沈阳城市森林生态系统健康与管理研究

本文系统研究了沈阳城市森林的布局与结构、城市森林功能、城市森林病虫害发生与树木健康状况和城市自然资源与社会经济状况等指标对沈阳城市森林生态系统健康与管理的影响。同时一，采用2种生态系统健康评价方法对沈阳城市森林生态系统健康状况进行了评价，并提出了沈阳城市森林生态系统健康管理的对策。研究结果如下：1、截至2004年末，沈阳城市森林植被覆盖率已经达到35％，城市森林林地分布基本合理，但需要进一步加强道路林地、居住区林地和城郊大面积生态林建设。2、沈阳城市森林以乔木为主，乔灌株数比为1.7：1，乔灌的覆盖度比约为7:1。3、沈阳城市森林不同类型林地中植物组成不同。公园林地中有74个属，137个种（变种）；庭院林地中有53个属，104个种（变种）；居住区林地中有45个属，81个种（变种）；道路林地中有43个属，94个种（变种）；运河风景林地中有75个属，142个种（变种）；棋盘山风景林地中有48个属，118个种（变种）。4、公园林地、庭院林地、居住区林地、道路林地和运河风景林地的Shannon一Wiener多样性指数分别为2.78、3.05、3.15、3.18和3.18，均匀度指数分别为0.56、0.66、0.72、0.70和0.64。除了棋盘山风景林地外，沈阳城市森林中栽植总量超过乔木总量5％的乔木树种有7个属，分别为李、柳树、杨树、桧柏、榆树、槐树和银杏，7种树木总量达到了全部乔木总量的82.09％；栽植总量超过灌木总量5％的灌木树种也有7个属，分别为水腊、丁香、李属，小聚、玫瑰、忍冬和连翘，7个属灌木总量达到了全部灌木总量的87.92％。5、公园林地、庭院林地、道路林地和防护林地中OBH＜20cm、20cm＜DBH＜60cm和DBH＞60cm树木的比例分别为：57.9％、40.0％、2.1％，49.2％、47.8％、3.0％，65.3％、33.1％、1.6％和64.6％、34.9％、0.5％，表明沈阳城市森林树木的规格总体上偏小。6、经样方调查和CITYgreen模型计算，沈阳城市森林的生态效益约2.0亿USD／yr.。公园林地、庭院林地和风景林地的景观指标相对较高；道路林地和居住区林地的景观效果一般；防护林地的景观效果较差。7、目前已经发现的沈阳城市森林病害约600余种，虫害约700余种，其中杨树主要病虫害39种，柳树的主要病虫害有33种，榆树和槐树的主要病虫害均为，1种。杨柳树腐烂病、光肩星天牛、天幕毛虫、桃红颈天牛和美国白蛾等是近10年来沈阳城市森林中普遍发生和造成严重危害的主要病虫害。沈阳城市森林主要树木的平均健康指数为2.68，处于一般健康状态。8、沈阳城市森林的土壤和水资源状况均不利于树木的健康生长，沈阳的社会经济发展也有待于进一步提高。9、经过生物指示物法（光肩星天牛为生物指示物）、专家权重法、公众问卷调查和对比研究，沈阳城市森林生态系统总体上处于亚健康状态。10、通过对沈阳城市森林资源、管理状况的调查研究和健康状况的评价，本文提出了沈阳城市森林生态系统健康管理的对策，包括合理规划沈阳城市森林林地布局，增加道路林地、居住区林地和城郊林地的面积和植被覆盖率；调整树木种类组成，避免单一或少数树种的大量栽植，提高生物多样性水平；保护大树和古树；增加城市森林管理资金的投入；应用先进技术，采取科学的病虫害防治和植物养护方法，促进树木的健康生长等。This project systematically studied the urban forest ecosystem health and management in Shenyang. The study explored factors, such as urban forest structure, distribution, pests, aesthetic value, ecological benefit, natural resources and socieo-economic status, that affecting the urban forest ecosystem health and management. Two methods were used to evaluate the ecosystem health. This project also proposed Shenyang's urban forest ecosystem health management strategies. The research results can be summarized as follows: 1. As of the end of 2004, urban forest coverage in Shenyang is about 35%, and is in relatively even patch distribution pattern. However, the street trees and roadside forest patches, residential block forest patches should be enhanced. 2. Trees are the major component of the Shenyang s urban forest, followed by shrubs. The quantity ratio of tree to shrub is about 1.7:1, and the coverage ratio of trees to shrub is about 7:1. 3. Species composition varies by location. There are 74 genera, 137 species (including varieties) in the public parks; 53 genera, 104 species (and var.) in the green spaces of the institution (including school), factory, and company; 45 genera, 81 species (var.) in residential blocks; 43 genera, 94 species (var.) in streets and roadside forest patches; 75 genera, 142 species (var.) in the Canal landscape forest patches; 48 genera, 118 species (var.) in the Qipan Mountain recreation forest. 