ObjectiveCentre-based cardiac rehabilitation (CR) is recognised as cost-effective for individuals following a cardiac event. However, home-based alternatives are becoming increasingly popular, especially since COVID-19, which necessitated alternative modes of care delivery. This review aimed to assess whether home-based CR interventions are cost-effective (vs centre-based CR).MethodsUsing the MEDLINE, Embase and PsycINFO databases, literature searches were conducted in October 2021 to identify full economic evaluations (synthesising costs and effects). Studies were included if they focused on home-based elements of a CR programme or full home-based programmes. Data extraction and critical appraisal were completed using the NHS EED handbook, Consolidated Health Economic Evaluation Reporting Standards and Drummond checklists and were summarised narratively. The protocol was registered on the PROSPERO database (CRD42021286252).ResultsNine studies were included in the review. Interventions were heterogeneous in terms of delivery, components of care and duration. Most studies were economic evaluations within clinical trials (8/9). All studies reported quality-adjusted life years, with the EQ-5D as the most common measure of health status (6/9 studies). Most studies (7/9 studies) concluded that home-based CR (added to or replacing centre-based CR) was cost-effective compared with centre-based options.ConclusionsEvidence suggests that home-based CR options are cost-effective. The limited size of the evidence base and heterogeneity in methods limits external validity. There were further limitations to the evidence base (eg, limited sample sizes) that increase uncertainty. Future research is needed to cover a greater range of home-based designs, including home-based options for psychological care, with greater sample sizes and the potential to acknowledge patient heterogeneity.

receiving departmental research funding from AbbVie, Novartis, Pfizer and Sanofi; was an investigator on Medical Research Council and Horizon 2020-funded consortia with industry partners (see psort.org.uk and https://www.bioma p-imi.eu); and reports that SOBI provided a drug for National Institute for Health Research-funded trial in pustular psoriasis.

Purpose: Pre-operative TNM stratification of colon cancer on computed tomography (CT) at present does not identify patients at high risk of recurrence that could be selected for pre-operative treatment. In this study, we aimed to identify an optimal method of predicting colon cancer recurrence by pre-operative CT staging. Methods: Preoperative CT scans of 414 patients with sigmoid colon cancer between were re-staged using 3 CT classification systems for poor prognosis disease. "CT-TNM": T3-4 tumours; "CT-T3 substage": T3 tumours with extramural depth over 5 mm and T4 tumours. "CT-TDV": tumours with extramural venous invasion (EMVI) or discontinuous tumour deposits. Kaplan Meier survival plots and Cox multi-regression analysis were performed. Results: Among the 414 patients included with sigmoid cancer with a median follow up of 61 months, 122 patients developed recurrence (29.5%). On multivariate analysis, nodal disease was not prognostic and only TDs (HR 1.90) and EMVI (HR 1.97) on CT were associated with recurrence. Significant differences in DFS were found by CT-T3 substage classification (HR 1.88, 95% CI(1.32-2.68)) but not CT-TNM (HR 1.55, 95% CI(0.94-255)). The presence of EMVI or TDs on CT (HR 2.45, 95% CI(1.68-3.56)) best identified poor outcome. Conclusion: T3 substage and detection of TDs or EMVI on CT were prognostic for DFS, whereas TNM and nodal staging on CT held no prognostic value. TDV staging of sigmoid colon cancer is superior to TNM on CT and could be used to pre-operatively identify patients at high risk of recurrence. 6 Meta-analysis of oncological outcomes of sigmoid cancers: a hidden epidemic of R1 "palliative" resections

Objective: Non-invasive prenatal testing (NIPT) identifies the risk of abnormalities in pregnancy, potentially reducing the risk of miscarriage associated with invasive tests. This study aimed to understand the preferences of current and future mothers about the content, format and timing of information provision about NIPT.Methods: An online discrete choice experiment was designed comprising four attributes: when in the pregnancy information is provided (4 levels); degree of detail (2 levels); information format (6 levels); cost to women for gathering information (5 levels). Respondents included women identified by an online-panel company in Sweden. The mathematical design was informed by D-efficient criteria. Choice data were analysed using uncorrelated random parameters logit and latent class models.Results: One thousand Swedish women (56% current mothers) aged 18-45 years completed the survey. On average, women preferred extensive information provided at/before 9 weeks of pregnancy. There was heterogeneity in preferences about the desired format of information provision (website, mobile app or individual discussion with a midwife) in the population. Conclusion:Women had clear preferences about the desired content, format and timing of information provision about NIPT. It is important to tailor information provision to enable informed choices about NIPT. Key pointsWhat's already known about the topic? � Non-invasive prenatal testing (NIPT) is an emerging approach that detects fetal DNA from a maternal blood sample to identify the risk of abnormalities in pregnancy.� Parents must be given the correct type and amount of information in an appropriate format.The information is needed to provide consent for undergoing NIPT. Stuart J. Wright and Garima Dalal are joint first authors.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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