Excess winter mortality and stalling international improvements in life expectancy and mortality rates

In the UK, government austerity has been suggested as a major reason for the stalling of life expectancy improvements and age-standardised mortality rates. However, these trends have also been observed in many other countries. Influenza has been suggested as a potential confounding factor, as this condition contributes significantly to excess winter mortality (EWM) rates each year. This study uses calculated EWM rates in 64 countries with more than 12 000 deaths per annum to show that the decade before the financial crash was characterised by lower than average rates of EWM. The observed international stalling in life expectancy may therefore have been happening as early as the year 2000 but may have been partly masked by a decade of lower than usual winter deaths. From a health service perspective, EWM is also a source of winter bed pressures because of the associated medical admissions. The coincidental decade of low EWM rates may have also created a false picture of low winter demand, to which managers will have responded by trimming resources. This will, in part, have contributed to current winter pressures as EWM rates have returned to more ‘normal’ levels.

Cost-effectiveness of a domestic violence and abuse training and support programme in primary care in the real world: updated modelling based on an MRC phase IV observational pragmatic implementation study

ObjectivesTo evaluate the cost-effectiveness of the implementation of the Identification and Referral to Improve Safety (IRIS) programme using up-to-date real-world information on costs and effectiveness from routine clinical practice. A Markov model was constructed to estimate mean costs and quality-adjusted life-years (QALYs) of IRIS versus usual care per woman registered at a general practice from a societal and health service perspective with a 10-year time horizon.Design and settingCost–utility analysis in UK general practices, including data from six sites which have been running IRIS for at least 2 years across England.ParticipantsBased on the Markov model, which uses health states to represent possible outcomes of the intervention, we stipulated a hypothetical cohort of 10 000 women aged 16 years or older.InterventionsThe IRIS trial was a randomised controlled trial that tested the effectiveness of a primary care training and support intervention to improve the response to women experiencing domestic violence and abuse, and found it to be cost-effective. As a result, the IRIS programme has been implemented across the UK, generating data on costs and effectiveness outside a trial context.ResultsThe IRIS programme saved £14 per woman aged 16 years or older registered in general practice (95% uncertainty interval −£151 to £37) and produced QALY gains of 0.001 per woman (95% uncertainty interval −0.005 to 0.006). The incremental net monetary benefit was positive both from a societal and National Health Service perspective (£42 and £22, respectively) and the IRIS programme was cost-effective in 61% of simulations using real-life data when the cost-effectiveness threshold was £20 000 per QALY gained as advised by National Institute for Health and Care Excellence.ConclusionThe IRIS programme is likely to be cost-effective and cost-saving from a societal perspective in the UK and cost-effective from a health service perspective, although there is considerable uncertainty surrounding these results, reflected in the large uncertainty intervals.