The authors identified 27 studies, the designs including observational studies, economic analyses, systematic reviews, and commentaries. The NNV has been used in the literature to describe three main themes: potential benefits of vaccination programmes, cost-effectiveness, and economic analyses, and modelling studies to compare different vaccination strategies.

Conclusions: NNV has been used in a wide variety of ways in the literature, yet there are no defined thresholds for what is a favourable NNV. Furthermore, the generalizability of the NNV is usually limited. Further work is required to determine the most appropriate use of this measure.

This is an open access article and can be read in free full text at:  http://dx.doi.org/10.1016/j.vaccine.2014.12.033

Hashim, A., et al. (2015). How and why researchers use the number needed to vaccinate to inform decision making—A systematic review. Vaccine, 33(6), 753–758.

Fourteen papers included and a narrative synthesis was undertaken. The authors find that "... emergency nurse practitioner service has a positive impact on quality of care, patient satisfaction and waiting times. There was insufficient evidence to draw conclusions regarding outcomes of a cost benefit analysis".

Now available to read in free full text at: http://dx.doi.org/10.1016/j.ijnurstu.2014.07.006 

Jennings, N., et al. (2015). The impact of nurse practitioner services on cost, quality of care, satisfaction and waiting times in the emergency department- a systematic review. International Journal of Nursing Studies, 52(1), 421–435.

Two dose schedules for bivalent or quadrivalent human papillomavirus vaccines were assumed to provide 10, 20, or 30 years’ vaccine type protection and cross protection or lifelong vaccine type protection without cross protection. Three dose schedules were assumed to give lifelong vaccine type and cross protection.

Interventions:  No, two, or three doses of human papillomavirus vaccine given routinely to 12 year old girls, with an initial catch-up campaign to 18 years.

The authors found that giving at least two doses of vaccine seemed to be "... highly cost effective across the entire range of scenarios considered at the quadrivalent vaccine list price of £86.50 (€109.23; $136.00) per dose. If two doses give only 10 years’ protection but adding a third dose extends this to lifetime protection, then the third dose also seems to be cost effective at £86.50 per dose (median incremental cost effectiveness ratio £17 000, interquartile range £11 700-£25 800). If two doses protect for more than 20 years, then the third dose will have to be priced substantially lower (median threshold price £31, interquartile range £28-£35) to be cost effective. Results are similar for a bivalent vaccine priced at £80.50 per dose and when the same scenarios are explored by parameterising a Canadian model (HPV-ADVISE) with economic data from the United Kingdom".

The authors conclude that two dose human papillomavirus vaccine schedules are likely to be the most cost effective option provided protection lasts for at least 20 years. As the precise duration of two dose schedules may not be known for decades, cohorts given two doses should be closely monitored.

This is an open access article and is available to read in free full text at:  http://www.bmj.com/content/350/bmj.g7584

Jit, M., et al. (2015). Comparison of two dose and three dose human papillomavirus vaccine schedules: Cost effectiveness analysis based on transmission model. BMJ, 350:g7584.

In this cost effectiveness analysis, the authors find that Tips saved about 179,099 quality-adjusted life years (QALYs) "...  and prevented 17,109 premature deaths in the U.S. With the campaign cost of roughly $48 million, Tips spent approximately $480 per quitter, $2,819 per premature death averted, $393 per LY saved, and $268 per QALY gained". They conclude that Tips was highly cost-effective.

This article is available to read in free full text at:  http://dx.doi.org/10.1016/j.amepre.2014.10.011

Xu, X., et al. (2015). A cost-effectiveness analysis of the first federally funded antismoking campaign. American Journal of Preventive Medicine 48(3), 318–325

Eleven randomised controlled trials were included: four evaluated alternative provider (n=683 participants) and seven evaluated complementary provider roles (n=1464 participants). Based on the results of their analysis, the authors conclude that "low-to-moderate quality evidence supports the effectiveness and two fair-to-high quality economic analyses support the cost-effectiveness of outpatient alternative provider CNSs. Low-to-moderate quality evidence supports the effectiveness of outpatient complementary provider CNSs; however, robust economic evaluations are needed to address cost-effectiveness".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1111/jep.12219 or contact your DHB library, or organisational or local library for assistance.

Kilpatrick, K., Kaasalainen, S., Donald, F., Reid, K., Carter, N., Bryant-Lukosius, D., Martin-Misener, R., Harbman, P., Marshall, D. A., Charbonneau-Smith, R. and DiCenso, A. (2014). The effectiveness and cost-effectiveness of clinical nurse specialists in outpatient roles: A systematic review. Journal of Evaluation in Clinical Practice, 20(6), 1106–1123

Over 1200 US hospitals are currently participating in Keystone ICU. This paper examines the cost changes and cost-effectiveness of the Keystone ICU project from the perspective of the hospital, using a decision tree model to address the choice faced at an individual hospital about implementing the programme) and nationally representative data sources.

The authors found that, this programme, as it is currently implemented by hospitals on an increasingly large scale in the USA, likely reduces the economic costs of central line-associated bloodstream infections for US hospitals. Awareness among hospitals about the programme's benefits should enhance implementation. The programme's implementation has the potential to substantially reduce morbidity, mortality and economic costs associated with central line-associated bloodstream infections.

This is an open access article and can be read in full text at: http://dx.doi.org/10.1136/bmjopen-2014-006065

Herzer, K.R., et al. (2014). Cost-effectiveness of a quality improvement programme to reduce central line-associated bloodstream infections in intensive care units in the USA. BMJ Open, 4, e006065.

