Cost-effectiveness of a Specialised Medium Secure Personality Disorder Service

2017 ◽  
Vol 41 (S1) ◽  
pp. S87-S88
Author(s):  
R. Woodward ◽  
R. Lingam ◽  
F. Papouli
Keyword(s):  
Cost Effectiveness ◽  
Personality Disorder ◽  
Current Model ◽  
Primary Objective ◽  
Service Development ◽  
North East ◽  
The North ◽  
Episodes Of Care ◽  
Competing Interest ◽  
The Cost

IntroductionThe Oswin unit located in the North East of England is commissioned primarily for offenders screened on the offender personality disorder (OPD) pathway based on measures of personality disorder being linked to moderate to high risks to other persons.ObjectivesThe Oswin Unit was re-designed in early 2014 meeting commissioning specifications to meet objectives based on access, measuring quality and reducing. The primary objective of this pathway is to ensure personality Disorder offenders have access to “community-to-community”, joint-up care and monitoring of risks. The Oswin unit implemented a re-designed service offering individuals formulation based assessments and risk management embedded in the OPD pathway. The overall objective of this project is to evaluate the effectiveness and risk amelioration of this hospital-based service.AimAs part of a broader service development and evaluation project, the cost-effectiveness of the current model of the unit was compared to that of the unit prior to the redesign of the service.MethodCollection of data on number of admission and length of stay and calculation of expenses per capita. Retrospective analysis of costs of care.ResultsAnalysis of comparative figures post-implementation of this new model of care found 41% more episodes of care. Cost-analysis indicated a saving of £200,000.ConclusionThe new Oswin Model meets commissioning objectives in offering access to hospital-based care and focused treatments for prisoners ‘stuck’ in prison pathways. This finding led to further investigation using thematic measures of quality of care to evaluate the effectiveness of this service and risk amelioration.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Caveat emptor NICE: biased use of cost-effectiveness is inefficient and inequitable

F1000Research ◽  
2015 ◽  
Vol 4 ◽  
pp. 1078 ◽  
Author(s):  
Jack Dowie ◽  
Mette Kjer Kaltoft ◽  
Jesper Bo Nielsen ◽  
Glenn Salkeld
Keyword(s):  
Cost Effectiveness ◽  
Health Gain ◽  
Cost Effective ◽  
The South ◽  
Constrained System ◽  
North East ◽  
The North ◽  
South West ◽  
Undesirable Consequence ◽  
The Cost

Concern with the threshold applied in cost-effectiveness analyses by bodies such as NICE distracts attention from their biased use of the principle. The bias results from the prior requirement that an intervention be effective (usually 'clinically effective') before its cost-effectiveness is considered. The underlying justification for the use of cost-effectiveness as a criterion, whatever the threshold adopted, is that decisions in a resource-constrained system have opportunity costs. Their existence rules out any restriction to those interventions that are 'incrementally cost-effective' at a chosen threshold and requires acceptance of those that are 'decrementally cost-effective' at the same threshold. Interventions that fall under the linear ICER line in the South-West quadrant of the cost-effectiveness plane are cost-effective because they create net health benefits, as do those in the North-East quadrant. If there is objection to the fact that they are cost-effective by reducing effectiveness as well as costs, it is possible to reject them, but only on policy grounds other than their failure to be cost-effective. Having established this, the paper considers and seeks to counter the arguments based on these other grounds. Most notably these include those proposing a different threshold in the South-West quadrant from the North-East one, i.e. propose a 'kinked ICER'. Another undesirable consequence of the biased use of cost-effectiveness is the failure to stimulate innovations that would increase overall health gain by being less effective in the condition concerned, but generate more benefits elsewhere. NICE can only reward innovations that cost more.

scholarly journals Spotting the Differences: The CEAC vs. CEAFC vs. CERAC

2021 ◽  
Author(s):  
Pedram Sendi ◽  
Klazien Matter-Walstra ◽  
Matthias Schwenkglenks
Keyword(s):  
Cost Effectiveness ◽  
Risk Aversion ◽  
Joint Distribution ◽  
Joint Probability ◽  
Cost Effective ◽  
Policy Makers ◽  
North East ◽  
The North ◽  
Program Costs ◽  
The Cost

