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Kypriotakis G, Kim S, Karam-Hage M, Robinson JD, Minnix JA, Blalock JA, Cui Y, Beneventi D, Kim B, Pan IW, Shih YCT, Cinciripini PM. Examining the Association between Abstinence from Smoking and Healthcare Costs among Patients with Cancer. Cancer Prev Res (Phila) 2024; 17:217-225. [PMID: 37940143 PMCID: PMC11097145 DOI: 10.1158/1940-6207.capr-23-0245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/26/2023] [Accepted: 11/03/2023] [Indexed: 11/10/2023]
Abstract
Continuous tobacco use in patients with cancer is linked to substantial healthcare costs due to increased risks and complications, whereas quitting smoking leads to improved treatment outcomes and cost reductions. Addressing the need for empirical evidence on the economic impact of smoking cessation, this study examined the association between smoking cessation and healthcare cost utilization among a sample of 930 patients with cancer treated at The University of Texas MD Anderson Cancer Center's Tobacco Research and Treatment Program (TRTP). Applying conditional quantile regression and propensity scores to address confounding, our findings revealed that abstinence achieved through the TRTP significantly reduced the median cost during a 3-month period post-quitting by $1,095 [β = -$1,095, P = 0.007, 95% confidence interval (CI), = (-$1,886 to -$304)]. Sensitivity analysis corroborated these conclusions, showing a pronounced cost reduction when outlier data were excluded. The long-term accrued cost savings from smoking cessation could potentially offset the cost of participation in the TRTP program, underscoring its cost effectiveness. An important implication of this study is that by reducing smoking rates, healthcare systems can more efficiently allocate resources, enhance patient health outcomes, and lessen the overall cancer burden. PREVENTION RELEVANCE This study emphasizes the dual impact of smoking cessation programs in patients with cancer: quitting smoking and reducing healthcare costs. It highlights the importance of integrating cessation programs into cancer prevention strategies, ensuring both individual health benefits and broader, system-wide economic efficiencies. See related Spotlight, p. 197.
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Affiliation(s)
- George Kypriotakis
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Seokhun Kim
- Center for Clinical Research and Evidence-Based Medicine, The University of Texas McGovern Medical School at Houston, Houston, TX
| | - Maher Karam-Hage
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jason D Robinson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jennifer A Minnix
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Janice A Blalock
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yong Cui
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Diane Beneventi
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - I-Wen Pan
- Department of Health Services Research The University of Texas MD Anderson Cancer Center, Houston, Texas (All work on this manuscript was conducted prior to Dr. Pan’s departure from The University of Texas MD Anderson Cancer Center.)
| | - Ya-Chen Tina Shih
- Program in Cancer Health Economics Research, UCLA Jonsson Cancer Center and School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Paul M Cinciripini
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Matthews SR, Elizabeth M, Roberts LN, Kaambwa B, Wade TD, Nixon RDV. Assessing the validity and responsiveness of a generic preference quality of life measure in the context of posttraumatic stress disorder. Qual Life Res 2023; 32:2817-2827. [PMID: 37179519 PMCID: PMC10474197 DOI: 10.1007/s11136-023-03432-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE There is limited research exploring the usefulness of generic preference-based quality of life (GPQoL) measures used to facilitate economic evaluation in the context of posttraumatic stress disorder (PTSD). The aim of the current study was to explore the validity and responsiveness of a common GPQoL measure (Assessment of Quality of Life 8 Dimension [AQoL-8D]) in relation to a PTSD condition-specific outcome measure (Posttraumatic Stress Disorder Checklist for the DSM-5 [PCL-5]). METHOD This aim was investigated in a sample of individuals (N = 147) who received trauma-focused cognitive-behavioural therapies for posttraumatic stress disorder. Convergent validity was investigated using spearman's correlations, and the level of agreement was investigated using Bland-Altman plots. Responsiveness was investigated by exploring the standardised response means (SRM) from pre-post-treatment across the two measures, which allow the comparison of the magnitude of change between the measures over time. RESULTS Correlations between the AQoL-8D (dimensions, utility and summary total scores) and the PCL-5 total score ranged from small to large and agreement between the measures was considered moderate to good. While SRMs were large for the AQoL-8D and PCL-5 total scores, the SRM for the PCL-5 was nearly double that of the AQoL-8D. CONCLUSION Our findings demonstrate that the AQoL-8D has good construct validity but present preliminary evidence that economic evaluations using only GPQoL measures may not fully capture the effectiveness of PTSD treatments.
