scholarly journals Cost-Effectiveness of guideline-based stepped and collaborative care versus treatment as usual for patients with depression – a cluster-randomized trial

2020 ◽  
Author(s):  
Christian Brettschneider ◽  
Daniela Heddaeus ◽  
Maya Steinmann ◽  
Martin Härter ◽  
Birgit Watzke ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Controlled Trial ◽  
Treatment Guideline ◽  
Stepped Care ◽  
Control Group ◽  
Care Model ◽  
Treatment As Usual ◽  
Life Years ◽  
Cluster Randomized

Abstract Objective Depression is associated with major patient burden. Its treatment requires complex and collaborative approaches. A stepped-care model based on the German National Clinical Practice Guideline “Unipolar Depression” has been shown to be effective. In this study we assess the cost-effectiveness of this guideline based stepped care model versus standard care in depression. Methods This prospective cluster-randomized controlled trial included 737 depressive adult patients. Primary care practices were randomized to an intervention (IG) or a control group (CG). The intervention consisted of a four-level stepped care model. The CG received treatment as usual. A cost-utility analysis from the societal perspective with a time horizon of 12 months was performed. We used quality-adjusted life years (QALY) based on the EQ-5D as effect measure. Resource utilization was assessed by patient questionnaires. We calculated adjusted group differences in costs and effects, incremental cost-effectiveness ratios and cost-effectiveness acceptability curves. The complete sample and subgroups based on depression severity were considered. Results In the IG, adjusted mean total costs (+5,016; SE: €2,691) and effects (+0.008 QALY; SE: 0.02) were higher than in the CG; yet, differences were not statistically significant. Significantly increased costs were found in the IG for outpatient physician services and psychiatrist services. Significantly increased total and indirect costs in the IG were found in the group with severe depression. Incremental cost-effectiveness ratios were unfavourable and the probability of cost-effectiveness was low, except for the group with moderate depression (70% for willingness-to-pay threshold of €50,000/QALY). Conclusions We found no evidence for cost-effectiveness of the intervention. However, we identified indicators that the intervention works according to the aims of the National Treatment Guideline.

scholarly journals Cost-effectiveness of a preferred intensity exercise programme for young people with depression compared with treatment as usual: an economic evaluation alongside a clinical trial in the UK

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e016211 ◽  
Author(s):  
David Turner ◽  
Tim Carter ◽  
Tracey Sach ◽  
Boliang Guo ◽  
Patrick Callaghan
Keyword(s):  
Cost Effectiveness ◽  
Young People ◽  
Exercise Intervention ◽  
Controlled Trial ◽  
Exercise Programme ◽  
Effective Intervention ◽  
Control Group ◽  
Treatment As Usual ◽  
Life Years ◽  
The Uk

ObjectivesTo assess the cost-effectiveness of preferred intensity exercise programme for young people with depression compared with a treatment as usual control group.DesignA ‘within trial’ cost-effectiveness and cost-utility analysis conducted alongside a randomised controlled trial. The perspective of the analysis was the UK National Health Service and social services.SettingThe intervention was provided in a community leisure centre setting.Participants86 young people aged 14–17 years attending Tier 2 and Tier 3 CAMHS (Child and Adolescent Mental Health Services) outpatient services presenting with depression.InterventionsThe intervention comprised 12 separate sessions of circuit training over a 6-week period. Sessions were supervised by a qualified exercise therapist. Participants also received treatment as usual. The comparator group received treatment as usual.ResultsWe found improvements in the Children’s Depression Inventory-2 (CDI-2) and estimated cost-effectiveness at £61 per point improvement in CDI-2 for the exercise group compared with control. We found no evidence that the exercise intervention led to differences in quality-adjusted life years (QALY). QALYs were estimated using the EQ-5D-5L (5-level version of EuroQol-5 dimension).ConclusionsThere is evidence that exercise can be an effective intervention for adolescents with depression and the current study shows that preferred intensity exercise could also represent a cost-effective intervention in terms of the CDI-2.Trial registration numberNCT01474837.

scholarly journals Primary dementia care based on the individual needs of the patient: study protocol of the cluster randomized controlled trial, DemStepCare

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Isabella Bablok ◽  
◽  
Harald Binder ◽  
Dominikus Stelzer ◽  
Klaus Kaier ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Dementia Care ◽  
Cluster Randomized Controlled Trial ◽  
Control Group ◽  
Care Model ◽  
Randomized Controlled ◽  
Individual Needs ◽  
Cluster Randomized ◽  
The Individual

