What ' s known on the subject? and What does the study add? Values for equivalent health states can vary substantially depending on the measure used and method of valuation; this has a direct impact on the results of economic analyses. To date, the majority of existing economic evaluations that include UTI as a health state refer to an analysis in which the Index of Well Being was used to estimate the quality of life experienced by young women with UTIs. Currently, there are no validated methods or fi lters for systematically searching for the type of generic quality of life data required for decision analytic models.This study is the only systematic review of quality of life in people with UTI in the literature. Twelve studies were identifi ed which report quality of life using a variety of generic methods; the results of these papers were summarized in a way that is useful for a health researcher seeking to populate a decision model, design a clinical study or assess the effect of UTI on quality of life relative to other conditions. One research group provided previously unpublished data from a large cohort study; these scores were mapped to EuroQol 5-Dimension values using published algorithms and probabilistic simulations.The aim of this review was to identify studies that have evaluated the impact of symptomatic urinary tract infection (UTI) and UTI-associated bacteraemia on quality of life, and to summarize these data in a way that is useful for a health researcher seeking to populate a cost -utility model, design a clinical study or assess the effect of UTIs on quality of life relative to other conditions. We conducted a systematic search of the literature using MEDLINE, EMBASE, the NHS Economic Evaluations database, Health Technology Assessment database, Health Economics Evaluations database, Cost-Effectiveness Analysis Registry and EuroQol website. Studies that reported utility values for symptomatic UTI or UTI-associated bacteraemia derived from a generic QoL measurement tool or expert opinion were included. Studies using disease-specifi c instruments were excluded. Twelve studies were identifi ed that included a generic measure of health-related quality of life for patients with UTIs. These measures included: the short-form (SF)-36 and SF-12 questionnaires; the Health Utilities Index Mark 2; Quality of Well Being; the Index of Well Being, standard gamble; the Health and Activity Limitation Index; and expert opinion. The authors of studies using either of the SF questionnaires were contacted for additional data. One research group provided previously unpublished data from a large cohort study; these scores were mapped to EuroQol 5-Dimension (EQ-5D) values using published algorithms and probabilistic simulations. The present review provides health researchers with several sources from which to select utility values to populate cost -utility models. It also shows that very few studies have measured quality of life in patients with UTI using generic preference-based measures of health and none have evalua...

BackgroundPharmacists play important role in ensuring timely care delivery at the ward level. The optimal level of pharmacist input, however, is not clearly defined. ObjectiveTo systematically review the evidence that assessed the outcomes of ward pharmacist input for people admitted with acute or emergent illness. MethodsThe protocol and search strategies were developed with input from clinicians. Medline, EMBASE, Centre for Reviews and Dissemination, The Cochrane Library, NHS Economic Evaluations, Health Technology Assessment and Health Economic Evaluations databases were searched.Inclusion criteria specified the population as adults and young people (age >16 years) who are admitted to hospital with suspected or confirmed acute or emergent illness. Only randomised controlled trials (RCTs) published in English were eligible for inclusion in the effectiveness review. Economic studies were limited to full economic evaluations and comparative cost analysis. Included studies were quality-assessed. Data were extracted, summarised. and meta-analysed, where appropriate. ResultsEighteen RCTs and 7 economic studies were included. The RCTs were from USA (n=3), Sweden (n=2), Netherlands. The economic studies were from UK (n=2), Sweden (n=2), Belgium and Netherlands. The results showed that regular pharmacist input was most cost effective. It reduced length-of-stay (mean= -1.74 days [95% CI: -2.76, -0.72], and increased patient and/or carer satisfaction (Relative Risk (RR) =1.49 [1.09, 2.03] at discharge). At £20,000 per quality-adjusted life-year (QALY)-gained cost-effectiveness threshold, it was either cost-saving or cost-effective (Incremental Cost Effectiveness Ratio (ICER) =£632/ QALY-gained). No evidence was found for 7-day pharmacist presence. Conclusions M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPTPharmacist inclusion in the ward multidisciplinary team improves patient safety and satisfaction and is costeffective when regularly provided throughout the ward stay. Research is needed to determine whether the provision of 7-day service is cost-effective. KEY WORDSClinical pharmacy, Systematic review, Meta-analysis, Cost effectiveness, acute medicine Adverse drug events (ADEs) are common in clinical settings, with a reported incidence from 2.3% in paediatric 2 inpatients to 27.4% in adult outpatients. 1 2 In adult inpatients, the reported incidence is 6.5%. 3 These ADEs are 3 direct causes of patient harm, dissatisfaction, prolonged hospital stay and increased costs. Pharmacists are 4 considered the medication experts in the health care team. Their extensive training in and knowledge of 5 pharmacology and therapeutics have placed them in the best position to undertake this role and to advise other 6 health care professionals on matters relating to appropriate prescribing and safe use of medicines. 4 7The pharmacist role in the hospital setting has evolved over the years, moving from a wholly dispensary-based 8 role to a more clinically-focused one based on the ward. 5 In fact, the presence of a ward-based p...

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Background Pharmacists working in community and primary care are increasingly developing advanced skills to provide enhanced services, particularly in dealing with minor acute illness. These services can potentially free-up primary care physicians' time; however, it is not clear whether they are sufficiently cost effective to be recommended for wider provision in the UK. Objective The aim of this study was to review published economic evaluations of enhanced pharmacy services in the community and primary care settings. Methods We undertook a systematic review of economic evaluations of enhanced pharmacy services to inform NICE guidelines for emergency and acute care. The review protocol was developed and agreed with the guideline committee.