Psychological therapies: is improving access cost effective?

2013 ◽  
Vol 671 (1) ◽  
pp. 8-8
Keyword(s):  
Cost Effective ◽  
Psychological Therapies ◽  
Access Cost

scholarly journals Cost-effectiveness of an Improving Access to Psychological Therapies service

2013 ◽  
Vol 202 (3) ◽  
pp. 220-227 ◽  
Author(s):  
Clara Mukuria ◽  
John Brazier ◽  
Michael Barkham ◽  
Janice Connell ◽  
Gillian Hardy ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Mental Health Problems ◽  
Short Form ◽  
Clinical Excellence ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Considerable Uncertainty ◽  
Psychological Therapies ◽  
Life Years ◽  
Demonstration Site

BackgroundEffective psychological therapies have been recommended for common mental health problems, such as depression and anxiety, but provision has been poor. Improving Access to Psychological Therapies (IAPT) may provide a cost-effective solution to this problem.AimsTo determine the cost-effectiveness of IAPT at the Doncaster demonstration site (2007–2009).MethodAn economic evaluation comparing costs and health outcomes for patients at the IAPT demonstration site with those for comparator sites, including a separate assessment of lost productivity. Sensitivity analyses were undertaken.ResultsThe IAPT site had higher service costs and was associated with small additional gains in quality-adjusted life-years (QALYs) compared with its comparator sites, resulting in a cost per QALY gained of £29 500 using the Short Form (SF-6D). Sensitivity analysis using predicted EQ-5D scores lowered this to £16 857. Costs per reliable and clinically significant (RCS) improvement were £9440 per participant.ConclusionsImproving Access to Psychological Therapies provided a service that was probably cost-effective within the usual National Institute for Health and Clinical Excellence (NICE) threshold range of £20 000-30 000, but there was considerable uncertainty surrounding the costs and outcome differences.

Prevention and Treatment of Posttraumatic Stress and Depressive Phenomena in Critical Illness Survivors

2017 ◽  
Author(s):  
Christina Jones ◽  
O. Joseph Bienvenu
Keyword(s):  
Quality Of Life ◽  
Intensive Care ◽  
Critical Illness ◽  
Posttraumatic Stress ◽  
Stress Disorder ◽  
Cost Effective ◽  
Psychological Recovery ◽  
Psychological Therapies ◽  
Prevention And Treatment

Patients recovering from critical illness can be left with significant psychological problems that have a profound effect on their quality of life. As yet, studies on prevention of posttraumatic stress disorder (PTSD) and/or depression are in their infancy. This chapter discusses multimodal rehabilitation strategies that can improve psychological recovery which are beginning to be established. Recognizing those patients needing further help and having a structured pathway for rehabilitation is the first step toward returning patients to as normal a life as possible after critical illness. Providing intensive care unit (ICU) diaries for as many patients as possible is a cost-effective way of helping patients come to terms with their ICU experience. Also discussed in the chapter are psychological therapies, which may be reserved for those survivors of critical illness who are experiencing more severe effects from critical illness and intensive care.

Access and organization: putting low intensity interventions to work in clinical services

2010 ◽  
pp. 19-34
Author(s):  
David A. Richards
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Cost Effective ◽  
Clinical Decision ◽  
Stepped Care ◽  
Clinical Services ◽  
Low Intensity ◽  
Psychological Therapies ◽  
Measuring Outcomes ◽  
Patient Centredness

Chapter 2 unpacks the term ‘access’, suggesting that it has six interlinked components—availability, utilization, effectiveness, equity, efficiency, and patient-centredness—that need to be satisfied if access is to be increased and setting out key strategies for improvement. These include providing cost-effective forms of CBT (low intensity), organizing systems so that they function more effectively (stepped care, collaborative care), routinely measuring outcomes, and providing a clear rationale for clinical decision making. These strategies are now encapsulated in the English Improving Access to Psychological Therapies (IAPT) initiative.

