ObjectivesTo analyse and compare the determinants of screening uptake for different National Health Service (NHS) health check-ups in the UK.DesignIndividual-level analysis of repeated cross-sectional surveys with balanced panel data.SettingThe UK.ParticipantsIndividuals taking part in the British Household Panel Survey (BHPS), 1992–2008.Outcome measureUptake of NHS health check-ups for cervical cancer screening, breast cancer screening, blood pressure checks, cholesterol tests, dental screening and eyesight tests.MethodsDynamic panel data models (random effects panel probit with initial conditions).ResultsHaving had a health check-up 1 year before, and previously in accordance with the recommended schedule, was associated with higher uptake of health check-ups. Individuals who visited a general practitioner (GP) had a significantly higher uptake in 5 of the 6 health check-ups. Uptake was highest in the recommended age group for breast and cervical cancer screening. For all health check-ups, age had a non-linear relationship. Lower self-rated health status was associated with increased uptake of blood pressure checks and cholesterol tests; smoking was associated with decreased uptake of 4 health check-ups. The effects of socioeconomic variables differed for the different health check-ups. Ethnicity did not have a significant influence on any health check-up. Permanent household income had an influence only on eyesight tests and dental screening.ConclusionsCommon determinants for having health check-ups are age, screening history and a GP visit. Policy interventions to increase uptake should consider the central role of the GP in promoting screening examinations and in preserving a high level of uptake. Possible economic barriers to access for prevention exist for dental screening and eyesight tests, and could be a target for policy intervention.Trial registrationThis observational study was not registered.

Objectives. In June 2011, the National Institute for Health and Care Excellence (NICE) Decision Support Unit published a Technical Support Document (TSD) providing recommendations on survival analysis for NICE technology appraisals (TAs). Survival analysis outputs are influential inputs into economic models estimating the cost-effectiveness of new cancer treatments. Hence, it is important that systematic and justifiable model selection approaches are used. This study investigates the extent to which the TSD recommendations have been followed since its publication. Methods. We reviewed NICE cancer TAs completed between July 2011 and July 2017. Information on survival analyses undertaken and associated critiques for overall survival (OS) and progression-free survival were extracted from the company submissions, Evidence Review Group (ERG) reports, and final appraisal determination documents. Results. Information was extracted from 58 TAs. Only 4 (7%) followed all TSD recommendations for OS outcomes. The vast majority (91%) compared a range of common parametric models and assessed their fit to the data (86%). Only a minority of TAs included an assessment of the shape of the hazard function (38%) or proportional hazards assumption (40%). Validation of the extrapolated portion of the survival function using external data was attempted in a minority of TAs (40%). Extrapolated survival functions were frequently criticized by ERGs (71%). Conclusions. Survival analysis within NICE TAs remains suboptimal, despite publication of the TSD. Model selection is not undertaken in a systematic way, resulting in inconsistencies between TAs. More attention needs to be given to assessing hazard functions and validation of extrapolated survival functions. Novel methods not described in the TSD have been used, particularly in the context of immuno-oncology, suggesting that an updated TSD may be of value.

Background: Negative pressure wound therapy (NPWT) proposes to provide better wound healing than standard wound management. Evidence quality of randomized controlled trials (RCTs) varies. Methods:We included participants with any kind of wounds and commercial as well as the homemade NPWT system. Comparators were any other wound dressing including variant NPWTs. We included RCTs randomizing patients or wounds in parallel or crossover designs. We searched PubMed and Cochrane Library on January 03, 2018. We assessed the risk of bias according to Cochrane and appropriateness of clinical endpoints according to the Food and Drug Administration (FDA). Results:We included 93 RCTs originating in 30 countries, 70 studies on open wounds and 23 studies on closed wounds. With respect to random sequence generation, we judged an unclear or high risk of bias in 50% (47 of 93) studies. With respect to allocation concealment, we judged an unclear or high risk of bias in 90% (84 of 93). We identified 41% (38 of 93) studies that based their conclusion on not appropriate endpoints. Conclusions:High risk of bias concerning random sequence generation and allocation concealment limited the credibility of the majority of 93 included RCTs on NPWT. A low risk of bias can and should be achieved with both items, and we recommend to align future RCTs to Cochrane.Many primary clinical endpoints were deemed not valid for making inferences on the efficacy of NPWT. We recommend using patient-centered endpoints as requested by the FDA and suggested in the present systematic review.

IntroductionMedical societies have developed guidelines for the detection, treatment and control of hypertension (HTN). Our analysis assessed the extent to which such guidelines were implemented in Germany in 2003 and 2001.MethodsUsing standardized clinical diagnostic and treatment appraisal forms, blood pressure levels and patient questionnaires for 55,518 participants from the cross-sectional Targets and Essential Data for Commitment of Treatment (DETECT) study (2003) were analyzed. Physician’s diagnosis of hypertension (HTNdoc) was defined as coding hypertension in the clinical appraisal questionnaire. Alternative definitions used were physician’s diagnosis or the patient’s self-reported diagnosis of hypertension (HTNdoc,pat), physician’s or patient’s self-reported diagnosis or a BP measurement with a systolic BP≥140 mmHg and/or a diastolic BP≥90 (HTNdoc,pat,bp) and diagnosis according to the National Health and Nutrition Examination Survey (HTNNHANES). The results were compared with the similar German HYDRA study to examine whether changes had occurred in diagnosis, treatment and adequate blood pressure control (BP below 140/90 mmHg) since 2001. Factors associated with pharmacotherapy and control were determined.ResultsThe overall prevalence rate for hypertension was 35.5% according to HTNdoc and 56.0% according to NHANES criteria. Among those defined by NHANES criteria, treatment and control rates were 56.0% and 20.3% in 2003, and these rates had improved from 55.3% and 18.0% in 2001. Significant predictors of receiving antihypertensive medication were: increasing age, female sex, obesity, previous myocardial infarction and the prevalence of comorbid conditions such as coronary heart disease (CHD), hyperlipidemia and diabetes mellitus (DM). Significant positive predictors of adequate blood pressure control were CHD and antihypertensive medication. Inadequate control was associated with increasing age, male sex and obesity.ConclusionsRates of treated and controlled hypertension according to NHANES criteria in DETECT remained low between 2001 and 2003, although there was some minor improvement.