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Affiliation(s)
- Sheradyn R. Matthews
- College of Education, Psychology and Social Work, Flinders University, P.O. Box 2100, Adelaide, SA 5001 Australia
| | - Marja Elizabeth
- College of Education, Psychology and Social Work, Flinders University, P.O. Box 2100, Adelaide, SA 5001 Australia
| | - Larissa N. Roberts
- College of Education, Psychology and Social Work, Flinders University, P.O. Box 2100, Adelaide, SA 5001 Australia
| | - Billingsley Kaambwa
- College of Medicine and Public Health, Flinders University, P.O Box 2100, Adelaide, SA 5001 Australia
| | - Tracey D. Wade
- Flinders University Institute for Mental Health and Wellbeing, P.O Box 2100, Adelaide, SA 5001 Australia
- College of Education, Psychology and Social Work, Flinders University, P.O. Box 2100, Adelaide, SA 5001 Australia
| | - Reginald D. V. Nixon
- Flinders University Institute for Mental Health and Wellbeing, P.O Box 2100, Adelaide, SA 5001 Australia
- College of Education, Psychology and Social Work, Flinders University, P.O. Box 2100, Adelaide, SA 5001 Australia
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Kumar P, Brander L, Kumar M, Cuijpers P. Planetary Health and Mental Health Nexus: Benefit of Environmental Management. Ann Glob Health 2023; 89:49. [PMID: 37521755 PMCID: PMC10377746 DOI: 10.5334/aogh.4079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/26/2023] [Indexed: 08/01/2023] Open
Abstract
Background Human activities have induced unprecedented global shifts in natural systems including the climate, the oceans, cryosphere and biosphere. The impacts of these changes on physical health are clear and are accelerating at an alarming rate. Climate change and its consequences, especially disruptive events like floods, droughts and heat waves also impact the mental health of affected populations, increasing risk for post-traumatic stress, depression and anxiety disorders. However, the impact of climate change on mental health is not well examined and has received less attention than climate's impacts on physical health. Goal The paper examines the planetary health-mental health nexus. It assesses the existing state of knowledge on the association between climate events, natural disasters, pollution, access to green space and mental health. It also presents a global analysis of the economic costs of climate-related mental health disorders by developing scenarios estimating the costs of mental illness at the country level predicted to be attributable to changes in environmental factors during the period 2020-2050. Findings Globally, the additional societal costs of mental disorders due to changes in climate-related hazards, air pollution and inadequate access to green space are estimated to be almost US$47 billion annually in 2030. These estimated costs will continue to grow exponentially to US$537 billion in 2050, relative to a baseline scenario in which these environmental factors remain at 2020 levels. Conclusions Our scenario analysis shows that the costs associated with climate-related mental health morbidity and mortality are high already and continue to will increase sharply in coming decades. There is need therefore to strengthen the evidence linking climate change to mental health and to prioritize the development of evidence-based and impactful interventions to address the global burden of environment-related mental disorders.
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Affiliation(s)
| | - Luke Brander
- Institute for Environmental Studies, Vrije Universiteit, The Netherlands
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Mustaffa KH, Shafie AA, Ngu LH. A comparison of self-evaluated survey and work sampling approach for estimating patient-care unit cost multiplier in genetic nursing activities. Asian Nurs Res (Korean Soc Nurs Sci) 2022; 16:170-179. [PMID: 35714898 DOI: 10.1016/j.anr.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 05/17/2022] [Accepted: 06/06/2022] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To compare patient care multipliers estimated from subjective evaluation against work sampling techniques in genetic nursing activities. METHODS An observational work sampling technique was conducted from November to December 2019 with nine genetic nurses in a tertiary referral centre in Malaysia. The work sampling activity instrument was devised, validated, and pilot tested. All care and noncare-related activities were sampled at 10-minute intervals within 8 hours of working over 14 days, followed by a subjective evaluation of activities survey over the same period. Bonferroni correction was undertaken for multiple testing with a p value of 0.0025. RESULTS The two techniques produced significant differences in genetic nurses' activities categorization. The work sampling showed that compared with subjective evaluation, direct care (19.3% versus 45.0%; p < .001) was estimated to be significantly lower, and indirect care (40.4% versus 25.6%; p < .001) and unit-related care (28.5% versus 16.9%; p < .001) were higher. Both techniques produced a similar proportion of time spent in other noncare activities (12.0%) but differed in genetic meetings and information-gathering activities. While the multipliers for patient face-to-face contact were significantly larger between work sampling (4.57) and the survey (1.94), the multipliers for patient care time were smaller between work sampling (1.47) and the survey (1.24), indicating that caution should be taken when multiplying for patient contact time compared to patient care activity to determine the cost of care provision. CONCLUSION A considerable proportion of time spent away from the patient needs to be allocated to patient-related care time. Thus, estimating the paid cost solely based on direct time with patients considerably underestimates the cost per hour of nurses' care. It is recommended to employ 'patient-related activity' instead of the 'face-to-face contact' multiplier because the former did not significantly differ from the one estimated using work sampling.
