scholarly journals Reducing the global burden of depression

2004 ◽  
Vol 184 (5) ◽  
pp. 393-403 ◽  
Author(s):  
Dan Chisholm ◽  
Kristy Sanderson ◽  
Jose Luis Ayuso-Mateos ◽  
Shekhar Saxena
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Antidepressant Drugs ◽  
Health Resources ◽  
Population Level ◽  
Cost Effective ◽  
Global Burden ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Effective Use

BackgroundInternational evidence on the cost and effects of interventions for reducing the global burden of depression remain scarce.AimsTo estimate the population-level cost-effectiveness of evidence-based depression interventions and their contribution towards reducing current burden.MethodPrimary-care-based depression interventions were modelled at the level of whole populations in 14 epidemiological subregions of the world. Total population-level costs (in international dollars or I) and effectiveness (disability adjusted life years (DALYs) averted) were combined to form average and incremental cost-effectiveness ratios.ResultsEvaluated interventions have the potential to reduce the current burden of depression by 10–30%. Pharmacotherapy with older antidepressant drugs, with or without proactive collaborative care, are currently more cost-effective strategies than those using newer antidepressants, particularly in lower-income subregions.ConclusionsEven in resource-poor regions, each DALYaverted by efficient depression treatments in primary care costs less than 1 year of average per capita income, making such interventions a cost-effective use of health resources. However, current levels of burden can only be reduced significantly if there is a substantial increase in treatment coverage.

scholarly journals Health benefits and costs of weight-loss dietary counselling by nurses in primary care: a cost-effectiveness analysis

2019 ◽  
Vol 23 (1) ◽  
pp. 83-93 ◽  
Author(s):  
Christine L Cleghorn ◽  
Nick Wilson ◽  
Nisha Nair ◽  
Giorgi Kvizhinadze ◽  
Nhung Nghiem ◽  
...  
Keyword(s):  
Primary Care ◽  
Weight Loss ◽  
Cost Effectiveness ◽  
Population Level ◽  
Cost Effective ◽  
Uncertainty Interval ◽  
Dietary Counselling ◽  
Life Years ◽  
Per Capita ◽  
The Impact

AbstractObjective:We aimed to estimate the cost-effectiveness of brief weight-loss counselling by dietitian-trained practice nurses, in a high-income-country case study.Design:A literature search of the impact of dietary counselling on BMI was performed to source the ‘best’ effect size for use in modelling. This was combined with multiple other input parameters (e.g. epidemiological and cost parameters for obesity-related diseases, likely uptake of counselling) in an established multistate life-table model with fourteen parallel BMI-related disease life tables using a 3 % discount rate.Setting:New Zealand (NZ).Participants:We calculated quality-adjusted life-years (QALY) gained and health-system costs over the remainder of the lifespan of the NZ population alive in 2011 (n 4·4 million).Results:Counselling was estimated to result in an increase of 250 QALY (95 % uncertainty interval −70, 560 QALY) over the population’s lifetime. The incremental cost-effectiveness ratio was 2011 $NZ 138 200 per QALY gained (2018 $US 102 700). Per capita QALY gains were higher for Māori (Indigenous population) than for non-Māori, but were still not cost-effective. If willingness-to-pay was set to the level of gross domestic product per capita per QALY gained (i.e. 2011 $NZ 45 000 or 2018 $US 33 400), the probability that the intervention would be cost-effective was 2 %.Conclusions:The study provides modelling-level evidence that brief dietary counselling for weight loss in primary care generates relatively small health gains at the population level and is unlikely to be cost-effective.

scholarly journals Pharmacist prescribing and care improves cardiovascular risk, but is it cost-effective? A cost-effectiveness analysis of the RxEACH study

