NHS Economic Evaluation Database Research Articles

Incremental net monetary benefit of using varenicline for smoking cessation: A systematic review and meta-analysis of economic evaluation studies.

To conduct a systematic review and meta-analysis and pool the incremental net benefits (INBs) of varenicline compared with behaviour support with bupropion or nicotine replacement therapy (NRT), behaviour support alone and unaided cessation in adult smokers making a first-time attempt to quit. A search for economic evaluation studies was conducted from inception to 30 September 2022, on PubMed, Embase, Cost-Effectiveness Analysis (CEA) Registry by Tufts Medical Centre, EconLit and the NHS Economic Evaluation Database (NHS EED). Eligible studies were included if they were (1) conducted among adults ages 18 years old and older who were smokers attempting to quit for the first time; (2) compared varenicline to behaviour support with bupropion or NRT, behaviour support alone and unaided cessation; and (3) performed a CEA or cost-utility analysis. The INBs were calculated and pooled across studies stratified by country income level and study perspective using the random-effects model. Statistical heterogeneity between studies was assessed using the I2 statistic and Cochrane Q statistic. Of the 1433 identified studies, 18 studies were included in our review. Our findings from healthcare system/payer perspective suggested that the use of varenicline is statistically significantly cost-effective compared with bupropion (pooled INB, $830.75 [95% confidence interval, $208.23, $1453.28]), NRTs ($636.16 [$192.48, $1079.84]) and unaided cessation ($4212.35 [$1755.79, $6668.92]) in high-income countries. Similarly, varenicline is also found to be cost-effective compared to bupropion ($2706.27 [$1284.44, $4128.11]), NRTs ($3310.01 [$1781.53, $4838.50]) and behavioural support alone ($5438.22 [$4105.99, $6770.46]) in low- and middle-income countries. Varenicline is cost-effective as a smoking cessation aid when compared with behavioural support with bupropion or nicotine replacement therapies and behavioural support alone in both high-income countries and low- and middle-income countries, from the healthcare system/payer perspective in adult smokers who attempt to quit for the first time.

Systematic methodological review of health state values in glaucoma cost-utility analyses.

Describing the characteristics and sources of health state utility values and reporting practice in the literature of cost-utility analyses facilitates an understanding of the level of the transparency, validity, and generalizability of cost-utility analyses. Improving the quality of reporting will support investigators in describing the incremental value of emerging glaucoma interventions. To describe the state of practice among published glaucoma cost-utility analysis studies, focusing on valuation of health and the quality of reporting. We searched several databases including Medline, CINHAL, Embase, Web of Science, Scopus, Biosis previews, the Health Economic Evaluations Database, and the NHS Economic Evaluation Database (NHS EED). We included full-text, English, published cost-utility analyses of glaucoma interventions with quality-adjusted life years (QALYs) as the primary outcome measure to calculate incremental cost-utility ratios. Excluded studies were non-English language, reviews, editorials, protocols, or other types of economic studies (cost-benefit, cost-minimization, cost-effectiveness). Study characteristics, operational definitions of glaucoma health states and health state utilities were extracted. The original source of the health utility was reviewed to determine the scale of measurement and the source of preference weighting. Items from the Systematic Review of Utilities for Cost-Effectiveness (SpRUCE checklist) were used to assess the reporting and quality of health utilities in glaucoma CUA. 43 CUAs were included, with 11 unique sources of health utilities. A wide range of health utilities for the same Hodapp-Parrish-Anderson glaucoma health states were reported; ocular hypertension (0.84-0.95), mild (0.68-0.94), moderate (0.57-0.92), advanced (0.58-0.88), severe/blind (0.46-0.76), and bilateral blindness (0.26-0.5). Most studies reported the basis for using health utilities (34, 79%) and any assumptions or adjustments applied to the health utilities (22, 51%). Few studies reported a framework for assessing the relevance of health utilities to a decision context (8, 19%). Even fewer (3, 7%) applied a systematic search strategy to identify health utilities and used a structured assessment of quality for inclusion. Overall, reporting has not improved over time. This review describes that few CUAs describe important rationale for using health state utility values. Including additional details on the search, appraisal, selection, and inclusion process of health utility values improves transparency, generalizability and supports the assessment of the validity of study conclusions. Future investigations should aim to use health utilities on the same scale of measurement across health states and consider the source and relevance to the decision context/purpose of conducting that cost-utility study.