4. The Shannon-Woener indices varies in parks, in institution, factory, and company yards, in streets and roadside forest patches, in residential blocks.there are 2.78, 3.05, 3.18, 3.15, 3.18, respectively; and the evenness indices are 0.56, 0.66, 0.70, 0.72, 0.64, respectively. Besides the Qipan Mountain forest patches, trees of 7 genera, Prunus spp., Salix spp., Populus spp., Sabina spp., Ulmus spp., Robinia spp. and Ginkgo biloba are of more than 5% the total urban trees, respectively. In fact, trees from these 7 genera are about 82% of all trees in Shenyang's urban forests. In terms of shrubs, species of 7 genera, Ligustrum spp., Syringa spp., Prunus spp., Berberis spp., Rosa spp., Lonicera spp., and Forsythia spp. are more than 5% the total urban shrubs, respectively. 88% of all the shrubs in Shenyang s urban forest are from these 7 genera. 5. The diameter class of DBH<20cm, 20cm60cm of trees in parks, in institution, factory, and company yards, in in streets and roadside forests, and in protective forests are 57.9%, 40.0%, 2.1%; 49.2%, 47.8%, 3.0%; 65.3%, 33.1%, 1.6%; and 64.6%, 34.9%, 0.5%, respectively. The result indicated that the DBH is relatively small in Shenyang s urban forests. 6. Using random plots sampling and CITYgreen model calculation, the ecological benefit of Shenyang's urban is about 0.2 billion US dollars per year. The aesthetic value of parks, institution and company yards, and scenary forest patches is relative high; however, the aesthetic value of protective forest patches is low. 7. There are more than 600 types of diseases and more than 700 kinds of insects in Shenyang's urban forest. Among them, Populus spp., Salix spp., Ulmus spp. and Robinia spp., are attached mainly by 39, 33, 11, and 11, difference types of pests respectively. The rot disease of the Populus spp. and Salix spp., and the insects such as, Anoplophora glabripennis, Malacosoma neustria, Aromia bungii, and Hyphantria cunea are major pests in Shenyang s urban forest for the past 10 years. The trees health condition is relatively poor by having the average health index of 2.68 for major species. 8. The urban soil and water resource are not favorable to tree's growth in Shenyang, and so is the socieo-economic status. 9. Through using bio-indicator, professional and public evaluation, and comparision with other urban forests, it can be concluded that the status of Shenyang s urban forest is not very healthy in general. 10. To improve the urban forest ecosystem health in Shenyang, a better urban forest design need to be implemented to enhance the area and vegetation coverage of the street and roadside forests, the residential block forests, and the surburb forest Species biodiversity need to be enhanced by adjust the species composition of urban forest trees to reduce the single or several tree species populations and to plant more varieties. A better fundings for urban forest health management need to be budgeted. Advanced technologies in tree care and scientific measures to control pests need to be adopted to prove better care for plants and to keep trees grow healthfully.