A total of 2,600 people with social care needs participated in a trial of community-based telecare in three English local authority areas. In the Whole Systems Demonstrator Telecare Questionnaire Study, 550 participants were randomised to intervention and 639 to control. Participants who were offered the telecare intervention received a package of equipment and monitoring services for 12 months, additional to their standard health and social care services. The control group received usual health and social care.

The cost per additional quality-adjusted life year (QALY) gained was £297,000. Cost-effectiveness acceptability curves indicated that the probability of cost-effectiveness at a willingness-to-pay of £30,000 per QALY gained was only 16%. Sensitivity analyses combining variations in equipment price and support cost parameters yielded a cost-effectiveness ratio of £161,000 per QALY.

The authors note that, while QALY gain in the intervention group was similar to that for controls, social and health services costs were higher. They conclude that second-generation telecare did not appear to be a cost-effective addition to usual care, assuming a commonly accepted willingness to pay for QALYs.

This is an open access article and can be read in full text at:  http://dx.doi.org/10.1093/ageing/afu067

Henderson, C., et al. (2014). Cost-effectiveness of telecare for people with social care needs: the Whole Systems Demonstrator cluster randomised trial. Age and Ageing, 43(6), 794-800.

Fifteen evaluation studies were included, involving campaigns promoting the use of child car seats or booster seats, pedometers, condoms, recreational safety helmets, and nicotine replacement therapy.

The economic merits of interventions could not be determined for health communication campaigns associated with use of recreational helmets, child car seats, and pedometers. The authors found  some evidence that "... campaigns with free condom distribution to promote safer sex practices were cost-effective among high-risk populations and the cost per quit achieved in campaigns promoting tobacco cessation with nicotine replacement therapy products may translate to a cost per quality-adjusted life-year less than $50,000".

Available in full text at: http://www.thecommunityguide.org/news/2012/HealthCommunicationCampaigns.html

Jacob, V., et al. (2014). Economics of mass media health campaigns with health-related product distribution: A Community Guide systematic review. American Journal of Preventive Medicine, 47(3), 348-359.

The study was undertaken between March 1, 2011, and March 31, 2013, at 42 practices in four centres in the UK. Forty-two practices were randomly assigned to GP triage (n=13), nurse triage (n=15), or usual care (n=14), and 20 990 patients (n=6695 vs 7012 vs 7283) were randomly assigned, of whom 16 211 provided primary outcome data.

GP triage was associated with a 33% increase in the mean number of contacts per person over 28 days compared with usual care, and nurse triage with a 48% increase. Although triage interventions were associated with increased contacts, estimated costs over 28 days were similar between all three groups.

The authors conclude that telephone triage might be useful in aiding the delivery of primary care. They note that the whole-system implications should be assessed when introduction of such a system is considered.

This is an open access article and can be read in free full text at: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61058-8/fulltext

Campbell, J.L., et al. (2014). Telephone triage for management of same-day consultation requests in general practice (the ESTEEM trial): A cluster-randomised controlled trial and cost-consequence analysis. The Lancet, 384(9957), 1859 - 1868.

"Of the 14 studies found, four were randomised controlled trials and one was a systematic review ... Only three provided a replicable protocol or detailed intervention delivery. Eleven lacked a theoretical framework. Twelve reported significant improvements in clinical (patient) outcomes ...; only four reported changes in short- and long-term outcomes (e.g. quality of life). Most studies used a small or targeted population. Only two studies assessed both benefits and costs of their intervention compared with usual care and cost effectiveness".

The authors conclude that more rigorous studies of diabetes workforce models are needed.

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1071/AH14018 or contact your DHB library, or organisational or local library for assistance.

Schofield, D., et al. (2014). An evaluation of the quality of evidence underpinning diabetes management models: A review of the literature. Australian Health Review, 38(5), 495-505.

The authors conclude from their analysis that the decision aid had a "... high chance of being cost effective, regardless of the value placed on obtaining additional vaccinations. It also appears to offer an efficient means of decision support for parents".

Available to read in full text at:  http://bjgp.org/content/64/625/e493.long

Tubeuf, S., et al. (2014). Cost effectiveness of a web-based decision aid for parents deciding about MMR vaccination: A three-arm cluster randomised controlled trial in primary care. British Journal of General Practice, 64(625), e493-e499.

HPV vaccination of New Zealand school boys is not yet a value-for-money option, according to a study just published by the University of Otago, Wellington.

Until the vaccine price drops and various other cost-saving strategies are also adopted – such as using just two doses rather than the current three doses of vaccine – the Government should focus on increasing HPV vaccination uptake in girls at schools, the authors say.

One of the study’s authors, Associate Professor Nick Wilson, says New Zealand has “some way to go” to catch up to the coverage levels of over 80% of school girls seen in some other countries such as the UK.

One way to achieve this could be to follow these other countries by continuing to allow free vaccination in the school setting for 12-year-old girls, but not funding other out-of-school options which parents sometimes don’t follow up on, Wilson says.

HPV vaccination is showing benefits around the world in terms of markedly dropping rates of genital warts and some types of pre-cancer, which can proceed on to cervical cancer. The vaccination is also very likely to prevent a range of other genital cancers and head and neck cancer in both women and men.

The University of Otago, Wellington study found that the current programme for girls was good value for money, but adding vaccination for boys would cost a lot more per amount of health gained - vaccination of boys at the level of coverage as currently achieved for girls would cost $117,500 per quality-adjusted life-year (QALY) gained.

