scholarly journals Is Electroconvulsive Therapy for Depression More Effective Than Placebo? A Systematic Review of Studies Since 2009

2017 ◽  
Vol 19 (1) ◽  
pp. 5-23 ◽  
Author(s):  
John Read ◽  
Chelsea Arnold
Keyword(s):  
Electroconvulsive Therapy ◽  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
End Of Treatment ◽  
Persistent Memory ◽  
Contradictory Evidence ◽  
Meta Analyses ◽  
The Cost ◽  
Robust Evidence

Background:A 2010 review of studies, previous reviews and meta-analyses found minimal evidence that electroconvulsive therapy (ECT) for depression was more effective than placebo during the treatment period and no evidence at all of efficacy beyond the end of treatment. The current review explored whether any contradictory evidence has since been generated.Method:MEDLINE and PsycINFO were searched to identify all post-2009 studies that had compared ECT and simulated ECT for depression, or had in any other way generated valid depression data for ECT recipients at two or more points in time.Results:Ninety-one studies met inclusion criteria. There were no new placebo-controlled trials. There have now been no such studies since 1985. Only 4 placebo-controlled studies have ever produced data beyond the end of treatment, none of which have found any advantage for ECT over placebo. Of the 91 studies, only 2 aimed to evaluate the efficacy of ECT. Both were severely flawed. None of the other 89 produced robust evidence that ECT is effective for depression, primarily because at least 60% maintained ECT participants on medication and 89% produced no meaningful follow-up data beyond the end of treatment. No studies investigated whether ECT prevents suicide.Conclusions:There is still no evidence that ECT is more effective than placebo for depression reduction or suicide prevention. Given the well-documented high risk of persistent memory dysfunction, the cost-benefit analysis for ECT remains so poor that its use cannot be scientifically, or ethically, justified.

The effectiveness of electroconvulsive therapy: A literature review

2010 ◽  
Vol 19 (4) ◽  
pp. 333-347 ◽  
Author(s):  
John Read ◽  
Richard Bentall
Keyword(s):  
Electroconvulsive Therapy ◽  
Conflicts Of Interest ◽  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
Anterograde Amnesia ◽  
Brain Dysfunction ◽  
Risk Of Death ◽  
Increased Risk ◽  
Meta Analyses ◽  
The Cost

SUMMARYAim – To review the literature on the efficacy of electroconvulsive therapy [ECT], with a particular focus on depression, its primary target group. Methods – PsycINFO, Medline, previous reviews and meta-analyses were searched in an attempt to identify all studies comparing ECT with simulated-ECT [SECT]. Results – These placebo controlled studies show minimal support for effectiveness with either depression or ‘schizophrenia’ during the course of treatment (i.e. only for some patients, on some measures, sometimes perceived only by psychiatrists but not by other raters), and no evidence, for either diagnostic group, of any benefits beyond the treatment period. There are no placebo-controlled studies evaluating the hypothesis that ECT prevents suicide, and no robust evidence from other kinds of studies to support the hypothesis. Conclusions – Given the strong evidence (summarised here) of persistent and, for some, permanent brain dysfunction, primarily evidenced in the form of retrograde and anterograde amnesia, and the evidence of a slight but significant increased risk of death, the cost-benefit analysis for ECT is so poor that its use cannot be scientifically justified.Declaration of Interest: Neither author has any financial conflicts of interest in relation to this paper.

Pharmacoeconomic analysis of bronchial asthma prophylaxis in adults and children with allergic rhinitis with sublingual allergen-specific immunotherapy

2021 ◽  
Author(s):  
Valeriya A Lemeshko ◽  
Svetlana S Ratushnyak ◽  
Filipp V Gorkavenko ◽  
Evgeniya V Nazarova ◽  
Natalia I Ilina ◽  
...  
Keyword(s):  
Allergic Rhinitis ◽  
Cost Benefit Analysis ◽  
Therapy Group ◽  
Pharmacoeconomic Analysis ◽  
Cost Benefit ◽  
Symptomatic Therapy ◽  
Tree Model ◽  
Allergen Specific Immunotherapy ◽  
The Cost

