Blood glucose self-monitoring in type 2 diabetes: a randomised controlled trial

Article history

The research reported in this issue of the journal was commissioned by the HTA Programme as project number 01/38/05. The contractual start date was in October 2002. The draft report began editorial review in August 2007 and was accepted for publication in September 2008. As the funder, by devising a commissioning brief, the HTA Programme specified the research question and study design. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors’ report and would like to thank the referees for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this report.

Declared competing interests of authors

None

Copyright statement

© 2009 Queen’s Printer and Controller of HMSO. This monograph may be freely reproduced for the purposes of private research and study and may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NCCHTA, Alpha House, Enterprise Road, Southampton Science Park, Chilworth, Southampton SO16 7NS, UK.

2009 Queen’s Printer and Controller of HMSO

Background

Objectives

We report here the results of a trial designed to test whether SMBG, used with or without instruction in incorporating findings into self-care, can improve glycaemic control in non-insulin-treated diabetes compared with standardised usual care.

Study design and patients

The Diabetes Glycaemic Education and Monitoring (DiGEM) study was a 4-year open, randomised, three-arm, parallel group trial with sequential recruitment from general practices in Oxfordshire and South Yorkshire. The trial was managed from the co-ordinating centre at the Department of Primary Health Care, University of Oxford following NHS R&D Health Technology Assessment Programme guidelines. The protocol was approved by the Oxfordshire B Research Ethics Committee,30 and registered with the International Standard Randomised Controlled Trial Number Register (ISRCTN47464659).

Our primary objective was to determine whether HbA1c at 12 months was significantly different between patients with non-insulin-treated type 2 diabetes receiving one of three allocated interventions: (1) standardised usual care with 3-monthly measurement of HbA1c by health professionals (control group); (2) use of a meter with training focused on clinician interpretation of results (less intensive self-monitoring); and (3) use of a meter with training in self-interpretation and application of the results to diet, physical activity and medication adherence (more intensive self-monitoring).

Between January 2003 and December 2005, 453 patients from 48 practices were randomised (see Figure 1) to receive standardised usual care (n = 152), less intensive self-monitoring (n = 150) or more intensive self-monitoring (n = 151). The mean number of patients per practice recruited in 24 Oxfordshire practices and 24 South Yorkshire practices was 10.2 and 8.3 respectively.

FIGURE 1.

Trial profile. ITT analysis, intention-to-treat analysis.

Patients

Patients were eligible for randomisation if they had type 2 diabetes, were aged 25 years or more at diagnosis and were managed with diet or oral hypoglycaemic agents alone, if their HbA1c at the assessment visit was ≥ 6.2% and they were independent in activities of daily living. Exclusion criteria were: the use of a blood glucose monitor twice a week or more often over the previous 3 months; serious disease or limited life expectancy that would make intensive glycaemic control inappropriate; or inability to follow trial procedures.

Measures

The primary outcome was HbA1c at the 12-month visit. Secondary outcomes were blood pressure, weight, total cholesterol, total/high-density lipoprotein (HDL) cholesterol ratio and body mass index. HbA1c was measured using a Variant II Hemoglobin Testing System (Bio-Rad Laboratories, Hercules, CA, USA) certified by the US National Glycohemoglobin Standardization Program and comparable to the Diabetes Control and Complications Trial Standard with an inter-assay co-efficient of variation (CV) across the range of the assay of < 2%. Cholesterol was assayed in local laboratories and results were aligned with the results of a sample of paired specimens analysed with an Olympus AU400 (Olympus, Tokyo, Japan) automated chemistry analyser, with an inter-assay CV across the range of < 2%. Blood pressure was measured twice in the right arm, with the subject seated, using a UA-779 electronic blood pressure monitor (A&D Instruments Ltd, Abingdon, UK), and the mean of these values was analysed.

Frequency of blood glucose testing and episodes of hypoglycaemia were transcribed from patient-held diaries. Episodes of hypoglycaemia were categorised as grade 2 (mild symptoms requiring minor intervention), grade 3 (moderate symptoms requiring immediate third-party intervention) or grade 4 (unconscious). Increases in hypoglycaemic medication collected from practice computer systems were defined as an increase in the dose or frequency prescribed, progression from use of a single oral agent to combination oral therapy, or addition of insulin to the treatment regimen.

Additional demographic and clinical data on duration of diabetes, diabetes-related complications and EuroQol 5 dimensions (EQ-5D) score31 were collected to characterise the groups and to identify subgroups for predefined analysis.

Additional data collection for health economic, quality of life, and qualitative analyses will be detailed separately.

Randomisation

We used computerised randomisation32 incorporating a partial minimisation procedure to adjust the randomisation probabilities between groups to balance three important covariates collected at baseline: duration of diabetes, HbA1c and current treatment (diet, oral monotherapy or oral combination therapy). The minimisation procedure to assign patients to their allocated intervention was conducted independently of recruitment and research nurses. The allocation was concealed from laboratory staff.

Procedures

Patients suitable for trial inclusion were identified from lists held on computer by their general practitioners (GPs). Those eligible were sent an invitation to participate signed by their GP, accompanied by an information sheet and a reply-paid envelope to facilitate response. One further letter was sent if no response was received within 1 month.

Eligibility for the trial and willingness to be randomised to blood glucose self-testing were confirmed with a pre-assessment telephone call and at the assessment visit. At the assessment visit, following informed consent, beliefs about diabetes were elicited using a standard approach to help patients understand how diabetes might present a threat to their health. 23 The roles of diet, physical activity and medication were discussed. Behaviour change techniques were selected on evidence for effectiveness, and included goal setting and review to help patients with lifestyle change. 28,29 The goal-setting and review approach was continued in subsequent visits. Baseline blood tests and clinical measurements were taken and questionnaires completed at the assessment visit.

Interventions

Following the assessment visit and confirmation of eligibility, patients were allocated to receive one of the three interventions. Their rationale is described in more detail in a previous paper. 30 The intervention was initiated at the first visit following randomisation and continued at the scheduled 1-, 3-, 6-, and 9-month visits. Each of the three interventions included a series of standardised components.

Patients allocated to the control (standardised usual care) intervention received further information about use of goal setting and review as a means of monitoring health-related behaviours, such as eating and physical activity. They were asked not to use a blood glucose meter unless their GP considered it essential for their clinical management. They were told that information about the success of the strategies used to keep blood glucose levels under control would be provided in the form of feedback on 3-monthly HbA1c test results. A diary was used to record self-care goals and strategies for achieving them.

Patients allocated to the less intensive self-monitoring intervention continued to use the goal-setting and review techniques introduced at the assessment visit. In addition, they were given a blood glucose meter. They were asked to record three values a day on 2 days during the week, one of which should be fasting, and the other two pre meal or 2 hours post meal, and to aim for fasting and pre-meal glucose levels glucose of 4–6 mmol/l, and 2-hour post meal levels of 6–8 mmol/l. The nurses gave advice about the need to consider contacting their clinician if readings were consistently high (> 15 mmol/l) or low (< 4 mmol/l). They were not given information about how to interpret their blood glucose readings. Separate diaries were used to record identified goals and activity, and blood glucose results.

Patients allocated to the more intensive self-monitoring intervention continued to use goal setting and review and were also given a meter. In addition, they were given training and support in timing, interpreting and using the results of their blood glucose test results to enhance motivation and maintain adherence to diet, physical activity and medication regimens. They were encouraged to experiment with monitoring to explore the effect of specific activities such as exercise on their blood glucose, and to reflect on abnormal values in an attempt to identify what might have contributed to them. A single diary was used to record goals, activities and blood glucose results.

Follow-up visits differed in content according to the allocated intervention, in line with usual practice. Patients allocated to the control intervention had a blood test for HbA1c measurement 2 weeks before their scheduled visit, which was then fed back to them as an indication of the impact of their self-care activities on their glycaemic control. HbA1c measurements were taken at the scheduled visit for those allocated to use of self-monitoring, but SMBG results were used to provide glycaemic feedback. Therefore, patients in each arm of the trial received feedback on glycaemic control, which was used to explore success of goals and set new ones. The patient’s GP was notified of all HbA1c results and asked to consider changes in medication in line with the National Institute for Clinical Excellence diabetes guidelines for all patients. 33 The GP was also notified if blood glucose readings were consistently above 15 mmol/l.

Blood glucose meters were calibrated to provide plasma-equivalent results (Optium, Abbott Diabetes Care, Maidenhead, UK). Calibration of meters was checked by the research nurses using a test aliquot at baseline and 6 months.

Data on adverse reactions or complications were collected at each study visit, along with information about use of medication.

Intervention delivery

Training and support for the research nurses delivering the intervention were designed to ensure adherence to the study protocol. 34 Research nurses were taught psychological theory, and were trained in behaviour change techniques and skills in delivering the intervention (6 days case-based training spread over 5 weeks). Intervention protocols included scripts of the topics to be covered to guide the nurses when talking to patients. Additional measures to ensure adherence to the intervention protocols included self-review of taped consultations by the research nurses and external review by a sociologist. Prompts were also built into the patient diaries to help patients adhere to their allocated intervention.

Statistical analysis

Role of the funding source

The trial was funded by grants from the NHS and the National Institute for Health Research (NIHR) Health Technology Assessment Programme, which nominated an independent chair of the trial steering committee, but had no role in data collection, analysis, interpretation or decision to publish. As principal investigator, AJ Farmer had full access to the data and takes final responsibility for the data as presented in the manuscript. The views and opinions expressed in this report are not necessarily those of the Department of Health.

Principal results

Baseline demographic and clinical characteristics were well balanced between the groups (Table 1). The median (interquartile range) duration of diabetes was 3.0 (1.8–6.4) years, mean (SD) age was 65.7 (10.2) years and mean (SD) HbA1c was 7.5% (1.1). Only 57 (12.6%) patients were lost to follow-up and this did not differ between groups (Figure 1). HDL cholesterol measurements were not obtained for 39 patients at baseline. At follow-up, HbA1c measurements were not collected for two patients, blood pressure measurements were not obtained for five patients, cholesterol measurements were not obtained for 10 patients and HDL cholesterol measurements were not obtained for 15 patients.

Primary results

The main results are shown in Table 2. At 12 months, there was no difference in HbA1c between the groups adjusted for baseline (p = 0.12). The mean difference in HbA1c from baseline to 12 months between the control and less intensive self-monitoring groups (not adjusted for baseline) was −0.14% [95% confidence interval (CI) −0.35 to 0.07], and between the control and more intensive self-monitoring groups was −0.17% (95% CI −0.37 to 0.03). Figure 2 shows the change in HbA1c over the 12-month period of follow-up, with no evidence of differences in HbA1c between groups over the period of follow-up (p = 0.38).

TABLE 2 - Changes in HbA1c, blood pressure, weight, cholesterol and body mass index between baseline and 1 year [numbers are mean (SD)]

HDL, high-density lipoprotein.

p-value for difference after adjustment for baseline.

Based on 414 participants with paired values (137/152, 136/150, 141/151).

Change is measured as 1-year follow-up minus baseline.

		No meter	Use of meter
		Control group (n = 152)	Less intensive self-monitoring (n = 150)	More intensive self-monitoring (n = 151)	p-value for difference between groupsa
HbA1c (%)	Baseline	7.49 (1.09)	7.41 (1.02)	7.53 (1.12)	0.12
	Follow-up	7.49 (1.20)	7.28 (0.88)	7.36 (1.05)
	Change	−0.00 (1.02)	−0.14 (0.82)	−0.17 (0.73)
Systolic blood pressure (mmHg)	Baseline	140.0 (18.1)	140.7 (17.0)	137.4 (18.3)	0.77
	Follow-up	136.2 (17.8)	137.3 (16.8)	134.1 (17.2)
	Change	−3.8 (14.0)	−3.4 (15.6)	−3.3 (13.6)
Diastolic blood pressure (mmHg)	Baseline	79.6 (10.1)	79.9 (10.1)	77.9 (9.9)	0.67
	Follow-up	77.1 (9.7)	77.8 (9.6)	75.8 (9.5)
	Change	−2.5 (8.5)	−2.1 (8.8)	−2.1 (7.5)
Weight (kg)	Baseline	86.7 (18.9)	90.4 (18.9)	86.9 (16.4)	0.37
	Follow-up	86.4 (19.4)	89.9 (19.0)	86.1 (15.7)
	Change	−0.3 (2.7)	−0.5 (2.6)	−0.8 (3.3)
Total cholesterol (mmol/l)	Baseline	4.73 (1.02)	4.64 (1.11)	4.67 (1.07)	0.010
	Follow-up	4.56 (1.03)	4.42 (0.95)	4.28 (0.84)
	Change	−0.16 (0.84)	−0.22 (0.93)	−0.40 (0.90)
Total/HDL cholesterol ratiob	Baseline	4.33 (1.12)	4.40 (1.33)	4.48 (1.35)	0.013
	Follow-up	4.18 (1.12)	4.11 (1.17)	4.02 (1.17)
	Change	−0.15 (0.72)	−0.29 (0.86)	−0.46 (0.91)
Body mass index (kg/m2)	Baseline	30.9 (6.1)	31.9 (6.2)	31.0 (5.3)	0.41
	Follow-up	30.8 (6.3)	31.8 (6.3)	30.7 (5.0)
	Change	−0.1 (1.0)	−0.2 (0.9)	−0.3 (1.2)

FIGURE 2.

Change in HbA1c over the duration of the trial.

Use of meter

Patients allocated to less intensive self-monitoring were significantly more likely to persist with use of the meter than those allocated to more intensive monitoring. Ninety-nine (66.0%) of those receiving the less intensive intervention and 79 (52.3%) of those receiving the more intensive intervention continued to use the meter at least twice a week for the full 12 months (p = 0.012) (Figure 3). Among those who continued to use a meter, the mean number of readings over the period of the trial was significantly higher among patients receiving the more intensive intervention than among those receiving the less intensive intervention (p = 0.022) (Figure 4). In the control group, eight patients initiated SMBG.

FIGURE 3.

Adherence to a minimal level of self-monitoring.

FIGURE 4.

Frequency of self-monitoring by randomisation group.

Methods

A cost–utility analysis was undertaken from a health-care perspective. The within-trial analysis estimated the total health-care costs and quality-adjusted life-years (QALYs) per patient for the 12-month trial period in each of the three groups: (1) standardised usual care, (2) less intensive SMBG and (3) more intensive SMBG; and then calculated the incremental total health-care costs and QALYs gained per patient of (1) less intensive SMBG compared with standardised usual care and (2) more intensive SMBG compared with standardised usual care. The effects of the changes in the main risk factors observed in the 12-month trial period on life expectancy, quality-adjusted life expectancy and diabetes complication costs were extrapolated to a lifetime horizon using the UK Prospective Diabetes Study (UKPDS) Outcomes Model. 36

Results

Costs

Intervention and medication costs

The intervention and medication cost results are summarised in Table 6. The 12-month cost of SMBG is similar (£96 versus £89) in both self-monitoring groups. Nurse time spent on standardised patient care is significantly greater in both SMBG groups than in the control group. The additional cost per patient over 1 year (including 10% opportunity cost for non-attended visits), however, is minor: £6 (95% CI 1–11) in the less intensive SMBG group and £5 (95% CI 0–10) in the more intensive SMBG group. The differences in overall intervention costs were statistically significant: £92 (95% CI 80–103) between less intensive SMBG and standard usual care and £84 (95% CI 73–96) between more intensive SMBG and standard usual care.

TABLE 6 - Mean intervention and medication costs (SD) and cost differences [95% CI] per patient (£, 2005–6 prices)

p < 0.05.

	1			2			3
	Control group (n = 152)			Less intensive self-monitoring (n = 150)			More intensive self-monitoring (n = 151)			Difference
	12 months pre-baseline	12-month follow-up	Change	12 months pre-baseline	12-month follow-up	Change	12 months pre-baseline	12-month follow-up	Change	2 vs 1	3 vs 1
Intervention	–	89 (27)	89 [85–93]	–	181 (49)	181 [173–189]	–	173 (68)	173 [162–184]	92a [80–103]	84a [73–96]
SMBG	–	10 (16)	10 [8–13]	–	96 (37)	96 [90–102]	–	89 (48)	89 [82–97]	86a [78–94]	79a [71–87]
Nurse visits	–	79 (21)	79 [75–82]	–	85 (20)	85 [81–88]	–	84 (26)	84 [80–88]	6a [1–11]	5a [0–10]
Medication	444 (278)	534 (309)	90a [66–114]	480 (311)	578 (342)	98a [73–123]	452 (302)	522 (317)	70a [47–93]	9.4 [−24 to 43]	−20 [−53 to 14]
Diabetes medication	98 (151)	124 (163)	26a [12–39]	120 (178)	144 (191)	25a [10–39]	113 (173)	123 (170)	10 [−3 to 23]	1 [−18 to 20]	−14 [−33 to 5]
Insulin	0 (0)	0.3 (4.0)	0.3 [−0.3 to 1.0]	0 (0)	2.5 (20.7)	2.5 [−0.8 to 5.9]	0 (0)	4.8 (33.7)	4.8 [−0.6 to 10.2]	2.2 [−3.0 to 7.4]	4.5 [−0.7 to 9.7]
Other medication	346 (222)	410 (240)	64a [46–83]	360 (241)	431 (279)	71a [49– 93]	339 (253)	394 (264)	55a [35–75]	7 [−21 to 35]	−9 [−37 to 19]

A substantial increase in overall medication costs (£70–98) compared with baseline is evident in all three groups. Although there is some indication that more patients started on insulin in the more and less intensive SMBG groups than in the control group (5, 4 and 1 patients respectively), no significant differences were found in the overall cost of diabetes medications between patients using SMBG and those receiving standardised usual care.

