Objective To estimate the utility (preference for health) associated with hip fracture and fear of falling among older women. Design Quality of life survey with the time trade off technique. The technique derives an estimate of preference for health states by finding the point at which respondents show no preference between a longer but lower quality of life and a shorter time in full health. Setting A randomised trial of external hip protectors for older women at risk of hip fracture. Participants 194 women aged > 75 years enrolled in the randomised controlled trial or who were eligible for the trial but refused completed a quality of life interview face to face. Outcome measures Respondents were asked to rate their own health by using the Euroqol instrument and then rate three health states (fear of falling, a "good" hip fracture, and a "bad" hip fracture) by using time trade off technique.Results On an interval scale between 0 (death) and 1 (full health), a "bad" hip fracture (which results in admission to a nursing home) was valued at 0.05; a "good" hip fracture (maintaining independent living in the community) 0.31, and fear of falling 0.67. Of women surveyed, 80% would rather be dead (utility = 0) than experience the loss of independence and quality of life that results from a bad hip fracture and subsequent admission to a nursing home. The differences in mean utility weights between the trial groups and the refusers were not significant. A test-retest study on 36 women found that the results were reliable with correlation coefficients within classes ranging from 0.61 to 0.88. Conclusions Among older women who have exceeded average life expectancy, quality of life is profoundly threatened by falls and hip fractures. Older women place a very high marginal value on their health. Any loss of ability to live independently in the community has a considerable detrimental effect on their quality of life.

Our data suggest that severe HPA-1a NAIT is underdiagnosed in the absence of routine antenatal screening. Serious bleeding complications and ICH, however, occur less frequently in first cases of NAIT than suspected from the literature, and the costs of screening and possible intervention must be balanced against the procedural risks.

Background and Purpose-Stroke is very common, but computed tomography (CT) scanning, an expensive and finite resource, is required to differentiate cerebral infarction, hemorrhage, and stroke mimics. We determined whether, and in what circumstances, CT is cost-effective in acute stroke. Methods-We developed a decision tree representing acute stroke care pathways populated with data from multiple sources. We determined the effect of diagnostic information from CT scanning on functional outcome, length of stay, costs, and quality of life during 5 years for 13 alternative CT strategies (varying proportions and types of patients and rapidity of scanning). Results-For 1000 patients aged 70 to 74 years, the policy "scan all strokes within 48 hours" cost £10 279 728 and achieved 1982.3 quality-adjusted life years (QALYs). The most cost-effective strategy was "scan all immediately" (£9 993 676 and 1982.4 QALYs). The least cost-effective was "scan patients on anticoagulants and those in a life-threatening condition immediately and the rest within 14 days" (£12 592 666 and 1931.8 QALYs). "Scan no patients" reduced QALYs (1904.2) and increased cost (£10 544 000). Conclusion-Immediate CT scanning is the most cost-effective strategy. For the majority of acute stroke patients, increasing independent survival by correct early diagnosis, ensuring appropriate subsequent treatment and management decisions, reduced costs of stroke and increased QALYs.