scholarly journals Cost-effectiveness of a Transdiagnostic Psychotherapy Program for Youth With Common Mental Health Problems

2021 ◽  
Author(s):  
Rasmus Trap Wolf ◽  
Pia Jeppesen ◽  
Mette Maria Agner Pedersen ◽  
Louise Berg Puggaard ◽  
Mikael Thastum ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Mental Health Problems ◽  
Base Case ◽  
Trial Period ◽  
Common Mental Health Problems ◽  
One Year ◽  
Psychotherapy Program ◽  
Preference Weights

Abstract Objectives: Our objective was to evaluate the cost-effectiveness of the transdiagnostic psychotherapy program Mind My Mind (MMM) for youth with common mental health problems using a cost-utility analysis (CUA) framework and data from a randomized controlled trial. Furthermore, we analyzed the impact of choice of informant with respect to both quality-of-life reporting and preference weights on the Incremental Cost Effectiveness Ratio (ICER). Methods: A total of 396 school-aged youth took part in the 6-month trial. CUAs were carried out for the trial-period and for four one-year extrapolation scenarios. Costs were based on a combination of budget and self-reported costs. Youths and parents were asked to report on the youth’s quality-of-life three times during the trial using the Child Health Utility 9D (CHU9D). Parental-reported CHU9D was used in the base case together with preference weights of a youth population. Analyses using self-reported CHU9D and preference weights of an adult population were also carried out. Results: The analysis of the trial period resulted in an ICER of €170,465. The analyses of the one-year scenarios resulted in ICERs between €23,653 and €50,480. The ICER increased by 24% and 71% compared to the base case when using self-reported CHU9D and adult preference weights, respectively. Conclusion: The MMM intervention has the potential to be cost-effective, but the ICER is dependent on the duration of the treatment effects. Results varied significantly with the choice of respondent and the choice of preference weights indicating that both factors should be considered when assessing CUA involving youth.

scholarly journals Economic evaluation alongside a randomised controlled trial to assess the effectiveness and cost-effectiveness of acupuncture in the management of chemotherapy-induced peripheral neuropathy

2020 ◽  
pp. 096452842092028
Author(s):  
Alex Molassiotis ◽  
Bryony Dawkins ◽  
Roberta Longo ◽  
Lorna KP Suen ◽  
Hui Lin Cheng ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Peripheral Neuropathy ◽  
Usual Care ◽  
Base Case ◽  
Cost Effective Treatment ◽  
The Cost

Objective To assess the cost-effectiveness of acupuncture in the management of chemotherapy-induced peripheral neuropathy (CIPN) in Hong Kong. Methods A within trial cost-utility analysis with the primary endpoint for the economic evaluation being the Quality Adjusted Life Year (QALY) and associated Incremental Cost Effectiveness Ratio (ICER) over 14 weeks of treatment. A secondary cost-effectiveness analysis was undertaken with the endpoint being change in pain as measured on the Brief Pain Inventory (BPI). Results Eighty-seven patients were randomised to acupuncture or usual care. Acupuncture resulted in significant improvements in pain intensity (8- and 14-week mean changes compared to usual care of −1.8 and −1.8, respectively), pain interference (8- and 14-week mean changes compared to usual care of −1.5 and −0.9, respectively) and indicators of quality of life and neurotoxicity-related symptoms. However, in the economic evaluation there was little difference in QALYs between the two arms (mean change 0.209 and 0.200 in the acupuncture and usual care arms, respectively). Also, costs yielded deterministic ICERs of HK$616,965.62, HK$824,083.44 and HK$540,727.56 per QALY gained from the health care provider perspective, the societal perspective and the patient perspective, respectively. These costs are significantly higher than the cost-effectiveness threshold of HK$180,450 that was used for the base case analysis. Conclusion While acupuncture can improve symptoms and quality of life indicators related to CIPN, it is unlikely to be a cost-effective treatment for CIPN-related pain in health care systems with limited resources. Trial registration number NCT02553863 (ClinicalTrials.gov) post-results.

scholarly journals Evaluation of a complex intervention (Engager) for prisoners with common mental health problems, near to and after release: study protocol for a randomised controlled trial

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e017931 ◽  
Author(s):  
Tim Kirkpatrick ◽  
Charlotte Lennox ◽  
Rod Taylor ◽  
Rob Anderson ◽  
Michael Maguire ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Standard Care ◽  
Mental Health Problems ◽  
Controlled Trial ◽  
Related Quality ◽  
Common Mental Health Problems ◽  
Randomised Controlled ◽  
Drug And Alcohol