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Affiliation(s)
- Khairu Hazwan Mustaffa
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Science, Universiti Sains Malaysia, Minden, Penang, Malaysia; Department of Pharmacy, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Terengganu, Malaysia
| | - Asrul Akmal Shafie
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Science, Universiti Sains Malaysia, Minden, Penang, Malaysia.
| | - Lock-Hock Ngu
- Department of Genetics, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
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Depression interventions for individuals with coronary artery disease - Cost-effectiveness calculations from an Irish perspective. J Psychosom Res 2022; 155:110747. [PMID: 35124528 DOI: 10.1016/j.jpsychores.2022.110747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/21/2021] [Accepted: 01/25/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND A substantial proportion of individuals with coronary artery disease experience moderate or severe acute depression that requires treatment. We assessed the cost-effectiveness of four interventions for depression in individuals with coronary artery disease. METHODS We assessed effectiveness of pharmacotherapy, psychotherapy, collaborative care and exercise as remission rate after 8 and 26 weeks using estimates from a recent network meta-analysis. The cost assessment included standard doses of antidepressants, contact frequency, and staff time per contact. Unit costs were calculated as health services' purchase price for pharmaceuticals and mid-point staff salaries obtained from the Irish Health Service Executive and validated by clinical staff. Incremental cost-effectiveness ratios were calculated as the incremental costs over incremental remissions compared to usual care. High- and low-cost scenarios and sensitivity analysis were performed with changed contact frequencies, and assuming individual vs. group psychotherapy or exercise. RESULTS After 8 weeks, the estimated incremental cost-effectiveness ratio was lowest for group exercise (€526 per remission), followed by pharmacotherapy (€589), individual psychotherapy (€3117) and collaborative care (€4964). After 26 weeks, pharmacotherapy was more cost-effective (€591) than collaborative care (€7203) and individual psychotherapy (€9387); no 26-week assessment for exercise was possible. Sensitivity analysis showed that group psychotherapy could be most cost-effective after 8 weeks (€519) and cost-effective after 26 weeks (€1565); however no group psychotherapy trials were available investigating its effectiveness. DISCUSSION Large variation in incremental cost-effectiveness ratios was seen. With the current assumptions, the most cost-effective depression intervention for individuals with coronary artery disease after 8 weeks was group exercise.
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Raciborski RA, Woodward EN, Painter JT. Economic analyses of behavioral health intervention implementation: Perspective on stakeholder engagement. Front Psychiatry 2022; 13:1031325. [PMID: 36620658 PMCID: PMC9815616 DOI: 10.3389/fpsyt.2022.1031325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
To provide full potential benefits to patients, behavioral health interventions often require comprehensive and systematic implementation efforts. The costs of these efforts should therefore be included when organizations decide to fund or adopt a new intervention. However, existing guidelines for conducting economic analyses like cost-effectiveness analyses and budget impact analyses are not well-suited to the complexity of the behavioral healthcare pathway and its many stakeholders. Stakeholder engagement, when used effectively with recent innovations in economic analysis, advance more equitable access to interventions for individuals living with behavioral health conditions. But early and ongoing stakeholder engagement has not yet been incorporated into best-practice guidelines for economic evaluation. We discuss our perspective, as researchers and clinicians in a large integrated health system, on how the integration of stakeholder engagement with existing economic analysis methods could improve decision-making about implementation of behavioral health interventions.
