Economic evaluation of stepped care for the management of childhood anxiety disorders: Results from a randomised trial

2019 ◽  
Vol 53 (7) ◽  
pp. 673-682 ◽  
Author(s):  
Mary Lou Chatterton ◽  
Ronald M Rapee ◽  
Max Catchpool ◽  
Heidi J Lyneham ◽  
Viviana Wuthrich ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Economic Evaluation ◽  
Confidence Interval ◽  
Anxiety Disorders ◽  
Health Sector ◽  
Stepped Care ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Quality Adjusted Life

Background: Stepped care has been promoted for the management of mental disorders; however, there is no empirical evidence to support the cost-effectiveness of this approach for the treatment of anxiety disorders in youth. Method: This economic evaluation was conducted within a randomised controlled trial comparing stepped care to a validated, manualised treatment in 281 young people, aged 7–17, with a diagnosed anxiety disorder. Intervention costs were determined from therapist records. Administrative data on medication and medical service use were used to determine additional health care costs during the study period. Parents also completed a resource use questionnaire to collect medications, services not captured in administrative data and parental lost productivity. Outcomes included participant-completed quality of life, Child Health Utility – nine-dimension and parent-completed Assessment of Quality of Life – eight-dimension to calculate quality-adjusted life years. Mean costs and quality-adjusted life years were compared between groups at 12-month follow-up. Results: Intervention delivery costs were significantly less for stepped care from the societal perspective (mean difference −$198, 95% confidence interval −$353 to −$19). Total combined costs were less for stepped care from both societal (−$1334, 95% confidence interval −$2386 to $510) and health sector (−$563, 95% confidence interval −$1353 to $643) perspectives but did not differ significantly from the manualised treatment. Youth and parental quality-adjusted life years were not significantly different between groups. Sensitivity analysis indicated that the results were robust. Conclusion: For youth with anxiety, this three-step model provided comparable outcomes and total health sector costs to a validated face-to-face programme. However, it was less costly to deliver from a societal perspective, making it an attractive option for some parents. Future economic evaluations comparing various models of stepped care to treatment as usual are recommended.

Utilities and Quality-Adjusted Life Years

1989 ◽  
Vol 5 (4) ◽  
pp. 559-575 ◽  
Author(s):  
George W. Torrance ◽  
David Feeny
Keyword(s):  
Quality Of Life ◽  
Cost Utility ◽  
Health Improvement ◽  
Quality Adjusted Life Years ◽  
Utility Analysis ◽  
Quality Adjustment ◽  
Life Years ◽  
Quality Adjusted Life ◽  
Broad Overview

Utilities and quality-adjusted life years (QALYs) are reviewed, with particular focus on their use in technology assessment. This article provides a broad overview and perspective on these two techniques and their interrelationship, with reference to other sources for details of implementation. The historical development, assumptions, strengths/weaknesses, and applications of each are summarized.Utilities are specifically designed for individual decision-making under uncertainty, but, with additional assumptions, utilities can be aggregated across individuals to provide a group utility function. QALYs are designed to aggregate in a single summary measure the total health improvement for a group of individuals, capturing improvements from impacts on both quantity of life and quality of life– with quality of life broadly defined. Utilities can be used as the quality-adjustment weights for QALYs; they are particularly appropriate for that purpose, and this combination provides a powerful and highly useful variation on cost-effectiveness analysis known as cost-utility analysis.

Quality of life and quality-adjusted life years of chronic schistosomiasis mansoni patients in Brazil in 2015

2018 ◽  
Vol 112 (5) ◽  
pp. 238-244
Author(s):  
Gilmara Lima Nascimento ◽  
Ana Lúcia Coutinho Domingues ◽  
Ricardo Arraes de Alencar Ximenes ◽  
Alexander Itria ◽  
Luciane Nascimento Cruz ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Quality Adjusted Life Years ◽  
Schistosomiasis Mansoni ◽  
Life Years ◽  
Quality Adjusted Life

scholarly journals The Use of “Quality-Adjusted Life Years” (QALYs) to Evaluate Treatment in Intensive Care

1995 ◽  
Vol 23 (3) ◽  
pp. 322-331 ◽  
Author(s):  
R. K. Kerridge ◽  
P. P. Glasziou ◽  
K. M. Hillman
Keyword(s):  
Quality Of Life ◽  
Patient Outcome ◽  
Intensive Care ◽  
Pulmonary Oedema ◽  
Trauma Patients ◽  
Quality Adjusted Life Years ◽  
Economic Justification ◽  
Life Years ◽  
Quality Adjusted Life