“This is clearly not cost-effective when using a typical threshold of the GDP-per-capita of New Zealand to gain an extra year of healthy life, which is around $45,000,” Wilson says.

“If New Zealand invested in vaccinating boys, there would be the likely opportunity cost of not funding interventions that achieve more health gain or, more bluntly, not getting the biggest ‘bang for our buck’ elsewhere in the health sector.”

Wilson suggests New Zealand would perhaps be better off investing in other vaccinations such as the meningococcal C vaccination used in a campaign in Northland recently.
However, the price of the HPV vaccine is almost certain to drop in the future, especially as PHARMAC has now taken over the role of price negotiating from the Ministry of Health, Wilson says.

PHARMAC can now negotiate vaccine prices at the same time as contracts for other products from the same pharmaceutical manufacturers.

The study found that a lower vaccine price would improve the cost-effectiveness of vaccinating boys. However, the combined vaccine and administration costs had to be under $125 per dose of vaccine delivered, before vaccinating boys became cost-effective at the GDP-per-capita threshold.

“Vaccinations are usually great value for money – but we are not at this point with giving the HPV vaccination for boys,” Wilson says.

The Australian Government is now providing fully subsidised HPV vaccination to school boys – in large part because this government seems to have struck a particularly good deal with the vaccine manufacturer, Wilson says.

“But national pride might also have played a part – since the HPV vaccine was first invented in Australia.”

The study is published in the international peer-reviewed journal BMC Infectious Diseases, and the study team was predominantly funded by the Health Research Council.

The aim of this study was to systematically and comprehensively review economic evaluations of tobacco control mass media campaigns.

The authors modelled the cost-effectiveness of the Ottawa Model for Smoking Cessation (OMSC), an intervention that includes in-hospital counselling, pharmacotherapy and posthospital follow-up, compared to usual care among smokers hospitalised with acute myocardial infarction, unstable angina, heart failure, and chronic obstructive pulmonary disease.

The authors find that, although it is "... generally accepted that integrated care models have a positive effect on the quality of care, health outcomes and patient satisfaction, it is less clear how cost effective they are. As the evidence-base in this field is rather weak, the authors suggest that we may have to revisit our understanding of the concept and our expectations in terms of its assessment".

The report is available to download and read in free full text at:  http://www.integratedcaretoday.com/wp-content/uploads/sites/16/2014/06/What-is-the-evidence-on-the-economic-impacts-of-integrated-care.pdf

Nolte, E. & Pitchforth, E. (2014). What is the evidence on the economic impacts of integrated care? Copenhagen: Regional Office for Europe of the World Health Organization.

They found that the "... estimated net economic benefits ranged from $640 million to $1.8 billion, with the corresponding net benefits per case averted ranging from $15,780 to $24,391. The per dollar rate of return on the CDC’s investments ranged from $3.88 to $23.85". 

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1377/hlthaff.2013.0865 or contact your DHB library, or organisational or local library for assistance.

Scott, R.D., et al. (2014). CDC central-line bloodstream infection prevention efforts produced net benefits of at least $640 million during 1990–2008. Health Affairs, 33(6), 1040-1047.

Six relevant economic evaluations were assessed (3 from North America and 3 studies from Europe). "All studies reported the use of home monitoring devices that measured and transmitted different physical indicators to nurses who provided personalised feedback to patients during weekdays. The six studies involved a total of 559 COPD patients of whom 281 were randomised to telehealth. The review demonstrated a potential for cost savings ... However, the quality of the economic evidence was poor ....[and] caution is advised for healthcare decision-makers seeking large-scale implementation of telehealth in routine clinical practice".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1177/1357633X14533896 or contact your DHB library, or organisational or local library for assistance.

Udsen, F.W., et al. (2014). A systematic review of the cost and cost-effectiveness of telehealth for patients suffering from chronic obstructive pulmonary disease. Journal of Telemedicine and Telecare, 20(4), 212-220.

To read the full abstract, and for information on how to access the full text, go to: http://www.healthpolicyjrnl.com/article/S0168-8510%2814%2900130-4/abstract or contact your DHB library, or organisational or local library for assistance.

Hakkinen, U., et al. (2014). Quality, cost, and their trade-off in treating AMI and stroke patients in European hospitals. Health Policy, 117(1), 15–27.

To read the full abstract, and for information on how to access the full text, go to: http://www.heartlungcirc.org/article/S1443-9506(13)01315-2/abstract or contact your DHB library, or organisational or local library for assistance.

Ong, K. S., et al. (2014). Cost-effectiveness of interventions to prevent cardiovascular disease in Australia's indigenous population. Heart, Lung and Circulation, 23 (5), 414-421.

To read the full abstract, and for information on how to access the full text, go to: http://www.aaic.net.au/Document/?D=20140045 or contact your DHB library, or organisational or local library for assistance.

Ho, K. M. (2014). Determinants of the relationship between cost and survival time after elective adult cardiac surgery. Anaesthesia and Intensive Care, 42 (3), 303-309.

To access a free full text version of the article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6316a4.htm?s_cid=mm6316a4_x

Centers for Disease Control and Prevention. (2014). Benefits from immunization during the Vaccines for Children program era — United States, 1994–2013. Morbidity and Mortality Weekly Report (MMWR), 63 (16), 352-355.

