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Health Technology Assessment: HTA

Jonathan Dc Ross, Jan Harding, Lelia Duley, Alan A Montgomery, Trish Hepburn, Wei Tan, Clare Brittain, Garry Meakin, Kirsty Sprange, Sukhwinder Thandi, Louise Jackson, Tracy Roberts, Janet Wilson, John White, Claire Dewsnap, Michelle Cole, Tessa Lawrence
BACKGROUND: Gonorrhoea is a common sexually transmitted infection that can cause pain and discomfort, affect fertility in women and lead to epididymo-orchitis in men. Current treatment is with ceftriaxone, but there is increasing evidence of antimicrobial resistance reducing its effectiveness. Gentamicin is a potential alternative treatment requiring further evaluation. OBJECTIVES: To assess the clinical effectiveness and cost-effectiveness of gentamicin as an alternative treatment to ceftriaxone in the treatment of gonorrhoea...
May 2019: Health Technology Assessment: HTA
Marc Serfaty, Michael King, Irwin Nazareth, Stirling Moorey, Trefor Aspden, Adrian Tookman, Kathryn Mannix, Anna Gola, Sarah Davis, John Wood, Louise Jones
BACKGROUND: With a prevalence of up to 16.5%, depression is one of the commonest mental disorders in people with advanced cancer. Depression reduces the quality of life (QoL) of patients and those close to them. The National Institute for Health and Care Excellence (NICE) guidelines recommend treating depression using antidepressants and/or psychological treatments, such as cognitive-behavioural therapy (CBT). Although CBT has been shown to be effective for people with cancer, it is unclear whether or not this is the case for people with advanced cancer and depression...
May 2019: Health Technology Assessment: HTA
Jonathan L Rees, Anjali Shah, Katherine Edwards, Maria T Sanchez-Santos, Danielle E Robinson, Antonella Delmestri, Andrew Carr, Nigel Arden, Sarah E Lamb, Amar Rangan, Andrew Judge, Rafael Pinedo-Villanueva, Tim Holt, Sally Hopewell, Daniel Prieto-Alhambra, Gary Collins
BACKGROUND: Shoulder dislocations are the most common joint dislocations seen in emergency departments. Most traumatic cases are anterior and cause recurrent dislocations. Management options include surgical and conservative treatments. There is a lack of evidence about which method is most effective after the first traumatic anterior shoulder dislocation (TASD). OBJECTIVES: To produce UK age- and sex-specific incidence rates for TASD. To assess whether or not surgery within 6 months of a first-time TASD decreases re-dislocation rates compared with no surgery...
April 2019: Health Technology Assessment: HTA
Hazel Everitt, Sabine Landau, Paul Little, Felicity L Bishop, Gillian O'Reilly, Alice Sibelli, Rachel Holland, Stephanie Hughes, Sula Windgassen, Paul McCrone, Kim Goldsmith, Nicholas Coleman, Robert Logan, Trudie Chalder, Rona Moss-Morris
BACKGROUND: Irritable bowel syndrome (IBS) affects 10-22% of people in the UK. Abdominal pain, bloating and altered bowel habits affect quality of life and can lead to time off work. Current treatment relies on a positive diagnosis, reassurance, lifestyle advice and drug therapies, but many people suffer ongoing symptoms. Cognitive-behavioural therapy (CBT) is recommended in guidelines for patients with ongoing symptoms but its availability is limited. OBJECTIVES: To determine the clinical effectiveness and cost-effectiveness of therapist telephone-delivered CBT (TCBT) and web-based CBT (WCBT) with minimal therapist support compared with treatment as usual (TAU) in refractory IBS...
April 2019: Health Technology Assessment: HTA
Athimalaipet V Ramanan, Andrew D Dick, Ashley P Jones, Dyfrig A Hughes, Andrew McKay, Anna Rosala-Hallas, Paula R Williamson, Ben Hardwick, Helen Hickey, Naomi Rainford, Graeme Hickey, Ruwanthi Kolamunnage-Dona, Giovanna Culeddu, Catrin Plumpton, Eifiona Wood, Sandrine Compeyrot-Lacassagne, Patricia Woo, Clive Edelsten, Michael W Beresford
BACKGROUND: Children with juvenile idiopathic arthritis (JIA) are at risk of uveitis. The role of adalimumab (Humira® ; AbbVie Inc., Ludwigshafen, Germany) in the management of uveitis in children needs to be determined. OBJECTIVE: To compare the efficacy, safety and cost-effectiveness of adalimumab in combination with methotrexate (MTX) versus placebo with MTX alone, with regard to controlling disease activity in refractory uveitis associated with JIA. DESIGN: This was a randomised (applying a ratio of 2 : 1 in favour of adalimumab), double-blind, placebo-controlled, multicentre parallel-group trial with an integrated economic evaluation...
