There is growing interest in the use of "distributionally-sensitive" forms of economic evaluation that capture both the impact of an intervention upon average population health and the distribution of that health amongst the population. This review aims to inform the conduct of distributionally sensitive evaluations in the UK by answering three questions: (1) How averse are the UK public towards inequalities in lifetime health between socioeconomic groups? (2) Does this aversion differ depending upon the type of health under consideration? (3) Are the UK public as averse to inequalities in health between socioeconomic groups as they are to inequalities in health between neutrally framed groups? EMBASE, MEDLINE, EconLit, and SSCI were searched for stated preference studies relevant to these questions in October 2017. Of the 2155 potentially relevant papers identified, 15 met the predefined hierarchical eligibility criteria. Seven elicited aversion to inequalities in health between socioeconomic groups, and eight elicited aversion between neutrally labelled groups. We find general, although not universal, evidence for aversion to inequalities in lifetime health between socioeconomic groups, albeit with significant variation in the strength of that preference across studies. Second, limited evidence regarding the impact of the type of health upon aversion. Third, some evidence that the UK public are more averse to inequalities in lifetime health when those inequalities are presented in the context of socioeconomic inequality than when presented in isolation.

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Issues. Event-level alcohol research can inform prevention efforts by determining whether drinking contexts-such as people or places-are associated with harmful outcomes. This review synthesises evidence on associations between characteristics of adults' drinking occasions and acute alcohol-related harm. Approach. We systematically searched Ovid MEDLINE, Ovid PsycInfo and the Web of Science Social Sciences Citation Index. Eligible papers used quantitative designs and event-level data collection methods. They linked one or more drinking contexts to acute alcohol-related harm. Following extraction of study characteristics, methods and findings, we assessed study quality and narratively synthesised the findings. PROSPERO ID: CRD42018119701. Key Findings. Searches identified 95 eligible papers, 65 (68%) of which study young adults and 62 (65%) of which are set in the United States, which limits generalisability to other populations. These papers studied a range of harms from assault to drink driving. Study quality is good overall although measures often lack validation. We found substantial evidence for direct effects of drinking context on harms. All of the contextual characteristics types studied (e.g. people, place, timing, psychological states, drink type) were consistently associated with harms. Certain contexts were frequently studied and associated with harms, in particular, weekend drinking, drinking in licensed premises and concurrent illicit drug use. Implications. The findings of our review indicate target drinking contexts for prevention efforts that are consistently associated with increased acute alcohol-related harm. Conclusion. A large range of contextual characteristics of drinking occasions are directly associated with acute alcohol-related harm, over and above levels of consumption. [Stevely AK, Holmes J, McNamara S, Meier PS. Drinking contexts and their association with acute alcohol-related harm: A systematic review of event-level studies on adults' drinking occasions. Drug Alcohol Rev 2020;39: [309][310][311][312][313][314][315][316][317][318][319][320]

Background Nivolumab with ipilimumab (the Regimen) is the first immuno-oncology combination treatment to demonstrate long-term clinical benefit for advanced melanoma patients. We evaluated the cost effectiveness of the Regimen in this population, with and without the availability of overall survival (OS) data. Methods A partitioned survival model and a Markov statetransition model were developed to estimate the lifetime costs and benefits of the Regimen versus ipilimumab. These models were built with and without the availability of OS data, as only progression-free survival data were available from the head-to-head, phase III trial against ipilimumab at the time of the National Institute for Health and Care Excellence (NICE) submission. Patient utilities and resource use data were sourced from trial data or the literature. Results Incremental cost-effectiveness ratios (ICERs) and absolute costs were similar between the models with and without OS data, but the model with OS data generated more than 1 additional quality-adjusted life-year (QALY) across both treatment arms. In both models, based on list prices, the Regimen was the most cost-effective treatment. Conclusions The analyses show that the Regimen is a costeffective treatment for advanced melanoma patients in England, and methods to overcome the lack of OS can give reasonable estimates of QALYs gained and ICERs.

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Background Socioeconomic status is a key predictor of lifetime health: poorer people can expect to live shorter lives with lower average health-related quality-of-life (HRQoL) than richer people. In this study, we aimed to improve understanding of the socioeconomic gradient in HRQoL by exploring how inequalities in different dimensions of HRQoL differ by age. Methods Data were derived from the Health Survey for England for 2017 and 2018 (14,412 participants). HRQoL was measured using the EQ-5D-5L instrument. We estimated mean EQ-5D utility scores and reported problems on five HRQoL dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression) for ages 16 to 90+ and stratified by neighbourhood deprivation quintiles. Relative and absolute measures of inequality were assessed. Results Mean EQ-5D utility scores declined with age and followed a socioeconomic gradient, with the lowest scores in the most deprived areas. Gaps between the most and least deprived quintiles emerged around the age of 35, reached their greatest extent at age 60 to 64 (relative HRQoL of most deprived compared to least deprived quintile: females = 0.77 (95% CI: 0.68–0.85); males = 0.78 (95% CI: 0.69–0.87)) before closing again in older age groups. Gaps were apparent for all five EQ-5D dimensions but were greatest for mobility and self-care. Conclusion There are stark socioeconomic inequalities in all dimensions of HRQoL in England. These inequalities start to develop from early adulthood and increase with age but reduce again around retirement age.

and Portugal. METHODS: Database searches identified 10 clinical trials of leuprolide 1-monthly (1M), 3-monthly (3M) and 6-monthly (6M) with Atrigel®, requiring 6, 4 and 2 hospital treatment visits respectively. Due to reported comparable efficacy, safety and adherence, cost-minimisation analysis was conducted. Costs of the product, specialist consultations and diagnostics (converted to 2010 euros) were considered during up to 12 months follow-up. The perspective was that of public payers. RESULTS: The review showed that with the use of leuprolide 1M, 3M and 6M the respective percentage of patients achieving testosterone suppression of Յ50ng/dl was 93.3%, 98.3% and 97.3% (pϾ0.05). However, 6M was the least cost treatment option, with average total annual costs from 788€ (Poland) to 1839€ (Portugal). The 3M option was 2.5% (Hungary) to 37.6% (Belgium) higher than 6M cost; while 1M formulation had the highest cost: 15.6% and 151.6% more than 6M for those countries, respectively. The 3M option was 11.2% to 45.3% less expensive than 1M. The cost drivers were the frequency of visits for injection and monitoring. The study showed that up to 50% additional visits could be funded with the savings resulting from switching eligible patients from 1M and 3M to 6M. Results were robust in one-way sensitivity analyses, as well as probabilistic sensitivity analysis. CONCLUSIONS: Leuprolide acetate with Atrigel® 1M, 3M and 6M formulations offer comparable efficacy and safety. However, driven by the frequency of visits, the 6-monthly formulation offers the greatest cost-savings for prostate cancer patients in the European countries studied.