Methods to handle uncertainty in economic evaluation have gained much attention in the literature and the cost-effectiveness acceptability curve (CEAC) is the most widely used method to summarize and present uncertainty associated with program costs and effects in cost-effectiveness analysis. Some researchers have emphasized the limitations of the CEAC for informing decision and policy makers as the CEAC is insensitive to radial shifts of the joint distribution of incremental costs and effects in the North-East and South-West quadrants of the cost-effective plane (CEP). Furthermore, it has been pointed out that the CEAC does not incorporate risk-aversion in valuing uncertain costs and effects. In the present article we show that the cost-effectiveness affordability curve (CEAFC) captures both dimensions of the joint distribution of incremental costs and effects on the CEP and is therefore sensitive to radial shifts of the joint distribution on the CEP. Furthermore, the CEAFC also informs about the budget impact of a new intervention as it estimates the joint probability an intervention is both affordable and cost-effective. Moreover, we show that the cost-effectiveness risk-aversion curve (CERAC) allows to incorporate risk-aversion into the analysis and can therefore be used to inform decision-makers who are risk-averse. We use data from a published cost-effectiveness model of palbociclib in addition to letrozole versus letrozole alone for the treatment of oestrogen-receptor positive, HER-2 negative, advanced breast cancer to demonstrate the differences between CEAC, CEAFC and CERAC and show how these can jointly be used to inform decision and policy makers.

scholarly journals Awareness of the cost of psychotropic medication among doctors: a service evaluation

2010 ◽  
Vol 34 (9) ◽  
pp. 364-366 ◽  
Author(s):  
Dhananjay Kumar Singh ◽  
Shakil Khawaja ◽  
Ishaq Pala ◽  
Jaleel Khaja ◽  
Ray Krishnanu ◽  
...  
Keyword(s):  
Cost Effective ◽  
Service Evaluation ◽  
Financial Resources ◽  
Clinical Implications ◽  
North East ◽  
The North ◽  
Old Age Psychiatry ◽  
Level Of Knowledge ◽  
The Cost ◽  
Structured Questionnaire

Aims and methodCost-effective prescribing is an increasingly important aspect of our practice. A service evaluation was carried out to assess the level of awareness and knowledge of different aspects of cost-effective prescribing among doctors working in the North East London Foundation Trust. A semi-structured questionnaire was used to benchmark knowledge against six standards.ResultsThe survey was completed by 71% of doctors working in adult or old age psychiatry. A total of 2% of doctors stated that they should always take into consideration the price of the drug when prescribing and only 5% of doctors claimed to know the price of medications they prescribe most frequently.Clinical implicationsStrategies to improve the poor level of knowledge and awareness in this area of clinical practice would be of benefit in making the best use of limited financial resources without any detriment to patient care.

scholarly journals Community interventions for people with complex emotional needs that meet the criteria for ‘personality disorder’ diagnoses: a systematic review of economic evaluations

2020 ◽  
Author(s):  
Joe Botham ◽  
Amy Clark ◽  
Thomas Steare ◽  
Ruth Stuart ◽  
Sian Oram ◽  
...  
Keyword(s):  
Mental Health ◽  
Cost Effectiveness ◽  
Personality Disorder ◽  
Economic Evaluations ◽  
Economic Evidence ◽  
Emotional Needs ◽  
Community Based Interventions ◽  
Community Based ◽  
Single Intervention ◽  
The Cost

AbstractBackgroundDiagnoses of “personality disorder” are prevalent among people using community secondary mental health services. Whilst the effectiveness of a range of community-based treatments have been considered, as the NHS budget is finite, it is also important to consider the cost-effectiveness of those interventions.AimsTo assess the cost-effectiveness of primary or secondary care community-based interventions for people with complex emotional needs that meet criteria for a diagnosis of “personality disorder” to inform healthcare policy making.MethodSystematic review (PRESPORO #: CRD42020134068) of five databases, supplemented by reference list screening and citation tracking of included papers. We included economic evaluations of interventions for adults with complex emotional needs associated with a diagnosis of ‘personality disorder’ in community mental health settings published between before 18 September 2019. Study quality was assessed using the CHEERS statement. Narrative synthesis was used to summarise study findings.ResultsEighteen studies were included. The studies mainly evaluated psychotherapeutic interventions. Studies were also identified which evaluated altering the setting in which care was delivered and joint crisis plans. No strong economic evidence to support a single intervention or model of community-based care was identified.ConclusionThere is no robust economic evidence to support a single intervention or model of community-based care for people with complex emotional needs. The review identified the strongest evidence for Dialectical Behavioural Therapy with all three identified studies indicating the intervention is likely to be cost-effective in community settings compared to treatment as usual. Further research is needed to provide robust evidence on the cost-effectiveness of community-based interventions upon which decision makers can confidently base guidelines or allocate resources.