April 2019: Health Technology Assessment: HTA
Roshan das Nair, Lucy E Bradshaw, Hannah Carpenter, Sara Clarke, Florence Day, Avril Drummond, Deborah Fitzsimmons, Shaun Harris, Alan A Montgomery, Gavin Newby, Catherine Sackley, Nadina B Lincoln
BACKGROUND: People with traumatic brain injuries (TBIs) commonly report memory impairments. These are persistent, debilitating and reduce quality of life, but patients do not routinely receive memory rehabilitation after discharge from hospital. OBJECTIVE: To assess the clinical effectiveness and cost-effectiveness of a group memory rehabilitation programme for people with TBI. DESIGN: Multicentre, pragmatic, cluster randomised controlled trial...
April 2019: Health Technology Assessment: HTA
Miriam Brazzelli, Mehdi Javanbakht, Mari Imamura, Jemma Hudson, Eoin Moloney, Frauke Becker, Sheila Wallace, Muhammad Imran Omar, Michael Shimonovich, Graeme MacLennan, Laura Ternent, Luke Vale, Isobel Montgomery, Phil Mackie, Lucky Saraswat, Ash Monga, Dawn Craig
BACKGROUND: Urinary incontinence in women is a distressing condition that restricts quality of life and results in a large economic burden to both the NHS and women themselves. OBJECTIVE: To evaluate the clinical effectiveness, safety and cost-effectiveness of surgical treatment for stress urinary incontinence (SUI) in women and explore women's preferences. DESIGN: An evidence synthesis, a discrete choice experiment (DCE) and an economic decision model, with a value-of-information (VOI) analysis...
March 2019: Health Technology Assessment: HTA
Jo Varley-Campbell, Rubén Mújica-Mota, Helen Coelho, Neel Ocean, Max Barnish, David Packman, Sophie Dodman, Chris Cooper, Tristan Snowsill, Tracey Kay, Neil Liversedge, Michelle Parr, Lisa Knight, Chris Hyde, Andrew Shennan, Martin Hoyle
BACKGROUND: Preterm birth may result in short- and long-term health problems for the child. Accurate diagnoses of preterm births could prevent unnecessary (or ensure appropriate) admissions into hospitals or transfers to specialist units. OBJECTIVES: The purpose of this report is to assess the test accuracy, clinical effectiveness and cost-effectiveness of the diagnostic tests PartoSure™ (Parsagen Diagnostics Inc., Boston, MA, USA), Actim® Partus (Medix Biochemica, Espoo, Finland) and the Rapid Fetal Fibronectin (fFN)® 10Q Cassette Kit (Hologic, Inc...
March 2019: Health Technology Assessment: HTA
Carina King, Carrie Llewellyn, Maryam Shahmanesh, Charles Abraham, Julia Bailey, Fiona Burns, Laura Clark, Andrew Copas, Alison Howarth, Gwenda Hughes, Cath Mercer, Alec Miners, Alex Pollard, Daniel Richardson, Alison Rodger, Anupama Roy, Richard Gilson
BACKGROUND: Sexually transmitted infections (STIs) continue to represent a major public health challenge. There is evidence that behavioural interventions to reduce risky sexual behaviours can reduce STI rates in patients attending sexual health (SH) services. However, it is not known if these interventions are effective when implemented at scale in SH settings in England. OBJECTIVES: The study (Santé) had two main objectives - (1) to develop and pilot a package of evidence-based sexual risk reduction interventions that can be delivered through SH services and (2) to assess the feasibility of conducting a randomised controlled trial (RCT) to determine effectiveness against usual care...
March 2019: Health Technology Assessment: HTA
Martin C Gulliford, Dorota Juszczyk, A Toby Prevost, Jamie Soames, Lisa McDermott, Kirin Sultana, Mark Wright, Robin Fox, Alastair D Hay, Paul Little, Michael Moore, Lucy Yardley, Mark Ashworth, Judith Charlton
BACKGROUND: Unnecessary prescribing of antibiotics in primary care is contributing to the emergence of antimicrobial drug resistance. OBJECTIVES: To develop and evaluate a multicomponent intervention for antimicrobial stewardship in primary care, and to evaluate the safety of reducing antibiotic prescribing for self-limiting respiratory infections (RTIs). INTERVENTIONS: A multicomponent intervention, developed as part of this study, including a webinar, monthly reports of general practice-specific data for antibiotic prescribing and decision support tools to inform appropriate antibiotic prescribing...