AIMS: to evaluate the cost-effectiveness of sASIT in children and adult patients with allergic rhinitis and / or allergic rhinoconjunctivitis. MATERIALS AND METHODS: the hypothesis of the study was based on results of the study by Devillier P. et al., 2019, according to which the incidence of asthma was 13.7% and 17.0% in the sASIT + symptomatic therapy groups and the symptomatic therapy group (odds ratio - 0.776, 95% confidence interval (0.622; 0.968)). Pharmacoeconomic study based on decision tree model. Costs taken into account: cost of sASIT, symptomatic therapy, diagnostics and routine follow-up visits due to BA, outpatient BA drug therapy, the cost of hospitalization due to BA. The modeling horizon was 5 years, including 2 years of sASIT therapy and 3 years of follow-up. RESULTS: the cost per patient when using sASIT in combination with symptomatic therapy was 166,711.93 rubles, with symptomatic therapy - 101,700.35 rubles. The CER for sASIT in combination with symptomatic therapy was 193,177.20 rubles. per 1 prevented case of asthma, for symptomatic therapy - 122,530.55 rubles. for 1 prevented case of BA. Thus, the cost of 1 averted AB case when using sASIT in combination with symptomatic therapy is 57.7% higher than with symptomatic therapy. According to the results of the cost-benefit analysis, ICUR for an additional year of life adjusted for its quality (QALY) when performing sASIT in combination with symptomatic therapy compared with symptomatic therapy alone in children and adults was 567,365.48 rubles, which is less than calculated willingness to pay threshold (WTPT) (RUB 2,248,898.50). CONCLUSIONS: based on the results of comparing the cost of 1 added QALY and WTPT, it can be concluded that sASIT in combination with symptomatic therapy compared to symptomatic therapy alone is potentially cost-effective in children and adults with AR.

Hostile Takeovers and Anti-takeover Defenses in the Russian Corporate Market

2007 ◽  
pp. 70-84 ◽  
Author(s):  
E. Demidova
Keyword(s):  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
Benefit Analysis ◽  
Costs And Benefits ◽  
Hostile Takeovers ◽  
Russian Market ◽  
Takeover Defenses ◽  
The Cost ◽  
European Markets

This article analyzes definitions and the role of hostile takeovers at the Russian and European markets for corporate control. It develops the methodology of assessing the efficiency of anti-takeover defenses adapted to the conditions of the Russian market. The paper uses the cost-benefit analysis, where the costs and benefits of the pre-bid and post-bid defenses are compared.

What's it Worth? Improving Surface Water Quality

1999 ◽  
Vol 40 (10) ◽  
pp. 153-159 ◽  
Author(s):  
D. H. Newsome ◽  
C. D. Stephen
Keyword(s):  
Water Quality ◽  
Surface Water ◽  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
Surface Water Quality ◽  
Control Measures ◽  
Benefit Analysis ◽  
The Cost

Many countries are investing in measures to improve surface water quality, but the investment programmes for so doing are increasingly becoming subject to cost-benefit analysis. Whilst the cost of control measures can usually be determined for individual improvement schemes, there are currently no established procedures for valuing the benefits attributable to improved surface water quality. The paper describes a methodology that has been derived that now makes this possible.

Individualized cancer follow-up supported by electronic Patient-Reported Outcomes: Development and evaluation (Preprint)

2020 ◽  
Author(s):  
Sissel Ravn ◽  
Henriette Vind Thaysen ◽  
Lene Seibaek ◽  
Victor Jilbert Verwaal ◽  
Lene Hjerrild Iversen
Keyword(s):  
Ct Scan ◽  
Advanced Cancer ◽  
Patient Reported Outcomes ◽  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
Structured Interviews ◽  
European Organization ◽  
Individualized Care ◽  
Patient Reported

BACKGROUND Cancer survivors experience unmet needs during follow-up. Besides recurrence, a follow-up includes detection of late side effects, rehabilitation, palliation and individualized care. OBJECTIVE We aimed to describe the development and evaluate the feasibility of an intervention providing individualized cancer follow-up supported by electronic patient-reported outcomes (e-PRO). METHODS The study was carried out as an interventional study at a Surgical and a Gynecological Department offering complex cancer surgery and follow-up for advanced cancer. The e-PRO screened for a priori defined clinical important symptoms and needs providing individualized follow-up. We included following questionnaires in the e-PRO; the general European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and the EORTC validated for colorectal and ovarian cancer patients. To support individualization, we included three prioritized issues of the patient’s preference in each e-PRO. The response-algorithm was aggregated based on the severity of the patient’s response. To ensure the sensitivity of the e-PRO, we performed semi-structured interviews with five patients. All clinicians (surgeons and gynecologists) performing the consultations reviewed the e-PRO. The evaluation was divided in two, 1)The feasibility was assessed by a)Patients’ response rate of the e-PRO, b)Number of follow-up visits documenting the use of e-PRO and c)Patients’ prioritized issues prior to the consultation(‘yes’ / ‘no’), and after the follow-up 2)Patients assessment of a)The need and purpose of the follow-up visit and b)the support provided during the follow-up visit. RESULTS In total, 187 patients were included in the study, of which 73%(n=136/187) patients responded to the e-PRO and were subjected to an individualized follow-up. The e-PRO was documented as applied in 79% of the follow-up visits. In total, 23% of the prioritized issues did not include a response. Stratified by time since surgery, significantly more patients did not fill out a prioritized issue had a follow-up >6 months since surgery. In total, 72 % follow-up visits were evaluated to be necessary in order to discuss the outcome of the CT scan, symptoms, and/or prioritized issues. Contrary, 19% of the follow-up visits were evaluated to be necessary only to discuss the result of the CT scan. A range from 19.3–56.3% of patients assessed the follow-up visit to provide support with respect to physical (42% of patients), mental (56%), sexual (19%) or dietary (27%) issues. Further, a range from 34–60% of the patients reported that they did not need support regarding physical (43% of patients), mental (34%), sexual (63%) or dietary (57%) issues. CONCLUSIONS An individualized follow-up based on e-PRO is feasible, and support most patients surgically treated for advanced cancer. However, results indicate that follow-up based on e-PRO may not be beneficial for all patients and circumstances. A thorough cost-benefit analysis may be warranted before implementation in routine clinic.