Economic evaluations of treatment of depressive disorders in adolescents: Protocol for a scoping review.

Depressive disorders in adolescents are common and impairing. Evidence-based treatments are available; however, at a cost. In the context of the COVID-19 pandemic, we anticipate increased demand for treatment services for adolescents with depression. We also anticipate that economic resources will be strained. Identifying cost-effective strategies to optimally treat depression in adolescents is imperative. This protocol for a scoping review aims to describe the literature with respect to economic evaluations of treatments for depression in adolescents. We will conduct a scoping review using established methods and reporting guidelines. MEDLINE, Embase, PsyclNFO, Econlit, and the International HTA Database will be searched from inception to June 13, 2023, with an update closer to time of manuscript submission, while the NHS Economic Evaluation Database archives will be searched from inception to December 2014. Publications that contain economic evaluations, in the context of a clinical trial or a model-based study, testing a treatment of depression in adolescents will be selected for inclusion. Extracted data items will include: economic evaluation perspectives, health outcome variables and costs used in economic evaluations, types of analyses performed, as well as quality of reporting and methodology. A narrative synthesis with summary tables will be used to describe our findings. Our findings will help identify gaps in the literature with respect to economic analyses for the treatment of depression such that these gaps can be filled with future research. Policy-makers, funders and administrators may also use our findings to inform their decisions around provision of various treatments for depression in adolescents. osf.io/5fteb (note that information on this link will be updated upon acceptance for publication based on reviewer comments).

The high cost of care and limited evidence on cost-effective strategies for Lewy body dementia: systematic review of evidence.

Lewy body dementia (LBD) is a prevalent yet frequently underdiagnosed form of dementia, accounting for up to 15% of all dementia cases. This study aims to increase awareness and advocacy for LBD by gathering and critically assessing the economic evidence, including the cost of illness and cost-effectiveness of interventions for managing LBD. A systematic literature review was undertaken with EMBASE, Medline, CINAHL, PsycINFO, NHS Economic Evaluation Database and EconLit. This search was supplemented by grey literature on Google Scholar and reviewing the reference lists of identified studies. The papers included in the review were published between 2008 and 2023, and involved participants with LBD (dementia with Lewy bodies or Parkinson's disease dementia), which either addressed the cost of illness or conducted an economic evaluation. Thirteen papers were included, comprising ten cost-of-illness studies and three economic evaluations. The cost of LBD tends to be higher than that of other forms of dementia, such as Alzheimer's disease, and these costs escalate more steeply as the disease progresses. These cost differences may not be solely influenced by the subtype of dementia, but possibly also by patient characteristics like physical and cognitive abilities. Cost-effectiveness of potential interventions for LBD is limited. Despite numerous drug trials and other interventions for dementia, very few have targeted LBD, let alone explored the cost-effectiveness of such therapies for LBD. This disparity highlights the urgent need for cost-effective strategies and interventions targeting LBD. We propose the establishment of universally accepted standards for LBD research.

The Application of Complexity Theory in Health and Social Care Research: A Scoping Review

Background: Complexity theory has been utilised by many researchers as an appropriate lens through which to examine health and care. Notwithstanding its potential value, many studies apply complexity theory in a tokenistic manner without engaging with its underlying concepts and underpinnings.
 Objectives: This scoping review aimed to map and synthesise available research which has utilised complexity theory in health and social care settings. The research question was: “How has complexity theory been applied in health and social care research?”.
 Eligibility criteria: Qualitative and quantitative empirical research that utilised complexity theory informed approaches, published in English between 2012 and 2021.
 Sources of evidence: Cochrane Database of Systematic Reviews, MEDLINE, CINAHL, EMBASE, Web of Science, PSYCHINFO, The NHS Economic Evaluation Database (NHS EED), The Health Economic Evaluations Database (HEED). Additionally, a hand search of the reference lists of relevant articles was conducted.
 Charting methods: Data extraction was performed employing Covidence and a data extraction tool was created to produce a descriptive summary of the results, addressing the research question. The review employed the Arksey and O’Malley (2005) revised six-step framework and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews (PRISMA-ScR).
 Results: A total of 2021 records were identified. 676 duplicate entries were removed before screening and a further 1108 did not meet the inclusion criteria. In total, 61 articles were subjected to data abstraction.
 Complexity theory was poorly defined and described and was frequently applied as a theoretical and analytical framework. Studies were predominantly hospital or health system focused and did not encompass the full continuum of care. Several studies used complexity theory within qualitative research to analyse and code data. The review also identified several case studies in which authors sought to understand a setting or service using a complexity-informed lens. Most publications originated in the United States and Canada. Complexity was applied in contexts where multi-disciplinary teams were involved, which has implications for managing the complexity of context. To perform research into complex systems in which power law distributions operate, there is a requirement to interpret the processes of dynamicity and that requires qualitative and longitudinal studies.  There is also value in an abductive logic of inquiry, which allows for the interweaving and entanglement of previous evidence into a greater understanding of the whole complex adaptive system. It is recognised that engaging with complex systems requires theoretical and methodological pluralism so researchers should embrace a rich tapestry of approaches to develop a rich understanding of the complex health and care systems in which we work. As there is currently no definitive procedure for reporting such studies, the authors propose guidance to be interpreted and adapted to support the reporting of theoretically and methodologically divergent research.
 Conclusion: Heterogeneity was inherent in the empirical studies regarding the application of complexity theory. The authors provide guidance on conducting primary research which uses complexity theory as a conceptual, theoretical or analytical framework which seeks to promote rigor and transparency in the area.