Farmers’ attitude to the effectiveness of ICTs Use in their Farming, Nay Pyi Taw, Myanmar

2020 ◽  
Vol 7 (11) ◽  
pp. 197-212
Author(s):  
Naing Kyi Win ◽  
Nyein Nyein Htwe
Keyword(s):  
Rural Communities ◽  
Cost Effective ◽  
Relevant Information ◽  
High Price ◽  
Personal Factors ◽  
Fm Radio ◽  
Access Cost ◽  
Ict Service ◽  
The Right ◽  
User Friendly

This study focused on farmers’ attitudes to the effectiveness of ICTs in their farming and farmers’ challenges in accessing it. Extension workers of the respective Townships identified the 144 sample farmers, and the data was collected through interviews using questionnaires during 2019.  There were frequency means and a dichotomous scale used to analyze the ICT attitude pattern among farmers and a 5-point Likert scale with the options.  This study explored the personal factors of ICT accessed farmers who are significantly getting young and middle age, high school, and graduate-level education and a moderate working experience compared with ICTs non- access farmers. 110 out of 144 farmers frequently used and accessed ICTs such as Radio, FM radio, TV, Facebook, Phone, and Agricultural Journals to obtain the agricultural information, but 34 farmers could not access ICTs due to the high cost, other social factors, and low ICT exposure. Most of the farmers received agricultural information from related Departments and Organizations traditionally, such as training, meeting, demonstration, trials, and conferences. More than half of the farmers were positively consistent agricultural information with their needs, but the rest did not meet their needs. Most farmers believed highly positive to agricultural information. However, some farmers responded negatively to agricultural details because they seem commonly knowledgeable information. Farmers mentioned in this study that more than half of farmers positively showed that attitude on high true and true regarding agricultural information. Moreover, farmers encountered insufficient electricity, challenging ICT exposure, low trust, and social problems. And also, farmers commonly faced challenges as high cost for ICT usage, high price for ICTs tools, and poor ICT service.  Besides, farmers’ other challenges were poor connectivity, inadequate support for the mother service provider, failure to attend the training, complexity to operate, and badly wanted news. Finally, this study recommended that farmers use effective utilization of ICTs in their farming in Nay Pyi Taw area that has the potential to make the rural communities prosperous as it enables the dissemination of required information in user-friendly patterns, easy to access, cost-effective ways at the right time with relevant information and training to be a skill.

scholarly journals Cost-Effectiveness Evaluations of Psychological Therapies for Schizophrenia and Bipolar Disorder: A Systematic Review

2019 ◽  
Vol 35 (4) ◽  
pp. 317-326 ◽  
Author(s):  
Gemma Elizabeth Shields ◽  
Deborah Buck ◽  
Jamie Elvidge ◽  
Karen Petra Hayhurst ◽  
Linda Mary Davies
Keyword(s):  
Bipolar Disorder ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Data Extraction ◽  
Cost Effective ◽  
Current Evidence ◽  
Economic Evaluations ◽  
Psychological Interventions ◽  
Routine Practice ◽  
Psychological Therapies

AbstractObjectivesThis review aims to assess the cost-effectiveness of psychological interventions for schizophrenia/bipolar disorder (BD), to determine the robustness of current evidence and identify gaps in the available evidence.MethodsElectronic searches (PsycINFO, MEDLINE, Embase) identified economic evaluations relating incremental cost to outcomes in the form of an incremental cost-effectiveness ratio published in English since 2000. Searches were concluded in November 2018. Inclusion criteria were: adults with schizophrenia/BD; any psychological/psychosocial intervention (e.g., psychological therapy and integrated/collaborative care); probability of cost-effectiveness at explicitly defined thresholds reported. Comparators could be routine practice, no intervention, or alternative psychological therapies. Screening, data extraction, and critical appraisal were performed using pre-specified criteria and forms. Results were summarized qualitatively. The protocol was registered on the PROSPERO database (CRD42017056579).ResultsOf 3,864 studies identified, 12 met the criteria for data extraction. All were integrated clinical and economic randomized controlled trials. The most common intervention was cognitive behavioral therapy (CBT, 6/12 studies). The most common measure of health benefit was the quality-adjusted life-year (6/12). Follow-up ranged from 6 months to 5 years. Interventions were found to be cost-effective in most studies (9/12): the probability of cost-effectiveness ranged from 35-99.5 percent. All studies had limitations and demonstrated uncertainty (particularly related to incremental costs).ConclusionsMost studies concluded psychological interventions for schizophrenia/BD are cost-effective, including CBT, although there was notable uncertainty. Heterogeneity across studies makes it difficult to reach strong conclusions. There is a particular need for more evidence in the population with BD and for longer-term evidence across both populations.

