The cost-effectiveness of short-term and long-term psychotherapy in the treatment of depressive and anxiety disorders during a 5-year follow-up

Background The Systemic Therapy for At Risk Teens (START) trial is a randomised controlled trial of multisystemic therapy (MST) compared with management as usual (MAU). The present study reports on long-term follow-up of the trial (to 60 months). Objectives The primary objective was to compare MST and MAU for the proportion of young people in each group with criminal convictions up to 60 months post baseline. Secondary outcomes included group comparisons of psychological and behavioural factors. An economic analysis was carried out to determine the cost-effectiveness of MST compared with MAU. Two qualitative studies were conducted to better understand the subjective experiences of the participants. Design Primary outcomes (collected up to 60 months) were collected using a centralised police database. Secondary outcomes were evaluated using self-report questionnaires completed by both young people and parents or carers at the 24-, 36- and 48-month follow-ups. Research assistants were blind to treatment allocation. Setting Participants were recruited from participating MST sites in nine areas of England. Secondary outcomes were typically collected within the family home. Participants A total of 684 families were recruited into the START trial and allocated randomly to a treatment group. Of these, 487 remained in the second phase of the trial. Young people were aged, on average, 13.8 years at baseline, with 63% male and 37% female. Interventions MST is a manualised programme for young people exhibiting antisocial behaviour and their families that uses principles from cognitive–behavioural and family therapy to provide an individualised approach. MAU content was not prespecified, but consisted of the standard care offered to young people who met eligibility for the trial. Main outcome measures Young people’s offending was evaluated using the Police National Computer. Secondary measures included validated self-report measures completed by both the young person and their parent or carer. The economic evaluation took a broad perspective and outcomes were assessed in terms of quality-adjusted life-years and offending. Results No significant differences were found in the proportion of offending between the groups (hazard ratio 1.03, 95% confidence interval 0.84 to 1.26; p = 0.78). No differences were found between the groups on secondary outcome measures, with a few exceptions that did not hold up consistently across the follow-up period. The economic analysis did not find evidence to support the cost-effectiveness of MST compared with MAU. Outcomes from the qualitative studies suggest that families mostly felt positive about MST, and that MST was associated with greater maturity in young men. Limitations Some intended evaluations were not possible to deliver. Selective attrition may have influenced the nature of the sample size. It is also unclear how representative the MAU services were of reality. Future research Recommendations are made for the evaluation of MST in populations with more severe behavioural problems, as well as for identifying and testing new moderators. Conclusions The results of the second phase of the START trial do not support the long-term superiority of MST to MAU, but elements of the intervention may be adapted successfully. Trial registration Current Controlled Trials ISRCTN77132214 and London South-East REC registration number 09/H1102/55. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 23. See the NIHR Journals Library website for further project information.

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Short-Term Cost Per Responder among New Tyrosine Kinase Inhibitors for Imatinib-Resistant CML in Chronic Phase (CML-CP) — Canada and Germany Perspectives.

Blood ◽

10.1182/blood.v110.11.4587.4587 ◽

2007 ◽

Vol 110 (11) ◽

pp. 4587-4587

Author(s):

Kim Carpiuc ◽

Khalid El Ouagari ◽

Jennifer Stephens ◽

Marc Botteman ◽

WeiWei Feng ◽

...

Keyword(s):

