scholarly journals MH2 THE COST-EFFECTIVENESS OF OPPORTUNISTIC SCREENING AND MINIMAL CONTACT PSYCHOTHERAPY TO PREVENT DEPRESSION IN PRIMARY CARE PATIENTS

2009 ◽  
Vol 12 (7) ◽  
pp. A223 ◽  
Author(s):  
M Van den Berg ◽  
F Smit ◽  
T Vos ◽  
P Van Baal
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Opportunistic Screening ◽  
Primary Care Patients ◽  
Minimal Contact ◽  
The Cost

scholarly journals Cost-effectiveness of preventing depression in primary care patients

2006 ◽  
Vol 188 (4) ◽  
pp. 330-336 ◽  
Author(s):  
Filip Smit ◽  
Godelief Willemse ◽  
Marc Koopmanschap ◽  
Simone Onrust ◽  
Pim Cuijpers ◽  
...  
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Depressive Disorder ◽  
Usual Care ◽  
Cost Effective ◽  
Randomised Clinical Trial ◽  
Improved Outcomes ◽  
Primary Care Patients ◽  
Minimal Contact ◽  
The Cost

BackgroundLittle is known about the cost-effectiveness of preventing mental disorders.AimsTo study the cost-effectiveness of care as usual plus minimal contact psychotherapy relative to usual care alone in preventing depressive disorder.MethodAn economic evaluation was conducted alongside a randomised clinical trial. Primary care patients with sub-threshold depression were assigned to minimal contact psychotherapy plus usual care (n=107) or to usual care alone (n=109).ResultsPrimary care patients with sub-threshold depression benefited from minimal contact psychotherapy as it reduced the risk of developing a full-blown depressive disorder from 18% to 12%. In addition, this intervention had a 70% probability of being more cost-effective than usual care alone. A sensitivity analysis indicated the robustness of these results.ConclusionsOver 1 year adjunctive minimal contact psychotherapy improved outcomes and generated lower costs. This intervention is therefore superior to usual care alone in terms of cost-effectiveness.

The cost-effectiveness of one-time opportunistic screening for atrial fibrillation in different age cohorts of inhabitants in Denmark aged 65 years and above: a Markov modelled analysis

2020 ◽  
Author(s):  
Lucca Katrine Sciera ◽  
Lars Frost ◽  
Lars Dybro ◽  
Peter Bo Poulsen
Keyword(s):  
Atrial Fibrillation ◽  
General Practice ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Population Data ◽  
National Registry ◽  
Opportunistic Screening ◽  
Age Cohorts ◽  
Life Years ◽  
The Cost

Abstract Aims The objective was to evaluate the cost-effectiveness of one-time opportunistic screening for atrial fibrillation (AF) in general practice in citizens aged ≥65 years in Denmark compared to a no-screening alternative following current Danish practice. Methods and results A decision tree and a Markov model were designed to simulate costs and quality-adjusted life years (QALYs) in a hypothetical cohort of citizens aged ≥65 years equivalent to the Danish population (1 M citizens) over the course of 19 years, using a healthcare and societal perspective. Share of detected AF patients following opportunistic screening was retrieved from a recent Danish screening study, whereas the risk stroke and bleedings in AF patients were based on population data from national registries and their associated costs was obtained from published national registry studies. The present study showed that one-time opportunistic screening for AF was more costly, but also more effective compared to a no-screening alternative. The analysis predicts that one-time opportunistic screening of all Danes aged ≥65 years potentially can identify an additional 10 300 AF patients and prevent 856 strokes in the period considered. The incremental cost of such a screening programme is €56.4 M, with a total gain of 6000 QALYs, resulting in an incremental cost-effectiveness ratio of €9400 per QALY gained. Conclusion Opportunistic screening in general practice in citizens aged ≥65 years in Denmark is cost-effective compared to a willingness-to-pay threshold of €22 000. The study and its findings support a potential implementation of opportunistic screening for AF at the general practitioner level in Denmark.

scholarly journals Opportunistic Discovery of Occult Disease by Use of Test Panels in New, Symptomatic Primary Care Outpatients: Yield and Cost of Case Finding

2000 ◽  
Vol 46 (8) ◽  
pp. 1091-1098 ◽  
Author(s):  
Yuzuru Takemura ◽  
Haku Ishida ◽  
Yuji Inoue ◽  
Hiroyuki Kobayashi ◽  
J Robert Beck
Keyword(s):  
Primary Care ◽  
Uric Acid ◽  
Cost Effectiveness ◽  
Disease Patient ◽  
Fecal Occult Blood ◽  
X Rays ◽  
Clinical Efficiency ◽  
National Defense Medical College ◽  
Occult Disease ◽  
The Cost