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Affiliation(s)
- Rebecca A Raciborski
- VA Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States.,Evidence, Policy, and Implementation Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
| | - Eva N Woodward
- VA Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States.,Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Jacob T Painter
- VA Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States.,Evidence, Policy, and Implementation Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States.,Division of Pharmaceutical Evaluation and Policy, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, United States
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Pokhilenko I, Janssen LMM, Evers SMAA, Drost RMWA, Schnitzler L, Paulus ATG. Do Costs in the Education Sector Matter? A Systematic Literature Review of the Economic Impact of Psychosocial Problems on the Education Sector. PHARMACOECONOMICS 2021; 39:889-900. [PMID: 34121169 PMCID: PMC8298334 DOI: 10.1007/s40273-021-01049-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Psychosocial (e.g., anxiety or behavior) problems lead to costs not only in the healthcare sector but also in education and other sectors. As psychosocial problems develop during the critical period of establishing educational trajectories, education costs are particularly relevant in the context of psychosocial problems among children and adolescents. OBJECTIVES This study aimed to gain insights into the methods used for the inclusion of education costs in health economics studies and into the proportion of the education costs in relation to the total costs associated with a condition or an intervention. METHODS We systematically searched the PubMed, Embase, SSCI, CINAHL, PsycINFO, ERIC, and Econlit databases in August 2019 for economic evaluations of mental health, psychosocial and educational interventions, and cost-of-illness studies of mental, behavioral, and neurodevelopmental disorders conducted from a societal perspective in populations of children and adolescents. An additional search was conducted in February 2021 to update the review. RESULTS In total, 49 articles were included in the analysis. The most common cost items were special education, school absenteeism, and various educational professionals (educational psychologist). A variety of methods were employed for the identification, measurement, and/or valuation of education costs. The proportion of education costs to the total costs of condition/intervention ranged from 0 to 67%, with the mean being 18.5%. DISCUSSION Since education costs can constitute a significant proportion of the total costs of an intervention or condition, including them in health economics studies might be important in informing optimal resource allocation decisions. Although various methods are available for including education costs in health economics studies, further research is needed to develop evidence-based methods for producing comparable estimates.
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Affiliation(s)
- 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, The Netherlands.
| | - 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, 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, The Netherlands
- Centre for Economic Evaluation and Machine Learning, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, 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, The Netherlands
| | - Lena Schnitzler
- 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, The Netherlands
- Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - 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, The Netherlands
- Faculty of Health Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
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Sung JY, Kacmarek CN, Schleider JL. Economic Evaluations of Mental Health Programs for Children and Adolescents in the United States: A Systematic Review. Clin Child Fam Psychol Rev 2021; 24:1-19. [PMID: 33428069 DOI: 10.1007/s10567-020-00333-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2020] [Indexed: 10/22/2022]
Abstract
The United States (US) spent 201 billion dollars on mental health-related concerns in 2016, ranking mental illness as the leading cause of disability and the single largest source of economic burden worldwide. With mental health-related treatment costs and economic burden only projected to rise, there is an increasing need for cost-inclusive evaluations of mental health interventions in the US. This systematic review evaluated the intervention characteristics and the quality of 9 economic evaluation studies (e.g., cost-effectiveness, cost-benefit) of youth mental health services conducted in the US from 2003 to 2019. Existing evaluations suggest that certain mental health interventions for youth, among the few that have been formally evaluated, may be cost-effective and cost-beneficial. However, intervention characteristics were generally homogenous, a majority of studies did not adhere to the standard of economic evaluations of the CHEERS checklist, and outcome measures were not consistently clinically useful, limiting the utility of such youth mental health economic evaluations to policymakers. By adhering to standards of economic evaluations and diversifying the characteristics of interventions subject to economic evaluations, intervention researchers can increase confidence in conclusions about which youth mental health interventions are cost-effective or cost-beneficial and more meaningfully inform evidence-based mental health policy.
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Affiliation(s)
- Jenna Y Sung
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794-2500, USA.