2019 ◽  
Vol 152 (4) ◽  
pp. 257-266 ◽  
Author(s):  
Yazid N. Al Hamarneh ◽  
Karissa Johnston ◽  
Carlo A. Marra ◽  
Ross T. Tsuyuki
Keyword(s):  
Cost Effectiveness ◽  
Health Outcomes ◽  
Usual Care ◽  
Population Level ◽  
Cost Effective ◽  
Pharmacist Intervention ◽  
Sensitivity Analyses ◽  
Pharmacist Prescribing ◽  
Canadian Health Care System ◽  
Life Years

Background: The RxEACH randomized trial demonstrated that community pharmacist prescribing and care reduced the risk for cardiovascular (CV) events by 21% compared to usual care. Objective: To evaluate the economic impact of pharmacist prescribing and care for CV risk reduction in a Canadian setting. Methods: A Markov cost-effectiveness model was developed to extrapolate potential differences in long-term CV outcomes, using different risk assessment equations. The mean change in CV risk for the 2 groups of RxEACH was extrapolated over 30 years, with costs and health outcomes discounted at 1.5% per year. The model incorporated health outcomes, costs and quality of life to estimate overall cost-effectiveness. It was assumed that the intervention would be 50% effective after 10 years. Individual-level results were scaled up to population level based on published statistics (29.2% of Canadian adults are at high risk for CV events). Costs considered included direct medical costs as well as the costs associated with implementing the pharmacist intervention. Uncertainty was explored via probabilistic sensitivity analysis. Results: It is estimated that the Canadian health care system would save more than $4.4 billion over 30 years if the pharmacist intervention were delivered to 15% of the eligible population. Pharmacist care would be associated with a gain of 576,689 quality-adjusted life years and avoid more than 8.9 million CV events. The intervention is economically dominant (i.e., it is both more effective and reduces costs when compared to usual care). Conclusion: Across a range of 1-way and probabilistic sensitivity analyses of key parameters and assumptions, pharmacist prescribing and care are both more effective and cost-saving compared to usual care. Canadians need and deserve such care.

scholarly journals Cost Effectiveness Analysis Using Disability-Adjusted Life Years for Cataract Surgery

2020 ◽  
Vol 17 (16) ◽  
pp. 6010
Author(s):  
Thinni Nurul Rochmah ◽  
Anggun Wulandari ◽  
Maznah Dahlui ◽  
Ernawaty ◽  
Ratna Dwi Wulandari
Keyword(s):  
Cost Effectiveness ◽  
Cataract Surgery ◽  
Cost Effective ◽  
Disability Adjusted Life Years ◽  
Cost Effectiveness Ratio ◽  
Small Incision Cataract Surgery ◽  
Post Surgery ◽  
Disability Adjusted Life ◽  
Life Years ◽  
The Cost

Cataracts are the second most prioritized eye disease in the world. Cataracts are an expensive treatment because surgery is the only method that can treat the disease. This study aims to analyze the cost effectiveness of each operating procedure. Specifically, phacoemulsification and Small Incision Cataract Surgery (SICS) with Disability-Adjusted Life Years (DALYs) as the effectiveness indicator is used. This study is an observational analytic study with a prospective framework. The sample size is 130 patients who have undergone phacoemulsification and 25 patients who have undergone SICS. The DALY for phacoemulsification at Day-7 (D-7) is 0.3204, and at Day-21 (D-21), it is 0.3204, while the DALY for SICS at D-7 is 0.3060, and at D-21, it is 0.3158. The incremental cost effectiveness ratio (ICER) for cataract surgery at D-7 is USD $1872.49, and at D-21, it is USD $5861.71, whereas the Indonesian Gross Domestic Product (GDP) is USD $4174.90. In conclusion, the phacoemulsification technique is more cost effective than the SICS technique. The ICER value is very cost effective at D-7 post-surgery compared to at D-21 post-surgery because the ICER is less than 1 GDP per capita per DALY.

scholarly journals Cost-effectiveness of computerized cognitive–behavioural therapy for the treatment of depression in primary care: findings from the Randomised Evaluation of the Effectiveness and Acceptability of Computerised Therapy (REEACT) trial

