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Knauer J, Terhorst Y, Philippi P, Kallinger S, Eiler S, Kilian R, Waldmann T, Moshagen M, Bader M, Baumeister H. Effectiveness and cost-effectiveness of a web-based routine assessment with integrated recommendations for action for depression and anxiety (RehaCAT+): protocol for a cluster randomised controlled trial for patients with elevated depressive symptoms in rehabilitation facilities. BMJ Open 2022; 12:e061259. [PMID: 35738644 PMCID: PMC9226881 DOI: 10.1136/bmjopen-2022-061259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The integration of a web-based computer-adaptive patient-reported outcome test (CAT) platform with persuasive design optimised features including recommendations for action into routine healthcare could provide a promising way to translate reliable diagnostic results into action. This study aims to evaluate the effectiveness and cost-effectiveness of such a platform for depression and anxiety (RehaCAT+) compared with the standard diagnostic system (RehaCAT) in cardiological and orthopaedic health clinics in routine care. METHODS AND ANALYSIS A two-arm, pragmatic, cluster-randomised controlled trial will be conducted. Twelve participating rehabilitation clinics in Germany will be randomly assigned to a control (RehaCAT) or experimental group (RehaCAT+) in a 1:1 design. A total sample of 1848 participants will be recruited across all clinics. The primary outcome, depression severity at 12 months follow-up (T3), will be assessed using the CAT Patient-Reported Outcome Measurement Information System Emotional Distress-Depression Item set. Secondary outcomes are depression at discharge (T1) and 6 months follow-up (T2) as well as anxiety, satisfaction with participation in social roles and activities, pain impairment, fatigue, sleep, health-related quality of life, self-efficacy, physical functioning, alcohol, personality and health economic-specific general quality of life and socioeconomic cost and benefits at T1-3. User behaviour, acceptance, facilitating and hindering factors will be assessed with semistructured qualitative interviews. Additionally, a smart sensing substudy will be conducted, with daily ecological momentary assessments and passive collection of smartphone usage variables. Data analysis will follow the intention-to-treat principle with additional per-protocol analyses. Cost-effectiveness analyses will be conducted from a societal perspective and the perspective of the statutory pension insurance. ETHICS AND DISSEMINATION The study will be conducted according to the Declaration of Helsinki. The Ethics Committee of Ulm University, has approved the study (on 24 February 2021 ref. 509/20). Written informed consent will be obtained for all participants. Results will be published via peer-reviewed journals. TRIAL REGISTRATION NUMBER DRKS00027447.
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Affiliation(s)
- Johannes Knauer
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Yannik Terhorst
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Paula Philippi
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Selina Kallinger
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Sandro Eiler
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Reinhold Kilian
- Department of Psychiatry and Psychotherapy II, Ulm University, Ulm, Germany
| | - Tamara Waldmann
- Department of Psychiatry and Psychotherapy II, Ulm University, Ulm, Germany
| | - Morten Moshagen
- Department of Psychological Research Methods, Ulm University, Ulm, Germany
| | - Martina Bader
- Department of Psychological Research Methods, Ulm University, Ulm, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
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Shields GE, Camacho E, Farragher T, Clarkson P, Verma A, Davies LM. Acknowledging Patient Heterogeneity in Economic Evaluations in Schizophrenia: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:147-156. [PMID: 35031093 DOI: 10.1016/j.jval.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/28/2021] [Accepted: 07/02/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Schizophrenia is a severe mental illness with heterogeneous etiology, range of symptoms, and course of illness. Cost-effectiveness analysis often applies averages from populations, which disregards patient heterogeneity even though there are a range of methods available to acknowledge patient heterogeneity. This review evaluates existing economic evaluations of interventions in schizophrenia to understand how patient heterogeneity is currently reflected in economic evaluation. METHODS Electronic searches of MEDLINE, Embase, and PsycINFO via Ovid and the Health Technology Assessment database were run to identify full economic evaluations of interventions aiming to reduce the symptoms associated with schizophrenia. Two levels of screening were used, and explicit inclusion criteria were applied. Prespecified data extraction and critical appraisal were performed. RESULTS Seventy-six relevant studies were identified. More than half (41 of 76) of the articles acknowledged patient heterogeneity in some way through discussion or methods. There was a range of patient characteristics considered, including demographics and socioeconomic factors (eg, age, educational level, ethnicity), clinical characteristics (eg, symptom severity, comorbidities), and preferences (eg, preferences related to outcomes or symptoms). Subgroup analyses were rarely reported (8 of 76). CONCLUSIONS Patient heterogeneity was frequently mentioned in studies but was rarely thoroughly investigated in the identified economic evaluations. When investigated, included patient characteristics and methods were found to be heterogeneous. Understanding and acknowledging patient heterogeneity may alter the conclusions of cost-effectiveness evaluations; subsequently, we would encourage further research in this area.
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Affiliation(s)
- Gemma E Shields
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research, and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, England, UK.
| | - Elizabeth Camacho
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research, and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, England, UK
| | - Tracey Farragher
- The Epidemiology and Public Health Group, Division of Population Health, Health Services Research, and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, England, UK
| | - Paul Clarkson
- Social Care and Society, Division of Population Health, Health Services Research, and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, England, UK
| | - Arpana Verma
- The Epidemiology and Public Health Group, Division of Population Health, Health Services Research, and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, England, UK; Manchester Academic Health Science Centre, The University of Manchester, Manchester, England, UK
| | - Linda M Davies
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research, and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, England, UK
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Yuasa A, Yonemoto N, LoPresti M, Ikeda S. Productivity loss/gain in cost-effectiveness analyses for vaccines: a systematic review. Expert Rev Pharmacoecon Outcomes Res 2021; 21:235-245. [PMID: 33593223 DOI: 10.1080/14737167.2021.1881484] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction: The kinds of costs included in cost-effectiveness analyses (CEAs) for vaccines, such as direct medical costs and indirect costs, may affect their outcomes. While some guidelines recommend inclusion of costs associated with productivity losses/gains, very little guidance is provided about the productivity elements to include and their calculation approach.Areas covered: We conducted a systematic review of CEAs for vaccines and vaccine programs published between 1 January 2010 and 19 November 2019 that included productivity costs using Medline, Embase, and the Cochrane Library. The kind of productivity elements included their calculation approach, and the impact of their inclusion on cost-effectiveness are summarized. Among 88 studies identified, productivity elements included were reported for 71 studies (81%) with absenteeism being the most commonly included element. Only 24 studies (27%) reported the approach used to calculate productivity costs (human capital vs. friction approach). Most studies (81%) reported a more favorable cost-effectiveness with the inclusion of productivity losses/gains.Expert opinion: Inclusion of productivity losses/gains for CEAs for vaccines has resulted in more favorable cost-effectiveness based on the studies reviewed. However, clearer guidance on the productivity elements to include by disease area and more transparency on the calculation method used may be needed.
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Affiliation(s)
- Akira Yuasa
- Pfizer Japan Inc., Tokyo, Japan.,Graduate School of Medicine, International University of Health and Welfare, Tokyo, Japan
| | | | | | - Shunya Ikeda
- Graduate School of Medicine, International University of Health and Welfare, Tokyo, Japan
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