| | | | - Jessica L Schleider
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794-2500, USA
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Exploring the identification, validation, and categorization of costs and benefits of education in mental health: The PECUNIA project. Int J Technol Assess Health Care 2020. [DOI: 10.1017/s0266462320000203] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BackgroundMental health problems can lead to costs and benefits in other sectors (e.g. in the education sector) in addition to the healthcare sector. These related costs and benefits are known as intersectoral costs and benefits (ICBs). Although some ICBs within the education sector have been identified previously, little is known about their extensiveness and transferability, which is crucial for their inclusion in health economics research.ObjectivesThe aim of this study was to identify ICBs in the education sector, to validate the list of ICBs in a broader European context, and to categorize the ICBs using mental health as a case study.MethodsPreviously identified ICBs in the education sector were used as a basis for this study. Additional ICBs were extracted from peer-reviewed literature in PubMed and grey literature from six European countries. A comprehensive list of unique items was developed based on the identified ICBs. The list was validated by surveying an international group of educational experts. The survey results were used to finalize the list, which was categorized according to the care atom.ResultsAdditional ICBs in the education sector were retrieved from ninety-six sources. Fourteen experts from six European countries assessed the list for completeness, clarity, and relevance. The final list contained twenty-four ICBs categorized into input, throughput, and output.ConclusionBy providing a comprehensive list of ICBs in the education sector, this study laid further foundations for the inclusion of important societal costs in health economics research in the broader European context.
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Purtle J, Lê-Scherban F, Nelson KL, Shattuck PT, Proctor EK, Brownson RC. State mental health agency officials' preferences for and sources of behavioral health research. Psychol Serv 2020; 17:93-97. [PMID: 31192673 PMCID: PMC6908783 DOI: 10.1037/ser0000364] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
State mental health agencies (SMHAs) are integral to public behavioral health service systems. As such, senior-level officials within SMHAs are important targets for advocacy and dissemination of behavioral health research findings. Evidence-informed decision making in SMHAs can potentially be enhanced by developing summaries of behavioral health research (e.g., policy briefs) that reflect SMHA officials' information preferences, but knowledge about these preferences is lacking. An exploratory study was conducted with the aims of characterizing senior-level SMHA officials' preferences for behavioral health research and describing where they turn for this research when making policy decisions. A cross-sectional, web-based survey of senior-level SMHA officials (1 per state) was conducted in March-May 2017 (n = 43, response rate = 84%). The features of behavioral health research that SMHA officials identified as "very important" most frequently were research being relevant to state residents (93.0%), providing data on cost-effectiveness (86.0%) and budget impact (81.4%), and being presented concisely (81.0%). The primary sources that SMHA officials turned to for behavioral research when making policy decisions were professional organizations (79.1%), SMHA agency staff (60.5%), and university researchers (55.8%). Compared with state legislators' responses to the same survey questions, results suggest that senior-level SMHA officials and legislators have similar preferences for behavioral health research but turn to different sources for this research. Advocates and researchers who seek to promote evidence-informed decision making in SMHAs should consider developing policy briefs that are concise, provide state-level prevalence data about behavioral conditions, and contain economic evaluation data, and they should disseminate these materials to multiple sources. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Koumakis L, Chatzaki C, Kazantzaki E, Maniadi E, Tsiknakis M. Dementia Care Frameworks and Assistive Technologies for Their Implementation: A Review. IEEE Rev Biomed Eng 2019; 12:4-18. [DOI: 10.1109/rbme.2019.2892614] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Schmidt M, Ekstrand J, Bengtsson Tops A. Clinical profiles and temporal patterns of psychiatric emergency room visitors in Sweden. Nord J Psychiatry 2018; 72:197-204. [PMID: 29254427 DOI: 10.1080/08039488.2017.1417477] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIMS To describe persons visiting the psychiatric emergency room (PER) in Sweden and to compare persons who frequently (PFV) and infrequently (PIFV) visit PERs in terms of group size, age, gender, PER location inside versus outside the home municipality, diagnosis (ICD 10), temporal patterns of visits and hospital admissions. METHODS This register study included all visits to PERs in one Swedish county over 3 years, 2013-2015 (N = 67,031 visits). The study employed descriptive statistics as well as Chi-square tests combined with Bonferroni correction to compare PFV with PIFV. RESULTS Of the total of 27,282 visitors, 2201 (8.1%) were identified as PFV (five or more visits within 12 months) and they accounted for 38.1% of the total visits. The study found differences between PFV and PIFV in gender, diagnostic profile, hospital admissions and temporal patterns. Differences were also detected with regard to distance between PERs and home municipalities. However, no age-related differences were found between the two groups. CONCLUSIONS PFV and PIFV have different clinical profiles and temporal patterns. These results may be important when planning, developing and evaluating interventions targeting the needs of each group, which is in accordance with a person-centred approach. Such an approach might eventually result in fewer visits to PERs.
