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Janssen LMM, Drost RMWA, Paulus ATG, Garfield K, Hollingworth W, Noble S, Thorn JC, Pokhilenko I, Evers SMAA. Aspects and Challenges of Resource Use Measurement in Health Economics: Towards a Comprehensive Measurement Framework. PHARMACOECONOMICS 2021; 39:983-993. [PMID: 34169466 PMCID: PMC8352823 DOI: 10.1007/s40273-021-01048-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 06/02/2023]
Abstract
BACKGROUND While the methods for conducting health economics research in general are improving, current guidelines provide limited guidance regarding resource use measurement (RUM). Consequently, a variety of methods exists, yet there is no overview of aspects to consider when deciding on the most appropriate RUM methodology. Therefore, this study aims to (1) identify and categorize existing knowledge regarding aspects of RUM, and (2) develop a framework that provides a comprehensive overview of methodological aspects regarding RUM. METHODS Relevant articles were identified by enrolling a search string in six databases and handsearching the DIRUM database. Included articles were descriptively reviewed and served as input for a comprehensive framework. Health economics experts were involved during the process to establish the framework's face validity. RESULTS Forty articles were included in the scoping review. The RUM framework consists of four methodological RUM domains: 'Whom to measure', addressing whom to ask and whom to measure; 'How to measure', addressing the different approaches of measurement; 'How often to measure', addressing recall period and measurement patterns; and 'Additional considerations', which covers additional aspects that are essential for further refining the methodologies for measurement. Evidence retrieved from the scoping review was categorized according to these domains. CONCLUSION This study clustered the aspects of RUM methodology in health economics into a comprehensive framework. The results may guide health economists in their decision making regarding the selection of appropriate RUM methods and developing instruments for RUM. Furthermore, policy makers may use these findings to review study results from an evidence-based perspective.
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Affiliation(s)
- Luca M M Janssen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, Maastricht, The Netherlands.
| | - Ruben M W A Drost
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, Maastricht, The Netherlands
| | - Aggie T G Paulus
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, Maastricht, The Netherlands
| | - Kirsty Garfield
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Sian Noble
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Joanna C Thorn
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Irina Pokhilenko
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, Maastricht, The Netherlands
| | - Silvia M A A Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, Maastricht, The Netherlands
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Centre for Economic Evaluation and Machine Learning, Utrecht, The Netherlands
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Drake RE, Luciano AE, Mueser KT, Covell NH, Essock SM, Xie H, McHugo GJ. Longitudinal Course of Clients With Co-occurring Schizophrenia-Spectrum and Substance Use Disorders in Urban Mental Health Centers: A 7-Year Prospective Study. Schizophr Bull 2016; 42:202-11. [PMID: 26294706 PMCID: PMC4681561 DOI: 10.1093/schbul/sbv110] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE A previous longitudinal study in rural New Hampshire showed that community mental health center clients with co-occurring schizophrenia-spectrum and substance use disorders (SZ/SUD) improved steadily and substantially over 10 years. The current study examined 7 years of prospective clinical and functional outcomes among inner-city Connecticut (CT) community mental health center clients with SZ/SUD. METHOD Participants were 150 adults with SZ/SUD, selected for high service needs, in 2 inner-city mental health centers in CT. Initially, all received integrated mental health and substance abuse treatments for at least the first 3 years as part of a clinical trial. Assessments at baseline and yearly over 7 years measured progress toward 6 target clinical and functional outcomes: absence of psychiatric symptoms, remission of substance abuse, independent housing, competitive employment, social contact with non-users of substances, and life satisfaction. RESULTS The CT SZ/SUD participants improved significantly on 5 of the 6 main outcomes: absence of psychiatric symptoms (45%-70%), remission of substance use disorders (8%-61%), independent housing (33%-47%), competitive employment (14%-28%), and life satisfaction (35%-53%). Only social contact with nonusers of substances was unimproved (14%-17%). CONCLUSIONS Many urban community mental health center clients with SZ/SUD and access to integrated treatment improve significantly on clinical, vocational, residential, and life satisfaction outcomes over time, similar to clients with SZ/SUD in rural areas. Thus, the long-term course for people with SZ/SUD is variable but often quite positive.
