PSY40 COST-EFFECTIVENESS OF PREGABALIN VERSUS USUAL CARE IN REFRACTORY OUT-PATIENTS WITH NEUROPATIC PAIN FOLLOWED IN PRIMARY CARE SETTINGS

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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Cost-effectiveness of counselling, graded-exercise and usual care for chronic fatigue: evidence from a randomised trial in primary care

BMC Health Services Research ◽

10.1186/1472-6963-12-264 ◽

2012 ◽

Vol 12 (1) ◽

Cited By ~ 14

Author(s):

Ramon Sabes-Figuera ◽

Paul McCrone ◽

Mike Hurley ◽

Michael King ◽

Ana Nora Donaldson ◽

...

Keyword(s):

Primary Care ◽

Cost Effectiveness ◽

Usual Care ◽

Randomised Trial ◽

Chronic Fatigue ◽

Graded Exercise

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Cost-effectiveness of cognitive behaviour therapy versus talking and usual care for depressed older people in primary care

BMC Health Services Research ◽

10.1186/1472-6963-11-33 ◽

2011 ◽

Vol 11 (1) ◽

Cited By ~ 10

Author(s):

Amanda J Holman ◽

Marc A Serfaty ◽

Baptiste E Leurent ◽

Michael B King

Keyword(s):

Primary Care ◽

Cost Effectiveness ◽

Older People ◽

Usual Care ◽

Cognitive Behaviour Therapy ◽

Behaviour Therapy ◽

Cognitive Behaviour

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The Cost-Effectiveness of Birth Cohort Screening for Hepatitis C Antibody in US Primary Care Settings

Gastroenterology ◽

10.1053/j.gastro.2012.12.013 ◽

2013 ◽

Vol 144 (2) ◽

pp. 457-459 ◽

Cited By ~ 7

Author(s):

Raj Vuppalanchi ◽

Paul Y. Kwo

Keyword(s):

Primary Care ◽

Cost Effectiveness ◽

Hepatitis C ◽

Birth Cohort ◽

Primary Care Settings ◽

The Cost

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The Stroke Prevention Programme: a programme of research to inform optimal stroke prevention in primary care

Programme Grants for Applied Research ◽

10.3310/pgfar04030 ◽

2016 ◽

Vol 4 (3) ◽

pp. 1-290

Author(s):

Kate Fletcher ◽

Jonathan Mant ◽

Richard McManus ◽

Richard Hobbs

Keyword(s):

Primary Care ◽

Cost Effectiveness ◽

Usual Care ◽

Research Programme ◽

Cost Effective ◽

Self Management ◽

Controlled Trials ◽

National Guidelines ◽

History Of ◽

General Practices

BackgroundThe management of cardiovascular (CV) risk factors in community populations is suboptimal. The aim of this programme was to explore the role of three approaches [use of a ‘polypill’; self-management of hypertension; and more intensive targets for blood pressure (BP) lowering after stroke] to improve prevention of CV disease (CVD) in the community.Research questions(1) Is it more cost-effective to titrate treatments to target levels of cholesterol and BP or to use fixed doses of statins and BP-lowering agents (polypill strategy)? (2) Will telemonitoring and self-management improve BP control in people on treatment for hypertension or with a history of stroke/transient ischaemic attack (TIA) in primary care and are they cost-effective? (3) In people with a history of stroke/TIA, can intensive BP-lowering targets be achieved in a primary care setting and what impact will this have on health outcomes and cost-effectiveness?DesignMixed methods, comprising three randomised controlled trials (RCTs); five cost-effectiveness analyses; qualitative studies; analysis of electronic general practice data; a screening study; a systematic review; and a questionnaire study.SettingUK general practices, predominantly from the West Midlands and the east of England.ParticipantsAdults registered with participating general practices. Inclusion criteria varied from study to study.InterventionsA polypill – a fixed-dose combination pill containing three antihypertensive medicines and simvastatin – compared with current practice and with optimal implementation of national guidelines; self-monitoring of BP with self-titration of medication, compared with usual care; and an intensive target for systolic BP of < 130 mmHg or a 10 mmHg reduction if baseline BP is < 140 mmHg, compared with a target of < 140 mmHg.ResultsFor patients known to be at high risk of CVD, treatment as per guidelines was the most cost-effective strategy. For people with unknown CV risk aged ≥ 50 years, offering a polypill is cost-effective [incremental cost-effectiveness ratio (ICER) of £8115 per quality-adjusted life-year (QALY)] compared with a strategy of screening and treating according to national guidelines. Both results were sensitive to the cost of the polypill. Self-management in people with uncontrolled hypertension led to a 5.4 mmHg [95% confidence interval (CI) 2.4 to 8.5 mmHg] reduction in systolic BP at 1 year, compared with usual care. It was cost-effective for men (ICER of £1624 per QALY) and women (ICER of £4923 per QALY). In people with stroke and other high-risk groups, self-management led to a 9.2 mmHg (95% CI 5.7 to 12.7 mmHg) reduction in systolic BP at 1 year compared with usual care and dominated (lower cost and better outcome) usual care. Aiming for the more intensive BP target after stroke led to a 2.9 mmHg (95% CI 0.2 to 5.7 mmHg) greater reduction in BP and dominated the 140 mmHg target.ConclusionsPotential for a polypill needs to be further explored in RCTs. Self-management should be offered to people with poorly controlled BP. Management of BP in the post-stroke population should focus on achieving a < 140 mmHg target.Trial registrationCurrent Controlled Trials ISRCTN17585681, ISRCTN87171227 and ISRCTN29062286.FundingThe National Institute for Health Research (NIHR) Programme Grants for Applied Research programme. Additional funding was provided by the NIHR National School for Primary Care Research, the NIHR Career Development Fellowship and the Department of Health Policy Research Programme.

