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Question: Is an injury prevention program consisting of 10 exercises designed to improve stability, muscle strength, co-ordination, and flexibility of the trunk, hip and leg muscles (known as The11) cost effective in adult male amateur soccer players? Design: Cost-effectiveness analysis of a cluster-randomised controlled trial. Participants: 479 adult male amateur soccer players aged 18–40 years. Intervention: The intervention group was instructed to perform the exercises at each training session (2 to 3 sessions per week) during one soccer season. The exercises focus on core stability, eccentric training of thigh muscles, proprioceptive training, dynamic stabilisation, and plyometrics with straight leg alignment. The control group continued their usual warm-up. Outcome measures: All injuries and costs associated with these injuries were compared between groups after bootstrapping (5000 replications). Results: No significant differences in the proportion of injured players and injury rate were found between the two groups. Mean overall costs in the intervention group were €161 (SD 447) per athlete and €256 (SD 555) per injured athlete. Mean overall costs in the control group were €361 (SD 1529) per athlete and €606 (SD 1944) per injured athlete. Statistically significant cost differences in favour of the intervention group were found per player (mean difference €201, 95% CI 15 to 426) and per injured player (mean difference €350, 95% CI 51 to 733). Conclusions: The exercises failed to significantly reduce the number of injuries in male amateur soccer players within one season, but did significantly reduce injury-related costs. The cost savings might be the result of a preventive effect on knee injuries, which often have substantial costs due to lengthy rehabilitation and lost productivity. Trial registration: NTR2416. [Krist MR, van Beijsterveldt AMC, Backx FJG, de Wit GA (2013) Preventive exercises reduced injury-related costs among adult male amateur soccer players: a clusterrandomised trial. Journal of Physiotherapy 59: 15–23] [Copyright &y& Elsevier]

Background Vaccine effectiveness is usually determined in randomized controlled trials (RCT) and if effective, additional information, e.g. on cost-effectiveness, is required to allow evidencebased decision making. A prerequisite for proper health economic modelling is the availability of good quality data on health care resources use, health outcomes and quality-oflife (QoL) data. The "Collecting health outcomes and economic data on hospitalized Community Acquired Pneumonia (CHO-CAP) - a prospective cohort study" is executed alongside the Community Acquired Pneumonia Immunization Trial with Adults (CAPiTA trial) to capture health outcomes and economic data of elderly hospitalized with CAP and matched controls without CAP. Methods/Design CAPiTA is a placebo-controlled double-blind RCT evaluating the effectiveness of a 13- valent conjugated pneumococcal vaccine in preventing vaccine-type pneumococcal CAP in 84,496 elderly in the Netherlands. Participants of CAPiTA, who consented and provided information on health status (EQ-5D) and socio-demographic background at the time of vaccination, constitute the source population of CHO-CAP and are eligible for the nested matched cohort study. CHO-CAP patients hospitalized with CAP form the "diseased" cohort and the "non-diseased" cohort consists of unaffected persons (i.e. no CAP). Observations in the diseased cohort and in matched controls from the non-diseased cohort are used to determine excess costs and QoL changes attributable to CAP. Based on an estimated 2,000 CAPiTA participants being hospitalized with CAP and an assumed CHO-CAP participation rate of 30% of all CAPiTA participants (+25,000), 600 CAP episodes are expected among CHO-CAP participants (the "diseased" cohort). For each patient with CAP, two non-diseased CHO-CAP subjects will be selected from the CHO-CAP cohort, with matching for age, gender and EQ-5D baseline-score. Data on healthcare and non-healthcare resources use, quality-of-life (using EQ-5D and SF-36 questionnaires) and selected health outcomes will be collected at 0, 1, 6 and 12 months after hospitalization for CAP. The CHO-CAP study was approved by the Central Committee on Research involving Human Subjects in the Netherlands. Discussion With an expected 600 CAP episodes this study will be one of the biggest prospectively studied cohorts of hospitalized elderly with CAP with regard to resources use and Qol data. Strengths of this study further include collection of out-of-pocket costs of patients and productivity losses of both patients and their caregivers and the follow-up period of up to one year post-discharge. This study is therefore expected to add more in-depth knowledge on the short and longer term outcomes of pneumonia in elderly. [ABSTRACT FROM AUTHOR]