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McPherson S, Oute J, Speed E. Quality-of-life measurement in depression trials: A consumerist relic. Health (London) 2023; 27:647-663. [PMID: 35088607 PMCID: PMC10423430 DOI: 10.1177/13634593221074887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Quality-of-life measurement in depression is advocated as a patient-centred indicator of recovery, but may instead enhance the mimetic authority of randomised controlled trials (RCTs) which have been roundly critiqued in mental health. In this paper we draw on the social life of methods approach to extend the well-developed critique of RCTs into the field of quality-of-life measurement. We accomplish this through consideration and critique of the conceptual and epistemological development of quality-of-life measurement in depression, including the role of psychometrics in its development. Examining conceptual developments from the 1970s onwards, we consider how the scientific literature on quality-of-life in depression aligns with behavioural economics and consumerism but falls short of engaging with genuinely patient-centred approaches to recovery. We argue that quality-of-life measures in depression were developed within a consumerist model of healthcare in which the medical model was a central pillar and 'choice' a rhetorical device only. While quality-of-life instrument development was largely funded by industry, psychometrics provided no coherent solution to the 'affective fallacy' (high correlations between quality-of-life and depressive symptoms). Industry has largely abandoned the measures, while psychotherapy research has increasingly endorsed them. We argue that in their design and implementation, quality-of-life measures for depression remain based on a commercial model of healthcare, are conceptually flawed and do not support concepts of patient-centred healthcare.
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Affiliation(s)
| | - Jeppe Oute
- University of South-Eastern Norway, Norway
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Thomas KH, Dalili MN, López-López JA, Keeney E, Phillippo D, Munafò MR, Stevenson M, Caldwell DM, Welton NJ. Smoking cessation medicines and e-cigarettes: a systematic review, network meta-analysis and cost-effectiveness analysis. Health Technol Assess 2021; 25:1-224. [PMID: 34668482 DOI: 10.3310/hta25590] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cigarette smoking is one of the leading causes of early death. Varenicline [Champix (UK), Pfizer Europe MA EEIG, Brussels, Belgium; or Chantix (USA), Pfizer Inc., Mission, KS, USA], bupropion (Zyban; GlaxoSmithKline, Brentford, UK) and nicotine replacement therapy are licensed aids for quitting smoking in the UK. Although not licensed, e-cigarettes may also be used in English smoking cessation services. Concerns have been raised about the safety of these medicines and e-cigarettes. OBJECTIVES To determine the clinical effectiveness, safety and cost-effectiveness of smoking cessation medicines and e-cigarettes. DESIGN Systematic reviews, network meta-analyses and cost-effectiveness analysis informed by the network meta-analysis results. SETTING Primary care practices, hospitals, clinics, universities, workplaces, nursing or residential homes. PARTICIPANTS Smokers aged ≥ 18 years of all ethnicities using UK-licensed smoking cessation therapies and/or e-cigarettes. INTERVENTIONS Varenicline, bupropion and nicotine replacement therapy as monotherapies and in combination treatments at standard, low or high dose, combination nicotine replacement therapy and e-cigarette monotherapies. MAIN OUTCOME MEASURES Effectiveness - continuous or sustained abstinence. Safety - serious adverse events, major adverse cardiovascular events and major adverse neuropsychiatric events. DATA SOURCES Ten databases, reference lists of relevant research articles and previous reviews. Searches were performed from inception until 16 March 2017 and updated on 19 February 2019. REVIEW METHODS Three reviewers screened the search results. Data were extracted and risk of bias was assessed by one reviewer and checked by the other reviewers. Network meta-analyses were conducted for effectiveness and safety outcomes. Cost-effectiveness was evaluated using an amended version of the Benefits of Smoking Cessation on Outcomes model. RESULTS Most monotherapies and combination treatments were more effective than placebo at achieving sustained abstinence. Varenicline standard plus nicotine replacement therapy standard (odds ratio 5.75, 95% credible interval 2.27 to 14.90) was ranked first for sustained abstinence, followed by e-cigarette low (odds ratio 3.22, 95% credible interval 0.97 to 12.60), although these estimates have high uncertainty. We found effect modification for counselling and dependence, with a higher proportion of smokers who received counselling achieving sustained abstinence than those who did not receive counselling, and higher odds of sustained abstinence among participants with higher average dependence scores. We found that bupropion standard increased odds of serious adverse events compared with placebo (odds ratio 1.27, 95% credible interval 1.04 to 1.58). There were no differences between interventions in terms of major adverse cardiovascular events. There was evidence of increased odds of major adverse neuropsychiatric events for smokers randomised to varenicline standard compared with those randomised to bupropion standard (odds ratio 1.43, 95% credible interval 1.02 to 2.09). There was a high level of uncertainty about the most cost-effective intervention, although all were cost-effective compared with nicotine replacement therapy low at the £20,000 per quality-adjusted life-year threshold. E-cigarette low appeared to be most cost-effective in the base case, followed by varenicline standard plus nicotine replacement therapy standard. When the impact of major adverse neuropsychiatric events was excluded, varenicline standard plus nicotine replacement therapy standard was most cost-effective, followed by varenicline low plus nicotine replacement therapy standard. When limited to licensed interventions in the UK, nicotine replacement therapy standard was most cost-effective, followed by varenicline standard. LIMITATIONS Comparisons between active interventions were informed almost exclusively by indirect evidence. Findings were imprecise because of the small numbers of adverse events identified. CONCLUSIONS Combined therapies of medicines are among the most clinically effective, safe and cost-effective treatment options for smokers. Although the combined therapy of nicotine replacement therapy and varenicline at standard doses was the most effective treatment, this is currently unlicensed for use in the UK. FUTURE WORK Researchers should examine the use of these treatments alongside counselling and continue investigating the long-term effectiveness and safety of e-cigarettes for smoking cessation compared with active interventions such as nicotine replacement therapy. STUDY REGISTRATION This study is registered as PROSPERO CRD42016041302. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 59. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kyla H Thomas
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael N Dalili
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - José A López-López
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Edna Keeney
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - David Phillippo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Marcus R Munafò
- Faculty of Life Sciences, School of Psychological Science, University of Bristol, Bristol, UK.,MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,UK Centre for Tobacco and Alcohol Studies, University of Bristol, Bristol, UK