2017 ◽  
Vol 47 (10) ◽  
pp. 1825-1835 ◽  
Author(s):  
A. Duarte ◽  
S. Walker ◽  
E. Littlewood ◽  
S. Brabyn ◽  
C. Hewitt ◽  
...  
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Cognitive Behavioural Therapy ◽  
Cost Effective ◽  
Behavioural Therapy ◽  
Scenario Analyses ◽  
Cognitive Behavioural ◽  
Life Years ◽  
Gp Care ◽  
The Cost

BackgroundComputerized cognitive–behavioural therapy (cCBT) forms a core component of stepped psychological care for depression. Existing evidence for cCBT has been informed by developer-led trials. This is the first study based on a large independent pragmatic trial to assess the cost-effectiveness of cCBT as an adjunct to usual general practitioner (GP) care compared with usual GP care alone and to establish the differential cost-effectiveness of a free-to-use cCBT programme (MoodGYM) in comparison with a commercial programme (Beating the Blues) in primary care.MethodCosts were estimated from a healthcare perspective and outcomes measured using quality-adjusted life years (QALYs) over 2 years. The incremental cost-effectiveness of each cCBT programme was compared with usual GP care. Uncertainty was estimated using probabilistic sensitivity analysis and scenario analyses were performed to assess the robustness of results.ResultsNeither cCBT programme was found to be cost-effective compared with usual GP care alone. At a £20 000 per QALY threshold, usual GP care alone had the highest probability of being cost-effective (0.55) followed by MoodGYM (0.42) and Beating the Blues (0.04). Usual GP care alone was also the cost-effective intervention in the majority of scenario analyses. However, the magnitude of the differences in costs and QALYs between all groups appeared minor (and non-significant).ConclusionsTechnically supported cCBT programmes do not appear any more cost-effective than usual GP care alone. No cost-effective advantage of the commercially developed cCBT programme was evident compared with the free-to-use cCBT programme. Current UK practice recommendations for cCBT may need to be reconsidered in the light of the results.

scholarly journals Evaluating the impact and cost-effectiveness of scaling-up HCV treatment among people who inject drugs in Ukraine

2021 ◽  
Author(s):  
Jack Stone ◽  
Josephine G Walker ◽  
Sandra Bivegete ◽  
Adam Trickey ◽  
Charles Chasela ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
People Who Inject Drugs ◽  
Cost Effective ◽  
Treatment Rate ◽  
Hcv Treatment ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Hcv Transmission ◽  
Preventative Interventions ◽  
The Impact

Introduction People who inject drugs (PWID) in Ukraine have a high prevalence of hepatitis C virus (HCV). Since 2015, PWID have been receiving HCV treatment, but their impact and cost-effectiveness has not been estimated. Methods We developed a dynamic model of HIV and HCV transmission among PWID in Ukraine, incorporating ongoing HCV treatment (5,933 treatments) over 2015-2021; 46.1% among current PWID. We estimated the impact of these treatments and different treatment scenarios over 2021-2030: continuing recent treatment rates (2,394 PWID/year) with 42.5/100% among current PWID, or treating 5,000/10,000 current PWID/year. We also estimated the treatment rate required to decrease HCV incidence by 80% if preventative interventions are scaled-up or not. Required costs were collated from previous studies in Ukraine. We estimated the incremental cost-effectiveness ratio (ICER) of the HCV treatments undertaken in 2020 (1,059) by projecting the incremental costs and disability adjusted life years (DALYs) averted over 2020-2070 (3% discount rate) compared to a counterfactual scenario without treatment from 2020 onwards. Results On average, 0.4% of infections among PWID were treated annually over 2015-2021, without which HCV incidence would have been 0.6% (95%CrI: 0.3-1.0%) higher in 2021. Continuing existing treatment rates could reduce HCV incidence by 10.2% (7.8-12.5%) or 16.4% (12.1-22.0%) by 2030 if 42.5% or 100% of treatments are given to current PWID, respectively. HCV incidence could reduce by 29.3% (20.7-44.7%) or 93.9% (54.3-99.9%) by 2030 if 5,000 or 10,000 PWID are treated annually. To reduce incidence by 80% by 2030, 19,275 (15,134-23,522) annual treatments are needed among current PWID, or 17,955 (14,052-21,954) if preventative interventions are scaled-up. The mean ICER was US$828.8/DALY averted; cost-effective at a willingness-to-pay threshold of US$3,096/DALY averted (1xGDP). Implications Existing HCV treatment is cost-effective but has had little preventative impact due to few current PWID being treated. Further treatment expansion for current PWID could significantly reduce HCV incidence.