Other health-care costs

Table 7 summarises details of ‘other health-care costs’ by resource use items based on the available data. Nine patients (2%) had at least one ‘other health-care resource use’ item missing for the pre-baseline period and 76 patients (17%) had incomplete data over the 12-month follow-up. Table 8 presents the results of the ‘other health-care costs’ analysis after imputing randomly missing data and censoring for patients who were lost to follow-up, together with the total health-care cost estimates, which include the intervention and medication costs.

TABLE 7 - Mean ‘other health-care’ costs (SD) per patient (£, 2005–6 prices): available cases

A&E, accident and emergency.

	1				2				3
	Control group (n = 152)				Less intensive self-monitoring (n = 150)				More intensive self-monitoring (n = 151)
	12 months pre-baseline		12-month follow-up		12 months pre-baseline		12-month follow-up		12 months pre-baseline		12-month follow-up
	n	Cost	n	Cost	n	Cost	n	Cost	n	Cost	n	Cost
Other health care	148	581 (817)	129	774 (1612)	148	549 (933)	131	670 (964)	148	690 (1480)	117	786 (1424)
Primary care
GP surgery	152	111 (87)	134	98 (84)	150	110 (93)	139	89 (74)	151	89 (61)	129	92 (68)
GP home	152	8 (34)	135	9 (39)	150	8 (25)	139	8 (30)	150	5 (20)	128	5 (21)
Nurse surgery	152	33 (33)	134	35 (26)	150	36 (41)	139	30 (26)	151	28 (23)	127	29 (24)
Nurse home	152	0.4 (3.8)	134	2.0 (13.9)	150	0.8 (5.4)	139	0.5 (2.9)	150	3.2 (23.4)	126	1.1 (8.3)
Hospital care
A&E	152	10 (31)	133	12 (36)	150	11 (31)	138	9 (28)	150	16 (41)	128	14 (35)
Outpatient	152	133 (243)	134	142 (218)	150	125 (196)	138	165 (358)	151	132 (229)	128	161 (302)
Day hospital	152	9 (31)	134	8 (39)	150	11 (35)	137	14 (46)	151	5 (22)	129	9 (32)
Inpatient	152	172 (674)	132	342 (1490)	149	141 (821)	137	253 (807)	151	309 (1362)	129	389 (1577)
Auxiliary health care
Dietician	151	5 (18)	134	4 (15)	150	5 (15)	137	3 (16)	151	9 (37)	127	3 (16)
Optician	151	17 (10)	134	19 (14)	150	18 (9)	137	18 (15)	151	17 (7)	127	18 (13)
Podiatrist: NHS	149	34 (55)	134	35 (63)	149	44 (68)	135	42 (52)	150	43 (90)	128	36 (53)
Podiatrist: private	152	43 (132)	132	27 (81)	150	29 (102)	137	20 (67)	151	26 (97)	128	16 (62)
Private health care	152	19 (71)	134	26 (126)	150	27 (86)	138	14 (58)	151	10 (43)	129	13 (62)

TABLE 8 - Mean ‘other health-care’ costs (SE) and cost differences [95% CI] per patient (£, 2005–6 prices)

A&E, accident and emergency.

p < 0.05.

Includes intervention and medication costs.

	1			2			3
	Control group (n = 152)			Less intensive self-monitoring (n = 150)			More intensive self-monitoring (n = 151)			Difference
	12 months pre-baseline	12-month follow-up	Change	12 months pre-baseline	12-month follow-up	Change	12 months pre-baseline	12-month follow-up	Change	2 vs 1	3 vs 1
Other health care	596 (66)	747 (130)	151 [−77 to 431]	567 (74)	676 (77)	109 [−93 to 297]	693 (120)	786 (145)	93 [−173 to 347]	−41 [−396 to 257]	−57 [−447 to 288]
Primary care
GP surgery	111 (7)	100 (7)	−11 [−25 to 3]	110 (7)	90 (6)	−20a [−36 to −5]	89 (5)	93 (6)	3 [−9 to 16]	−9 [−32 to 11]	14 [−5 to 34]
GP home	8 (3)	9 (3)	2 [−5 to 9]	8 (2)	8 (3)	0 [−5 to 6]	5 (2)	5 (2)	0 [−4 to 5]	−1 [−11 to 8]	−2 [−10 to 7]
Nurse surgery	33 (3)	35 (2)	1 [−5 to 6]	36 (3)	30 (2)	−6 [−15 to 0]	28 (2)	32 (3)	3 [−3 to 11]	−7 [−17 to 2]	2 [−6 to 12]
Nurse home	0.4 (0.3)	1.9 (1.2)	1.5 [−0.4 to 4.4]	0.8 (0.4)	0.5 (0.3)	−0.3 [−1.3 to 0.5]	3.2 (1.9)	1.1 (0.7)	−2.1 [−6 to 1]	−1.8 [−4.8 to 0.2]	−3.6 [−8.3 to 0.7]
Hospital care
A&E	10 (3)	12 (3)	2 [−5 to 9]	11 (2)	9 (2)	−3 [−9 to 4]	16 (3)	14 (3)	−3 [−11 to 6]	−5 [−14 to 4]	−5 [−17 to 7]
Outpatient	133 (19)	140 (18)	7 [−35 to 54]	125 (16)	163 (29)	37 [−12 to 102]	132 (18)	161 (25)	29 [−24 to 87]	30 [−35 to 102]	23 [−47 to 93]
Day hospital	9 (2)	9 (3)	−1 [−8 to 7]	11 (3)	13 (4)	3 [−6 to 12]	5 (2)	9 (3)	4 [−3 to 10]	4 [−9 to 16]	5 [−6 to 14]
Inpatient	172 (54)	327 (121)	155 [−55 to 410]	143 (66)	267 (67)	124 [−61 to 304]	309 (111)	383 (137)	74 [−172 to 314]	−30 [−385 to 245]	−81 [−449 to 237]
Auxiliary health care
Dietician	5 (1)	4 (1)	−1 [−4 to 2]	5 (1)	3 (1)	−2 [−5 to 2]	9 (3)	4 (1)	−5a [−11 to 0]	−1 [−6 to 3]	−4 [−11 to 2]
Optician	17 (1)	19 (1)	2 [−1 to 4]	18 (1)	18 (1)	0 [−2 to 2]	17 (1)	18 (1)	1 [−1 to 4]	−2 [−5 to 2]	−1 [−4 to 3]
Podiatrist: NHS	34 (4)	36 (5)	2 [−8 to 13]	44 (5)	42 (4)	−2 [−12 to 6]	44 (7)	36 (5)	−8 [−18 to 0]	−5 [−19 to 8]	−10 [−25 to 4]
Podiatrist: private	43 (11)	28 (7)	−16a [−34 to −1]	29 (8)	21 (6)	−8 [−22 to 5]	26 (8)	16 (5)	−10a [−20 to −2]	7 [−14 to 30]	6 [−12 to 25]
Private health care	19 (6)	25 (10)	7 [−8 to 22]	27 (7)	14 (5)	−13 [−27 to 1]	10 (3)	15 (6)	5 [−3 to 16]	−20 [−40 to 1]	−1 [−19 to 16]
Total health careb	1042 (70)	1371 (136)	329a [103–625]	1048 (82)	1434 (84)	387a [188–573]	1145 (127)	1482 (150)	337a [77–588]	58 [−305 to 349]	8 [−381 to 354]

There was a non-significant increase in the ‘other health-care costs’ between the pre-baseline and the follow-up periods, averaging approximately £100–150 per patient in each group, which was attributable mainly to additional hospitalisation.

Total mean health-care costs per patient (see Table 8), including medications, intervention costs and other health-care costs, averaged £1042 for standardised usual care, £1048 for less intensive SMBG and £1145 for more intensive SMBG over the 12-month period prior to baseline. They increased by about £300–400 over the trial period to £1371, £1434 and £1482 respectively. There were no statistically significant differences between the groups.

In summary, only the intervention costs differed significantly between the control group and the two SMBG groups. All other cost changes during the trial follow-up compared with the 12-month period prior to baseline were similar between the groups.

Outcomes

Within-trial outcomes

Table 9 summarises the results of both the complete case-based and the imputed full data set-based EQ-5D utility analyses. Three hundred and thirteen patients (69%) completed the whole EQ-5D questionnaire both at baseline and at 12-month follow-up. There was no significant change during the trial in the mean utility per patient for the standardised usual care group. In contrast, both SMBG groups showed a reduction in their quality of life, and this reached statistical significance for the more intensive monitoring group. As there was some imbalance between the groups at baseline, follow-up results were adjusted for this variation using standard parametric techniques for the incremental comparison. The full case-based analysis suggests that the negative impact of the more intensive SMBG results in significantly lower quality of life (−0.072 (95% CI −0.127 to −0.017)] compared with the control group. Sensitivity analysis based only on patients alive at the end of the trial showed very similar results [−0.062 (95% CI −0.112 to −0.012)].

TABLE 9 - Mean utility values (SE) and utility differences [95% CI] per patient

p < 0.05.

		Utility			Difference
	n	Baseline	12-month follow-up	Change	2 vs 1	3 vs 1
Complete cases
Control group (1)	105	0.802 (0.021)	0.804 (0.024)	0.002 [−0.034 to 0.038]
Less intensive self-monitoring (2)	111	0.798 (0.025)	0.761 (0.029)	−0.037 [−0.080 to 0.005]	−0.040 [−0.094 to 0.015]	−0.053 [−0.109 to 0.004]
More intensive self-monitoring (3)	97	0.828 (0.020)	0.772 (0.028)	−0.056 [−0.099 to −0.013]a
Imputed full data set
Control group (1)	152	0.799 (0.023)	0.798 (0.034)	−0.001 [−0.060 to 0.059]
Less intensive self-monitoring (2)	150	0.781 (0.022)	0.755 (0.024)	−0.027 [−0.069 to 0.015]	−0.029 [−0.084 to 0.025]	−0.072 [−0.127 to −0.017]a
More intensive self-monitoring (3)	151	0.807 (0.024)	0.733 (0.024)	−0.075 [−0.119 to −0.031]a

Table 10 shows the distribution of responses to the EQ-5D across the different levels of each dimension. This table indicates that decrease in the quality of life among patients in the SMBG groups was due primarily to greater levels of anxiety and depression at 12-month follow-up than at baseline.

TABLE 10 - Proportion (%) of EQ-5D answers across the dimensions: complete case analysis

	Mobility			Self-care			Usual activities			Pain			Anxiety
	1	2	3	1	2	3	1	2	3	1	2	3	1	2	3
Baseline
Control group	62	38	0	92	8	0	82	17	1	51	44	5	71	29	0
Less intensive self-monitoring	66	34	0	92	8	0	78	22	0	52	41	7	77	21	2
More intensive self-monitoring	67	33	0	95	5	0	85	14	1	55	42	3	77	23	0
12-month follow-up
Control group	66	34	0	90	10	0	77	23	0	53	43	4	82	16	2
Less intensive self-monitoring	61	39	0	90	10	0	78	19	3	55	38	7	72	24	4
More intensive self-monitoring	67	33	0	91	9	0	78	22	0	52	43	5	69	29	2

Life-time extrapolation

The extrapolated effects of the interventions compared with usual care, and the total QALYs gained and total costs incurred by the different treatment groups are given in Table 11. The mean gain in QALYs beyond the trial period was estimated to be 0.045 per patient for standardised usual care, 0.049 per patient for less intensive SMBG and 0.060 per patient for more intensive SMBG. Complication costs were reduced in the beyond-trial period, by £69, £102 and £97 respectively in the three groups, with no significant difference between groups.

TABLE 11 - QALYs gained and costsa [95% CI] per patient over a lifetime

QALY, quality-adjusted life-year.

Costs for year, 2005–6 prices.

p<0.05.

Compared with no intervention.

	1	2	3	Difference
	Control group (n = 152)	Less intensive self-monitoring (n = 150)	More intensive self-monitoring (n = 151)	2 vs 1	3 vs 1
Trial period
QALYs gained	0.000 [−0.013 to 0.014]	−0.008 [−0.023 to 0.007]	−0.035 [−0.050 to –0.020]a	−0.008 [−0.029 to 0.012]	−0.036 [−0.056 to −0.015]b
Costs	89 [85–93]	181 [173–189]	173 [162–184]	92 [80–103]b	84 [73–96]b
Beyond trial extrapolationc
QALYs gained	0.045 [0.021–0.069]	0.049 [0.027–0.071]	0.060 [0.040–0.080]	0.004 [−0.027 to 0.035]	0.015 [−0.016 to 0.046]
Costs	−69 [−147 to 9]	−102 [−176 to −28]	−97 [−158 to −37]	−33 [−133 to 67]	−28 [−128 to 72]
Lifetime total
QALYs gained	0.045 [0.016–0.074]	0.041 [0.013–0.069]	0.025 [−0.002 to 0.051]	−0.004 [−0.043 to 0.035]	−0.020 [−0.059 to 0.019]
Costs	20 [−58 to 98]	79 [5–152]	76 [15–137]	59 [−41 to 159]	56 [−44 to 156]

Cost-effectiveness

Table 11 presents the overall differences in costs and outcomes between the SMBG groups and the control group. The mean estimates suggest that both forms of SMBG are more costly (£59 and £56) and less effective (−0.004 and −0.020 QALYs) than standardised usual care, with relatively wide CIs around the point estimates.

A formal ICER is not reported, as its calculation is meaningful only when the intervention is more costly and more effective than the comparator. Uncertainty intervals surrounding the ICER point estimates were assessed by recalculating the differences in costs and effects 1000 times using non-parametric bootstrapping with replacement. 47 Figure 5 illustrates the distribution of the incremental cost and effect pairs between the control group and the less and more intensive SMBG groups plotted on the cost-effectiveness plane. 45 This shows that the 95% CIs of the ICERs cannot be meaningfully defined, as they range from the interventions dominating standardised usual care to the SMBG groups being dominated by the control group (points falling into all four quadrants of the plane).

FIGURE 5.

Cost-utility analysis of self-monitoring of blood glucose compared with standardised usual care on the cost-effectiveness plane.

The cumulative probability that SMBG is cost-effective compared with standardised usual care as a function of decision makers’ maximum willingness-to-pay for an additional QALY can be illustrated by cost-effectiveness acceptability curves48 (Figure 6). In the UK, the current cost-effectiveness ceiling ratio is £20,000–30,000 per QALY gained. 49 The probability of the more intensive SMBG having a cost-effectiveness ratio lower than this does not reach 15%, and the probability of the less intensive SMBG being cost-effective remains below 40% at this threshold. Overall, the cost–utility analysis suggests that the investigated forms of SMBG are not cost-effective in comparison with standardised usual care.

FIGURE 6.

Cost-effectiveness acceptability curves: probability that self-monitoring of blood glucose (SMBG) is cost-effective compared with standardised usual care as a function of decision makers’ maximum willingness to pay for an additional QALY.

Summary

Within the trial, SMBG was found to be significantly more expensive than standardised usual care, by £92 and £84 for the less and more intensive SMBG groups respectively. There appears to be an initial negative impact of SMBG on quality of life measured using the EQ-5D. Potential additional lifetime gains in QALYs resulting from the lower levels of risk factors achieved at the end of trial follow-up were outweighed by the initial negative impacts for both SMBG groups compared with standardised usual care. Results of the extrapolation also suggest that the incremental lifetime savings in diabetes complications did not offset the additional intervention costs. The cost–utility analysis showed that it is unlikely that either investigated form of SMBG is cost-effective compared with standardised usual care.