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Affiliation(s)
- Robert E. Drake
- Department of Psychiatry, Dartmouth Psychiatric Research Center, Lebanon, NH;,*To whom correspondence should be addressed; Department of Psychiatry, Dartmouth Psychiatric Research Center, Lebanon, NH, e-mail:
| | - Alison E. Luciano
- Department of Psychiatry, Dartmouth Psychiatric Research Center, Lebanon, NH
| | - Kim T. Mueser
- Department of Occupational Therapy, Center for Psychiatric Rehabilitation, Boston, MA
| | - Nancy H. Covell
- Department of Psychiatry, Columbia Medical School, New York, NY
| | - Susan M. Essock
- Department of Psychiatry, Columbia Medical School, New York, NY
| | - Haiyi Xie
- Department of Psychiatry, Dartmouth Psychiatric Research Center, Lebanon, NH
| | - Gregory J. McHugo
- Departments of Psychiatry and Community and Family Medicine, Dartmouth Medical School, Lebanon, NH
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Seidl H, Meisinger C, Wende R, Holle R. Empirical analysis shows reduced cost data collection may be an efficient method in economic clinical trials. BMC Health Serv Res 2012; 12:318. [PMID: 22978572 PMCID: PMC3520702 DOI: 10.1186/1472-6963-12-318] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 09/11/2012] [Indexed: 12/13/2022] Open
Abstract
Background Data collection for economic evaluation alongside clinical trials is burdensome and cost-intensive. Limiting both the frequency of data collection and recall periods can solve the problem. As a consequence, gaps in survey periods arise and must be filled appropriately. The aims of our study are to assess the validity of incomplete cost data collection and define suitable resource categories. Methods In the randomised KORINNA study, cost data from 234 elderly patients were collected quarterly over a 1-year period. Different strategies for incomplete data collection were compared with complete data collection. The sample size calculation was modified in response to elasticity of variance. Results Resource categories suitable for incomplete data collection were physiotherapy, ambulatory clinic in hospital, medication, consultations, outpatient nursing service and paid household help. Cost estimation from complete and incomplete data collection showed no difference when omitting information from one quarter. When omitting information from two quarters, costs were underestimated by 3.9% to 4.6%. With respect to the observed increased standard deviation, a larger sample size would be required, increased by 3%. Nevertheless, more time was saved than extra time would be required for additional patients. Conclusion Cost data can be collected efficiently by reducing the frequency of data collection. This can be achieved by incomplete data collection for shortened periods or complete data collection by extending recall windows. In our analysis, cost estimates per year for ambulatory healthcare and non-healthcare services in terms of three data collections was as valid and accurate as a four complete data collections. In contrast, data on hospitalisation, rehabilitation stays and care insurance benefits should be collected for the entire target period, using extended recall windows. When applying the method of incomplete data collection, sample size calculation has to be modified because of the increased standard deviation. This approach is suitable to enable economic evaluation with lower costs to both study participants and investigators. Trial registration The trial registration number is ISRCTN02893746
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Affiliation(s)
- Hildegard Seidl
- Helmholtz Zentrum München-German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Munich, Germany.