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Affiliation(s)
- Manuela Schmidt
- a Faculty of Health Science , Kristianstad University , Kristianstad , Sweden.,b Department of Health Sciences , Lund University , Lund , Sweden
| | - Joakim Ekstrand
- c Faculty of Business , Kristianstad University , Kristianstad , Sweden
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Deidda M, Boyd KA, Minnis H, Donaldson J, Brown K, Boyer NRS, McIntosh E. Protocol for the economic evaluation of a complex intervention to improve the mental health of maltreated infants and children in foster care in the UK (The BeST? services trial). BMJ Open 2018. [PMID: 29540420 PMCID: PMC5857651 DOI: 10.1136/bmjopen-2017-020066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Children who have experienced abuse and neglect are at increased risk of mental and physical health problems throughout life. This places an enormous burden on individuals, families and society in terms of health services, education, social care and judiciary sectors. Evidence suggests that early intervention can mitigate the negative consequences of child maltreatment, exerting long-term positive effects on the health of maltreated children entering foster care. However, evidence on cost-effectiveness of such complex interventions is limited. This protocol describes the first economic evaluation of its kind in the UK. METHODS AND ANALYSIS An economic evaluation alongside the Best Services Trial (BeST?) has been prospectively designed to identify, measure and value key resource and outcome impacts arising from the New Orleans intervention model (NIM) (an infant mental health service) compared with case management (CM) (enhanced social work services as usual). A within-trial economic evaluation and long-term model from a National Health Service/Personal Social Service and a broader societal perspective will be undertaken alongside the National Institute for Health Research (NIHR)-Public Health Research Unit (PHRU)-funded randomised multicentre BeST?. BeST? aims to evaluate NIM compared with CM for maltreated children entering foster care in a UK context. Collection of Paediatric Quality of Life Inventory (PedsQL) and the recent mapping of PedsQL to EuroQol-5-Dimensions (EQ-5D) will facilitate the estimation of quality-adjusted life years specific to the infant population for a cost-utility analysis. Other effectiveness outcomes will be incorporated into a cost-effectiveness analysis (CEA) and cost-consequences analysis (CCA). A long-term economic model and multiple economic evaluation frameworks will provide decision-makers with a comprehensive, multiperspective guide regarding cost-effectiveness of NIM. The long-term population health economic model will be developed to synthesise trial data with routine linked data and key government sector parameters informed by literature. Methods guidance for population health economic evaluation will be adopted (lifetime horizon, 1.5% discount rate for costs and benefits, CCA framework, multisector perspective). ETHICS AND DISSEMINATION Ethics approval was obtained by the West of Scotland Ethics Committee. Results of the main trial and economic evaluation will be submitted for publication in a peer-reviewed journal as well as published in the peer-reviewed NIHR journals library (Public Health Research Programme). TRIAL REGISTRATION NUMBER NCT02653716; Pre-results.
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Affiliation(s)
- Manuela Deidda
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | - Kathleen Anne Boyd
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | - Helen Minnis
- Mental Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Kevin Brown
- Family Assessment and Contact Service, Glasgow, UK
| | - Nicole R S Boyer
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
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14
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Nickel F, Barth J, Kolominsky-Rabas PL. Health economic evaluations of non-pharmacological interventions for persons with dementia and their informal caregivers: a systematic review. BMC Geriatr 2018. [PMID: 29523090 PMCID: PMC5845149 DOI: 10.1186/s12877-018-0751-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background This systematic review aims to review the literature on trial-based economic evaluations of non-pharmacological interventions directly targeted at persons with dementia as well as persons with mild cognitive impairment and their respective caregivers. Methods A systematic literature research was conducted for the timeframe from 2010 to 2016 in the following databases: Centre for Reviews and Dissemination, EconLit, Embase, Cochrane Library, PsycINFO and PubMed. Study quality was assessed according to the Drummond criteria. Results In total sixteen publications were identified. Health economic evaluations indicated the cost-effectiveness of physical exercise interventions and occupational therapy. There was also evidence to suggest that psychological and behavioral therapies are cost-effective. Health economic studies investigating psychosocial interventions mainly targeted towards informal caregivers showed inconsistent results. Conclusions Due to the increasing prevalence of dementia non-pharmacological interventions and their health economic impact are of increasing importance for health care decision-makers and HTA agencies. Electronic supplementary material The online version of this article (10.1186/s12877-018-0751-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Franziska Nickel
- Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health (IZPH), Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany. .,National Graduate College 'Optimisation strategies in Dementia - OptiDem', Karl and Veronica Carstens-Foundation, Essen, Germany.