Methods

Questionnaires were included at baseline and 12 months to measure dietary intake and physical activity (the diabetes self-care activities questionnaire with five subscales),51 medication adherence (the medication adherence rating scale),52 and the scores in the diabetes treatment satisfaction questionnaire53 and the well-being questionnaire (12 items). 54

Beliefs about diabetes and its management were assessed using the revised illness perceptions questionnaire (IPQ-R)55 which has eight subscales. The beliefs about medicines questionnaire (BMQ)56 with two-subscales was used to assess beliefs about medication benefits and harms; the medication adherence report schedule (MARS57, one subscale) was used to report medication adherence, and a self-reported questionnaire (summary of diabetes self-care activity, SDSCA,58 five subscales) assessed eating and physical activity. Treatment satisfaction was assessed with the Diabetes Treatment Satisfaction Questionnaire (DTSQ,58 three sub-scales) and overall well-being with the well-being questionnaire (W-BQ12). 59 Attitudes to SMBG were assessed with the self-monitoring blood glucose beliefs questionnaire (4 subscales). 60

The response set used for the analysis presented here comprises those patients responding to questionnaires at both baseline and 12 months. All analyses are conducted using analysis of covariance (ANCOVA), adjusting for baseline values.

Results

Of the 453 patients randomised in the trial, 339 (74.8%) completed questionnaires at baseline and 12 months and were included in the final analysis.

Methods

Semi-structured interviews with patients taking part in the DiGEM trial were used to explore the experiences and perspectives of SMBG. A sample of 40 patients was recruited from participants in the clinical trial. Trial participants were contacted by post and asked if they would like to take part in a related substudy, involving a single, semi-structured interview, to discuss their experience of having diabetes and taking part in the trial. Invitations were sent to those who had been in the trial for a minimum of 3 months to ensure that patients had at least undergone their 3-month follow-up visit with the study nurse, and so would be able to discuss their views on the feedback they had received about their glycaemic control, enabling a comparison across the three intervention groups.

Interviews were conducted with the first 20 participants who replied positively to the invitation. After the first group of interviews had been conducted and the characteristics of these participants determined, we adopted a purposive sampling technique to recruit the remaining participants. Further letters of invitation were sent only to those whose characteristics had not been represented in the initial interviews with patients selected to span a range of age groups, socioeconomic classifications, both genders and the three intervention groups. Selection was also balanced to obtain an equal number of participants attending clinics with each study facilitator, as well as a range of baseline medication adherence scores (as assessed by the self-reported MARS questionnaire) and dietary and exercise behaviours (assessed by the self-reported SDSCA questionnaire). All respondents were given the option of being interviewed on a weekday or at the weekend and in a place of their choosing so that employed people and those who were not mobile would not be excluded.

Interviews were semi-structured in design to allow both open-ended questioning, which would allow respondents to speak in an undirected fashion, and inquiry about specific topics. The interview began with questions about demographics, followed by an illness narrative, in which patients were encouraged to talk at length about their experiences since being diagnosed with diabetes. In the second part of the interview, inquiry was made about specific topics, which are summarised in Box 1. The interviews lasted between 25 and 90 minutes.

Analysis of the interviews was conducted concurrently with data collection to facilitate exploration of emergent themes in ongoing interviews. The grounded theory approach was used, in which the analytical themes are derived from or ‘emerge’ from the data. 16 The transcripts from the semi-structured interviews were imported into the NU*DIST computer program (QSR International, 2002).

Interview transcripts were read and reread in order to identify general themes. Any text relating to SMBG was highlighted and assigned a unique code under one of these general themes. These themes were determined as the transcripts were read and added to the coding structure as necessary. Items in general themes were compared with each other and coding was refined to produce subthemes based on the similarities and differences between items. Broader categories were then identified and text units reviewed to ensure all categories emerging from the data had been identified. Results were gathered into broad categories to facilitate discussion.

Results of in-depth interviews on trial participants

Interpretation of results

Generalisability

This was a large, rigorously designed and conducted randomised controlled trial. We successfully conducted independent randomisation, concealed allocation for measurement of the main outcome and had a low loss to follow-up. Participants were drawn from a well-defined sampling frame with reasons for exclusion recorded. The majority were taking oral hypoglycaemic medication and were not using a meter, with a minority testing no more than once a week. The demographic and clinical characteristics of the trial population at entry were similar to those seen in other trials, although with slightly lower HbA1c. These non-insulin-treated patients under good control represent the target group for current recommendations of up to twice-daily self-monitoring and testing after meals. 62,63 However, it could be argued that the trial does not include sufficient patients with very poor glycaemic control to exclude a benefit of self-monitoring in this subgroup to initiate better control.

Design of trials to evaluate SMBG is difficult because of the need to include education about the use and interpretation of testing,64 while maintaining an appropriate comparison group which is also given the opportunity to improve self-care activities. 65 We achieved this by providing a common structure for interventions incorporating standardised best practice in all three arms of the trial, within which nurses discussed issues of glycaemic control, assessed by either HbA1c or SMBG, and its role in setting and monitoring self-care goals. 30 The stepwise approach to the interventions across the three arms of the trial allowed examination of what aspects of the intervention, if any, were responsible for improved outcomes. Recent consensus guidelines have based recommendations for SMBG on a theoretical potential to better self-manage glycaemic control. 11,12 We incorporated SMBG into a framework that, based on psychological theory, should have optimised its utility. Careful specification, training and monitoring of consultations ensured that the allocated interventions were delivered as planned. 66

Although our trial included only 15% of those potentially eligible, it is unlikely that the patients enrolled in our trial were less able to make best use of the procedure than those who were not enrolled. In addition, patients enrolled in our trial were able to have 3-monthly HbA1c testing. Our results may not be generalisable to groups where this is not possible, although again this seems unlikely. The main limitation to generalisability is, therefore, that the relatively good control of the motivated patients who enrolled for the trial left less room for improvement of HbA1c than in those with initially poorer control who were not motivated to join the study. It remains possible that a subgroup of patients with high initial HbA1c levels, who would gain significant clinical benefit from self-monitoring in initiating better control, might be identifiable.

Comparisons with other studies

Comparisons with early trials of blood glucose monitoring are of limited relevance owing to their small size, the large quantity of blood required by older meters and the skill required for their use. However, more recent trials have been conducted with meters utilising technologies that require smaller amounts of blood and simplified procedures for testing. Our findings support those of a recent small trial using standardised counselling for both intervention and control groups. The trial reported a non-significant HbA1c reduction of 0.17% in the intervention group compared with the control group. 67 However, our findings are less encouraging than the findings of two of the largest trials of SMBG to date, although CIs of differences encompass the estimated effect from recent meta-analyses. 65 One of these trials reported a significant decrease in HbA1c of 0.3% in the intervention group compared with the control group. 20 However, more than 30% of those randomised were lost to follow-up. Initial specific training in use of a blood glucose meter was not matched by additional training for the control group, although all patients received dietary advice regardless of randomisation. A second trial reported a reduction in HbA1c of 0.46% in the intervention group compared with the control group. However, standardised counselling supporting lifestyle modification was provided only to the self-monitoring group. 19 This type of educational support for self-management in itself has been estimated as improving HbA1c by 0.26%. 4

Fewer people allocated to more intensive monitoring than to less intensive monitoring continue testing. Previous studies have found that trying to understand blood glucose measurements may lead to frustration when results do not fall into a pattern, or may cease to be of interest when they are entirely predictable. 21 The increased recording of hypoglycaemia in the self-monitoring arms may be due to an increased awareness of low blood glucose from using the meter rather than a true biochemical difference between groups. Although no improvement in glycaemic control was observed, there was a small but significant improvement in total cholesterol with the monitoring intervention. Although it is possible that an increased intensity of self-management might lead to this change, it is counter-intuitive that an intervention targeted at glycaemic control should not also have led to improved glycaemic outcomes. These findings may represent a statistical anomaly.

Interpretation of in-depth interviews and questionnaires about well-being, beliefs and behaviour

Health economic study – meaning and implications

This is the first detailed economic evaluation of SMBG to be performed prospectively alongside a randomised trial. The economic analysis was closely related to the trial design and was designed to be conservative: the length of the interventions was 1 year and no long-term treatment effects were assumed beyond the first year for any of the groups. As the evaluation was carried out on an intention-to-treat basis, one should be careful when drawing conclusions for specific subgroups of patients (e.g. compliant patients only) from the current cost–utility estimates.

A validated simulation model was used to extrapolate the effects of the interventions beyond the trial period. The uncertainty investigated in this analysis incorporated the first-order uncertainties inherent in the trial design and the simulation model. We also examined the effects of parameter uncertainty by repeatedly running the model with different sets of bootstrapped parameters, which had the effect of increasing the width of the CIs around the base-case results without any substantial influence on the final cost-effectiveness results.

If the utility analysis had been restricted only to those patients with complete data, it would have greatly reduced the sample size and would also have resulted in biased estimates, as those included are likely to be a non-representative subset of the overall sample by being healthier and more compliant to the allocated intervention. The use of conditional multiple imputation for missing values allowed the whole data set to be analysed.

The increased costs of the enhanced support offered to all groups within the trial may overestimate the costs of implementation in practice, but the additional costs of blood glucose measurement test supplies are of a similar order to this enhanced care. The trial does not provide evidence that the use of SMBG is cost-effective, but if the technology were to be offered to patients, the fall in EQ-5D score observed over 1 year suggests that they should be reviewed regularly and that any concerns about the use of meters should be closely monitored.

Implications for health care

Although the trial did not provide evidence that routine use of SMBG is beneficial, the qualitative study suggests that some individuals may benefit. Our trial suggests that if support for self-management training is available along with 3-monthly HbA1c management, then titration of medication without self-monitoring may be the optimum strategy. However, if HbA1c remains above 8% and progressively deteriorates, then self-monitoring may be necessary in this group and insulin therapy may eventually be required.

Hypoglycaemia remains an issue for some patients using sulfonylurea drugs. However, the majority of such events are associated with changes in food intake or exercise, and therefore are not predictable by SMBG. Nevertheless, use of a monitor may be helpful for people reporting frequent hypoglycaemia, in order to establish whether therapy is too intensive if HbA1c levels are equivocal.

Recommendations for research

The qualitative element of the trial identifies a group of patients who consider that use of SMBG provides them with motivation to adopt and maintain behaviours that lead to better diabetes control. Further work is required to characterise those who gain most benefit in terms of glycaemic control and whether this is related to use of the procedure.

Our results suggest that routine use of meters may not be appropriate for reasonably well-controlled patients, although their role in the management of patients with less well-controlled diabetes is not clear. However, a pragmatic strategy of self-management education with HbA1c monitoring may be appropriate in the first instance. If glycaemic control is not then achieved, SMBG may be appropriate, first to explore any potential motivating effect, and second because insulin treatment is likely to be required. Exploring the utility of this strategy may be appropriate, although the potential adverse effect on mood would need to be actively addressed.

There is an increased rate of hypoglycaemia reported among individuals using self-monitoring. Further exploration of hypoglycaemia rates during the trial, questionnaire, HbA1c measures and medication adjustment measures are needed to establish whether these differences are likely to result from biochemical differences or greater awareness of hypoglycaemia as a cause of symptoms.

Conclusions

Routine SMBG for non-insulin-treated patients with type 2 diabetes is not well accepted and appears to offer, at best, small advantages; the cost, effort and time involved in the procedures may be better directed to supporting other health-related behaviours. SMBG may be associated with a negative impact on health status, and is not associated with anticipated improvements in perceived personal control over self-management. Current guidelines for the use of SMBG require review. This trial does not provide convincing evidence to support the routine use of SMBG for non-insulin-treated patients with reasonably well-controlled type 2 diabetes.

Contribution of authors

AJ Farmer, A-L Kinmonth and HAW Neil had the original idea for the study and wrote the trial protocol with P Yudkin, D French and RR Holman. D Mant contributed to the trial design. A Gray contributed the design of the health economic study. AJ Farmer, AN Wade, DP French and A-L Kinmonth developed the trial measures and intervention. AN Wade, AJ Farmer, A Craven and E Goyder managed the trial. P Yudkin was trial statistician and analysed the clinical outcomes data. J Simon conducted the health economic analysis. DP French analysed the questionnaire data. AN Wade and S Ziebland analysed the interview data. AJ Farmer, AN Wade, DP French and J Simon wrote the first draft of this report. AJ Farmer wrote the final draft. All members of the writing group contributed to interpretation of results, reviewed and commented on the final draft.

The qualitative chapter and discussion are adapted from the DPhil thesis submitted by AN Wade.

A Farmer was supported by an NHS R&D Career Development Award from 2001 to 2005. AN Wade was supported by a Rhodes Scholarship. J Simon was supported by an NHS R&D Research Scientist Award.

The DiGEM trial group

Investigators AJ Farmer, HAW Neil, A-L Kinmonth, D Mant, S Ziebland, DP French, A Gray, P Yudkin and RR Holman.

Steering committee N Stott (Chair), AJ Farmer, HAW Neil (to 2005), S Sutton, H Tewson, D Chapman, H Hearnshaw, E Goyder (from 2005), P Glasziou (from 2005), M Jiwa (2004–2005) and M Gordon (from 2005).

Writing group AJ Farmer, AN Wade, DP French, J Simon, P. Yudkin, A Gray, A Craven, L Goyder, RR Holman, D Mant, A-L Kinmonth, HAW Neil.

Intervention development AN Wade, A Farmer, DP French, A-L Kinmonth and MP Selwood.

Coordinating centres (Oxford) AN Wade (to 2005, trial coordinator), A Craven (trial manager), P Yudkin (trial statistician) J Simon (health economist) and A Fuller (data manager); (Sheffield) Vivienne Walker.

Data monitoring committee C Baigent (Chair), J Levy and K Wheatley.

Research nurses (Oxford) MP Selwood, H Kirlow, M Chapman and S Turner; (Sheffield) A Casbolt, K Dobson, A Willert, A Roberts and H Wood.

Central laboratory K Islam.

Publications

Farmer A, Neil A. Variations in glucose self-monitoring during oral hypoglycaemic therapy in primary care. Diabet Med 2005;22:511–12.

Farmer A, Neil A. In response to ‘Variations in glucose self-monitoring during oral hypoglycaemic therapy in primary care’ [letter]. Diabet Med 2005;24:511–12.

Farmer A, Wade A, Frence DP, Goyder E, Kinmouth AL, Neil A. The DiGEM tial protocol – a randomised controlled trial to determine the effect on glycaemic control of different strategies of SMBG in people with type 2 diabetes [ISRCTN47464659]. BMC Family Practice 2005;6(25):6–25.

Farmer A, Wade A, Goyder E, Yudkin P, French D, Craven A, et al. Impact of self monitoring of blood gluscose in the management of patients with non-insulin treated diabetes: open parallell group randomised trial. BMJ 2007;335(7611):132.

Farmer A, Wade A, Yudkin P, Kinmonth AL, Neil A. Impact of self monitoring of blood glucose on patients with non-insulin dependent diabetes – sub group analysis. EASD Annual Meeting Amsterdam, Amsterdam, 2007.

French DP, Wade A, Yudkin P, Neil HAW, Kinmonth AL, Farmer A. Self-monitoring of blood glucose changed non-insulin treated type 2 diabetes patients’ beliefs about diabetes and self-monitoring in a randomised trial. Diabet Med 2008;25:1218–28.

Simon J, Gray A, Clarke P, Wade A, Neil A, Farmer A. Cost effectiveness of self monitoring of blood glucose in patients with non-insulin treated type 2 diabetes: economic evaluation of data from the DiGEM trial. BMJ 2008;336:1177–80.

Disclaimers

The views expressed in this publication are those of the authors and not necessarily those of the HTA Programme or the Department of Health.

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    By Bradley M, Cullum N, Nelson EA, Petticrew M, Sheldon T, Torgerson D.

19. A systematic literature review of spiral and electron beam computed tomography: with particular reference to clinical applications in hepatic lesions, pulmonary embolus and coronary artery disease.

    By Berry E, Kelly S, Hutton J, Harris KM, Roderick P, Boyce JC, et al.

20. What role for statins? A review and economic model.

    By Ebrahim S, Davey Smith G, McCabe C, Payne N, Pickin M, Sheldon TA, et al.

21. Factors that limit the quality, number and progress of randomised controlled trials.

    A review by Prescott RJ, Counsell CE, Gillespie WJ, Grant AM, Russell IT, Kiauka S, et al.

22. Antimicrobial prophylaxis in total hip replacement: a systematic review.

    By Glenny AM, Song F.

23. Health promoting schools and health promotion in schools: two systematic reviews.

    By Lister-Sharp D, Chapman S, Stewart-Brown S, Sowden A.

24. Economic evaluation of a primary care-based education programme for patients with osteoarthritis of the knee.

    A review by Lord J, Victor C, Littlejohns P, Ross FM, Axford JS.

1. The estimation of marginal time preference in a UK-wide sample (TEMPUS) project.

   A review by Cairns JA, van der Pol MM.

2. Geriatric rehabilitation following fractures in older people: a systematic review.

   By Cameron I, Crotty M, Currie C, Finnegan T, Gillespie L, Gillespie W, et al.