Nebulised furosemide for the treatment of patients with obstructive lung disease: a systematic review protocol

IntroductionObstructive lung diseases (OLDs) such as asthma and chronic obstructive pulmonary disease are major global sources of morbidity and mortality. Current treatments broadly include bronchodilators such as beta agonists/antimuscarinics and...

Cost components of school-based oral health-promoting programs: A systematic review protocol.

Oral health-promoting school programs play a crucial role in achieving universal coverage of oral health care, by addressing oral diseases and promoting the well-being and quality of life of children and adolescents. However, a lack of studies has evaluated the costs associated with implementing these programs, which hinders decision-makers in adopting them on a large scale. This review aims to assess the cost components involved in school-based oral health-promoting programs. This review will include studies that have conducted either partial or full economic evaluations, focusing on describing the cost components of oral health-promoting programs implemented in primary schools involving students aged 6 to 14. A systematic search was conducted across multiple databases: MEDLINE, The Cochrane Library, the Virtual Health Library, the NHS Economic Evaluation Database, Web of Science, Scopus, and EMBASE. Additionally, gray literature was searched using the Health Technology Assessment Database. Two independent reviewers will screen the titles and abstracts, followed by a full-text review based on predefined inclusion criteria. Data extraction and critical appraisal evaluation will also be carried out independently by two reviewers. In case of disagreements, the reviewer team will resolve them through discussion. The systematic review resulting from this protocol aims to provide evidence regarding the cost components and necessary resources for implementing and maintaining oral health-promoting school programs. This information can assist decision-makers in adopting these programs on a larger scale and effectively addressing oral diseases among children and adolescents. CRD42022363743.

A systematic review of whole disease models for informing healthcare resource allocation decisions.

Whole disease models (WDM) are large-scale, system-level models which can evaluate multiple decision questions across an entire care pathway. Whilst this type of model can offer several advantages as a platform for undertaking economic analyses, the availability and quality of existing WDMs is unknown. This systematic review aimed to identify existing WDMs to explore which disease areas they cover, to critically assess the quality of these models and provide recommendations for future research. An electronic search was performed on multiple databases (MEDLINE, EMBASE, the NHS Economic Evaluation Database and the Health Technology Assessment database) on 23rd July 2023. Two independent reviewers selected studies for inclusion. Study quality was assessed using the National Institute for Health and Care Excellence (NICE) appraisal checklist for economic evaluations. Model characteristics were descriptively summarised. Forty-four WDMs were identified, of which thirty-two were developed after 2010. The main disease areas covered by existing WDMs are heart disease, cancer, acquired immune deficiency syndrome and metabolic disease. The quality of included WDMs is generally low. Common limitations included failure to consider the harms and costs of adverse events (AEs) of interventions, lack of probabilistic sensitivity analysis (PSA) and poor reporting. There has been an increase in the number of WDMs since 2010. However, their quality is generally low which means they may require significant modification before they could be re-used, such as modelling AEs of interventions and incorporation of PSA. Sufficient details of the WDMs need to be reported to allow future reuse/adaptation.

Economic Evaluation of Telerehabilitation: Systematic Literature Review of Cost-Utility Studies.

