Avoiding excessive dialysis-associated volume depletion may help preserve residual kidney function (RKF). To establish whether knowledge of the estimated normally hydrated weight from bioimpedance measurements (BI-NHW) when setting the post-hemodialysis target weight (TW) might mitigate rate of loss of RKF, we undertook an open label, randomized controlled trial in incident patients receiving HD, with clinicians and patients blinded to bioimpedance readings in controls. A total of 439 patients with over 500 ml urine/day or residual GFR exceeding 3 ml/min/1.73m² were recruited from 34 United Kingdom centers and randomized 1:1, stratified by center. Fluid assessments were made for up to 24 months using a standardized proforma in both groups, supplemented by availability of BI-NHW in the intervention group. Primary outcome was time to anuria, analyzed using competing-risk survival models adjusted for baseline characteristics, by intention to treat. Secondary outcomes included rate of RKF decline (mean urea and creatinine clearance), blood pressure and patient-reported outcomes. There were no group differences in cause-specific hazard rates of anuria (0.751; 95% confidence interval (0.459, 1.229)) or sub-distribution hazard rates (0.742 (0.453, 1.215)). RKF decline was markedly slower than anticipated, pooled linear rates in year 1: -0.178 (-0.196, -0.159)), year 2: -0.061 (-0.086, -0.036)) ml/min/1.73m²/month. Blood pressure and patient reported outcomes did not differ by group. The mean difference agreement between TW and BI-NHW was similar for both groups, Bioimpedance: -0.04 kg; Control: -0.25 kg. Thus, use of a standardized clinical protocol for fluid assessment when setting TW is associated with excellent preservation of RKF. Hence, bioimpedance measurements are not necessary to achieve this.

Reviews on the cost/outcome of donor human milk (DHM) for infants requiring care in the neonatal intensive care unit (NICU) setting have been undertaken. However, the cost‐effectiveness evidence is unclear. Therefore, we conducted a systematic review of published full economic evaluations of DHM versus standard feeding in infants in neonatal care with the aim of undertaking a narrative synthesis of the cost‐effectiveness evidence and critical appraisal of the methods used. MEDLINE, EMBASE, Web of Science, Cochrane Library, Centre for Reviews and Dissemination (CRD) and PROSPERO databases were searched. Studies were included if they were full economic evaluations (model‐based or trial‐based), the participants were infants in neonatal units requiring nutritional support, the intervention was DHM and the comparator was any standard feeding option. There were no restrictions on outcome measures. Two authors independently assessed eligibility, extracted data, assessed quality and cross‐checked results, with disagreements resolved by consensus. Information extracted focused on study context, and economic evaluation methods and results. Of 2861 studies, seven were included. Six (86%) studies originated from high‐income countries. Four (57%) of the studies were model‐based. Although we could not directly compare the different studies, due to the heterogenous nature of health and economic parameters used in the studies, all DHM interventions indicated cost‐effective or cost saving results. This review suggests that economic evaluation of DHM interventions is an expanding area of research. Although these interventions show promise, future economic evaluations of DHM interventions need to explicitly provide more details on long‐term costs and consequences.

Objectives: Rapid socioeconomic and nutrition transitions in Chinese populations have contributed to the growth in childhood obesity. This study presents a cost-effectiveness analysis of a school- and family-based childhood obesity prevention programme in China.Methods: A trial-based economic evaluation assessed cost-effectiveness at 12 months. Forty schools with 1,641 children were randomised to either receive the multi-component (diet and physical activity) intervention or to continue with usual activities. Both public sector and societal perspectives were adopted. Costs and benefits in the form of quality-adjusted life years (QALYs) were compared and uncertainty was assessed using established UK and US thresholds.Results: The intervention cost was 35.53 Yuan (£7.04/US$10.01) per child from a public sector perspective and 536.95 Yuan (£106/US$151) from a societal perspective. The incremental cost-effectiveness ratio (ICER) was 272.7 Yuan (£54/US$77)/BMI z-score change. The ICER was 8,888 Yuan (£1,760/US$2,502) and 73,831 Yuan (£14,620/US$20,796) per QALY from a public sector and societal perspective, respectively and was cost-effective using UK (£20,000) and US (US$50,000) per QALY thresholds.Conclusion: A multi-component school-based prevention programme is a cost-effective means of preventing childhood obesity in China.