scholarly journals Lifestyle coaching for mental health difficulties: scoping review

2018 ◽  
Vol 17 (1) ◽  
pp. 29-44 ◽  
Author(s):  
Lauren Bishop ◽  
Ann Hemingway ◽  
Sara Ashencaen Crabtree
Keyword(s):  
Mental Health ◽  
Scoping Review ◽  
Mental Healthcare ◽  
Cost Effective ◽  
Evidence Base ◽  
Research Literature ◽  
Self Management ◽  
Content Type ◽  
Psychological Therapies ◽  
Health Strategy

Purpose UK mental health strategy calls for interventions that empower people to self-manage their condition. In lifestyle coaching, coach and client work collaboratively on positive behaviour change to improve client health. There is debate about the appropriateness of coaching for mental health, yet claims have not been supported with evidence. Therefore, the purpose of this paper is to explore the nature and scope of the existing research literature in this field. Design/methodology/approach Scoping review. Findings The growing evidence base shows positive outcomes of coaching; for instance, symptom reduction, enhanced self-management and achievement of personal goals. Research limitations/implications The evidence base is small and of variable quality, offering insights that warrant further exploration. Practical implications Coaching not only supports better self-management but also addresses further mental health strategy priorities (such as improved physical health and social functioning). Coaches need not be mental health experts; therefore coaching may be a cost-effective intervention. Social implications As mental ill-health prevalence continues to rise despite widespread use of Improving Access to Psychological Therapies and medication, there is a need to explore how novel approaches such as coaching might be integrated into mental healthcare. Originality/value This is the first study to collate the evidence on mental health coaching, highlighting its extensive potential, which should be further explored in research and practice.

Strange bedfellows: economics, happiness and mental disorder

2009 ◽  
Vol 18 (3) ◽  
pp. 208-213 ◽  
Author(s):  
Brian Cooper
Keyword(s):  
Mental Disorders ◽  
Common Mental Disorders ◽  
Scale Up ◽  
Cost Effective ◽  
Behavioural Therapy ◽  
Information Criteria ◽  
Problem Definition ◽  
Sources Of Information ◽  
Psychological Therapies ◽  
The Common

SUMMARYAim – The high economic and social costs associated with the ‘common mental disorders’, and the need to scale up appropriate care services, are now widely recognized, but responses vary from country to country. In Britain, a current government initiative to promote psychological therapy is driven both by economic pressures and by research on the factors of happiness, or life-satisfaction. This article provides a short critical review of the project. Method – A health policy analysis, with regard to problem definition; objectives; sources of information; criteria for evaluation; impact on existing services, and comparison with alternative strategies. Results – The new programme, Improving Access to Psychological Therapies (IAPT), aims to expand treatment services by training 3,600 ‘psychological therapists’ in cognitive behavioural therapy (CBT), which they will then apply in the wider community. This service, with an initial budget of £173 million, will provide treatment for depression and chronic anxiety from local centres across the country. The programme is intended to pay for itself by reducing incapacity costs. Closer examination, however, raises questions concerning the project’s theoretical basis, logistics and research methodology, and casts doubt on its advantages over alternative approaches. Conclusions – The IAPT project is ill-designed to achieve its objectives and unsuitable as a model for treatment and care of the common mental disorders in other countries. An alternative strategy, based on closer integration of community mental health and primary health care, should be tested and on previous experience seems likely to prove more cost-effective.Declaration of Interest: None.

scholarly journals Evaluating the effectiveness and cost-effectiveness of British Sign Language Improving Access to Psychological Therapies: an exploratory study

2017 ◽  
Vol 5 (24) ◽  
pp. 1-196 ◽  
Author(s):  
Alys Young ◽  
Katherine Rogers ◽  
Linda Davies ◽  
Mark Pilling ◽  
Karina Lovell ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Sign Language ◽  
Exploratory Study ◽  
Service Providers ◽  
Cost Effective ◽  
Deaf People ◽  
Deaf Community ◽  
Psychological Therapies ◽  
British Sign Language ◽  
British Sign