Telerehabilitation could benefit a large population by increasing adherence to rehabilitation protocols. Our objective was to review and discuss the use of cost-utility approaches in economic evaluations of telerehabilitation interventions. A review of the literature on PubMed, Scopus, Centres for Review and Dissemination databases (including the HTA database, the Database of Abstracts of Reviews of Effects, and the NHS Economic Evaluation Database), Cochrane Library, and ClinicalTrials.gov (last search on February 8, 2021) was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The inclusion criteria were defined in accordance with the PICOS (population, intervention, comparison, outcomes, and study design) system: the included studies had to evaluate patients in rehabilitation therapy for all diseases and disorders (population) through exercise-based telerehabilitation (intervention) and had to have a control group that received face-to-face rehabilitation (comparison), and these studies had to evaluate effectiveness through gain in quality of life (outcome) and used the design of randomized and controlled clinical studies (study). We included 11 economic evaluations, of which 6 concerned cardiovascular diseases. Several types of interventions were assessed as telerehabilitation, consisting in monitoring of rehabilitation at home (monitored by physicians) or a rehabilitation program with exercise and an educational intervention at home alone. All studies were based on randomized clinical trials and used a validated health-related quality of life instrument to describe patients' health states. Four evaluations used the EQ-5D, 1 used the EQ-5D-5L, 2 used the EQ-5D-3L, 3 used the Short-Form Six-Dimension questionnaire, and 1 used the 36-item Short Form survey. The mean quality-adjusted life years gained using telerehabilitation services varied from -0.09 to 0.89. These results were reported in terms of the probability that the intervention was cost-effective at different thresholds for willingness-to-pay values. Most studies showed results about telerehabilitation as dominant (ie, more effective and less costly) together with superiority or noninferiority in outcomes. There is evidence to support telerehabilitation as a cost-effective intervention for a large population among different disease areas. There is a need for conducting cost-effectiveness studies in countries because the available evidence has limited generalizability in such countries. PROSPERO CRD42021248785; https://tinyurl.com/4xurdvwf.

Systematic review of economic evaluations of aromatase inhibitors in estrogen receptor-positive breast cancer: quality evaluation

BackgroundBreast cancer (BC) is a leading cause of premature death in women and the most expensive malignancy to treat. Since the introduction of targeted therapies has resulted in changes to BC therapy practices, health economic evaluations have become more important in this area. Taking generic medications, Aromatase Inhibitors (AIs), as a case study, we conducted a systematic review of the recent economic evaluations of AIs for estrogen receptor-positive breast cancer patients and evaluated the quality of these health economic studies.ObjectiveTo systematically review and examine the quality of the available economic studies of AIs in estrogen receptor-positive breast cancer.MethodsA literature search was performed using six relevant databases (MEDLINE, Embase, Database of s of Reviews of Effects, Health Technology Assessment Database, NHS Economic Evaluation Database, and SCOPUS) from January 2010 to July 2021. All economic studies were independently assessed by two reviewers using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist to evaluate the quality of the economic evaluations. This systematic review is registered in the PROSPERO database. To compare the different currencies used in these studies, all costs were converted to international dollars (2021).ResultsA total of eight studies were included in the review; six (75%) were performed from the healthcare providers’ perspective. They were conducted in seven different countries, and all were model-based analyses using Markov models. Six (75%) considered both Quality Adjusted Life Years (QALYs) and Life Years (LY) outcomes, and all costs were derived from national databases. When compared to tamoxifen, AIs were generally cost-effective in postmenopausal women. Only half of the studies addressed the increased mortality following adverse events, and none mentioned medication adherence. For the quality assessment, six studies fulfilled 85% of the CHEERS checklist requirements and are deemed good quality.ConclusionAIs are generally considered cost-effective compared to tamoxifen in estrogen receptor-positive breast cancer. The overall quality of the included studies was between high and average but characterizing heterogeneity, and distributional effects should be considered in any future economic evaluation studies of AIs. Studies should include adherence and adverse effects profiles to provide evidence to facilitate decision-making among policymakers.