IntroductionThe ‘Engager’ programme is a ‘through-the-gate’ intervention designed to support prisoners with common mental health problems as they transition from prison back into the community. The trial will evaluate the clinical and cost-effectiveness of the Engager intervention.Methods and analysisThe study is a parallel two-group randomised controlled trial with 1:1 individual allocation to either: (a) the Engager intervention plus standard care (intervention group) or (b) standard care alone (control group) across two investigation centres (South West and North West of England). Two hundred and eighty prisoners meeting eligibility criteria will take part. Engager is a person-centred complex intervention delivered by practitioners and aimed at addressing offenders’ mental health and social care needs. It comprises one-to-one support for participants prior to release from prison and for up to 20 weeks postrelease. The primary outcome is change in psychological distress measured by the Clinical Outcomes in Routine Evaluation-Outcome Measure at 6 months postrelease. Secondary outcomes include: assessment of subjective met/unmet need, drug and alcohol use, health-related quality of life and well-being-related quality of life measured at 3, 6 and 12 months postrelease; change in objective social domains, drug and alcohol dependence, service utilisation and perceived helpfulness of services and change in psychological constructs related to desistence at 6 and 12 months postrelease; and recidivism at 12 months postrelease. A process evaluation will assess fidelity of intervention delivery, test hypothesised mechanisms of action and look for unintended consequences. An economic evaluation will estimate the cost-effectiveness.Ethics and disseminationThis study has been approved by the Wales Research Ethics Committee 3 (ref: 15/WA/0314) and the National Offender Management Service (ref: 2015–283). Findings will be disseminated to commissioners, clinicians and service users via papers and presentations.Trial registration numberISRCTN11707331; Pre-results.

scholarly journals Determining the cost-effectiveness requirements of an exoskeleton preventing second hip fractures using value of information

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Stefania Manetti ◽  
Giuseppe Turchetti ◽  
Francesco Fusco
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Hip Fracture ◽  
Hip Fractures ◽  
Cost Effective ◽  
Future Research ◽  
Base Case ◽  
Secondary Analyses ◽  
The Cost

Abstract Background Falls may lead to hip fractures, which have a detrimental effect on the prognosis of patients as well as a considerable impact on healthcare expenditures. Since a secondary hip fracture (SHF) may lead to even higher costs than primary fractures, the development of innovative services is crucial to limit falls and curb costs in high-risk patients. An early economic evaluation assessed which patients with a second hip fracture could benefit most from an exoskeleton preventing falls and whether its development is feasible. Methods The life-course of hip fractured patients presenting with dementia or cardiovascular diseases was simulated using a Markov model relying on the United Kingdom administrative data and complemented by published literature. A group of experts provided the exoskeleton parameters. Secondary analyses included a threshold analysis to identify the exoskeleton requirements (e.g. minimum impact of the exoskeleton on patients’ quality of life) leading to a reimbursable incremental cost-effectiveness ratio. Similarly, the uncertainty around these requirements was modelled by varying their standard errors and represented alongside population Expected Value of Perfect Information (EVPI). Results Our base-case found the exoskeleton cost-effective when providing a statistically significant reduction in SHF risk. The secondary analyses identified 286 cost-effective combinations of the exoskeleton requirements. The uncertainty around these requirements was explored producing further 22,880 scenarios, which showed that this significant reduction in SHF risk was not necessary to support the exoskeleton adoption in clinical practice. Conversely, a significant improvement in women quality of life was crucial to obtain an acceptable population EVPI regardless of the cost of the exoskeleton. Conclusions Our study identified the exoskeleton requisites to be cost-effective and the value of future research. Decision-makers could use our analyses to assess not only whether the exoskeleton could be cost-effective but also how much further research and development of the exoskeleton is worth to be pursued.

scholarly journals Cost-Effectiveness of Operative Versus Nonoperative Management of Acute Achilles Tendon Ruptures

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Scott Ellis ◽  
Jayme Koltsov ◽  
Benedict Nwachukwu ◽  
Anca Marinescu ◽  
Caitlin Gribbin
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Achilles Tendon ◽  
Operative Treatment ◽  
Nonoperative Management ◽  
Cost Effective ◽  
Operative Management ◽  
Base Case ◽  
Tendon Ruptures

