scholarly journals A protocol for the economic evaluation of the smoking Cessation in Pregnancy Incentives Trial III (CPIT III)

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e038827
Author(s):  
Nicola McMeekin ◽  
Lesley Sinclair ◽  
Linda Bauld ◽  
David Michael Tappin ◽  
Alex Mitchell ◽  
...  
Keyword(s):  
Economic Evaluation ◽  
Usual Care ◽  
Pregnant Women ◽  
Financial Incentives ◽  
Cost Effective ◽  
Good Opportunity ◽  
Link Type ◽  
The Uk ◽  
In Pregnancy

IntroductionSmoking results in an average 10-year loss of life, but smokers who permanently quit before age 40 can expect a near normal lifespan. Pregnancy poses a good opportunity to help women to stop; around 80% of women in the UK have a baby, most of whom are less than 40 years of age. Smoking prevalence during pregnancy is high: 17%–23% in the UK. Smoking during pregnancy causes low birth weight and increases the risk of premature birth. After birth, passive smoking is linked to sudden infant death syndrome, respiratory diseases and increased likelihood of taking up smoking. These risks impact the long-term health of the child with associated increase in health costs. Emerging evidence suggests that offering financial incentives to pregnant women to quit is highly cost effective.This protocol describes the economic evaluation of a multi-centre randomised controlled trial (Cessation in Pregnancy Incentives Trial III, CPIT III) designed to establish whether offering financial incentives, in addition to usual care, is effective and cost effective in helping pregnant women to quit.Methods and analysisThe economic evaluation will identify, measure and value resource use and outcomes from CPIT III, comparing participants randomised to either usual care or usual care plus up to £400 financial incentives. Within-trial and long-term analyses will be conducted from a National Health Service and Personal Social Services perspective; the outcome for both analyses will be quality adjusted life-years measured using EQ-5D-5L. Patient level data collected during the trial will be used for the within-trial analysis, with an additional outcome of cotinine validated quit rates at 34–38 weeks gestation and 6 months postpartum. The long-term model will be informed by data from the trial and published literature.Ethics and disseminationTrial registration numberISRCTN15236311; Pre-results (https://doi.org/10.1186/ISRCTN15236311).

scholarly journals Repeat screening for syphilis in pregnancy as an alternative screening strategy in the UK: a cost-effectiveness analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e038505
Author(s):  
Susie Huntington ◽  
Georgie Weston ◽  
Farah Seedat ◽  
John Marshall ◽  
Heather Bailey ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Pregnant Women ◽  
Neonatal Death ◽  
Cost Effective ◽  
Screening Strategy ◽  
Base Case ◽  
Scenario Analyses ◽  
The Uk ◽  
The Cost ◽  
In Pregnancy

ObjectivesTo assess the cost-effectiveness of universal repeat screening for syphilis in late pregnancy, compared with the current strategy of single screening in early pregnancy with repeat screening offered only to high-risk women.DesignA decision tree model was developed to assess the incremental costs and health benefits of the two screening strategies. The base case analysis considered short-term costs during the pregnancy and the initial weeks after delivery. Deterministic and probabilistic sensitivity analyses and scenario analyses were conducted to assess the robustness of the results.SettingUK antenatal screening programme.PopulationHypothetical cohort of pregnant women who access antenatal care and receive a syphilis screen in 1 year.Primary and secondary outcome measuresThe primary outcome was the cost to avoid one case of congenital syphilis (CS). Secondary outcomes were the cost to avoid one case of intrauterine fetal demise (IUFD) or neonatal death and the number of women needing to be screened/treated to avoid one case of CS, IUFD or neonatal death. The cost per quality-adjusted life year gained was assessed in scenario analyses.ResultsBase case results indicated that for pregnant women in the UK (n=725 891), the repeat screening strategy would result in 5.5 fewer cases of CS (from 8.8 to 3.3), 0.1 fewer cases of neonatal death and 0.3 fewer cases of IUFD annually compared with the single screening strategy. This equates to an additional £1.8 million per case of CS prevented. When lifetime horizon was considered, the incremental cost-effectiveness ratio for the repeat screening strategy was £120 494.ConclusionsUniversal repeat screening for syphilis in pregnancy is unlikely to be cost-effective in the current UK setting where syphilis prevalence is low. Repeat screening may be cost-effective in countries with a higher syphilis incidence in pregnancy, particularly if the cost per screen is low.