| | - Janina Barth
- Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health (IZPH), Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany.,National Graduate College 'Optimisation strategies in Dementia - OptiDem', Karl and Veronica Carstens-Foundation, Essen, Germany
| | - Peter L Kolominsky-Rabas
- Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health (IZPH), Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany.,National Graduate College 'Optimisation strategies in Dementia - OptiDem', Karl and Veronica Carstens-Foundation, Essen, Germany
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15
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Chorozoglou M, Reading I, Eaton S, Hutchings N, Hall NJ. Health economics and quality of life in a feasibility RCT of paediatric acute appendicitis: a protocol study. BMJ Paediatr Open 2018; 2:e000347. [PMID: 30276343 PMCID: PMC6157565 DOI: 10.1136/bmjpo-2018-000347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 07/31/2018] [Accepted: 08/01/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Acute appendicitis is one of the most common acute surgical emergencies in children and accounts for an annual cost of approximately £50 million to the National Health Service. Investigating alternative treatment options offers the best prospect of enhancing the quality of care for patients and potential opportunities for cost savings through better allocative efficiency. A feasibility randomised controlled trial (RCT) comparing a non-operative treatment pathway with appendicectomy for children with acute uncomplicated appendicitis is underway (CONTRACT feasibility RCT). AIMS The prime objective of this economic substudy conducted alongside the CONTRACT feasibility RCT is to better understand and assess: (1) cost data collection tools and cost drivers by identifying patients' pathways and (2) patient quality of life by assessing alternative paediatric health-related quality of life (HRQoL) instruments. Outcomes from this study will inform a future efficacy RCT assessing the effectiveness and cost-effectiveness of non-operative treatment pathway for the treatment of acute uncomplicated appendicitis in children. METHODS The economic substudy will use individual-level data and will be conducted from the health system perspective over the study's 6-month follow-up period. Microcosting will include health resource and service use, while potential benefits acquired will be measured using the HRQoL measures, Child Health Utility 9D (CHU-9D) and Euroqol-5 dimensions and 5 levels (EQ-5D-5L). We will assess the appropriateness of using the cost per quality-adjusted life year framework in the future RCT, as well as testing and identifying the most suitable HRQoL instrument. CONCLUSIONS The outcomes of the investigational economic substudy will be used to inform the design of our future definitive RCT. However, the result from this economic study will also provide a detailed description and account of the issues inherent in paediatric Economic Evaluations Alongside Clinical Trials with an emphasis on costing methods of interventions taking place in secondary care settings. TRIAL REGISTRATION NUMBER ISRCTN1583043.
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Affiliation(s)
- Maria Chorozoglou
- Southampton Health Technology Assessment Centre (SHTAC), Faculty of Medicine, University of Southampton, Southampton, UK
| | - Isabel Reading
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Simon Eaton
- Developmental Biology & Cancer Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Natalie Hutchings
- Southampton Clinical Trials Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Nigel J Hall
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, UK
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16
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Singh SP, Tuomainen H, Girolamo GD, Maras A, Santosh P, McNicholas F, Schulze U, Purper-Ouakil D, Tremmery S, Franić T, Madan J, Paul M, Verhulst FC, Dieleman GC, Warwick J, Wolke D, Street C, Daffern C, Tah P, Griffin J, Canaway A, Signorini G, Gerritsen S, Adams L, O'Hara L, Aslan S, Russet F, Davidović N, Tuffrey A, Wilson A, Gatherer C, Walker L. Protocol for a cohort study of adolescent mental health service users with a nested cluster randomised controlled trial to assess the clinical and cost-effectiveness of managed transition in improving transitions from child to adult mental health services (the MILESTONE study). BMJ Open 2017; 7:e016055. [PMID: 29042376 PMCID: PMC5652531 DOI: 10.1136/bmjopen-2017-016055] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 08/18/2017] [Accepted: 08/25/2017] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Disruption of care during transition from child and adolescent mental health services (CAMHS) to adult mental health services may adversely affect the health and well-being of service users. The MILESTONE (Managing the Link and Strengthening Transition from Child to Adult Mental Healthcare) study evaluates the longitudinal course and outcomes of adolescents approaching the transition boundary (TB) of their CAMHS and determines the effectiveness of the model of managed transition in improving outcomes, compared with usual care. METHODS AND ANALYSIS This is a cohort study with a nested cluster randomised controlled trial. Recruited CAMHS have been randomised to provide either (1) managed transition using the Transition Readiness and Appropriateness Measure score summary as a decision aid, or (2) usual care for young people reaching the TB. Participants are young people within 1 year of reaching the TB of their CAMHS in eight European countries; one parent/carer and a CAMHS clinician for each recruited young person; and adult mental health clinician or other community-based care provider, if young person transitions. The primary outcome is Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA) measuring health and social functioning at 15 months postintervention. The secondary outcomes include mental health, quality of life, transition experience and healthcare usage assessed at 9, 15 and 24 months postintervention. With a mean cluster size of 21, a total of 840 participants randomised in a 1:2 intervention to control are required, providing 89% power to detect a difference in HoNOSCA score of 0.30 SD. The addition of 210 recruits for the cohort study ensures sufficient power for studying predictors, resulting in 1050 participants and an approximate 1:3 randomisation. ETHICS AND DISSEMINATION The study protocol was approved by the UK National Research Ethics Service (15/WM/0052) and equivalent ethics boards in participating countries. Results will be reported at conferences, in peer-reviewed publications and to all relevant stakeholder groups. TRIAL REGISTRATION NUMBER ISRCTN83240263; NCT03013595 (pre-results).