Assesses the relative cost-effectiveness of various non-television advertising media (including radio and online media) in encouraging 25–39 year-old male smokers to respond to a cessation-related call to action. It was found that, contrary to the current assumption that the use of a consistent message across multiple media is the most cost-effective way of reaching target audiences, the online-only campaign phase was substantially more cost-effective than the other phases.

To read the full abstract, and for information on how to access the full text, go to: http://onlinelibrary.wiley.com/doi/10.1111/1753-6405.12175/abstract or contact your DHB library, local or organisational library for assistance.

Clayforth, C., et al. (2014). A cost-effectiveness analysis of online, radio and print tobacco control advertisements targeting 25–39 year-old males. Australian and New Zealand Journal of Public Health,  38: 270–274

Guy Jr, G., P., et al. (2014). Costs and benefits of an organised fecal immunochemical test-based colorectal cancer screening program in the United States. Cancer, 120: 2308–2315.

To read the full abstract, and for access to a free full text version of the article, go to: http://www.biomedcentral.com/1471-2407/14/261/abstract

Ouakrim, D. A., et al. (2014). Cost-effectiveness of family history-based colorectal cancer screening in Australia. BMC Cancer, 14, 261.

Annual screening with the UK Lung Screening Study eligibility criteria was estimated to result in 956 lung cancer deaths prevented and 457 overdiagnosed cancers from 330 000 screening episodes. Biennial screening would result in 802 lung cancer deaths prevented and 383 overdiagnosed cancers for 180 000 screening episodes. The authors suggest that the intervention effect could justify the human costs and that the benefit of biennial screening is subject to additional uncertainty but the issue merits further empirical research.

To read the full abstract and for information on how to access the full text, go to: http://www.nature.com/bjc/journal/v110/n7/full/bjc201463a.html or contact your local, DHB or organsational library for assistance.

Duffy, S. W., et al. (2014). Translation of research results to simple estimates of the likely effect of a lung cancer screening programme in the United Kingdom. British Journal of Cancer, 110, 1834-1840.

Analysis indicates that inviting 100 000 women from age 20 years yields an additional: 119 000 screens, 20 000 non-negative results, 8000 colposcopy referrals, and an extra 3000 women treated when compared with inviting from age 25 years. Screening from age 20 years prevents between three and nine frank invasive cancers and between 0 and 23 cancers in total (depending on the scenario). To prevent one frank invasive cancer, it is necessary to do between 12 500 and 40 000 additional screening tests in the age group 20–24 years and treat between 300 and 900 women.

To read the full abstract and for information on how to access the full text, go to: http://www.nature.com/bjc/journal/v110/n7/abs/bjc201465a.html or contact your local, DHB or organsational library for assistance.

Landy, R., et al. (2014). Benefits and harms of cervical screening from age 20 years compared with screening from age 25 years. British Journal of Cancer, 110, 1841-1846.

To read the full abstract, and for access to a free full text version of the article, go to: http://jama.jamanetwork.com/article.aspx?articleID=1853165

Pace, L. E., & Keating, N. L. (2014). A systematic assessment of benefits and risks to guide breast cancer screening decisions. JAMA, 311 (13), 1327-1335.

To read the full abstract and for information on how to access the full text, go to: http://www.healthpolicyjrnl.com/article/S0168-8510%2814%2900056-6/abstract or contact your local, DHB or organsational library for assistance.

Nord, E., & Johansen, R. (2014). Concerns for severity in priority setting in health care: A review of trade-off data in preference studies and implications for societal willingness to pay for a QALY. Health Policy, 116(2-3), 281–288.

From the results of the study, the authors conclude that the intervention "... was a low-cost investment for individuals with established diabetes and may result in medication cost-savings to the health system. Although QALYs were similar between groups, other benefits arising from the intervention should also be considered when determining the overall value of this strategy".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1016/j.diabres.2013.12.032 or contact your DHB library, or organisational or local library for assistance.

Gordon, L.G., et al. (2014). A cost-effectiveness analysis of a telephone-linked care intervention for individuals with Type 2 diabetes. Diabetes Research and Clinical Practice, 104(1), 103-111.

The webpages of 127 international HTA agencies were searched for guidelines containing recommendations on methods for the preparation of economic evaluations. Additionally, the HTA agencies were requested information on methods for economic evaluations. 

Twenty-five publications of 14 HTA agencies were included in the analysis. The authors found that methods for economic evaluations vary widely. The greatest accordance could be found for the type of analysis and comparator. 

The authors conclude that there is a considerable unexplainable variance in recommendations. Further effort is needed to harmonize methods for preparing economic evaluations.

This is an open access article and is available to read in free full text at:  http://www.biomedcentral.com/1472-6963/13/371

Mathes, T., et al. (2013). Methods of international health technology assessment agencies for economic evaluations- a comparative analysis. BMC Health Services Research, 13:371.

Eight hospital sites across England participated with four installing shock-absorbing flooring in one bay, and four maintaining their standard flooring.

While the shock-absorbing flooring was cost saving, it generated QALY (quality-adjusted life years) losses due to an increase in the faller rate. The authors note that fursther research is required to investigate whether the intervention flooring results in a higher faller rate than standard flooring.

To read the full abstract, and for information on how to access the full text, go to: http://ageing.oxfordjournals.org/content/42/5/641.abstract or contact your DHB library, or organisational or local library for assistance.