Objectives In many countries, single-use endoscopy accessories such as forceps have almost replaced their reusable counterparts. We reviewed the evidence on the broader economic cost and environmental impacts associated with single-use and multiple-use accessories for gastrointestinal (GI) endoscopes. Design Systematic review following the reporting guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Data sources MEDLINE, Embase, Web of Science and Cochrane Database of Systematic Reviews were searched from 1 January 2000 to 25 September 2024. Eligibility criteria We included published economic evaluations on single-use and reusable GI endoscope accessories which were written in English. Data extraction and synthesis Two independent reviewers extracted data and quality-assessed identified studies according to the Consensus on Health Economic Criteria checklist. Results Seven economic analyses were included: all were cost analyses. Three studies were from the USA, three from Europe and one from Korea. Patients in these studies underwent GI endoscopy (n=3), colonoscopy (n=2), gastroscopy (n=1) and endoscopic retrograde cholangiopancreatography (n=1). All studies compared single-use with reusable accessories, of which six were forceps. Reprocessing and purchase costs were included in all studies, repair costs were included in three studies, and environmental impact was only considered in one study. Most studies (n=5) reported a higher cost per procedure associated with single-use accessories. Conclusions Apart from two studies, all studies indicated that the cost per procedure was greater using single-use accessories/forceps. Future economic evaluations of single versus reusable accessories/forceps should include costs and also consequences of health and beyond, especially environmental impact.

Background The consequences of critical illness can be substantial and multifactorial, encompassing physical deconditioning, mental health impairments, fatigue, and declines in health-related quality of life. We hypothesise that for people discharged after intensive care unit (ICU) for a critical illness, a six-week remote multicomponent rehabilitation intervention improves health-related quality of life, physical function, fatigue, mood, and other health-related outcomes after eight weeks, compared to standard care. Methods This is a pragmatic, randomised controlled, open-label, assessor blind, multicentre, clinical and cost effectiveness trial with internal pilot and embedded process evaluation. Recruitment will take place in NHS hospitals across the UK. Adults (n=428: control n= 197; intervention: n=231) within 12 weeks of discharge from hospital following an ICU admission for critical illness, requiring mechanical ventilation ≥48hours will be recruited. The intervention is a six week multicomponent, structured, rehabilitation programme, delivered remotely by a trained intervention team. The intervention includes four components: weekly symptom management; targeted exercise; psychological support, and peer support and information. The control group will receive standard NHS care. The primary outcome is Health-related quality of life (HRQoL) at eight weeks post-randomisation measured using the EQ-5D-5L. Secondary outcomes are: HRQoL (six months), physical function, fatigue, anxiety and depression, healthcare resource use at eight weeks and six months and intervention acceptability. Conclusions This trial will test a centrally delivered mulitcomponent rehabilitation intervention for survivors of critical illness, irrespective of geographic location or critical illness diagnosis. Trial registration The trial is registered (04.07.2022) with the International Standard Randomised Controlled Trial Number (ISRCTN) Register ISRCTN11266403 https://doi.org/10.1186/ISRCTN11266403

Future decision making on health care will need to consider broader environmental and sustainability issues. One example is adoption of single-use endoscopes instead of reusable endoscopes in gastroenterology, largely due to their perceived benefit of reducing cross-infection. Besides considerations related to technical performance, there are differences not only in the cost to healthcare but also in the impact they have on the environment. The primary aim of this systematic review was to synthesize evidence on the costs and consequences of using single-use gastrointestinal endoscopes vs. reusable ones adopting various reprocessing methods. The secondary aim was to review and discuss the way in which environmental impact is costed and reported by the studies included in this review.We searched multiple databases and the internet to September 2024. We included and quality-assessed partial and full economic evaluations according to predetermined criteria.Seven studies (2 cost analyses and 5 cost-utility analyses [CUA]) were included. All focused on duodenoscopes for endoscopic retrograde cholangiopancreatography. Five studies compared single-use with reusable duodenoscopes whereas two studies compared different reprocessing methods for reusable duodenoscopes. The most common outcomes were infection risk (n = 6) and quality-adjusted life years (n = 5). Environmental impact was considered in only two studies. All studies stated that the per-procedure cost was higher using single-use endoscopes but three CUAs indicated that single-use endoscopes were more cost-effective. Several studies used doubtful assumptions, reducing their credibility.Future economic evaluations of single-use vs. reusable endoscopes require more robust comparative evidence and should include costs and consequences beyond health, especially environmental impact.