3. Screening for sickle cell disease and thalassaemia: a systematic review with supplementary research.

   By Davies SC, Cronin E, Gill M, Greengross P, Hickman M, Normand C.

4. Community provision of hearing aids and related audiology services.

   A review by Reeves DJ, Alborz A, Hickson FS, Bamford JM.

5. False-negative results in screening programmes: systematic review of impact and implications.

   By Petticrew MP, Sowden AJ, Lister-Sharp D, Wright K.

6. Costs and benefits of community postnatal support workers: a randomised controlled trial.

   By Morrell CJ, Spiby H, Stewart P, Walters S, Morgan A.

7. Implantable contraceptives (subdermal implants and hormonally impregnated intrauterine systems) versus other forms of reversible contraceptives: two systematic reviews to assess relative effectiveness, acceptability, tolerability and cost-effectiveness.

   By French RS, Cowan FM, Mansour DJA, Morris S, Procter T, Hughes D, et al.

8. An introduction to statistical methods for health technology assessment.

   A review by White SJ, Ashby D, Brown PJ.

9. Disease-modifying drugs for multiple sclerosis: a rapid and systematic review.

   By Clegg A, Bryant J, Milne R.

10. Publication and related biases.

    A review by Song F, Eastwood AJ, Gilbody S, Duley L, Sutton AJ.

11. Cost and outcome implications of the organisation of vascular services.

    By Michaels J, Brazier J, Palfreyman S, Shackley P, Slack R.

12. Monitoring blood glucose control in diabetes mellitus: a systematic review.

    By Coster S, Gulliford MC, Seed PT, Powrie JK, Swaminathan R.

13. The effectiveness of domiciliary health visiting: a systematic review of international studies and a selective review of the British literature.

    By Elkan R, Kendrick D, Hewitt M, Robinson JJA, Tolley K, Blair M, et al.

14. The determinants of screening uptake and interventions for increasing uptake: a systematic review.

    By Jepson R, Clegg A, Forbes C, Lewis R, Sowden A, Kleijnen J.

15. The effectiveness and cost-effectiveness of prophylactic removal of wisdom teeth.

    A rapid review by Song F, O’Meara S, Wilson P, Golder S, Kleijnen J.

16. Ultrasound screening in pregnancy: a systematic review of the clinical effectiveness, cost-effectiveness and women’s views.

    By Bricker L, Garcia J, Henderson J, Mugford M, Neilson J, Roberts T, et al.

17. A rapid and systematic review of the effectiveness and cost-effectiveness of the taxanes used in the treatment of advanced breast and ovarian cancer.

    By Lister-Sharp D, McDonagh MS, Khan KS, Kleijnen J.

18. Liquid-based cytology in cervical screening: a rapid and systematic review.

    By Payne N, Chilcott J, McGoogan E.

19. Randomised controlled trial of non-directive counselling, cognitive–behaviour therapy and usual general practitioner care in the management of depression as well as mixed anxiety and depression in primary care.

    By King M, Sibbald B, Ward E, Bower P, Lloyd M, Gabbay M, et al.

20. Routine referral for radiography of patients presenting with low back pain: is patients’ outcome influenced by GPs’ referral for plain radiography?

    By Kerry S, Hilton S, Patel S, Dundas D, Rink E, Lord J.

21. Systematic reviews of wound care management: (3) antimicrobial agents for chronic wounds; (4) diabetic foot ulceration.

    By O’Meara S, Cullum N, Majid M, Sheldon T.

22. Using routine data to complement and enhance the results of randomised controlled trials.

    By Lewsey JD, Leyland AH, Murray GD, Boddy FA.

23. Coronary artery stents in the treatment of ischaemic heart disease: a rapid and systematic review.

    By Meads C, Cummins C, Jolly K, Stevens A, Burls A, Hyde C.

24. Outcome measures for adult critical care: a systematic review.

    By Hayes JA, Black NA, Jenkinson C, Young JD, Rowan KM, Daly K, et al.

25. A systematic review to evaluate the effectiveness of interventions to promote the initiation of breastfeeding.

    By Fairbank L, O’Meara S, Renfrew MJ, Woolridge M, Sowden AJ, Lister-Sharp D.

26. Implantable cardioverter defibrillators: arrhythmias. A rapid and systematic review.

    By Parkes J, Bryant J, Milne R.

27. Treatments for fatigue in multiple sclerosis: a rapid and systematic review.

    By Brañas P, Jordan R, Fry-Smith A, Burls A, Hyde C.

28. Early asthma prophylaxis, natural history, skeletal development and economy (EASE): a pilot randomised controlled trial.

    By Baxter-Jones ADG, Helms PJ, Russell G, Grant A, Ross S, Cairns JA, et al.

29. Screening for hypercholesterolaemia versus case finding for familial hypercholesterolaemia: a systematic review and cost-effectiveness analysis.

    By Marks D, Wonderling D, Thorogood M, Lambert H, Humphries SE, Neil HAW.

30. A rapid and systematic review of the clinical effectiveness and cost-effectiveness of glycoprotein IIb/IIIa antagonists in the medical management of unstable angina.

    By McDonagh MS, Bachmann LM, Golder S, Kleijnen J, ter Riet G.

31. A randomised controlled trial of prehospital intravenous fluid replacement therapy in serious trauma.

    By Turner J, Nicholl J, Webber L, Cox H, Dixon S, Yates D.

32. Intrathecal pumps for giving opioids in chronic pain: a systematic review.

    By Williams JE, Louw G, Towlerton G.

33. Combination therapy (interferon alfa and ribavirin) in the treatment of chronic hepatitis C: a rapid and systematic review.

    By Shepherd J, Waugh N, Hewitson P.

34. A systematic review of comparisons of effect sizes derived from randomised and non-randomised studies.

    By MacLehose RR, Reeves BC, Harvey IM, Sheldon TA, Russell IT, Black AMS.

35. Intravascular ultrasound-guided interventions in coronary artery disease: a systematic literature review, with decision-analytic modelling, of outcomes and cost-effectiveness.

    By Berry E, Kelly S, Hutton J, Lindsay HSJ, Blaxill JM, Evans JA, et al.

36. A randomised controlled trial to evaluate the effectiveness and cost-effectiveness of counselling patients with chronic depression.

    By Simpson S, Corney R, Fitzgerald P, Beecham J.

37. Systematic review of treatments for atopic eczema.

    By Hoare C, Li Wan Po A, Williams H.

38. Bayesian methods in health technology assessment: a review.

    By Spiegelhalter DJ, Myles JP, Jones DR, Abrams KR.

39. The management of dyspepsia: a systematic review.

    By Delaney B, Moayyedi P, Deeks J, Innes M, Soo S, Barton P, et al.

40. A systematic review of treatments for severe psoriasis.

    By Griffiths CEM, Clark CM, Chalmers RJG, Li Wan Po A, Williams HC.

1. Clinical and cost-effectiveness of donepezil, rivastigmine and galantamine for Alzheimer’s disease: a rapid and systematic review.

   By Clegg A, Bryant J, Nicholson T, McIntyre L, De Broe S, Gerard K, et al.

2. The clinical effectiveness and cost-effectiveness of riluzole for motor neurone disease: a rapid and systematic review.

   By Stewart A, Sandercock J, Bryan S, Hyde C, Barton PM, Fry-Smith A, et al.

3. Equity and the economic evaluation of healthcare.

   By Sassi F, Archard L, Le Grand J.

4. Quality-of-life measures in chronic diseases of childhood.

   By Eiser C, Morse R.

5. Eliciting public preferences for healthcare: a systematic review of techniques.

   By Ryan M, Scott DA, Reeves C, Bate A, van Teijlingen ER, Russell EM, et al.

6. General health status measures for people with cognitive impairment: learning disability and acquired brain injury.

   By Riemsma RP, Forbes CA, Glanville JM, Eastwood AJ, Kleijnen J.

7. An assessment of screening strategies for fragile X syndrome in the UK.

   By Pembrey ME, Barnicoat AJ, Carmichael B, Bobrow M, Turner G.

8. Issues in methodological research: perspectives from researchers and commissioners.

   By Lilford RJ, Richardson A, Stevens A, Fitzpatrick R, Edwards S, Rock F, et al.

9. Systematic reviews of wound care management: (5) beds; (6) compression; (7) laser therapy, therapeutic ultrasound, electrotherapy and electromagnetic therapy.

   By Cullum N, Nelson EA, Flemming K, Sheldon T.

10. Effects of educational and psychosocial interventions for adolescents with diabetes mellitus: a systematic review.

    By Hampson SE, Skinner TC, Hart J, Storey L, Gage H, Foxcroft D, et al.

11. Effectiveness of autologous chondrocyte transplantation for hyaline cartilage defects in knees: a rapid and systematic review.

    By Jobanputra P, Parry D, Fry-Smith A, Burls A.

12. Statistical assessment of the learning curves of health technologies.

    By Ramsay CR, Grant AM, Wallace SA, Garthwaite PH, Monk AF, Russell IT.

13. The effectiveness and cost-effectiveness of temozolomide for the treatment of recurrent malignant glioma: a rapid and systematic review.

    By Dinnes J, Cave C, Huang S, Major K, Milne R.

14. A rapid and systematic review of the clinical effectiveness and cost-effectiveness of debriding agents in treating surgical wounds healing by secondary intention.

    By Lewis R, Whiting P, ter Riet G, O’Meara S, Glanville J.

15. Home treatment for mental health problems: a systematic review.

    By Burns T, Knapp M, Catty J, Healey A, Henderson J, Watt H, et al.

16. How to develop cost-conscious guidelines.

    By Eccles M, Mason J.

17. The role of specialist nurses in multiple sclerosis: a rapid and systematic review.

    By De Broe S, Christopher F, Waugh N.

18. A rapid and systematic review of the clinical effectiveness and cost-effectiveness of orlistat in the management of obesity.

    By O’Meara S, Riemsma R, Shirran L, Mather L, ter Riet G.

19. The clinical effectiveness and cost-effectiveness of pioglitazone for type 2 diabetes mellitus: a rapid and systematic review.

    By Chilcott J, Wight J, Lloyd Jones M, Tappenden P.

20. Extended scope of nursing practice: a multicentre randomised controlled trial of appropriately trained nurses and preregistration house officers in preoperative assessment in elective general surgery.

    By Kinley H, Czoski-Murray C, George S, McCabe C, Primrose J, Reilly C, et al.

21. Systematic reviews of the effectiveness of day care for people with severe mental disorders: (1) Acute day hospital versus admission; (2) Vocational rehabilitation; (3) Day hospital versus outpatient care.

    By Marshall M, Crowther R, Almaraz- Serrano A, Creed F, Sledge W, Kluiter H, et al.

22. The measurement and monitoring of surgical adverse events.

    By Bruce J, Russell EM, Mollison J, Krukowski ZH.

23. Action research: a systematic review and guidance for assessment.

    By Waterman H, Tillen D, Dickson R, de Koning K.

24. A rapid and systematic review of the clinical effectiveness and cost-effectiveness of gemcitabine for the treatment of pancreatic cancer.

    By Ward S, Morris E, Bansback N, Calvert N, Crellin A, Forman D, et al.

25. A rapid and systematic review of the evidence for the clinical effectiveness and cost-effectiveness of irinotecan, oxaliplatin and raltitrexed for the treatment of advanced colorectal cancer.

    By Lloyd Jones M, Hummel S, Bansback N, Orr B, Seymour M.

26. Comparison of the effectiveness of inhaler devices in asthma and chronic obstructive airways disease: a systematic review of the literature.

    By Brocklebank D, Ram F, Wright J, Barry P, Cates C, Davies L, et al.

27. The cost-effectiveness of magnetic resonance imaging for investigation of the knee joint.

    By Bryan S, Weatherburn G, Bungay H, Hatrick C, Salas C, Parry D, et al.

28. A rapid and systematic review of the clinical effectiveness and cost-effectiveness of topotecan for ovarian cancer.

    By Forbes C, Shirran L, Bagnall A-M, Duffy S, ter Riet G.

29. Superseded by a report published in a later volume.

30. The role of radiography in primary care patients with low back pain of at least 6 weeks duration: a randomised (unblinded) controlled trial.

    By Kendrick D, Fielding K, Bentley E, Miller P, Kerslake R, Pringle M.

31. Design and use of questionnaires: a review of best practice applicable to surveys of health service staff and patients.

    By McColl E, Jacoby A, Thomas L, Soutter J, Bamford C, Steen N, et al.

32. A rapid and systematic review of the clinical effectiveness and cost-effectiveness of paclitaxel, docetaxel, gemcitabine and vinorelbine in non-small-cell lung cancer.

    By Clegg A, Scott DA, Sidhu M, Hewitson P, Waugh N.

33. Subgroup analyses in randomised controlled trials: quantifying the risks of false-positives and false-negatives.

    By Brookes ST, Whitley E, Peters TJ, Mulheran PA, Egger M, Davey Smith G.

34. Depot antipsychotic medication in the treatment of patients with schizophrenia: (1) Meta-review; (2) Patient and nurse attitudes.

    By David AS, Adams C.

35. A systematic review of controlled trials of the effectiveness and cost-effectiveness of brief psychological treatments for depression.

    By Churchill R, Hunot V, Corney R, Knapp M, McGuire H, Tylee A, et al.

36. Cost analysis of child health surveillance.

    By Sanderson D, Wright D, Acton C, Duree D.

1. A study of the methods used to select review criteria for clinical audit.

   By Hearnshaw H, Harker R, Cheater F, Baker R, Grimshaw G.

2. Fludarabine as second-line therapy for B cell chronic lymphocytic leukaemia: a technology assessment.

   By Hyde C, Wake B, Bryan S, Barton P, Fry-Smith A, Davenport C, et al.

3. Rituximab as third-line treatment for refractory or recurrent Stage III or IV follicular non-Hodgkin’s lymphoma: a systematic review and economic evaluation.

   By Wake B, Hyde C, Bryan S, Barton P, Song F, Fry-Smith A, et al.

4. A systematic review of discharge arrangements for older people.

   By Parker SG, Peet SM, McPherson A, Cannaby AM, Baker R, Wilson A, et al.

5. The clinical effectiveness and cost-effectiveness of inhaler devices used in the routine management of chronic asthma in older children: a systematic review and economic evaluation.

   By Peters J, Stevenson M, Beverley C, Lim J, Smith S.

6. The clinical effectiveness and cost-effectiveness of sibutramine in the management of obesity: a technology assessment.

   By O’Meara S, Riemsma R, Shirran L, Mather L, ter Riet G.

7. The cost-effectiveness of magnetic resonance angiography for carotid artery stenosis and peripheral vascular disease: a systematic review.

   By Berry E, Kelly S, Westwood ME, Davies LM, Gough MJ, Bamford JM, et al.

8. Promoting physical activity in South Asian Muslim women through ‘exercise on prescription’.

   By Carroll B, Ali N, Azam N.

9. Zanamivir for the treatment of influenza in adults: a systematic review and economic evaluation.

   By Burls A, Clark W, Stewart T, Preston C, Bryan S, Jefferson T, et al.

10. A review of the natural history and epidemiology of multiple sclerosis: implications for resource allocation and health economic models.

    By Richards RG, Sampson FC, Beard SM, Tappenden P.

11. Screening for gestational diabetes: a systematic review and economic evaluation.

    By Scott DA, Loveman E, McIntyre L, Waugh N.

12. The clinical effectiveness and cost-effectiveness of surgery for people with morbid obesity: a systematic review and economic evaluation.

    By Clegg AJ, Colquitt J, Sidhu MK, Royle P, Loveman E, Walker A.

13. The clinical effectiveness of trastuzumab for breast cancer: a systematic review.

    By Lewis R, Bagnall A-M, Forbes C, Shirran E, Duffy S, Kleijnen J, et al.

14. The clinical effectiveness and cost-effectiveness of vinorelbine for breast cancer: a systematic review and economic evaluation.

    By Lewis R, Bagnall A-M, King S, Woolacott N, Forbes C, Shirran L, et al.

15. A systematic review of the effectiveness and cost-effectiveness of metal-on-metal hip resurfacing arthroplasty for treatment of hip disease.

    By Vale L, Wyness L, McCormack K, McKenzie L, Brazzelli M, Stearns SC.

16. The clinical effectiveness and cost-effectiveness of bupropion and nicotine replacement therapy for smoking cessation: a systematic review and economic evaluation.

    By Woolacott NF, Jones L, Forbes CA, Mather LC, Sowden AJ, Song FJ, et al.

17. A systematic review of effectiveness and economic evaluation of new drug treatments for juvenile idiopathic arthritis: etanercept.

    By Cummins C, Connock M, Fry-Smith A, Burls A.