scholarly journals The Smoking Cessation in Pregnancy Incentives Trial (CPIT): study protocol for a phase III randomised controlled trial

2019 ◽  
Author(s):  
Lesley Sinclair ◽  
Margaret McFadden ◽  
Helen Tilbrook ◽  
Alex Mitchell ◽  
Ada Keding ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Birth Weight ◽  
Pregnant Women ◽  
Financial Incentives ◽  
Late Pregnancy ◽  
Cost Effective ◽  
Phase Iii ◽  
Pregnant Smokers ◽  
Randomised Controlled ◽  
The Uk

Abstract Background Eighty percent of UK women have at least one baby, making pregnancy an opportunity to help women to stop smoking before their health is irreparably compromised. Smoking cessation during pregnancy helps protect infants from miscarriage, still birth, low birth weight, asthma, attention deficit disorder and adult cardiovascular disease. UK national guidelines highlight lack of evidence for effectiveness of financial incentives to help pregnant smokers quit. This includes a research recommendation: Within a UK context, are incentives an acceptable, effective and cost-effective way to help pregnant women who smoke to quit? Methods CPIT III is a pragmatic, 39-month, multi-centre, parallel group, individually randomised controlled superiority trial of the effect on smoking status of adding to usual smoking cessation support the offer of up to £400 of financial voucher incentives, compared with usual support alone, to quit smoking during pregnancy. Participants (n = 940) are pregnant smokers (age > 16, <24 weeks pregnant, English speaking), who consent via telephone to take part and are willing to be followed-up in late pregnancy and 6 months after birth. The primary outcome is cotinine/anabasine validated abstinence from smoking in late pregnancy. Secondary outcomes include engagement with cessation services, quit rates at four weeks from agreed quit date and 6 months after birth, and birth weight. Outcomes will be analysed by intention-to-treat, and regression models will be used to compare treatment effects on outcomes. A meta-analysis will include data from the feasibility study in Glasgow. An economic evaluation will assess cost-effectiveness from a UK NHS perspective. Process evaluation using a case study approach will identify opportunities to improve recruitment and learning for future implementation. Research questions: What is the therapeutic efficacy of incentives? Are incentives cost-effective? What are the potential facilitators and barriers to implementing incentives in different parts of the UK? Discussion This phase III trial in Scotland, England and Northern Ireland, follows a successful phase II trial in Glasgow UK. The participating sites have diverse smoking cessation services, that represent most cessation services in the UK and serve demographically varied populations. If found to be acceptable and cost-effective this trial could demonstrate that financial incentives are effective and transferable to most UK cessation services for pregnant women.

scholarly journals Cost-effectiveness of habit-based advice for weight control versus usual care in general practice in the Ten Top Tips (10TT) trial: economic evaluation based on a randomised controlled trial

BMJ Open ◽  
2018 ◽  
Vol 8 (8) ◽  
pp. e017511 ◽  
Author(s):  
Nishma Patel ◽  
Rebecca J Beeken ◽  
Baptiste Leurent ◽  
Rumana Z Omar ◽  
Irwin Nazareth ◽  
...  
Keyword(s):  
General Practice ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Randomised Controlled Trial ◽  
Health Service ◽  
Usual Care ◽  
Controlled Trial ◽  
Cost Effective ◽  
The Mean ◽  
Randomised Controlled

ObjectiveTen Top Tips (10TT) is a primary care-led behavioural intervention which aims to help adults reduce and manage their weight by following 10 weight loss tips. The intervention promotes habit formation to encourage long-term behavioural changes. The aim of this study was to estimate the cost-effectiveness of 10TT in general practice from the perspective of the UK National Health Service.DesignAn economic evaluation was conducted alongside an individually randomised controlled trial.Setting14 general practitioner practices in England.ParticipantsAll patients were aged ≥18 years, with body mass index ≥30 kg/m2. A total of 537 patients were recruited; 270 received the usual care offered by their practices and 267 received the 10TT intervention.Outcomes measuresHealth service use and quality-adjusted life years (QALYs) were measured over 2 years. Analysis was conducted in terms of incremental net monetary benefits (NMBs), using non-parametric bootstrapping and multiple imputation.ResultsOver a 2-year time horizon, the mean costs and QALYs per patient in the 10TT group were £1889 (95% CI £1522 to £2566) and 1.51 (95% CI 1.44 to 1.58). The mean costs and QALYs for usual care were £1925 (95% CI £1599 to £2251) and 1.51 (95% CI 1.45 to 1.57), respectively. This generated a mean cost difference of −£36 (95% CI −£512 to £441) and a mean QALY difference of 0.001 (95% CI −0.080 to 0.082). The incremental NMB for 10TT versus usual care was £49 (95% CI −£1709 to £1800) at a maximum willingness to pay for a QALY of £20 000. 10TT had a 52% probability of being cost-effective at this threshold.ConclusionsCosts and QALYs for 10TT were not significantly different from usual care and therefore 10TT is as cost-effective as usual care. There was no evidence to recommend nor advice against offering 10TT to obese patients in general practices based on cost-effectiveness considerations.Trial registration numberISRCTN16347068; Post-results.