Category: Ankle, Sports Introduction/Purpose: The management of acute Achilles tendon ruptures remains controversial. Proponents of operative treatment cite lower rates of re-rupture, the potential for better functional outcomes and earlier return to activity. However, operative management incurs the added risks of surgical complications and the considerable cost of the surgical procedure. The goal of this study was to evaluate the cost-effectiveness of operative versus nonoperative management of acute Achilles tendon ruptures using the best available evidence regarding the costs and benefits of these two strategies. Methods: A Markov cost-utility analysis was conducted from the societal perspective to evaluate the cost-effectiveness of operative versus nonoperative management of acute Achilles tendon ruptures over a two-year time-period. Hospital costs were derived from New York SPARCS data, physician and rehabilitation costs were derived from Medicare physician fee schedules, and indirect costs of missed work were calculated using the average U.S. hourly earnings from the Bureau of Labor Statistics. Rates of re-rupture, major and minor complications, and the costs of managing these complications were obtained from the literature. For the base-case model, operative and non-operative patients were assumed to have the same utilities (quality of life) following surgery. The robustness of the model to uncertainty in the input parameters was examined through sensitivity analyses varying inputs over plausible ranges from the literature. Results are presented as costs (2014 US$), quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios with 95% confidence intervals. Results: In the base-case model, nonoperative management of acute Achilles tendon ruptures dominated operative management, resulting in both lower costs and greater benefits. The total cost of operative management was $13,936 versus $13,430 for nonoperative management. The initial surgical cost for Achilles tendon repair, $3,145 ($3,045-$3,244), was largely offset through reduced indirect costs from fewer missed days of work, 19 (4-34) days). In sensitivity analyses, if surgical costs dropped below $2,621 or the hourly wage rose above $29, then operative treatment became a cost-effective strategy at the willingness-to-pay threshold of $50,000/QALY. The model results were highly sensitive to the relative utilities for operative versus nonoperative treatment. If nonoperative utilities decreased relative to operative utilities by just 1.6%, then operative management became the dominant treatment strategy. Conclusion: Surgical costs and the economic impact associated with return to work are important determinants of cost- effectiveness for Achilles tendon ruptures. These results suggest that operative treatment of Achilles tendon injury may be cost- effective at low-cost centers and for high wage earning individuals. Furthermore, operative treatment is cost-effective if it produces incrementally better function and quality of life relative to nonoperative management. The available literature is inconclusive regarding differences in function and quality of life between operative and nonoperative treatment. Further research is needed to evaluate the quality of life benefits associated with operative and non-operative treatment of Achilles tendon injury.

scholarly journals Mediation effects of depression and anxiety on social support and quality of life among caregivers of persons with severe burns injury

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Kevin Bonsu ◽  
Nuworza Kugbey ◽  
Martin Amogre Ayanore ◽  
Ethel Akpene Atefoe
Keyword(s):  
Quality Of Life ◽  
Social Support ◽  
Mental Health Problems ◽  
Depression And Anxiety ◽  
Mediation Effects ◽  
Health And Wellbeing ◽  
Severe Burns ◽  
Common Mental Health Problems ◽  
Negative Impacts

Abstract Objective Caregiving is associated with several psychosocial challenges including stress, depression and anxiety. These challenges have been found to have significant negative impacts on the health and wellbeing of caregivers, but the mechanisms of these effects are poorly understood. This study examined whether depression and anxiety serve as mediators between social support and quality of life caregivers of persons with severe burns injury. Results A sample of 100 caregivers of persons with severe burns injury were administered questionnaires to assess their depression, anxiety, social support and quality of life. Findings show that depression and anxiety were negatively correlated with quality of life whereas social support was positively correlated with quality of life. Results further showed that only depression significantly mediated the link between social support and quality of life among the caregivers. These findings emphasize the need to screen caregivers for common mental health problems and provide them support in the caregiving process to promote their health and wellbeing.

Cost-Effectiveness Analysis of Oral Iron Chelation Therapy with Deferasirox (Exjade®, ICL670) Versus Infusional Chelation Therapy with Deferoxamine in Patients with Transfusion-Dependent Myelodysplastic Syndrome.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5585-5585 ◽  
Author(s):  
Thomas E. Delea ◽  
Simu K. Thomas ◽  
Jean-Francois Baladi ◽  
Pradyumna D. Phatak
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Chelation Therapy ◽  
Iron Chelation ◽  
Iron Chelator ◽  
Iron Chelation Therapy ◽  
The Difference ◽  
One Year ◽  
The Cost