18. Clinical effectiveness and cost-effectiveness of growth hormone in children: a systematic review and economic evaluation.

    By Bryant J, Cave C, Mihaylova B, Chase D, McIntyre L, Gerard K, et al.

19. Clinical effectiveness and cost-effectiveness of growth hormone in adults in relation to impact on quality of life: a systematic review and economic evaluation.

    By Bryant J, Loveman E, Chase D, Mihaylova B, Cave C, Gerard K, et al.

20. Clinical medication review by a pharmacist of patients on repeat prescriptions in general practice: a randomised controlled trial.

    By Zermansky AG, Petty DR, Raynor DK, Lowe CJ, Freementle N, Vail A.

21. The effectiveness of infliximab and etanercept for the treatment of rheumatoid arthritis: a systematic review and economic evaluation.

    By Jobanputra P, Barton P, Bryan S, Burls A.

22. A systematic review and economic evaluation of computerised cognitive behaviour therapy for depression and anxiety.

    By Kaltenthaler E, Shackley P, Stevens K, Beverley C, Parry G, Chilcott J.

23. A systematic review and economic evaluation of pegylated liposomal doxorubicin hydrochloride for ovarian cancer.

    By Forbes C, Wilby J, Richardson G, Sculpher M, Mather L, Reimsma R.

24. A systematic review of the effectiveness of interventions based on a stages-of-change approach to promote individual behaviour change.

    By Riemsma RP, Pattenden J, Bridle C, Sowden AJ, Mather L, Watt IS, et al.

25. A systematic review update of the clinical effectiveness and cost-effectiveness of glycoprotein IIb/IIIa antagonists.

    By Robinson M, Ginnelly L, Sculpher M, Jones L, Riemsma R, Palmer S, et al.

26. A systematic review of the effectiveness, cost-effectiveness and barriers to implementation of thrombolytic and neuroprotective therapy for acute ischaemic stroke in the NHS.

    By Sandercock P, Berge E, Dennis M, Forbes J, Hand P, Kwan J, et al.

27. A randomised controlled crossover trial of nurse practitioner versus doctor-led outpatient care in a bronchiectasis clinic.

    By Caine N, Sharples LD, Hollingworth W, French J, Keogan M, Exley A, et al.

28. Clinical effectiveness and cost – consequences of selective serotonin reuptake inhibitors in the treatment of sex offenders.

    By Adi Y, Ashcroft D, Browne K, Beech A, Fry-Smith A, Hyde C.

29. Treatment of established osteoporosis: a systematic review and cost–utility analysis.

    By Kanis JA, Brazier JE, Stevenson M, Calvert NW, Lloyd Jones M.

30. Which anaesthetic agents are cost-effective in day surgery? Literature review, national survey of practice and randomised controlled trial.

    By Elliott RA Payne K, Moore JK, Davies LM, Harper NJN, St Leger AS, et al.

31. Screening for hepatitis C among injecting drug users and in genitourinary medicine clinics: systematic reviews of effectiveness, modelling study and national survey of current practice.

    By Stein K, Dalziel K, Walker A, McIntyre L, Jenkins B, Horne J, et al.

32. The measurement of satisfaction with healthcare: implications for practice from a systematic review of the literature.

    By Crow R, Gage H, Hampson S, Hart J, Kimber A, Storey L, et al.

33. The effectiveness and cost-effectiveness of imatinib in chronic myeloid leukaemia: a systematic review.

    By Garside R, Round A, Dalziel K, Stein K, Royle R.

34. A comparative study of hypertonic saline, daily and alternate-day rhDNase in children with cystic fibrosis.

    By Suri R, Wallis C, Bush A, Thompson S, Normand C, Flather M, et al.

35. A systematic review of the costs and effectiveness of different models of paediatric home care.

    By Parker G, Bhakta P, Lovett CA, Paisley S, Olsen R, Turner D, et al.

1. How important are comprehensive literature searches and the assessment of trial quality in systematic reviews? Empirical study.

   By Egger M, Jüni P, Bartlett C, Holenstein F, Sterne J.

2. Systematic review of the effectiveness and cost-effectiveness, and economic evaluation, of home versus hospital or satellite unit haemodialysis for people with end-stage renal failure.

   By Mowatt G, Vale L, Perez J, Wyness L, Fraser C, MacLeod A, et al.

3. Systematic review and economic evaluation of the effectiveness of infliximab for the treatment of Crohn’s disease.

   By Clark W, Raftery J, Barton P, Song F, Fry-Smith A, Burls A.

4. A review of the clinical effectiveness and cost-effectiveness of routine anti-D prophylaxis for pregnant women who are rhesus negative.

   By Chilcott J, Lloyd Jones M, Wight J, Forman K, Wray J, Beverley C, et al.

5. Systematic review and evaluation of the use of tumour markers in paediatric oncology: Ewing’s sarcoma and neuroblastoma.

   By Riley RD, Burchill SA, Abrams KR, Heney D, Lambert PC, Jones DR, et al.

6. The cost-effectiveness of screening for Helicobacter pylori to reduce mortality and morbidity from gastric cancer and peptic ulcer disease: a discrete-event simulation model.

   By Roderick P, Davies R, Raftery J, Crabbe D, Pearce R, Bhandari P, et al.

7. The clinical effectiveness and cost-effectiveness of routine dental checks: a systematic review and economic evaluation.

   By Davenport C, Elley K, Salas C, Taylor-Weetman CL, Fry-Smith A, Bryan S, et al.

8. A multicentre randomised controlled trial assessing the costs and benefits of using structured information and analysis of women’s preferences in the management of menorrhagia.

   By Kennedy ADM, Sculpher MJ, Coulter A, Dwyer N, Rees M, Horsley S, et al.

9. Clinical effectiveness and cost–utility of photodynamic therapy for wet age-related macular degeneration: a systematic review and economic evaluation.

   By Meads C, Salas C, Roberts T, Moore D, Fry-Smith A, Hyde C.

10. Evaluation of molecular tests for prenatal diagnosis of chromosome abnormalities.

    By Grimshaw GM, Szczepura A, Hultén M, MacDonald F, Nevin NC, Sutton F, et al.

11. First and second trimester antenatal screening for Down’s syndrome: the results of the Serum, Urine and Ultrasound Screening Study (SURUSS).

    By Wald NJ, Rodeck C, Hackshaw AK, Walters J, Chitty L, Mackinson AM.

12. The effectiveness and cost-effectiveness of ultrasound locating devices for central venous access: a systematic review and economic evaluation.

    By Calvert N, Hind D, McWilliams RG, Thomas SM, Beverley C, Davidson A.

13. A systematic review of atypical antipsychotics in schizophrenia.

    By Bagnall A-M, Jones L, Lewis R, Ginnelly L, Glanville J, Torgerson D, et al.

14. Prostate Testing for Cancer and Treatment (ProtecT) feasibility study.

    By Donovan J, Hamdy F, Neal D, Peters T, Oliver S, Brindle L, et al.

15. Early thrombolysis for the treatment of acute myocardial infarction: a systematic review and economic evaluation.

    By Boland A, Dundar Y, Bagust A, Haycox A, Hill R, Mujica Mota R, et al.

16. Screening for fragile X syndrome: a literature review and modelling.

    By Song FJ, Barton P, Sleightholme V, Yao GL, Fry-Smith A.

17. Systematic review of endoscopic sinus surgery for nasal polyps.

    By Dalziel K, Stein K, Round A, Garside R, Royle P.

18. Towards efficient guidelines: how to monitor guideline use in primary care.

    By Hutchinson A, McIntosh A, Cox S, Gilbert C.

19. Effectiveness and cost-effectiveness of acute hospital-based spinal cord injuries services: systematic review.

    By Bagnall A-M, Jones L, Richardson G, Duffy S, Riemsma R.

20. Prioritisation of health technology assessment. The PATHS model: methods and case studies.

    By Townsend J, Buxton M, Harper G.

21. Systematic review of the clinical effectiveness and cost-effectiveness of tension-free vaginal tape for treatment of urinary stress incontinence.

    By Cody J, Wyness L, Wallace S, Glazener C, Kilonzo M, Stearns S, et al.

22. The clinical and cost-effectiveness of patient education models for diabetes: a systematic review and economic evaluation.

    By Loveman E, Cave C, Green C, Royle P, Dunn N, Waugh N.

23. The role of modelling in prioritising and planning clinical trials.

    By Chilcott J, Brennan A, Booth A, Karnon J, Tappenden P.

24. Cost–benefit evaluation of routine influenza immunisation in people 65–74 years of age.

    By Allsup S, Gosney M, Haycox A, Regan M.

25. The clinical and cost-effectiveness of pulsatile machine perfusion versus cold storage of kidneys for transplantation retrieved from heart-beating and non-heart-beating donors.

    By Wight J, Chilcott J, Holmes M, Brewer N.

26. Can randomised trials rely on existing electronic data? A feasibility study to explore the value of routine data in health technology assessment.

    By Williams JG, Cheung WY, Cohen DR, Hutchings HA, Longo MF, Russell IT.

27. Evaluating non-randomised intervention studies.

    By Deeks JJ, Dinnes J, D’Amico R, Sowden AJ, Sakarovitch C, Song F, et al.

28. A randomised controlled trial to assess the impact of a package comprising a patient-orientated, evidence-based self- help guidebook and patient-centred consultations on disease management and satisfaction in inflammatory bowel disease.

    By Kennedy A, Nelson E, Reeves D, Richardson G, Roberts C, Robinson A, et al.

29. The effectiveness of diagnostic tests for the assessment of shoulder pain due to soft tissue disorders: a systematic review.

    By Dinnes J, Loveman E, McIntyre L, Waugh N.

30. The value of digital imaging in diabetic retinopathy.

    By Sharp PF, Olson J, Strachan F, Hipwell J, Ludbrook A, O’Donnell M, et al.

31. Lowering blood pressure to prevent myocardial infarction and stroke: a new preventive strategy.

    By Law M, Wald N, Morris J.

32. Clinical and cost-effectiveness of capecitabine and tegafur with uracil for the treatment of metastatic colorectal cancer: systematic review and economic evaluation.

    By Ward S, Kaltenthaler E, Cowan J, Brewer N.

33. Clinical and cost-effectiveness of new and emerging technologies for early localised prostate cancer: a systematic review.

    By Hummel S, Paisley S, Morgan A, Currie E, Brewer N.

34. Literature searching for clinical and cost-effectiveness studies used in health technology assessment reports carried out for the National Institute for Clinical Excellence appraisal system.

    By Royle P, Waugh N.

35. Systematic review and economic decision modelling for the prevention and treatment of influenza A and B.

    By Turner D, Wailoo A, Nicholson K, Cooper N, Sutton A, Abrams K.

36. A randomised controlled trial to evaluate the clinical and cost-effectiveness of Hickman line insertions in adult cancer patients by nurses.

    By Boland A, Haycox A, Bagust A, Fitzsimmons L.

37. Redesigning postnatal care: a randomised controlled trial of protocol-based midwifery-led care focused on individual women’s physical and psychological health needs.

    By MacArthur C, Winter HR, Bick DE, Lilford RJ, Lancashire RJ, Knowles H, et al.

38. Estimating implied rates of discount in healthcare decision-making.

    By West RR, McNabb R, Thompson AGH, Sheldon TA, Grimley Evans J.

39. Systematic review of isolation policies in the hospital management of methicillin-resistant Staphylococcus aureus: a review of the literature with epidemiological and economic modelling.

    By Cooper BS, Stone SP, Kibbler CC, Cookson BD, Roberts JA, Medley GF, et al.

40. Treatments for spasticity and pain in multiple sclerosis: a systematic review.

    By Beard S, Hunn A, Wight J.

41. The inclusion of reports of randomised trials published in languages other than English in systematic reviews.

    By Moher D, Pham B, Lawson ML, Klassen TP.

42. The impact of screening on future health-promoting behaviours and health beliefs: a systematic review.

    By Bankhead CR, Brett J, Bukach C, Webster P, Stewart-Brown S, Munafo M, et al.

1. What is the best imaging strategy for acute stroke?

   By Wardlaw JM, Keir SL, Seymour J, Lewis S, Sandercock PAG, Dennis MS, et al.

2. Systematic review and modelling of the investigation of acute and chronic chest pain presenting in primary care.

   By Mant J, McManus RJ, Oakes RAL, Delaney BC, Barton PM, Deeks JJ, et al.

3. The effectiveness and cost-effectiveness of microwave and thermal balloon endometrial ablation for heavy menstrual bleeding: a systematic review and economic modelling.

   By Garside R, Stein K, Wyatt K, Round A, Price A.

4. A systematic review of the role of bisphosphonates in metastatic disease.

   By Ross JR, Saunders Y, Edmonds PM, Patel S, Wonderling D, Normand C, et al.

5. Systematic review of the clinical effectiveness and cost-effectiveness of capecitabine (Xeloda^®) for locally advanced and/or metastatic breast cancer.

   By Jones L, Hawkins N, Westwood M, Wright K, Richardson G, Riemsma R.

6. Effectiveness and efficiency of guideline dissemination and implementation strategies.

   By Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L, et al.

7. Clinical effectiveness and costs of the Sugarbaker procedure for the treatment of pseudomyxoma peritonei.

   By Bryant J, Clegg AJ, Sidhu MK, Brodin H, Royle P, Davidson P.

8. Psychological treatment for insomnia in the regulation of long-term hypnotic drug use.

   By Morgan K, Dixon S, Mathers N, Thompson J, Tomeny M.

9. Improving the evaluation of therapeutic interventions in multiple sclerosis: development of a patient-based measure of outcome.

   By Hobart JC, Riazi A, Lamping DL, Fitzpatrick R, Thompson AJ.

10. A systematic review and economic evaluation of magnetic resonance cholangiopancreatography compared with diagnostic endoscopic retrograde cholangiopancreatography.

    By Kaltenthaler E, Bravo Vergel Y, Chilcott J, Thomas S, Blakeborough T, Walters SJ, et al.

11. The use of modelling to evaluate new drugs for patients with a chronic condition: the case of antibodies against tumour necrosis factor in rheumatoid arthritis.

    By Barton P, Jobanputra P, Wilson J, Bryan S, Burls A.

12. Clinical effectiveness and cost-effectiveness of neonatal screening for inborn errors of metabolism using tandem mass spectrometry: a systematic review.

    By Pandor A, Eastham J, Beverley C, Chilcott J, Paisley S.

13. Clinical effectiveness and cost-effectiveness of pioglitazone and rosiglitazone in the treatment of type 2 diabetes: a systematic review and economic evaluation.

    By Czoski-Murray C, Warren E, Chilcott J, Beverley C, Psyllaki MA, Cowan J.

14. Routine examination of the newborn: the EMREN study. Evaluation of an extension of the midwife role including a randomised controlled trial of appropriately trained midwives and paediatric senior house officers.

    By Townsend J, Wolke D, Hayes J, Davé S, Rogers C, Bloomfield L, et al.

15. Involving consumers in research and development agenda setting for the NHS: developing an evidence-based approach.

    By Oliver S, Clarke-Jones L, Rees R, Milne R, Buchanan P, Gabbay J, et al.

16. A multi-centre randomised controlled trial of minimally invasive direct coronary bypass grafting versus percutaneous transluminal coronary angioplasty with stenting for proximal stenosis of the left anterior descending coronary artery.

    By Reeves BC, Angelini GD, Bryan AJ, Taylor FC, Cripps T, Spyt TJ, et al.

17. Does early magnetic resonance imaging influence management or improve outcome in patients referred to secondary care with low back pain? A pragmatic randomised controlled trial.

    By Gilbert FJ, Grant AM, Gillan MGC, Vale L, Scott NW, Campbell MK, et al.

18. The clinical and cost-effectiveness of anakinra for the treatment of rheumatoid arthritis in adults: a systematic review and economic analysis.

    By Clark W, Jobanputra P, Barton P, Burls A.

19. A rapid and systematic review and economic evaluation of the clinical and cost-effectiveness of newer drugs for treatment of mania associated with bipolar affective disorder.

    By Bridle C, Palmer S, Bagnall A-M, Darba J, Duffy S, Sculpher M, et al.

20. Liquid-based cytology in cervical screening: an updated rapid and systematic review and economic analysis.

    By Karnon J, Peters J, Platt J, Chilcott J, McGoogan E, Brewer N.

21. Systematic review of the long-term effects and economic consequences of treatments for obesity and implications for health improvement.

    By Avenell A, Broom J, Brown TJ, Poobalan A, Aucott L, Stearns SC, et al.

22. Autoantibody testing in children with newly diagnosed type 1 diabetes mellitus.

    By Dretzke J, Cummins C, Sandercock J, Fry-Smith A, Barrett T, Burls A.

23. Clinical effectiveness and cost-effectiveness of prehospital intravenous fluids in trauma patients.

    By Dretzke J, Sandercock J, Bayliss S, Burls A.