| | - Matt Stevenson
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Deborah M Caldwell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicky J Welton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Brabyn S, Araya R, Barkham M, Bower P, Cooper C, Duarte A, Kessler D, Knowles S, Lovell K, Littlewood E, Mattock R, Palmer S, Pervin J, Richards D, Tallon D, White D, Walker S, Worthy G, Gilbody S. The second Randomised Evaluation of the Effectiveness, cost-effectiveness and Acceptability of Computerised Therapy (REEACT-2) trial: does the provision of telephone support enhance the effectiveness of computer-delivered cognitive behaviour therapy? A randomised controlled trial. Health Technol Assess 2018; 20:1-64. [PMID: 27922448 DOI: 10.3310/hta20890] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Computerised cognitive behaviour therapy (cCBT) is an efficient form of therapy potentially improving access to psychological care. Indirect evidence suggests that the uptake and effectiveness of cCBT can be increased if facilitated by telephone, but this is not routinely offered in the NHS. OBJECTIVES To compare the clinical effectiveness and cost-effectiveness of telephone-facilitated free-to-use cCBT [e.g. MoodGYM (National Institute for Mental Health Research, Australian National University, Canberra, ACT, Australia)] with minimally supported cCBT. DESIGN This study was a multisite, pragmatic, open, two-arm, parallel-group randomised controlled trial with a concurrent economic evaluation. SETTING Participants were recruited from GP practices in Bristol, Manchester, Sheffield, Hull and the north-east of England. PARTICIPANTS Potential participants were eligible to participate in the trial if they were adults with depression scoring ≥ 10 on the Patient Health Questionnaire-9 (PHQ-9). INTERVENTIONS Participants were randomised using a computer-generated random number sequence to receive minimally supported cCBT or telephone-facilitated cCBT. Participants continued with usual general practitioner care. MAIN OUTCOME MEASURES The primary outcome was self-reported symptoms of depression, as assessed by the PHQ-9 at 4 months post randomisation. SECONDARY OUTCOMES Secondary outcomes were depression at 12 months and anxiety, somatoform complaints, health utility (as assessed by the European Quality of Life-5 Dimensions questionnaire) and resource use at 4 and 12 months. RESULTS Clinical effectiveness: 182 participants were randomised to minimally supported cCBT and 187 participants to telephone-facilitated cCBT. There was a difference in the severity of depression at 4 and 12 months, with lower levels in the telephone-facilitated group. The odds of no longer being depressed (defined as a PHQ-9 score of < 10) at 4 months were twice as high in the telephone-facilitated cCBT group [odds ratio (OR) 2.05, 95% confidence interval (CI) 1.23 to 3.42]. The benefit of telephone-facilitated cCBT was no longer significant at 12 months (OR 1.63, 95% CI 0.98 to 2.71). At 4 months the between-group difference in PHQ-9 scores was 1.9 (95% CI 0.5 to 3.3). At 12 months the results still favoured telephone-facilitated cCBT but were no longer statistically significant, with a difference in PHQ-9 score of 0.9 (95% CI -0.5 to 2.3). When considering the whole follow-up period, telephone-facilitated cCBT was asssociated with significantly lower PHQ-9 scores than minimally supported cCBT (mean difference -1.41, 95% CI -2.63 to -0.17; p = 0.025). There was a significant improvement in anxiety scores over the trial period (between-group difference 1.1, 95% CI 0.1 to 2.3; p = 0.037). In the case of somatic complaints (assessed using the Patient Health Questionnaire-15), there was a borderline statistically significant difference over the trial period (between-group difference 1.1, 95% CI 0.0 to 1.8; p = 0.051). There were gains in quality-adjusted life-years at reduced cost when telephone facilitation was added to MoodGYM. However, the results were subject to uncertainty. CONCLUSIONS The results showed short-term benefits from the addition of telephone facilitation to cCBT. The effect was small to moderate and comparable with that of other primary care psychological interventions. Telephone facilitation should be considered when offering cCBT for depression. LIMITATIONS Participants' depression was assessed with the PHQ-9, cCBT use was quite low and there was a slightly greater than anticipated loss to follow-up. FUTURE RESEARCH RECOMMENDATIONS Improve the acceptability of cCBT and its capacity to address coexisting disorders. Large-scale pragmatic trials of cCBT with bibliotherapy and telephone-based interventions are required. TRIAL REGISTRATION Current Controlled Trials ISRCTN55310481. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 89. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Sally Brabyn
- Department of Health Sciences, University of York, York, UK
| | - Ricardo Araya
- Department of Population Health, Centre of Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Michael Barkham
- Centre for Psychological Services Research, University of Sheffield, Sheffield, UK
| | - Peter Bower
- Centre for Primary Care, University of Manchester, Manchester, UK
| | - Cindy Cooper
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Ana Duarte
- Centre for Health Economics, University of York, York, UK
| | - David Kessler
- Academic Unit of Primary Health Care, University of Bristol, Bristol, UK
| | - Sarah Knowles
- Centre for Primary Care, University of Manchester, Manchester, UK
| | - Karina Lovell
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | | | - Richard Mattock
- Department of Health Sciences, University of York, York, UK.,Centre for Health Economics, University of York, York, UK
| | - Stephen Palmer
- Centre for Health Economics, University of York, York, UK
| | - Jodi Pervin
- Department of Health Sciences, University of York, York, UK
| | - David Richards
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Debbie Tallon
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - David White
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Simon Walker
- Centre for Health Economics, University of York, York, UK
| | | | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
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Jiao B, Rosen Z, Bellanger M, Belkin G, Muennig P. The cost-effectiveness of PHQ screening and collaborative care for depression in New York City. PLoS One 2017; 12:e0184210. [PMID: 28859154 PMCID: PMC5578679 DOI: 10.1371/journal.pone.0184210] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 08/21/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Depression is under-diagnosed and under-treated in most areas of the US. New York City is currently looking to close gaps in identifying and treating depression through the adoption of a screening and collaborative care model deployed throughout the city. METHODS We examine the cost-effectiveness of universal two-stage screening with the 2- and 9-item Patient Health Questionnaires (PHQ-2 and PHQ-9) in New York City followed by collaborative care for those who screen positive. We conducted microsimulations on hypothetical adult participants between ages 20 and 70. RESULTS The incremental cost-effectiveness of the interventions over the average lifespan of a 20-year-old adult in NYC is approximately $1,726/QALY gained (95% plausible interval: cost-saving, $10,594/QALY gained). CONCLUSIONS Two-stage screening coupled with collaborative care for depression in the clinical setting appears to be significantly less expensive than most clinical preventive interventions, such as HIV screening in high-risk patients. However, effectiveness is dependent on the city's ability to manage scale up of collaborative care models.
