***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background The aim of the present study was to evaluate the cost-effectiveness of tailored print communication ( TPC ) , telephone motivational interviewing ( TMI ) , a combination of the two , and no intervention on two outcomes in adults aged 45 to 70 , half of them having hypertension : increasing the number of public health guidelines met for three behaviors ( physical activity and fruit and vegetable consumption ) , and impact on quality adjusted life years ( QALYs ) . Methods Participants ( n = 1,629 ) from 23 Dutch general practice s were r and omized into one of four groups , which received 4 TPCs , 4 TMIs , 2 of each ( combined ) , or no intervention ( control ) , respectively . The self-reported outcomes , measured at baseline and 73 weeks follow-up ( 7 months after the last intervention component ) , were difference in total number of guidelines met at follow-up compared to baseline , and number of QALYs experienced over 73 weeks . The costs of implementing the intervention were estimated using a bottom-up approach . Results At 73 weeks follow-up participants showed increased adherence with 0.62 ( TPC ) , 0.40 ( TMI ) , 0.50 ( combined ) , and 0.26 ( control ) guidelines compared to baseline , and experienced 1.09 , 1.08 , 1.08 , and 1.07 QALYs , respectively . The costs for the control group were considered to be zero . TMI was more expensive ( € 107 per person ) than both the combined intervention ( € 80 ) and TPC ( € 57 ) . The control condition was most cost-effective for lower ceiling ratios , while TPC had the highest probability of being most cost-effective for higher ceiling ratios ( more than € 160 per additional guideline met , and € 2,851 for each individual QALY ) . Conclusions For low society 's willingness to pay , the control group was most cost-effective for the number of QALYs experienced over 73 weeks . This also applied to the increase in the number of guidelines met at lower ceiling ratios , whereas at higher ceiling ratios , TPC had a higher probability of being more cost-effective than the TMI , combined or control conditions . This also seemed to apply for QALYs experienced over 73 weeks . More research is needed on the long-term efficacy of both TPC and TMI , as well as on how to increase their cost-effectiveness . Trial registration Dutch Trial Register Background Non-adherence to antihypertensive drugs is high , and the economic consequences of non-adherence may be substantial . The Medication Events Monitoring System ( MEMS ) , which is a method to improve adherence , has been shown to be a useful tool for the management of adherence problems . Objective To assess the cost effectiveness of the MEMS compared with usual care in a population of hypertensive patients with poor adherence . The MEMS programme consisted of provision of containers fitted with electronic caps together with adherence training if indicated . Methods In a r and omised controlled trial , 164 hypertensive patients in the experimental strategy and 89 patients in the usual care strategy were followed for 5 months . Patients who had a systolic blood pressure ( SBP ) ≥160 mm Hg and /or diastolic BP ( DBP ) ≥95 mm Hg despite the use of antihypertensive drugs were eligible . Patients were recruited by a GP , and treatment took place in general practice .In the experimental strategy , electronic monitoring of the intake of antihypertensive drugs was introduced without change of medication . Unsatisfactory adherence was defined as < 85 % of days with the number of doses taken as prescribed . In the usual care strategy , antihypertensive treatment was intensified by the addition or change of antihypertensive drugs , if necessary , without provision of an electronic monitor . Outcome parameters included the proportion of patients with normalised blood pressure ( NBP ) at 5 months and QALYs . Costs were quantified from the healthcare and societal perspective . Non-parametric bootstrap simulations were per formed to quantify the uncertainty around the mean estimates and cost-effectiveness acceptability curves were presented . In addition , a number of univariate sensitivity analyses were performed on deterministic variables . Results At 5 months , 3.1 % ( 95 % UI [ uncertainty interval ] −9.7 % , + 15.8 % ) more patients had NBP , and 0.003 ( 95 % UI −0.005 , + 0.010 ) more QALYs were generated in the experimental strategy . A statistically significant lower percentage of patients had a dose escalation in the experimental strategy . Irrespective of the ceiling ratio for cost effectiveness , the cost-effectiveness probability was between 75 % and 80 % for the analysis from the healthcare perspective using proportion of patients with NBP as the outcome parameter . For the analysis from the societal perspective using QALYs as the outcome parameter , this probability was between 45 % and 51 % . Conclusion For a time horizon of 5 months , a difference