Cultural assets and sustainable development: the economic significance of Cultural Heritage

This article assesses the condition of the Cultural Heritage as a form of capital that gives rise to a significant flow of economic returns widely outweighing the effort it takes to preserve it. More specifically, the data related to Spain is provided from the perspective of aggregate demand drawing up an estimation of both the direct and indirect economic impacts arising from the Cultural Heritage valuation. The results highlight again the relevance of cultural tourism in the delivery of these economic returns and as a catalyst of activities leading to the sustainable socioeconomic devel-opment of multiple territories.

El Buen Vivir como alternativa al desarrollo. Algunas reflexiones económicas y no tan económicas

El texto parte de una crítica a cómo los países colonizadores han usado los fantasmas del “desarrollo” y del “progreso” para dominar a los que consideraban países “atrasados”. En el debate del post-desarrollismo se recoge el Buen Vivir como una alternativa al desarrollo, no como una alternativa de desarrollo. El Buen vivir como practicas vivenciales de resistencia al colonialismo, y como una categoría central de los pueblos indígenas, pero no como una visión única. Su importancia toma cuerpo en varias Constituciones por que los límites bio-físicos de la naturaleza están siendo superados. Por esto es necesaria una nueva economía que respete los “derechos de la naturaleza”. Se relatan los diversos componentes que esta nueva economía puede tener para una transición paciente hacia el Buen Vivir.

Cooperativism, entrepreneurship and economic development: a linking theoretical model

Cooperatives, as a kind of firms, are considered by many scholars as an remarkable alternative for overcoming the economic crisis started in 2008. Besides, there are other scholars which pointed out the important role that these firms play in the regional economic development. Nevertheless, when one examines the economic literature on cooperatives, it is detected that this kind of firms is mainly studied starting from the point of view of their own characteristics and particularities of participation and solidarity. In this sense, following a different analysis framework, this article proposes a theoretical model in order to explain the behavior of cooperatives based on the entrepreneurship theory with the aim of increasing the knowledge about this kind of firms and, more specifically, their contribution to regional economic development.

Social economy and economic crisis in the basque country abstract

This article examines the socio-economic evolution of the social economy sector in the Basque Country during the 2008-2014 period of economic crisis. Data have been obtained within a framework of collaboration between university, Basque Government and private sector of the social economy. The results suggest that such entities have evolved better, both in terms of number of enterprises and employment, than the general economy of the Basque Country, while the context of public policies aimed at social economy has worsened over the years. However, in economic terms (measured through the Gross Value Added generated), they have not been able to cope with the crisis in equal conditions to the general economy. The main contribution of this research lies in that, unlike similar studies, it discusses the evolution of the whole sector of the social economy, taking as reference a broad period of the current economic crisis.

Bio-folio: applying portfolio theory to biodiversity

Genes, species and ecosystems are often considered to be assets. The need to ensure a sufficient diversity of this asset is being increasingly recognised today. Asset managers in banks and insurance companies face a similar challenge. They are asked to manage the assets of their investors by constructing efficient portfolios. They deliberately make use of a phenomenon observed in the formation of portfolios: returns are additive, while risks diversify. This phenomenon and its implications are at the heart of portfolio theory. Portfolio theory, like few other economic theories, has dramatically transformed the practical work of banks and insurance companies. Before portfolio theory was developed about 50 years ago, asset managers were confronted with a situation similar to the situation the research on biodiversity faces today. While the need for diversification was generally accepted, a concept that linked risk and return on a portfolio level and showed the value of diversification was missing. Portfolio theory has closed this gap. This article first explains the fundamentals of portfolio theory and transfers it to biodiversity. A large part of this article is then dedicated to some of the implications portfolio theory has for the valuation and management of biodiversity. The last section introduces three development openings for further research.