Latimer, N., et al. (2013). Cost–utility analysis of a shock-absorbing floor intervention to prevent injuries from falls in hospital wards for older people. Age and Ageing, 42(5), 641-645

See also: Pilot cluster randomised controlled trial of flooring to reduce injuries from falls in wards for older people: http://ageing.oxfordjournals.org/content/42/5/633

Only 10 studies met the inclusion criteria and overall quality was poor. The authors note that there is a need for well-designed trials to determine the cost-effectiveness of enhanced recovery pathway from institutional and societal perspectives.

To read the full abstract, and for information on how to access the full text, go to: http://journals.lww.com/annalsofsurgery/pages/articleviewer.aspx?year=2014&issue=04000&article=00010&type=abstract
or contact your DHB library, or organisational or local library for assistance.

Lee, L., et al. (2014). A systematic review of economic evaluations of enhanced recovery pathways for colorectal surgery. Annals of Surgery, 259(4), 670–676.

The authors conclude that there is "... clear and reliable evidence that home palliative care increases the chance of dying at home and reduces symptom burden in particular for patients with cancer, without impacting on caregiver grief ... More work is needed to study cost-effectiveness especially for people with non-malignant conditions .... and to compare different models of home palliative care".

This article is available to read in full text at: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007760.pub2/full

Gomes, B., Calanzani, N., Curiale, V., McCrone, P. & Higginson, I.J. (2013). Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers. Cochrane Database of Systematic Reviews, 6. Art. No.: CD007760. DOI: 10.1002/14651858.CD007760.pub2.

The primary purpose of the study was to examine the Quality, Innovation, Productivity and Prevention (QIPP) potential of cardiac rehabilitation and to establish whether the benefits of cardiac rehabilitation outweigh the costs in terms of the potential impact on readmissions alone.

Over and above the well-documented, positive effects of rehabilitation on mortality, morbidity and quality of life, the results suggest that increasing the uptake of  'gold standard' cardiac rehabilitation has the potential to reduce cardiac-related readmissions and deliver significant financial savings.

Access to the full text of the report is free online at: http://www.improvement.nhs.uk/documents/Case_for_CR.pdf

After analysis, the study found that call-back counselling was a cost-effective intervention for smoking cessation that could be provided by a centralised service for a large population, and to reach people in isolated communities.

To read the full abstract, and for information on how to access the full text, go to: http://tobaccocontrol.bmj.com/content/early/2013/06/07/tobaccocontrol-2012-050907.short or contact your DHB library, or organisational or local library for assistance.

Lal, A., et al. (2013). The cost—effectiveness of call-back counselling for smoking cessation. Tobacco Control, [published online First 8 June 2013].

The study used a decision model that incorporated a Markov process that was developed in 2012 to estimate the net benefit and cost of PSA screening versus no screening as a function of baseline risk. The study found that the harms of screening outweighed the benefits under a number of plausible scenarios. Conclusions were sensitive to the estimated quality-of-life impacts of prostate cancer treatment as well as the incidence of cancers not detected by screening tests (poorer prognosis) and those that were detected by screening tests (better prognosis).

To read the full abstract, and for access to a free full text version of the article, go to: https://www.mja.com.au/journal/2013/198/10/risk-assessment-guide-prostate-cancer-screening-decisions-cost-effectiveness

Martin, A. J., et al. (2013). Risk assessment to guide prostate cancer screening decisions: A cost-effectiveness analysis. Medical Journal of Australia, 198(10), 546-550.

The authors undertook an incremental cost-effectiveness analysis from the health service provider perspective, over the period of hospitalisation (time horizon) using the Australian Dollar  at 2008 values. Analyses were based on data from a randomized trial among 1,206 acute and rehabilitation inpatients. The intervention implemented was a multimedia patient education program provided with trained health professional follow-up shown to reduce falls among cognitively intact hospital patients.

The authors found that there was a 52% probability the complete program was both more effective and less costly (from the health service perspective) than providing usual care alone.

To read the full abstract, and for access to a free full text version of the article, go to: http://www.biomedcentral.com/1741-7015/11/135/abstract

Haines, T. P., et al. (2013). Cost effectiveness of patient education for the prevention of falls in hospital: economic evaluation from a randomized controlled trial. BMC Medicine, 11:135.

After taking into account the varying expenditures, the authors demonstrated there was a saving of 15.2% per patient after implementation of the pathway.

The study authors concluded that the cost efficiency savings, coupled with increased satisfaction and no rise in morbidity, offered a very attractive means of managing women undergoing vaginal hysterectomy. They believe that their data can be reproduced in other centres and recommend that the pathway be used routinely in women undergoing these procedures.

To read the full abstract, and for information on how to access the full text, go to: http://onlinelibrary.wiley.com/doi/10.1002/hpm.2182/abstract or contact your DHB library, or organisational or local library for assistance.

Relph, S., et al (2013). Cost effectiveness of enhanced recovery after surgery programme for vaginal hysterectomy: A comparison of pre and post-implementation expenditures. The International Journal of Health Planning and Management, [published online 10 May 2013].

The authors identified large reductions in number of hospitalisations, length of average hospital stay, and, to a lesser extent, number of emergency room visits, as a result of the telemonitoring intervention, although home visits by nurses increased both during and after the intervention.

Overall, the telehealth programme resulted in significant savings: the equivalent of over CAD1,557 per patient (as calculated on an annualised basis). The authors recommend additional assessments to confirm the cost-effectiveness of this mode of care delivery.

To view the full abstract and for information on how to access the full text, go to: http://dx.doi.org/10.1017/S0266462313000111 or contact your DHB library, or organisational or local library for assistance.