in both cost and effect could not be detected between an adherence-improving programme compared with usual care for hypertensive patients . The probability that the adherence-improving programme is cost effective is at best moderate . Moreover , the costeffectiveness result is surrounded with considerable uncertainty and large-scale implementation warrants additional research into the economic consequences of this intervention . Patients may benefit from the use of a MEMS monitor in situations where BP targets are not reached because of suspected non-adherence and both patient and GP are reluctant to increase the dose or number of antihypertensive drugs Background Non-adherence to anti-psychotics is common , expensive and affects recovery . We therefore examine the cost-effectiveness of adherence therapy for people with schizophrenia by multi-centre r and omised trial in Amsterdam , London , Leipzig and Verona . Methods Participants received 8 sessions of adherence therapy or health education . We measured lost productivity and use of health/social care , criminal justice system and informal care at baseline and one year to estimate and compare mean total costs from health/social care and societal perspectives . Outcomes were the Short Form 36 ( SF-36 ) mental component score ( MCS ) and quality -adjusted life years ( QALYs ) gained ( SF-36 and EuroQoL 5 dimension ( EQ5D ) ) . Cost-effectiveness was examined for all cost and outcome combinations using cost-effectiveness acceptability curves ( CEACs ) . Results 409 participants were recruited . There were no cost or outcome differences between  adherence therapy and health education . The probability of adherence therapy being cost-effective compared to health education was between 0.3 and 0.6 for the six cost- outcome combinations at the willingness to pay thresholds we examined . Conclusions Adherence therapy appears equivalent to health education . It is unclear whether it would have performed differently against a treatment as usual control , whether such an intervention can impact on quality of life in the short-term , or whether it is likely to be cost-effective in some sites but not others . Trial registration Trial registration : Current Controlled TrialsIS RCT Background High levels of adherence to medications for HIV infection are essential for optimal clinical outcomes and to reduce viral transmission , but many patients do not achieve required levels . Clinician-delivered interventions can improve patients ’ adherence , but usually require substantial effort by trained individuals and may not be widely available . Computer-delivered interventions can address this problem by reducing required staff time for delivery and by making the interventions widely available via the Internet . We previously developed a computer-delivered intervention design ed to improve patients ’ level of health literacy as a strategy to improve their HIV medication adherence . The intervention was shown to increase patients ’ adherence , but it was not clear that the benefits result ing from the increase in adherence could justify the costs of developing and deploying the intervention . The purpose of this study was to evaluate the relation of development and deployment costs to the effectiveness of the intervention . Methods Costs of intervention development were drawn from accounting reports for the grant under which its development was supported , adjusted for costs primarily result ing from the project ’s research purpose . Effectiveness of the intervention was drawn from results of the parent study . The relation of the intervention ’s effects to changes in health status , expressed as utilities , was also evaluated in order to assess the net cost of the intervention in terms of quality adjusted life years ( QALYs ) . Sensitivity analyses evaluated ranges of possible intervention effectiveness and duration s of its effects , and costs were evaluated over several deployment scenarios . Results The intervention ’s cost effectiveness depends largely on the number of persons using it and the duration of its effectiveness . Even with modest effects for a small number of patients the intervention was associated with net cost savings in some scenarios and for duration s greater than three months and longer it was usually associated with a favorable cost per QALY . For intermediate and larger assumed effects and longer duration s of intervention effectiveness , the intervention was associated with net cost savings . Conclusions Computer-delivered adherence interventions may be a cost-effective strategy to improve adherence in persons treated for HIV.Trial registration Clinical trials.gov identifier NCT01304186 BACKGROUND Comprehensive geriatric assessment ( CGA ) can be effective in inpatient units , but such inpatient setting s are prohibitively expensive . If similar benefits could be obtained in outpatient setting s , CGA might be a more attractive option . OBJECTIVES