scholarly journals Cost-Effectiveness of Three Poliovirus Immunization Schedules in Shanghai, China

Vaccines ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. 1062
Author(s):  
Jia Ren ◽  
Hairenguli Maimaiti ◽  
Xiaodong Sun ◽  
Zhuoying Huang ◽  
Jiechen Liu ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Polio Eradication ◽  
Paralytic Poliomyelitis ◽  
Tree Model ◽  
Monetary Benefit ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Polio Immunization ◽  
The Cost

In Shanghai, China, a polio immunization schedule of four inactivated polio vaccines (IPV) has been implemented since 2020, replacing the schedules of a combination of two IPVs and two bivalent live attenuated oral polio vaccines (bOPV), and four trivalent live attenuated oral polio vaccines (tOPV). This study aimed to assess the cost-effectiveness of these three schedules in infants born in 2016, in preventing vaccine-associated paralytic poliomyelitis (VAPP). We performed a decision tree model and estimated incremental cost-effectiveness ratio (ICER). Compared to the four-tOPV schedule, the two-IPV-two-bOPV schedule averted 1.2 VAPP cases and 16.83 disability-adjusted life years (DALY) annually; while the four-IPV schedule averted 1.35 VAPP cases and 18.96 DALY annually. Consequently, ICERVAPP and ICERDALY were substantially high for two-IPV-two-bOPV (CNY 12.96 million and 0.93 million), and four-IPV (CNY 21.24 million and 1.52 million). Moreover, net monetary benefit of the two-IPV-two-bOPV and four-IPV schedules was highest when the cost of IPV was hypothesized to be less than CNY 23.75 or CNY 9.11, respectively, and willingness-to-pay was hypothesized as CNY 0.6 million in averting one VAPP-induced DALY. IPV-containing schedules are currently cost-ineffective in Shanghai. They may be cost-effective by reducing the prices of IPV, which may accelerate polio eradication in Chinese settings.

scholarly journals Assessing Cost-Effectiveness in Obesity: Active Transport Program for Primary School Children—TravelSMART Schools Curriculum Program

2011 ◽  
Vol 8 (4) ◽  
pp. 503-515 ◽  
Author(s):  
Marj Moodie ◽  
Michelle M. Haby ◽  
Boyd Swinburn ◽  
Robert Carter
Keyword(s):  
Cost Effectiveness ◽  
Active Transport ◽  
Obesity Prevention ◽  
Cost Effective ◽  
Primary School Children ◽  
Uncertainty Interval ◽  
Prevention Measure ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Cost Offsets

Background:To assess from a societal perspective the cost-effectiveness of a school program to increase active transport in 10- to 11-year-old Australian children as an obesity prevention measure.Methods:The TravelSMART Schools Curriculum program was modeled nationally for 2001 in terms of its impact on Body Mass Index (BMI) and Disability-Adjusted Life Years (DALYs) measured against current practice. Cost offsets and DALY benefits were modeled until the eligible cohort reached age 100 or died. The intervention was qualitatively assessed against second stage filter criteria (‘equity,’ ‘strength of evidence,’ ‘acceptability to stakeholders,’ ‘feasibility of implementation,’ ‘sustainability,’ and ‘side-effects’) given their potential impact on funding decisions.Results:The modeled intervention reached 267,700 children and cost $AUD13.3M (95% uncertainty interval [UI] $6.9M; $22.8M) per year. It resulted in an incremental saving of 890 (95%UI −540; 2,900) BMI units, which translated to 95 (95% UI −40; 230) DALYs and a net cost per DALY saved of $AUD117,000 (95% UI dominated; $1.06M).Conclusions:The intervention was not cost-effective as an obesity prevention measure under base-run modeling assumptions. The attribution of some costs to nonobesity objectives would be justified given the program’s multiple benefits. Cost-effectiveness would be further improved by considering the wider school community impacts.