Socio-economic inequalities in cerebral palsy prevalence in the United Kingdom: a register-based study

Evidence is unclear as to whether there is a socio-economic gradient in cerebral palsy (CP) prevalence beyond what would be expected from the socio-economic gradient for low birthweight, a strong risk factor for CP. We conducted a population-based study in five regions of the UK with CP registers, to investigate the relationship between CP prevalence and socio-economic deprivation, and how it varies by region, by birthweight and by severity and type of CP. The total study population was 1 657 569 livebirths, born between 1984 and 1997. Wards of residence were classified into five quintiles according to a census-based deprivation index, from Q1 (least deprived) to Q5 (most deprived). Socio-economic gradients were modelled by Poisson regression, and region-specific estimates combined by meta-analysis.

The prevalence of postneonatally acquired CP was 0.14 per 1000 livebirths overall. The mean deprivation gradient, expressed as the relative risk in the most deprived vs. the least deprived quintile, was 1.86 (95% confidence interval [95% CI 1.19, 2.88]). The prevalence of non-acquired CP was 2.22 per 1000 livebirths. For non-acquired CP the gradient was 1.16 [95% CI 1.00, 1.35]. Evidence for a socio-economic gradient was strongest for spastic bilateral cases (1.32 [95% CI 1.09, 1.59]) and cases with severe intellectual impairment (1.59 [95% CI 1.06, 2.39]). There was evidence for differences in gradient between regions. The gradient of risk of CP among normal birthweight births was not statistically significant overall (1.21 [95% CI 0.95, 1.54]), but was significant in two regions. There was non-significant evidence of a reduction in gradients over time.

The reduction of the higher rates of postneonatally acquired CP in the more socioeconomically deprived areas is a clear goal for prevention. While we found evidence for a socio-economic gradient for non-acquired CP of antenatal or perinatal origin, the picture was not consistent across regions, and there was some evidence of a decline in inequalities over time. The steeper gradients in some regions for normal birthweight cases and cases with severe intellectual impairment require further investigation.

Hair cortisol reflects socio-economic factors and hair zinc in preschoolers

This study examined the relationship between children's hair cortisol and socioeconomic status of the family, as measured by parental education and income. Low family socioeconomic status has traditionally been considered a long-term environmental stressor. Measurement of hair cortisol provides an integrated index of cumulative stress exposure across an extended period of time. The present study is the first to examine the relationship between hair cortisol and parental education as well as parental income in a representative sample of preschoolers. Data on hair cortisol, family income, and parental education were collected for a representative sample of 339 children (Mean age=4.6 years; SD=.5 years) from across 23 neighbourhoods of the city of Vancouver, Canada. As maternal education was shown previously to be associated with hair zinc level, hair zinc measurements were included as well in order to explore potential relationships between hair zinc and hair cortisol. The relationship between hair cortisol and parental education was examined using hierarchical regression, with hair zinc, gender, age, and single parenthood included as covariates. Maternal and paternal education both were correlated significantly with hair cortisol (r=-0.18; p=.001). The relationship remained statistically significant even after controlling for all demographic covariates as well as for hair zinc and after taking the neighbourhood-level clustering of the data into account. Parental income, on the other hand, was not related significantly to children's hair cortisol. This study provides evidence that lower maternal and paternal education are associated with higher hair cortisol levels. As hair cortisol provides an integrated index of cortisol exposure over an extended time period, these findings suggest a possibly stable influence of SES on the function of the hypothalamic-pituitary-adrenal (HPA) axis. Cumulative exposure to cortisol during early childhood may be greater in children from low socio-economic backgrounds, possibly through increased exposure to environmental stressors.