Abstract Background Most people with dementia (PwD) are cared for at home, with general practitioners (GPs) playing a key part in the treatment. However, primary dementia care suffers from a number of shortcomings: Often, diagnoses are made too late and therapies by GPs do not follow the guidelines. In cases of acute crises, PwD are too often admitted to hospital with adverse effects on the further course of the disease. The aim of this study is to implement and evaluate a new GP-based, complex dementia care model, DemStepCare. DemStepCare aims to ensure demand-oriented, stepped care for PwD and their caregivers. Methods/design In a cluster randomized controlled trial, the care of PwD receiving a complex intervention, where the GP is supported by a multi-professional team, is compared to (slightly expanded) usual care. GPs are clustered by GP practice, with 120 GP practices participating in total. GP practices are randomized to an intervention or a control group. 800 PwD are to be included per group. Recruitment takes place in Rhineland-Palatinate, Germany. In addition, a second control group with at least 800 PwD will be formed using aggregated routine data from German health insurance companies. The intervention comprises the training of GPs, case management including repeated risk assessment of the patients’ care situation, the demand-oriented service of an outpatient clinic, an electronic case record, external medication analyses and a link to regional support services. The primary aims of the intervention are to positively influence the quality of life for PwD, to reduce the caregivers’ burden, and to reduce the days spent in hospital. Secondary endpoints address medication adequacy and GPs’ attitudes and sensitivity towards dementia, among others. Discussion The GP-based dementia care model DemStepCare is intended to combine a number of promising interventions to provide a complex, stepped intervention that follows the individual needs of PwD and their caregivers. Its effectiveness and feasibility will be assessed in a formative and a summative evaluation. Trial registration German Register of Clinical Trials (Deutsches Register Klinischer Studien, DRKS), DRKS00023560. Registered 13 November 2020 - Retrospectively registered. HTML&TRIAL_ID=DRKS00023560.

scholarly journals Cost-effectiveness of a primary care model for anxiety disorders

2009 ◽  
Vol 195 (4) ◽  
pp. 308-317 ◽  
Author(s):  
Hans-Helmut König ◽  
Anja Born ◽  
Dirk Heider ◽  
Herbert Matschinger ◽  
Sven Heinrich ◽  
...  
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Anxiety Disorders ◽  
Controlled Trial ◽  
Intervention Group ◽  
Control Group ◽  
Service Utilisation ◽  
Care Model ◽  
Adequate Treatment

BackgroundIndividuals with anxiety disorders often do not receive an accurate diagnosis or adequate treatment in primary care.AimsTo analyse the cost-effectiveness of an optimised care model for people with anxiety disorders in primary care.MethodIn a cluster randomised controlled trial, 46 primary care practices with 389 individuals positively screened with anxiety were randomised to intervention (23 practices, 201 participants) or usual care (23 practices, 188 participants). Physicians in the intervention group received training on diagnosis and treatment of anxiety disorders combined with the offer of a psychiatric consultation–liaison service for 6 months. Anxiety, depression, quality of life, service utilisation and costs were assessed at baseline, 6-month and 9-month follow-up.ResultsResultsNo significant differences were observed between intervention and control group on the Beck Anxiety Inventory, Beck Depression Inventory and EQ–5D during follow-up. Total costs were higher in the intervention group (€4911 v. €3453, P = 0.09). The probability of an incremental cost-effectiveness ratio <€50 000 per quality-adjusted life year was below 10%.ConclusionsThe optimised care model did not prove to be cost-effective.

Tablet-Based Outpatient Care for People With Dementia

GeroPsych ◽  
2019 ◽  
Vol 32 (3) ◽  
pp. 135-144 ◽  
Author(s):  
Sonia Lech ◽  
Julie L. O’Sullivan ◽  
Paul Gellert ◽  
Jan‐Niklas Voigt-Antons ◽  
Robert Greinacher ◽  
...  
Keyword(s):  
Group Treatment ◽  
Controlled Trial ◽  
Intervention Group ◽  
Control Group ◽  
Outpatient Basis ◽  
Treatment As Usual ◽  
Intention To Treat ◽  
People With Dementia ◽  
Cluster Randomized

Abstract. Most people with dementia (PwD) are treated on an outpatient basis, predominantly by general practitioners (GPs). This article provides a detailed protocol of a study aimed at developing and evaluating a tablet-based intervention to improve outpatient dementia care by fostering guideline-based treatment. A cluster-randomized controlled trial with an intervention group (tablet-based intervention) and a control group (treatment as usual plus information handbook) will be conducted. Clusters will be randomized at GP level. Primary outcome is defined as adherence to dementia guideline recommendations after 9 months. Secondary outcomes include various health outcomes assessed in PwD (e.g., quality of life) and informal caregivers (e.g., caregiver burden). Outcomes will be analyzed by an intention-to-treat analysis and using mixed models.

