Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 31 appraisals
PloS one
Beyond numbers: The governance role of data assets in real earnings management.
While data assets are increasingly recognized as strategic resources in the digital economy, their implications for financial reporting quality remain underexplored. Employing a textual analysis approach based on deep learning techniques to construct a measure of data assets, this study investigates their impact on real earnings management (REM) using a sample of Chinese A-share listed firms from 2010 to 2023. We document a negative association between data assets and REM. Our findings remain robust after addressing endogeneity concerns using instrumental variables based on regional digital infrastructure and propensity score matching. Mechanism analyses reveal that data assets mitigate REM through two distinct channels: curbing managerial short-termism and strengthening external monitoring via increased analyst coverage. Cross-sectional tests indicate that this governance effect is more pronounced among firms facing earnings pressure. Furthermore, data assets primarily constrain cost-side manipulation strategies, specifically abnormal production costs and discretionary expenditures. Finally, we show that the reduction in REM driven by data assets contributes to enhanced long-term firm value. Collectively, these findings uncover a novel governance effect of data assets, suggesting that digital infrastructure investments yield positive externalities for corporate financial behavior.
9 July 2026
Read appraisal →Journal of robotic surgery
Mapping the scientific landscape of robotic hernia repair: a bibliometric and topic modeling analysis of thematic transitions
Robotic hernia repair (RHR) has profoundly transformed modern surgery, yet it remains intensely debated. To understand this dynamic field, bibliometric analysis offers a powerful tool to evaluate its evolving research trends. Our study presents a comprehensive bibliometric and machine learning analysis of 1,503 publications from 2003 to 2025. The literature demonstrates a growth trend (R2 = 0.96), characterized by initial latency (2003-2015), steady adoption (2016-2020) and a recent exponential explosion (2020-2025) peaking at 262 publications in 2025. The United States is the leading contributing nation (n = 892), followed by Italy (n = 98), Germany (n = 71), and China (n = 68). Key contributors include Kudsi OY, Malcher F, and Muysoms F, with Surgical Endoscopy serving as the predominant publication venue (n = 203). Spatial and relational networks were mapped using VOSviewer and CiteSpace. Critically, Latent Dirichlet Allocation (LDA) topic modeling combined with principal component analysis (PCA) stratified the corpus into four major research domains comprising the anatomical spectrum, the balance between resource and risk management, hardware evolution and surgical education, and technical complexity coupled with high-level evidence. Longitudinal regression of thematic probabilities revealed a significant thematic transition in research emphasis from early hardware feasibility and technical exploration toward value-based evaluation. Current research priorities are increasingly focused on rigorous cost-effectiveness evaluation in high-risk populations together with the generation of high-quality randomized evidence. In conclusion, this multidimensional analysis illustrates how this field is increasingly guided by the interconnected domains of Evidence, Education and Economics, which align with established frameworks for sustainable surgical progress.
21 June 2026
Read appraisal →International journal of biometeorology
Impact of balneotherapy on drug consumption: a systematic review and an economic evaluation of drug deprescribing
Some previous studies have suggested that balneotherapy could be associated with a decrease in drug consumption. No study has investigated pharmacoeconomic consequences in terms of monetary savings. The present study was performed to evaluate potential savings (according to societal perspective) associated with decreased drug consumption resulting from spa treatments using randomized clinical trials (RCT) identified after a systematic review. Among 48 RCT, 8 trials investigating rheumatological diseases (low back or shoulder pain, osteoarthritis, ankylosing spondylitis, fibromyalgia), were included in the economic evaluation of direct costs (€) using 2024 data of drug reimbursements according to French health insurance data. Savings calculated related to non-steroidal anti-inflammatory drugs (NSAIDs') decrease were between €0.05 million and €1.03 million at 6 months (mean value: €504.900) for the 441,776 patients who underwent rheumatology-oriented spa treatment in France in 2024 versus controls. For analgesics, values ranged from €0.73 million to around €2.31 million (mean value: €1,547.400). Despite several limitations that could not be overlooked (heterogeneity of studied populations, interventions, duration, outcome measures), the study showsfor the first timethat decreased drug consumption resulting from balneotherapy is associated with important savings regarding NSAIDs and, to a greater extent, analgesics. Balneotherapy is a unique opportunity for deprescribing, enabling both significant monetary savings for national health insurance, complementary health insurances and patients, while preventing adverse drug reactions or decreasing physiotherapy sessions or hospitalizations.
11 June 2026
Read appraisal →Rheumatology international
Cost-effectiveness of artificial intelligence interventions for musculoskeletal disorders of the spine: a systematic review
Musculoskeletal disorders (MSDs) represent a substantial global health burden, and artificial intelligence (AI)-based technologies are emerging as potential approaches for their management. However, evidence regarding the cost-effectiveness of these interventions remains limited. This systematic review synthesised the available evidence on the cost-effectiveness of AI-based technologies for managing MSDs of the spine. This systematic review was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. PubMed, Medline, CINAHL, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and Directory of Open Access Journals (DOAJ) databases were searched. After title and abstract screening, the remaining articles underwent full-text review by two independent reviewers, who extracted economic outcome data comparing AI-based interventions versus control. A total of 347 studies were identified, with 59 duplicates removed and 251 excluded based on title and abstract. After full-text review, seven eligible studies were included in the review. These studies represented five countries (United States (n = 2), Germany (n = 2), Denmark (n = 1), Australia (n = 1) and South Korea (n = 1)). The studies adopted a healthcare perspective (n = 4), a societal perspective (n = 2) and a healthcare and societal perspective (n = 1). Time durations varied widely, from four weeks to twelve months in trials to three years or lifetime in models, with one study using a 20-month post-implementation period. The AI components of the interventions encompassed a range of technologies, including a deep learning-based diagnostic and exercise prescription platform, AI-driven chest radiograph screening, the self-BACK application, standardised Magnetic Resonance Imaging (MRI) protocols, the Back Pain Choices online decision support tool, and the Kaia back pain application. In three studies, AI-based interventions for MSDs of the spine showed consistent positive QALY gains. Across the seven studies, five interventions (71%) were found to be cost-effective or cost-saving, four (57%) were dominant, while two (29%) were not cost-effective, indicating that most AI-based and digital interventions for MSDs of the spine provide favourable economic value compared with standard care. This is the first systematic review to synthesise evidence on the cost-effectiveness of AI-based technologies for the management of MSDs of the spine. The results suggest that AI-based interventions have the potential to contribute to more efficient healthcare resource use and may support policy and decision-making. However, their impact on reducing the economic burden of MSDs of the spine and improving health outcomes is not yet conclusive, and further standardised economic evaluations are needed to strengthen the evidence base. PROSPERO registration number: https://www.crd.york.ac.uk/PROSPERO/view/CRD42025642775 .