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Brunette MF, Dawson R, O'Keefe CD, Narasimhan M, Noordsy DL, Wojcik J, Green AI. A randomized trial of clozapine vs. other antipsychotics for cannabis use disorder in patients with schizophrenia. J Dual Diagn 2011; 7:50-63. [PMID: 25914610 PMCID: PMC4407140 DOI: 10.1080/15504263.2011.570118] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Cannabis use disorder is the most common co-occurring drug use disorder in people with schizophrenia and is associated with poor outcomes. We launched a randomized controlled trial to assess the impact of clozapine compared with treatment as usual on cannabis use in patients with schizophrenia and co-occurring cannabis use disorder. METHODS Thirty-one patients with schizophrenia and co-occurring cannabis use disorder were randomly assigned to switch to clozapine or to stay on their current antipsychotic and were then followed weekly for 12 weeks. Blinded raters assessed participants weekly with the Timeline Follow-back for substance use and the expanded Brief Psychiatric Rating Scale for symptoms. Longitudinal random effects models were used to investigate the time-varying differences in cannabis use and other outcomes between the treatment as usual and clozapine groups. RESULTS The two groups differed in average intensity of cannabis use by approximately 4.5 joints/week, with lesser use in the clozapine group (t = -1.77; df = 28.5; p=.086; effect size ~ 0.6). Symptoms and functioning were not different between the two groups. CONCLUSIONS Clozapine may reduce cannabis use among patients with schizophrenia and co-occurring cannabis use disorder. Further controlled trials are warranted.
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Affiliation(s)
- Mary F Brunette
- Department of Psychiatry, Dartmouth Medical School, Hanover, New Hampshire 03755
| | - Ree Dawson
- Frontier Science Research and Technology, Boston, MA
| | | | - Meera Narasimhan
- Department of Psychiatry, University of South Carolina, Columbia, SC
| | - Douglas L Noordsy
- Department of Psychiatry, Dartmouth Medical School, Hanover, New Hampshire 03755
| | - Joanne Wojcik
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Alan I Green
- Department of Psychiatry, Dartmouth Medical School, Hanover, New Hampshire 03755
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Brunette MF, Drake RE, Xie H, McHugo GJ, Green AI. Clozapine use and relapses of substance use disorder among patients with co-occurring schizophrenia and substance use disorders. Schizophr Bull 2006; 32:637-43. [PMID: 16782758 PMCID: PMC2632279 DOI: 10.1093/schbul/sbl003] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Previous correlational research with schizophrenic patients has suggested that the second-generation antipsychotic medication clozapine helps to induce remissions of substance use disorder in patients with co-occurring psychosis and substance abuse. This research, however, could be biased by selection factors. Studying patients who are currently in substance abuse remission could control for level of motivation to stop using substances and other methodological confounds. METHODS To test whether clozapine was associated with prevention of substance abuse relapses, we examined patients with schizophrenia or schizoaffective disorder who were in their first 6-month remission of substance use disorder during a prospective 10-year follow-up study. All patients received yearly multimodal assessments of substance use. Antipsychotic medications were prescribed by community doctors as part of usual clinical care. RESULTS Patients using clozapine at the first 6-month period of substance abuse remission (n = 25) were much less likely to relapse over the next year compared with those on other antipsychotic medications (n = 70): 8.0% vs 40.0%, chi(2) = 8.73 (df = 1), P = .003. Although medication assignment was not randomized, several potential confounders were similar between the groups. CONCLUSION Clozapine should be considered for the treatment of patients with schizophrenia and co-occurring substance use disorder to prevent relapses to substance abuse.
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Affiliation(s)
- Mary F Brunette
- Department of Psychiatry, Dartmouth Medical School, New Hampshire-Dartmouth Psychiatric Research Center, Concord, NH 03301, USA.
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Brent RJ. The role of public and private transfers in the cost-benefit analysis of mental health programs. HEALTH ECONOMICS 2004; 13:1125-1136. [PMID: 15386671 DOI: 10.1002/hec.899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This paper revisits the issue of whether to include maintenance costs in an economic evaluation in mental health. The source of these maintenance costs may be public or private transfers. The issue is discussed in terms of a formal cost-benefit criterion. It is shown that, when transfers have productivity effects, income distribution is important, and one recognizes that public transfers have tax implications, transfers can have real resource effects and cannot be ignored. The criterion is then applied to an evaluation of three case management programs in California that sought to reduce the intensive hospitalization of the severely mentally ill.