March 2019: Health Technology Assessment: HTA
Linda Clare, Aleksandra Kudlicka, Jan R Oyebode, Roy W Jones, Antony Bayer, Iracema Leroi, Michael Kopelman, Ian A James, Alison Culverwell, Jackie Pool, Andrew Brand, Catherine Henderson, Zoe Hoare, Martin Knapp, Sarah Morgan-Trimmer, Alistair Burns, Anne Corbett, Rhiannon Whitaker, Bob Woods
BACKGROUND: Cognitive rehabilitation (CR) is an individualised, person-centred intervention for people with mild to moderate dementia that addresses the impact of cognitive impairment on everyday functioning. OBJECTIVES: To determine whether or not CR is a clinically effective and cost-effective intervention for people with mild to moderate Alzheimer's disease or vascular or mixed dementia, and their carers. DESIGN: This multicentre randomised controlled trial compared CR with treatment as usual (TAU)...
March 2019: Health Technology Assessment: HTA
Ioannis Gallos, Helen Williams, Malcolm Price, Karen Pickering, Abi Merriel, Aurelio Tobias, David Lissauer, Harry Gee, Özge Tunçalp, Gillian Gyte, Vidhya Moorthy, Tracy Roberts, Jonathan Deeks, Justus Hofmeyr, Metin Gülmezoglu, Arri Coomarasamy
BACKGROUND: Postpartum haemorrhage (PPH) is the leading cause of maternal mortality worldwide. Prophylactic uterotonic drugs can reduce blood loss and are routinely recommended. There are several uterotonic drugs for preventing PPH, but it is still debatable which drug or combination of drugs is the most effective. OBJECTIVES: To identify the most effective and cost-effective uterotonic drug(s) to prevent PPH, and generate a ranking according to their effectiveness and side-effect profile...
February 2019: Health Technology Assessment: HTA
Paul Tappenden, Christopher Carroll, Jean Hamilton, Eva Kaltenthaler, Ruth Wong, Jonathan Wadsley, Laura Moss, Sabapathy Balasubramanian
BACKGROUND: Medullary thyroid cancer (MTC) is a rare form of cancer that affects patients' health-related quality of life (HRQoL) and survival. Cabozantinib (Cometriq® ; Ipsen, Paris, France) and vandetanib (Caprelsa® ; Sanofi Genzyme, Cambridge, MA, USA) are currently the treatment modality of choice for treating unresectable progressive and symptomatic MTC. OBJECTIVES: (1) To evaluate the clinical effectiveness and safety of cabozantinib and vandetanib. (2) To estimate the incremental cost-effectiveness of cabozantinib and vandetanib versus each other and best supportive care...
February 2019: Health Technology Assessment: HTA
Anthony P Morrison, Melissa Pyle, Andrew Gumley, Matthias Schwannauer, Douglas Turkington, Graeme MacLennan, John Norrie, Jemma Hudson, Samantha Bowe, Paul French, Paul Hutton, Rory Byrne, Suzy Syrett, Robert Dudley, Hamish J McLeod, Helen Griffiths, Thomas Re Barnes, Linda Davies, Gemma Shields, Deborah Buck, Sarah Tully, David Kingdon
BACKGROUND: Clozapine (clozaril, Mylan Products Ltd) is a first-choice treatment for people with schizophrenia who have a poor response to standard antipsychotic medication. However, a significant number of patients who trial clozapine have an inadequate response and experience persistent symptoms, called clozapine-resistant schizophrenia (CRS). There is little evidence regarding the clinical effectiveness of pharmacological or psychological interventions for this population. OBJECTIVES: To evaluate the clinical effectiveness and cost-effectiveness of cognitive-behavioural therapy (CBT) for people with CRS and to identify factors predicting outcome...
February 2019: Health Technology Assessment: HTA
Sue Gessler, Michael King, Alessandra Lemma, Julie Barber, Louise Jones, Susan Dunning, Val Madden, Stephen Pilling, Rachael Hunter, Peter Fonagy, Karen Summerville, Nicola MacDonald, Adeola Olaitan, Anne Lanceley
BACKGROUND: Women affected by gynaecological cancer are often unaware of the sexual consequences of both the cancer and its treatment. Most do not receive appropriate advice or help to recover sexual function, and the effect on their sexuality may be profound, both physically and emotionally. However, several potential therapies can be effective in helping recover some sexual engagement and change self-perception around sex. A major initial challenge is informing and involving patients in an appropriate and sensitive manner, and a further issue is delivering therapies in busy gynaelogical oncology clinics...