Socio-economic deprivation and visual acuity at presentation in exudative age-related macular degeneration

Aim: To evaluate the influence of socio-economic factors on visual acuity (VA) at presentation in exudative age- related macular degeneration (AMD). Methods: The medical records of all consecutive patients with newly diagnosed exudative AMD examined at the Ophthalmology Departments of Grampian University Hospitals-NHS Trust, Aberdeen, and Gartnavel General Hospital, Glasgow, between July 2004 and June 2005, were reviewed. Demographics, duration of symptoms, VA in study and fellow eye, exudative AMD characteristics, status of fellow eye and patient home address, used to determine the Scottish Index of Multiple Deprivation (SIMD) score, were recorded. The effect of these parameters on VA at presentation was investigated using general linear modelling. Results: Two-hundred and forty patients (median age 79 years) were included in this study; 44 (18.3%) belonged to the lowest 20% SIMD score (most deprived). Age and location and type of the choroidal neovascular- isation were statistically significantly associated with VA at presentation (p = 0.003, p

Surveillance for ocular hypertension: An evidence synthesis and economic evaluation

OBJECTIVES: To determine effective and efficient monitoring criteria for ocular hypertension [raised intraocular pressure (IOP)] through (i) identification and validation of glaucoma risk prediction models; and (ii) development of models to determine optimal surveillance pathways.

DESIGN: A discrete event simulation economic modelling evaluation. Data from systematic reviews of risk prediction models and agreement between tonometers, secondary analyses of existing datasets (to validate identified risk models and determine optimal monitoring criteria) and public preferences were used to structure and populate the economic model.

SETTING: Primary and secondary care.

PARTICIPANTS: Adults with ocular hypertension (IOP > 21 mmHg) and the public (surveillance preferences).

INTERVENTIONS: We compared five pathways: two based on National Institute for Health and Clinical Excellence (NICE) guidelines with monitoring interval and treatment depending on initial risk stratification, 'NICE intensive' (4-monthly to annual monitoring) and 'NICE conservative' (6-monthly to biennial monitoring); two pathways, differing in location (hospital and community), with monitoring biennially and treatment initiated for a ≥ 6% 5-year glaucoma risk; and a 'treat all' pathway involving treatment with a prostaglandin analogue if IOP > 21 mmHg and IOP measured annually in the community.

MAIN OUTCOME MEASURES: Glaucoma cases detected; tonometer agreement; public preferences; costs; willingness to pay and quality-adjusted life-years (QALYs).

RESULTS: The best available glaucoma risk prediction model estimated the 5-year risk based on age and ocular predictors (IOP, central corneal thickness, optic nerve damage and index of visual field status). Taking the average of two IOP readings, by tonometry, true change was detected at two years. Sizeable measurement variability was noted between tonometers. There was a general public preference for monitoring; good communication and understanding of the process predicted service value. 'Treat all' was the least costly and 'NICE intensive' the most costly pathway. Biennial monitoring reduced the number of cases of glaucoma conversion compared with a 'treat all' pathway and provided more QALYs, but the incremental cost-effectiveness ratio (ICER) was considerably more than £30,000. The 'NICE intensive' pathway also avoided glaucoma conversion, but NICE-based pathways were either dominated (more costly and less effective) by biennial hospital monitoring or had a ICERs > £30,000. Results were not sensitive to the risk threshold for initiating surveillance but were sensitive to the risk threshold for initiating treatment, NHS costs and treatment adherence.

LIMITATIONS: Optimal monitoring intervals were based on IOP data. There were insufficient data to determine the optimal frequency of measurement of the visual field or optic nerve head for identification of glaucoma. The economic modelling took a 20-year time horizon which may be insufficient to capture long-term benefits. Sensitivity analyses may not fully capture the uncertainty surrounding parameter estimates.

CONCLUSIONS: For confirmed ocular hypertension, findings suggest that there is no clear benefit from intensive monitoring. Consideration of the patient experience is important. A cohort study is recommended to provide data to refine the glaucoma risk prediction model, determine the optimum type and frequency of serial glaucoma tests and estimate costs and patient preferences for monitoring and treatment.

FUNDING: The National Institute for Health Research Health Technology Assessment Programme.