24. Newer hypnotic drugs for the short-term management of insomnia: a systematic review and economic evaluation.

    By Dündar Y, Boland A, Strobl J, Dodd S, Haycox A, Bagust A, et al.

25. Development and validation of methods for assessing the quality of diagnostic accuracy studies.

    By Whiting P, Rutjes AWS, Dinnes J, Reitsma JB, Bossuyt PMM, Kleijnen J.

26. EVALUATE hysterectomy trial: a multicentre randomised trial comparing abdominal, vaginal and laparoscopic methods of hysterectomy.

    By Garry R, Fountain J, Brown J, Manca A, Mason S, Sculpher M, et al.

27. Methods for expected value of information analysis in complex health economic models: developments on the health economics of interferon-β and glatiramer acetate for multiple sclerosis.

    By Tappenden P, Chilcott JB, Eggington S, Oakley J, McCabe C.

28. Effectiveness and cost-effectiveness of imatinib for first-line treatment of chronic myeloid leukaemia in chronic phase: a systematic review and economic analysis.

    By Dalziel K, Round A, Stein K, Garside R, Price A.

29. VenUS I: a randomised controlled trial of two types of bandage for treating venous leg ulcers.

    By Iglesias C, Nelson EA, Cullum NA, Torgerson DJ, on behalf of the VenUS Team.

30. Systematic review of the effectiveness and cost-effectiveness, and economic evaluation, of myocardial perfusion scintigraphy for the diagnosis and management of angina and myocardial infarction.

    By Mowatt G, Vale L, Brazzelli M, Hernandez R, Murray A, Scott N, et al.

31. A pilot study on the use of decision theory and value of information analysis as part of the NHS Health Technology Assessment programme.

    By Claxton K, Ginnelly L, Sculpher M, Philips Z, Palmer S.

32. The Social Support and Family Health Study: a randomised controlled trial and economic evaluation of two alternative forms of postnatal support for mothers living in disadvantaged inner-city areas.

    By Wiggins M, Oakley A, Roberts I, Turner H, Rajan L, Austerberry H, et al.

33. Psychosocial aspects of genetic screening of pregnant women and newborns: a systematic review.

    By Green JM, Hewison J, Bekker HL, Bryant, Cuckle HS.

34. Evaluation of abnormal uterine bleeding: comparison of three outpatient procedures within cohorts defined by age and menopausal status.

    By Critchley HOD, Warner P, Lee AJ, Brechin S, Guise J, Graham B.

35. Coronary artery stents: a rapid systematic review and economic evaluation.

    By Hill R, Bagust A, Bakhai A, Dickson R, Dündar Y, Haycox A, et al.

36. Review of guidelines for good practice in decision-analytic modelling in health technology assessment.

    By Philips Z, Ginnelly L, Sculpher M, Claxton K, Golder S, Riemsma R, et al.

37. Rituximab (MabThera^®) for aggressive non-Hodgkin’s lymphoma: systematic review and economic evaluation.

    By Knight C, Hind D, Brewer N, Abbott V.

38. Clinical effectiveness and cost-effectiveness of clopidogrel and modified-release dipyridamole in the secondary prevention of occlusive vascular events: a systematic review and economic evaluation.

    By Jones L, Griffin S, Palmer S, Main C, Orton V, Sculpher M, et al.

39. Pegylated interferon α-2a and -2b in combination with ribavirin in the treatment of chronic hepatitis C: a systematic review and economic evaluation.

    By Shepherd J, Brodin H, Cave C, Waugh N, Price A, Gabbay J.

40. Clopidogrel used in combination with aspirin compared with aspirin alone in the treatment of non-ST-segment- elevation acute coronary syndromes: a systematic review and economic evaluation.

    By Main C, Palmer S, Griffin S, Jones L, Orton V, Sculpher M, et al.

41. Provision, uptake and cost of cardiac rehabilitation programmes: improving services to under-represented groups.

    By Beswick AD, Rees K, Griebsch I, Taylor FC, Burke M, West RR, et al.

42. Involving South Asian patients in clinical trials.

    By Hussain-Gambles M, Leese B, Atkin K, Brown J, Mason S, Tovey P.

43. Clinical and cost-effectiveness of continuous subcutaneous insulin infusion for diabetes.

    By Colquitt JL, Green C, Sidhu MK, Hartwell D, Waugh N.

44. Identification and assessment of ongoing trials in health technology assessment reviews.

    By Song FJ, Fry-Smith A, Davenport C, Bayliss S, Adi Y, Wilson JS, et al.

45. Systematic review and economic evaluation of a long-acting insulin analogue, insulin glargine

    By Warren E, Weatherley-Jones E, Chilcott J, Beverley C.

46. Supplementation of a home-based exercise programme with a class-based programme for people with osteoarthritis of the knees: a randomised controlled trial and health economic analysis.

    By McCarthy CJ, Mills PM, Pullen R, Richardson G, Hawkins N, Roberts CR, et al.

47. Clinical and cost-effectiveness of once-daily versus more frequent use of same potency topical corticosteroids for atopic eczema: a systematic review and economic evaluation.

    By Green C, Colquitt JL, Kirby J, Davidson P, Payne E.

48. Acupuncture of chronic headache disorders in primary care: randomised controlled trial and economic analysis.

    By Vickers AJ, Rees RW, Zollman CE, McCarney R, Smith CM, Ellis N, et al.

49. Generalisability in economic evaluation studies in healthcare: a review and case studies.

    By Sculpher MJ, Pang FS, Manca A, Drummond MF, Golder S, Urdahl H, et al.

50. Virtual outreach: a randomised controlled trial and economic evaluation of joint teleconferenced medical consultations.

    By Wallace P, Barber J, Clayton W, Currell R, Fleming K, Garner P, et al.

1. Randomised controlled multiple treatment comparison to provide a cost-effectiveness rationale for the selection of antimicrobial therapy in acne.

   By Ozolins M, Eady EA, Avery A, Cunliffe WJ, O’Neill C, Simpson NB, et al.

2. Do the findings of case series studies vary significantly according to methodological characteristics?

   By Dalziel K, Round A, Stein K, Garside R, Castelnuovo E, Payne L.

3. Improving the referral process for familial breast cancer genetic counselling: findings of three randomised controlled trials of two interventions.

   By Wilson BJ, Torrance N, Mollison J, Wordsworth S, Gray JR, Haites NE, et al.

4. Randomised evaluation of alternative electrosurgical modalities to treat bladder outflow obstruction in men with benign prostatic hyperplasia.

   By Fowler C, McAllister W, Plail R, Karim O, Yang Q.

5. A pragmatic randomised controlled trial of the cost-effectiveness of palliative therapies for patients with inoperable oesophageal cancer.

   By Shenfine J, McNamee P, Steen N, Bond J, Griffin SM.

6. Impact of computer-aided detection prompts on the sensitivity and specificity of screening mammography.

   By Taylor P, Champness J, Given- Wilson R, Johnston K, Potts H.

7. Issues in data monitoring and interim analysis of trials.

   By Grant AM, Altman DG, Babiker AB, Campbell MK, Clemens FJ, Darbyshire JH, et al.

8. Lay public’s understanding of equipoise and randomisation in randomised controlled trials.

   By Robinson EJ, Kerr CEP, Stevens AJ, Lilford RJ, Braunholtz DA, Edwards SJ, et al.

9. Clinical and cost-effectiveness of electroconvulsive therapy for depressive illness, schizophrenia, catatonia and mania: systematic reviews and economic modelling studies.

   By Greenhalgh J, Knight C, Hind D, Beverley C, Walters S.

10. Measurement of health-related quality of life for people with dementia: development of a new instrument (DEMQOL) and an evaluation of current methodology.

    By Smith SC, Lamping DL, Banerjee S, Harwood R, Foley B, Smith P, et al.

11. Clinical effectiveness and cost-effectiveness of drotrecogin alfa (activated) (Xigris^®) for the treatment of severe sepsis in adults: a systematic review and economic evaluation.

    By Green C, Dinnes J, Takeda A, Shepherd J, Hartwell D, Cave C, et al.

12. A methodological review of how heterogeneity has been examined in systematic reviews of diagnostic test accuracy.

    By Dinnes J, Deeks J, Kirby J, Roderick P.

13. Cervical screening programmes: can automation help? Evidence from systematic reviews, an economic analysis and a simulation modelling exercise applied to the UK.

    By Willis BH, Barton P, Pearmain P, Bryan S, Hyde C.

14. Laparoscopic surgery for inguinal hernia repair: systematic review of effectiveness and economic evaluation.

    By McCormack K, Wake B, Perez J, Fraser C, Cook J, McIntosh E, et al.

15. Clinical effectiveness, tolerability and cost-effectiveness of newer drugs for epilepsy in adults: a systematic review and economic evaluation.

    By Wilby J, Kainth A, Hawkins N, Epstein D, McIntosh H, McDaid C, et al.

16. A randomised controlled trial to compare the cost-effectiveness of tricyclic antidepressants, selective serotonin reuptake inhibitors and lofepramine.

    By Peveler R, Kendrick T, Buxton M, Longworth L, Baldwin D, Moore M, et al.

17. Clinical effectiveness and cost-effectiveness of immediate angioplasty for acute myocardial infarction: systematic review and economic evaluation.

    By Hartwell D, Colquitt J, Loveman E, Clegg AJ, Brodin H, Waugh N, et al.

18. A randomised controlled comparison of alternative strategies in stroke care.

    By Kalra L, Evans A, Perez I, Knapp M, Swift C, Donaldson N.

19. The investigation and analysis of critical incidents and adverse events in healthcare.

    By Woloshynowych M, Rogers S, Taylor-Adams S, Vincent C.

20. Potential use of routine databases in health technology assessment.

    By Raftery J, Roderick P, Stevens A.

21. Clinical and cost-effectiveness of newer immunosuppressive regimens in renal transplantation: a systematic review and modelling study.

    By Woodroffe R, Yao GL, Meads C, Bayliss S, Ready A, Raftery J, et al.

22. A systematic review and economic evaluation of alendronate, etidronate, risedronate, raloxifene and teriparatide for the prevention and treatment of postmenopausal osteoporosis.

    By Stevenson M, Lloyd Jones M, De Nigris E, Brewer N, Davis S, Oakley J.

23. A systematic review to examine the impact of psycho-educational interventions on health outcomes and costs in adults and children with difficult asthma.

    By Smith JR, Mugford M, Holland R, Candy B, Noble MJ, Harrison BDW, et al.

24. An evaluation of the costs, effectiveness and quality of renal replacement therapy provision in renal satellite units in England and Wales.

    By Roderick P, Nicholson T, Armitage A, Mehta R, Mullee M, Gerard K, et al.

25. Imatinib for the treatment of patients with unresectable and/or metastatic gastrointestinal stromal tumours: systematic review and economic evaluation.

    By Wilson J, Connock M, Song F, Yao G, Fry-Smith A, Raftery J, et al.

26. Indirect comparisons of competing interventions.

    By Glenny AM, Altman DG, Song F, Sakarovitch C, Deeks JJ, D’Amico R, et al.

27. Cost-effectiveness of alternative strategies for the initial medical management of non-ST elevation acute coronary syndrome: systematic review and decision-analytical modelling.

    By Robinson M, Palmer S, Sculpher M, Philips Z, Ginnelly L, Bowens A, et al.

28. Outcomes of electrically stimulated gracilis neosphincter surgery.

    By Tillin T, Chambers M, Feldman R.

29. The effectiveness and cost-effectiveness of pimecrolimus and tacrolimus for atopic eczema: a systematic review and economic evaluation.

    By Garside R, Stein K, Castelnuovo E, Pitt M, Ashcroft D, Dimmock P, et al.

30. Systematic review on urine albumin testing for early detection of diabetic complications.

    By Newman DJ, Mattock MB, Dawnay ABS, Kerry S, McGuire A, Yaqoob M, et al.

31. Randomised controlled trial of the cost-effectiveness of water-based therapy for lower limb osteoarthritis.

    By Cochrane T, Davey RC, Matthes Edwards SM.

32. Longer term clinical and economic benefits of offering acupuncture care to patients with chronic low back pain.

    By Thomas KJ, MacPherson H, Ratcliffe J, Thorpe L, Brazier J, Campbell M, et al.

33. Cost-effectiveness and safety of epidural steroids in the management of sciatica.

    By Price C, Arden N, Coglan L, Rogers P.

34. The British Rheumatoid Outcome Study Group (BROSG) randomised controlled trial to compare the effectiveness and cost-effectiveness of aggressive versus symptomatic therapy in established rheumatoid arthritis.

    By Symmons D, Tricker K, Roberts C, Davies L, Dawes P, Scott DL.

35. Conceptual framework and systematic review of the effects of participants’ and professionals’ preferences in randomised controlled trials.

    By King M, Nazareth I, Lampe F, Bower P, Chandler M, Morou M, et al.

36. The clinical and cost-effectiveness of implantable cardioverter defibrillators: a systematic review.

    By Bryant J, Brodin H, Loveman E, Payne E, Clegg A.

37. A trial of problem-solving by community mental health nurses for anxiety, depression and life difficulties among general practice patients. The CPN-GP study.

    By Kendrick T, Simons L, Mynors-Wallis L, Gray A, Lathlean J, Pickering R, et al.

38. The causes and effects of socio-demographic exclusions from clinical trials.

    By Bartlett C, Doyal L, Ebrahim S, Davey P, Bachmann M, Egger M, et al.

39. Is hydrotherapy cost-effective? A randomised controlled trial of combined hydrotherapy programmes compared with physiotherapy land techniques in children with juvenile idiopathic arthritis.

    By Epps H, Ginnelly L, Utley M, Southwood T, Gallivan S, Sculpher M, et al.

40. A randomised controlled trial and cost-effectiveness study of systematic screening (targeted and total population screening) versus routine practice for the detection of atrial fibrillation in people aged 65 and over. The SAFE study.

    By Hobbs FDR, Fitzmaurice DA, Mant J, Murray E, Jowett S, Bryan S, et al.

41. Displaced intracapsular hip fractures in fit, older people: a randomised comparison of reduction and fixation, bipolar hemiarthroplasty and total hip arthroplasty.

    By Keating JF, Grant A, Masson M, Scott NW, Forbes JF.

42. Long-term outcome of cognitive behaviour therapy clinical trials in central Scotland.

    By Durham RC, Chambers JA, Power KG, Sharp DM, Macdonald RR, Major KA, et al.

43. The effectiveness and cost-effectiveness of dual-chamber pacemakers compared with single-chamber pacemakers for bradycardia due to atrioventricular block or sick sinus syndrome: systematic review and economic evaluation.

    By Castelnuovo E, Stein K, Pitt M, Garside R, Payne E.

44. Newborn screening for congenital heart defects: a systematic review and cost-effectiveness analysis.

    By Knowles R, Griebsch I, Dezateux C, Brown J, Bull C, Wren C.

45. The clinical and cost-effectiveness of left ventricular assist devices for end-stage heart failure: a systematic review and economic evaluation.

    By Clegg AJ, Scott DA, Loveman E, Colquitt J, Hutchinson J, Royle P, et al.

46. The effectiveness of the Heidelberg Retina Tomograph and laser diagnostic glaucoma scanning system (GDx) in detecting and monitoring glaucoma.

    By Kwartz AJ, Henson DB, Harper RA, Spencer AF, McLeod D.

47. Clinical and cost-effectiveness of autologous chondrocyte implantation for cartilage defects in knee joints: systematic review and economic evaluation.

    By Clar C, Cummins E, McIntyre L, Thomas S, Lamb J, Bain L, et al.

48. Systematic review of effectiveness of different treatments for childhood retinoblastoma.

    By McDaid C, Hartley S, Bagnall A-M, Ritchie G, Light K, Riemsma R.

49. Towards evidence-based guidelines for the prevention of venous thromboembolism: systematic reviews of mechanical methods, oral anticoagulation, dextran and regional anaesthesia as thromboprophylaxis.

    By Roderick P, Ferris G, Wilson K, Halls H, Jackson D, Collins R, et al.

50. The effectiveness and cost-effectiveness of parent training/education programmes for the treatment of conduct disorder, including oppositional defiant disorder, in children.

    By Dretzke J, Frew E, Davenport C, Barlow J, Stewart-Brown S, Sandercock J, et al.

1. The clinical and cost-effectiveness of donepezil, rivastigmine, galantamine and memantine for Alzheimer’s disease.

   By Loveman E, Green C, Kirby J, Takeda A, Picot J, Payne E, et al.

2. FOOD: a multicentre randomised trial evaluating feeding policies in patients admitted to hospital with a recent stroke.

   By Dennis M, Lewis S, Cranswick G, Forbes J.

3. The clinical effectiveness and cost-effectiveness of computed tomography screening for lung cancer: systematic reviews.

