Dual stain cytology, or "diagnostic cytology", offers a significant increase in sensitivity compared to cytology, with a slight decrease in specificity. This can reduce additional investigations like colposcopies, biopsies, and follow-up visits. Cervical cancer screening for women between 25 and 65 years of age with diagnostic cytology is estimated to reduce the incidence of cervical cancer by 36% and reduce annual cervical cancer mortalities by 40%. The reduced number of screening visits and the decrease in incidence and mortality will improve quality of life. In this article, a model was created to evaluate the cost-effectiveness of diagnostic cytology for Belgium. In this approach, precancerous cells are more likely to be immediately identified during the first screening visit. This reduces both the number and frequency of follow-up visits required. After two cycles (6 years), the prevalence of CIN and cervical cancer is decreased significantly in the screened population. At a population level, these shifts can reduce the screening budget by 21%, resulting in savings of 5.3 million euro a year in Belgium. Diagnostic cytology benefits all stakeholders involved in cervical cancer screening.

Objective: To evaluate the clinical and economic impact of adopting noninvasive prenatal testing (NIPT) using circulating cell-free DNA as a first-line screening method for trisomy 21, 18, and 13 in the general pregnancy population. Methods: A decision-analytical model was developed to assess the impact of adopting NIPT as a primary screening test compared to conventional screening methods. The model takes the Belgium perspective and includes only the direct medical cost of screening, diagnosis, and procedure-related complications. NIPT costs are EUR 260. Clinical outcomes and the cost per trisomy detected were assessed. Sensitivity analysis measured the impact of NIPT false-positive rate (FPR) on modelled results. Results: The cost per trisomy detected was EUR 63,016 for conventional screening versus EUR 66,633 for NIPT, with a difference of EUR 3,617. NIPT reduced unnecessary invasive tests by 94.8%, decreased procedure-related miscarriages by 90.8%, and increased trisomies detected by 29.1%. Increasing the FPR of NIPT (from < 0.01 to 1.0%) increased the average number of invasive procedures required to diagnose a trisomy from 2.2 to 4.5, respectively. Conclusion: NIPT first-line screening at a reasonable cost is cost-effective and provides better clinical outcomes. However, modelled results are dependent on the adoption of an NIPT with a low FPR.

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Objectives: On-demand stimulation of the sphenopalatine ganglion (SPG) by means of an implantable neurostimulation system has been shown to be a safe and clinically promising therapy for the treatment of chronic cluster headache. Our objective was to estimate changes in cluster headache medication cost observed in patients treated with the ATI PULSANTE Neurostimulation System, using baseline and 12-month utilization data from the recent Pathway registry and United Kingdom drug costs for reference. MethOds: Detailed patient-level data of n= 71 chronic cluster headache patients followed through 12 months in Pathway R1 (NCT01677026) were analyzed to assess weekly utilization of acute cluster headache medications at baseline and 12 months. Cost estimates for all drug/dosage combinations were developed based on current 2017 pharmaceutical prices published in the British National Formulary (BNF 73, 2017), and used the lowest priced product and largest available package size in each instance to determine cost. Results: In the patients receiving SPG stimulation treatment, overall weekly medication costs per patient were reduced by 54.8% from £197.60 to £89.42 (-£108.20) from baseline to 12 months. Under a steady-state assumption, the observed drug cost reductions resulted in annualized acute drug cost savings to the U.K. National Health Service (NHS) of £5,626 (reduction from £10,276 to £4,650 per year). cOnclusiOns: Our analysis suggests that SPG stimulation for the treatment of chronic cluster headache is associated with pronounced reductions in acute cluster headache medication usage, leading to sizable annual savings in medication costs for the United Kingdom's NHS. On the basis of prior clinical studies investigating SPG therapy, these reductions stem from both effective treatment of attacks with stimulation, and also a reduction in attack frequency observed in stimulation-treated patients.

Objectives: To evaluate the overall and individual quality of mean uterine artery pulsatility index (UtPI) measurements performed in a Danish multi-centre validation study of first trimester screening for pre-eclampsia. Methods: Women attending first trimester screening for aneuploidies in six hospitals from May 2019 to February 2020 were offered to participate in the pre-eclampsia screening validation study. As part of the project, mean UtPI was measured on all participants by FMF certified sonographers. We performed quality assessment of UtPI measurements, including graphical visualisation of UtPI data corrected for maternal weight and gestational age using scatter plots. Inter-operator comparisons were illustrated via forest plots (mean and standard deviation) and monthly trends were plotted in cumulative sum (CUSUM) charts. In order to provide individual feedback, plots were also made for each UtPI operator. Results: We retrieved data on 3,969 UtPI measurements from 82 sonographers. Overall, there was evidence of a negative bias relative to the current FMF reference distribution. UtPI measurements were lower than expected (bias = 0.06 SD Log10[MoM]). Most sonographers (84 % [69/82]) measured UtPI within the acceptable range (bias < 0.3 SD Log10[MoM]). Conclusions: UtPI measurements were overall slightly lower than expected according to the FMF reference. Each sonographer will receive individual feedback, and a reevaluation of the performance is scheduled in three months. VP50.02 Ophthalmic artery Doppler as an auxiliary method in the differentiation between pre-eclampsia and chronic hypertension in pregnant women