scholarly journals Effectiveness and cost-effectiveness of a cardiovascular risk prediction algorithm for people with severe mental illness (PRIMROSE)

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e018181 ◽  
Author(s):  
Ella Zomer ◽  
David Osborn ◽  
Irwin Nazareth ◽  
Ruth Blackburn ◽  
Alexandra Burton ◽  
...  
Keyword(s):  
Mental Illness ◽  
Cardiovascular Risk ◽  
Cost Effectiveness ◽  
General Population ◽  
Cost Saving ◽  
Severe Mental Illness ◽  
Secondary Outcome ◽  
Health Improvement ◽  
Parameter Estimates ◽  
Life Years

ObjectivesTo determine the cost-effectiveness of two bespoke severe mental illness (SMI)-specific risk algorithms compared with standard risk algorithms for primary cardiovascular disease (CVD) prevention in those with SMI.SettingPrimary care setting in the UK. The analysis was from the National Health Service perspective.Participants1000 individuals with SMI from The Health Improvement Network Database, aged 30–74 years and without existing CVD, populated the model.InterventionsFour cardiovascular risk algorithms were assessed: (1) general population lipid, (2) general population body mass index (BMI), (3) SMI-specific lipid and (4) SMI-specific BMI, compared against no algorithm. At baseline, each cardiovascular risk algorithm was applied and those considered high risk (>10%) were assumed to be prescribed statin therapy while others received usual care.Primary and secondary outcome measuresQuality-adjusted life years (QALYs) and costs were accrued for each algorithm including no algorithm, and cost-effectiveness was calculated using the net monetary benefit (NMB) approach. Deterministic and probabilistic sensitivity analyses were performed to test assumptions made and uncertainty around parameter estimates.ResultsThe SMI-specific BMI algorithm had the highest NMB resulting in 15 additional QALYs and a cost saving of approximately £53 000 per 1000 patients with SMI over 10 years, followed by the general population lipid algorithm (13 additional QALYs and a cost saving of £46 000).ConclusionsThe general population lipid and SMI-specific BMI algorithms performed equally well. The ease and acceptability of use of an SMI-specific BMI algorithm (blood tests not required) makes it an attractive algorithm to implement in clinical settings.

Effectiveness and cost-effectiveness of a cardiovascular risk prediction algorithm for people with severe mental illness

2016 ◽  
Vol 33 (S1) ◽  
pp. S191-S191
Author(s):  
E. Zomer ◽  
D. Osborn ◽  
I. Nazareth ◽  
R. Blackburn ◽  
A. Burton ◽  
...  
Keyword(s):  
Mental Illness ◽  
Cardiovascular Risk ◽  
Cost Effectiveness ◽  
General Population ◽  
Severe Mental Illness ◽  
Risk Prediction ◽  
Health Improvement ◽  
Health State ◽  
Cardiovascular Risk Prediction ◽  
Cvd Prevention

IntroductionCardiovascular risk prediction tools are important for cardiovascular disease (CVD) prevention, however, which algorithms are appropriate for people with severe mental illness (SMI) is unclear.Objectives/aimsTo determine the cost-effectiveness using the net monetary benefit (NMB) approach of two bespoke SMI-specific risk algorithms compared to standard risk algorithms for primary CVD prevention in those with SMI, from an NHS perspective.MethodsA microsimulation model was populated with 1000 individuals with SMI from The Health Improvement Network Database, aged 30–74 years without CVD. Four cardiovascular risk algorithms were assessed; (1) general population lipid, (2) general population BMI, (3) SMI-specific lipid and (4) SMI-specific BMI, compared against no algorithm. At baseline, each cardiovascular risk algorithm was applied and those high-risk (> 10%) were assumed to be prescribed statin therapy, others received usual care. Individuals entered the model in a ‘healthy’ free of CVD health state and with each year could retain their current health state, have cardiovascular events (non-fatal/fatal) or die from other causes according to transition probabilities.ResultsThe SMI-specific BMI and general population lipid algorithms had the highest NMB of the four algorithms resulting in 12 additional QALYs and a cost saving of approximately £37,000 (US$ 58,000) per 1000 patients with SMI over 10 years.ConclusionsThe general population lipid and SMI-specific BMI algorithms performed equally well. The ease and acceptability of use of a SMI-specific BMI algorithm (blood tests not required) makes it an attractive algorithm to implement in clinical settings.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Estimating the cost-effectiveness of screening a general population for cardiovascular risk with high-sensitivity troponin-I

2021 ◽  
Author(s):  
Paul Jülicher ◽  
Christos Varounis
Keyword(s):  
Cardiovascular Risk ◽  
Cost Effectiveness ◽  
General Population ◽  
Troponin I ◽  
Indirect Costs ◽  
High Sensitivity ◽  
Cost Effective ◽  
Direct And Indirect Costs ◽  
Life Years ◽  
The Cost