   By Black C, Bagust A, Boland A, Walker S, McLeod C, De Verteuil R, et al.

4. A systematic review of the effectiveness and cost-effectiveness of neuroimaging assessments used to visualise the seizure focus in people with refractory epilepsy being considered for surgery.

   By Whiting P, Gupta R, Burch J, Mujica Mota RE, Wright K, Marson A, et al.

5. Comparison of conference abstracts and presentations with full-text articles in the health technology assessments of rapidly evolving technologies.

   By Dundar Y, Dodd S, Dickson R, Walley T, Haycox A, Williamson PR.

6. Systematic review and evaluation of methods of assessing urinary incontinence.

   By Martin JL, Williams KS, Abrams KR, Turner DA, Sutton AJ, Chapple C, et al.

7. The clinical effectiveness and cost-effectiveness of newer drugs for children with epilepsy. A systematic review.

   By Connock M, Frew E, Evans B-W, Bryan S, Cummins C, Fry-Smith A, et al.

8. Surveillance of Barrett’s oesophagus: exploring the uncertainty through systematic review, expert workshop and economic modelling.

   By Garside R, Pitt M, Somerville M, Stein K, Price A, Gilbert N.

9. Topotecan, pegylated liposomal doxorubicin hydrochloride and paclitaxel for second-line or subsequent treatment of advanced ovarian cancer: a systematic review and economic evaluation.

   By Main C, Bojke L, Griffin S, Norman G, Barbieri M, Mather L, et al.

10. Evaluation of molecular techniques in prediction and diagnosis of cytomegalovirus disease in immunocompromised patients.

    By Szczepura A, Westmoreland D, Vinogradova Y, Fox J, Clark M.

11. Screening for thrombophilia in high-risk situations: systematic review and cost-effectiveness analysis. The Thrombosis: Risk and Economic Assessment of Thrombophilia Screening (TREATS) study.

    By Wu O, Robertson L, Twaddle S, Lowe GDO, Clark P, Greaves M, et al.

12. A series of systematic reviews to inform a decision analysis for sampling and treating infected diabetic foot ulcers.

    By Nelson EA, O’Meara S, Craig D, Iglesias C, Golder S, Dalton J, et al.

13. Randomised clinical trial, observational study and assessment of cost-effectiveness of the treatment of varicose veins (REACTIV trial).

    By Michaels JA, Campbell WB, Brazier JE, MacIntyre JB, Palfreyman SJ, Ratcliffe J, et al.

14. The cost-effectiveness of screening for oral cancer in primary care.

    By Speight PM, Palmer S, Moles DR, Downer MC, Smith DH, Henriksson M, et al.

15. Measurement of the clinical and cost-effectiveness of non-invasive diagnostic testing strategies for deep vein thrombosis.

    By Goodacre S, Sampson F, Stevenson M, Wailoo A, Sutton A, Thomas S, et al.

16. Systematic review of the effectiveness and cost-effectiveness of HealOzone^® for the treatment of occlusal pit/fissure caries and root caries.

    By Brazzelli M, McKenzie L, Fielding S, Fraser C, Clarkson J, Kilonzo M, et al.

17. Randomised controlled trials of conventional antipsychotic versus new atypical drugs, and new atypical drugs versus clozapine, in people with schizophrenia responding poorly to, or intolerant of, current drug treatment.

    By Lewis SW, Davies L, Jones PB, Barnes TRE, Murray RM, Kerwin R, et al.

18. Diagnostic tests and algorithms used in the investigation of haematuria: systematic reviews and economic evaluation.

    By Rodgers M, Nixon J, Hempel S, Aho T, Kelly J, Neal D, et al.

19. Cognitive behavioural therapy in addition to antispasmodic therapy for irritable bowel syndrome in primary care: randomised controlled trial.

    By Kennedy TM, Chalder T, McCrone P, Darnley S, Knapp M, Jones RH, et al.

20. A systematic review of the clinical effectiveness and cost-effectiveness of enzyme replacement therapies for Fabry’s disease and mucopolysaccharidosis type 1.

    By Connock M, Juarez-Garcia A, Frew E, Mans A, Dretzke J, Fry-Smith A, et al.

21. Health benefits of antiviral therapy for mild chronic hepatitis C: randomised controlled trial and economic evaluation.

    By Wright M, Grieve R, Roberts J, Main J, Thomas HC, on behalf of the UK Mild Hepatitis C Trial Investigators.

22. Pressure relieving support surfaces: a randomised evaluation.

    By Nixon J, Nelson EA, Cranny G, Iglesias CP, Hawkins K, Cullum NA, et al.

23. A systematic review and economic model of the effectiveness and cost-effectiveness of methylphenidate, dexamfetamine and atomoxetine for the treatment of attention deficit hyperactivity disorder in children and adolescents.

    By King S, Griffin S, Hodges Z, Weatherly H, Asseburg C, Richardson G, et al.

24. The clinical effectiveness and cost-effectiveness of enzyme replacement therapy for Gaucher’s disease: a systematic review.

    By Connock M, Burls A, Frew E, Fry-Smith A, Juarez-Garcia A, McCabe C, et al.

25. Effectiveness and cost-effectiveness of salicylic acid and cryotherapy for cutaneous warts. An economic decision model.

    By Thomas KS, Keogh-Brown MR, Chalmers JR, Fordham RJ, Holland RC, Armstrong SJ, et al.

26. A systematic literature review of the effectiveness of non-pharmacological interventions to prevent wandering in dementia and evaluation of the ethical implications and acceptability of their use.

    By Robinson L, Hutchings D, Corner L, Beyer F, Dickinson H, Vanoli A, et al.

27. A review of the evidence on the effects and costs of implantable cardioverter defibrillator therapy in different patient groups, and modelling of cost-effectiveness and cost–utility for these groups in a UK context.

    By Buxton M, Caine N, Chase D, Connelly D, Grace A, Jackson C, et al.

28. Adefovir dipivoxil and pegylated interferon alfa-2a for the treatment of chronic hepatitis B: a systematic review and economic evaluation.

    By Shepherd J, Jones J, Takeda A, Davidson P, Price A.

29. An evaluation of the clinical and cost-effectiveness of pulmonary artery catheters in patient management in intensive care: a systematic review and a randomised controlled trial.

    By Harvey S, Stevens K, Harrison D, Young D, Brampton W, McCabe C, et al.

30. Accurate, practical and cost-effective assessment of carotid stenosis in the UK.

    By Wardlaw JM, Chappell FM, Stevenson M, De Nigris E, Thomas S, Gillard J, et al.

31. Etanercept and infliximab for the treatment of psoriatic arthritis: a systematic review and economic evaluation.

    By Woolacott N, Bravo Vergel Y, Hawkins N, Kainth A, Khadjesari Z, Misso K, et al.

32. The cost-effectiveness of testing for hepatitis C in former injecting drug users.

    By Castelnuovo E, Thompson-Coon J, Pitt M, Cramp M, Siebert U, Price A, et al.

33. Computerised cognitive behaviour therapy for depression and anxiety update: a systematic review and economic evaluation.

    By Kaltenthaler E, Brazier J, De Nigris E, Tumur I, Ferriter M, Beverley C, et al.

34. Cost-effectiveness of using prognostic information to select women with breast cancer for adjuvant systemic therapy.

    By Williams C, Brunskill S, Altman D, Briggs A, Campbell H, Clarke M, et al.

35. Psychological therapies including dialectical behaviour therapy for borderline personality disorder: a systematic review and preliminary economic evaluation.

    By Brazier J, Tumur I, Holmes M, Ferriter M, Parry G, Dent-Brown K, et al.

36. Clinical effectiveness and cost-effectiveness of tests for the diagnosis and investigation of urinary tract infection in children: a systematic review and economic model.

    By Whiting P, Westwood M, Bojke L, Palmer S, Richardson G, Cooper J, et al.

37. Cognitive behavioural therapy in chronic fatigue syndrome: a randomised controlled trial of an outpatient group programme.

    By O’Dowd H, Gladwell P, Rogers CA, Hollinghurst S, Gregory A.

38. A comparison of the cost-effectiveness of five strategies for the prevention of nonsteroidal anti-inflammatory drug-induced gastrointestinal toxicity: a systematic review with economic modelling.

    By Brown TJ, Hooper L, Elliott RA, Payne K, Webb R, Roberts C, et al.

39. The effectiveness and cost-effectiveness of computed tomography screening for coronary artery disease: systematic review.

    By Waugh N, Black C, Walker S, McIntyre L, Cummins E, Hillis G.

40. What are the clinical outcome and cost-effectiveness of endoscopy undertaken by nurses when compared with doctors? A Multi-Institution Nurse Endoscopy Trial (MINuET).

    By Williams J, Russell I, Durai D, Cheung W-Y, Farrin A, Bloor K, et al.

41. The clinical and cost-effectiveness of oxaliplatin and capecitabine for the adjuvant treatment of colon cancer: systematic review and economic evaluation.

    By Pandor A, Eggington S, Paisley S, Tappenden P, Sutcliffe P.

42. A systematic review of the effectiveness of adalimumab, etanercept and infliximab for the treatment of rheumatoid arthritis in adults and an economic evaluation of their cost-effectiveness.

    By Chen Y-F, Jobanputra P, Barton P, Jowett S, Bryan S, Clark W, et al.

43. Telemedicine in dermatology: a randomised controlled trial.

    By Bowns IR, Collins K, Walters SJ, McDonagh AJG.

44. Cost-effectiveness of cell salvage and alternative methods of minimising perioperative allogeneic blood transfusion: a systematic review and economic model.

    By Davies L, Brown TJ, Haynes S, Payne K, Elliott RA, McCollum C.

45. Clinical effectiveness and cost-effectiveness of laparoscopic surgery for colorectal cancer: systematic reviews and economic evaluation.

    By Murray A, Lourenco T, de Verteuil R, Hernandez R, Fraser C, McKinley A, et al.

46. Etanercept and efalizumab for the treatment of psoriasis: a systematic review.

    By Woolacott N, Hawkins N, Mason A, Kainth A, Khadjesari Z, Bravo Vergel Y, et al.

47. Systematic reviews of clinical decision tools for acute abdominal pain.

    By Liu JLY, Wyatt JC, Deeks JJ, Clamp S, Keen J, Verde P, et al.

48. Evaluation of the ventricular assist device programme in the UK.

    By Sharples L, Buxton M, Caine N, Cafferty F, Demiris N, Dyer M, et al.

49. A systematic review and economic model of the clinical and cost-effectiveness of immunosuppressive therapy for renal transplantation in children.

    By Yao G, Albon E, Adi Y, Milford D, Bayliss S, Ready A, et al.

50. Amniocentesis results: investigation of anxiety. The ARIA trial.

    By Hewison J, Nixon J, Fountain J, Cocks K, Jones C, Mason G, et al.

1. Pemetrexed disodium for the treatment of malignant pleural mesothelioma: a systematic review and economic evaluation.

   By Dundar Y, Bagust A, Dickson R, Dodd S, Green J, Haycox A, et al.

2. A systematic review and economic model of the clinical effectiveness and cost-effectiveness of docetaxel in combination with prednisone or prednisolone for the treatment of hormone-refractory metastatic prostate cancer.

   By Collins R, Fenwick E, Trowman R, Perard R, Norman G, Light K, et al.

3. A systematic review of rapid diagnostic tests for the detection of tuberculosis infection.

   By Dinnes J, Deeks J, Kunst H, Gibson A, Cummins E, Waugh N, et al.

4. The clinical effectiveness and cost-effectiveness of strontium ranelate for the prevention of osteoporotic fragility fractures in postmenopausal women.

   By Stevenson M, Davis S, Lloyd-Jones M, Beverley C.

5. A systematic review of quantitative and qualitative research on the role and effectiveness of written information available to patients about individual medicines.

   By Raynor DK, Blenkinsopp A, Knapp P, Grime J, Nicolson DJ, Pollock K, et al.

6. Oral naltrexone as a treatment for relapse prevention in formerly opioid-dependent drug users: a systematic review and economic evaluation.

   By Adi Y, Juarez-Garcia A, Wang D, Jowett S, Frew E, Day E, et al.

7. Glucocorticoid-induced osteoporosis: a systematic review and cost–utility analysis.

   By Kanis JA, Stevenson M, McCloskey EV, Davis S, Lloyd-Jones M.

8. Epidemiological, social, diagnostic and economic evaluation of population screening for genital chlamydial infection.

   By Low N, McCarthy A, Macleod J, Salisbury C, Campbell R, Roberts TE, et al.

9. Methadone and buprenorphine for the management of opioid dependence: a systematic review and economic evaluation.

   By Connock M, Juarez-Garcia A, Jowett S, Frew E, Liu Z, Taylor RJ, et al.

10. Exercise Evaluation Randomised Trial (EXERT): a randomised trial comparing GP referral for leisure centre-based exercise, community-based walking and advice only.

    By Isaacs AJ, Critchley JA, See Tai S, Buckingham K, Westley D, Harridge SDR, et al.

11. Interferon alfa (pegylated and non-pegylated) and ribavirin for the treatment of mild chronic hepatitis C: a systematic review and economic evaluation.

    By Shepherd J, Jones J, Hartwell D, Davidson P, Price A, Waugh N.

12. Systematic review and economic evaluation of bevacizumab and cetuximab for the treatment of metastatic colorectal cancer.

    By Tappenden P, Jones R, Paisley S, Carroll C.

13. A systematic review and economic evaluation of epoetin alfa, epoetin beta and darbepoetin alfa in anaemia associated with cancer, especially that attributable to cancer treatment.

    By Wilson J, Yao GL, Raftery J, Bohlius J, Brunskill S, Sandercock J, et al.

14. A systematic review and economic evaluation of statins for the prevention of coronary events.

    By Ward S, Lloyd Jones M, Pandor A, Holmes M, Ara R, Ryan A, et al.

15. A systematic review of the effectiveness and cost-effectiveness of different models of community-based respite care for frail older people and their carers.

    By Mason A, Weatherly H, Spilsbury K, Arksey H, Golder S, Adamson J, et al.

16. Additional therapy for young children with spastic cerebral palsy: a randomised controlled trial.

    By Weindling AM, Cunningham CC, Glenn SM, Edwards RT, Reeves DJ.

17. Screening for type 2 diabetes: literature review and economic modelling.

    By Waugh N, Scotland G, McNamee P, Gillett M, Brennan A, Goyder E, et al.

18. The effectiveness and cost-effectiveness of cinacalcet for secondary hyperparathyroidism in end-stage renal disease patients on dialysis: a systematic review and economic evaluation.

    By Garside R, Pitt M, Anderson R, Mealing S, Roome C, Snaith A, et al.

19. The clinical effectiveness and cost-effectiveness of gemcitabine for metastatic breast cancer: a systematic review and economic evaluation.

    By Takeda AL, Jones J, Loveman E, Tan SC, Clegg AJ.

20. A systematic review of duplex ultrasound, magnetic resonance angiography and computed tomography angiography for the diagnosis and assessment of symptomatic, lower limb peripheral arterial disease.

    By Collins R, Cranny G, Burch J, Aguiar-Ibáñez R, Craig D, Wright K, et al.

21. The clinical effectiveness and cost-effectiveness of treatments for children with idiopathic steroid-resistant nephrotic syndrome: a systematic review.

    By Colquitt JL, Kirby J, Green C, Cooper K, Trompeter RS.

22. A systematic review of the routine monitoring of growth in children of primary school age to identify growth-related conditions.

    By Fayter D, Nixon J, Hartley S, Rithalia A, Butler G, Rudolf M, et al.

23. Systematic review of the effectiveness of preventing and treating Staphylococcus aureus carriage in reducing peritoneal catheter-related infections.

    By McCormack K, Rabindranath K, Kilonzo M, Vale L, Fraser C, McIntyre L, et al.

24. The clinical effectiveness and cost of repetitive transcranial magnetic stimulation versus electroconvulsive therapy in severe depression: a multicentre pragmatic randomised controlled trial and economic analysis.

    By McLoughlin DM, Mogg A, Eranti S, Pluck G, Purvis R, Edwards D, et al.

25. A randomised controlled trial and economic evaluation of direct versus indirect and individual versus group modes of speech and language therapy for children with primary language impairment.

    By Boyle J, McCartney E, Forbes J, O’Hare A.

26. Hormonal therapies for early breast cancer: systematic review and economic evaluation.

    By Hind D, Ward S, De Nigris E, Simpson E, Carroll C, Wyld L.

27. Cardioprotection against the toxic effects of anthracyclines given to children with cancer: a systematic review.

    By Bryant J, Picot J, Levitt G, Sullivan I, Baxter L, Clegg A.

28. Adalimumab, etanercept and infliximab for the treatment of ankylosing spondylitis: a systematic review and economic evaluation.