BackgroundImproving Access to Psychological Therapies (IAPT) is a National Institute for Health and Care Excellence-approved approach to intervention for depression and/or anxiety. This exploratory study sets the groundwork for comparing psychological therapies for Deaf sign language users experiencing anxiety and/or depression, delivered in British Sign Language (BSL) by a Deaf therapist with usual access through an interpreter within the IAPT national programme.Objectives(1) To explore the following questions: (a) is BSL-IAPT more effective than standard IAPT for Deaf people with anxiety and/or depression? and (b) is any additional benefit from BSL-IAPT worth any additional cost to provide it? (2) To establish relevant BSL versions of assessment tools and methods to answer research questions (a) and (b). (3) To gauge the feasibility of a larger-scale definitive study and to inform its future design.DesignA mixed-methods exploratory study combing an economic model to synthesise data from multiple sources; a qualitative study of understanding and acceptability of randomisation and trial terminology; statistical determination of clinical cut-off points of standardised assessments in BSL; secondary data analysis of anonymised IAPT client records; realist inquiry incorporating interviews with service providers and survey results.SettingsIAPT service providers (NHS and private); the Deaf community.ParticipantsDeaf people who use BSL and who are clients of IAPT services (n = 502); healthy Deaf volunteers (n = 104); IAPT service providers (NHS and private) (n = 118).InterventionsIAPT at steps 2 and 3.Main outcome measuresReliable recovery and reliable improvement defined by IAPT; Deaf community views on the acceptability of randomisation; BSL terminology for trial-related language; clinical cut-off measurements for the BSL versions of the Patient Health Questionnaire-9 items (PHQ-9) and the Generalised Anxiety Disorder-7 (GAD-7); a valid BSL version of the EuroQol-5 Dimensions five-level version (EQ-5D-5L); costs, quality-adjusted life-years and incremental cost-effectiveness ratios.Data sourcesIAPT service provider anonymised records of the characteristics and clinical outcomes of Deaf BSL users of BSL-IAPT and of standard IAPT; published literature.ResultsRandomisation may be acceptable to Deaf people who use IAPT if linguistic and cultural requirements are addressed. Specifications for effective information in BSL for recruitment have been established. A valid EQ-5D-5L in BSL has been produced. The clinical cut-off point for the GAD-7 BSL is 6 and for the PHQ-9 BSL is 8. No significant difference in rates of reliable recovery and reliable improvement between Deaf users of standard IAPT or BSL-IAPT has been found. Whether or not BSL-IAPT is more cost-effective than standard IAPT is uncertain.LimitationsThe small number of participating standard IAPT services who have seen Deaf clients means that there is statistical uncertainty in the comparable clinical outcome result. Clinical cut-off scores have not been verified through gold standard clinical interview methodology. Limited data availability means that whether or not BSL-IAPT is more cost-effective than standard IAPT is uncertain.ConclusionsThere is a lack of evidence to definitively compare reliable recovery and reliable improvement between Deaf users of standard IAPT and BSL-IAPT. Instrumentation and prerequisites for a larger-scale study have been established.Future workA prospective observational study for definitive results is justified.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

The application of electron microscopy to diagnosis in gynecologic neoplasms and tumor-like conditions

1984 ◽  
Vol 42 ◽  
pp. 102-105
Author(s):  
Lawrence M. Roth
Keyword(s):  
Electron Microscopy ◽  
Reproductive Tract ◽  
Malignant Tumors ◽  
Frozen Section ◽  
Cost Effective ◽  
Female Reproductive Tract ◽  
Ultrastructural Examination ◽  
Specific Diagnosis ◽  
Potential Value ◽  
Gynecologic Neoplasms

The female reproductive tract may be the site of a wide variety of benign and malignant tumors, as well as non-neoplastic tumor-like conditions, most of which can be diagnosed by light microscopic examination including special stains and more recently immunoperoxidase techniques. Nevertheless there are situations where ultrastructural examination can contribute substantially to an accurate and specific diagnosis. It is my opinion that electron microscopy can be of greatest benefit and is most cost effective when applied in conjunction with other methodologies. Thus, I have developed an approach which has proved useful for me and may have benefit for others. In cases where it is deemed of potential value, glutaraldehyde-fixed material is obtained at the time of frozen section or otherwise at operation. Coordination with the gynecologic oncologist is required in the latter situation. This material is processed and blocked and is available if a future need arises.

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