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

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.

Download Full-text

Community interventions for people with complex emotional needs that meet the criteria for personality disorder diagnoses: systematic review of economic evaluations and expert commentary

BJPsych Open ◽

10.1192/bjo.2021.1043 ◽

2021 ◽

Vol 7 (6) ◽

Author(s):

Joe Botham ◽

Amy Clark ◽

Thomas Steare ◽

Ruth Stuart ◽

Sian Oram ◽

...

Keyword(s):

Mental Health ◽

Personality Disorder ◽

Cost Effective ◽

Economic Evaluations ◽

Economic Evidence ◽

Emotional Needs ◽

Community Based Interventions ◽

Community Based ◽

Single Intervention ◽

The Cost

Background Diagnoses of personality disorder are prevalent among people using community secondary mental health services. Identifying cost-effective community-based interventions is important when working with finite resources. Aims To assess the cost-effectiveness of primary or secondary care community-based interventions for people with complex emotional needs who meet criteria for a diagnosis of personality disorder to inform healthcare policy-making. Method Systematic review (PROSPERO: CRD42020134068) of databases. 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 before 18 September 2019. Study quality was assessed using the CHEERS statement. Results Eighteen studies were included. The studies mainly evaluated psychotherapeutic interventions. Studies were also identified that 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. Conclusions Robust economic evidence to support a single intervention or model of community-based care for people with complex emotional needs is lacking. The strongest evidence was for dialectical behaviour therapy, with all three identified studies indicating that it is likely to be cost-effective in community settings compared with treatment as usual. More robust evidence is required on the cost-effectiveness of community-based interventions on which decision makers can confidently base guidelines or allocate resources. The evidence should be based on consistent measures of costs and outcomes with sufficient sample sizes to demonstrate impacts on these.

Download Full-text

Economic evaluations of public health interventions for mental health: A systematic literature review

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.057 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

I Feldman ◽

M Gebreslassie ◽

F Sampaio ◽

C Nystrand ◽

R Ssegonja

Keyword(s):

Public Health ◽

Mental Health ◽

Cost Effectiveness ◽

Suicide Prevention ◽

High Potential ◽

Health Interventions ◽

Economic Evaluations ◽

Public Health Interventions ◽

High Quality ◽

The Cost

Abstract Background To review the literature on economic evaluations of public health interventions targeting prevention of mental health problems and suicide, to support evidence based societal resource allocation. Methods A systematic review of economic evaluations within mental health and suicide prevention was conducted including studies published between 2000 and 2018. The studies were identified through Medline, PsychINFO, Web of Science. The quality of relevant studies and the transferability of their results were assessed using a criterion set out by the Swedish Agency for Health Technology Assessment. Results Nineteen studies of moderate to high quality were included in this review, which evaluated 18 interventions in mental health and 4 interventions in suicide prevention. Fourteen (63%) of all interventions were cost-effective. None of the studies that evaluated suicide prevention was of high quality. The interventions largely focused on psychological interventions at school, the workplace and within elderly care as well as screening and brief interventions in primary care. Nine studies (around 50% of included articles) had a high potential for transferability to the Swedish context. Conclusions Public health interventions aiming to improve mental health have a high potential to be economically beneficial to society, but high-quality evidence on the cost-effectiveness of suicide prevention is limited. Key messages Public health interventions aiming to improve mental health have a high potential to be economically beneficial to society. Evidence on the cost-effectiveness of suicide prevention is limited.

Download Full-text

Cost-effectiveness of mental health promotion and prevention for young people: a systematic review

European Journal of Public Health ◽

10.1093/eurpub/ckz186.183 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

M Schmidt ◽

A Werbrouck ◽

N Verhaeghe ◽

K Putman ◽

S Simoens ◽

...

Keyword(s):

Mental Health ◽

Health Promotion ◽

Cost Effectiveness ◽

Mental Health Promotion ◽

Economic Evaluations ◽

Prevention Interventions ◽

Bullying Interventions ◽

The Cost ◽

Disorder Prevention

Abstract Background Effective mental health promotion and mental disorder prevention interventions may reduce the impact that mental health problems have on young people’s wellbeing. The objectives of this research were to summarize and assess health economic evaluations of mental health promotion and prevention for children and adolescents aged 6-18 years. Methods Four electronic databases were searched for full health economic evaluations published between January 1, 2013 and October 31, 2018 that evaluated the cost-effectiveness of universal mental health promotion and primary mental disorder prevention interventions. Each study was subject to a systematic quality-appraisal. Results Nine studies were included. Eight were carried out in the European Union, and eight evaluated school-based interventions. All evaluated interventions led to incremental costs compared to their comparators and most were associated with small increases in quality-adjusted life years. Four studies evaluated the cost-effectiveness of cognitive behavioural therapy-based interventions for the prevention of depression or anxiety, with mixed results. Cost-effectiveness estimates for mental health promotion and anti-bullying interventions were promising. Drivers of cost-effectiveness were implementation costs, intervention effectiveness, delivery mode and duration, baseline prevalence, and the perspective of the evaluation. The overall study quality was reasonable, though most studies only assessed short-term costs and effects. Conclusions Few studies were found. This limits the possibility of drawing strong conclusions about cost-effectiveness. There is some evidence based on decision-analytic modelling that anti-bullying interventions represent value for money. There is a lack of studies that take into account long-term costs and effects. Key messages Based on the evidence, schools should be supported in the implementation of long-term anti-bullying programmes to improve young people’s wellbeing. More research is needed on the long-term costs and effects of mental health promotion and prevention for children and adolescents.