Cytogenetic Response ◽

Sensitivity Analyses ◽

Short Term ◽

Cost Of Treatment ◽

Imatinib Resistant ◽

Cost Per Responder ◽

Grade 3 ◽

The Cost

Abstract BACKGROUND: For indications such as imatinib-resistant CML where data on durability of response or survival is still emerging, an alternative to modeling long-term cost-effectiveness is to perform a short-term analysis estimating average cost per responder based on cytogenetic responses, as the first 6–12 months have been shown to be a useful surrogate marker for treatment efficacy. This study incorporates cytogenetic response (MCyR or CCyR) with drug and adverse event (AE) costs to compare the 6-month cost per responder between dasatinib and nilotinib in patients with CML-CP. METHODS: The average cost per responder was estimated by dividing the 6-month cost of treatment with cytogenetic response. Total cost of treatment included drug costs only for the primary analysis, but adding the cost of managing grade 3/4 AEs in sensitivity analyses. Based on time to event information, AEs were assumed to occur within the first 6 months of treatment. As no head-to-head comparison studies for nilotinib and dasatinib exist, data were obtained from studies believed to have the most comparable patient populations and similar length of study follow-up. Data on dasatinib were obtained from the published dasatinib phase II START-C study and the dasatinib FDA Oncologic Drug Advisory Committee (ODAC) briefing document. Two alternative cost perspectives were taken representing two cost structures. Dasatinib daily drug cost (140 mg/day) was assumed at Can$150.94 and Germany €146.66. For nilotinib, data were obtained from the nilotinib phase II 120-day efficacy and safety update clinical study reports submitted for registration, with daily drug (800 mg/day) cost based upon price parity with 800 mg/day imatinib. The model was developed from a payer perspective considering direct medical costs only. RESULTS: Short-term (6-month) MCyR and CCyR rates for imatinib-resistant patients treated with 140 mg daily dasatinib were reported to be 31% and 22%. The corresponding numbers for 800 mg daily nilotinib were 51% and 31%, respectively. Primary cost drivers for AEs were myelosuppression events. Excluding the cost of AEs, the 6-month cost per MCyR was estimated to be Can$87,641 for dasatinib and Can$72,226 for nilotinib (Germany: €85,157 for dasatinib, €59,259 for nilotinib). The 6-month cost per CCyR was Can$123,480 for dasatinib, and Can$118,823 for nilotinib (Germany: €119,995 for dasatinib, €97,490 for nilotinib). Costs of treatment-related AEs for dasatinib and nilotinib were estimated at Can$10,429 and Can$4,861, respectively. Including AE costs in sensitivity analyses increased the cost per responder by 39% for dasatinib (7–17% for Germany) and by 13% for nilotinib (6–7% for Germany). CONCLUSION: The average 6-month cost per MCyR and CCyR is lower for nilotinib compared to dasatinib when daily drug costs for nilotinib are assumed at price parity with imatinib 800mg regardless of whether AEs are included. The analysis incorporating AEs may be conservative considering only severe grade 3/4 AEs were included and indirect costs were not addressed. In the absence of head-to-head studies, these analyses should be updated as longer follow-up data become available, with ideal analyses using total costs and cytogenetic response rates at 1 year of follow-up, as well as expansion into long-term cost effectiveness analyses.

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Long-term effectiveness and prediction of treatment outcome in cognitive behavioral therapy and sertraline for late-life anxiety disorders

International Psychogeriatrics ◽

10.1017/s1041610209990536 ◽

2009 ◽

Vol 21 (6) ◽

pp. 1148-1159 ◽

Cited By ~ 22

Author(s):

Josien Schuurmans ◽

Hannie Comijs ◽

Paul M. G. Emmelkamp ◽

Ingrid J. C. Weijnen ◽

Marcel van den Hout ◽

...

Keyword(s):

Treatment Outcome ◽

Anxiety Disorders ◽

Behavioral Therapy ◽

Late Life ◽

Term Treatment ◽

Short Term ◽

Long Term Treatment ◽

One Year

ABSTRACTBackground: Although anxiety disorders are prevalent in older adults, randomized controlled trials of treatment effectiveness for late-life anxiety are scarce and have focused primarily on the effectiveness of psychotherapeutic interventions. However, recent findings suggest that in some cases, pharmacological treatment may be more beneficial for late-life anxiety disorders. As yet, there have been no systematic studies investigating prognostic factors for the outcome of cognitive behavioral therapy (CBT) and pharmacotherapy for late-life anxiety. The objective of the present study was to study long-term treatment outcomes and to explore differential predictors for both short-term and long-term treatment outcomes of sertraline and CBT for late-life anxiety disorders.Methods: Participants of a randomized controlled trial (RCT) comparing sertraline and CBT for the treatment of late-life anxiety were contacted one year after completing their treatment, so that predictors for both short-term and long-term treatment outcome could be established.Results: Sertraline showed a greater reduction of symptoms than CBT on anxiety (Hamilton Anxiety Rating Scale; HARS) and worry (Worry Domain Questionnaire) ratings at one-year follow-up. The strongest predictor for short-term CBT outcome was poor perceived health, explaining 40% of the variance in post-treatment residual gain scores on the HARS. The strongest predictor for long-term CBT outcome was neuroticism, explaining 20% of the variance in residual gain scores at one-year follow-up. Analyses revealed no significant predictors for treatment outcome in sertraline participants.Conclusions: Our study suggests that long-term use of sertraline might be more beneficial for late-life anxiety than a 15-week CBT program. Poor perceived health and neuroticism are predictive of less improvement after CBT in anxious older adults. Implications of these findings are discussed.