To assess the cost-effectiveness ( CE ) of an outpatient geriatric assessment with an intervention to increase adherence . SUBJECTS Three hundred fifty-one community-dwelling , elderly subjects with at least one of four geriatric conditions . MEASURES In addition to the measures of functioning , we collected data on the costs of the intervention itself and on the use of medical services in the 64 weeks after the intervention . RESULTS The intervention , which prevented functional decline , cost $ 273 per participant . The intervention group averaged three more visits than the control group in the first 32 weeks after the intervention , but only 1.2 extra visits in the next 32 weeks . We estimate that the costs of these additional medical services would be $ 473 for the 5 years after the intervention , leading to a total cost per Quality Adjusted Life Year ( QALY ) of $ 10,600 . CONCLUSIONS The CE of this program compares favorably with many common medical interventions . Whether investments should be made in health care re sources on treatments that lead to modest improvements in the functioning of community-dwelling elderly people remains a societal decision Background Non-adherence to antidepressants generates higher costs for the treatment of depression . Little is known about the cost-effectiveness of pharmacist 's interventions aim ed at improving adherence to antidepressants . The study aim ed to evaluate the cost-effectiveness of a community pharmacist intervention in comparison with usual care in depressed patients initiating treatment with antidepressants in primary care . Methods Patients were recruited by general practitioners and r and omized to community pharmacist intervention ( 87 ) that received an educational intervention and usual care ( 92 ) . Adherence to antidepressants , clinical symptoms , Quality -Adjusted Life-Years ( QALYs ) , use of healthcare services and productivity losses were measured at baseline , 3 and 6 months . Results There were no significant differences between groups in costs or effects . From a societal perspective , the incremental cost-effectiveness ratio ( ICER ) for the community pharmacist intervention compared with usual care was € 1,866 for extra adherent patient and € 9,872 per extra QALY . In terms of remission of depressive symptoms , the usual care dominated the community pharmacist intervention . If willingness to pay ( WTP ) is € 30,000 per extra adherent patient , remission of symptoms or QALYs , the probability of the community pharmacist intervention being cost-effective was 0.71 , 0.46 and 0.75 , respectively ( societal perspective ) . From a healthcare perspective , the probability of the community pharmacist intervention being cost-effective in terms of adherence , QALYs and remission was of 0.71 , 0.76 and 0.46 , respectively , if WTP is € 30,000 . Conclusion A brief community pharmacist intervention addressed to depressed patients initiating antidepressant treatment showed a probability of being cost-effective of 0.71 and 0.75 in terms of improvement of adherence and QALYs , respectively , when compared to usual care . Regular implementation of the community pharmacist intervention is not recommended . Trial Registration Clinical Trials.gov Background Smoking prevalence is high among Pakistani and Bangladeshi men in the UK , but there are few tailored smoking cessation programmes for Pakistani and Bangladeshi communities . The aim of this study was to pilot a cluster r and omised controlled trial comparing the effectiveness of Pakistani and Bangladeshi  smoking cessation outreach workers with st and ard care to improve access to and the success of English smoking cessation services . Methods A pilot cluster r and omised controlled trial was conducted in Birmingham , UK . Geographical lower layer super output areas were used to identify natural communities where more than 10 % of the population were of Pakistani and Bangladeshi origin . 16 agglomerations of super output areas were r and omised to normal care controls vs. outreach intervention . The number of people setting quit date s using NHS services , vali date d abstinence from smoking at four weeks , and stated abstinence at three and six months were assessed . The impact of the intervention on choice and adherence to treatments , attendance at clinic appointments and patient satisfaction were also assessed . Results We were able to r and omise geographical areas and deliver the outreach worker-based services . More Pakistani and Bangladeshi men made quit attempts with NHS services in intervention areas compared with control areas , rate ratio ( RR ) 1.32 ( 95%CI : 1.03 - 1.69 ) . There was a small increase in the number of 4-week abstinent smokers in intervention areas ( RR 1.30 , 95%CI 
    Output:
    
The authors found that although the majority of adherence-enhancing interventions were cost-effective or cost-saving , variation exists within different intervention types .