25 May 2026
Read appraisal →JMIR human factors
Support, Monitoring, and Reminder Technology for Mild Dementia (SMART4MD) for People With Mild Cognitive Impairment and Their Informal Caregivers: Cost-Effectiveness Analysis
BACKGROUND: Support, Monitoring, and Reminder Technology for Mild Dementia (SMART4MD), a customized tablet app, was developed to improve or maintain the quality of life of people with mild cognitive impairment (MCI) and their informal caregivers. OBJECTIVE: This study conducts an 18-month economic evaluation of the SMART4MD app, in addition to standard care, compared with standard care alone in Sweden and Spain, from a health care provider perspective. METHODS: In a pragmatic randomized controlled trial, people with MCI and their informal caregivers were randomized to the intervention and control groups. Health care costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were measured in 345 Swedish people with MCI and their informal caregivers, and in 347 Spanish people with MCI. RESULTS: The analysis showed higher incremental costs and lower QALYs for Swedish people with MCI than for controls, whereas higher incremental costs and higher QALYs were observed for Spanish people with MCI. The intervention was not found to be cost-effective for Swedish informal caregivers, with an ICER of €78,000/QALY (€1=US $1.16). CONCLUSIONS: The differing findings regarding cost-effectiveness for people with MCI in Sweden and Spain highlight the need for further research with extended follow-up, ideally involving a larger sample size and conducted across different national contexts. TRIAL REGISTRATION: ClinicalTrials.gov NCT03325699; https://clinicaltrials.gov/ct2/show/NCT03325699.
23 May 2026
Read appraisal →BMJ open
Patient preferences and willingness-to-pay for AI-enabled blended type 2 diabetes care by digital experience and socioeconomic status: a discrete-choice experiment in China
OBJECTIVES: To elicit stated preferences and willingness-to-pay (WTP) for artificial intelligence (AI)-enabled blended care in type 2 diabetes mellitus (T2DM), and to examine preference heterogeneity by digital experience and socioeconomic status (SES). DESIGN: Cross-sectional discrete choice experiment (DCE). SETTING: 12 community health centres in Jiaozuo and Puyang, Henan Province, China. Data were collected between June and August 2025. PARTICIPANTS: 423 adults diagnosed with T2DM for at least 6 months, recruited using consecutive convenience sampling from routine follow-up appointments. Of 769 participants who completed the survey, 346 were excluded following prespecified data quality criteria (retention rate: 55.0%). OUTCOME MEASURES: Outcome measures included preference weights and WTP (in Chinese Yuan, ¥) for five DCE attributes: monthly subscription fee, recommendation source, feedback modality, in-person follow-up frequency and expert oversight, estimated using mixed logit models. Simulated uptake probabilities for tailored service packages across four user profiles were computed. RESULTS: Among 423 participants, 80.6% had never used AI tools. Price was the dominant driver of choice (62.7% relative attribute importance). Profound preference heterogeneity emerged across subgroups: rural residents (n=78) were highly price-sensitive but preferred physician endorsement (WTP ¥17.58 (US$2.55), 95% CI ¥5.98 to ¥29.17); female participants (n=224) valued guideline recommendations (WTP ¥18.45 (US$2.67), 95% CI ¥7.81 to ¥29.40); and diabetes app users (n=34) were the least price-sensitive but showed a negative preference for AI instant feedback, instead preferring human dietitian feedback. Expert oversight carried a consistent negative WTP across all profiles. Targeting tailored service bundles to intended subgroups increased uptake by 8-16 percentage points compared with non-targeted bundles. CONCLUSIONS: A 'digital experience paradox' exists whereby digitally experienced users view human interaction as a premium service, while underserved groups rely on specific trust markers such as physician endorsement. To avoid widening the digital divide, AI-enabled blended diabetes care must move beyond standardised models towards configurable, equity-driven service pathways.
22 May 2026
Read appraisal →The British journal of ophthalmology
Impact of artificial intelligence on the availability, accessibility, acceptability and quality of ophthalmic disease screening services: a scoping review
This scoping review examines the existing literature on the application of artificial intelligence (AI) in screening for eye diseases, with a focus on evaluating whether AI-assisted diagnostic technologies enhance the availability, accessibility, acceptability and quality of screening services. 42 original studies were selected for in-depth analysis, including those employing health economic evaluations. Methodological quality was assessed using the Mixed Methods Appraisal Tool, with the majority of studies demonstrating high quality-24 scored 5/5, 15 scored 4/5 and the rest scored 3/5. Among the included studies, 34 compared manual screening with either AI-assisted or fully AI-driven approaches. Availability was the most frequently studied aspect (28 studies), followed by acceptability (12 studies), whereas accessibility and service quality were less commonly addressed. Overall, AI shows significant potential to improve the cost-effectiveness of eye care services and enhance patient access, particularly in remote or underserved regions. It was also well-accepted by patients, with high satisfaction and improved referral compliance. The findings suggest that AI holds promise for advancing eye disease screening, although large-scale, long-term trials are needed to effectively integrate AI into the reconstruction of screening processes and the reshaping of eye health service systems.
22 May 2026
Read appraisal →The Cochrane database of systematic reviews
Dose reduction and discontinuation of non-tumor necrosis factor (TNF) biologic and targeted synthetic disease-modifying antirheumatic drugs (DMARDs) for people with rheumatoid arthritis in remission or low disease activity
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To determine the benefits and harms of dose reduction or discontinuation of non-TNF biologic or targeted synthetic DMARDs in people with rheumatoid arthritis who are in remission or have low disease activity.
21 May 2026
Read appraisal →PloS one
Data-driven differentiation analysis of urban high-tech industries: Research on bibliometrics and large language models.
This study examines inter-city heterogeneity in China's high-tech industries from a regional innovation systems (RIS) perspective, with a particular focus on how variations in knowledge production, technological application, and actor configurations are associated with divergent urban innovation trajectories. We compile more than 39,000 publications from the Web of Science (WOS) and nearly 10,000 patent records from the national patent database for the period 2016-2025, covering four representative cities-Wuhan, Chengdu, Hangzhou, and Tianjin-and four technological domains: artificial intelligence (AI), fiber-optic communication (FOC), intelligent connected vehicles (ICV), and storage chips (SC). The study develops an integrated analytical framework combining bibliometric analysis, co-word network modeling, collaboration network mapping, and large language model (LLM)-assisted semantic interpretation. LLMs are employed primarily in keyword cleaning, terminology standardization, and topic identification, improving the consistency and interpretability of textual metadata. Visualizations generated using VOSviewer highlight pronounced inter-city differences in technological portfolios, research priorities, and collaboration structures. The results suggest distinct urban innovation configurations across the four cities. Wuhan exhibits strong positioning in FOC and SC, reflecting a combined industry-academy orientation. Hangzhou shows high frontier intensity in AI and ICV, consistent with an industry-led and digitally driven innovation profile. Chengdu demonstrates substantial academic output but comparatively weaker evidence of technological translation, while Tianjin, despite a smaller overall scale, displays notable specialization in applied domains such as brain-computer interfaces and smart port technologies. Rather than replacing quantitative analysis, LLM-assisted interpretation supports the identification and contextualization of these patterns by enhancing semantic coherence and reducing noise in large-scale textual data. Overall, the proposed framework provides a reproducible and scalable approach for examining regional technological differentiation and is applicable to comparative studies of urban innovation systems across different regions and industrial contexts.