Download Full-text

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.

Download Full-text

Economic Evaluations of Next-Generation Precision Oncology: A Critical Review

JCO Precision Oncology ◽

10.1200/po.17.00311 ◽

2018 ◽

pp. 1-23 ◽

Cited By ~ 2

Author(s):

Deirdre Weymann ◽

Reka Pataky ◽

Dean A. Regier

Keyword(s):

Cost Effectiveness ◽

English Language ◽

Economic Evaluations ◽

Precision Oncology ◽

Cancer Type ◽

Economic Evidence ◽

Next Generation ◽

Patient Health ◽

Study Characteristics ◽

The Cost

Purpose Precision oncology has the potential to improve patient health and reduce treatment costs. Yet the up-front cost of genomic testing with next-generation sequencing (NGS) technologies can be prohibitive. Our study is a structured review of economic evaluations of precision oncology informed by NGS. The aim is to characterize the availability and scope of economic evidence. Materials and Methods We searched Medline (PubMed), Embase (Ovid), and Web of Science databases for English-language full-text peer-reviewed articles published between 2000 and 2016. We focused our search on articles that estimated the benefit of precision oncology in relation to its costs. We excluded studies that did not undertake full economic evaluations or did not focus on NGS technologies. We reviewed all included studies and summarized key methodological and empirical study characteristics. Results Fifty-five economic evaluations met our inclusion criteria. The number of published studies increased steadily, from three studies between 2005 and 2007 to 26 between 2014 and 2016. Most studies evaluated multiplex panels (86%). We found testing was frequently used to predict prognosis (67%), to diagnose patients (24%), or to identify targeted therapeutic options (7%). Methods and cost effectiveness differed according to NGS technology, test strategy, and cancer type. Deterministic and probabilistic analyses were typically used to characterize parameter and decision uncertainty (91% and 75%). Conclusion Although the availability of economic evidence examining precision oncology increased over time, methods used often did not align with current guidelines. Future evaluations should undertake extensive sensitivity analysis to address all sources of uncertainty associated with rapidly changing NGS technologies. Furthermore, additional research is needed evaluating the cost effectiveness of more comprehensive next-generation technologies before implementing these on a wider scale.

Download Full-text

An economic evaluation of a mobile text messaging intervention to improve mental health care in resource-poor communities in China: a cost-effectiveness study

BMC Health Services Research ◽

10.1186/s12913-020-05855-6 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Rubee Dev ◽

Jinghua Li ◽

Donglan Zhang ◽

Yiyuan Cai ◽

Chun Hao ◽

...

Keyword(s):

Mental Health ◽

Economic Evaluation ◽

Cost Effectiveness ◽

Mental Disorders ◽

Health Program ◽

Mental Health Program ◽

Cost Utility ◽

Severe Mental Disorders ◽

Community Based ◽

The Cost

Abstract Background Severe mental disorders, a leading cause of disability has become a major public health problem. In order to promote mental health, a series of programs have been promulgated by the Chinese government. However, economic evaluations of such programs are lacking. The purpose of this study is to develop and validate an economic model to assess the cost and health outcomes of the LEAN (Lay health supporters, E-platform, Award, and iNtegration) program, and to perform an economic evaluation of LEAN versus the nationwide community-based mental health program that provides free antipsychotic medications. Methods A cost-effectiveness and cost-utility analysis of the LEAN intervention will be performed. A Markov model will be developed, validated and used to assess and compare the costs and outcomes for the LEAN intervention versus nationwide community-based mental health program. The calculated sample size is 258 participants for the analysis. A societal perspective will be applied with the time horizon of 1-year after the termination of the LEAN program. The cost-utility will be measured primarily using Quality Adjusted Life Years and the cost-effectiveness will be measured using number of relapses and number of re-hospitalizations avoided 6-month after the intervention. Univariate and probabilistic sensitivity analysis will be conducted for the analysis of uncertainty. Discussion If proven cost-effective, this study will contribute to the nationwide implementation of the program, not only for schizophrenia but for all kind of severe mental disorders. Markov model developed as part of the study will benefit potential researchers in analyzing cost-effectiveness of other programs. The Chinese context of the study may limit the generalizability of the study results to some extent. Trial registration This study was registered in a Chinese Clinical Trial Registry (ChiCTR2000034962) on 25 July 2020.