Cost-effectiveness and cost-utility analysis of a web-based computer-tailored intervention for prevention of binge drinking among Spanish adolescents

2020 ◽  
Author(s):  
Ana Magdalena Vargas-Martínez ◽  
Marta Lima-Serrano ◽  
Marta Trapero-Bertran
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Binge Drinking ◽  
Societal Perspective ◽  
Cost Utility ◽  
Health Concern ◽  
Control Group ◽  
Tailored Intervention ◽  
Web Based ◽  
Life Years

Abstract BackgroundWorldwide, binge drinking (BD) today follows being a public health concern among adolescents. This study sought to assess the cost-effectiveness and cost-utility of a web-based computer-tailored intervention to prevent BD in adolescence.MethodsThe sample was drawn from a study evaluating the Alerta Alcohol programme. The population consisted of adolescents aged 15–19. Decision tree analysis was used to estimate costs and health outcomes, as measured by number of BD occasions and quality-adjusted life years (QALYs). Incremental Cost-Effectiveness and Cost-Utility Ratios were also calculated from National Health Service (NHS) and societal perspective and for a time horizon of four months. Multivariate deterministic sensitivity analysis of best/worst scenarios by subgroups was used to account for uncertainty.ResultsThe intervention was dominant from the societal perspective resulting in savings of €7,986.37 by one BD occasion averted per month. With regard to Incremental Cost-Utility Ratios, the intervention resulted in an incremental cost of €71.05 per QALY gained from NHS perspective and this was dominant, from societal perspective, resulting in savings of €34,126.64 per QALY gained in comparison with the control group. Subgroup analyses showed that the intervention resulted dominant for girls from both perspectives, and for those who were older (17 years or more) from NHS perspective.ConclusionComputer-tailored feedback is a cost-effective way to reduce BD and to increase QALYs among adolescents. However, long-term follow-up would probably be needed to capture major changes both in reduction of BD and in increasing of health-related quality of life.Trial registration(ClinicalTrials.gov): NCT03288896. Registration date: September 20, 2017. “Retrospectively registered”.

scholarly journals Economic evaluation of mindfulness group therapy for patients with depression, anxiety, stress and adjustment disorders compared with treatment as usual

2018 ◽  
Vol 216 (4) ◽  
pp. 197-203 ◽  
Author(s):  
Sanjib Saha ◽  
Johan Jarl ◽  
Ulf-G Gerdtham ◽  
Kristina Sundquist ◽  
Jan Sundquist
Keyword(s):  
Cost Effectiveness ◽  
Group Therapy ◽  
Societal Perspective ◽  
Control Group ◽  
Adjustment Disorders ◽  
Trial Duration ◽  
Treatment As Usual ◽  
Healthcare Perspective ◽  
Life Years ◽  
Significant Difference

BackgroundA randomised controlled trial found that a structured mindfulness group therapy (MGT) programme was as effective as treatment as usual (mostly cognitive–behavioural therapy) for patients with a diagnosis of depression, anxiety or stress and adjustment disorders in Sweden (ClinicalTrials.gov: NCT01476371).AimsTo perform a cost-effectiveness analysis of MGT compared with treatment as usual from both a healthcare and a societal perspective for the trial duration (8 weeks).MethodThe costs from a healthcare perspective included treatment as usual, medication and costs for providing MGT. The societal perspective included costs from the healthcare perspective plus savings from productivity gains for the trial duration. The effectiveness was measured as quality-adjusted life-years (QALY) using the EQ-5D-5L questionnaire and the UK value set. Uncertainty surrounding the incremental costs and effects were estimated using non-parametric bootstrapping with 5000 replications and presented with 95% confidence intervals and cost-effectiveness acceptability curves.ResultsThe MGT group had significantly lower healthcare and societal costs (mean differences –€115 (95% CI −193 to −36) and –€112 (95% CI −207 to −17), respectively) compared with the control group. In terms of effectiveness, there was no significant difference in QALY gain (mean difference −0.003, 95% CI −0.0076 to 0.0012) between the two groups.ConclusionsMGT is a cost-saving alternative to treatment as usual over the trial duration from both a healthcare and a societal perspective for patients with a diagnosis of depression, anxiety or stress and adjustment disorders in Sweden.

scholarly journals Cost–effectiveness of combinatorial pharmacogenomic testing for depression from the Canadian public payer perspective