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Affiliation(s)
- Robert J Brent
- Department of Economics, Fordham University, Bronx, New York 10458, USA.
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Rozario PA, Morrow-Howell N, Proctor E. Comparing the Congruency of Self-Report and Provider Records of Depressed Elders??? Service Use by Provider Type. Med Care 2004; 42:952-9. [PMID: 15377927 DOI: 10.1097/00005650-200410000-00003] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND An accurate accounting of service use is necessary to understand use patterns and outcomes. Yet such an accounting remains challenging, in part because of the reliability and validity of the collection method and sources. OBJECTIVES This study describes 2 methods of data collection: self-report and the retrieval of provider records. We report on the effort, yield, and challenges of retrieving records. Then, we compare the congruency and completeness of 2 methods: self-report and provider records. Finally, we examine the impact of various patients' characteristics on congruency rates. METHOD Our sample of depressed older participants was recruited from an inpatient geropsychiatry unit before they were discharged into the community. We interviewed participants at 3 points during a 6-month period. Provider records were obtained across provider type, based on self-report and snowballing technique. We calculated congruency rates and examined completeness of either data source on 91 participants with completed provider records. Using logistic regression, we examined the differences in congruency by provider type as well as factors related to the congruency. RESULTS The record retrieval process is labor-intensive and challenging. We found that congruency rates were statistically higher for pharmacy and hospital providers and lower for physicians. We also found higher counts of service use, higher depression levels, and being married were significantly related with lower congruency between self-report of service use and provider records. DISCUSSION Although we found relatively high congruency rates between self-report and service records, the choice of methods depends on the purpose of the research and breadth of provider types.
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Affiliation(s)
- Philip A Rozario
- Adelphi University School of Social Work, Garden City, New York, USA.
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Chisholm D, Knapp MR, Knudsen HC, Amaddeo F, Gaite L, van Wijngaarden B. Client Socio-Demographic and Service Receipt Inventory--European Version: development of an instrument for international research. EPSILON Study 5. European Psychiatric Services: Inputs Linked to Outcome Domains and Needs. Br J Psychiatry Suppl 2000:s28-33. [PMID: 10945075 DOI: 10.1192/bjp.177.39.s28] [Citation(s) in RCA: 352] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cross-cultural comparison of mental health service utilisation and costs is complicated by the heterogeneity of service systems. For data to be locally meaningful yet internationally comparable, a carefully constructed approach to its collection is required. AIMS To develop a research method and instrument for the collection of data on the service utilisation and related characteristics of people with mental disorders, as the basis for calculating the costs of care. METHOD Various approaches to the collection of service use data and key stages of instrument development were identified in order to select the most appropriate methods. RESULTS Based on previous work, and following translation and cross-cultural validation, an instrument was developed: the Client Socio-Demographic and Service Receipt Inventory--European Version (CSSRI-EU). This was subsequently administered to 404 people with schizophrenia across five countries. CONCLUSION The CSSRI-EU provides a standardised yet adaptable method for collating service receipt and associated data alongside assessment of patient outcomes.
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Affiliation(s)
- D Chisholm
- Centre for the Economics of Mental Health, King's College, London
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Abstract
Co-occurring substance abuse is common among people with chronic mental illnesses such as schizophrenia. Although gender differences have been established among substance abusers in the general population and among people with schizophrenia, little is known about gender differences in people with the dual disorders of schizophrenia and substance abuse. This study examines gender differences in 37 women and 135 men with dual disorders, and finds many differences consistent with those found in people with single disorders: dually diagnosed women had more social contact and fewer legal problems but greater problems with victimization and medical illness compared with dually diagnosed men. Unexpectedly, men and women had similar courses and severities of substance abuse. These findings may be critical in planning effective services that explicitly address women's family and social needs, issues related to victimization, and high rates of medical illness.
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Affiliation(s)
- M F Brunette
- New Hampshire-Dartmouth Psychiatric Research Center, Lebanon, USA
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