Background Androgenetic alopecia (male pattern and female pattern hair loss) is characterized by thinning of the scalp hair. Intradermal injection of autologous platelet‐rich plasma (PRP) might have an effect on hair regrowth. Aims The aim was to evaluate efficacy and safety of platelet‐rich plasma compared to placebo or no treatment in people with pattern hair loss. Patients/Methods We searched the databases CENTRAL and MEDLINE on December 24, 2018 and included randomized controlled trials (RCTs). Primary outcomes were mean change of hair density from baseline and serious treatment‐related adverse events. Secondary outcome was mean change of hair thickness from baseline. Time point of outcome assessment was 6 months after start of treatment. Results We identified 13 relevant randomized controlled trials with 356 randomized (343 analyzed) people or half‐head areas who received PRP in a simple parallel or half‐head design. The pooled data of seven studies (171 analyzed people or half‐head areas) were favorable in the PRP group on hair density. We estimated a mean difference from baseline of 30.35 associated with a wide 95% confidence interval (1.77‐58.93), a considerable heterogeneity (I2 = 100%), and unclear risk of bias in most of the studies. Regarding hair thickness, data were also favorable in the PRP group, but these data were limited to a single study. We did not identify serious treatment‐related adverse events. Conclusion The results of seven RCTs indicated that autologous platelet‐rich plasma was associated with an increase of hair density when compared to placebo.

Aims:The aim of this study was to develop two diabetes specific preference-based measures (Diabetes Health Profile -3 Dimension; DHP-3D and the Diabetes Health Profile -5 Dimension; DHP-5D) for use in the calculation of Quality Adjusted Life Years, a key outcome in economic evaluation. These measures were based on the non-preference-based instrument the Diabetes Health Profile. Methods:For DHP-3D, psychometric and Rasch analyses were used to develop a health state classification system based on the DHP-18. The DHP-5D added two dimensions to the DHP-3D to extend the range of impacts measured. Each classification system was valued by 150 general public respondents in the United Kingdom using Time Trade Off. Multivariate regression was to estimate utility value sets. The matched dimensions across each measure were compared using z score tests. Results:The DHP-3D included three dimensions defined as mood, eating and social limitations, and the DHP-5D added dimensions defined as hypoglycemic attacks and vitality. For both, the random effects generalized least squares regression model produced consistent value sets, with the DHP-3D and DHP-5D ranging from 0.983 (best state) to 0.717(worst state), and 0.979 to 0.618 respectively. The addition of the two extra dimensions leads to significant differences for the more severe levels of each matched dimension. Conclusions:We have developed two diabetes specific preference-based measures that, subject to psychometric assessment, can be used to provide condition specific utility values to complement generic utilities from more widely validated measures such as the EQ-5D.

No previous analysis has investigated the determinants of screening uptake for breast and cervical cancer screening for possible spillover effects from one type of screening examination to the other type of screening examination with a dynamic bivariate panel probit model. For our analysis, we used a dynamic random effects bivariate panel probit model with initial conditions (Wooldridge-type estimator) and dependent variables were the participation of breast and cervical cancer screening in the recent year. The balanced panel sample consisted of 844 women from the British Household Panel Survey (BHPS) from the time period 1992 to 2008. Our analysis showed the high relevance of past screening behaviour and the importance of state dependency for the same and the other type of cancer screening examinations even after controlling for covariates and unobserved heterogeneity. The uptake for breast and cervical cancer screening was higher when the same screening examination was done one or three years earlier. This result is in accordance with the medical screening programmes in Great Britain. With regard to breast and cervical cancer screening positive spillover effects existed between screening examinations in the third order lags. Women with a previous visit to a general practitioner and individuals in the recommended age groups had a higher uptake for breast and cervical cancer screening. Other socioeconomic and health related variables had non-uniform results in both screening examinations. Promoting the uptake of one female prevention activity could also enhance the uptake of the other prevention activity.

Methods: A large online survey was conducted using a discrete choice experiment (DCE) with duration as an additional attribute on members of the UK general population (n=1,493) to elicit values for health (social limitations, mood, vitality, hypoglycaemia) and non-health (stress, hassle, control, support) aspects of selfmanagement in diabetes. The data was modelled using a conditional fixed-effects logit model and utility estimates were anchored on the 1-0 full health-dead scale. Results:The model produced significant and consistent coefficients, with one logical inconsistency and three insignificant coefficients for the milder levels of some attributes. The anchored utilities range from 1 for the best state to -0.029 for the worst state (meaning worse than dead) defined by the classification system. Conclusion:The results presented here can potentially be used to generate utility values capturing the day to day impact of interventions in diabetes on both health and self-management. These utility values can potentially be used to generate QALYs for use in economic models of the cost-effectiveness of interventions in diabetes.