2 - Schools incorporating the Life Sciences and Medicine
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Item The clinical and cost-effectiveness of open mesh repairs in adults presenting with a clinically diagnosed unilateral, primary inguinal hernia who are operated in an elective setting : systematic review and economic evaluation(2015-11) Sharma, Pawana; Boyers, Dwayne; Scott, Neil William; Hernandez, Rodolfo Andres; Fraser, Cynthia Mary; Cruickshank, Moira; Ahmed, Irfan; Ramsay, Craig Robert; Brazzelli, Miriam Giovanna; University of Aberdeen.Aberdeen Centre for Evaluation; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Health Economics Research Unit; University of Aberdeen.Institute of Applied Health Sciences; University of Aberdeen.Medical Statistics; University of Aberdeen.Aberdeen Health Psychology Group; University of Aberdeen.Applied MedicineItem A systematic review of the use of an expertise-based randomised controlled trial design(2015-05-30) Cook, Jonathan A.; Elders, Andrew; Boachie, Charles; Bassinga, Ted; Fraser, Cynthia Mary; Altman, Doug; Boutron, Isabelle; Ramsay, Craig R; MacLennan, Graeme S; University of Aberdeen.Aberdeen Centre for Evaluation; University of Aberdeen.Institute of Applied Health SciencesItem Romiplostim for the treatment of chronic immune or idiopathic thrombocytopenic purpura(2009-09) Mowatt, Graham; Boachie, Charles; Crowther, Mark; Fraser, Cynthia Mary; Hernandez, Rodolfo Andres; Jia, Xueli; Ternent, Laura; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Health Economics Research UnitItem Eltrombopag for the treatment of chronic idiopathic (immune) thrombocytopenic purpura : A Single Technology Appraisal(NIHR Health Technology Assessment programme, 2008-12) Boyers, Dwayne; Jia, Xueli; Crowther, M; Jenkinson, David James; Fraser, Cynthia Mary; Mowatt, Graham; University of Aberdeen.Other Applied Health SciencesItem Systematic review of the safety and efficacy of foam sclerotherapy for venous disease of the lower limbs(2007-08) Jia, X.; Mowatt, Graham; Burr, Jennifer Margaret; Cassar, Kevin; Cook, Jonathan Alistair; Fraser, Cynthia Mary; University of Aberdeen.Other Applied Health SciencesItem Systematic review of the clinical effectiveness and cost-effectiveness of laparoscopic surgery for inguinal hernia repair.(2005) McCormack, Kirsty; Wake, B.; Gonzalez Perez, Juan Gregorio; Fraser, Cynthia Mary; Cook, Jonathan Alistair; McIntosh, Emma; Vale, Luke David; Grant, Adrian Maxwell; University of Aberdeen.Other Applied Health SciencesItem The clinical effectiveness of transurethral incision of the prostate : a systematic review of randomised controlled trials(2010-02) Lourenco, Tania; Shaw, Matthew; Fraser, Cynthia Mary; MacLennan, Graeme Stewart; N'Dow, James Michael Olu; Pickard, Robert; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Academic Urology Unit; University of Aberdeen.Institute of Applied Health SciencesItem Screening tests for detecting open angle glaucoma : systematic review and meta-analysis(The Association for Research in Vision and Ophthalmology, Inc., 2008-07-09) Mowatt, Graham; Burr, Jennifer Margaret; Cook, Jonathan Alistair; Siddiqui, M. A. Rehman; Ramsay, Craig R; Fraser, Cynthia Mary; Azuara-Blanco, Augusto; Deeks, Jonathan JPURPOSE. To assess the comparative accuracy of potential screening tests for open angle glaucoma (OAG). METHODS. Medline, Embase, Biosis (to November 2005), Science Citation Index (to December 2005), and The Cochrane Library (Issue 4, 2005) were searched. Studies assessing candidate screening tests for detecting OAG in persons older than 40 years that reported true and false positives and negatives were included. Meta-analysis was undertaken using the hierarchical summary receiver operating characteristic model. RESULTS. Forty studies enrolling over 48,000 people reported nine tests. Most tests were reported by only a few studies. Frequency-doubling technology (FDT; C-20-1) was significantly more sensitive than ophthalmoscopy (30, 95% credible interval [CrI] 0–62) and Goldmann applanation tonometry (GAT; 45, 95% CrI 17–68), whereas threshold standard automated perimetry (SAP) and Heidelberg Retinal Tomograph (HRT II) were both more sensitive than GAT (41, 95% CrI 14–64 and 39, 95% CrI 3–64, respectively). GAT was more specific than both FDT C-20-5 (19, 95% CrI 0-53) and threshold SAP (14, 95% CrI 1-37). Judging performance by diagnostic odds ratio, FDT, oculokinetic perimetry, and HRT II are promising tests. Ophthalmoscopy, SAP, retinal photography, and GAT had relatively poor performance as single tests. These findings are based on heterogeneous data of limited quality and as such are associated with considerable uncertainty. CONCLUSIONS. No test or group of tests was clearly superior for glaucoma screening. Further research is needed to evaluate the comparative accuracy of the most promising tests.Item Romiplostim for the treatment of chronic immune or idiopathic thrombocytopenic purpura : a single technology appraisal(Gray, 2009) Mowatt, Graham; Boachie, C; Crowther, M; Fraser, Cynthia