scholarly journals What if we combine Quit and win and individual approach to help smokers quit at the community level?

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
J Kovacevic ◽  
D Zombori
Keyword(s):  
Sex Education ◽  
Financial Incentives ◽  
Local Community ◽  
Smoking Status ◽  
Economic Status ◽  
Cost Effective ◽  
Social Characteristics ◽  
Individual Approach ◽  
Effective Interventions

Abstract Issue Tobacco eventually kills up to a half of its users. Helping smokers who wish to quit is one of the six cost effective interventions listed by World Bank to decrease smoking harm. Tobacco Control Scale in 2016, shows diversity in approaches and coverage to help smokers quit across Europe. Comprehensive interventions are most effective. Combining contest, financial incentives, individual approach and triggers (start of Lent or other) could be implemented in other settings. Description of the problem Contest to motivate smokers for a quit attempt and individual help provided, has been conducted yearly since 2015 in a local community in Pozega-Slavonia County in Croatia. Data on all participants from 2015 through 2018 contests were collected by questionnaires and long term smoking status (6 months) evaluated by phone interviewing. Statistical analysis was conducted in SPSS. The objective was to determine how effective in helping smokers quit is a novel combination of evidence-based approaches “Quit and win” and individual support in local setting and to establish certain smokers characteristics as possible predictors of outcome. Results Data for 153 participants were collected. There were more (54%) male participants. Participants mean age was 35.8 years (range 18-67). Short term (30 day) abstinence rate was 73.9% (113/153) and out of those 34.1% (31/91) abstained long term (6 months). Long term follow-up was 80.5% (91/113). Overall, long term quit rate was 23.7% (31/131). There were no statistically significant differences in short and long term quit rates depending on age, sex, education, employment or socio-economic status, pack-year measure or personal success estimates. Lessons Comprehensive contest approach was found to be effective in helping smokers quit. Interest for implementation was shown by several counties and cities in Croatia. Effectiveness regardless of personal and social characteristics of contestants shows potential in different settings. Key messages Comprehensive interventions that include contest, financial incentives, individual approach and triggers in smoking cessation helped one in four involved smokers to quit. This approach has potential for implementation in diverse local communities as no difference in quit rates in different sex, age or socioeconomic groups were detected.

scholarly journals Cost-effectiveness of an internet-based perioperative care programme to enhance postoperative recovery in gynaecological patients: economic evaluation alongside a stepped-wedge cluster-randomised trial

BMJ Open ◽  
2018 ◽  
Vol 8 (1) ◽  
pp. e017782
Author(s):  
Esther V A Bouwsma ◽  
Judith E Bosmans ◽  
Johanna M van Dongen ◽  
Hans A M Brölmann ◽  
Johannes R Anema ◽  
...  
Keyword(s):  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Usual Care ◽  
Perioperative Care ◽  
Cost Effective ◽  
Stepped Wedge ◽  
Gynaecological Surgery ◽  
Care Programme ◽  
Societal Costs ◽  
Cluster Randomised