Abstract Background: Diagnostic test panels have been advocated by the Japan Society of Clinical Pathology for evaluation of presenting complaints of new outpatients in primary care medicine. The tests have additional potential utility for opportunistic finding of asymptomatic diseases, but data are lacking on the number of new conditions identified by the test panels and on the cost per identified case. Methods: We studied 540 new, symptomatic patients at the Comprehensive Medicine Clinics of National Defense Medical College during 1991–1997. All underwent testing with the “Essential Laboratory Tests” panel (2) [ELT(2) panel]. This panel includes hematologic tests, urinalysis, total protein, C-reactive protein, albumin, cholesterol, triglycerides, glucose, urea nitrogen, creatinine, uric acid, serum protein fractionation, six enzymes, and optional tests, including x-rays, electrocardiogram, and fecal occult blood. Results: The ELT(2) panel uncovered 276 additional diagnoses of asymptomatic disease or abnormal health status. The most frequent occult condition was hyperlipidemia (100 cases) followed by liver dysfunction (53 cases). Clinical efficiency of the panel (occult diseases/patient) varied depending on the category of tentative initial diagnosis, with the highest efficiency in patients with cardiovascular disease. We created smaller panels by combining 11 basic tests [called the ELT(1) baseline panel] with one or more additional tests from the ELT(2) and analyzed their cost-effectiveness. Addition of four tests (total cholesterol, alanine aminotransferase, glucose, and uric acid) improved both clinical efficiency (0.41 occult disease/patient) and economic efficiency [¥2372 (∼$22.50 US)/occult disease] at a cost-effectiveness of ¥177 per incremental case of occult disease. Addition of further tests decreased cost-effectiveness. Conclusions: Although the ELT(2) panel has supplemental utility for opportunistic screening of some significant, occult diseases and conditions, universal utilization of the full panel is not supported by the cost-effectiveness found in this study.

scholarly journals The Cost of Hepatitis C Testing Strategies in Primary Care Patients with Abnormal Transaminases

2019 ◽  
Vol 35 (4) ◽  
pp. 1340-1342 ◽  
Author(s):  
Andrew D. Schreiner ◽  
Don C. Rockey ◽  
William P. Moran
Keyword(s):  
Primary Care ◽  
Hepatitis C ◽  
Testing Strategies ◽  
Primary Care Patients ◽  
The Cost

Incremental cost-effectiveness of a collaborative care intervention for panic disorder

2006 ◽  
Vol 36 (3) ◽  
pp. 353-363 ◽  
Author(s):  
WAYNE KATON ◽  
JOAN RUSSO ◽  
CATHY SHERBOURNE ◽  
MURRAY B. STEIN ◽  
MICHELLE CRASKE ◽  
...  
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Panic Disorder ◽  
Incremental Cost ◽  
Usual Care ◽  
Moderate Increase ◽  
Patient Costs ◽  
Care Intervention ◽  
Life Years ◽  
Primary Care Patients

Background. Panic disorder is a prevalent, often disabling, disorder among primary-care patients, but there are large gaps in quality of treatment in primary care. This study describes the incremental cost-effectiveness of a combined cognitive behavioral therapy (CBT) and pharmacotherapy intervention for patients with panic disorder versus usual primary-care treatment.Method. This randomized control trial recruited 232 primary-care patients meeting DSM-IV criteria for panic disorder from March 2000 to March 2002 from six primary-care clinics from university-affiliated clinics at the University of Washington (Seattle) and University of California (Los Angeles and San Diego). Patients were randomly assigned to receive either treatment as usual or a combined CBT and pharmacotherapy intervention for panic disorder delivered in primary care by a mental health therapist. Intervention patients had up to six sessions of CBT modified for the primary-care setting in the first 12 weeks, and up to six telephone follow-ups over the next 9 months. The primary outcome variables were total out-patient costs, anxiety-free days (AFDs) and quality adjusted life-years (QALYs).Results. Relative to usual care, intervention patients experienced 60·4 [95% confidence interval (CI) 42·9–77·9] more AFDs over a 12-month period. Total incremental out-patient costs were $492 higher (95% CI $236–747) in intervention versus usual care patients with a cost per additional AFD of $8.40 (95% CI $2.80–14.0) and a cost per QALY ranging from $14158 (95% CI $6791–21496) to $24776 (95% CI $11885–37618). The cost per QALY estimate is well within the range of other commonly accepted medical interventions such as statin use and treatment of hypertension.Conclusions. The combined CBT and pharmacotherapy intervention was associated with a robust clinical improvement compared to usual care with a moderate increase in ambulatory costs.

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