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Cost-effectiveness

ESC CardioMed ◽

10.1093/med/9780198784906.003.0339 ◽

2018 ◽

pp. 1395-1399

Author(s):

Ruben L. J. Osnabrugge ◽

A. Pieter Kappetein

Keyword(s):

Coronary Artery Disease ◽

Cost Effectiveness ◽

Coronary Artery ◽

Drug Eluting Stents ◽

Long Term Follow Up ◽

Drug Eluting ◽

Artery Disease ◽

The Cost

Approximately 2% of the total healthcare expenditure in the European Union is spent on coronary artery disease and these expenditures are expected to increase. In order to make rational decisions on resource allocation, clinical and economic outcomes of treatment strategies need to be analysed together. Cost-effectiveness studies provide a framework for making such decisions. The early economic studies comparing balloon angioplasty with coronary artery bypass grafting (CABG) show that the early cost benefit of angioplasty is lost at long-term follow-up. CABG provides a clinically and economically attractive treatment option in patients with severe coronary artery disease. Later studies with bare-metal or drug eluting stents showed that the higher invasiveness of CABG leads to a longer hospital stay and higher upfront costs. However, at longer follow-up the cost difference is small and clinical outcomes with CABG are better than with percutaneous coronary intervention (PCI). This makes CABG superior to PCI at long-term follow-up, both clinically and economically in patients with extensive coronary disease. Nevertheless, in patients with less complex coronary artery disease, PCI with drug-eluting stents may be preferred on both clinical and economic grounds. Although reduction in stent price does not have a big impact, several other developments may impact future economic comparisons between PCI and CABG. Newer-generation stents will enhance the clinical and economic profile of PCI. Moreover, better clinical decision-making tools and fractional flow reserve will impact the cost-effectiveness equation.

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Brentuximab vedotin in relapsed/refractory Hodgkin lymphoma following autologous stem cell transplant: A cost-effectiveness analysis updated with 5-year follow-up data from the pivotal trial.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.7_suppl.19 ◽

2016 ◽

Vol 34 (7_suppl) ◽

pp. 19-19 ◽

Cited By ~ 1

Author(s):

Christopher Parker ◽

Gemma Kay ◽

Esprit Ma ◽

Beth Woods ◽

James Eaton ◽

...

Keyword(s):

Stem Cell ◽

Cost Effectiveness ◽

Clinical Outcomes ◽

Brentuximab Vedotin ◽

Sensitivity Analyses ◽

Pivotal Trial ◽

Effectiveness Analysis ◽

The Cost

19 Background: In 2015, the Scottish Medicines Consortium (SMC) made a positive recommandation for brentuximab vedotin (BV) in patients with relapsed or refractory (R/R) Hodgkin lymphoma (HL) who have received autologous stem cell transplantation (ASCT) based on 3-year follow-up data from the pivotal phase 2 single-arm trial (SG035-0003; NCT00848926). At 3-years, the incremental cost-effectiveness ratio (ICER) for brentuximab vedotin compared with chemotherapy +/- radiotherapy (C/R) was £43,731 per quality-adjusted life year (QALY). This study re-evaluated the cost-effectiveness analysis with 5-year follow-up data from the pivotal trial. Methods: A partitioned survival model was developed using a Scottish health system perspective over a lifetime time-horizon. Three health states were evaluated: progression-free survival (PFS), post-progression survival, and death. The relevant comparators were C/R, or C/R with intent to allogeneic stem cell transplantation. Clinical outcomes (PFS and overall survival [OS]) for BV were estimated based on data from the pivotal trial in 102 patients. A naïve comparison with the specified comparators was conducted using published survival data. ICERs were calculated with measures of the clinical outcomes, direct costs and QALYs. Deterministic and probabilistic sensitivity analyses were conducted to evaluate the robustness of the model. Results: The 5-year follow-up data reduced the base case ICER for BV from £43,731 to £38,769 per QALY versus C/R and increased the probability of cost-effectiveness. The variation in ICER for BV generated by the deterministic sensitivity analyses was also reduced resulting from reduced uncertainty in the estimation of long term clinical outcomes. Conclusions: This update has strengthened the cost-effectiveness evidence for BV in patients with R/R HL post-ASCT. The 5-year follow-up has reduced the uncertainty in the long term outcomes and reduced the ICER, which is low in comparison to other treatments for orphan diseases approved by UK agencies. BV may therefore represent a cost-effective treatment option for this patient group.

