Cost-effectiveness of quality improvement intervention to reduce time between CT-detection and ureteroscopic laser fragmentation in acute symptomatic ureteric stones management.

OBJECTIVE: To prospectively assess clinical and cost effectiveness of emergency ureteroscopic laser fragmentation of urinary stones causing symptoms or obstruction. PATIENTS AND METHODS: 100 consecutive patients with an average (median) age 55.6 (57.5) years and average (median) stone size of 8.2 mm (± 7 mm) between October 2018 and December 2021 who underwent emergency ureteroscopy and laser fragmentation formed the study cohort as part of a clinical service quality improvement. Primary outcome was single procedure stone-free rate and cost-effectiveness. The secondary outcomes were complications, re-admission and re-intervention. A decision analysis model was constructed to compare the cost-effectiveness of emergency ureteroscopy with laser fragmentation (EUL) and emergency temporary stenting followed by delayed ureteroscopy with laser fragmentation (DUL) using our results and success rates for modelling. RESULTS: Single procedure stone-free rates (SFR) for EUL and DUL were 85%. The re-intervention rate, re-admission and complication rates of the study cohort (EUL) were 9%, 18%, and 4%, respectively, compared to 15%, 20%, and 5%, respectively for the control cohort (DUL). The decision analysis modelling demonstrated that the EUL treatment option was more cost-efficient, averting £2868 (€3260) per patient for the UK health sector. Total cost of delayed intervention was £7783 (€8847) for DUL in contrast to £4915 (€5580) for EUL. CONCLUSIONS: Implementation of quality improvement project based on a reduction in CT detection-to-laser fragmentation time interval in acute ureteric obstruction or symptoms caused by stones had similar clinical effectiveness compared to delayed ureteroscopic management, but more cost-effective.

Seeking outcomes under tight budgets: A case for health impact bonds in Post-COVID times.

With global public debt at record levels, governments are facing unprecedented challenges in providing essential health services. This exploratory study aims to assess the relevance of Health Impact Bonds (HIBs) as a means of financing preventative health services during times of fiscal constraint and in the aftermath of the COVID pandemic. The study draws on a review of the literature on HIBs, along with a case study analysis of HIBs implemented in the UK. The findings of the study indicate that, although HIBs offer promise as an innovative funding tool for preventative health services in tight fiscal situations, certain challenges are limiting their broader adoption.

Cost-Effectiveness of Prostate Cancer Detection in Biopsy-Naïve Men: Ultrasound Shear Wave Elastography vs. Multiparametric Diagnostic Magnetic Resonance Imaging.

This exploratory study investigates the cost-effectiveness of ultrasound shear wave elastography (SWE) imaging in comparison to pre-biopsy multiparametric magnetic resonance imaging (mpMRI) in men with suspected prostate cancer. This research is motivated by the early evidence of the good performance of SWE in distinguishing cancerous from benign prostate tissues. We used a decision analysis model representing the care-pathways of men referred with a high prostate specific antigen (PSA) and/or abnormal digital rectal examination (DRE) in a UK setting from the payer's perspective with results reported in 2016 GBP. We then appraised the cost-effectiveness of a novel approach based on SWE compared to the more conventional and widely practiced mpMRI-based approaches using data reported in the literature. Deterministic and probabilistic sensitivity analyses were used to address uncertainty regarding the parameter values utilised. Our exploratory results implied that SWE approach yielded an additional quality-adjusted life year (QALY) at the cost of GBP 10,048 compared to the standard mpMRI-based approach in the UK. This is lower than the official willingness to pay threshold of GBP 20,000 (the UK healthcare system guidelines) and is therefore a suitable replacement for the current practice. Sensitivity analyses confirmed the robustness of our results.

The Luxury of Lockdown.

Regression analysis based on data from Oxford COVID-19 Government Response Tracker and the World Bank datasets for 169 countries suggests that containment policies have, in general, a significant role in reducing the pandemic's fatality rate across all countries. However (i) there is at least a three weeks lag in realising the impact, (ii) the effectiveness increases with per capita income and, more specifically, (iii) workplace closure is ineffective in low-income countries. The analysis of data from Demographic and Health Survey (the DHS Programme) and IMF Policy Tracker indicates that developing countries are unlikely to have the basis required for effectively adopting stringent lockdown measures and instead would need to consider specifically targeted lockdown policies. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1057/s41287-021-00389-x.

L'analyse de régression réalisée sur des données issues du panel de données de l'étude Oxford COVID-19 sur le suivi de la riposte gouvernementale et du panel de données de la Banque mondiale pour 169 pays suggère que les politiques de confinement ont, en général, un rôle important dans la réduction du taux de mortalité lié à la pandémie dans tous les pays. Cependant (i) il y a au moins trois semaines de délai dans l'apparition de l'impact, (ii) l'efficacité augmente avec le revenu par habitant et, plus précisément, (iii) la fermeture des lieux de travail est inefficace dans les pays à faible revenu. L'analyse des données de l'Enquête Démographique et de Santé (le programme EDS) et du Suivi des politiques du FMI indique qu'il est peu probable que les pays en développement disposent des bases nécessaires pour adopter efficacement des mesures de confinement strict et devraient plutôt envisager des politiques de confinement localisé.