Economic evaluations of maternal health interventions: a scoping review

Background Evidence on the affordability and cost-effectiveness of interventions is critical to decision-making for clinical practice guidelines and development of national health policies. This study aimed to develop a repository of primary economic evaluations to support global maternal health guideline development and provide insights into the body of research conducted in this field. Methods A scoping review was conducted to identify and map available economic evaluations of maternal health interventions. We searched six databases (NHS Economic Evaluation Database, EconLit, PubMed, Embase, CINAHL and PsycInfo) on 20 November 2020 with no date, setting or language restrictions. Two authors assessed eligibility and extracted data independently. Included studies were categorised by subpopulation of women, level of care, intervention type, mechanism, and period, economic evaluation type and perspective, and whether the intervention is currently recommended by the World Health Organization. Frequency analysis was used to determine prevalence of parameters. Results In total 923 studies conducted in 72 countries were included. Most studies were conducted in high-income country settings (71.8%). Over half pertained to a general population of pregnant women, with the remainder focused on specific subgroups, such as women with preterm birth (6.2%) or those undergoing caesarean section (5.5%). The most common interventions of interest related to non-obstetric infections (23.9%), labour and childbirth care (17.0%), and obstetric complications (15.7%). Few studies addressed the major causes of maternal deaths globally. Over a third (36.5%) of studies were cost-utility analyses, 1.4% were cost-benefit analyses and the remainder were cost-effectiveness analyses. Conclusions This review provides a navigable, consolidated resource of economic evaluations in maternal health. We identified a clear evidence gap regarding economic evaluations of maternal health interventions in low- and middle-income countries. Future economic research should focus on interventions to address major drivers of maternal morbidity and mortality in these settings.

5589252 SYSTEMATIC LITERATURE REVIEW OF HEALTH-RELATED QUALITY OF LIFE BURDEN IN PATIENTS ACROSS THE SPECTRUM OF THALASSEMIA

Background: Recent systematic literature reviews (SLRs) have highlighted the health-related quality of life (HRQoL) burden in transfusion-dependent thalassemia (TDT), particularly β-thalassemia (β-thal). However, less is known about HRQoL in non–transfusion-dependent thalassemia (NTDT) and alpha-thalassemia (α-thal). Aims: To conduct an SLR on the real-world HRQoL burden across the spectrum of thalassemia and report evidence gaps. Methods: Searches (Jan 2010 to Sep 2021) were conducted in MEDLINE, Embase, Cochrane Database of Systematic Reviews, Health Technology Assessment Database, NHS Economic Evaluation Database, and EconLit for real-world studies reporting on HRQoL and utilities in adult and pediatric patients with thalassemia. Conference abstracts from Jan 2017 to Sep 2021 were also searched. References were screened by two independent reviewers, and HRQoL data were extracted by one reviewer and validated by another. Results were grouped by genotype (β-thal/α-thal) and transfusion phenotype (TDT/NTDT). Results: A total of 2,548 records were screened at title/abstract and 448 at full text. 126 publications from 116 unique studies were included and data extracted. Most evidence was published since 2015 (95/126) and sample sizes of study populations ranged from 22 to 1240. Most TDT/NTDT studies were conducted in β-thal (84/126); 10 were in mixed α-thal and β-thal, of which 2 reported data separately for Hemoglobin H disease (HbH) pediatric patients; the remaining studies did not specify the thalassemia genotype. HRQoL was significantly poorer in TD β-thal adult or adult/pediatric patients compared with healthy controls across the majority of domains. Among TDT patients, HRQoL also tended to decrease with increasing age. The burden associated with pediatric TD β-thal also impacts caregivers, with one study reporting significantly reduced HRQoL compared with healthy controls (p<0.001). In NTD β-thal patients, 2 studies identified significantly worse PedsQL scores in nearly all domains compared with healthy controls. Across studies in adult or mixed adult/pediatric patients, HRQoL (as measured by SF-36) tended to be poorer among NTDT (β-thal intermedia) compared with TDT (β-thal major) patients. For example, a prospective study found significantly lower SF-36 mental component scores at baseline in adult NTDT vs. TDT (mean [standard deviation (SD)]: 47.4 [8.4] vs. 51.6 [7.2]; p=0.009). While in pediatric patients, there was a pattern for poorer HRQoL burden in TDT vs. NTDT. TD α-thal and β-thal pediatric patients had similar total and subdomains of PedsQL scores, except for physical functioning, whereby homozygous β-thal patients had the best HRQoL, followed by HbH patients, with β-thal/Hb E patients demonstrating the greatest HRQoL burden (mean [SD]: 76.52 [15.23] vs. 61.16 [18.39] vs. 56.88 [17.17], p=0.008). Another study did not find differences in any PedsQL subdomain between HbH, β-thal, and homozygous β-thal (TDT and NTDT, patients 5-18 years; N=315). Conclusion: This SLR highlights the negative impact on HRQoL across the spectrum of thalassemia. Adding to previous SLRs, it shows limited evidence is available for NTDT patients; however, studies suggest that HRQoL burden may be worse in NTDT than TDT adult patients. Characterizing the HRQoL burden of α-thal is a clear evidence gap. High-quality, real-world studies in NTDT and α-thal are needed to better understand the HRQoL burden and the potential impact of new treatments on HRQoL.