Download Full-text

Marginal assessment of the cost and benefits of aphasia treatment: Evidence from community-based telerehabilitation treatment for aphasia

Journal of Telemedicine and Telecare ◽

10.1177/1357633x20982773 ◽

2021 ◽

pp. 1357633X2098277

Author(s):

Molly Jacobs ◽

Patrick M Briley ◽

Heather Harris Wright ◽

Charles Ellis

Keyword(s):

Cost Effectiveness ◽

Economies Of Scale ◽

Reference Group ◽

Unit Cost ◽

Community Based ◽

Face To Face ◽

Conduction Aphasia ◽

Aphasia Treatment ◽

The Cost ◽

The Relationship

Introduction Few studies have reported information related to the cost-effectiveness of traditional face-to-face treatments for aphasia. The emergence and demand for telepractice approaches to aphasia treatment has resulted in an urgent need to understand the costs and cost-benefits of this approach. Methods Eighteen stroke survivors with aphasia completed community-based aphasia telerehabilitation treatment, utilizing the Language-Oriented Treatment (LOT) delivered via Webex videoconferencing program. Marginal benefits to treatment were calculated as the change in Western Aphasia Battery-Revised (WAB-R) score pre- and post-treatment and marginal cost of treatment was calculated as the relationship between change in WAB-R aphasia quotient (AQ) and the average cost per treatment. Controlling for demographic variables, Bayesian estimation evaluated the primary contributors to WAB-R change and assessed cost-effectiveness of treatment by aphasia type. Results Thirteen out of 18 participants experienced significant improvement in WAB-R AQ following telerehabilitation delivered therapy. Compared to anomic aphasia (reference group), those with conduction aphasia had relatively similar levels of improvement whereas those with Broca’s aphasia had smaller improvement. Those with global aphasia had the largest improvement. Each one-point of improvement cost between US$89 and US$864 for those who improved (mean = US$200) depending on aphasia type/severity. Discussion Individuals with severe aphasia may have the greatest gains per unit cost from treatment. Both improvement magnitude and the cost per unit of improvement were driven by aphasia type, severity and race. Economies of scale to aphasia treatment–cost may be minimized by treating a variety of types of aphasia at various levels of severity.

Download Full-text

A Systematic Review of Cost-Effectiveness Analyses Alongside Randomised Controlled Trials of Acupuncture

Acupuncture in Medicine ◽

10.1136/acupmed-2012-010178 ◽

2012 ◽

Vol 30 (4) ◽

pp. 273-285 ◽

Cited By ~ 38

Author(s):

Song-Yi Kim ◽

Hyangsook Lee ◽

Younbyoung Chae ◽

Hi-Joon Park ◽

Hyejung Lee

Keyword(s):

Cost Effectiveness ◽

Usual Care ◽

Randomised Controlled Trials ◽

Risk Of Bias ◽

Economic Evaluations ◽

Controlled Trials ◽

German Studies ◽

Life Years ◽

Randomised Controlled ◽

The Cost

Objective To summarise the evidence on the cost-effectiveness of acupuncture. Methods We identified full economic evaluations such as cost-effectiveness analysis (CEA), cost-utility analysis (CUA) and cost-benefit analysis (CBA) alongside randomised controlled trials (RCTs) that assessed the consequences and costs of acupuncture for any medical condition. Eleven electronic databases were searched up to March 2011 without language restrictions. Eligible RCTs were assessed using the Cochrane criteria for risk of bias and a modified version of the checklist for economic evaluation. The general characteristics and the results of each economic analysis such as incremental cost-effectiveness ratios (ICERs) were extracted. Results Of 17 included studies, nine were CUAs that measured quality-adjusted life years (QALYs) and eight were CEAs that assessed effectiveness of acupuncture based on improvements in clinical symptoms. All CUAs showed that acupuncture with or without usual care was cost-effective compared with waiting list control or usual care alone, with ICERs ranging from ¢3011/QALY (dysmenorrhoea) to ¢22 298/QALY (allergic rhinitis) in German studies, and from £3855/QALY (osteoarthritis) to £9951/QALY (headache) in UK studies. In the CEAs, acupuncture was beneficial at a relatively low cost in six European and Asian studies. All CUAs were well-designed with a low risk of bias, but this was not the case for CEAs. Conclusions Overall, this review demonstrates the cost-effectiveness of acupuncture. Despite such promising results, any generalisation of these results needs to be made with caution given the diversity of diseases and the different status of acupuncture in the various countries.

Download Full-text