CCS in the North Sea region: A comparison on the cost-effectiveness of storing CO2 in the Utsira formation at regional and national scales

2011 ◽  
Vol 5 (6) ◽  
pp. 1517-1532 ◽  
Author(s):  
Neil Strachan ◽  
Ric Hoefnagels ◽  
Andrea Ramírez ◽  
Machteld van den Broek ◽  
Audun Fidje ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
North Sea ◽  
The North ◽  
The North Sea ◽  
The Cost

scholarly journals Applying GIS in Analysing Black Spot Areas in Penang, Malaysia

2018 ◽  
Vol 50 (2) ◽  
pp. 113
Author(s):  
Wan Muhammad Taufiq Wan Hussin ◽  
Tarmiji Masron ◽  
Mohd Norarshad Nordin
Keyword(s):  
Spatial Pattern ◽  
Nearest Neighbor ◽  
Black Spot ◽  
Primary Objective ◽  
Accident Rate ◽  
Fatal Accident ◽  
Gis Application ◽  
North East ◽  
The North ◽  
Accident Data

This study aims to analyze fatal accident rate involving all vehicle types in the North East District of Penang. It covers fatal accident data within the duration of three years from 2011 till 2013. The primary objective is to analyze the spatial pattern and fatal accident black spot areas using Geographic Information System (GIS) application. Average Nearest Neighbor (ANN) tool is used to analyze fatal accident spatial pattern, while Kernel Density Estimation (KDE) method is utilized for fatal accident analysis. The Fatal Accident rates in 2011, 2012 and 2013 were the highest with each accounted up to 90, 88 and 91 cases. The result of ANN shows that the fatal accident pattern for 2011, 2012 and 2013 is clustered with null hypothesis rejected. The KDE analysis result shows that most fatal accident black spot areas happened at main road areas or segments.

scholarly journals Handling Uncertainty in Cost-Effectiveness Analysis: Budget Impact and Risk Aversion

Healthcare ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1419
Author(s):  
Pedram Sendi ◽  
Klazien Matter-Walstra ◽  
Matthias Schwenkglenks
Keyword(s):  
Cost Effectiveness ◽  
Risk Aversion ◽  
Joint Distribution ◽  
Budget Impact ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Policy Makers ◽  
North East ◽  
Effectiveness Analysis ◽  
The Cost

Methods to handle uncertainty in economic evaluation have gained much attention in the literature, and the cost-effectiveness acceptability curve (CEAC) is the most widely used method to summarise and present uncertainty associated with program costs and effects in cost-effectiveness analysis. Some researchers have emphasised the limitations of the CEAC for informing decision and policy makers, as the CEAC is insensitive to radial shifts of the joint distribution of incremental costs and effects in the North-East and South-West quadrants of the cost-effective plane (CEP). Furthermore, it has been pointed out that the CEAC does not incorporate risk-aversion in valuing uncertain costs and effects. In the present article, we show that the cost-effectiveness affordability curve (CEAFC) captures both dimensions of the joint distribution of incremental costs and effects on the CEP and is, therefore, sensitive to radial shifts of the joint distribution on the CEP. Furthermore, the CEAFC also informs about the budget impact of a new intervention, as it can be used to estimate the joint probability that an intervention is both affordable and cost-effective. Moreover, we show that the cost-effectiveness risk-aversion curve (CERAC) allows the analyst to incorporate different levels of risk-aversion into the analysis and can, therefore, be used to inform decision-makers who are risk-averse. We use data from a published cost-effectiveness model of palbociclib in addition to letrozole versus letrozole alone for the treatment of oestrogen-receptor positive, HER-2 negative, advanced breast cancer to demonstrate the differences between CEAC, CEAFC and CERAC, and show how these can jointly be used to inform decision and policy makers.