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Antidepressant Medication Use Among Patients with Depression: Comparison between Usual Care and Collaborative Care Using Care Managers

Clinical Practice and Epidemiology in Mental Health ◽

10.2174/1745017901309010084 ◽

2013 ◽

Vol 9 (1) ◽

pp. 84-87 ◽

Cited By ~ 3

Author(s):

Ramona S DeJesus ◽

Kurt B Angstman ◽

Stephen S Cha ◽

Mark D Williams

Keyword(s):

Primary Care ◽

Usual Care ◽

Collaborative Care ◽

Antidepressant Medication ◽

Primary Care Clinics ◽

Primary Care Settings ◽

Care Managers ◽

Significant Difference ◽

Depression Management ◽

Treatment Improvement

Depression poses a significant economic and health burden, yet it remains underdiagnosed and inadequately treated. The STAR*D trial funded by the National Institute of Mental Health showed that more than one antidepressant medication is often necessary to achieve disease remission among patients seen in both psychiatric and primary care settings. The collaborative care model (CCM), using care managers, has been shown to be effective in numerous studies in achieving sustained outcomes in depression management compared to usual care. This model was adopted in a statewide depression treatment improvement initiative among primary care clinics in Minnesota, which was launched in March 2008. In this study, records of patients who were enrolled in CCM from March 2008 until March 2009 were reviewed and compared to those under usual care. Patients who were followed under the CCM had a significantly greater number of antidepressant medication utilizations when compared to those under usual care. After 6 months, mean PHQ-9 score of patients under CCM was statistically lower than those in usual care. There was no significant difference in both mean PHQ-9 scores at 6 months and antidepressant utilization between the 2 groups among patients aged 65 years and older.

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Exploring the cost-effectiveness of a Dutch collaborative stepped care intervention for the treatment of depression and/or anxiety when adapted to the Australian context: a model-based cost-utility analysis

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796021000470 ◽

2021 ◽

Vol 30 ◽

Author(s):

Y. Y. Lee ◽

M. G. Harris ◽

H. A. Whiteford ◽

S. K. Davidson ◽

M. L. Chatterton ◽

...

Keyword(s):