ObjectivesTo evaluate the cost-effectiveness and cost-utility of an internet-based perioperative care programme compared with usual care for gynaecological patients.DesignEconomic evaluation from a societal perspective alongside a stepped-wedge cluster-randomised controlled trial with 12 months of follow-up.SettingSecondary care, nine hospitals in the Netherlands, 2011–2014.Participants433 employed women aged 18–65 years scheduled for a hysterectomy and/or laparoscopic adnexal surgery.InterventionThe intervention comprised an internet-based care programme aimed at improving convalescence and preventing delayed return to work (RTW) following gynaecological surgery and was sequentially rolled out. Depending on the implementation phase of their hospital, patients were allocated to usual care (n=206) or to the intervention (n=227).Main outcome measuresThe primary outcome was duration until full sustainable RTW. Secondary outcomes were quality-adjusted life years (QALYs), health-related quality of life and recovery.ResultsAt 12 months, there were no statistically significant differences in total societal costs (€−647; 95% CI €−2116 to €753) and duration until RTW (−4.1; 95% CI −10.8 to 2.6) between groups. The incremental cost-effectiveness ratio (ICER) for RTW was 56; each day earlier RTW in the intervention group was associated with cost savings of €56 compared with usual care. The probability of the intervention being cost-effective was 0.79 at a willingness-to-pay (WTP) of €0 per day earlier RTW, which increased to 0.97 at a WTP of €76 per day earlier RTW. The difference in QALYs gained over 12 months between the groups was clinically irrelevant resulting in a low probability of cost-effectiveness for QALYs.ConclusionsConsidering that on average the costs of a day of sickness absence are €230, the care programme is considered cost-effective in comparison with usual care for duration until sustainable RTW after gynaecological surgery for benign disease. Future research should indicate whether widespread implementation of this care programme has the potential to reduce societal costs associated with gynaecological surgery.Trial registration numberNTR2933; Results.

scholarly journals Provision of acute medicine services for pregnant women in UK hospitals: Data from the Society for Acute Medicine Benchmarking Audit 2019

2020 ◽  
pp. 1753495X2092950
Author(s):  
Catherine Atkin ◽  
Paarul Prinja ◽  
Anita Banerjee ◽  
Mark Holland ◽  
Dan Lasserson
Keyword(s):  
Pregnant Women ◽  
Medical Problems ◽  
Acute Medicine ◽  
Hospital Size ◽  
Obstetric Medicine ◽  
Provision Of Services ◽  
Timely Access ◽  
The Uk ◽  
Local Guideline ◽  
In Pregnancy

Background Medical problems during pregnancy are the leading cause of maternal mortality in the UK. Pregnant women often present through acute services to the medical team, requiring timely access to appropriate services, physicians trained to manage medical problems in pregnancy, with locally agreed guidance available. Methods Data were collected through the Society for Acute Medicine Benchmarking Audit, a national audit of service delivery and patient care in acute medicine over a 24 hour period. Results One hundred and thirty hospitals participated: 5.5% had an acute medicine consultant trained in obstetric medicine, and 38% of hospitals had a named lead for maternal medicine. This was not related to hospital size (p = 0.313). Sixty-four units had local guidelines for medical problems in pregnancy; 43% had a local guideline for venous thromboembolism in pregnancy. Centres with a named lead had more guidelines (p = 0.019). Conclusion Current provision of services within acute medicine for pregnant women does not meet national recommendations.

Proton pump inhibitors and upper gastrointestinal cancers

2019 ◽  
Vol 12 (9) ◽  
pp. 526-530
Author(s):  
Monica Kumar
Keyword(s):  
Gastric Cancer ◽  
General Practice ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Cost Effective ◽  
Gastrointestinal Cancers ◽  
Increased Risk ◽  
The Uk ◽  
Upper Gastrointestinal

Proton pump inhibitors (PPIs) were introduced in the 1980s. They are now one of the most commonly prescribed drugs in general practice. They are cost-effective when used correctly; however, PPIs are often used beyond accepted clinical indications. Recent published studies performed outside the UK have suggested that adverse effects are associated with long-term use of PPIs; in particular, an increased risk of gastric cancer. This article will aim to systematically assess the evidence and discuss its application to our clinical practice.

scholarly journals The cost-effectiveness of pegaspargase versus native asparaginase for first-line treatment of acute lymphoblastic leukaemia: a UK-based cost-utility analysis

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Xingdi Hu ◽  
Kingsley P. Wildman ◽  
Subham Basu ◽  
Peggy L. Lin ◽  
Clare Rowntree ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Line Treatment ◽  
Newly Diagnosed ◽  
First Line ◽  
Link Type ◽  
Search Trial ◽  
Erwinia Asparaginase ◽  
The Uk ◽  
The Cost