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Affiliation(s)
- Boshen Jiao
- Mailman School of Public Health, Columbia University, New York, NY, United States of America
- * E-mail:
| | - Zohn Rosen
- Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Martine Bellanger
- Ecole des Hautes Etudes en Santé Publique, 15 Avenue du Professeur Léon-Bernard—CS, Rennes, France
| | - Gary Belkin
- New York City Department of Health and Mental Hygiene, Long Island City, NY, United States of America
| | - Peter Muennig
- Mailman School of Public Health, Columbia University, New York, NY, United States of America
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Yang WC, Lin CH, Wang FC, Lu MJ. Factors related to the improvement in quality of life for depressed inpatients treated with fluoxetine. BMC Psychiatry 2017; 17:309. [PMID: 28841824 PMCID: PMC5574134 DOI: 10.1186/s12888-017-1471-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 08/16/2017] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND The aim of this study was to explore the relationships between depressive symptoms and health-related quality of life (HRQOL) measurements for inpatients with major depressive disorder (MDD) before and after 6-week fluoxetine treatment, and to elucidate the factors related to the HRQOL changes. METHODS A total of 131 inpatients with MDD were enrolled to receive 20 mg of fluoxetine for 6 weeks. Symptom severity and adverse events were assessed at weeks 0, 1, 2, 3, 4, and 6 using the 17-item Hamilton Depression Rating Scale (HAMD-17) and UKU Side Effect Rating Scale, respectively. HRQOL was measured using the Short Form 36 (SF-36), including 8 subscales, physical component summary (PCS) and mental component summary (MCS), at baseline and week 6. Spearman's coefficient, Cohen's d, and multiple linear regression model were used for statistical analysis. RESULTS One hundred and six patients completing all measures at weeks 0 and 6 entered the analysis. HAMD-17 negatively correlated with SF-36 at baseline and week 6. The HAMD-17 had a larger effect size than SF-36. MCS, rather than PCS, showed statistically significant improvement. After using multiple linear regression analysis, age at onset, HAMD-17 score change, and number of adverse events reported during the trial period were related to MCS change after adjusting for confounding variables. CONCLUSIONS Fluoxetine treatment was associated with an improvement in depressive symptomology and HRQOL. Depressive symptoms had a greater extent of change than HRQOL. Clinicians must consider the negative effects of adverse events caused by antidepressants on the improvement of HRQOL. TRIAL REGISTRATION http://clinicaltrials.gov , NCT01075529 , retrospectively registered 24/2/2010.
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Affiliation(s)
- Wei-Cheng Yang
- 0000 0004 0582 5722grid.414813.bKaohsiung Municipal Kai-Syuan Psychiatric Hospital, No.130, Kaisyuan 2nd Road, Lingya District, Kaohsiung City, 80276 Taiwan
| | - Ching-Hua Lin
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, No.130, Kaisyuan 2nd Road, Lingya District, Kaohsiung City, 80276, Taiwan. .,Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, No.100, Shihcyuan 1st Road, Sanmin District, Kaohsiung City, 80708, Taiwan.
| | - Fu-Chiang Wang
- 0000 0004 0582 5722grid.414813.bKaohsiung Municipal Kai-Syuan Psychiatric Hospital, No.130, Kaisyuan 2nd Road, Lingya District, Kaohsiung City, 80276 Taiwan
| | - Mei-Jou Lu
- 0000 0004 0582 5722grid.414813.bKaohsiung Municipal Kai-Syuan Psychiatric Hospital, No.130, Kaisyuan 2nd Road, Lingya District, Kaohsiung City, 80276 Taiwan
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Lissåker CT, Wallert J, Held C, Olsson E. Emotional distress as a predictor of statin non-adherence among Swedish first-time myocardial infarction patients, 2006-2013. J Psychosom Res 2017; 97:30-37. [PMID: 28606496 DOI: 10.1016/j.jpsychores.2017.02.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 02/27/2017] [Accepted: 02/27/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Emotional distress (depression and anxiety) has been known to affect mortality after a myocardial infarction (MI). One possible mechanism is through medication non-adherence. Few studies have investigated the link between statin adherence and emotional distress, and results are not consistent. We aimed to explore whether emotional distress affects adherence among first-time MI patients younger than 75years old receiving a prescription for the first time. METHODS We identified first-MI individuals younger than 75years from the SWEDEHEART national quality registers discharged with a statin prescription. The main exposure was the anxiety/depression portion of the EQ-5D from Interview 1 (6-10weeks post-MI) and Interview 2 (12-14months post-MI). We calculated adherence from the Swedish Prescribed Drugs Register during three observation periods (OP): [1] Interview 1 to Interview 2, [2] one year post Interview 2, and [3] two years post Interview 1. RESULTS Emotional distress at Interview 1 was not associated with statin adherence for OP1 (RR: 0.99, 95% CI: 0.98, 1.01). Emotional distress at Interview 2 was associated with lower adherence one year later (RR: 0.95, 95% CI: 0.93, 0.98). Emotional distress at Interview 1 was associated with a small decrease in adherence in the complete OP for adherence (RR: 0.98, 95% CI: 0.96, 0.99). CONCLUSION Emotional distress was marginally, but independently, associated with lower adherence to statin two years after the MI. Our study suggests that emotional distress may be an important factor for long-term statin adherence, and, thus, may play a clinically important role in long-term outcome.
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Affiliation(s)
- C T Lissåker
- Department of Women's and Children's Health, Uppsala University, Sweden.
| | - J Wallert
- Department of Women's and Children's Health, Uppsala University, Sweden.
| | - C Held
- Uppsala Clinical Research Center, Uppsala University, Sweden; Department of Medical Sciences: Cardiology, Uppsala University, Sweden.
| | - E Olsson
- Department of Women's and Children's Health, Uppsala University, Sweden.