16 May 2026
Read appraisal →BMJ open
Prevalence of anxiety and depression in adults who are high users of healthcare services and magnitude of associated costs: a systematic review
OBJECTIVES: Anxiety and depression are common and associated with higher use of general healthcare services. The aims of this systematic review were to (1) estimate the prevalence of anxiety and depression in adults who are high or costly users of general healthcare services in comparison to routine users and (2) estimate the magnitude of healthcare costs associated with the presence of anxiety and depression. DESIGN: Systematic review of the available literature. DATA SOURCES: MEDLINE, PsycINFO, EMBASE, CINAHL, PROSPERO and Cochrane Library were systematically searched without language restriction from inception to 1 April 2019 and updated on 25 October 2022, 16 October 2024 and 18 February 2026. ELIGIBILITY CRITERIA: Eligible studies described adults aged ≥18 years who were defined as high or costly general healthcare users and where the prevalence and/or associated costs of anxiety and/or depression were quantified. DATA EXTRACTION AND SYNTHESIS: Three reviewers independently extracted information on study characteristics, exposure and outcomes. RESULTS: From the 38 412 identified articles, 27 studies from 10 countries (in Europe, North America and Asia) involving 6 145 907 participants met eligibility criteria and were included. There were wide variations in the estimated prevalence of anxiety (3.8-67.2%) and depression (4.7-77.9%) among high healthcare users. The prevalence of both disorders was higher among high healthcare users than routine users in all studies with non-high user comparator groups. Only four studies investigated healthcare costs associated with depression. These uniformly reported that general healthcare costs are higher for those with depression than those without. No studies investigated costs associated with anxiety. CONCLUSIONS: Anxiety and depression are over-represented among high or costly healthcare users, although accurate quantification of the magnitude of difference is precluded by significant methodological heterogeneity and variability in definitions used. Improved identification of covert mental health problems is essential for the provision of effective interventions for patients and healthcare expenditure reduction. Future research should prioritise a standardised approach, with agreed definitions for high and/or costly healthcare use in different contexts. PROSPERO REGISTRATION NUMBER: CRD42018102628.
15 May 2026
Read appraisal →JMIR mHealth and uHealth
Efficacy and Safety of a Telemedicine System in Patients With Gestational Diabetes Mellitus (TELEGLAM): Single-Center, 2-Arm, Randomized, Open-Label, Parallel-Group Study
BACKGROUND: In the management of gestational diabetes mellitus (GDM), the usual medical treatment requires frequent visits for glucose monitoring and insulin dose adjustment, and this imposes significant physical, psychological, and economic burdens on pregnant women. As mobile health platforms become increasingly integrated into diabetes care, telemedicine may help alleviate these burdens; however, evidence evaluating its effectiveness as a replacement for routine in-person GDM care remains limited. OBJECTIVE: This study aims to evaluate the impact of telemedicine on the quality of life and costs for patients with GDM requiring insulin therapy. METHODS: This single-center, 2-arm, randomized, open-label, parallel-group study included patients with GDM who started insulin injection therapy. Participants were randomized to either the telemedicine or standard face-to-face care groups for 10 (SD 2) weeks. The telemedicine intervention used a smartphone-linked platform that enabled the automatic transfer of glucose data from connected glucose meters and facilitated real-time video consultations. Primary end points included costs and patient satisfaction. Costs were assessed using claims data, transportation calculations, and wage-based productivity losses, while patient satisfaction was evaluated through changes in the Problem Areas in Diabetes Survey and Diabetes Therapy-Related Quality of Life questionnaire scores. Secondary outcomes included glycemic control and perinatal outcomes. RESULTS: In total, 38 participants were included, with 18 assigned to the telemedicine group and 20 to the standard care group. Total costs (32,712, 95% CI 15,412-50,013 vs 59,202, 95% CI 42,603-75,800 Japanese yen; $284, 95% CI 134-435 vs $515, 95% CI 370-659, purchasing power parity [PPP]-adjusted; P=.01), direct non-health care costs (922, 95% CI -240 to 2084 vs 2561, 95% CI 1447-3676 yen; $8, 95% CI -2 to 18 vs $22, 95% CI 13 to 32 PPP-adjusted; P=.02), and indirect costs (8981, 95% CI -7119 to 25,082 vs 32,832, 95% CI 17,384-48,279 yen; $78, 95% CI -62 to 218 vs $285, 95% CI 151-420 PPP-adjusted; P=.01) reduced significantly in the telemedicine group compared with the standard care group. The improvements in the Problem Areas in Diabetes Survey (-7.6, 95% CI -13.7 to -1.4; P=.02) and Diabetes Therapy-Related Quality of Life domain 1 (10.5, 95% CI 0.9-20.1; P=.03) scores from the baseline were significantly greater in the telemedicine group than that in the standard care group. Nonetheless, glycemic control and frequency of perinatal complications were comparable between the 2 groups. Consultation time was similar across groups, suggesting no added workload for clinicians. CONCLUSIONS: In this randomized trial, mobile health-enabled telemedicine safely replaced routine in-person visits for patients with GDM requiring insulin therapy. Telemedicine significantly reduced psychological and economic burdens without compromising glycemic or perinatal outcomes, demonstrating its value as a patient-centered and cost-efficient model of care. These findings support the broader implementation of mobile-based telemedicine approaches in GDM management.
12 May 2026
Read appraisal →Journal of wound care
Comparison between foam dressings impregnated with ionic silver and silver sulfadiazine cream 1% in treating deep burns.
OBJECTIVE: The aim of this trial was to evaluate the effectiveness of foam dressings impregnated with ionic silver (AgF) compared to the traditional treatment of 1% silver sulfadiazine cream (SSD) in deep burns (deep dermal and full-thickness burns) and assess the cost-effectiveness ratio between the two treatments. METHOD: This was a randomised clinical trial of patients who were divided into two equal-sized treatment groups: Group 1-SSD or Group 2 - AgF. Inclusion criteria were patients aged between 18-60 years with burns of thermal origin affecting 10-30% of the body surface area, and with a comparable percentage of deep burns. The following outcomes were analysed: pain; discomfort; wound infection; need for new grafting; ease of dressing application; length of stay; and cost of treatment. RESULTS: A total of 40 patients took part (20 in each group). Regarding patients' experience of pain, data analysis revealed more effective pain control in patients treated with AgF. Additionally, the AgF dressing was considered safer, more comfortable and presented an average lower cost of 30.6% compared to the SSD. CONCLUSION: The findings of this trial showed that, compared to the SSD, the AgF dressings were more effective in treating deep burns, to prepare them for skin graft surgery.
10 May 2026
Read appraisal →PloS one
A GNN-based approach for accurate trade balance forecasting and interpretable analysis
In this study, we developed a machine learning pipeline to predict trade balances across 229 countries, utilizing a Graph Neural Network (GNN), and compared it with several deep learning and regression-based models. The data preprocessing involved handling missing values, normalizing features, and conducting exploratory data analysis to uncover key patterns. Feature selection was performed using a Random Forest Regressor to identify the most influential predictors of trade balances. We then evaluated multiple models, including a complex Deep Neural Network (DNN), Transformer with multi-head attention, Random Forest, and a hybrid ensemble model, using various regression metrics. Among these, the GNN proved to be the most effective model, achieving an MSE of 0.06, RMSE of 0.26, MAE of 0.18, and an R² of 0.91. These results demonstrate that GNN outperforms other models in terms of accuracy, robustness, and consistency in predicting trade balances. We compared models across several key evaluation metrics and conducted a detailed comparison of residual plots to assess prediction quality and error distribution. Residual plots and ROC curves were used to validate the reliability and performance of the GNN and other models, ensuring robust and accurate predictions across the board. This study highlights the potential of machine learning techniques to improve trade balance forecasting, providing policymakers and economists with a more adaptable and precise tool for navigating complex global trade dynamics. The findings contribute to more informed economic strategies and enhanced forecasting methodologies.
