This cost-effectiveness analysis (CEA) of 4CMenB infant vaccination in England comprehensively considers the broad burden of serogroup B invasive meningococcal disease (MenB IMD), which has not been considered, or was only partially considered in previous CEAs.Methods: A review of previous MenB vaccination CEAs was conducted to identify aspects considered in the evaluation of costs and health outcomes of the disease burden of MenB IMD. To inform the model structure and comprehensive analysis, the aspects were grouped into 5 categories. A stepwise analysis was conducted to analyze the impact of each category, and the more comprehensive consideration of disease burden, on the incremental cost-effectiveness ratio (ICER).Results: MenB IMD incidence decreased by 46.0% in infants and children 0-4 years old within 5 years after introduction of the program. Stepwise inclusion of the 5 disease burden categories to a conventional narrow CEA setting reduced the ICER from £360 595 to £18 645-that is, considering the impact of all 5 categories, 4CMenB infant vaccination is cost-effective at a threshold of £20 000 per QALY gained.Conclusions: When considering comprehensively the MenB IMD burden, 4CMenB infant vaccination can be cost-effective, a finding contrary to previous CEAs. This analysis allows policy decision-makers globally to infer the impact of current disease burden considerations on the cost-effectiveness and the comprehensive assessment necessary for MenB IMD. Although this comprehensive CEA can help inform decision making today, it may be limited in capturing the full disease burden and complex interactions of health and economics of MenB IMD.

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Laparoscopy is a safe and comfortable approach for adrenalectomy and should be the technique of choice. From the economic point of view, laparoscopic adrenalectomy is cheaper than open adrenalectomy, but in all cases, surgical costs are only a minimal part of the budget, and the greater savings must come from the reduction in the presurgical diagnostic process.

INTRODUCTION Preoperative nutritional status is a predictive modifiable factor of survival in gastrointestinal oncology surgery. The aim of the study was to analyze the influence of nutritional risk (NR) on survival in patients undergoing gastric cancer (GC) surgery. MATERIAL AND METHODS Retrospective study of 50 patients with gastric adenocarcinoma who underwent surgery over a 2-year period. To identify patients with malnutrition, the malnutrition criteria of the European Society for Clinical Nutrition and Metabolism (ESPEN) were followed, and the nutritional risk was calculated with The nutritional Risk Screening (NRS2002). Patients were divided into two groups: NR (NRS≥3) and non-NR (NRS≤2), and survival was compared between the two. RESULTS The 5-year survival of GC patients was 22%, with a median survival of 15.8 months [SEM: 4.760, 95% CI = (6.473-25.132)]. NR patients had lower 5-year survivals (14% vs 57%, p = 0.004). Additionally, they had 4.4 times [95% CI = (1.714-11.495)] higher risk of mortality during oncological follow-up than patients without NR. CONCLUSIONS NR patients undergoing GC surgery have lower long-term survival. The preoperative NR can be considered a prognostic factor for survival and it should be evaluated preoperatively in gastrointestinal cancer surgery.