Systematic Review of Cost-Effectiveness Analysis for Surgical and Neurostimulation Treatments for Drug-Resistant Epilepsy in Adults.

Surgical and neurostimulator treatments are effective for reducing seizure burden in selected individuals living with drug-resistant epilepsy (DRE). We aimed to determine the presence and key model determinants for cost-effectiveness of these interventions, compared with medical management alone, to assist with decisions about resource allocation. A systematic literature search was conducted on June 1, 2022, using MEDLINE, EMBASE, the NHS Economic Evaluation Database, and the Cost-Effectiveness Analysis database. Included studies were economic evaluations in adult DRE cohorts, comparing surgical and neurostimulator treatments (vagus nerve stimulation [VNS], responsive neurostimulation [RNS], and deep brain stimulation [DBS]) vs medical management alone and reporting cost-benefit analysis, cost-utility, or cost-effectiveness. Exclusion criteria were studies with pediatric cohorts and those published in a language other than English. Three independent reviewers screened, extracted, and assessed data against the Consolidated Health Economic Evaluation Reporting Standards checklist, and a fourth reviewer adjudicated discrepancies. Ten studies met inclusion criteria. Seven studies evaluated epilepsy surgery, and 3 evaluated neurostimulation treatments. All relevant studies established that epilepsy surgery is a cost-effective intervention compared with medical management alone, for quality-adjusted life-years and seizure freedom at 2 and 5 years. All relevant studies found neurostimulator treatments to be potentially cost-effective. The incremental cost-effectiveness ratio (ICER), with lower ICER indicating greater cost-effectiveness, was reported for 9 studies and varied between GBP £3,013 and US $61,333. Cost adaptation revealed ICERs from US $170 to US $121,726. Key model determinants included, but were not limited to, improved surgical outcomes and quality of life, reduced surgical and presurgical evaluation costs, higher rates of surgical eligibility after referral and evaluation, epilepsy subtype, less expensive neurostimulator devices with improved longevity, and cost analysis strategy used in the analysis. There is consistent evidence that epilepsy surgery is a cost-effective treatment of eligible candidates with DRE. Limited evidence suggests that VNS, RNS, and DBS may be cost-effective therapies for DRE, although more health economic evaluations alongside prospective clinical trials are needed to validate these findings. PROSPERO CRD42021278436.

Airway Complications After Anterior Cervical Spine Surgery: Etiology and Risk Factors.

Narrative Review. To provide an overview of etiology and risk factors of airway complications after anterior cervical spine surgery (ACSS). A search was performed in PubMed and adapted for use in other databases, including Embase, Cochrane Library, Cochrane Register of Controlled Trials, Health Technology Assessment database, and NHS Economic Evaluation Database. 81 full-text studies were reviewed. A total of 53 papers were included were included in the review and an additional four references were extracted from other references. 39 papers were categorized as etiology and 42 as risk factors. Most of the literature on airway compromise after ACSS is level III or IV evidence. Currently, there are no systems in place to risk-stratify patients undergoing ACSS regarding airway compromise or guidelines on how to manage patients when these complications do occur. This review focused on theory, primarily etiology and risk factors.

Application of complexity theory in health and social care research: a scoping review

BackgroundComplexity theory has been chosen by many authors as a suitable lens through which to examine health and social care. Despite its potential value, many empirical investigations apply the theory...

Adverse drug events in cost-effectiveness analyses of interventions for diabetic conditions: a scoping review protocol.