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Affiliation(s)
- Swaran P Singh
- Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, Universityof Warwick, Coventry, UK
| | - Helena Tuomainen
- Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, Universityof Warwick, Coventry, UK
| | - Giovanni de Girolamo
- Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Center, Brescia, Italy
| | - Athanasios Maras
- Yulius Academy, Rotterdam, The Netherlands
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Paramala Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD), National and Specialist Child and Adolescent Mental Health Services, MaudsleyHospital, London, UK
- HealthTracker Ltd, Gillingham, UK
| | - Fiona McNicholas
- Department of Child and Adolescent Psychiatry, University College Dublin School of Medicine and Medical Science, Dublin, Republic of Ireland
- Geary Institute, University College Dublin, Dublin, Republic of Ireland
- Department of Child Psychiatry, Our Lady's Hospital for Sick Children, Dublin, Republic of Ireland
- Lucena Clinic, SJOG, Dublin, Republic of Ireland
| | - Ulrike Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | | | - Sabine Tremmery
- Departmentof Neurosciences, Child & Adolescent Psychiatry, University of Leuven, Leuven, Belgium
- Department of Child & Adolescent Psychiatry, University Hospitals Leuven, Leuven, Belgium
| | - Tomislav Franić
- Department of Psychiatry, Clinical Hospital Center Split, Split, Croatia
| | - Jason Madan
- Warwick Clinical Trials Unit, Warwick Medical School, Warwick Medical School, Coventry, UK
| | - Moli Paul
- Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, Universityof Warwick, Coventry, UK
- Coventry and Warwickshire Partnership NHS Trust, UK
| | - Frank C Verhulst
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Gwen C Dieleman
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jane Warwick
- Warwick Clinical Trials Unit, Warwick Medical School, Warwick Medical School, Coventry, UK
| | - Dieter Wolke
- Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, Universityof Warwick, Coventry, UK
- Departmentof Psychology, Universityof Warwick, Coventry, UK
| | - Cathy Street
- Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, Universityof Warwick, Coventry, UK
| | - Claire Daffern
- Warwick Clinical Trials Unit, Warwick Medical School, Warwick Medical School, Coventry, UK
| | - Priya Tah
- Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, Universityof Warwick, Coventry, UK
| | - James Griffin
- Warwick Clinical Trials Unit, Warwick Medical School, Warwick Medical School, Coventry, UK
| | - Alastair Canaway
- Warwick Clinical Trials Unit, Warwick Medical School, Warwick Medical School, Coventry, UK
| | - Giulia Signorini
- Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Center, Brescia, Italy
| | - Suzanne Gerritsen
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Laura Adams
- School of Psychology, Plymouth University, UK
| | - Lesley O'Hara
- SJOG Research Foundation, Dublin, Republic of Ireland
| | - Sonja Aslan
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - Frédérick Russet
- Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Nikolina Davidović
- Department of Psychiatry, Clinical Hospital Center Split, Split, Croatia
| | - Amanda Tuffrey
- Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, Universityof Warwick, Coventry, UK
| | - Anna Wilson
- Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, Universityof Warwick, Coventry, UK
| | - Charlotte Gatherer
- Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, Universityof Warwick, Coventry, UK
| | - Leanne Walker
- Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, Universityof Warwick, Coventry, UK
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