Abstract Aims  To estimate the cost-effectiveness of using the cardiac specific marker high-sensitivity troponin-I (hsTnI) for assessing cardiovascular disease (CVD) risk in a general population. Methods and results  A discrete-event simulation model was developed from a societal perspective of a low-risk (Germany) and a high-risk (Kazakhstan) country. The model compared a Screen&Prevent strategy guided by hsTnI against a do-nothing strategy. Risk functions were derived from published data of a prospective cohort study [Nord-Trøndelag Health (HUNT) Study]. The model assessed the number of CVD events and deaths, healthy life years, direct and indirect costs in PPP 2018 Dollar, and quality-adjusted life years (QALY) over a time horizon of 10 years. Screen&Prevent reduced the number of CVD events per 1000 subjects by 5.1 and 5.0, equal to a number-needed-to-screen of 195 and 191 in Kazakhstan and Germany. Screen&Prevent was cost saving in Kazakhstan and cost-effective in Germany with an incremental-cost-effectiveness ratio of $6755 ($2294; $24 054) per QALY gained at an opportunity-cost based willingness-to-pay threshold of $27 373. Varying input variables in univariate and probabilistic sensitivity analyses confirmed the robustness of the analysis. Conclusion  Assessing the cardiovascular risk with hsTnI in a general population and subsequently referring those at high risk to preventive means would very likely be cost-effective or cost-saving by avoiding CVD events and associated direct and indirect costs. This conclusion is retained even if only the direct costs or only the costs for screening and prevention are considered. Future studies should evaluate the incremental cost-effectiveness of hsTnI-guided assessment strategies against established risk algorithms.

scholarly journals Development of unmanned aerial vehicle (UAV) networks delivering early defibrillation for out-of-hospital cardiac arrests (OHCA) in areas lacking timely access to emergency medical services (EMS) in Germany: a comparative economic study

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e043791
Author(s):  
Jan Bauer ◽  
Dieter Moormann ◽  
Reinhard Strametz ◽  
David A Groneberg
Keyword(s):  
Cost Effectiveness ◽  
Emergency Medical Services ◽  
Rural Areas ◽  
Medical Services ◽  
Secondary Outcome ◽  
Annual Average ◽  
Emergency Medical ◽  
Life Years ◽  
Timely Access ◽  
The Cost

ObjectivesThis study wants to assess the cost-effectiveness of unmanned aerial vehicles (UAV) equipped with automated external defibrillators (AED) in out-of-hospital cardiac arrests (OHCA). Especially in rural areas with longer response times of emergency medical services (EMS) early lay defibrillation could lead to a significant higher survival in OHCA.Participants3296 emergency medical stations in Germany.SettingRural areas in Germany.Primary and secondary outcome measuresThree UAV networks providing 80%, 90% or 100% coverage for rural areas lacking timely access to EMS (ie, time-to-defibrillation: >10 min) were developed using a location allocation analysis. For each UAV network, primary outcome was the cost-effectiveness using the incremental cost-effectiveness ratio (ICER) calculated by the ratio of financial costs to additional life years gained compared with current EMS.ResultsCurrent EMS with 3926 emergency stations was able to gain 1224 life years on annual average in the study area. The UAV network providing 100% coverage consisted of 1933 UAV with average annual costs of €43.5 million and 1845 additional life years gained on annual average (ICER: €23 568). The UAV network providing 90% coverage consisted of 1074 UAV with average annual costs of €24.2 million and 1661 additional life years gained on annual average (ICER: €14 548). The UAV network providing 80% coverage consisted of 798 UAV with average annual costs of €18.0 million and 1477 additional life years gained on annual average (ICER: €12 158).ConclusionThese results reveal the relevant life-saving potential of all modelled UAV networks. Furthermore, all analysed UAV networks could be deemed cost-effective. However, real-life applications are needed to validate the findings.

scholarly journals Cost Analysis of a High Support Housing Initiative for Persons with Severe Mental Illness and Long-Term Psychiatric Hospitalization

2018 ◽  
Vol 63 (7) ◽  
pp. 492-500 ◽  
Author(s):  
David Rudoler ◽  
Claire de Oliveira ◽  
Binu Jacob ◽  
Melonie Hopkins ◽  
Paul Kurdyak
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Cost Saving ◽  
Cost Analysis ◽  
Severe Mental Illness ◽  
Inpatient Care ◽  
Cost Savings ◽  
Support Housing ◽  
High Support

Objective: The objective of this article was to conduct a cost analysis comparing the costs of a supportive housing intervention to inpatient care for clients with severe mental illness who were designated alternative-level care while inpatient at the Centre for Addiction and Mental Health in Toronto. The intervention, called the High Support Housing Initiative, was implemented in 2013 through a collaboration between 15 agencies in the Toronto area. Method: The perspective of this cost analysis was that of the Ontario Ministry of Health and Long-Term Care. We compared the cost of inpatient mental health care to high-support housing. Cost data were derived from a variety of sources, including health administrative data, expenditures reported by housing providers, and document analysis. Results: The High Support Housing Initiative was cost saving relative to inpatient care. The average cost savings per diem were between $140 and $160. This amounts to an annual cost savings of approximately $51,000 to $58,000. When tested through sensitivity analysis, the intervention remained cost saving in most scenarios; however, the result was highly sensitive to health system costs for clients of the High Support Housing Initiative program. Conclusions: This study suggests the High Support Housing Initiative is potentially cost saving relative to inpatient hospitalization at the Centre for Addiction and Mental Health.