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Zhang F, Yang Y, Huang T, Zhang Y, Zhao L, Li S. Is there a difference between EQ-5D and SF-6D in the clinical setting? a comparative study on the quality of life measured by AIMS2-SF, EQ-5D and SF-6D scales for osteoarthritis patients. Int J Rheum Dis 2016; 21:1185-1192. [PMID: 27463704 DOI: 10.1111/1756-185x.12907] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Fang Zhang
- School of Business Administration; Shenyang Pharmaceutical University; Shenyang China
| | - Yu Yang
- Beijing Union University Hospital; Beijing China
| | - Tao Huang
- Department of Orthopedics; First Affiliated Hospital; China Medical University; Shenyang China
| | - Yiye Zhang
- School of Business Administration; Shenyang Pharmaceutical University; Shenyang China
| | - Li Zhao
- School of Business Administration; Shenyang Pharmaceutical University; Shenyang China
| | - Shuchuen Li
- Discipline of Pharmacy and Experimental Pharmacology; School of Biomedical Sciences and Pharmacy; University of Newcastle; Newcastle New South Wales Australia
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Bauer A, Knapp M, Parsonage M. Lifetime costs of perinatal anxiety and depression. J Affect Disord 2016; 192:83-90. [PMID: 26707352 DOI: 10.1016/j.jad.2015.12.005] [Citation(s) in RCA: 175] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 11/25/2015] [Accepted: 12/07/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Anxiety and depression are common among women during pregnancy and the year after birth. The consequences, both for the women themselves and for their children, can be considerable and last for many years. This study focuses on the economic consequences, aiming to estimate the total costs and health-related quality of life losses over the lifetime of mothers and their children. METHOD A pathway or decision modelling approach was employed, based on data from previous studies. Systematic and pragmatic literature reviews were conducted to identify evidence of impacts of perinatal anxiety and depression on mothers and their children. RESULTS The present value of total lifetime costs of perinatal depression (anxiety) was £75,728 (£34,811) per woman with condition. If prevalence estimates were applied the respective cost of perinatal anxiety and depression combined was about £8500 per woman giving birth; for the United Kingdom, the aggregated costs were £6.6 billion. The majority of the costs related to adverse impacts on children and almost a fifth were borne by the public sector. LIMITATIONS The method was exploratory in nature, based on a diverse range of literature and encountered important data gaps. CONCLUSIONS Findings suggest the need to allocate more resources to support women with perinatal mental illness. More research is required to understand the type of interventions that can reduce long-term negative effects for both mothers and offspring.
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Affiliation(s)
- Annette Bauer
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK.
| | - Martin Knapp
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK
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Vallejo-Torres L, Castilla I, González N, Hunter R, Serrano-Pérez P, Perestelo-Pérez L. Cost-effectiveness of electroconvulsive therapy compared to repetitive transcranial magnetic stimulation for treatment-resistant severe depression: a decision model. Psychol Med 2015; 45:1459-1470. [PMID: 25354790 PMCID: PMC4413854 DOI: 10.1017/s0033291714002554] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 07/04/2014] [Accepted: 09/26/2014] [Indexed: 11/12/2022]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is widely applied to treat severe depression resistant to standard treatment. Results from previous studies comparing the cost-effectiveness of this technique with treatment alternatives such as repetitive transcranial magnetic stimulation (rTMS) are conflicting. METHOD We conducted a cost-effectiveness analysis comparing ECT alone, rTMS alone and rTMS followed by ECT when rTMS fails under the perspective of the Spanish National Health Service. The analysis is based on a Markov model which simulates the costs and health outcomes of individuals treated under these alternatives over a 12-month period. Data to populate this model were extracted and synthesized from a series of randomized controlled trials and other studies that have compared these techniques on the patient group of interest. We measure effectiveness using quality-adjusted life years (QALYs) and characterize the uncertainty using probabilistic sensitivity analyses. RESULTS ECT alone was found to be less costly and more effective than rTMS alone, while the strategy of providing rTMS followed by ECT when rTMS fails is the most expensive and effective option. The incremental cost per QALY gained of this latter strategy was found to be above the reference willingness-to-pay threshold used in these types of studies in Spain and other countries. The probability that ECT alone is the most cost-effective alternative was estimated to be around 70%. CONCLUSIONS ECT is likely to be the most cost-effective option in the treatment of resistant severe depression for a willingness to pay of €30,000 per QALY.
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Affiliation(s)
- L. Vallejo-Torres
- Departamento de Economía de las Instituciones, Estadística Económica y Econometría, Universidad de la Laguna, Spain
- Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain
| | - I. Castilla
- Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Tenerife, Spain
- Fundación Canaria de Investigación y Salud (FUNCIS), Spain
| | - N. González
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain
- Research Unit Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - R. Hunter
- Research Department of Primary Care and Population Health, University College London, UK
| | | | - L. Perestelo-Pérez
- Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain
- Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Tenerife, Spain
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Cost-effectiveness of collaborative care for depression in UK primary care: economic evaluation of a randomised controlled trial (CADET). PLoS One 2014; 9:e104225. [PMID: 25121991 PMCID: PMC4133193 DOI: 10.1371/journal.pone.0104225] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 07/09/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Collaborative care is an effective treatment for the management of depression but evidence on its cost-effectiveness in the UK is lacking. AIMS To assess the cost-effectiveness of collaborative care in a UK primary care setting. METHODS An economic evaluation alongside a multi-centre cluster randomised controlled trial comparing collaborative care with usual primary care for adults with depression (n = 581). Costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICER) were calculated over a 12-month follow-up, from the perspective of the UK National Health Service and Personal Social Services (i.e. Third Party Payer). Sensitivity analyses are reported, and uncertainty is presented using the cost-effectiveness acceptability curve (CEAC) and the cost-effectiveness plane. RESULTS The collaborative care intervention had a mean cost of £272.50 per participant. Health and social care service use, excluding collaborative care, indicated a similar profile of resource use between collaborative care and usual care participants. Collaborative care offered a mean incremental gain of 0.02 (95% CI: -0.02, 0.06) quality-adjusted life-years over 12 months, at a mean incremental cost of £270.72 (95% CI: -202.98, 886.04), and resulted in an estimated mean cost per QALY of £14,248. Where costs associated with informal care are considered in sensitivity analyses collaborative care is expected to be less costly and more effective, thereby dominating treatment as usual. CONCLUSION Collaborative care offers health gains at a relatively low cost, and is cost-effective compared with usual care against a decision-maker willingness to pay threshold of £20,000 per QALY gained. Results here support the commissioning of collaborative care in a UK primary care setting.