scholarly journals Economic Analysis of the Use of VCS2000 for Pork Carcass Meat Yield Grading in Korea

Animals ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 1297
Author(s):  
Juntae Kim ◽  
Hyo-Dong Han ◽  
Wang Yeol Lee ◽  
Collins Wakholi ◽  
Jayoung Lee ◽  
...  
Keyword(s):  
Economic Analysis ◽  
Net Present Value ◽  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
Feed Consumption ◽  
Cost Ratio ◽  
Benefit Analysis ◽  
Labor Costs ◽  
Meat Yield ◽  
The Cost

Currently, the pork industry is incorporating in-line automation with the aim of increasing the slaughtered pork carcass throughput while monitoring quality and safety. In Korea, 21 parameters (such as back-fat thickness and carcass weight) are used for quality grading of pork carcasses. Recently, the VCS2000 system—an automatic meat yield grading machine system—was introduced to enhance grading efficiency and therefore increase pork carcass production. The VCS2000 system is able to predict pork carcass yield based on image analysis. This study also conducted an economic analysis of the system using a cost—benefit analysis. The subsection items of the cost-benefit analysis considered were net present value (NPV), internal rate of return (IRR), and benefit/cost ratio (BC ratio), and each method was verified through sensitivity analysis. For our analysis, the benefits were grouped into three categories: the benefits of reducing labor costs, the benefits of improving meat yield production, and the benefits of reducing pig feed consumption through optimization. The cost-benefit analysis of the system resulted in an NPV of approximately 615.6 million Korean won, an IRR of 13.52%, and a B/C ratio of 1.65.

scholarly journals High rates of relapse in adolescents crack users after inpatient clinic discharge

2016 ◽  
Vol 65 (3) ◽  
pp. 215-222
Author(s):  
Rosemeri Siqueira Pedroso ◽  
Luciano Santos Pinto Guimarães ◽  
Luciana Bohrer Zanetello ◽  
Veralice Maria Gonçalves ◽  
Ronaldo Lopes-Rosa ◽  
...  
Keyword(s):  
Contingency Management ◽  
Cost Benefit ◽  
Structured Interview ◽  
Therapeutic Modality ◽  
Behavioral Strategies ◽  
Crack Use ◽  
Sociodemographic Profile ◽  
The Cost ◽  
Crack Users

ABSTRACT Objective The objective of the present study was to evaluate 88 adolescent crack users referred to hospitalization and to follow them up after discharge to investigate relapse and factors associated with treatment. Methods Cohort (30 and 90 days after discharge) from a psychiatric hospital and a rehab clinic for treatment for chemical dependency in Porto Alegre between 2011 and 2012. Instruments: Semi-structured interview, conducted to evaluate the sociodemographic profile of the sample and describe the pattern of psychoactive substance use; Crack Use Relapse Scale/CURS; Questionnaire Tracking Users to Crack/QTUC; K-SADS-PL. Results In the first follow-up period (30 days after discharge), 65.9% of participants had relapsed. In the second follow-up period (90 days after discharge), 86.4% of participants had relapsed. Conclusion This is one of the first studies that show the extremely high prevalence of early relapse in adolescent crack users after discharge, questioning the cost/benefit of inpatient treatment for this population. Moreover, these results corroborate studies which suggested, young psychostimulants users might need tailored intensive outpatient treatment with contingency management and other behavioral strategies, in order to increase compliance and reduce drug or crime relapse, but this specific therapeutic modality is still scarce and must be developed in Brazil.

scholarly journals Beyond the Stern Review: Lessons from a risky venture at the limits of the cost–benefit analysis

2009 ◽  
Vol 68 (10) ◽  
pp. 2479-2484 ◽  
Author(s):  
Jean-Charles Hourcade ◽  
Philippe Ambrosi ◽  
Patrice Dumas
Keyword(s):  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
Benefit Analysis ◽  
Stern Review ◽  
The Cost
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