4 May 2026
Read appraisal →European journal of preventive cardiology
Economic evaluation of alternative cardiac rehabilitation programmes compared to centre-based cardiac rehabilitation programmes: a systematic review.
AIMS: Traditional centre-based cardiac rehabilitation (CBCR) has several drawbacks, including high costs, limited accessibility, and low utilisation rates. As a result, alternative cardiac rehabilitation programmes (ACRPs), such as home-based rehabilitation and telerehabilitation, have been developed. This systematic review aims to synthesise existing evidence on the economic evaluation of ACRPs compared to CBCR. METHODS AND RESULTS: We searched databases of MEDLINE, Embase, CINAHL, Cochrane CENTRAL, Web of Science, and EconLit, as well as trials registers of Clinicaltrials.gov, International Clinical Trials Registry Platform, and EU Clinical Trials Register. The last search date was 20 March 2025. We included randomised controlled trials that directly compared ACRP with CBCR in terms of cost and effectiveness. Study quality was assessed using the Cochrane Risk of Bias tool and the Drummond 10-item checklist. Both qualitative and quantitative syntheses were conducted, with random-effects models applied in the meta-analysis. Thirteen studies met the inclusion criteria, comprising 2040 participants. Meta-analysis showed a non-significant trend favouring CBCR over ACRP for EQ-5D (SMD = -0.32; 95% CI: -0.71 to 0.06; I2 = 79%). For QALY, there was no difference between ACRP and CBCR (SMD = -0.02; 95% CI: -0.19 to 0.15; I2 = 0). Ten of the thirteen studies reported lower costs for ACRP compared with traditional CBCR. Three of five economic evaluations found ACRP to be cost-effective. CONCLUSION: ACRPs demonstrate cost-effectiveness comparable to traditional CBCR. This review highlights the potential of ACRPs, such as home-based rehabilitation and telerehabilitation, as solutions for broader implementation in CR practice. This study reviewed existing research to compare the cost and effectiveness of alternative cardiac rehabilitation programmes with traditional centre-based programmes.Alternative cardiac rehabilitation programmes provide similar health benefits to centre-based programmes.They are often less expensive, with most studies showing lower costs.
26 Apr 2026
Read appraisal →Biomedizinische Technik. Biomedical engineering
AI in healthcare: mapping Romania's transition from research to intellectual property & industry solutions
OBJECTIVES: Romania is aligning its healthcare AI ecosystem with the European Union's AI Act (2024/1689), through its own National AI Strategy. Despite a growing volume of research in medical AI, significant gaps remain in translating this output into patents and domestically developed high-risk medical devices. This study assesses Romania's research productivity, patenting activity, and commercial solutions in medical AI. METHODS: We conducted an analysis combining bibliometric data, patent information, and medical device databases, and analyzed 619 Romanian-authored articles on medical AI, 272 patent records, and identified domestic AI-powered software providers. RESULTS: Romania's publication output in medical AI has surged post-2018, primarily driven by academic institutions in Bucharest and Cluj. Patents are predominantly filed by multinationals, indicating a potential disconnect between research and industrial output. Six AI medical software solutions were identified, most under the low-risk classifications. CONCLUSIONS: While Romania is expanding its medical AI research, it faces barriers in converting academic output into innovation. The dominance of foreign corporations in patent filings, reliance on international funding for high-impact research, and the scarcity of domestically developed high-risk medical AI solutions highlight important gaps. Addressing these disparities is essential for national alignment in the AI medical innovation space.
26 Apr 2026
Read appraisal →Behavior research methods
A review and evaluation of doubly robust approaches for estimating average treatment effects
In nonexperimental studies, obtaining an unbiased estimate of the average treatment effect (ATE) typically requires two key assumptions: that all relevant covariates are measured (i.e., no unmeasured confounding) and that the statistical model used for covariate adjustment is correctly specified. Two common approaches for adjustment are specifying an outcome model and propensity score weighting. To mitigate bias from model misspecification, doubly robust methods combine both approaches, ensuring unbiased ATE estimates if either the outcome model or the propensity score model is correctly specified. In this study, we review four doubly robust methods that have received considerable attention in the methodological literature but remain underutilized in psychological research: augmented inverse probability weighting, regression weighted by the inverse propensity score, regression incorporating the inverse propensity score as a covariate, and calibrated propensity score weighting. Using two simulation studies, we compare these methods with regression estimation and inverse probability weighting estimators. Our results suggest that doubly robust methods-particularly regression weighted by the inverse propensity score-offer greater protection against bias from model misspecification across various data-generating scenarios. We also discuss practical considerations for implementing doubly robust methods, including weight normalization, propensity score truncation, and potential efficiency losses due to overfitting. The different methods for estimating the ATE are illustrated in a data example.
26 Apr 2026
Read appraisal →Journal of medical economics
Value frameworks for digital health technologies: a comparative analysis
AIMS: This study aimed to review and compare existing value frameworks for digital health technologies (DHTs) and identify common domains to guide their evaluation. MATERIALS AND METHODS: A comprehensive literature search was conducted across PubMed, Embase, and Google Scholar, along with citation and website searches, was conducted in August 2025. English-language publications that provided guidance on evaluating value of DHTs were included. A narrative review approach was employed to synthesize findings and identify key value domains and indicators. RESULTS: From an initial pool of 1,132 articles, four met the inclusion criteria and formed the basis of the review, supplemented by additional frameworks from relevant organizations. Six core value domains were identified: technical and security aspects, data rights and governance, clinical characteristics, economic characteristics, health inequalities, and user preferences. Five value frameworks from the United Kingdom (UK) National Health Service, Digital Therapeutic Alliance, World Bank, Institute for Clinical and Economic Review-Peterson Health Technology Institute, and UK National Institute for Health and Care Excellence were compared across these domains. A heat map analysis demonstrated variation in the inclusion of indicators, reflecting differing stakeholder priorities and perspectives. LIMITATIONS: Limitations include potential bias, subjectivity, and limited scope inherent in a narrative review, although elements of PRISMA were applied to reduce risks. Non-English frameworks and those specific to certain technologies were excluded. Additionally, frameworks for both DHTs and digital therapeutics were considered together. CONCLUSION: Six core value domains are consistently emphasized across value frameworks. However, variations across value frameworks highlights the influence of stakeholder needs and priorities. Further research is needed to refine these frameworks and support consistent and informed decision-making in DHTs adoption and implementation. Digital health technologies (DHTs) are increasingly used in healthcare, but their value is assessed in variable ways. We reviewed published studies to identify common elements. Six key areas emerged: technical and security aspects, data rights and governance, clinical and economic characteristics, health inequalities, and user preferences. While some areas are consistently included, others vary across frameworks. Our findings suggest that more consistent approaches could support clear decisions about adopting digital health tools.
