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Diarrhea, either caused by rotavirus or non-rotavirus infection, resulted in substantial negative impacts on the quality of life of both the children and their caregivers.

Background Genetic testing has potential roles in identifying whether an individual would have risk of adverse drug reactions (ADRs) from a particular medicine. Robust cost-effectiveness results on genetic testing would be useful for clinical practice and policy decision-making on allocating resources effectively. This study aimed to update a systematic review on economic evaluations of pharmacogenetic testing to prevent ADRs and critically appraise the quality of reporting and sources of evidence for model input parameters. Methods We searched studies through Medline via PubMed, Scopus and CRD’s NHS Economic Evaluation up to October 2019. Studies investigating polymorphism-based pharmacogenetic testing, which guided drug therapies to prevent ADRs, using economic evaluation methods were included. Two reviewers independently performed data extraction and assessed the quality of reporting using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guidelines and the quality of data sources using the hierarchy of evidence developed by Cooper et al. Results Fifty-nine economic evaluations of pharmacogenetic testing to avoid drug-induced ADRs were found between 2002 and 2018. Cost-utility and cost-effectiveness analyses were the most common methods of economic evaluation of pharmacogenetic testing. Most studies complied with the CHEERS checklist, except for single study-based economic evaluations which did not report uncertainty analysis (78%). There was a lack of high-quality evidence not only for estimating the clinical effectiveness of pharmacogenetic testing, but also baseline clinical data. About 14% of the studies obtained clinical effectiveness data of testing from a meta-analysis of case-control studies with direct comparison, which was not listed in the hierarchy of evidence used. Conclusions Our review suggested that future single study-based economic evaluations of pharmacogenetic testing should report uncertainty analysis, as this could significantly affect the robustness of economic evaluation results. A specific ranking system for the quality of evidence is needed for the economic evaluation of pharmacogenetic testing of ADRs. Differences in parameters, methods and outcomes across studies, as well as population-level and system-level differences, may lead to the difficulty of comparing cost-effectiveness results across countries.

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objeCtives: Liver transplantation is an effective treatment option for end-stage liver disease and acute liver failure, including patients with hepatitis C (HCV) and hepatitis B (HBV). Recent health technology assessments of treatments for HCV and HBV have relied on data from a large cohort study of transplanted patients to inform estimates of costs of liver tranplantations; however this was conducted in the 1990s. The overall aim of this study was to estimate the current cost of liver transplant for patients with HCV and HBV in the UK. Methods: Historical summary data from the original cohort study were updated to reflect current unit costs and key changes in clinical practice. Semi-structured interviews were conducted with experts and a computer-based user-interface was developed to elicit estimates of key resource use items. Uncertainty in the experts' estimates was captured by eliciting probability distributions for each item from each expert. Updated unit costs were obtained from national sources. Data were analysed by phase of the transplant procedure. Results: The expert elicitation exercise included two hepatologists, three transplant surgeons and one liver transplant coordinator. Few patients with HBV are now being transplanted due to improvements in anti-viral treatments. Mean total costs for patients with HCV were £18,055 pre-transplantation, £64,452 during the transplant phase and £36,009 in two years post-transplant. The average cost per transplanted patient with HCV from assessment to two years post-transplant is £111,810. ConClusions: There have been some significant changes in clinical practice since the original study such as change in standard immunosuppressant therapy, more patients with co-morbidities being placed on the transplant waiting list, increased use of sub-optimal organs and reluctance to re-transplant patients with graft failure and recurrence of HCV.objeCtives: The impact of liver diseases (LDs) on health-related quality of life (HRQoL) is an important aspect to understand the burden of these conditions and improve their management. A well characterized impact of the major LDs