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Analysing psychosocial difficulties in depression: a content comparison between systematic literature review and patient perspective. BIOMED RESEARCH INTERNATIONAL 2014; 2014:319634. [PMID: 25009814 PMCID: PMC4070279 DOI: 10.1155/2014/319634] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 05/06/2014] [Accepted: 05/27/2014] [Indexed: 11/17/2022]
Abstract
Despite all the knowledge on depression, it is still unclear whether current literature covers all the psychosocial difficulties (PSDs) important for depressed patients. The aim of the present study was to identify the gaps in the recent literature concerning PSDs and their related variables. Psychosocial difficulties were defined according to the World Health Organization International Classification of Functioning, Disability and Health (ICF). A comparative approach between a systematic literature review, a focus group, and individual interviews with depressed patients was used. Literature reported the main psychosocial difficulties almost fully, but not in the same degree of importance as patients' reports. Furthermore, the covered areas were very general and related to symptomatology. Regarding the related variables, literature focused on clinical variables and treatments above all but did not report that many psychosocial difficulties influence other PSDs. This study identified many existing research gaps in recent literature mainly in the area of related variables of PSDs. Future steps in this direction are needed. Moreover, we suggest that clinicians select interventions covering not only symptoms, but also PSDs and their modifiable related variables. Furthermore, identification of interventions for particular psychosocial difficulties and personalisation of therapies according to individuals' PSDs are necessary.
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Hunter RM, Nazareth I, Morris S, King M. Modelling the cost-effectiveness of preventing major depression in general practice patients. Psychol Med 2014; 44:1381-90. [PMID: 23947797 PMCID: PMC3967840 DOI: 10.1017/s0033291713002067] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 07/02/2013] [Accepted: 07/21/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND The prevention of depression is a key public health policy priority. PredictD is the first risk algorithm for the prediction of the onset of major depression. Our aim in this study was to model the cost-effectiveness of PredictD in depression prevention in general practice (GP). METHOD A decision analytical model was developed to determine the cost-effectiveness of two approaches, each of which was compared to treatment as usual (TAU) over 12 months: (1) the PredictD risk algorithm plus a low-intensity depression prevention programme; and (2) a universal prevention programme in which there was no initial identification of those at risk. The model simulates the incidence of depression and disease progression over 12 months and calculates the net monetary benefit (NMB) from the National Health Service (NHS) perspective. RESULTS Providing patients with PredictD and a depression prevention programme prevented 15 (17%) cases of depression in a cohort of 1000 patients over 12 months and had the highest probability of being the optimal choice at a willingness to pay (WTP) of £20,000 for a quality-adjusted life year (QALY). Universal prevention was strongly dominated by PredictD plus a depression prevention programme in that universal prevention resulted in less QALYs than PredictD plus prevention for a greater cost. CONCLUSIONS Using PredictD to identify primary-care patients at high risk of depression and providing them with a low-intensity prevention programme is potentially cost-effective at a WTP of £20,000 per QALY.
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Affiliation(s)
- R. M. Hunter
- Department of Primary Care and Population Sciences, University College London Medical School, UK
| | - I. Nazareth
- Department of Primary Care and Population Sciences, University College London Medical School, UK
| | - S. Morris
- Department of Applied Health Research, University College London Medical School, UK
| | - M. King
- Department of Mental Health Sciences, University College London Medical School, UK
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Mohiuddin S, Payne K. Utility Values for Adults with Unipolar Depression: Systematic Review and Meta-Analysis. Med Decis Making 2014; 34:666-85. [PMID: 24695961 DOI: 10.1177/0272989x14524990] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 01/28/2014] [Indexed: 01/18/2023]
Abstract
BACKGROUND Unipolar depression is a mental illness with a substantial health-related and economic burden. Health interventions for depression predominately focus on improving sufferers' health-related quality of life (HRQoL). Utility is a measure of HRQoL that is required for use in model-based cost-utility analyses to assess the added value of health interventions. This review aimed to identify, summarize, and where feasible, synthesize published utilities for unipolar depression. METHODS A structured electronic search combining common terms for unipolar depression and utility was conducted in MEDLINE, EMBASE, and PsycINFO. Utility values identified were summarized, and the study designs were appraised in terms of the patient population and valuation method used to generate utilities. Random-effect meta-analyses were applied to pool mean utilities identified for 3 depressive health states (mild, moderate, and severe) elicited from direct and indirect valuation methods separately. RESULTS Thirty-five studies were identified that reported utilities for various levels of depression severity. The most commonly used direct valuation method for eliciting utilities was standard gamble (SG) (n = 5), and the most commonly used indirect valuation method was EQ-5D (n = 20). The pooled mean (standard deviation) utilities from studies using SG as a direct valuation method were mild = 0.69 (0.14), moderate = 0.52 (0.28), and severe = 0.27 (0.26). The pooled utilities from studies using EQ-5D as an indirect valuation method were mild = 0.56 (0.16), moderate = 0.45 (0.18), and severe = 0.25 (0.15). CONCLUSIONS This systematic review is a useful resource for decision analysts who need health-related utility values to populate model-based cost-utility analyses of health interventions for the management of unipolar depression. Further research is necessary to understand whether direct or indirect valuation methods are the most robust sources for utilities in depression.