Paré, G., et al. (2013). Home telemonitoring for chronic disease management: An economic assessment. International Journal of Technology Assessment in Health Care, 29(2), 155-161.

The same evaluation is the subject of a white paper that is available in full text at: http://www.telushealth.com/docs/default-source/whitepapers/home-monitoring-for-chronic-disease-management-an-economic-assessment.pdf?sfvrsn=12

The study was a community based telehealth intervention in three local authority areas in England. Participants were 3230 people with a long term condition (heart failure, chronic obstructive pulmonary disease, or diabetes) were recruited into the Whole Systems Demonstrator telehealth trial between May 2008 and December 2009. Of participants taking part in the Whole Systems Demonstrator telehealth questionnaire study examining acceptability, effectiveness, and cost effectiveness, 845 were randomised to telehealth and 728 to usual care.

Intervention participants received a package of telehealth equipment and monitoring services for 12 months, in addition to the standard health and social care services available in their area. Controls received usual health and social care.

The primary outcome for the cost effectiveness analysis was incremental cost per quality adjusted life year (QALY) gained.

The authors undertook net benefit analyses of costs and outcomes for 965 patients (534 receiving telehealth; 431 usual care). Based on this analysis they conclude that the QALY gain by patients using telehealth in addition to usual care was similar to that by patients receiving usual care only, and total costs associated with the telehealth intervention were higher. Telehealth does not seem to be a cost effective addition to standard support and treatment.

This is an open access article and is available to read in full text at: http://www.bmj.com/content/346/bmj.f1035

Henderson, C., et al. (2013). Cost effectiveness of telehealth for patients with long term conditions (Whole Systems Demonstrator telehealth questionnaire study): Nested economic evaluation in a pragmatic, cluster randomised controlled trial. BMJ, 346:f1035.

Seven studies met the study inclusion criteria and were included in the systematic review with a total sample of 3,690 patients. The combined overall results showed that care pathways have a significant positive effect on mortality and readmission rate. A shorter length of hospital stay was also observed compared with the standard care group. No significant difference was found in the hospitalisation costs. More positive results were observed in controlled trials compared to randomized controlled trials.

The authors note that readers should be cautious with overall conclusions: "what works for one organization may not work for another because of the subtle differences in processes and bottlenecks".

This is an open access article and is available to read in full text at: http://www.biomedcentral.com/1471-2261/12/81/abstract

Kul, S., et al. (2012). Effects of care pathways on the in-hospital treatment of heart failure: A systematic review. BMC Cardiovascular Disorders, 12:81 doi:10.1186/1471-2261-12-81

Using linked, routinely collected data on all South Australian hospital separations from July 2001 to June 2008, an analysis of the RAC-E of services provided at four metropolitan hospitals was undertaken using a decision analytic framework. Observed (plus extrapolated) and expected lifetime costs and survival were compared across patient populations, from which the relative cost-effectiveness of services provided at the different hospitals was estimated.

This is an open access article and is available to read in full text at: http://www.biomedcentral.com/1472-6963/12/266/abstract

Pham, C., et al. (2012). Evaluating the effects of variation in clinical practice: A risk adjusted cost-effectiveness (RAC-E) analysis of acute stroke services. BMC Health Services Research, 12: 266, doi:10.1186/1472-6963-12-266

It can help staff to identify, track and calculate the financial benefits that may be associated with improvements gained from implementing The Productive Ward.  

Both publications are available to download at: http://www.institute.nhs.uk/quality_and_value/productivity_series/productive_ward.html

This systematic review seeks to examine the cost-effectiveness of CR for patients with MI or HF and inform policy makers in Singapore on published cost-effectiveness studies on CR.

This is an open access article and is available to read in full text at: http://www.biomedcentral.com/1472-6963/12/243/abstract

Wong, W.P., et al. (2012). A systematic review of economic evaluations of cardiac rehabilitation. BMC Health Services Research, 12:243.

The authors compared healthcare costs associated with the current outpatient management model with a more historic inpatient care model.

"Seventy-three (38.6%) patients were admitted to any hospital at diagnosis, of which 57 (30.2%) were admitted to our tertiary care facility. Total cost per patient was estimated to be $2140. If managed exclusively as an inpatient, cost per patient was estimated to be $5517, or 2.5 times greater than the outpatient model ($1443 per capita if not hospitalized in a tertiary centre)".

The authors suggest that this economic data endorses outpatient management models in Canada.

To view the full abstract and for information on how to access the full text, go to:
http://www.canadianjournalofdiabetes.com/article/S1499-2671(12)00073-1/abstract or contact your DHB library, or organisational or local library for assistance.

Foulds, J., et al. (2012). Healthcare costs for initial management of children with new-onset type 1 diabetes mellitus in Central and Northern Alberta. Canadian Journal of Diabetes, 36(3) , 128-132.

The authors find that the two organisations approach resource allocation decisions in different ways, and suggest that there is a case for establishing a uniform framework for option appraisal and priority setting so as to avoid allocative inefficiency. They note that the same applies to any other national health care system.

To view the full abstract and for information on how to access the full text, go to:
http://jhsrp.rsmjournals.com/content/17/3/157.abstract or contact your DHB library, or organisational or local library for assistance.

Shah, K., et al. (2012). Is the aim of the English health care system to maximize QALYs? Journal of Health Services, Research & Policy, 17(3), 157-163

To view the full abstract and for information on how to access the full text, go to:
http://stroke.ahajournals.org/content/43/8/2198.abstract or contact your DHB library, or organisational or local library for assistance.

