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University of Sheffield research which evaluated the clinical and cost-effectiveness of statins for the primary and secondary prevention of cardiovascular events has directly led to an additional 3.3 million people in England and Wales becoming eligible for this treatment. Statins have been shown to reduce the risk of future cardiovascular events, such as heart attacks and stroke.
Guidance on statin prescribing in England and Wales, issued by the National Institute for Health and Care Excellence (NICE) Appraisal Committee in January 2006 was informed by our research report. Following this guidance the number of patients receiving statins has increased year on year with the number of prescriptions increasing by 29% between 2007 and 2011, enabling these patients to benefit from reduced risk of heart attacks and stroke and CVD related deaths.
Research on risk assessment and screening led by Wright at Plymouth University and including clinical participants from the Centre for Fetal Medicine at King's College Hospital and Tübingen University, has improved fetal and maternal healthcare. This research and work supporting the Fetal Anomaly Screening Program (FASP) has contributed to reductions in the number of unnecessary invasive diagnosis procedures in the UK, and has improved screening performance through the implementation of the NHS-endorsed Down's syndrome screening Quality Assurance Support Service (DQASS). The research has also contributed to the risk algorithms of the Fetal Medicine Foundation (FMF) which are used by the NHS and national and international companies that provide technologies for the clinical management of pregnancies by identifying high-risk groups for chromosomal abnormalities and preeclampsia.
Abdominal aortic aneurysms (AAAs) affect more than 4% of British men aged 65-74 and are responsible for over 6,800 deaths annually. The MASS trial showed that screening could reduce AAA-related mortality by 42%, and the Health Economics Research Group (HERG) demonstrated, through the MASS trial, that AAA screening was cost-effective. HERG thus helped inform the policy announced by UK ministers in 2008 to introduce a national screening programme for all men reaching 65. By Spring 2013 it was fully introduced in England — offering screening to 300,000 men annually; the latest Annual Report (2011-12) claimed an uptake rate of 75%. In 2008 the DH estimated the health gain from a screening programme would be at least 130,000 QALYS over 20 years. Internationally, MASS is the most significant trial of AAA screening, and provides the most robust evidence-based model of its cost-effectiveness. It extensively influenced AAA screening guidelines, policies and services, including in the USA and Europe.
Research at the University of Sheffield has resulted in FRAX, the first internationally-applicable fracture risk calculator that provides individualised 10-year probabilities of major osteoporotic fractures from readily available clinical risk factors. It has replaced bone mineral density (BMD) as the sole quantitative measure of fracture risk, thus increasing global access to risk assessment and improving targeting of treatment to patients at highest risk. FRAX is incorporated widely into national and international guidelines for osteoporosis management. Launched in 2008, it now provides country-specific calculations for 53 nations, in 28 languages. The online tool alone recently processed its 6.6 millionth calculation.
Approximately 25,000 people in the UK die each year from venous thromboembolism (VTE); furthermore, VTE affects 1 in 100,000 women of childbearing age and causes one-third of all maternal deaths. Thrombophilia, pregnancy and the use of oral oestrogens can all place women at increased risk of VTE when compared with other individuals. University of Glasgow researchers quantified the probability of VTE among at-risk women and analysed the benefits and cost-effectiveness of thrombophilia screening. Their research is cited in the recommendations and evidence bases of leading national and international clinical guidelines. This work also galvanised an overhaul of VTE prevention policy within NHS Scotland by emphasising the need for regional health boards to implement and audit standardised in-house protocols and provide accessible patient information on VTE.
Neuberger, together with David McCarthy (Imperial), who, in their earlier work, had raised concerns about the sustainability of the Pensions Protection Fund (PPF), were commissioned by the Fund to conduct research on alternative levy structures. This led to the development of a new risk-based levy structure, which was implemented over the years 2012-2013. This research and its resulting impact have not only shaped how the PPF operates in ensuring the levy's burden is fairly shared, but has also benefited all UK holders of occupation based pensions and the taxpayer at large.
Onchocerciasis (river blindness) is a debilitating disease of major public health importance in the wet tropics. The African Programme for Onchocerciasis Control (APOC) seeks to control or eliminate the disease in 19 countries. Accurate mapping of Loiasis (eye-worm) was a requirement for implementation of APOC's mass-treatment prophylactic medication programme in order to mitigate against serious adverse reactions to the Onchocerciasis medication in areas also highly endemic for Loiasis. Model-based geostatistical methods developed at Lancaster were used to obtain the required maps and contributed to a change in practice of APOC in a major health programme in Africa. Our maps are used to plan the delivery of the mass-treatment programme to rural communities throughout the APOC countries, an estimated total population of 115 million.
Our research has led to the development of guidelines on the diagnosis of deep vein thrombosis (DVT), reducing the risk of death and saving resources by reducing unnecessary tests and treatments.
Meta-analysis and decision-analysis modelling studies undertaken at the University of Sheffield between 2005 and 2007 formed the basis of the National Institute for Health and Clinical Excellence (NICE) and the American College of Chest Physicians (ACCP) guidelines for diagnosing DVT. These guidelines determine the management of over 140,000 patients each year in the United Kingdom with suspected DVT, and many more in other countries.
Research by G Favato of Kingston University established that it is cost-effective to vaccinate males against the HPV virus, overturning previous studies that had suggested such vaccination was not cost-effective.
This research was presented to the Italian Agency for Drug Approval (AIFA). As a result, AIFA changed its vaccination policy for HPV, removing its previous restriction of vaccination to females only and approving vaccination also for males.
The Italian regions of Emilia-Romagna and Sicily have now begun voluntary vaccination programmes for males under 26, with economic benefits amounting to €98.9 million. In addition, Emilia-Romagna has introduced a vaccination programme for HIV-infected males under 26, providing health benefits for a high-risk sub-population.
Research conducted by LSHTM has played a key role in supporting the global elimination of congenital syphilis. Two studies providing evidence of the health burden of congenital syphilis in Africa and the effectiveness of benzathine penicillin treatment form a pillar upon which WHO established its new syphilis elimination initiative. Further research has resulted in the adoption of new point-of-care tests for screening pregnant women for syphilis in 30 countries. As a result, more women are diagnosed and fewer babies die of syphilis.