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Affiliation(s)
- Syed Mohiuddin
- Manchester Centre for Health Economics, Institute of Population Health, University of Manchester, Manchester, UK (SM, KP)
| | - Katherine Payne
- Manchester Centre for Health Economics, Institute of Population Health, University of Manchester, Manchester, UK (SM, KP)
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Sonntag M, König HH, Konnopka A. The estimation of utility weights in cost-utility analysis for mental disorders: a systematic review. PHARMACOECONOMICS 2013; 31:1131-54. [PMID: 24293216 DOI: 10.1007/s40273-013-0107-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To systematically review approaches and instruments used to derive utility weights in cost-utility analyses (CUAs) within the field of mental disorders and to identify factors that may have influenced the choice of the approach. METHODS We searched the databases DARE (Database of Abstracts of Reviews of Effects), NHS EED (National Health Service Economic Evaluation Database), HTA (Health Technology Assessment), and PubMed for CUAs. Studies were included if they were full economic evaluations and reported quality-adjusted life-years as the health outcome. Study characteristics and instruments used to estimate utility weights were described and a logistic regression analysis was conducted to identify factors associated with the choice of either the direct (e.g. standard gamble) or the preference-based measure (PBM) approach (e.g. EQ-5D). RESULTS We identified 227 CUAs with a maximum in 2009, 2010, and 2012. Most CUAs were conducted in depression, dementia, or psychosis, and came from the US or the UK, with the EQ-5D being the most frequently used instrument. The application of the direct approach was significantly associated with depression, psychosis, and model-based studies. The PBM approach was more likely to be used in recent studies, dementia, Europe, and empirical studies. Utility weights used in model-based studies were derived from only a small number of studies. LIMITATIONS We only searched four databases and did not evaluate the quality of the included studies. CONCLUSIONS Direct instruments and PBMs are used to elicit utility weights in CUAs with different frequencies regarding study type, mental disorder, and country.
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Affiliation(s)
- Michael Sonntag
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany,
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Transcranial magnetic stimulation (TMS) for major depression: a multisite, naturalistic, observational study of quality of life outcome measures in clinical practice. CNS Spectr 2013; 18:322-32. [PMID: 23895940 DOI: 10.1017/s1092852913000357] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) is an effective and safe therapy for major depressive disorder (MDD). This study assessed quality of life (QOL) and functional status outcomes for depressed patients after an acute course of TMS. METHODS Forty-two, U.S.-based, clinical TMS practice sites treated 307 outpatients with a primary diagnosis of MDD and persistent symptoms despite prior adequate antidepressant pharmacotherapy. Treatment parameters were based on individual clinical considerations and followed the labeled procedures for use of the approved TMS device. Patient self-reported QOL outcomes included change in the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and the EuroQol 5-Dimensions (EQ-5D) ratings from baseline to end of the acute treatment phase. RESULTS Statistically significant improvement in functional status on a broad range of mental health and physical health domains was observed on the SF-36 following acute TMS treatment. Similarly, statistically significant improvement in patient-reported QOL was observed on all domains of the EQ-5D and on the General Health Perception and Health Index scores. Improvement on these measures was observed across the entire range of baseline depression symptom severity. CONCLUSION These data confirm that TMS is effective in the acute treatment of MDD in routine clinical practice settings. This symptom benefit is accompanied by statistically and clinically meaningful improvements in patient-reported QOL and functional status outcomes.
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Watkins KE, Cuellar AE, Hepner KA, Hunter SB, Paddock SM, Ewing BA, de la Cruz E. The cost-effectiveness of depression treatment for co-occurring disorders: a clinical trial. J Subst Abuse Treat 2013; 46:128-33. [PMID: 24094613 DOI: 10.1016/j.jsat.2013.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 07/15/2013] [Accepted: 08/01/2013] [Indexed: 11/18/2022]
Abstract
The authors aimed to determine the economic value of providing on-site group cognitive behavioral therapy (CBT) for depression to clients receiving residential substance use disorder (SUD) treatment. Using a quasi-experimental design and an intention-to-treat analysis, the incremental cost-effectiveness and cost-utility ratio of the intervention were estimated relative to usual care residential treatment. The average cost of a treatment episode was $908, compared to $180 for usual care. The incremental cost effectiveness ratio was $131 for each point improvement of the BDI-II and $49 for each additional depression-free day. The incremental cost-utility ratio ranged from $9,249 to $17,834 for each additional quality adjusted life year. Although the intervention costs substantially more than usual care, the cost effectiveness and cost-utility ratios compare favorably to other depression interventions. Health care reform should promote dissemination of group CBT to individuals with depression in residential SUD treatment.
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Abstract
BACKGROUND Compared with the United Kingdom, mental health services in Ireland are under-funded and under-developed. This may be partly due to the neglect of economic analyses concerning mental health services in Ireland, as few policy makers would invest in the sector without evidence that such investment represents 'value-for-money' economically. Aim The aim of this paper is to highlight how mental health services can conduct economic service evaluations that ultimately will drive the policy-making agenda and future governmental investment. METHODS A guide to the economic evaluation of mental health services, based on a narrative review of relevant policy documents and papers, in an Irish context. RESULTS Three types of economic analyses that can be undertaken within mental health services are outlined: (a) cost-benefit analysis, (b) cost-utility analysis and (c) cost-minimisation analysis. In addition, a newly formulated questionnaire (i.e. the 'EcoPsy 12') is presented. CONCLUSIONS Economic evaluations of mental health services can provide re-assurances to policy-makers that (much-needed) investment in such services is economically viable.
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Jutkowitz E, Pizzi L, Hess E, Suh DC, Gitlin LN. Comparison of three societally derived health-state classification values among older African Americans with depressive symptoms. Qual Life Res 2013; 22:1491-8. [PMID: 22972437 PMCID: PMC3822045 DOI: 10.1007/s11136-012-0263-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare societal values across three health-state classification systems in older African Americans with depression and to describe the association of these instruments to depression severity. METHODS We summarized baseline values for EQ-5D (US weights) and HUI2/3 (Canadian weights) and their subscales for 118 older African American participants enrolled in a randomized depression treatment trial and calculated correlations between the different instruments. We evaluated ceiling and floor effects for each instrument by comparing the proportion at the highest and lowest possible score for each tool. Also, utility scores were assessed by level of depression severity (mild, moderate, moderate severe, severe) scores as measured by the Patient Health Questionnaire (PHQ-9). RESULTS Mean utility values were 0.58 (SD = 0.21) for EQ-5D, 0.52 (SD = 0.21) for HUI2, and 0.36 (SD = 0.31) for HUI3. For the EQ-5D, 72 % of participants reported having some problems on the anxiety/depression domain. On the emotion domain for the HUI2, 23 % reported the highest level of impairment compared to only 3 % on the HUI3. No participant scored at the floor for the EQ-5D, HUI2, or HUI3 index; one participant scored at the ceiling value on the HUI3 index. Correlations ranged from 0.63 to 0.82 (all of which were significant at an alpha level of 0.05). In general, utility scores trended inversely with depression level. CONCLUSION Small differences in the three preference-weighted health-state classification systems were evident for this sample of older African Americans with depressive symptoms, with HUI scores lower than EQ-5D. For this sample, utility scores were lower (i.e., poorer) than the general United States population with depression on each utility measure.