This study examines the feasibility of using Quality-Adjusted Life Years (QALYs) to assess patient outcome and the economic justification of treatment in an Intensive Care Unit (ICU). 248 patients were followed for three years after admission. Survival and quality of life for each patient was evaluated. Outcome for each patient was quantified in discounted Quality-Adjusted Life Years (dQALYs). The economic justification of treatment was evaluated by comparing the total and marginal cost per dQALY for this patient group with the published cost per QALY for other medical interventions. 150 patients were alive after three years. Quality of life for most longterm survivors was good. Patient outcome (QALYs) was greatest for asthma and trauma patients, and least for cardiogenic pulmonary oedema. The tentative estimated cost- effectiveness of treatment varied from AUD $297 per QALY for asthma to AUD $2323 per QALY for patients with pulmonary oedema. This compares favourably with many preventative and non-acute medical treatments. Although the methodology is developmental, the measurement of patient outcome using QALYs appears to be feasible in a general hospital ICU.

Comparative effectiveness of treatment options for pediatric craniopharyngiomas

2014 ◽  
Vol 13 (2) ◽  
pp. 178-188 ◽  
Author(s):  
Zarina S. Ali ◽  
Robert L. Bailey ◽  
Lawrence B. Daniels ◽  
Venus Vakhshori ◽  
Daniel J. Lewis ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Treatment Guidelines ◽  
Treatment Options ◽  
Surgical Approaches ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Subtotal Removal ◽  
Quality Adjusted Life

Object No clear treatment guidelines for pediatric craniopharyngiomas exist. The authors developed a decision analytical model to evaluate outcomes of 4 surgical approaches for craniopharyngiomas in children, including attempted gross-total resection (GTR), planned subtotal removal plus radiotherapy, biopsy plus radiotherapy, and endoscopic resections of all kinds. Methods Pooled data, including the authors' own experience, were used to create evidence tables, from which incidence, relative risks, and summary outcomes in quality-adjusted life years (QALYs) were calculated for the 4 management strategies. Results Quality-adjusted life years at the 5-year follow-up were 2.3 ± 0.1 for attempted GTR, 2.9 ± 0.2 for planned subtotal removal plus radiotherapy, 3.9 ± 0.2 for biopsy plus radiotherapy, and 3.7 ± 0.2 for endoscopic resection (F = 17,150, p < 0.001). Similarly, QALYs at 10-year follow-up were 4.5 ± 0.2 for attempted GTR, 5.7 ± 0.5 for planned subtotal removal plus radiotherapy, and 7.8 ± 0.5 for biopsy plus radiotherapy (F = 6,173, p < 0.001). On post hoc pairwise comparisons, the differences between all pairs compared were also highly significant (p < 0.001). Since follow-up data at 10 years are lacking for endoscopic cases, this category was excluded from 10-year comparisons. Conclusions Biopsy with subsequent radiotherapy is the preferred approach with respect to improved overall quality of life. While endoscopic approaches also show promise in preserving quality of life at five-year follow-up, there are not sufficient data to draw conclusions about this comparison at 10 years.

scholarly journals Patients with unilateral transfemoral amputation treated with a percutaneous osseointegrated prosthesis

2018 ◽  
Vol 100-B (4) ◽  
pp. 527-534 ◽  
Author(s):  
E. Hansson ◽  
K. Hagberg ◽  
M. Cawson ◽  
T. H. Brodtkorb
Keyword(s):  
Quality Of Life ◽  
Prospective Clinical Study ◽  
Quality Adjusted Life Years ◽  
Transfemoral Amputation ◽  
Healthcare Perspective ◽  
Life Years ◽  
The Cost ◽  
The Impact ◽  
Quality Adjusted Life

Aims The aim of this study was to compare the cost-effectiveness of treatment with an osseointegrated percutaneous (OI-) prosthesis and a socket-suspended (S-) prosthesis for patients with a transfemoral amputation. Patients and Methods A Markov model was developed to estimate the medical costs and changes in quality-adjusted life-years (QALYs) attributable to treatment of unilateral transfemoral amputation over a projected period of 20 years from a healthcare perspective. Data were collected alongside a prospective clinical study of 51 patients followed for two years. Results OI-prostheses had an incremental cost per QALY gained of €83 374 compared with S-prostheses. The clinical improvement seen with OI-prostheses was reflected in QALYs gained. Results were most sensitive to the utility value for both treatment arms. The impact of an annual decline in utility values of 1%, 2%, and 3%, for patients with S-prostheses resulted in a cost per QALY gained of €37 020, €24 662, and €18 952, respectively, over 20 years. Conclusion From a healthcare perspective, treatment with an OI-prosthesis results in improved quality of life at a relatively high cost compared with that for S-prosthesis. When patients treated with S-prostheses had a decline in quality of life over time, the cost per QALY gained by OI-prosthesis treatment was considerably reduced. Cite this article: Bone Joint J 2018;100-B:527–34.

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