scholarly journals Making wider use of the world's most widely used vaccine: Bacille Calmette–Guérin revaccination reconsidered

2013 ◽  
Vol 10 (87) ◽  
pp. 20130365 ◽  
Author(s):  
Christopher Dye
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Primary Vaccination ◽  
Delayed Type Hypersensitivity ◽  
Bacille Calmette Guerin ◽  
Pulmonary Tb ◽  
Immunization Programme ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Duration Of Protection

Approximately 100 million newborn children receive Bacille Calmette–Guérin (BCG) annually, because vaccination is consistently protective against childhood tuberculous meningitis and miliary TB. By contrast, BCG efficacy against pulmonary TB in children and adults is highly variable, ranging from 0% to 80%, though it tends to be higher in individuals who have no detectable prior exposure to mycobacterial infections, as judged by the absence of delayed-type hypersensitivity response (a negative tuberculin skin test, TST). The duration of protection against pulmonary TB is also variable, but lasts about 10 years on average. These observations raise the possibility that BCG revaccination, following primary vaccination in infancy, could be efficacious among TST-negative adolescents as they move into adulthood, the period of highest risk for pulmonary disease. To inform continuing debate about revaccination, this paper assesses the effectiveness and cost-effectiveness of revaccinating adolescents in a setting with intense transmission—Cape Town, South Africa. For a cost of revaccination in the range US$1–10 per person, and vaccine efficacy between 10% and 80% with protection for 10 years, the incremental cost per year of healthy life recovered (disability-adjusted life years, DALY) in the vaccinated population lies between US$116 and US$9237. The intervention is about twice as cost-effective when allowing for the extra benefits of preventing transmission, with costs per DALY recovered in the range US$52–$4540. At 80% efficacy, revaccination averted 17% of cases. Under the scenarios investigated, BCG revaccination is cost-effective against international benchmarks, though not highly effective. Cost-effectiveness ratios would be more favourable if we also allow for TB cases averted by preventing transmission to HIV-positive people, for the protection of HIV-negative people who later acquire HIV infection, for the possible non-specific benefits of BCG, for the fact that some adolescents would receive BCG for the first time, and for cost sharing when BCG is integrated into an adolescent immunization programme. These findings suggest, subject to further evaluation, that BCG revaccination could be cost-effective in some settings.

scholarly journals Prevention and control of dengue and Chikungunya in Colombia: A cost-effectiveness analysis

2021 ◽  
Vol 15 (12) ◽  
pp. e0010086
Author(s):  
Anneke L. Claypool ◽  
Margaret L. Brandeau ◽  
Jeremy D. Goldhaber-Fiebert
Keyword(s):  
Cost Effectiveness ◽  
Health Benefits ◽  
Cost Effective ◽  
Emerging Diseases ◽  
Transmission Model ◽  
Insecticide Treated Nets ◽  
Transmission Parameters ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Current Price