Krueger, H., et al. (2012). Cost avoidance associated with optimal stroke care in Canada. Stroke, 43, 2198-2206.

Twenty-nine studies were included in the review. Four had two intervention arms which were treated as independent studies, giving a total of 33 estimates.  All studies except one reported a benefit from sending reminders to patients prior to their appointment. The synthesis suggests that the weighted mean relative change in non-attendance was 34% of the baseline non-attendance rate. Automated reminders were less effective than manual phone calls (29% vs 39% of baseline value). There appeared to be no difference in non-attendance rate, whether the reminder was sent the day before the appointment or the week before. Cost and savings were not measured formally in any of the papers, but almost half of them included cost estimates. The average cost of using either SMS, automated phone calls or phone calls was €0.41 per reminder.

The authors conclude that, although formal evidence of cost-effectiveness is lacking, the implication of the review is that all hospitals should consider using automated reminders to reduce non-attendance at appointments.

Hasvold, P.E. & Wootton, R. (2012). Use of telephone and SMS reminders to improve attendance at hospital appointments: a systematic review. Journal of Telemedicine and Telecare, 17 (7), 358-364.

This an open access article available to read in full text online at: http://jtt.rsmjournals.com/content/17/7/358.full

Data are drawn from the Behavioral Risk Factor Surveillance System (1991-2006) and reveal consistent evidence that these programs have a statistically significant effect to reduce prevalence of cigarette smoking among adults. Simulations indicate that had all states spent the CDC recommended level of funding from 1991 to 2006 then cigarette smoking prevalence would have been 1.40 percent to 8.07 percent lower in 2006, translating to between 635,000 to 3.7 million fewer adult cigarette smokers.

Rhoads, Jennifer K. (2012).  The effect of comprehensive state tobacco control programs on adult cigarette smoking. Journal of Health Economics, [Epublished 5 March 2012].

To read the full abstract, and for information on how to access the full text, go to: http://www.sciencedirect.com/science/article/pii/S0167629612000124 or contact your local or organisational library for assistance.

Analysis showed that primary HPV screening was the preferred primary test over the age of 30 in many considered scenarios. Primary cytology screening was preferred only in scenarios with low costs of cytology and in scenarios with a high prevalence of HPV in combination with high costs of HPV testing. The authors conclude, therefore, that most European countries should consider switching from primary cytology to HPV screening for cervical cancer. HPV screening must, however, only be implemented in situations where screening is well controlled.

de Kok, I. M. C. M., et al. (2012). Primary screening for human papillomavirus compared with cytology screening for cervical cancer in European settings: Cost effectiveness analysis based on a Dutch microsimulation model. BMJ, 344, e670.

To read the full abstract, and for access to a free full text version of the article, go to: http://www.bmj.com/content/344/bmj.e670

Main outcome measures used were quality adjusted life years (QALYs), combining life years gained from screening with losses of quality of life from false positive diagnoses and surgery. Analysis showed that inclusion of the effects of harms reduced the updated estimate of net cumulative QALYs gained after 20 years from 3301 to 1536, or by more than half. Sensitivity analysis showed these results were robust to a range of assumptions, particularly up to 10 years. It also indicated the importance of the level and duration of harms from surgery. The author concludes that this analysis supports the claim that the introduction of breast cancer screening might have caused net harm for up to 10 years after the start of screening.

Raftery, J. (2011). Possible net harms of breast cancer screening: Updated modelling of Forrest report. BMJ, 343, d7627.

To read the full abstract, and for access to a free full text version of the article, go to: http://www.bmj.com/content/343/bmj.d7627

Puliti, D., et al. (2012). Balancing harms and benefits of service mammography screening programs: A cohort study. Breast Cancer Research, 14 (R9), doi:10.1186/bcr3090.

To read the full abstract, and for access to a free full text version of the article, go to: http://breast-cancer-research.com/content/14/1/R9/abstract

Analysis found that an additional 753 person years in the labour force would have been achieved from 1993 to 2003 for the male cohort aged 60-64 years in 2003, if a lifestyle intervention had been introduced in 1983; with 890 person years for the equivalent female group. The impact on labour force participation was lower for the metformin intervention, and increased with age for both interventions. The male cohort aged 60-64 years in 2003 would have earned an additional $30 million in income with the metformin intervention, and the equivalent female cohort would have earned an additional $25 million. If the lifestyle intervention was introduced, the same male and female cohorts would have earned an additional $34 million and $28 million respectively from 1993 to 2003. For the individuals involved, on average, males would have earned an additional $44,600 per year and females an additional $31,800 per year, if they had continued to work as a result of preventing diabetes.

Passey, M. E. (2012). The impact of diabetes prevention on labour force participation and income of older Australians: An economic study. BMC Public Health, 12 (16), doi:10.1186/1471-2458-12-16.

To read the full abstract, and for access to a free full text version of the article, go to: http://www.biomedcentral.com/1471-2458/12/16/abstract

Results from the model indicated that diabetes prevention interventions have the potential to be cost-effective, but the outcome reveals a high level of uncertainty. In particular, the interventions were found to be cost-saving for men and women aged 30 or 50 years at the start of the intervention, and cost-effective for men and women aged 70 years. However, there was also a high degree of uncertainty around the incremental cost-effectiveness ratios (ICERs).

Neumann, A., Schwarz, P., & Lindholm, L. (2011). Estimating the cost-effectiveness of lifestyle intervention programmes to prevent diabetes based on an example from Germany: Markov modelling. Cost Effectiveness and Resource Allocation, 9 (17), doi:10.1186/1478-7547-9-17.

