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Exploratory analysis to conceptualize and evaluate the potential cost-effectiveness and economic drivers of using a novel tissue valve compared with mechanical heart valves for surgical aortic valve replacement (SAVR) in people aged 55–64 and 65+ with aortic stenosis (AS) from a National Health Service (NHS) UK perspective. A decision-analytic model was developed using a partitioned survival model. Parameter inputs were obtained from published literature. Deterministic and probabilistic sensitivity analyses (DSA and PSA) were conducted to explore the uncertainty around the parameters. The novel tissue valve was potentially associated with higher quality-adjusted life years (QALYs) of 0.01 per person. Potential cost savings were greatest for those aged 55–64 (£408) versus those aged 65+(£53). DSA indicated the results to be most dependent on relative differences in general mortality, procedure costs, and reoperation rates. PSA estimated around 75% of the iterations to be cost-effective at £20,000 per QALY for those aged 55–64, and 57% for those aged 65+. The exploratory analysis suggests that the novel tissue valve could be a cost-effective intervention for people over the age of 55 with AS who are suitable for SAVR in the UK. [ABSTRACT FROM AUTHOR]

Background: People with diabetes are at increased risk of developing chronic kidney disease (CKD) and should undergo annual screening, but adherence is poor. A home urinalysis self-test has been developed to improve compliance with screening. The objective of this paper is to report on a clinical evaluation and economic analysis of home urinalysis self-testing.Research Design and Methods: People with diabetes who had not undergone screening within the previous 18 months were recruited to a single-arm clinical evaluation to assess the uptake and compliance of home urinalysis self-testing. An economic evaluation assessed the likely cost-consequences of the use of home urinalysis self-testing over a lifetime time horizon.Results: A total of 2,196 people with diabetes were contacted as part of the clinical evaluation. Of these, 695 people agreed to be sent a home urinalysis self-testing kit and 499 people completed and returned the test. Cost savings of £2,008 per person were estimated over a lifetime due to increased CKD diagnosis and reduced progression to end stage renal disease.Conclusions: Home urinalysis self-testing of ACR in people with diabetes is estimated to be a cost-effective use of NHS resources in England in people who would otherwise not comply with standard care. [ABSTRACT FROM AUTHOR]

Background: An evaluation was conducted to estimate the cost-effectiveness of insufflation of warmed humidified CO2 during open and laparoscopic colorectal surgery compared with usual care from a UK NHS perspective.Methods: Decision analytic models were developed for open and laparoscopic surgery. Incremental costs per quality-adjusted life year (QALY) were estimated. The open surgery model used data on the incidence of intra-operative hypothermia and applied risks of complications for hypothermia and normothermia. The laparoscopic surgery model utilised data describing complications directly. Sensitivity analyses were conducted.Results: Compared with usual care, insufflation of warmed humidified CO2 dominated. For open surgery, savings of £20 and incremental QALYs of 0.013 were estimated per patient. For laparoscopic surgery, savings of £345 and incremental QALYs of 0.001 per patient were estimated. Results were robust to most sensitivity analyses.Conclusions: Considering the current evidence base, the intervention is likely to be cost-effective compared with usual care in patients undergoing colorectal surgery. [ABSTRACT FROM AUTHOR]

Background: Existing primary care cognitive assessment tools are crude or time‐consuming screening instruments which can only detect cognitive impairment when it is well established, impacting carers and patient quality‐of‐life. We initiated the Accelerating Dementia Pathway Technologies (ADePT) study to develop a real‐world evidence basis to support the adoption of the Integrated Cognitive Assessment (ICA), a 5 minute computerised cognitive test that employs artificial intelligence to improve its accuracy, as an inexpensive screening tool for the detection of cognitive impairment and improving the efficiency of the dementia care pathway. Method: Patients referred to memory clinics from primary care General Practitioners (GPs) were recruited. Participants completed the ICA either at home or in the clinic along with medical history and usability questionnaires. The GP referral and ICA outcome were compared with the specialist diagnosis obtained at the memory clinic. The clinical outcomes as well as costing data were used as part of an economic analysis to assess the potential health economic benefits of the use of the ICA in the dementia diagnosis pathway in the United Kingdom. Result: 87 participants referred to memory clinics were recruited who completed all assessments (40 dementia, 19 mild cognitive impairment, 12 inconclusive, 5 healthy, 3 non‐dementia conditions). From these patients the ICA was able to identify cognitive impairment with a sensitivity of ∼90%. The results of the health economics model, utilising real world data collected from the ADePT study estimates that if the ICA were introduced in a primary care setting then it could result in a cost saving to the health and social care system of approximately £147 per patient over a lifetime horizon (∼£44m of direct costs to the health care system) or £283 per patient if introduced into a secondary care setting. Conclusion: The results from this study demonstrate the potential of the ICA as a screening tool to support accurate referrals from primary care settings to memory clinics. The introduction of disease modifying treatments for Alzheimer's and dementia will further improve the case for earlier detection of the condition and therefore increase the cost‐effectiveness of more accurate screening using tests such as the ICA tool. [ABSTRACT FROM AUTHOR]