February 2019: Health Technology Assessment: HTA
Mark J Peters, Imran Khan, Kerry Woolfall, Elizabeth Deja, Paul R Mouncey, Jerome Wulff, Alexina Mason, Rachel Agbeko, Elizabeth S Draper, Blaise Fenn, Doug W Gould, Abby Koelewyn, Nigel Klein, Christine Mackerness, Sian Martin, Lauran O'Neill, Padmanabhan Ramnarayan, Shane Tibby, Lyvonne Tume, Jason Watkins, Kent Thorburn, Paul Wellman, David A Harrison, Kathryn M Rowan
BACKGROUND: Fever accelerates host immune system control of pathogens but at a high metabolic cost. The optimal approach to fever management and the optimal temperature thresholds used for treatment in critically ill children are unknown. OBJECTIVES: To determine the feasibility of conducting a definitive randomised controlled trial (RCT) to evaluate the clinical effectiveness and cost-effectiveness of different temperature thresholds for antipyretic management...
February 2019: Health Technology Assessment: HTA
Karen Luyt, Sally Jary, Charlotte Lea, Grace J Young, David Odd, Helen Miller, Grazyna Kmita, Cathy Williams, Peter S Blair, Aída Moure Fernández, William Hollingworth, Michelle Morgan, Adam Smith-Collins, N Jade Thai, Steven Walker-Cox, Kristian Aquilina, Ian Pople, Andrew Whitelaw
BACKGROUND: The drainage, irrigation and fibrinolytic therapy (DRIFT) trial, conducted in 2003-6, showed a reduced rate of death or severe disability at 2 years in the DRIFT compared with the standard treatment group, among preterm infants with intraventricular haemorrhage (IVH) and post-haemorrhagic ventricular dilatation. OBJECTIVES: To compare cognitive function, visual and sensorimotor ability, emotional well-being, use of specialist health/rehabilitative and educational services, neuroimaging, and economic costs and benefits at school age...
February 2019: Health Technology Assessment: HTA
John Strang, Michael Kelleher, Soraya Mayet, Ed Day, Jennifer Hellier, Sarah Byford, Caroline Murphy, Blair McLennan, James Shearer, Elizabeth Ryan, John Marsden
BACKGROUND: People recovering from heroin addiction need better treatments than are currently offered. The chronic relapsing nature of drug dependence means that helping a patient to achieve abstinence is often difficult. Naltrexone blocks the effects of ingested heroin; however, evidence is conflicting regarding the best delivery method. OBJECTIVES: The primary purpose of the trial was to evaluate the clinical effectiveness and cost-effectiveness of extended-release naltrexone versus standard oral naltrexone versus relapse prevention therapy without medication for opioid use disorder (OUD)...
January 2019: Health Technology Assessment: HTA
Adrian R Martineau, David A Jolliffe, Lauren Greenberg, John F Aloia, Peter Bergman, Gal Dubnov-Raz, Susanna Esposito, Davaasambuu Ganmaa, Adit A Ginde, Emma C Goodall, Cameron C Grant, Wim Janssens, Megan E Jensen, Conor P Kerley, Ilkka Laaksi, Semira Manaseki-Holland, David Mauger, David R Murdoch, Rachel Neale, Judy R Rees, Steve Simpson, Iwona Stelmach, Geeta Trilok Kumar, Mitsuyoshi Urashima, Carlos A Camargo, Christopher J Griffiths, Richard L Hooper
BACKGROUND: Randomised controlled trials (RCTs) exploring the potential of vitamin D to prevent acute respiratory infections have yielded mixed results. Individual participant data (IPD) meta-analysis has the potential to identify factors that may explain this heterogeneity. OBJECTIVES: To assess the overall effect of vitamin D supplementation on the risk of acute respiratory infections (ARIs) and to identify factors modifying this effect. DATA SOURCES: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, ClinicalTrials...
January 2019: Health Technology Assessment: HTA
Wendy Atkin, Amanda J Cross, Ines Kralj-Hans, Eilidh MacRae, Carolyn Piggott, Sheena Pearson, Kate Wooldrage, Jeremy Brown, Fiona Lucas, Aaron Prendergast, Natalie Marchevsky, Bhavita Patel, Kevin Pack, Rosemary Howe, Hanna Skrobanski, Robert Kerrison, Nicholas Swart, Julia Snowball, Stephen W Duffy, Stephen Morris, Christian von Wagner, Stephen Halloran
BACKGROUND: In the UK, patients with one or two adenomas, of which at least one is ≥ 10 mm in size, or three or four small adenomas, are deemed to be at intermediate risk of colorectal cancer (CRC) and referred for surveillance colonoscopy 3 years post polypectomy. However, colonoscopy is costly, can cause discomfort and carries a small risk of complications. OBJECTIVES: To determine whether or not annual faecal immunochemical tests (FITs) are effective, acceptable and cost saving compared with colonoscopy surveillance for detecting CRC and advanced adenomas (AAs)...
January 2019: Health Technology Assessment: HTA
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