    By McLeod C, Bagust A, Boland A, Dagenais P, Dickson R, Dundar Y, et al.

29. Prenatal screening and treatment strategies to prevent group B streptococcal and other bacterial infections in early infancy: cost-effectiveness and expected value of information analyses.

    By Colbourn T, Asseburg C, Bojke L, Philips Z, Claxton K, Ades AE, et al.

30. Clinical effectiveness and cost-effectiveness of bone morphogenetic proteins in the non-healing of fractures and spinal fusion: a systematic review.

    By Garrison KR, Donell S, Ryder J, Shemilt I, Mugford M, Harvey I, et al.

31. A randomised controlled trial of postoperative radiotherapy following breast-conserving surgery in a minimum-risk older population. The PRIME trial.

    By Prescott RJ, Kunkler IH, Williams LJ, King CC, Jack W, van der Pol M, et al.

32. Current practice, accuracy, effectiveness and cost-effectiveness of the school entry hearing screen.

    By Bamford J, Fortnum H, Bristow K, Smith J, Vamvakas G, Davies L, et al.

33. The clinical effectiveness and cost-effectiveness of inhaled insulin in diabetes mellitus: a systematic review and economic evaluation.

    By Black C, Cummins E, Royle P, Philip S, Waugh N.

34. Surveillance of cirrhosis for hepatocellular carcinoma: systematic review and economic analysis.

    By Thompson Coon J, Rogers G, Hewson P, Wright D, Anderson R, Cramp M, et al.

35. The Birmingham Rehabilitation Uptake Maximisation Study (BRUM). Homebased compared with hospital-based cardiac rehabilitation in a multi-ethnic population: cost-effectiveness and patient adherence.

    By Jolly K, Taylor R, Lip GYH, Greenfield S, Raftery J, Mant J, et al.

36. A systematic review of the clinical, public health and cost-effectiveness of rapid diagnostic tests for the detection and identification of bacterial intestinal pathogens in faeces and food.

    By Abubakar I, Irvine L, Aldus CF, Wyatt GM, Fordham R, Schelenz S, et al.

37. A randomised controlled trial examining the longer-term outcomes of standard versus new antiepileptic drugs. The SANAD trial.

    By Marson AG, Appleton R, Baker GA, Chadwick DW, Doughty J, Eaton B, et al.

38. Clinical effectiveness and cost-effectiveness of different models of managing long-term oral anti-coagulation therapy: a systematic review and economic modelling.

    By Connock M, Stevens C, Fry-Smith A, Jowett S, Fitzmaurice D, Moore D, et al.

39. A systematic review and economic model of the clinical effectiveness and cost-effectiveness of interventions for preventing relapse in people with bipolar disorder.

    By Soares-Weiser K, Bravo Vergel Y, Beynon S, Dunn G, Barbieri M, Duffy S, et al.

40. Taxanes for the adjuvant treatment of early breast cancer: systematic review and economic evaluation.

    By Ward S, Simpson E, Davis S, Hind D, Rees A, Wilkinson A.

41. The clinical effectiveness and cost-effectiveness of screening for open angle glaucoma: a systematic review and economic evaluation.

    By Burr JM, Mowatt G, Hernández R, Siddiqui MAR, Cook J, Lourenco T, et al.

42. Acceptability, benefit and costs of early screening for hearing disability: a study of potential screening tests and models.

    By Davis A, Smith P, Ferguson M, Stephens D, Gianopoulos I.

43. Contamination in trials of educational interventions.

    By Keogh-Brown MR, Bachmann MO, Shepstone L, Hewitt C, Howe A, Ramsay CR, et al.

44. Overview of the clinical effectiveness of positron emission tomography imaging in selected cancers.

    By Facey K, Bradbury I, Laking G, Payne E.

45. The effectiveness and cost-effectiveness of carmustine implants and temozolomide for the treatment of newly diagnosed high-grade glioma: a systematic review and economic evaluation.

    By Garside R, Pitt M, Anderson R, Rogers G, Dyer M, Mealing S, et al.

46. Drug-eluting stents: a systematic review and economic evaluation.

    By Hill RA, Boland A, Dickson R, Dündar Y, Haycox A, McLeod C, et al.

47. The clinical effectiveness and cost-effectiveness of cardiac resynchronisation (biventricular pacing) for heart failure: systematic review and economic model.

    By Fox M, Mealing S, Anderson R, Dean J, Stein K, Price A, et al.

48. Recruitment to randomised trials: strategies for trial enrolment and participation study. The STEPS study.

    By Campbell MK, Snowdon C, Francis D, Elbourne D, McDonald AM, Knight R, et al.

49. Cost-effectiveness of functional cardiac testing in the diagnosis and management of coronary artery disease: a randomised controlled trial. The CECaT trial.

    By Sharples L, Hughes V, Crean A, Dyer M, Buxton M, Goldsmith K, et al.

50. Evaluation of diagnostic tests when there is no gold standard. A review of methods.

    By Rutjes AWS, Reitsma JB, Coomarasamy A, Khan KS, Bossuyt PMM.

51. Systematic reviews of the clinical effectiveness and cost-effectiveness of proton pump inhibitors in acute upper gastrointestinal bleeding.

    By Leontiadis GI, Sreedharan A, Dorward S, Barton P, Delaney B, Howden CW, et al.

52. A review and critique of modelling in prioritising and designing screening programmes.

    By Karnon J, Goyder E, Tappenden P, McPhie S, Towers I, Brazier J, et al.

53. An assessment of the impact of the NHS Health Technology Assessment Programme.

    By Hanney S, Buxton M, Green C, Coulson D, Raftery J.

1. A systematic review and economic model of switching from nonglycopeptide to glycopeptide antibiotic prophylaxis for surgery.

   By Cranny G, Elliott R, Weatherly H, Chambers D, Hawkins N, Myers L, et al.

2. ‘Cut down to quit’ with nicotine replacement therapies in smoking cessation: a systematic review of effectiveness and economic analysis.

   By Wang D, Connock M, Barton P, Fry-Smith A, Aveyard P, Moore D.

3. A systematic review of the effectiveness of strategies for reducing fracture risk in children with juvenile idiopathic arthritis with additional data on long-term risk of fracture and cost of disease management.

   By Thornton J, Ashcroft D, O’Neill T, Elliott R, Adams J, Roberts C, et al.

4. Does befriending by trained lay workers improve psychological well-being and quality of life for carers of people with dementia, and at what cost? A randomised controlled trial.

   By Charlesworth G, Shepstone L, Wilson E, Thalanany M, Mugford M, Poland F.

5. A multi-centre retrospective cohort study comparing the efficacy, safety and cost-effectiveness of hysterectomy and uterine artery embolisation for the treatment of symptomatic uterine fibroids. The HOPEFUL study.

   By Hirst A, Dutton S, Wu O, Briggs A, Edwards C, Waldenmaier L, et al.

6. Methods of prediction and prevention of pre-eclampsia: systematic reviews of accuracy and effectiveness literature with economic modelling.

   By Meads CA, Cnossen JS, Meher S, Juarez-Garcia A, ter Riet G, Duley L, et al.

7. The use of economic evaluations in NHS decision-making: a review and empirical investigation.

   By Williams I, McIver S, Moore D, Bryan S.

8. Stapled haemorrhoidectomy (haemorrhoidopexy) for the treatment of haemorrhoids: a systematic review and economic evaluation.

   By Burch J, Epstein D, Baba-Akbari A, Weatherly H, Fox D, Golder S, et al.

9. The clinical effectiveness of diabetes education models for Type 2 diabetes: a systematic review.

   By Loveman E, Frampton GK, Clegg AJ.

10. Payment to healthcare professionals for patient recruitment to trials: systematic review and qualitative study.

    By Raftery J, Bryant J, Powell J, Kerr C, Hawker S.

11. Cyclooxygenase-2 selective non-steroidal anti-inflammatory drugs (etodolac, meloxicam, celecoxib, rofecoxib, etoricoxib, valdecoxib and lumiracoxib) for osteoarthritis and rheumatoid arthritis: a systematic review and economic evaluation.

    By Chen Y-F, Jobanputra P, Barton P, Bryan S, Fry-Smith A, Harris G, et al.

12. The clinical effectiveness and cost-effectiveness of central venous catheters treated with anti-infective agents in preventing bloodstream infections: a systematic review and economic evaluation.

    By Hockenhull JC, Dwan K, Boland A, Smith G, Bagust A, Dundar Y, et al.

13. Stepped treatment of older adults on laxatives. The STOOL trial.

    By Mihaylov S, Stark C, McColl E, Steen N, Vanoli A, Rubin G, et al.

14. A randomised controlled trial of cognitive behaviour therapy in adolescents with major depression treated by selective serotonin reuptake inhibitors. The ADAPT trial.

    By Goodyer IM, Dubicka B, Wilkinson P, Kelvin R, Roberts C, Byford S, et al.

15. The use of irinotecan, oxaliplatin and raltitrexed for the treatment of advanced colorectal cancer: systematic review and economic evaluation.

    By Hind D, Tappenden P, Tumur I, Eggington E, Sutcliffe P, Ryan A.

16. Ranibizumab and pegaptanib for the treatment of age-related macular degeneration: a systematic review and economic evaluation.

    By Colquitt JL, Jones J, Tan SC, Takeda A, Clegg AJ, Price A.

17. Systematic review of the clinical effectiveness and cost-effectiveness of 64-slice or higher computed tomography angiography as an alternative to invasive coronary angiography in the investigation of coronary artery disease.

    By Mowatt G, Cummins E, Waugh N, Walker S, Cook J, Jia X, et al.

18. Structural neuroimaging in psychosis: a systematic review and economic evaluation.

    By Albon E, Tsourapas A, Frew E, Davenport C, Oyebode F, Bayliss S, et al.

19. Systematic review and economic analysis of the comparative effectiveness of different inhaled corticosteroids and their usage with long-acting beta₂ agonists for the treatment of chronic asthma in adults and children aged 12 years and over.

    By Shepherd J, Rogers G, Anderson R, Main C, Thompson-Coon J, Hartwell D, et al.

20. Systematic review and economic analysis of the comparative effectiveness of different inhaled corticosteroids and their usage with long-acting beta₂ agonists for the treatment of chronic asthma in children under the age of 12 years.

    By Main C, Shepherd J, Anderson R, Rogers G, Thompson-Coon J, Liu Z, et al.

21. Ezetimibe for the treatment of hypercholesterolaemia: a systematic review and economic evaluation.

    By Ara R, Tumur I, Pandor A, Duenas A, Williams R, Wilkinson A, et al.

22. Topical or oral ibuprofen for chronic knee pain in older people. The TOIB study.

    By Underwood M, Ashby D, Carnes D, Castelnuovo E, Cross P, Harding G, et al.

23. A prospective randomised comparison of minor surgery in primary and secondary care. The MiSTIC trial.

    By George S, Pockney P, Primrose J, Smith H, Little P, Kinley H, et al.

24. A review and critical appraisal of measures of therapist–patient interactions in mental health settings.

    By Cahill J, Barkham M, Hardy G, Gilbody S, Richards D, Bower P, et al.

25. The clinical effectiveness and cost-effectiveness of screening programmes for amblyopia and strabismus in children up to the age of 4–5 years: a systematic review and economic evaluation.

    By Carlton J, Karnon J, Czoski-Murray C, Smith KJ, Marr J.

26. A systematic review of the clinical effectiveness and cost-effectiveness and economic modelling of minimal incision total hip replacement approaches in the management of arthritic disease of the hip.

    By de Verteuil R, Imamura M, Zhu S, Glazener C, Fraser C, Munro N, et al.

27. A preliminary model-based assessment of the cost–utility of a screening programme for early age-related macular degeneration.

    By Karnon J, Czoski-Murray C, Smith K, Brand C, Chakravarthy U, Davis S, et al.

28. Intravenous magnesium sulphate and sotalol for prevention of atrial fibrillation after coronary artery bypass surgery: a systematic review and economic evaluation.

    By Shepherd J, Jones J, Frampton GK, Tanajewski L, Turner D, Price A.

29. Absorbent products for urinary/faecal incontinence: a comparative evaluation of key product categories.

    By Fader M, Cottenden A, Getliffe K, Gage H, Clarke-O’Neill S, Jamieson K, et al.

30. A systematic review of repetitive functional task practice with modelling of resource use, costs and effectiveness.

    By French B, Leathley M, Sutton C, McAdam J, Thomas L, Forster A, et al.

31. The effectiveness and cost-effectivness of minimal access surgery amongst people with gastro-oesophageal reflux disease – a UK collaborative study. The reflux trial.

    By Grant A, Wileman S, Ramsay C, Bojke L, Epstein D, Sculpher M, et al.

32. Time to full publication of studies of anti-cancer medicines for breast cancer and the potential for publication bias: a short systematic review.

    By Takeda A, Loveman E, Harris P, Hartwell D, Welch K.

33. Performance of screening tests for child physical abuse in accident and emergency departments.

    By Woodman J, Pitt M, Wentz R, Taylor B, Hodes D, Gilbert RE.

34. Curative catheter ablation in atrial fibrillation and typical atrial flutter: systematic review and economic evaluation.

    By Rodgers M, McKenna C, Palmer S, Chambers D, Van Hout S, Golder S, et al.

35. Systematic review and economic modelling of effectiveness and cost utility of surgical treatments for men with benign prostatic enlargement.

    By Lourenco T, Armstrong N, N’Dow J, Nabi G, Deverill M, Pickard R, et al.

36. Immunoprophylaxis against respiratory syncytial virus (RSV) with palivizumab in children: a systematic review and economic evaluation.

    By Wang D, Cummins C, Bayliss S, Sandercock J, Burls A.

1. Deferasirox for the treatment of iron overload associated with regular blood transfusions (transfusional haemosiderosis) in patients suffering with chronic anaemia: a systematic review and economic evaluation.

   By McLeod C, Fleeman N, Kirkham J, Bagust A, Boland A, Chu P, et al.

2. Thrombophilia testing in people with venous thromboembolism: systematic review and cost-effectiveness analysis.

   By Simpson EL, Stevenson MD, Rawdin A, Papaioannou D.

3. Surgical procedures and non-surgical devices for the management of non-apnoeic snoring: a systematic review of clinical effects and associated treatment costs.

   By Main C, Liu Z, Welch K, Weiner G, Quentin Jones S, Stein K.

4. Continuous positive airway pressure devices for the treatment of obstructive sleep apnoea–hypopnoea syndrome: a systematic review and economic analysis.

   By McDaid C, Griffin S, Weatherly H, Durée K, van der Burgt M, van Hout S, Akers J, et al.

5. Use of classical and novel biomarkers as prognostic risk factors for localised prostate cancer: a systematic review.

   By Sutcliffe P, Hummel S, Simpson E, Young T, Rees A, Wilkinson A, et al.

6. The harmful health effects of recreational ecstasy: a systematic review of observational evidence.

   By Rogers G, Elston J, Garside R, Roome C, Taylor R, Younger P, et al.

7. Systematic review of the clinical effectiveness and cost-effectiveness of oesophageal Doppler monitoring in critically ill and high-risk surgical patients.

   By Mowatt G, Houston G, Hernández R, de Verteuil R, Fraser C, Cuthbertson B, et al.

8. The use of surrogate outcomes in model-based cost-effectiveness analyses: a survey of UK Health Technology Assessment reports.

   By Taylor RS, Elston J.

9. Controlling Hypertension and Hypotension Immediately Post Stroke (CHHIPS) – a randomised controlled trial.

   By Potter J, Mistri A, Brodie F, Chernova J, Wilson E, Jagger C, et al.

10. Routine antenatal anti-D prophylaxis for RhD-negative women: a systematic review and economic evaluation.

    By Pilgrim H, Lloyd-Jones M, Rees A.

11. Amantadine, oseltamivir and zanamivir for the prophylaxis of influenza (including a review of existing guidance no. 67): a systematic review and economic evaluation.

    By Tappenden P, Jackson R, Cooper K, Rees A, Simpson E, Read R, et al.

12. Improving the evaluation of therapeutic interventions in multiple sclerosis: the role of new psychometric methods.

    By Hobart J, Cano S.

13. Treatment of severe ankle sprain: a pragmatic randomised controlled trial comparing the clinical effectiveness and cost-effectiveness of three types of mechanical ankle support with tubular bandage. The CAST trial.

    By Cooke MW, Marsh JL, Clark M, Nakash R, Jarvis RM, Hutton JL, et al. , on behalf of the CAST trial group.

14. Non-occupational postexposure prophylaxis for HIV: a systematic review.

    By Bryant J, Baxter L, Hird S.

Health Technology Assessment Programme

1. Director, NIHR HTA Programme, Professor of Clinical Pharmacology, University of Liverpool

2. Director, Medical Care Research Unit, University of Sheffield