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Background: In April 2018, the UK government implemented a levy on soft drinks importers and manufacturers, tiered according to the amount of sugar in drinks. The stated aim was to encourage manufacturers to reduce sugar and portion sizes. Previous evidence suggests that the policy has been successful in reducing sugar in drinks in the short-term since implementation, but their sustained effects have not been explored. This study aimed to assess the impact of the soft drink industry levy (SDIL) on sugar levels, price, portion size and use of non-sugar sweeteners in the medium-term. Methods and findings: Product data from 30 November 2017 to 14 March 2020 from one major UK retail supermarket were analysed (112,452 observations, 126 weekly time points). We used interrupted time series analysis, to assess the impact of the soft-drink industry levy (SDIL) on levy-eligible soft drinks, with exempt drinks (i.e. 100% fruit juices, milks, flavoured milks) acting as a comparator series. At the point of implementation of the SDIL (April 2018) there was a step change in the proportion of eligible drinks with sugar content below the SDIL levy threshold (5g per 100ml) (+0.08, 95%CI: +0.04, +0.12), with a similar sized decrease in the proportion in the highest levy category (> = 8g sugar per 100ml) (-0.06, 95%CI: -0.10, -0.03). Between April 2018 and March 2020, the proportion of eligible drinks below the SDIL levy threshold continued to gradually increase (p = 0.003), while those in the highest levy category decreased (p = 0.007). There was a step change in price of eligible drinks in the higher levy category at the point of implementation of +£0.049 (95%CI: +£0.034, +£0.065) per 100mL (for comparison, the levy is set at £0.024 per 100mL for this group). Trends in price for the high levy category were not altered by the SDIL. In the no levy category, there was a step change in price at the implementation (+£0.012 per 100mL, 95%CI: +£0.008, +£0.023), followed by a second step change in October 2018 (-£0.018p per 100mL, 95%CI: -£0.033, -£0.001p). The volume of products in the higher levy group decreased at the time of the implementation (-305mL on average including multipacks, 95%CI: -511, -99). The change in trend for the product volume of drinks in the higher levy group between April 2018 and March 2020 was in the increasing direction (+704mL per year, 95%CI: -95, 1504), but it did not meet our threshold for statistical significance (p = 0.084). There were no changes observed in the volume of lower levy drinks or no levy drinks. There was a step change in the proportion of drinks with non-sugar sweeteners at the implementation of the SDIL (+0.04, 95%CI: +0.02, +0.06). Conclusion: These results suggest that the SDIL was successful in [1] producing reductions in sugar levels that were maintained over the medium term up to March 2020 and [2] a reduction in product volume for higher tier drinks that may be diminishing over time. Our results also show that the SDIL was associated with a maintained price differential between high and low sugar drinks. [ABSTRACT FROM AUTHOR]

The fourth hurdle, the requirement that pharmaceutical manufacturers can demonstrate that their new products represent good value for money as well as being of good quality, effective and safe, is increasingly being required by healthcare systems. In crossing this 'fourth' hurdle, companies will usually need to demonstrate that their products are more effective than relevant comparators and that the increased cost is offset by the enhanced benefits. Decision makers, however, must draw their conclusions not only on the basis of the underpinning science but also on the social values of the people they serve. [ABSTRACT FROM AUTHOR]

Psoriasis is a chronic inflammatory skin condition that is associated with (linked to) additional conditions such as diabetes and obesity (called comorbidities), which in turn are associated with an increased risk of infection. One concern people with psoriasis have is whether the psoriasis itself, rather than the comorbidities, is associated with an increased risk of getting a serious infection, which is defined as having any infection serious enough to lead to hospital admission. Several studies have suggested that this may be the case. However, these studies have limitations: for example, one study did not consider other lifestyle factors that could be responsible for the risk of infection. We therefore wanted to do a more robust study to find out whether psoriasis truly leads to a higher risk of getting a serious infection. We used data from the UK Clinical Practice Research Datalink. This is a database covering patient information from General Practices (GPs) around the UK and is representative of the general population of the country. In our analysis, we included 69 312 people with psoriasis and 338 598 people without psoriasis (the 'comparators') who attended their general practice and contributed patient information for a median of five years. To calculate incidence, broadly meaning rates of new cases of a disease, we calculated 'person years' which takes into account both the number of people in the study and the amount of time each person spends in the study, and then how many of these develop the disease during the study time. Using this method, we found that people with psoriasis had a higher incidence rate of serious infection, at 20.5 per 1000 person‐years, than the comparators at 16.1 per 1000 person‐years. After adjusting for other factors that may be otherwise responsible for infection risk, people with psoriasis had a relative 36% increased probability of getting a serious infection during the follow‐up time compared with the general population. This translated into three more people out of 100 people with psoriasis developing a serious infection after 10 years of follow‐up compared with the general population. Our study shows that people with psoriasis have a small but increased risk of serious infection compared with people without psoriasis. However, because the absolute increased probability of serious infection is small, people with psoriasis should not be unduly concerned. We recommend further research to understand how psoriasis leads to this slight increase in the risk of serious infection in the body. Linked Article: Yiu et al. Br J Dermatol 2021; 184:78–86. Linked Article: Yiu et al. Br J Dermatol 2021; 184:78–86. [ABSTRACT FROM AUTHOR]