25 Apr 2026
Read appraisal →Journal of medical economics
Cost-effectiveness of tirzepatide versus semaglutide for patients with obesity or overweight in the US: evidence from the SURMOUNT-5 head-to-head phase-3 trial
PURPOSE: This study evaluated the cost-effectiveness (from the United States [US] societal perspective) of tirzepatide at its maximum-tolerated-dose (MTD) compared to semaglutide (MTD), both administered adjunct to a reduced-calorie diet and increased physical activity. The analysis focused on individuals with obesity (body mass index [BMI] ≥ 30 kg/m2), or overweight (BMI ≥27 to <30 kg/m2 + ≥1 obesity-related complication), using data from the head-to-head Phase-3 SURMOUNT-5 trial (patients without type 2 diabetes [T2D]). PATIENTS AND METHODS: This patient-level simulation modeling study assessed the cost and long-term clinical outcomes of tirzepatide (MTD) versus semaglutide (MTD), using data from the SURMOUNT-5 trial population. The modeled population were at risk of developing obesity-related complications including cardiovascular disease (CVD) and obstructive sleep apnea (OSA), amongst others. These outcomes were modeled using cardiometabolic parameters including weight, systolic blood pressure, high-density lipoprotein, glycated hemoglobin (HbA1c) and total cholesterol, by assessing their impact on healthcare and wider societal costs, quality of life, and mortality. Incremental cost-effectiveness ratios (ICERs; cost/quality-adjusted life year [QALY]) and incremental net health benefit (iNHBs) were calculated, and uncertainty was assessed through sensitivity and scenario analyses. RESULTS: Tirzepatide (MTD) was estimated to be less costly and more efficacious compared to semaglutide (MTD) with per patient cost savings of $41,688, 0.506 QALYs gained and positive iNHB of 0.784, indicating a net health benefit for tirzepatide. The model predicted that per 1,000 patients, 70 fewer patients will develop T2D, 10 fewer will develop CVD with tirzepatide (MTD) and patients spend 3.07 more years living with moderate/severe OSA when treated with semaglutide (MTD). CONCLUSION: Based on this simulation model, using head-to-head SURMOUNT-5 trial data, tirzepatide (MTD) had lower total costs and higher QALYs compared to semaglutide (MTD). This supports that tirzepatide (MTD) is a cost-effective treatment option for individuals with obesity or overweight compared to semaglutide (MTD). This study focused on evaluating the cost-effectiveness of two weight management drugs, tirzepatide and semaglutide, for adults in the US who are overweight or have obesity. Using data from the SURMOUNT-5 trial, the analysis showed that tirzepatide was more effective and less costly, providing better weight loss and health benefits compared to semaglutide.The findings revealed that for every 1,000 individuals treated with tirzepatide, there were 70 fewer cases of type 2 diabetes and 10 fewer cases of heart disease compared to those treated with semaglutide. Additionally, patients on semaglutide experienced a longer duration living with moderate or severe sleep apnea. The study highlighted that tirzepatide led to greater improvements in reducing weight and returning blood sugar levels to normal. Over a lifetime, tirzepatide was found to save $41,688 per patient and provide an additional 0.5 quality-adjusted life years (QALYs; a measure that helps compare how much different treatments improve both length and quality of life), emphasizing its advantages both financially and health-wise.Tirzepatide also demonstrated a reduction in absenteeism (when people are not at work because of illness or health problems) and presenteeism (when people are at work but not fully productive because they are unwell), meaning fewer days lost from work compared to semaglutide, thus highlighting productivity benefits. Overall, the research supports that tirzepatide offered a more cost-effective and beneficial treatment option for weight management in the US healthcare context compared to semaglutide.
24 Apr 2026
Read appraisal →Journal of Korean medical science
Association Between Changes in Socioeconomic Status Before and After Human Immunodeficiency Virus Infection Diagnosis and Mortality Rates in Korea
BACKGROUND: This study investigated changes in medical insurance status as a surrogate marker of socioeconomic status after human immunodeficiency virus (HIV) infection, and their association with mortality among people living with HIV in Korea. METHODS: This study included 13,112 individuals newly diagnosed with HIV between 2004 and 2018, identified from the claims data of the National Health Insurance System-National Health Information Database. Participants' medical insurance status was categorized into National Health Insurance (NHI) and medical aid (MA). Using the Cox proportional hazards model, the association between mortality and changes in medical insurance status before and after HIV infection diagnosis was assessed using hazard ratios (HRs) and confidence intervals (CIs). RESULTS: The insurance coverage rates before HIV diagnosis were 95.1% and 4.9% for NHI and MA recipients, respectively. After diagnosis, the insurance coverage rates were 13.4% and 86.6% for MA and NHI recipients, respectively, demonstrating a threefold increase in the proportion of MA recipients. The conversion rate from NHI to MA was highest in the 35-44 and 45-54-year age groups at HIV infection diagnosis (32.9% and 29.4%, respectively). Compared with NHI recipients, the HR was significantly higher among individuals that transitioned from NHI to MA (HR, 1.66; 95% CI, 1.39-1.97) and individuals that remained on MA (HR, 1.74; 95% CI, 1.40-2.18), suggesting a higher mortality rate in these groups. CONCLUSION: In Korea, where highly active antiretroviral therapy is essentially free of charge, a significant association was observed between a decline in medical insurance status following HIV diagnosis and increased mortality.
23 Apr 2026
Read appraisal →BMJ open
Cost-effectiveness of osteoporotic fracture risk assessment in people with intellectual disabilities: a UK NHS modelling study
OBJECTIVES: We compared the cost-effectiveness of alternative fracture risk assessment strategies for people with intellectual disabilities (ID) aged ≥40 years from a UK National Health Services perspective over a lifetime horizon. DESIGN: Cost-effectiveness analysis using a lifetime decision-analytical model. SETTING: UK primary care, with data from literature and national databases. PARTICIPANTS: People with ID. INTERVENTIONS: Three strategies were assessed: (S1) Risk assessment using the UK QFracture score; (S2) use of IDFracture (a fracture risk prediction tool specifically developed for adults with ID); and (S3) conducting a one-time dual-energy X-ray absorptiometry (DXA) scan in all. S1 and S2 were followed by DXA scan for those at risk. At-risk individuals received treatment according to UK practice (bisphosphonates plus vitamin D and calcium for osteoporosis, and vitamin D and calcium alone for osteopenia). PRIMARY OUTCOME MEASURES: Direct healthcare costs and quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). RESULTS: In the base case, S2 (ICER: -£2568/QALY) was dominant (ie, less costly and more effective) and S3 (ICER: £1678/QALY) was cost-effective relative to S1 for major osteoporotic fracture (MOF). For hip fracture, S2 (ICER: £32 116/QALY) and S3 (ICER: £49 536/QALY) were not cost-effective relative to S1 under the National Institute for Health and Care Excellence-recommended cost-effectiveness thresholds. Findings from the sensitivity analyses were predominantly consistent with the base-case results. Subgroup analyses showed that age-specific and gender-specific strategies could be used. CONCLUSION: For people with ID aged ≥40 years, a proactive approach to risk assessment for MOF is not only clinically beneficial, but also cost-effective.