To read the full abstract, and for access to a free full text version of the article, go to: http://www.resource-allocation.com/content/9/1/17/abstract

Its scope includes the determinants of health and its definition and valuation, as well as the demand for and supply of health care; planning and market mechanisms; micro-economic evaluation of individual procedures and treatments; and evaluation of the performance of health care systems.

A mathematical programming model was developed to calculate optimal allocations for the Dutch population of the following interventions: smoking cessation support, diet and exercise to reduce overweight, statins, and medication to reduce blood pressure. Outcomes were total lifetime health care costs and QALYs. Budget sizes were varied and the division of resources between the general population and diabetes patients was assessed.

Full implementation of all interventions resulted in a gain of 560,000 QALY at a cost of euro 640 per capita, about euro 12,900 per QALY on average. The large majority of these QALY gains could be obtained at incremental costs below euro 20,000 per QALY. Low or high budgets (below euro 9 or above euro 100 per capita) were predominantly spent in the general population. Moderate budgets were mostly spent in diabetes patients.

Conclusions: Major health gains can be realized efficiently by offering prevention to both the general and the diabetic population. However, a priori setting a specific distribution of resources is suboptimal. Resource allocation models allow accounting for capacity constraints and program size in addition to efficiency.

Feenstra, T.L., et al. (2011). Targeted versus universal prevention. A resource allocation model to prioritize cardiovascular prevention. Cost Effectiveness and Resource Allocation, 9:14

Available to read in free full text at: http://www.resource-allocation.com/content/9/1/14/abstract

The authors created a spreadsheet model to quantify the reduction in cardiovascular disease in England and Wales over a decade, assuming the benefits apply consistently for men and women across age and risk groups.

The results of the analysis were that a programme across the entire population of England and Wales (about 50 million people) that reduced cardiovascular events by just 1% would result in savings to the health service worth at least £30m (€34m; $48m) a year compared with no additional intervention. Reducing mean cholesterol concentrations or blood pressure levels in the population by 5% (as already achieved by similar interventions in some other countries) would result in annual savings worth at least £80m to £100m. Legislation or other measures to reduce dietary salt intake by 3 g/day (current mean intake approximately 8.5 g/day) would prevent approximately 30 000 cardiovascular events, with savings worth at least £40m a year. Legislation to reduce intake of industrial trans fatty acid by approximately 0.5% of total energy content might gain around 570 000 life years and generate NHS savings worth at least £230m a year.

The authors conclude that any intervention that achieved even a modest population-wide reduction in any major cardiovascular risk factor would produce a net cost saving to the NHS, as well as improving health. They go on to say that, given the conservative assumptions used in this model, the true benefits would probably be greater.

Barton, P., et al. (2011). Effectiveness and cost effectiveness of cardiovascular disease prevention in whole populations: Modelling study. BMJ, 343:d4044

Available in full text at: http://www.bmj.com/content/343/bmj.d4044.full

It also makes the important link between access and continuity of care – with  evidence that patients are actually willing to wait longer to see their preferred clinician – and suggests ways of helping patients achieve effective ‘therapeutic’ relationships.

The report defines Continuity of Care as being ‘about care experienced by individual patients – not populations – over time’, and identifies two specific types:

Relationship Continuity
Describes the doctor-patient relationship in its most basic sense.

Management Continuity
Describes co-ordination and co-operation between service providers to enable the patient to navigate the healthcare system as simply as possible.

The report makes 30 recommendations to policy-makers, managers and commissioners, and practices.

The report is available in full text at: http://www.rcgp.org.uk/pdf/RCGP_Continuity_of_Care.pdf

Hill, A.P. & Freeman, G.K. (2011). Promoting continuity of care in general practice. London: Royal College of General Practitioners.

The EDISSE study is a prospective non-randomized controlled cluster trial that compared stroke services (n = 151 patients) to usual care (n = 187 patients). Health status and cost trial-data were entered in multi-dimensional stroke life-tables. The tables distinguish four levels of disability which are defined by the modified Rankin scale. Quality-of-life scores (EuroQoL-5D), transition and survival probabilities are based on concurrent Dutch follow-up studies. Outcomes are quality-adjusted life years lived and lifetime medical cost by disability category. An economic analysis compares outcomes from a successful stroke service to usual care, by bootstrapping individual costs and effects data from patients in each arm.

Results: Lifetime costs and QALYs after stroke depend on age-of-onset of first-ever stroke. Lifetime QALYs after stroke are 2.42 (90% CI - 0.49 - 2.75) for male patients in usual care and 2.75 (-0.61; 6.26) for females. Lifetime costs for men in the usual care setting are €39,335 (15,951; 79,837) and €42,944 (14,081; 95,944) for women. A comparison with the stroke service results in an ICER of €11,685 saved per QALY gained (€14,211 and €7,745 for men and women respectively). This stroke service is with 90% certainty cost-effective.

The authors conclude that, their analysis shows the potential of large health benefits and cost savings of stroke services, taking a lifetime perspective, also in other European settings.

Baeten, S. A., et al. (2011). Lifetime health effects and medical costs of integrated stroke services - a non-randomized controlled cluster-trial based life table approach. Cost Effectiveness and Resource Allocation,  8(21),  doi:10.1186/1478-7547-8-21

This article is available free in full text at: http://www.resource-allocation.com/content/8/1/21