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Affiliation(s)
- Eric Jutkowitz
- Department of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware Street SE, Minneapolis, MN 55455, USA,
| | - Laura Pizzi
- Department of Pharmacy Practice, Jefferson School of Pharmacy, 130 South 9th Street, Suite 1540, Philadelphia, PA 19107, USA,
| | - Edward Hess
- School of Medicine, Johns Hopkins University, 511 N. Washington Street, Baltimore, MD 21205, USA,
| | - Dong-Churl Suh
- College of Pharmacy, Chung-Ang University, 221 Heukseok-dong, Dongjak-gu, Seoul, South Korea,
| | - Laura N. Gitlin
- Johns Hopkins University School of Nursing Center for Innovative Care in Aging, Johns Hopkins University, 525 Wolfe Street, Suite 316, Baltimore, MD 21205, USA,
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Turner N, Campbell J, Peters TJ, Wiles N, Hollinghurst S. A comparison of four different approaches to measuring health utility in depressed patients. Health Qual Life Outcomes 2013; 11:81. [PMID: 23659557 PMCID: PMC3663709 DOI: 10.1186/1477-7525-11-81] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 05/07/2013] [Indexed: 03/17/2023] Open
Abstract
Background A variety of instruments are used to measure health related quality of life. Few data exist on the performance and agreement of different instruments in a depressed population. The aim of this study was to investigate agreement between, and suitability of, the EQ-5D-3L, EQ-5D Visual Analogue Scale (EQ-5D VAS), SF-6D and SF-12 new algorithm for measuring health utility in depressed patients. Methods The intraclass correlation coefficient (ICC) and Bland and Altman approaches were used to assess agreement. Instrument sensitivity was analysed by: (1) plotting utility scores for the instruments against one another; (2) correlating utility scores and depressive symptoms (Beck Depression Inventory (BDI)); and (3) using Tukey’s procedure. Receiver Operating Characteristic (ROC) analysis assessed instrument responsiveness to change. Acceptability was assessed by comparing instrument completion rates. Results The overall ICC was 0.57. Bland and Altman plots showed wide limits of agreement for each pair wise comparison, except between the SF-6D and SF-12 new algorithm. Plots of utility scores displayed ’ceiling effects’ in the EQ-5D-3L index and ’floor effects’ in the SF-6D and SF-12 new algorithm. All instruments showed a negative monotonic relationship with BDI, but the EQ-5D-3L index and EQ-5D VAS could not differentiate between depression severity sub-groups. The SF-based instruments were better able to detect changes in health state over time. There was no difference in completion rates of the four instruments. Conclusions There was a lack of agreement between utility scores generated by the different instruments. According to the criteria of sensitivity, responsiveness and acceptability that we applied, the SF-6D and SF-12 may be more suitable for the measurement of health related utility in a depressed population than the EQ-5D-3L, which is the instrument currently recommended by NICE.
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Affiliation(s)
- Nicholas Turner
- Centre for Mental Health, Addiction and Suicide Research, School of Social and Community Medicine, University of Bristol, Oakfield House, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK.
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Quality of life, health status, and depression: comparison between adolescents and adults after the Fontan procedure with healthy counterparts. J Cardiovasc Nurs 2013; 27:539-46. [PMID: 21912272 DOI: 10.1097/jcn.0b013e31822ce5f6] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Quality of life (QOL) in adolescents and adults who have undergone the Fontan procedure and are living with only 1 ventricle is presumed to be diminished. OBJECTIVES This study aimed to compare QOL, health status, and prevalence of depression in adolescents/adults after the Fontan procedure with healthy counterparts and to identify predictors of QOL in the Fontan group. METHODS Using a comparative, cross-sectional design, 54 adolescents and adults with single ventricle congenital heart disease who have undergone the Fontan procedure were compared with 66 age-matched healthy counterparts. Quality of life, health status, depression, and social support were measured using the Satisfaction With Life Scale, Short Form Survey Version 2, Patient Health Questionnaire Depression Module, and Multidimensional Scale of Perceived Social Support. Clinical variables were abstracted from medical records. Predictors of QOL were determined using multiple linear regression. RESULTS Adolescents and adults in the Fontan group reported lower physical health status (mean [SD] = 46.5 [9.3] vs mean [SD] = 55.9 [5.1], P < .001) and were more depressed (mean [SD] = 7.3 [5.9] vs mean [SD] = 4.5 [4.3], P < .004) than their healthy counterparts. There were no differences in QOL, mental health status, or social support between the 2 groups. Functional status (New York Heart Association class), depression, and social support accounted for 55% of the variance in QOL in the Fontan group. CONCLUSIONS Despite lower levels of physical health, the QOL of Fontan patients was comparable with that of their healthy counterparts; this finding contradicts previous proxy reports, self-reports, and assumptions that QOL is lower in patients with complex single ventricle congenital heart disease. However, because Fontan patients were more depressed than their healthy counterparts, the need for early screening and detection is warranted.
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Lipton RB, Buse DC, Serrano D. Assessing the quality of health-related quality of life measures. Cephalalgia 2012; 33:223-5. [DOI: 10.1177/0333102412468681] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Richard B Lipton
- Albert Einstein College of Medicine, USA
- Montefiore Headache Center, USA
| | - Dawn C Buse
- Albert Einstein College of Medicine, USA
- Montefiore Headache Center, USA
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Cabello M, Mellor-Marsá B, Sabariego C, Cieza A, Bickenbach J, Ayuso-Mateos JL. Psychosocial features of depression: a systematic literature review. J Affect Disord 2012; 141:22-33. [PMID: 22209189 DOI: 10.1016/j.jad.2011.12.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 12/07/2011] [Accepted: 12/09/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite the great burden of depression on sufferers and society, there is a lack of reliable information regarding the full range of psychosocial difficulties associated with depression and their related variables. This systematic review aimed to demonstrate the utility of the International Classification of Functioning, Disability and Health (ICF) in describing the psychosocial difficulties that shape the lived experience of persons with depression. METHODS An electronic search that included publications from 2005 to 2010 in the MEDLINE and PsycHINFO databases was conducted to collect psychosocial outcomes. Quality of studies was also considered. RESULTS 103 studies were included. 477 outcomes referring psychosocial difficulties were extracted and grouped into 32 ICF related categories. Emotional functions (19% of studies), followed by energy and drive (17% of studies), were the most frequent psychosocial outcomes. The onset, course, determinants, and related variables of the most important psychosocial difficulties, reported in at least 10% of studies, were described. Medication played a dual role as determinant of onset and change in some psychosocial areas, e.g. in pain, sleep, and energy and drive. LIMITATIONS The search was limited by year of publication and focused only on minor and major depression diagnoses: other depressive disorders were not included. Some underresearched, but relevant psychosocial areas could have not been analyzed. CONCLUSIONS The present systematic review provides information on the psychosocial difficulties that depressive patients face in their daily lives. Future studies on depression should include outcome instruments that cover these relevant areas in order to comprehensively describe psychosocial functioning.