Abstract Background L-asparaginase is a key component of treatment for patients with acute lymphoblastic leukaemia (ALL) in the UK. Commonly used forms of asparaginase are native E. coli-derived asparaginase (native asparaginase) and pegaspargase in first-line combination therapy, and native Erwinia chrysanthemi-derived asparaginase (Erwinia asparaginase) as second-line treatment. The objective of this study was to evaluate the cost-effectiveness of pegaspargase versus native asparaginase in first-line combination therapy for patients with newly diagnosed ALL. A combined decision tree and health-state transition Markov cost-effectiveness model was developed to assess the relative costs and health outcomes of pegaspargase versus native asparaginase in the UK setting. Results In base case analyses, first-line pegaspargase (followed by Erwinia asparaginase in cases of hypersensitivity) dominated first-line native asparaginase followed by Erwinia asparaginase; i.e. resulted in lower costs and more quality-adjusted life year gain. The favourable hypersensitivity rates and administration profile of pegaspargase led to lifetime cost savings of £4741 versus native asparaginase. Pegaspargase remained cost-effective versus all treatment strategies in all scenario analyses, including use of the 2500 IU/m2 dose, recommended for patients ≤21 years of age. Conclusions Pegaspargase, as part of multi-drug chemotherapy, is a cost-effective option for the treatment of newly diagnosed ALL. Based on this study, The National Institute for Health and Care Excellence Technology Appraisal Committee concluded that it could recommend pegaspargase as a cost-effective use of National Health Service resources in England & Wales for treating ALL in children, young people and adults with untreated, newly diagnosed disease. Trial registration UKALL 2011, EudraCT number 2010-020924-22; UKALL 2003, EudraCT number 2007-004013-34; UKALL14, EudraCT number 2009-012717-22.

scholarly journals Online Video Instruction on Hand Expression of Colostrum in Pregnancy is an Effective Educational Tool

Nutrients ◽  
2019 ◽  
Vol 11 (4) ◽  
pp. 883 ◽  
Author(s):  
Therese A. O’Sullivan ◽  
Joy Cooke ◽  
Chris McCafferty ◽  
Roslyn Giglia
Keyword(s):  
Pregnant Women ◽  
Large Scale ◽  
Instructional Video ◽  
Online Video ◽  
Educational Tool ◽  
Video Instruction ◽  
Face To Face ◽  
Almost All ◽  
In Pregnancy

The use of antenatal colostrum expression in the weeks prior to birth may help improve long-term breastfeeding, but few large-scale studies exist. Typically, antenatal colostrum expression instruction relies on face-to-face education, making large interventions costly. We aimed to determine whether an expert online instructional video can improve knowledge and confidence around antenatal colostrum expressing. Pregnant women were asked to complete a questionnaire pre- and post-watching the instructional video online. Ninety five pregnant women completed both pre- and post-questionnaires. Total antenatal colostrum expression knowledge scores improved after watching the video, from a mean of 3.05 ± 1.70 correct out of a maximum of 7, to 6.32 ± 0.76 (p < 0.001). Self-reported confidence around hand expressing in pregnancy also improved from an average ranking of not confident (2.56 ± 1.17, out of a possible 5) to confident (4.32 ± 0.80, p < 0.001). Almost all women (98%) reported that they would recommend the video to a friend or family member if antenatal colostrum expression was suggested by their healthcare provider. Findings suggest that the use of an online expert video is an acceptable and effective way to educate pregnant women in antenatal colostrum expression.

Time-Limited in-Work Benefits in the UK: A Review of Recent Evidence

2012 ◽  
Vol 219 ◽  
pp. R53-R64
Author(s):  
Haroon Chowdry
Keyword(s):  
Financial Incentives ◽  
Welfare To Work ◽  
Employment Retention ◽  
Lone Parents ◽  
The Uk

This paper reviews three UK-based welfare-to-work programmes featuring time-limited financial incentives to leave out-of-work benefits for employment. The policies considered are (i) the Employment Retention and Advancement demonstration, aimed at lone parents and the long-term unemployed; (ii) In-Work Credit, aimed at lone parents on welfare; (iii) Pathways to Work, aimed at recipients of incapacity benefits. I illustrate the difficulties in extrapolating from specific findings to general policy-relevant conclusions. Finally, I depict the challenge facing evaluators in future and point to the directions in which evaluation will need to develop if it is to contribute more fully to policy-relevant evaluation.

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