Background Chikungunya and dengue are emerging diseases that have caused large outbreaks in various regions of the world. Both are both spread by Aedes aegypti and Aedes albopictus mosquitos. We developed a dynamic transmission model of chikungunya and dengue, calibrated to data from Colombia (June 2014 –December 2017). Methodology/Principal findings We evaluated the health benefits and cost-effectiveness of residual insecticide treatment, long-lasting insecticide-treated nets, routine dengue vaccination for children aged 9, catchup vaccination for individuals aged 10–19 or 10–29, and portfolios of these interventions. Model calibration resulted in 300 realistic transmission parameters sets that produced close matches to disease-specific incidence and deaths. Insecticide was the preferred intervention and was cost-effective. Insecticide averted an estimated 95 chikungunya cases and 114 dengue cases per 100,000 people, 61 deaths, and 4,523 disability-adjusted life years (DALYs). In sensitivity analysis, strategies that included dengue vaccination were cost-effective only when the vaccine cost was 14% of the current price. Conclusions/Significance Insecticide to prevent chikungunya and dengue in Columbia could generate significant health benefits and be cost-effective. Because of limits on diagnostic accuracy and vaccine efficacy, the cost of dengue testing and vaccination must decrease dramatically for such vaccination to be cost-effective in Colombia. The vectors for chikungunya and dengue have recently spread to new regions, highlighting the importance of understanding the effectiveness and cost-effectiveness of policies aimed at preventing these diseases.

scholarly journals Cost-Effectiveness of Sertraline in Primary Care According to Initial Severity and Duration of Depressive Symptoms: Findings from the PANDA RCT

2019 ◽  
Vol 4 (3) ◽  
pp. 427-438 ◽  
Author(s):  
William Hollingworth ◽  
◽  
Christopher G. Fawsitt ◽  
Padraig Dixon ◽  
Larisa Duffy ◽  
...  
Keyword(s):  
Primary Care ◽  
Depressive Symptoms ◽  
Cost Effectiveness ◽  
Symptom Severity ◽  
Secondary Analysis ◽  
Cost Effective ◽  
Duration Of Symptoms ◽  
Life Years ◽  
Net Benefits ◽  
The Cost

Abstract Background Antidepressants are commonly prescribed for depression, but it is unclear whether treatment efficacy depends on severity and duration of symptoms and how prescribing might be targeted cost-effectively. Objectives We investigated the cost-effectiveness of the antidepressant sertraline compared with placebo in subgroups defined by severity and duration of depressive symptoms. Methods We undertook a cost-effectiveness analysis from the perspective of the NHS and Personal and Social Services (PSS) in the UK alongside the PANDA (What are the indications for Prescribing ANtiDepressants that will leAd to a clinical benefit?) randomised controlled trial (RCT), which compared sertraline with placebo over a 12-week period. Quality of life data were collected at baseline and at 2, 6, and 12 weeks post-randomisation using EQ-5D-5L, from which we calculated quality-adjusted life years (QALYs). Costs (in 2017/18£) were collected using patient records and from resource use questionnaires administered at each follow-up interval. Differences in mean costs and mean QALYs and net monetary benefits were estimated. Our primary analysis used net monetary benefit regressions to identify any interaction between the cost-effectiveness of sertraline and subgroups defined by baseline symptom severity (0–11; 12–19; 20+ on the Clinical Interview Schedule—Revised) and, separately, duration of symptoms (greater or less than 2 years duration). A secondary analysis estimated the cost-effectiveness of sertraline versus placebo, irrespective of duration or severity. Results There was no evidence of an association between the baseline severity of depressive symptoms and the cost-effectiveness of sertraline. Compared to patients with low symptom severity, the expected net benefits in patients with moderate symptoms were £24 (95% CI − £280 to £328; p value 0.876) and the expected net benefits in patients with high symptom severity were £37 (95% CI − £221 to £296; p value 0.776). Patients who had a longer history of depressive symptoms at baseline had lower expected net benefits from sertraline than those with a shorter history; however, the difference was uncertain (− £27 [95% CI − £258 to £204]; p value 0.817). In the secondary analysis, patients treated with sertraline had higher expected net benefits (£122 [95% CI £18 to £226]; p value 0.101) than those in the placebo group. Sertraline had a high probability (> 95%) of being cost-effective if the health system was willing to pay at least £20,000 per QALY gained. Conclusions We found insufficient evidence of a prespecified threshold based on severity or symptom duration that GPs could use to target prescribing to a subgroup of patients where sertraline is most cost-effective. Sertraline is probably a cost-effective treatment for depressive symptoms in UK primary care. Trial Registration Controlled Trials ISRCTN Registry, ISRCTN84544741.

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