The effect of socio-economic deprivation on severity of glaucoma at presentation

OBJECTIVE: To evaluate the influence of socio-economic factors on severity of glaucoma at presentation

METHODS: All newly diagnosed glaucoma patients at the University Hospitals-NHS, Aberdeen and South Glasgow University Hospitals-NHS, in 2006, were included. Glaucoma was severe at presentation if there was a repeatable visual-field loss with a mean deviation index greater than 12 dB in the Humphreys visual fields test or an absolute paracentral scotoma within the central 5 degrees of the visual fields. Home address was used to determine the Scottish Index of Multiple Deprivation (SIMD) rank. The SIMD rank, demographics and severity of glaucoma at presentation were investigated using general linear modelling.

RESULTS: There were 48 patients with severe glaucoma and 74 patients with non-severe glaucoma. In four, the severity could not be determined. Severity of glaucoma at presentation was significantly associated with SIMD rank, being most severe in patients from areas with the lowest ranks (p = 0.026). Age was a significant factor (p = 0.024), with severe glaucoma being more common in elderly patients.

CONCLUSIONS: Age and socio-economic deprivation were associated with severity of glaucoma at presentation, with patients from areas of higher socio-economic deprivation presenting with more advanced glaucoma.

The influence of market deregulation on fast food consumption and body mass index:A cross-national time series analysis

Objective
To investigate the effect of fast food consumption on mean population body mass index (BMI) and explore the possible influence of market deregulation on fast food consumption and BMI.

Methods
The within-country association between fast food consumption and BMI in 25 high-income member countries of the Organisation for Economic Co-operation and Development between 1999 and 2008 was explored through multivariate panel regression models, after adjustment for per capita gross domestic product, urbanization, trade openness, lifestyle indicators and other covariates. The possible mediating effect of annual per capita intake of soft drinks, animal fats and total calories on the association between fast food consumption and BMI was also analysed. Two-stage least squares regression models were conducted, using economic freedom as an instrumental variable, to study the causal effect of fast food consumption on BMI.

Findings
After adjustment for covariates, each 1-unit increase in annual fast food transactions per capita was associated with an increase of 0.033 kg/m2 in age-standardized BMI (95% confidence interval, CI: 0.013–0.052). Only the intake of soft drinks – not animal fat or total calories – mediated the observed association (β: 0.030; 95% CI: 0.010–0.050). Economic freedom was an independent predictor of fast food consumption (β: 0.27; 95% CI: 0.16–0.37). When economic freedom was used as an instrumental variable, the association between fast food and BMI weakened but remained significant (β: 0.023; 95% CI: 0.001–0.045).

Conclusion
Fast food consumption is an independent predictor of mean BMI in high-income countries. Market deregulation policies may contribute to the obesity epidemic by facilitating the spread of fast food.

Arcellacea (Testate Amoebae) as Bio-indicators of Road Salt Contamination in Lakes

Winter deicing operations occur extensively in mid- to high-latitude metropolitan regions around the world and result in a significant reduction in road accidents. Deicing salts can, however, pose a major threat to water quality and aquatic organisms. In this paper we examine the utility of Arcellacea (testate amoebae) for monitoring lakes that have become contaminated by winter deicing salts, particularly sodium chloride. We analysed 50 sediment samples and salt-related water-property variables (chloride concentrations; conductivity) from 15 lakes in the Greater Toronto Area and adjacent areas of southern Ontario, Canada. The sampled lakes included lakes in proximity to major highways and suburban roads, and control lakes in forested settings away from road influences. Samples from the most contaminated lakes, with chloride concentrations in excess of 400 mg/l and conductivities of >800 μS/cm, were dominated by species typically found in brackish and/or inhospitable lake environments and by lower faunal diversities (lowest Shannon Diversity Index values) than samples with lower readings. Q-R-mode cluster analysis and Detrended Correspondence Analysis (DCA) resulted in the recognition of four assemblage groupings. These reflect varying levels of salt contamination in the study lakes, along with other local influences, including nutrient loading. The response to nutrients can, however, be isolated if the planktic eutrophic indicator species Cucurbitella tricuspis is removed from the counts. The findings show that the group have considerable potential for biomonitoring in salt-contaminated lakes, and through application to lake sediment cores, may provide significant insights into long-term benthic community health, which is integral for remedial efforts.