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Affiliation(s)
- Maria Cabello
- Instituto de Salud Carlos III, Centro de Investigación en Red de Salud Mental, CIBERSAM, Spain
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Whitehurst DGT, Bryan S, Lewis M. Systematic Review and Empirical Comparison of Contemporaneous EQ-5D and SF-6D Group Mean Scores. Med Decis Making 2011; 31:E34-44. [DOI: 10.1177/0272989x11421529] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background. Group mean estimates and their underlying distributions are the focus of assessment for cost and outcome variables in economic evaluation. Research focusing on the comparability of alternative preference-based measures of health-related quality of life has typically focused on analysis of individual-level data within specific clinical specialties or community-based samples. Purpose. To explore the relationship between group mean scores for the EQ-5D and SF-6D across the utility scoring range. Methods. Studies were identified via a systematic search of 13 online electronic databases, a review of reference lists of included papers, and hand searches of key journals. Studies were included if they reported contemporaneous mean EQ-5D and SF-6D health state scores. All (sub)group comparisons of group mean EQ-5D and SF-6D scores identifiable from text, tables, or figures were extracted from identified studies. A total of 921 group mean comparisons were extracted from 56 studies. The nature of the relationship between the paired scores was examined using ranked scatter graphs and analysis of agreement. Results. Systematic differences in group mean estimates were observed at both ends of the utility scale. At the lower (upper) end of the scale, the SF-6D (EQ-5D) provides higher mean utility estimates. Conclusions. These findings show that group mean EQ-5D and SF-6D scores are not directly comparable. This raises serious concerns about the cross-study comparability of economic evaluations that differ in the choice of preference-based measures, although the review focuses on 2 of the available instruments only. Further work is needed to address the practical implications of noninterchangeable utility estimates for cost-per-QALY estimates and decision making.
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Affiliation(s)
- David G. T. Whitehurst
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada (DGTW, SB)
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Staffordshire, UK (DGTW, ML)
| | - Stirling Bryan
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada (DGTW, SB)
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Staffordshire, UK (DGTW, ML)
| | - Martyn Lewis
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada (DGTW, SB)
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Staffordshire, UK (DGTW, ML)
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Development and validation of a 6-day standard for the identification of frequent mental distress. Soc Psychiatry Psychiatr Epidemiol 2011; 46:403-11. [PMID: 20401465 DOI: 10.1007/s00127-010-0204-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2009] [Accepted: 02/23/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE The goals of the current study were to assess the concurrent validity of a single-item measure of general mental distress with established, multi-item mental health measures used in population-level surveillance and to establish the optimal cutpoint for determining psychological distress (previously identified as frequent mental distress) using recently available data from the Behavioral Risk Factor Surveillance System survey. METHODS Data for this study were obtained from the core questionnaire and two optional modules available as part of the 2006 and 2007 Behavioral Risk Factor Surveillance System (BRFSS) surveys. Frequent mental distress (FMD) was identified by the number of days of self-reported poor mental health during the last 30 days. Comparisons of the number of days with poor mental health and positive scores for measures of depression and serious mental illness were calculated to identify the most efficient cutpoint for establishing FMD. RESULTS Comparisons of results obtained from ROC analyses using the PHQ-8 and K6 reported 0.867 (95% CI 0.861-0.872) and 0.840 (95% CI 0.836-0.845) of the area under the curve, respectively, suggesting good accuracy. Using the Youden index, 6 days of poor mental health in the past 30 days, rather than the existing 14-day standard, was identified as the point at which the sum of the sensitivity and specificity was greatest. CONCLUSION Results from this study suggest that a 6-day standard (FMD-6) can be used as a valid and reliable indicator of generalized mental distress with strong associations to both diagnosable depressive symptomology and serious mental illness.
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Lambert RA, Lorgelly P, Harvey I, Poland F. Cost-effectiveness analysis of an occupational therapy-led lifestyle approach and routine general practitioner's care for panic disorder. Soc Psychiatry Psychiatr Epidemiol 2010; 45:741-50. [PMID: 19688282 DOI: 10.1007/s00127-009-0114-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Accepted: 07/31/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess the cost-effectiveness of an occupational therapy-led lifestyle approach to treating panic disorder in primary care compared with routine general practitioner's (GP) care. The burden of mental health disorders is considerable. Cost-effective interventions are necessary to alleviate some of these burdens. Habitual lifestyle behaviours influence mood, although to date mainly single lifestyle factor trials have been conducted to examine the effects on anxiety. METHODS An economic evaluation was conducted alongside an unblinded pragmatic randomised controlled trial with assessment at 5 and 10 months. Costs and consequences, as measured by the Beck anxiety inventory (BAI) and quality adjusted life years (QALYs), were compared using incremental cost-effectiveness ratios (ICERs). RESULTS The occupational therapy-led lifestyle intervention was more costly than routine GP care at both 5 and 10 months. Significant outcome improvements were evident at 5 months when using the BAI, although these were not maintained at 10 months. Small differences in mean QALYs were found. The estimated ICER was 36 pounds per BAI improvement for 5 months and 39 pounds for 10 months, and 18,905 pounds per QALY gained for 5 months and 8,283 pounds for 10 months. CONCLUSIONS If the maximum willingness to pay per additional QALY is 30,000 pounds, then there is an 86% chance that a lifestyle intervention may be considered to be value-for-money over 10 months.
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Affiliation(s)
- Rodney A Lambert
- School of Allied Health Professions, University of East Anglia, Norwich, UK.
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