The objective of this review is to provide an overview of adverse drug events in cost-effectiveness analyses related to the pharmacological treatments of diabetes and diabetes-related complications. The inclusion of adverse drug events in cost-effectiveness analyses is recognized in health technology assessments guidelines, but in practice, this is inconsistent. This inconsistency may affect the reliability of the evaluation and, therefore, indicate that the information provided for decision-making in health care is misleading. Reviewing if and how adverse drug events are incorporated in cost-effectiveness analyses is necessary to address this gap. Studies including participants who are receiving pharmacological interventions for diabetes, diabetic retinopathy, or diabetic macular edema will be considered for inclusion. We will include sources that focus on cost-effectiveness analyses using modeling framework, and are published in English between 2011 and the present. Other types of analyses and other types of conditions will be excluded. The information sources to be searched include MEDLINE, CINAHL, Scopus, Web of Science, NHS Economic Evaluations Database, and Health Technology Assessment Database. Studies in English will be considered for inclusion in the review. Potential sources will be assessed by two independent reviewers and imported into the JBI System for the Unified Management, Assessment and Review of Information. The results of the search and the study inclusion process will be reported in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram. A specific data extraction form will be used to extract and analyze the data. Results will be presented in tabular and graphic formats with a narrative summary, and will be discussed in the context of current literature and guidelines.

Systematic review of economic evaluations for internet- and mobile-based interventions for mental health problems

In view of the staggering disease and economic burden of mental disorders, internet and mobile-based interventions (IMIs) targeting mental disorders have often been touted to be cost-effective; however, available evidence is inconclusive and outdated. This review aimed to provide an overview of the cost-effectiveness of IMIs for mental disorders and symptoms. A systematic search was conducted for trial-based economic evaluations published before 10th May 2021. Electronic databases (including MEDLINE, PsycINFO, CENTRAL, PSYNDEX, and NHS Economic Evaluations Database) were searched for randomized controlled trials examining IMIs targeting mental disorders and symptoms and conducting a full health economic evaluation. Methodological quality and risk of bias were assessed. Cost-effectiveness was assumed at or below £30,000 per quality-adjusted life year gained. Of the 4044 studies, 36 economic evaluations were reviewed. Guided IMIs were likely to be cost-effective in depression and anxiety. The quality of most evaluations was good, albeit with some risks of bias. Heterogeneity across studies was high because of factors such as different costing methods, design, comparison groups, and outcomes used. IMIs for anxiety and depression have potential to be cost-effective. However, more research is needed into unguided (preventive) IMIs with active control conditions (e.g., treatment as usual) and longer time horizon across a wider range of disorders.Trial registration: PROSPERO Registration No. CRD42018093808.

Interventions to address potentially inappropriate prescriptions and over-the-counter medication use among adults 65 years and older in primary care settings: protocol for a systematic review

PurposeTo inform recommendations by the Canadian Task Force on Preventive Health Care on potentially inappropriate prescribing and over-the-counter (OTC) medication use among adults aged 65 years and older in primary care settings. This protocol outlines the planned scope and methods for a systematic review of the benefits and harms and acceptability of interventions to reduce potentially inappropriate prescriptions and OTC medication use.MethodsDe novo systematic reviews will be conducted to synthesize the available evidence on (a) the benefits and harms of interventions to reduce potentially inappropriate prescriptions and OTC medications compared to no intervention, usual care, or non- or minimally active intervention among adults aged 65 years and older and (b) the acceptability of these interventions or attributes among patients. Outcomes of interest for the benefits and harms review are all-cause mortality, hospitalization, non-serious adverse drug reactions, quality of life, emergency department visits, injurious falls, medical visits, and the number of medications (and number of pills). Outcomes for the acceptability review are the preference for and relative importance of different interventions or their attributes. For the benefits and harms review, we will search MEDLINE, Embase, and Cochrane Central Register of Controlled Trials for randomized controlled trials. For the acceptability review, we will search MEDLINE, Embase, PsycInfo, Cochrane Central Register of Controlled Trials, and the NHS Economic Evaluation Database for experimental and observational studies with a comparator. Websites of relevant organizations, other grey literature sources, and reference lists of included studies and reviews will be searched. Title and abstract screening will be completed by two independent reviewers using the liberal accelerated approach. Full-text review, data extraction, risk of bias assessments, and GRADE (Grading of Recommendations Assessment, Development and Evaluation) will be completed independently by two reviewers, with any disagreements resolved by consensus or by consulting with a third reviewer. The GRADE approach will be used to assess the certainty of the evidence for outcomes.DiscussionThe results of this systematic review will be used by the Canadian Task Force on Preventive Health Care to inform their recommendation on potentially inappropriate prescribing and OTC medication use among adults aged 65 years and older.Systematic review registrationPROSPERO (KQ1: CRD42022302313; KQ2: CRD42022302324); Open Science Framework (https://osf.io/urj4b/).

