mouse models, Crispr-Cas9, and molecular biology techniques, we explored the importance of IFNγ-inducible NAMPT during melanoma growth. (3) Results: We demonstrated that IFNγ mediates the metabolic reprogramming of melanoma cells by inducing Nampt through a Stat1 binding site in the Nampt gene, increasing cell proliferation and survival. Further, IFN/STAT1-inducible Nampt promotes melanoma in vivo. (4) Conclusions: We provided evidence that melanoma cells directly respond to IFNγ by increasing NAMPT levels, improving their fitness and growth in vivo (control n = 36, SBS KO n = 46). This discovery unveils a possible therapeutic target that may improve the efficacy of immunotherapies involving IFN responses in the clinic.

The goal of this research was to understand better the perspectives held by physicians and patients regarding what factors determine the appropriateness of medical visits. We also wished to create a convenient measure of those perspectives. In our first study, we conducted focus groups separately composed of 22 physicians and 16 patients to determine their respective views. In our second study, a 40-item measure derived from Study 1 themes was administered to a sample of 202 patients. Study 1 identified 20 themes, collapsing into 6 dimensions. Physicians held views that some patients were manipulative when seeking medical care. Study 2 revealed factors of "Symptom Experience" and "Doctor Expertise." The two studies revealed that the perception of medical utilization varies between patients and physicians, but both groups share many similar beliefs. (Contains 5 tables.)

Extension, with its access to long-term volunteers, has the unique ability to teach citizen scientists about the connection between climate variability and the resulting effects on plants, animals, and thus, humans. The USA National Phenology Network's Nature's Notebook on-line program provides a science learning tool for Extension's Master Gardener, Master Naturalist, and Master Water Steward training programs, engaging volunteers to contribute to a scientifically rigorous data resource. We give examples of how Extension programs in Arizona, Florida, and Maine are currently incorporating Nature's Notebook, and encourage use of the program in other Extension locations.