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Cost-effectiveness of a high-intensity versus a low-intensity smoking cessation intervention in a dental setting: long-term follow-up

BMJ Open ◽

10.1136/bmjopen-2019-030934 ◽

2019 ◽

Vol 9 (8) ◽

pp. e030934 ◽

Cited By ~ 1

Author(s):

Inna Feldman ◽

Asgeir Runar Helgason ◽

Pia Johansson ◽

Åke Tegelberg ◽

Eva Nohlert

Keyword(s):

Smoking Cessation ◽

Cost Effectiveness ◽

Incremental Cost ◽

High Intensity ◽

Short Term ◽

Low Intensity ◽

Cessation Treatment ◽

Long Term Follow Up

ObjectivesThe aim of this study was to conduct a cost-effectiveness analysis (CEA) of a high-intensity and a low-intensity smoking cessation treatment programme (HIT and LIT) using long-term follow-up effectiveness data and to validate the cost-effectiveness results based on short-term follow-up.Design and outcome measuresIntervention effectiveness was estimated in a randomised controlled trial as numbers of abstinent participants after 1 and 5–8 years of follow-up. The economic evaluation was performed from a societal perspective using a Markov model by estimating future disease-related costs (in Euro (€) 2018) and health effects (in quality-adjusted life-years (QALYs)). Programmes were explicitly compared in an incremental analysis, and the results were presented as an incremental cost-effectiveness ratio.SettingThe study was conducted in dental clinics in Sweden.Participants294 smokers aged 19–71 years were included in the study.InterventionsBehaviour therapy, coaching and pharmacological advice (HIT) was compared with one counselling session introducing a conventional self-help programme (LIT).ResultsThe more costly HIT led to higher number of 6-month continuous abstinent participants after 1 year and higher number of sustained abstinent participants after 5–8 years, which translates into larger societal costs avoided and health gains than LIT. The incremental cost/QALY of HIT compared with LIT amounted to €918 and €3786 using short-term and long-term effectiveness, respectively, which is considered very cost-effective in Sweden.ConclusionCEA favours the more costly HIT if decision makers are willing to spend at least €4000/QALY for tobacco cessation treatment.

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Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people: systematic review and economic evaluation

Health Technology Assessment ◽

10.3310/hta21640 ◽

2017 ◽

Vol 21 (64) ◽

pp. 1-244 ◽

Cited By ~ 9

Author(s):

Ana Duarte ◽

Teumzghi Mebrahtu ◽

Pedro Saramago Goncalves ◽

Melissa Harden ◽

Ruth Murphy ◽

...

Keyword(s):

Cost Effectiveness ◽

Young People ◽

Clinical Effectiveness ◽

Children And Young People ◽

Biological Treatments ◽

Randomised Controlled ◽

The Cost

Background Psoriasis is a chronic inflammatory disease that predominantly affects the skin. Adalimumab (HUMIRA®, AbbVie, Maidenhead, UK), etanercept (Enbrel®, Pfizer, New York, NY, USA) and ustekinumab (STELARA®, Janssen Biotech, Inc., Titusville, NJ, USA) are the three biological treatments currently licensed for psoriasis in children. Objective To determine the clinical effectiveness and cost-effectiveness of adalimumab, etanercept and ustekinumab within their respective licensed indications for the treatment of plaque psoriasis in children and young people. Data sources Searches of the literature and regulatory sources, contact with European psoriasis registries, company submissions and clinical study reports from manufacturers, and previous National Institute for Health and Care Excellence (NICE) technology appraisal documentation. Review methods Included studies were summarised and subjected to detailed critical appraisal. A network meta-analysis incorporating adult data was developed to connect the effectiveness data in children and young people and populate a de novo decision-analytic model. The model estimated the cost-effectiveness of adalimumab, etanercept and ustekinumab compared with each other and with either methotrexate or best supportive care (BSC), depending on the position of the intervention in the management pathway. Results Of the 2386 non-duplicate records identified, nine studies (one randomised controlled trial for each drug plus six observational studies) were included in the review of clinical effectiveness and safety. Etanercept and ustekinumab resulted in significantly greater improvements in psoriasis symptoms than placebo at 12 weeks’ follow-up. The magnitude and persistence of the effects beyond 12 weeks is less certain. Adalimumab resulted in significantly greater improvements in psoriasis symptoms than methotrexate for some but not all measures at 16 weeks. Quality-of-life benefits were inconsistent across different measures. There was limited evidence of excess short-term adverse events; however, the possibility of rare events cannot be excluded. The majority of the incremental cost-effectiveness ratios for the use of biologics in children and young people exceeded NICE’s usual threshold for cost-effectiveness and were reduced significantly only when combined assumptions that align with those made in the management of psoriasis in adults were adopted. Limitations The clinical evidence base for short- and long-term outcomes was limited in terms of total participant numbers, length of follow-up and the absence of young children. Conclusions The paucity of clinical and economic evidence to inform the cost-effectiveness of biological treatments in children and young people imposed a number of strong assumptions and uncertainties. Health-related quality-of-life (HRQoL) gains associated with treatment and the number of hospitalisations in children and young people are areas of considerable uncertainty. The findings suggest that biological treatments may not be cost-effective for the management of psoriasis in children and young people at a willingness-to-pay threshold of £30,000 per quality-adjusted life-year, unless a number of strong assumptions about HRQoL and the costs of BSC are combined. Registry data on biological treatments would help determine safety, patterns of treatment switching, impact on comorbidities and long-term withdrawal rates. Further research is also needed into the resource use and costs associated with BSC. Adequately powered randomised controlled trials (including comparisons against placebo) could substantially reduce the uncertainty surrounding the effectiveness of biological treatments in biologic-experienced populations of children and young people, particularly in younger children. Such trials should establish the impact of biological therapies on HRQoL in this population, ideally by collecting direct estimates of EuroQol-5 Dimensions for Youth (EQ-5D-Y) utilities. Study registration This study is registered as PROSPERO CRD42016039494. Funding The National Institute for Health Research Health Technology Assessment programme.