Economic evaluation of physical activity interventions for type 2 diabetes management: a systematic review

BackgroundEconomic evaluation of physical activity interventions has become an important area for policymaking considering the high costs attributable to physical inactivity. However, the evidence for such interventions targeting type 2 diabetes control is scarce. Therefore, the present study aimed to synthesize economic evaluation studies of physical activity interventions for type 2 diabetes management.MethodsA systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement (PROSPERO reference number CRD42021231021). An electronic search was performed in PubMed, Web of Science, Cochrane Library and NHS Economic Evaluation Database. Studies were eligible if they included: adults with type 2 diabetes; any physical activity intervention in the community settings; an experimental or quasi-experimental design; and a parameter of economic evaluation [cost analysis of interventions, cost-effectiveness analysis (including cost-utility analysis) and cost-benefit analysis] as an outcome.ResultsTen studies were included in this review: seven were randomized controlled trials and three were quasi-experimental studies. All studies included direct costs, and four also included indirect costs. Four studies demonstrated that physical activity interventions were cost-saving, six studies showed cost-effectiveness, and two studies reported cost-utility. The estimates varied considerably across the studies with different analytical and methodological approaches.ConclusionOverall, this systematic review found that physical activity interventions are a worth investment for type 2 diabetes management. However, comparability across interventions was limited due to heterogeneity in interventions type, design and delivery, which may explain the differences in the economic measures.

Evaluation of telehomecare Studies in Patients with Chronic Heart Failure: A health Technology Assessment Study

Background: Heart failure (HF) is a major complication resulting from a variety of heart diseases. HF is an increasingly important issue, whose prevalence has doubled in the last two decades. This is due to increased life expectancy, treatment and prevention of other heart diseases, and increased life expectancy. Promoting self-care through tele homecare is an emerging strategy for managing chronic diseases.&#x0D; Objectives: The purpose of this study is to evaluate tele-care studies in patients with chronic heart failure (CHF). This is based evaluating the types of technologies used for patients in this method, effectiveness, cost-effectiveness and safety of these technologies based on the aspects of health technology assessment.&#x0D; Methods: PubMed, Scopus, Web of Science, Cochrane databases, HTA (Health Technology Assessment), NHS EED (National Health System Economic Evaluation Database), DARE (Database of Abstract of Reviews of Effects), Embase, and (Society for Information Display) SID were searched using medical subject heading (Mesh) keywords. Then, studies were evaluated by two people and disputed by a third party. The quality of the extracted studies was evaluated based on the (Risk of Bias) RoB 2.0 checklist. The difference between the mean and its standard deviation was calculated (which was used as the effect size). To analyze the results, meta-analysis of random effects was performed. In addition, the subgroup and meta-regression analysis were performed to discover possible sources of heterogeneity. Finally, studies were evaluated in terms of Health Problem and Current Use of the Technology (CUR), Description and technical characteristics of technology (TEC), safety (SAF), Clinical effectiveness (EFF), Costs and economic evaluation (ECO) of 9 Aspects of Health Technology Assessment (HTA). Studies were evaluated with respect to the long-distance care in patients with CHF. We approach the method through systematic review and meta-analysis based on the principles of PRISMA-P. This systematic review examined the effectiveness of long-distance care interventions in patients with CHF, compared with conventional care methods. In general, evaluation of studies extracted in this systematic review will try to identify, evaluate and combine the effects of tele-care in patients with HF using meta-analytical methods in the evidence. Evaluating studies conducted in the field of tele-care in patients with CHF will help us to better understand how these methods work in the management of chronic heart disease [effectiveness, safety and cost reduction] and determine which care interventions Distance is more effective in patients with HF based on their characteristics according to clinical outcomes and resource use.&#x0D; Conclusion: The results of this study can be used as a guide to provide valid evidence for the decision of senior managers of the Ministry of Health and large hospitals to use common technologies used in distance care for patients with CHF and other chronic diseases. This study will also provide a new understanding of the various studies that have been conducted to help patients with chronic failure by different types of remote care technologies in terms of effectiveness, safety, technology, and economic costs.