Mary; Hernández, Rodolfo Andrés; Jia, X; Ternent, LauraThis paper presents a summary of the evidence review group (ERG) report into the clinical and cost-effectiveness of romiplostim for the treatment of adults with chronic immune or idiopathic thrombocytopenic purpura (ITP) based upon a review of the manufacturer’s submission to the National Institute for Health and Clinical Excellence (NICE) as part of the single technology appraisal (STA) process. The submission’s evidence came from two relatively high-quality randomised controlled trials (RCTs). The ERG found no evidence that any important data were missed or that data extraction was inaccurate. In both RCTs more patients in the romiplostim than in the placebo group achieved a durable platelet response [non-splenectomised patients: romiplostim 25/41 (61%), placebo 1/21 (5%), odds ratio (OR) 24.45, 95% confidence interval (CI) 3.34 to 179.18; splenectomised patients: romiplostim 16/42 (38%), placebo 0/21 (0%), OR 8.5 (95% CI 1.15 to 372)] and an overall platelet response [non splenectomised patients: romiplostim 36/41 (88%), placebo 3/21 (14%), OR 34.74, 95% CI 7.77 to 155.38; splenectomised patients: romiplostim 33/42 (79%), placebo 0/21 (0%), OR 16.6 (95% CI 2.37 to 706]. The difference in mean period with a platelet response was 13.9 weeks (95% CI 10.5 to 17.4) in favour of romiplostim in the RCT of non-splectomised patients and 12.1 weeks (95% CI 8.7 to 15.6) in favour of romiplostim in the RCT of splectomised patients. The manufacturer’s economic model evaluated the cost-effectiveness of romiplostim compared with standard care. The ERG had concerns about the way the decision problem was addressed in the economic model and about the non-adjustment of findings for confounding factors. In non-splenectomised patients, using romiplostim as a first option treatment, the base-case incremental costeffectiveness ratio (ICER) was £14,840 per quality adjusted life-year (QALY). In splenectomised patients the ICER was £14,655 per QALY. Additional sensitivity analyses performed by the ERG identified two issues of importance: whether individuals entered the model on watch and rescue or on active therapy in the comparator arm (ICER £21,674 per QALY for non-splenectomised patients, £29,771 per QALY for splenectomised patients); whether it was assumed that any unused medicine would be wasted. Combining all of the separate sensitivity analyses, and assuming that watch and rescue was not the first-line treatment, increased the ICERs further (non-splenectomised £37,290 per QALY; splenectomised £131,017 per QALY). In conclusion, the manufacturer’s submission and additional work conducted by the ERG suggest that romiplostim has short-term efficacy for the treatment of ITP, but there is no robust evidence on long-term effectiveness or cost-effectiveness of romiplostim compared with relevant comparators.Item Systematic review of economic evaluations of laparoscopic surgery for colorectal cancer(Wiley-Blackwell, 2008) Hernández, Rodolfo Andrés; De Verteuil, Robyn; Fraser, Cynthia Mary; Vale, Luke David; Aberdeen Health Technology Assessment Group; University of Aberdeen, School of Medicine & Dentistry, Division of Applied Health SciencesObjective Colorectal cancer is one of the most common cancers and the standard surgical treatment for this cancer is open resection (OS), but laparoscopic surgery (LS) may be an alternative treatment. In 2000, a Health Technology Assessment (HTA) review found little evidence on costs and cost-effectiveness in comparing the two methods. The evidence base has since expanded and this study systematically reviews the economic evaluations on the subject published since 2000. Method Systematic review of studies reporting costs and outcomes of LS vs OS for colorectal cancer. National Health Service Economic Evaluation Database (NHS EED) methods for abstract writing were followed. Studies were summarized and incremental cost-effectiveness ratios (ICER) for common outcomes were calculated. Results Five studies met the inclusion criteria. LS generally had higher healthcare costs. Most studies reported longer operational time and shorter length of stay and similar long-term outcomes with LS vs OS. Only one outcome, complications, was common across all studies but results lacked consistency (e.g. in two studies, OS was less costly but more effective; in another study, LS was less costly but more effective; and in the further two studies, LS could potentially be cost effective depending on the decision-makers' willingness to pay for the health gain). Conclusion The evidence on cost-effectiveness is not consistent. LS was generally more costly than OS. However, the effectiveness data used in individual economic evaluation were imprecise and unreliable when compared with data from systematic reviews of effectiveness. Nevertheless, short-term benefits of LS (e.g. shorter recovery) may make LS appear less costly when productivity gains are considered.
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