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The cost-effectiveness of a two-step blood pressure screening programme in a dental health-care setting

PLoS ONE ◽

10.1371/journal.pone.0252037 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0252037

Author(s):

Helen Andersson ◽

Mikael Svensson ◽

Håkan Bergh

Keyword(s):

Blood Pressure ◽

Health Care ◽

Cost Effectiveness ◽

Societal Perspective ◽

Screening Programme ◽

Baseline Scenario ◽

Short Term ◽

The Cost ◽

Term Analysis

Background Hypertension is one of the largest contributors to the disease burden and a major economic challenge for health-care systems. Early detection of persons with high blood pressure can be achieved through screening and has the potential to reduce morbidity and mortality. We evaluate the cost-effectiveness of an opportunistic hypertension screening programme in a dental-care facility for individuals aged 40–75 in comparison to care as usual (the no-screening baseline scenario). Methods A cost-effectiveness analysis (CEA) was carried out from the payer and societal perspectives, and the short-term (from screening until diagnosis has been established) cost per identified case of hypertension and long-term (20 years) cost per quality-adjusted life year (QALY) were reported. Data on the short-term cost were based on a real-world screening programme in which 2025 healthy individuals were screened for hypertension. Data on the long-term cost were based on the short-term outcomes combined with modelling in a Markov cohort model. Deterministic and probabilistic sensitivity analyses were carried out to assess uncertainty. Results The short-term analysis showed an additional cost of 4,800 SEK (€470) per identified case of hypertension from the payer perspective and from the societal perspective 12,800 SEK (€1,240). The long-term analysis showed a payer cost per QALY of 2.2 million SEK (€210,000) and from the societal perspective 2.8 million SEK per QALY (€270,000). Conclusion The long-term model results showed that the screening model is unlikely to be cost-effective in a country with a well-developed health-care system and a relatively low prevalence of hypertension.

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Cost-effectiveness and long-term effectiveness of Internet-based cognitive behaviour therapy for severe health anxiety

Psychological Medicine ◽

10.1017/s0033291712001079 ◽

2012 ◽

Vol 43 (2) ◽

pp. 363-374 ◽

Cited By ~ 57

Author(s):

E. Hedman ◽

E. Andersson ◽

N. Lindefors ◽

G. Andersson ◽

C. Rück ◽

...

Keyword(s):

Cost Effectiveness ◽

Primary Outcome ◽

Outcome Measure ◽

Health Anxiety ◽

Primary Outcome Measure ◽

Behaviour Therapy ◽

Cognitive Behaviour ◽

The Cost

BackgroundSevere health anxiety is a common condition associated with functional disability, making it a costly disorder from a societal perspective. Internet-based cognitive behaviour therapy (ICBT) is a promising treatment but no previous study has assessed the cost-effectiveness or long-term outcome of ICBT for severe health anxiety. The aim of this study was to investigate the cost-effectiveness and 1-year treatment effects of ICBT for severe health anxiety.MethodCost-effectiveness and 1-year follow-up data were obtained from a randomized controlled trial (RCT) comparing ICBT (n = 40) to an attention control condition (CC,n = 41). The primary outcome measure was the Health Anxiety Inventory (HAI). A societal perspective was taken and incremental cost-effectiveness ratios (ICERs) were calculated using bootstrap sampling.ResultsThe main ICER was −£1244, indicating the societal economic gain for each additional case of remission when administering ICBT. Baseline to 1-year follow-up effect sizes on the primary outcome measure were large (d = 1.71–1.95).ConclusionsICBT is a cost-effective treatment for severe health anxiety that can produce substantial and enduring effects.

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