Components of Sustainable Health Systems: What Is Known About The Cost-Effectiveness of Clinical Care?

BACKGROUND Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder associated with numerous functional deficits and poor long-term outcomes. Internationally, behavioral interventions are recommended as part of a multimodal treatment approach for children with ADHD. Currently in Japan there are limited interventions available targeting ADHD. Well Parent Japan (WPJ), a new hybrid parent training program, provides a culturally acceptable, and effective way to help support Japanese children with ADHD and their parents. OBJECTIVE This pragmatic multi-center randomised controlled trial will provide preliminary evidence about the effectiveness and cost-effectiveness of WPJ evaluated against treatment as usual (TAU) within routine Japanese mental health services. METHODS Mothers of children (6-12 years) diagnosed with ADHD will be recruited from child and adolescent mental health care services at three hospital sites across Japan (Fukui, Fukuoka and Okinawa). Mothers will be randomized to immediate treatment or TAU. The effectiveness and cost effectiveness of WPJ over TAU at the end of intervention and at 3-month follow-up will be evaluated. The primary outcome is maternal Parent Domain stress in the parenting role. The following secondary outcomes will be explored: child behavior, including severity of ADHD symptoms; parenting practices; emotional well-being and the parent-child relationship. Data analysis will follow intention-to-treat principles with treatment effects quantified through ANCOVA by means of multi-level modeling. An incremental cost effectiveness ratio (ICER) will be used to analyse the cost-effectiveness of the WPJ intervention. RESULTS Study funding was secured from a Proof of Concept grant in July 2018. IRB approval for the data collection sites was obtained between 2017 and 2019. Data collection began in August 2019 with expected completion date of January 2022. Subject recruitment (N = 120) was completed in May 2021. Effectiveness and cost-effectivenss analyses are expected to be completed by July 2022 and December 2022 respectively. These timelines are subject to change due to Covid-19. CONCLUSIONS This is the first multisite pragmatic trial of WPJ based on the recruitment of children referred directly to routine clinical services in Japan. This multisite randomized trial tests the effectiveness of WPJ with children and families by comparing WPJ directly to the usual clinical care on offer for children diagnosed with ADHD in Japan. We also seek to assess and compare the cost effectiveness of WPJ with TAU in Japan. CLINICALTRIAL The study was retrospectively registered with ISRCTN after the first of three waves of participant recruitment. Trial registration number: ISRCTN66978270 (https://www.isrctn.com/ISRCTN66978270).

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Cost-effectiveness of Diabetes Self-management Programs in Community Primary Care Settings

The Diabetes Educator ◽

10.1177/0145721709340931 ◽

2009 ◽

Vol 35 (5) ◽

pp. 761-769 ◽

Cited By ~ 49

Author(s):

Carol A. Brownson ◽

Thomas J. Hoerger ◽

Edwin B. Fisher ◽

Kerry E. Kilpatrick

Keyword(s):

Primary Care ◽

Cost Effectiveness ◽

Simulation Model ◽

Health Systems ◽

Self Management ◽

Systems Perspective ◽

Primary Care Settings ◽

Life Years ◽

The Cost

Purpose The purpose of this study is to estimate the cost-effectiveness of diabetes self-management programs in real-world community primary care settings. Estimates incorporated lifetime reductions in disease progression, costs of adverse events, and increases in quality of life. Methods Clinical results and costs were based on programs of the Diabetes Initiative of the Robert Wood Johnson Foundation, implemented in primary care and community settings in disadvantaged areas with notable health disparities. Program results were used as inputs to a Markov simulation model to estimate the long-term effects of self-management interventions. A health systems perspective was adopted. Results The simulation model estimates that the intervention does reduce discounted lifetime treatment and complication costs by $3385, but this is more than offset by the $15 031 cost of implementing the intervention and maintaining its effects in subsequent years. The intervention is estimated to reduce long-term complications, leading to an increase in remaining life-years and quality-adjusted life-years (QALYs). The incremental cost-effectiveness ratio is $39 563/QALY, well below a common benchmark of $50 000/QALY. Sensitivity analyses tested the robustness of the model’s estimates under various alternative assumptions. The model generally predicts acceptable cost-effectiveness ratios. Conclusions Self-management programs for type 2 diabetes are cost-effective from a health systems perspective when the cost savings due to reductions in long-term complications are recognized. These findings may justify increased reimbursement for effective self-management programs in diverse settings.

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Cost-effectiveness of early intervention in psychosis: systematic review

The British Journal of Psychiatry ◽

10.1192/bjp.2018.298 ◽

2019 ◽

Vol 215 (01) ◽

pp. 388-394 ◽

Cited By ~ 13

Author(s):

David Aceituno ◽

Norha Vera ◽

A. Matthew Prina ◽

Paul McCrone

Keyword(s):

Mental Health ◽

Early Intervention ◽

Cost Effectiveness ◽

Health Systems ◽

Psychotic Disorders ◽

First Episode ◽

Economic Evaluations ◽

Eligibility Criteria ◽

The Cost ◽

Early Intervention In Psychosis

BackgroundEarly intervention in psychosis (EIP) has been developed as an approach to improve the prognosis of people with psychotic disorders and it has been claimed to be a more efficient model of care. However, the evidence is not definitive and doubts have spread regard to the economic outcomes of EIP services amid the usually restricted mental health budget.AimsWe aimed to review the cost-effectiveness evidence of EIP services worldwide.MethodWe systematically reviewed the economic literature about EIP following the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement guidelines. Studies were selected according to previously stated criteria and analysed with standardised critical appraisal tools for trial-based economic evaluations and modelling studies.ResultsA total of 16 studies were selected after applying the eligibility criteria. Most of them were economic evaluations alongside clinical trials. The overall evidence was consistent in the cost-effectiveness of EIP compared with standard care for first episode of psychosis and the Clinical High Risk for Psychosis paradigm. Such evidence was replicated among different health systems, but mainly in high-income countries. The methodological quality of such evidence, however, was moderate and heterogeneity was significant across the studies.ConclusionsThere is consistent evidence that the implementation of EIP services might be a cost-effective alternative across different health systems. Such evidence, nevertheless, derives from heterogeneous and sometimes methodologically flawed studies, reducing the certainty of such statement. More efforts must be done to rigorously assess the value of this intervention, before expanding it among systems where mental health budgets are more constrained.Declaration of interestNone.

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Optimizing Medical Education With Instructional Technology

Advances in Medical Education, Research, and Ethics - Optimizing Medical Education With Instructional Technology ◽

10.4018/978-1-5225-6289-4.ch005 ◽

2018 ◽

pp. 71-78

Author(s):

George C. Chang Chien ◽

Armen Haroutunian ◽

Bryant England ◽

Kenneth D. Candido

Keyword(s):

Medical Education ◽

Virtual Reality ◽

Cost Effectiveness ◽

Clinical Care ◽

Three Dimensional ◽

Delivery Cost ◽

Contemporary Medicine ◽

Methods Of Learning ◽

The Cost ◽

Historical Methods

Technological advancements and imaging evolution in contemporary medicine continue to change the ways medical education and clinical care are delivered. Historical methods of learning anatomy through human cadaveric dissection may be supplanted by three-dimensional renderings, injection models, and virtual reality simulations. The cost effectiveness of new imaging and study modalities may demonstrate major advantages in the logistics of information delivery, cost containment, and skills development in the current healthcare environment.

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