20 Apr 2026
Read appraisal →Archives of disease in childhood. Fetal and neonatal edition
Cost-consequence analysis of early full milk feeding versus gradual feeding with intravenous support in preterm infants: results from the FEED1 trial
OBJECTIVE: To assess the economic consequences of initiating full milk feeds from birth compared with intravenous fluids with gradual feeding in infants born preterm. DESIGN: Within-trial economic evaluation alongside a prospective, multicentre, randomised controlled trial (Fluids Exclusively Enteral from Day 1). A cost-consequence approach was used (revised from the planned cost-effectiveness analysis to avoid double counting length of stay within costs). SETTING: 46 UK National Health Service (NHS) neonatal units. PATIENTS: Preterm infants born at 30+0to 32+6 weeks' gestation. INTERVENTIONS: Infants were allocated to either full milk feeds or gradual feeding with intravenous support within 3 hours of birth. MAIN OUTCOME MEASURE: Resource use and costs were captured from birth to 6 weeks' corrected age. Costs were assessed from an NHS and personal social services perspective. The primary clinical outcome was length of hospital stay. RESULTS: 2088 infants were enrolled. There was no statistically significant difference in mean (95% CI) length of hospital stay between groups (-0.050 days (-0.638 to 0.538)). Mean total costs were £670 lower in the full milk group (95% CI: -£1562 to £223; p=0.141). Subgroup analyses suggested lower costs among infants born at 30 weeks' gestation and those below the 10th birth weight centile; no evidence of interaction was found. CONCLUSIONS: Initiating full milk feeds from birth was associated with a modest reduction in costs compared with gradual feeding. While overall hospital stays and costs were not significantly reduced, early full feeding may offer economic advantages in selected subgroups. Further research is needed to assess long-term outcomes. TRIAL REGISTRATION NUMBER: ISRCTN89654042.
19 Apr 2026
Read appraisal →BMJ open
Remote assessment and practice implementation for disorders in ears, nose and throat: a mixed-methodology observational study in the United Kingdom
INTRODUCTION: Ear, nose and throat (ENT) conditions are highly prevalent in primary and secondary care, yet patients frequently face prolonged waits for specialist review. In England, over half of ENT patients wait beyond the NHS 18-week referral-to-treatment target. Many of these cases can be effectively managed with advice and non-surgical interventions, presenting an opportunity for remote service innovation.This study aims to evaluate the clinical effectiveness, cost-effectiveness, acceptability and environmental sustainability of a digitally enabled remote ENT clinic model compared with traditional face-to-face pathways. METHODS AND ANALYSIS: This single-centre, mixed-methods, prospective cohort study will be conducted at University Hospitals Birmingham NHS Foundation Trust. Remote clinics will use trained staff to collect diagnostic data (including endoscopic imaging and boothless hearing tests) for consultant review via secure cloud-based software. Quantitative analysis will assess patient outcomes, costs, waiting times, carbon footprint and satisfaction. Qualitative data from semi-structured interviews with patients, clinicians and managers will explore acceptability, scalability and barriers to implementation. The qualitative data will be analysed using the framework methodology, according to the non-adoption, abandonment, scale-up, spread and sustainability framework, while the strengthening the reporting of observational studies in epidemiology framework will be used to guide the reporting of quantitative data. Cost-effectiveness analyses will follow NICE guidelines, while environmental impact will be measurement will be informed by the sustainability in quality improvement framework. Recruitment will be aiming for 300 completed datasets and 30-35 interviews. ETHICS AND DISSEMINATION: Ethical approval has been granted (IRAS 350908; REC 25/SW/0116). Findings will be disseminated via conferences, peer-reviewed journals and institutional communication channels.
17 Apr 2026
Read appraisal →Psychological medicine
Cost-utility and cost-effectiveness of SELFIE, a transdiagnostic ecological momentary intervention for improving self-esteem in youth aged 12-26 years exposed to childhood adversity: Findings from a multicenter randomized controlled trial
BACKGROUND: A novel transdiagnostic blended Ecological Momentary Intervention (EMI) for improving self-esteem in youth who experienced childhood adversity has shown beneficial effects. However, evidence on the cost-effectiveness of SELFIE and EMIs overall is lacking. METHODS: In this RCT-based economic evaluation, participants aged 12-26 years with low self-esteem (<26 on the Rosenberg Self-Esteem Scale [RSES]) and experienced childhood adversity were recruited from specialized mental health services and the general population and randomly allocated to CAU (control condition) or CAU + SELFIE (experimental condition). The Trimbos/iMTA Questionnaire for Costs Associated with Psychiatric Illness (TiC-P), the RSES, and EQ-5D-5L were assessed at baseline, post-intervention, and 6-, 18-, and 24-month follow-up. Incremental cost-effectiveness (ICER) and cost-utility (ICUR) ratios, and acceptability curves, were generated. Sensitivity and subgroup analyses assessed robustness. RESULTS: From a societal perspective, the ICER presented €1,219 per improved point of self-esteem, and the ICUR presented €53,986 per QALY gained. The probability of cost-effectiveness was 26% at a willingness-to-pay (WTP) threshold of €20,000/QALY and 49% at €50,000/QALY. At €50,000/QALY, the probability of cost-effectiveness was 77% from a healthcare perspective (ICUR €15,671/QALY gained) and 87% for participants recruited from specialized mental health services (ICUR €-14,567/QALY gained). CONCLUSIONS: At the societal level, the SELFIE intervention exceeded the WTP threshold. Tests for robustness showed higher probabilities of cost-effectiveness from a healthcare perspective, likely reflecting the absence of educational productivity loss costs in the societal perspective, and in youth recruited from specialized mental health services. The innovative field of blended EMIs yields encouraging first results, urging more cost-effectiveness research.
14 Apr 2026
Read appraisal →European respiratory review : an official journal of the European Respiratory Society
The burden of autoimmune pulmonary alveolar proteinosis: a systematic review
BACKGROUND: Autoimmune pulmonary alveolar proteinosis (aPAP) is characterised by abnormal alveolar surfactant accumulation and reduced pulmonary gas transfer. Disease severity and progression depend on pulmonary surfactant accumulation, the rate of which varies widely among patients. Currently, whole-lung lavage (WLL) is the most widely accepted therapy. This review addresses the burden of aPAP on patients, caregivers and society. METHODS: MEDLINE and Embase databases were systematically searched for reports on the manifestations, treatment burden, caregiver impact and healthcare costs of aPAP published after 2000. RESULTS: Out of 1023 publications identified, 50 reported relevant data (for 2855 aPAP patients), including 43 observational studies and seven phase 2/3 trials. Commonly reported symptoms included dyspnoea, cough and sputum production. Clinical manifestations included progressive hypoxaemia, reduced exercise capacity, reduced quality of life, and an increased rate of serious infections. Low prevalence and nonspecific signs and symptoms contributed to delayed diagnosis of aPAP, frequent misdiagnoses, use of multiple tests with nondiagnostic results, and therapies that were inappropriate or exacerbated the disease. WLL was the most frequently administered therapy, and many patients required repeat procedures. Medical care costs were higher for PAP patients than for non-PAP control patients. CONCLUSIONS: The results highlight the multifactorial and substantial burden of aPAP on patients. Significant unmet needs remain, particularly in achieving timely and accurate diagnosis and in providing effective, well-tolerated therapies that address the underlying pathophysiology of the disease.
10 Apr 2026
Read appraisal →Sexual health
E-screening for sexually transmissible infections and blood-borne viruses in New South Wales, Australia: a cost analysis.