2020 ◽  
Vol 21 (8) ◽  
pp. 521-531 ◽  
Author(s):  
Julie-Anne Tanner ◽  
Paige E Davies ◽  
Christopher C Overall ◽  
Daniel Grima ◽  
Julian Nam ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Treatment Strategies ◽  
Public Healthcare ◽  
Treatment As Usual ◽  
System Perspective ◽  
Payer Perspective ◽  
Life Years ◽  
Public Payer ◽  
The Cost

Aim: Evaluate the cost–effectiveness of combinatorial pharmacogenomic (PGx) testing, versus treatment as usual (TAU), to guide treatment for patients with depression, from the Canadian public healthcare system perspective. Materials & methods: Clinical and economic data associated with depression were extracted from published literature. Clinical (quality-adjusted life years; QALYs) and economic (incremental cost–effectiveness ratio) outcomes were modeled using combinatorial PGx and TAU treatment strategies across a 5-year time horizon. Results: With the combinatorial PGx strategy to guide treatment, patients were projected to gain 0.14–0.19 QALYs versus TAU. Accounting for test price, combinatorial PGx saved CAD $1,687–$3,056 versus TAU. Incremental cost–effectiveness ratios ranged from -$11,861 to -$16,124/QALY gained. Conclusion: Combinatorial PGx testing was more efficacious and less costly compared with the TAU for depression.

scholarly journals Cabozantinib for patients with advanced hepatocellular carcinoma: a cost-effectiveness analysis

2019 ◽  
Vol 12 ◽  
pp. 175628481987830 ◽  
Author(s):  
Amir Shlomai ◽  
Moshe Leshno ◽  
Daniel A. Goldstein
Keyword(s):  
Hepatocellular Carcinoma ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Systemic Therapy ◽  
Kinase Inhibitor ◽  
Controlled Trial ◽  
Advanced Hepatocellular Carcinoma ◽  
Advanced Hcc ◽  
Life Years ◽  
Prior Systemic Therapy

Background and aims: The multi-kinase inhibitor sorafenib is a first-line drug for patients with advanced hepatocellular carcinoma (HCC). Treatment options for patients whose disease has progressed on sorafenib are limited. In a recent randomized controlled trial (CELESTIAL trial), patients with advanced HCC who had failed prior systemic therapy had moderate progression-free survival and overall survival advantages when treated with the multi-kinase inhibitor cabozantinib. However, since this treatment is costly and is accompanied by significant adverse events in a large proportion of patients, its cost-effectiveness in these patients should be determined. Methods: We developed a Markov model incorporating health outcomes, measured by life-years and quality-adjusted life-years (QALYs) to evaluate the cost-effectiveness of cabozantinib compared with placebo in patients who have failed prior systemic therapy. Results: Treatment with cabozantinib results in a mean gain of 11.6 weeks of life (0.22 life-years) as compared with placebo. When quality of life was incorporated, treatment with cabozantinib produced a gain of 0.16 QALYs. The total mean incremental cost of cabozantinib was US$76,406 per patient. The incremental cost-effectiveness ratio for cabozantinib compared with best supportive care was US$469,374/QALY using the recommended dose of 60 mg cabozantinib daily. Conclusion: Our results suggest that the use of cabozantinib in patients with advanced HCC who have progressed on prior treatment, results in a modest incremental benefit with high incremental costs, suggesting that it is not cost-effective at conventional willingness to pay thresholds.

scholarly journals Cost utility of behavioural activation delivered by the non-specialist

2011 ◽  
Vol 199 (6) ◽  
pp. 510-511 ◽  
Author(s):  
David Ekers ◽  
Christine Godfrey ◽  
Simon Gilbody ◽  
Steve Parrott ◽  
David A. Richards ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Controlled Trial ◽  
Cost Effective ◽  
Threshold Value ◽  
Quality Adjusted Life Year ◽  
Cost Utility ◽  
Behavioural Activation ◽  
Treatment As Usual ◽  
Intention To Treat

SummaryBehavioural activation by non-specialists appears effective in the treatment of depression. We examined incremental cost-effectiveness of behavioural activation (n = 24) v. treatment as usual (n = 23) in a randomised controlled trial. Intention-to-treat analyses indicated a quality-adjusted life-year (QALY) difference in favour of behavioural activation of 0.20 (95% CI 0.01–0.39, P = 0.042), incremental cost-effectiveness ratio of £5756 per QALY and a 97% probability that behavioural activation is more cost-effective at a threshold value of £20 000. Results are promising for dissemination of behavioural activation but require replication in a larger study.

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