Abstract Background. Patients with symptomatic myelodysplastic syndrome (MDS) frequently receive chronic transfusions, along with chelation therapy to prevent complications of iron overload. Deferoxamine (DFO) is an effective iron chelator, but must be administered as an 8–12 hour infusion 5–7 times per week, leading to poor compliance and/or reduced quality of life. Deferasirox (DSX) is an investigational once-daily oral iron chelator that has been shown to produce reductions in liver iron concentrations and serum ferritin similar to those obtained with DFO. The objective of this analysis was to evaluate from a US perspective the cost-effectiveness (CE) of DSX vs DFO in patients with transfusion-dependent MDS. Methods. Data from a variety of published and unpublished sources were used to estimate the CE of chelation therapy with DSX vs DFO in MDS patients receiving frequent transfusions (≥8 per year). As there are no long-term studies describing the complications of iron overload in MDS, we focused on the short-term (i.e., one year) cost and quality-of-life effects of chelation therapy. As comparative data for DSX vs DFO in MDS are unavailable, we estimated the average dose (mg/kg/d) of DSX based on results for MDS patients in a non-comparative Phase II study. The relative dose of DFO that would result in similar efficacy was based on data from comparative studies in other transfusion-dependent anemias. To be conservative, we assumed that all patients would be fully compliant with chelation therapy. CE was measured in terms of the ratio of the difference (DSX vs DFO) in costs of chelation therapy to the difference in quality adjusted life years (QALYs) over one year of treatment. Analyses were based on the wholesale acquisition cost of generic DFO and the anticipated cost of DSX in the US. Mean weight was estimated to be 70 kg, based on data for MDS patients in DSX clinical studies. The cost of DFO administration was based on analyses of health insurance claims data for patients with transfusion-dependent anemias. Utilities (weights representing patient quality of life) for MDS patients receiving transfusions were based on published data for patients with anemia from metastatic cancer. The difference in quality of life for DSX vs DFO was based on results of a study that used time-trade-off methods to estimate community-based preferences for oral vs infusional iron chelation therapy. Results. Total annual costs are estimated to be $7,679 greater with DSX ($35,672 vs $27,993 with DFO). Annual costs of DFO included $20,185 for drug acquisition and $7,808 for drug administration. One year of treatment with DSX is estimated to result in a gain of 0.23 QALYs (0.78 vs 0.55 with DFO). The CE of DSX vs DFO is therefore estimated to be $33,387 per QALY gained. CE of DSX vs DFO was sensitive to the assumed dosages of DSX and DFO, the cost of infusional therapy, and the decrement in quality of life associated with infusional therapy. Conclusion: The CE of DSX versus DFO in patient with transfusion-dependent MDS is favorable compared with that of other generally-accepted treatments for patients with hematologic/oncologic disorders. These results may be conservative, as they did not consider the potential benefits of improved compliance with DSX or side effects of infusion therapy.

The Cost-effectiveness of Biannual Serum Urate (SU) Monitoring after Reaching Target in Gout: A Health Economic Analysis Comparing SU Monitoring

2018 ◽  
Vol 45 (5) ◽  
pp. 697-704 ◽  
Author(s):  
Philip C. Robinson ◽  
Nicola Dalbeth ◽  
Peter Donovan
Keyword(s):  
Quality Of Life ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Serum Urate ◽  
Base Case ◽  
Component Level ◽  
Health Economic Analysis ◽  
Lifetime Horizon

Objective.The 2012 American College of Rheumatology gout management guidelines recommend monitoring serum urate (SU) every 6 months after target SU has been achieved. Our objective was to determine through modeling whether this testing would be cost-effective, considering financial cost, quality of life, and estimated change in adherence.Methods.A cost-utility analysis was completed with a 3-arm model: (1) no regular urate monitoring; (2) annual urate monitoring; and (3) biannual urate monitoring. Inputs to the model for health-related quality of life, flare rate, and treatment location were drawn from the medical literature and modeled over a lifetime horizon.Results.No monitoring was the least costly (Australian$6974) but least effective [13.51 quality-adjusted life-yrs (QALY)], while annual urate monitoring [A$7117; 13.53 QALY; incremental cost-effectiveness ratio (ICER) A$13,678/QALY gained] and biannual monitoring [A$7298; 13.54 QALY; ICER A$15,420 per QALY gained] were both cost-effective alternatives in base case analysis. Sensitivity analysis on both an individual component level and a probabilistic sensitivity analysis (PSA) demonstrated that the result was robust to changes in input variables. An improvement in adherence of ≥ 3.5% with biannual monitoring was all that was required to demonstrate cost-effectiveness. In PSA, the probability of biannual monitoring was 78%, no monitoring was 20%, and annual monitoring was 2%.Conclusion.The results suggest that biannual SU monitoring after attaining target SU is the most cost-effective, compared with no testing and annual testing.

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