BACKGROUND: MyCheck is an e-testing pathway, first implemented at Sydney Sexual Health Centre, which enhances access to STI/HIV testing via telehealth and off-site sample collection; thus, reducing clinic visits. This study evaluates MyCheck's direct and indirect costs versus standard in-person screening (Xpress). METHODS: A 12-month bottom-up cost analysis from a societal perspective compared MyCheck and Xpress. Direct medical (health system), direct non-medical (patient travel) and indirect non-medical (productivity) costs were calculated using retrospective Sydney Sexual Health Centre data. Costs included pathology, staff time, overheads, consumables, patient travel and forgone productivity. Statewide scale-up costs were estimated, with sensitivity analyses adjusting for inflation, minimum wage and an increase in the proportion of MyCheck users with productivity loss. RESULTS: From January to July 2023, Sydney Sexual Health Centre conducted 2548 screening episodes (45% MyCheck, 55% Xpress), with MyCheck attracting more men who have sex with men/transgender and gender diverse patients. MyCheck's shorter appointments (median 5 min vs Xpress's 15 min) led to lower staff costs (A$5 vs A$16). MyCheck had higher overall health system cost (A$127/patient) compared with Xpress (A$91/patient), mostly due to pathology costs. However, considering patient travel cost and productivity loss for Xpress, MyCheck's societal cost (A$137) was lower than Xpress (A$146), yielding A$104,260 annual savings. Statewide scale-up provides significant societal savings (A$419,077/year). CONCLUSION: This analysis of MyCheck's direct and indirect costs compared with traditional in-person screening demonstrates significant societal savings, despite higher direct pathology costs. It underscores the importance of a broader societal perspective in cost analyses. Lowering private pathology costs could further enhance MyCheck's cost-effectiveness. MyCheck, an innovative e-screening pathway, reduces barriers for STI/blood-borne virus screening by improving patient convenience and reduced opportunity costs. Despite higher direct pathology costs, its societal cost savings support statewide scale-up for improved screening accessibility.
9 Apr 2026
Read appraisal →Neurology
Efficacy of Pyridostigmine in Myasthenia Gravis: A Randomized, Double-Blind, Placebo-Controlled Crossover Trial
BACKGROUND AND OBJECTIVES: Pyridostigmine, an acetylcholinesterase inhibitor, is a symptomatic drug approved for the treatment of myasthenia gravis (MG), but no randomized controlled trials substantiate its widespread use. We aimed to assess the efficacy and cost utility of pyridostigmine in patients with anti-acetylcholine receptor-positive MG (AChR MG). METHODS: A randomized, double-blind, placebo-controlled crossover trial was conducted at Leiden University Medical Center, a tertiary center for the treatment of MG in the Netherlands. Main eligibility criteria were current use of pyridostigmine and a stable dose of other MG treatments. Participants were assigned to a sequence of 2 treatment periods for 5 days separated by a 2-day washout, in which patients either first received placebo and then pyridostigmine, or vice versa. Pyridostigmine dosing matched each participant's prestudy regimen. The primary outcome was change in the Myasthenia Gravis Impairment Index (MGII) score. Secondary efficacy outcome measures included the Myasthenia Gravis Activities of Daily Living (MG-ADL) scale, the Quantitative Myasthenia Gravis (QMG) score, and the revised 15-item Myasthenia Gravis Quality of Life (MG-QOL15r) questionnaire. For the post hoc cost-utility analysis, a mathematical model was developed to translate the observed study results into long-term annual effect on societal costs and quality-adjusted life years (QALYs). RESULTS: A total of 19 patients (median age 59 years, 58% female) were recruited between March 23, 2023, and February 21, 2024. The estimated mean difference in the MGII score between pyridostigmine and placebo interventions was 5.3 (95% CI 1.9-8.7, p = 0.004). Secondary efficacy outcome measures showed estimated mean differences of 1.4 (95% CI 0.5-2.3) for the QMG score, 1.2 (95% CI 0.5-1.8) for the MG-ADL score, and 2.0 (95% CI 0.03-3.91) for the MG-QoL15r score. The post hoc cost-utility analysis showed lower annual societal costs (€6,565, 95% CI €328-€15,945) and annual improved QALYs (0.106, 95% CI 0.019-0.210) for patients using pyridostigmine. DISCUSSION: This trial showed that, in patients with AChR MG chronically treated with pyridostigmine, pyridostigmine demonstrated benefit over placebo across all efficacy outcome measures and substantially reduced societal costs. TRIAL REGISTRATION INFORMATION: The trial was registered at EudraCT (2021-004110-20, registration date: July 12, 2022) and ClinicalTrials.gov (NCT05919407, registration date: June 16, 2023). First patient enrolled: March 23, 2023. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that, in adults with AChR ab-positive ocular or generalized MG on stable standard-of-care therapy and currently using pyridostigmine, pyridostigmine improves MG symptoms compared with placebo.
9 Apr 2026
Read appraisal →Journal of Korean medical science
Effectiveness and Cost-Utility of Anti-Adhesion Agents in Intra-Abdominal Surgery Patients
BACKGROUND: Adhesive intestinal obstruction (AIO) is a common and critical complication of intra-abdominal surgery, often requiring preventative measures such as using anti-adhesion agents (AAA). However, despite their prevalence and significance, a notable lack of long-term and large-scale clinical evidence exists supporting the effectiveness and cost-utility of these agents. This study aimed to evaluate the effectiveness and cost-utility of applying AAA in patients undergoing intra-abdominal surgery. METHODS: This is a retrospective observational study utilizing the Korean National Health Insurance Database in combination with the data from the Clinical Data Warehouse collected from six university-affiliated hospitals in Korea. The study included patients who underwent intra-abdominal surgeries between April and December 2016, with 2-year follow-up. The effectiveness of AAA was assessed by the incidence rate of AIO, and cost-utility was evaluated through calculating quality-adjusted life years (QALYs) and direct costs. Subgroup and sensitivity analyses were conducted to confirm the consistency and robustness of the study findings. RESULTS: A total of 2,831 patients were included in the study. Among them, 1,365 (47.2%) received AAA while 1,466 (52.8%) did not. The group that received AAA exhibited a significantly lower incidence of AIO, with a rate of 12.4% compared to 18.5% in the non-user group. Utility scores were higher in the user group, averaging 1.992 QALYs versus 1.986 in the non-user group. Direct costs were significantly lower in the user group, totaling 3,794 USD, which is 1,330 USD less than those incurred by the non-user group. Subgroup and sensitivity analyses reinforced these findings, demonstrating consistent reductions in AIO incidence, increased QALYs, and decreased costs observed across various subgroups, particularly among older patients and those without chronic conditions. CONCLUSION: These findings highlight the clinical effectiveness and cost-utility of AAA in patients undergoing intra-abdominal surgery. By significantly reducing the incidence of AIO and lowering healthcare costs, these agents provide empirical evidence supporting their broader adoption in clinical practice. This study addresses critical gaps in the understanding of postoperative management and offers valuable insights that could inform future healthcare policies.