Optical coherence tomography for the diagnosis, monitoring and guiding of treatment for neovascular age-related macular degeneration:a systematic review and economic evaluation

BACKGROUND: Age-related macular degeneration is the most common cause of sight impairment in the UK. In neovascular age-related macular degeneration (nAMD), vision worsens rapidly (over weeks) due to abnormal blood vessels developing that leak fluid and blood at the macula.

OBJECTIVES: To determine the optimal role of optical coherence tomography (OCT) in diagnosing people newly presenting with suspected nAMD and monitoring those previously diagnosed with the disease.

DATA SOURCES: Databases searched: MEDLINE (1946 to March 2013), MEDLINE In-Process & Other Non-Indexed Citations (March 2013), EMBASE (1988 to March 2013), Biosciences Information Service (1995 to March 2013), Science Citation Index (1995 to March 2013), The Cochrane Library (Issue 2 2013), Database of Abstracts of Reviews of Effects (inception to March 2013), Medion (inception to March 2013), Health Technology Assessment database (inception to March 2013).

REVIEW METHODS: Types of studies: direct/indirect studies reporting diagnostic outcomes.

INDEX TEST: time domain optical coherence tomography (TD-OCT) or spectral domain optical coherence tomography (SD-OCT).

COMPARATORS: clinical evaluation, visual acuity, Amsler grid, colour fundus photographs, infrared reflectance, red-free images/blue reflectance, fundus autofluorescence imaging, indocyanine green angiography, preferential hyperacuity perimetry, microperimetry. Reference standard: fundus fluorescein angiography (FFA). Risk of bias was assessed using quality assessment of diagnostic accuracy studies, version 2. Meta-analysis models were fitted using hierarchical summary receiver operating characteristic curves. A Markov model was developed (65-year-old cohort, nAMD prevalence 70%), with nine strategies for diagnosis and/or monitoring, and cost-utility analysis conducted. NHS and Personal Social Services perspective was adopted. Costs (2011/12 prices) and quality-adjusted life-years (QALYs) were discounted (3.5%). Deterministic and probabilistic sensitivity analyses were performed.

RESULTS: In pooled estimates of diagnostic studies (all TD-OCT), sensitivity and specificity [95% confidence interval (CI)] was 88% (46% to 98%) and 78% (64% to 88%) respectively. For monitoring, the pooled sensitivity and specificity (95% CI) was 85% (72% to 93%) and 48% (30% to 67%) respectively. The FFA for diagnosis and nurse-technician-led monitoring strategy had the lowest cost (£39,769; QALYs 10.473) and dominated all others except FFA for diagnosis and ophthalmologist-led monitoring (£44,649; QALYs 10.575; incremental cost-effectiveness ratio £47,768). The least costly strategy had a 46.4% probability of being cost-effective at £30,000 willingness-to-pay threshold.

LIMITATIONS: Very few studies provided sufficient information for inclusion in meta-analyses. Only a few studies reported other tests; for some tests no studies were identified. The modelling was hampered by a lack of data on the diagnostic accuracy of strategies involving several tests.

CONCLUSIONS: Based on a small body of evidence of variable quality, OCT had high sensitivity and moderate specificity for diagnosis, and relatively high sensitivity but low specificity for monitoring. Strategies involving OCT alone for diagnosis and/or monitoring were unlikely to be cost-effective. Further research is required on (i) the performance of SD-OCT compared with FFA, especially for monitoring but also for diagnosis; (ii) the performance of strategies involving combinations/sequences of tests, for diagnosis and monitoring; (iii) the likelihood of active and inactive nAMD becoming inactive or active respectively; and (iv) assessment of treatment-associated utility weights (e.g. decrements), through a preference-based study.

STUDY REGISTRATION: This study is registered as PROSPERO CRD42012001930.

FUNDING: The National Institute for Health Research Health Technology Assessment programme.