Primary Care ◽

Cost Effectiveness ◽

Health Outcomes ◽

Cost Effective ◽

Stepped Care ◽

Primary Care Settings ◽

Self Help ◽

Australian Context ◽

Treatment Of Depression ◽

The Cost

Abstract Aims Depression and anxiety are among the most common mental health conditions treated in primary care. They frequently co-occur and involve recommended treatments that overlap. Evidence from randomised controlled trials (RCTs) shows specific stepped care interventions to be cost-effective in improving symptom remission. However, most RCTs have focused on either depression or anxiety, which limits their generalisability to routine primary care settings. This study aimed to evaluate the cost-effectiveness of a collaborative stepped care (CSC) intervention to treat depression and/or anxiety among adults in Australian primary care settings. Method A quasi-decision tree model was developed to evaluate the cost-effectiveness of a CSC intervention relative to care-as-usual (CAU). The model adapted a CSC intervention described in a previous Dutch RCT to the Australian context. This 8-month, cluster RCT recruited patients with depression and/or anxiety (n = 158) from 30 primary care clinics in the Netherlands. The CSC intervention involved two steps: (1) guided self-help with a nurse at a primary care clinic; and (2) referral to specialised mental healthcare. The cost-effectiveness model adopted a health sector perspective and synthesised data from two main sources: RCT data on intervention pathways, remission probabilities and healthcare service utilisation; and Australia-specific data on demography, epidemiology and unit costs from external sources. Incremental costs and incremental health outcomes were estimated across a 1-year time horizon. Health outcomes were measured as disability-adjusted life years (DALYs) due to remitted cases of depression and/or anxiety. Incremental cost-effectiveness ratios (ICERs) were measured in 2019 Australian dollars (A$) per DALY averted. Uncertainty and sensitivity analyses were performed to test the robustness of cost-effectiveness findings. Result The CSC intervention had a high probability (99.6%) of being cost-effective relative to CAU. The resulting ICER (A$5207/DALY; 95% uncertainty interval: dominant to 25 345) fell below the willingness-to-pay threshold of A$50 000/DALY. ICERs were robust to changes in model parameters and assumptions. Conclusions This study found that a Dutch CSC intervention, with nurse-delivered guided self-help treatment as a first step, could potentially be cost-effective in treating depression and/or anxiety if transferred to the Australian primary care context. However, adaptations may be required to ensure feasibility and acceptability in the Australian healthcare context. In addition, further evidence is needed to verify the real-world cost-effectiveness of the CSC intervention when implemented in routine practice and to evaluate its effectiveness/cost-effectiveness when compared to other viable stepped care interventions for the treatment of depression and/or anxiety.

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The Impact of Pharmacist Care on Diabetes Outcomes in Primary Care Settings: An Umbrella Review of Systematic Reviews

University of the Future: Re-Imagining Research and Higher Education ◽

10.29117/quarfe.2020.0174 ◽

2020 ◽

Author(s):

Sara Hamdi Abdulrhim ◽

Sownd Sankaralingam ◽

Mohamed Izham

Keyword(s):

Primary Care ◽

Usual Care ◽

Systematic Reviews ◽

Diabetes Care ◽

Economic Outcomes ◽

Diabetes Outcomes ◽

Primary Care Settings ◽

Pharmacist Interventions ◽

The Impact ◽

Pharmacist Care

Objective: To systematically review published systematic reviews (SRs) examining the impact of pharmacist interventions in multidisciplinary diabetes care teams on diabetes-related clinical, humanistic, and economic outcomes in primary care settings. Methods: PubMed, EMBASE, Scopus, Database of Abstracts of Reviews of Effects, Cochrane Library, Joanna Briggs Institute (JBI) Database, Google Scholar, and PROSPERO were searched from inception to 2018. Studies published in English evaluating the effect of pharmacist interventions on diabetes outcomes were included. Two independent reviewers were involved in the screening of titles and abstracts, selection of studies, and methodological quality assessment. Results: Seven SRs were included in the study. Three of them included only randomized controlled trials, while the rest involved other study designs. Educational interventions by clinical pharmacists within the healthcare team were the most common types of interventions reported across all SRs. Pharmacist’s interventions compared to usual care resulted in favorable significant improvements in hemoglobin A1c (HbA1c), fasting blood glucose, blood pressure, body mass index, total cholesterol, lowdensity lipoprotein, high-density lipoprotein and triglycerides in more than 50% of the SRs. Improvement in HbA1c was the mostly reported clinical outcome of pharmacist intervention in the literature (reported in six SRs). Pharmacist’s interventions led to significant cost-saving ($8–$85,000 per person per year), cost-utility, and cost-benefit (benefit-to-cost ratio range from 1:1 to 8.5:1) versus usual care. Pharmacist’s interventions improved patients’ quality of life (QoL) in three SRs; however, no conclusion can be drawn due to the use of diverse QoL assessment tools. Conclusion: Most SRs support the benefit of pharmacist care on diabetes-related clinical, humanistic, and economic outcomes in primary care settings. Improvements in diabetes outcomes can significantly reduce the burden of diabetes on the healthcare system. Hence, the incorporation of pharmacists into multidisciplinary diabetes care teams is beneficial and should be strongly considered by clinicians and health policymakers.

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