Abstract MP019: Should Global Cardiovascular Risk Guide Treatment of Stage One Hypertension? A Cost-effectiveness Analysis

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Andrew Moran ◽  
Petra Rasmussen ◽  
Rachel Zhao ◽  
Pamela G Coxson ◽  
David Guzman ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Cost Effectiveness ◽  
Cost Saving ◽  
Risk Function ◽  
Annual Number ◽  
Base Case ◽  
Cvd Risk ◽  
Policy Model ◽  
Life Years ◽  
Stage 1

Introduction: Current U.S. hypertension guidelines base treatment on clinic blood pressure (BP) alone. International guidelines recommend adding global cardiovascular disease (CVD) risk to guide treatment. We projected incremental effectiveness and costs of treating stage 1 hypertension based on CVD risk assessment. Methods: We used the Coronary Heart Disease (CHD) Policy Model, a validated state-transition simulation of the CVD epidemic in the US, to model CHD and stroke events, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness (ICE) of increasingly aggressive treatment of hypertensive patients. Census and national survey data were used to estimate joint distributions of risk factors by age and sex; the CVD risk function was based on Framingham. We modeled treatment of BP to an approximate target <140/90 mmHg using standard dose medications, including averaged annual drug costs (e.g., $253 for a systolic BP reduction of 11.5 mmHg; $1,036 for reduction of 36.7 mmHg) and monitoring costs (2 or 4 visits/year for stage 1 or 2 plus 1 lab test/year for all). We compared a strategy in which only stage 2 hypertensives (≥160/≥100 mmHg) were treated to increasingly aggressive strategies in which stage 1 hypertensives (140-159/90-99 mmHg) with successively lower global CVD risk (15%, 10%, 5% risk, then all of stage 1) were also treated. Results: Reaching hypertension treatment targets with any policy simulated would prevent between 389,000 and 478,000 CVD events annually ( Table ). Treating all stage 2 and ≥15% CVD risk stage 1 hypertensives would be cost-saving and treating stage 1 with ≥10% or ≥5% CVD risk would incur modest costs. Treating all stage 1 would cost $161,000/QALY more than treating only ≥5% CVD risk. Conclusions: Treatment of low risk stage 1 hypertensives appears to come at high cost and limited added benefit unless treatment costs can be minimized. Using global CVD risk assessment might allow re-allocation of resources toward controlling hypertension in the highest risk patients. Table Simulated CVD outcomes, costs, and cost-effectiveness, 2010-2011, the CHD Policy Model Scenario Annual number hypertensives treated Annual CVD events Annual QALYs (millions) Annual costs (millions, $US) ICER * Base case, no intervention - 2,387,000 127.67 $827,313 reference Treat only stage 2 23,364,180 1,997,000 128.78 $825,264 cost saving Treat stage 2 + stage 1 >=15% CVD risk 30,654,361 1,943,000 128.93 $824,541 cost saving Treat stage 2 + stage 1 >=10% CVD risk 34,947,200 1,928,000 128.97 $824,898 $9,381 Treat stage 2 + stage 1 >= 5% CVD risk 44,321,985 1,913,000 129.02 $826,433 $28,931 Treat stage 2 + all stage 1 50,863,390 1,909,000 129.04 $828,290 $160,630 *ICER = difference in cost/difference in QALY in comparison with the next less effective strategy

Cost-effectiveness of assertive community treatment for homeless persons with severe mental illness

1999 ◽  
Vol 174 (4) ◽  
pp. 346-352 ◽  
Author(s):  
Anthony F. Lehman ◽  
Lisa Dixon ◽  
Jeffrey S. Hoch ◽  
Bruce Deforge ◽  
Eimer Kernan ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Cost Effectiveness ◽  
Severe Mental Illness ◽  
Usual Care ◽  
Assertive Community Treatment ◽  
Cost Effective ◽  
Homeless Persons ◽  
Community Treatment ◽  
Stable Housing

BackgroundHomelessness is a major public health problem among persons with severe mental illness (SMI). Cost-effective programmes that address this problem are needed.AimsTo evaluate the cost-effectiveness of an assertive community treatment (ACT) programme for these persons in Baltimore, Maryland.MethodsA total of 152 homeless persons with SMI were randomly allocated to either ACT or usual services. Direct treatment costs and effectiveness, represented by days of stable housing, were assessed.ResultsCompared with usual care, ACT costs were significantly lower for mental health in-patient days and mental health emergency room care, and significantly higher for mental health out-patient visits and treatment for substance misuse. ACT patients spent 31% more days in stable housing than those receiving usual care. ACT and usual services incurred $242 and $415 respectively in direct treatment costs per day of stable housing, an efficiency ratio of 0. 58 in favour of ACT. Patterns of care and costs varied according to race.ConclusionACT provides a cost-effective approach to reducing homelessness among persons with severe and persistent mental illnesses.

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