Governance in the Sixth Schedule Areas in India’s North-East: Context, Content and Challenges

2020 ◽  
Vol 66 (2) ◽  
pp. 191-205
Author(s):  
Prabhat Kumar Datta ◽  
Panchali Sen
Keyword(s):  
Primary Objective ◽  
Eastern Region ◽  
North East ◽  
The North ◽  
Rebel Groups ◽  
North Eastern ◽  
E Region ◽  
Self Rule ◽  
International Boundaries ◽  
Background Context

Nestled in the foothills of the Himalayas in the eastern range North-East (N-E) has the ‘seven sisters’—Arunachal Pradesh, Assam, Manipur, Meghalaya, Mizoram, Nagaland and Tripura, along with a small and beautiful cousin in the Himalayan fringes, namely, Sikkim. Nearly ninety-eight per cent of N-E is surrounded by international boundaries and two per cent with the rest of India. Often known as ‘the ethnic cauldron’, this region is the home of extraordinarily diverse mosaic of ethnic groups having distinctive social, cultural and economic identity, more akin to their South Asia neighbours than mainland India. It is a habitat of a good number of ethnic rebel groups whose agendas vary from complete session from India to fighting for ethnic identities and home lands. The primary objective of the colonial rule in N-E was to ensure its administrative insulation which might have largely contributed to the continuation of the backwardness of the N-E region. It is probably the only political region in the country where every large state is a region unto itself within a sub-continental nation. This uniqueness is found reflected in the legislations and institutions like the North Eastern Council Act, 1971, setting a nodal agency for the economic development of the region with a secretariat of its own and a separate Union Ministry of Development of North Eastern Region created in 2001. In this article, an attempt has been made to analyse the background, context, content and significance of the Sixth Schedule in the Constitution of India which was incorporated to provide self-rule to the tribal population in the N-E India.

scholarly journals Costs and outcomes of an intervention programme for offenders with personality disorders

2012 ◽  
Vol 200 (4) ◽  
pp. 336-341 ◽  
Author(s):  
Barbara Barrett ◽  
Sarah Byford
Keyword(s):  
Cost Effectiveness ◽  
Personality Disorder ◽  
Personality Disorders ◽  
Mentally Disordered Offenders ◽  
Intervention Programme ◽  
Cost Offset ◽  
Dangerous Offenders ◽  
Markov Decision Model ◽  
The Cost

BackgroundThe dangerous severe personality disorder programme was developed in high secure prisons and hospitals at great expense to identify and treat the most dangerous offenders with personality disorders.AimsTo evaluate whether the long-term costs of the programme are greater or less than the long-term outcomes.MethodWe used a Markov decision model with a cost-effectiveness analysis to determine the incremental cost of the programme per serious offence prevented and a cost-offset analysis to consider whether monetary benefits were greater than costs.ResultsCosts were consistently higher for the intervention programme and the cost per serious offence prevented was over £2 million, although there was some evidence that adjustments to the programme could lead to similar interventions becoming cost-effective.ConclusionsLittle evidence was found to support the cost-effectiveness of the intervention programme for offenders with personality disorders, although delivery of the programme in a lower-cost prison would probably yield greater benefits than costs. There are frequent calls for mentally disordered offenders to be detained in secure hospitals rather than prisons; however, if reoffending remains the outcome of interest for policy makers, it is likely that the costs of detention in hospital will remain greater than the benefits for dangerous offenders with a personality disorder.

scholarly journals ‘Enhanced Support for High Intensity Users of the Criminal Justice System’: An Evaluation of Mental Health Nurse Input into Integrated Offender Management Services in the North East of England

2015 ◽  
Vol 15 (1) ◽  
pp. 43-55 ◽  
Author(s):  
Wendy Dyer ◽  
Paul Biddle
Keyword(s):  
Mental Health ◽  
Criminal Justice ◽  
Justice System ◽  
Mental Health Problems ◽  
Service Development ◽  
Mental Health Nurses ◽  
North East ◽  
The North ◽  
Mental Health Nurse ◽  
Health Nurse

The current UK Government's focus on the development of services to manage and support offenders with mental health problems has resulted in a number of innovative project developments. This research examines a service development in the North East of England which co-located mental health nurses with two Integrated Offender Management teams. While not solving all problems, the benefits of co-location were clear, although such innovations are now at risk from government changes which will make Integrated Offender Management the responsibility of new providers without compelling them to co-operate with health services.

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