8 Apr 2026
Read appraisal →CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
Behavioural nudges to reduce low-value care for low back pain in the emergency department (NUDG-ED): a 2 × 2 factorial, pragmatic cluster randomized trial
BACKGROUND: Low-value care exposes patients to unnecessary risk and wastes scarce health resources. We aimed to determine if patient- or clinician-directed nudges could reduce low-value care for low back pain in the emergency department. METHODS: We conducted a 2 × 2 factorial, cluster randomized controlled trial involving patients with low back pain presenting to emergency departments. Eight emergency departments were randomized to receive patient nudges (6 electronic information posters discouraging unnecessary imaging and opioids, displayed on 55-inch screens in waiting rooms), clinician nudges (3 electronic health record alerts that provided indications for lumbar spine imaging and suggested alternatives to opioids), both patient and clinician nudges, or no nudges. The primary outcome was the proportion of encounters for low back pain with low-value care, defined as non-indicated lumbar spine imaging test, opioid prescription at discharge, or both. We calculated odds ratios (ORs), adjusted for baseline and clustering. RESULTS: There were 3770 encounters for low back pain during the study period. The overall baseline prevalence of low-value care was 41.6%. During the intervention period, the proportion of encounters with low-value care reduced to 36.4% with patient nudges versus 38.1% without, but the difference was not significant (adjusted OR 0.80, 95% confidence interval [CI] 0.51 to 1.27). The proportion of encounters with low-value care was 39.4% with clinician nudges versus 35.0% without (adjusted OR 1.31, 95% CI 0.84 to 2.05). We did not observe an interaction effect between the interventions (p = 0.4). The patient nudge may have reduced strong beliefs among patients in the value of imaging for low back pain. We found no important differences in secondary outcomes. INTERPRETATION: Nudges - including waiting room information posters targeting patients and electronic health record alerts targeting clinicians - did not reduce low-value care in emergency departments. TRIAL REGISTRATION: www.anzctr.org.au, ACTRN12623001000695.
8 Apr 2026
Read appraisal →JMIR dermatology
Community-Based Teledermatology for Urgent Suspected Skin Cancer: Health Economic Cost-Comparison and Discrete Event Simulation Study
BACKGROUND: The increasing incidence and financial burden of skin cancer place immense pressure on the UK's National Health Service (NHS). Systemic challenges, including dermatologist shortages and long waiting lists, complicate timely assessment of skin lesions for patients under the urgent suspected cancer pathway. While teledermatology offers an innovative solution compared to traditional face-to-face appointments, standard teledermatology models still face limitations in addressing health care access barriers. Community-based decentralized models may reduce such barriers, but the cost and operational impact of such specific models remain largely underresearched. OBJECTIVE: This study evaluated the differences in financial cost to the NHS and patient waiting times at the Northern Care Alliance NHS Foundation Trust by comparing a community-based teledermatology model using Pathpoint eDerma against the Trust's standard-of-care for patients in the urgent suspected skin cancer pathway. METHODS: This study used an ambidirectional design involving 2 distinct analyses. The cost comparison analysis (CCA) compared costs incurred under the teledermatology model (intervention arm, n=563) against the Trust's standard care, represented by a synthetic comparator arm (n=4011). The discrete event simulation (DES) modeled the operational impact on patient waiting times over a 1-year period. Data for the intervention arm were collected prospectively from December 2022 to May 2023 for CCA and up to November 2023 for DES, while comparator data were collected retrospectively from September 2021 to December 2022. Publicly available resource costs were incorporated to ensure the robustness of the analyses. RESULTS: The community-based teledermatology model was associated with significant improvements in both cost to the NHS and patient waiting times. The CCA revealed a mean cost saving of £45 (£1=US $1.24) per referral (95% CI £22-£60; P<.001). This cost saving was associated with a 26% reduction in the proportion of patients requiring a full diagnostic biopsy, falling from 48% (1925/4011) in standard care to 22% (124/563) in the teledermatology model as well as time savings in face-to-face clinics and administration. Furthermore, the DES demonstrated that, on average, the teledermatology pathways decreased the time to reach a clinical diagnosis by 9.90 (95% CI 9.64-10.16) days; to communicate a diagnosis to patients by 54.18 (95% CI 50.76-57.61) days; and to reach a histopathological diagnosis by 62.8 (95% CI 59.76-65.83) days compared to standard care. CONCLUSIONS: The implementation of the community-based teledermatology model appears to be a highly effective, cost-efficient strategy associated with shortened patient journeys. The intervention showed a faster initial triage phase, but the study identified the histopathology process as the next major systemic constraint that could deter further pathway efficiency. Achieving timely diagnosis for all patients, including those requiring diagnostic biopsies, will necessitate continued strategic investment in innovative technologies to accelerate this downstream process.
7 Apr 2026
Read appraisal →The pharmacogenomics journal
Economic effectiveness of pharmacogenomics-guided prescribing for psychiatric disorders: a systematic review and meta-analysis
Pharmacogenomics (PGx)-guided prescribing is a promising approach to reduce variability in drug response, although its cost-effectiveness remains uncertain. We performed a systematic review and meta-analysis evaluating the cost-effectiveness of PGx-guided prescribing compared to standard care in psychiatry. In January 2026, we searched MEDLINE, Embase and PsycINFO for studies published between 2014 and 2025. We included any peer-reviewed study that included adults with a diagnosed psychiatric disorder, comparing PGx-guided prescribing to standard care, and reported both quality-of-life and economic outcomes. Given the lack of consensus on synthesising economic evidence, both a narrative synthesis and meta-analysis were conducted. Pooled incremental net benefit (INB) was used as the effect measure for the meta-analysis and heterogeneity measures including the I2 test were used to assess heterogeneity and determine which model to use for the meta-analysis. From an initial 1 271 records, 17 studies were included. The narrative synthesis found that 88% of studies favoured PGx-guided prescribing. Meta-analyses produced positive, though non-significant, pooled Incremental Net Benefits (INBs) for the total study groups (£1 623.14, 95% CI: -£116.50 to £3 362.79, p = 0.07, I2 = 100%), and for a statistically homogeneous subgroup (£41.54, 95% CI: -£18.27 to £101.35, p = 0.17, I2 = 0%). Our review indicates that PGx-guided prescribing can be cost-effective in psychiatry but highlights the need for increased consensus in economic modelling methods.
5 Apr 2026
Read appraisal →BMJ global health
Impacts of rising food prices on nutritional outcomes and mortality of children in low and middle-income countries: a systematic review
BACKGROUND: Estimates indicate that 45% of mortality among children under 5-year old is linked to nutrition. Increased food prices can reduce access to nutritious foods, increasing nutritional and health risks for children, particularly in low and middle-income countries (LMICs). We synthesised evidence on the relationship of rising food costs with nutritional outcomes and mortality in children in LMICs. METHODS: EMBASE, MEDLINE, Global Health, EconLit, Web of Science and six grey literature sources were searched in September 2023. Searches included key phrases such as 'food price shocks' and 'child malnutrition'. We included any longitudinal study design, with any measure of food price increase and any measure of child malnutrition or mortality as outcomes. Results were analysed narratively with risk of bias assessed using the Newcastle Ottawa Scale. RESULTS: A total of 18 studies were included, covering 104 LMICs. There were 16 repeated cross-sectional or panel studies, one longitudinal cohort study and one quasi-experimental study. Five of these studies were multicountry. 16/18 studies reported a range of adverse nutritional outcomes associated with higher food costs, including mortality (five studies), stunting and low height for age (six studies), and wasting and low weight for height (five studies). Low birth weight, admissions to feeding centres, reduced consumption of rice, fruit, vegetables and animal protein, and reduced haemoglobin concentrations were also associated with higher food prices in one study each. Subgroup analyses were limited although two studies identified larger impacts on children in urban areas, and two studies identified larger impacts where children were exposed to higher food prices at younger ages. DISCUSSION: Rising food prices present a risk to child health and nutrition in LMICs. Policies should prioritise increasing household income alongside structural reforms to mitigate the nutritional impacts of elevated food prices on young children and pregnant women. PROSPERO REGISTRATION NUMBER: CRD42023469198.
4 Apr 2026
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