scholarly journals Calculation of the cost-effectiveness of subcutaneous administration of trastuzumab

2020 ◽  
Vol 55 (1) ◽  
pp. 9-11
Author(s):  
I. M. OMAROVA ◽  
J. O. NURKETAEVA ◽  
D. D. DOROGAN
Keyword(s):  
Targeted Therapy ◽  
Cost Effectiveness ◽  
Cost Minimization ◽  
Pharmacoeconomic Analysis ◽  
Subcutaneous Administration ◽  
Comparable Efficacy ◽  
Minimization Method ◽  
Efficient Treatment ◽  
Outpatient Chemotherapy ◽  
The Cost

Rational selection of medicines with an assessment of their pharmacoeconomic effectiveness is the most effective way to ensure safe and efficient treatment and economical use of budget funds allocated for drug therapy, as well as to reduce the time of hospitalization and treatment of patients. The purpose of the research was to evaluate the pharmacoeconomic effectiveness of using the subcutaneous and intravenous forms of drug Trastuzumab. Research tasks: 1. Estimate costs when using subcutaneous trastuzumab in an outpatient chemotherapy room (OCR). 2. Estimate costs when using intravenous trastuzumab in a day patient department (DPD). 3. Estimate costs when using intravenous trastuzumab in a round-the-clock hospital. Results: The paper presents the pharmacoeconomic analysis of targeted therapy with trastuzumab in two forms for intravenous administration (IV) and trastuzumab emtansine for subcutaneous administration (SC) in breast cancer by cost minimization method. The costs of used drugs are according to the price-list of the unified national distributor SK Pharmacia as of January 1, 2018. At comparable efficacy and toxicity, the estimated cost-effectiveness of trastuzumab per 100 patients per year is KZT 16,939,600 ($ 50,972) for SC administration in OCR and IV administration in DPD vs. KZT 41,783,200 ($ 125,728) for SC administration in OCR and IV administration in a round-the-clock hospital. Conclusions: Based on the above, the subcutaneous form is economically feasible for conducting targeted therapy with trastuzumab.

scholarly journals Calculation of the cost-effectiveness of subcutaneous administration of trastuzumab

2020 ◽  
Vol 55 (1) ◽  
pp. 11-13
Author(s):  
I. M. Omarova ◽  
J. O. Nurketaeva ◽  
D. D. Dorogan
Keyword(s):  
Cost Effectiveness ◽  
Cost Minimization ◽  
Subcutaneous Administration ◽  
Comparable Efficacy ◽  
Trastuzumab Emtansine ◽  
Minimization Method ◽  
Efficient Treatment ◽  
Outpatient Chemotherapy ◽  
The Cost ◽  
Selection Of

Rational selection of medicines with an assessment of their pharmacoeconomic effectiveness is the most effective way to ensure safe and efficient treatment and economical use of budget funds allocated for drug therapy, as well as to reduce the time of hospitalization and treatment of patients. The purpose of the research was to evaluate the pharmacoeconomic effectiveness of using the subcutaneous and intravenous forms of drug Trastuzumab. Research tasks: 1. Estimate costs when using subcutaneous trastuzumab in an outpatient chemotherapy room (OCR). 2. Estimate costs when using intravenous trastuzumab in a day patient department (DPD) 3. Estimate costs when using intravenous trastuzumab in a round-the-clock hospital Results: The paper presents the pharmacoeconomic analysis of targeted therapy with trastuzumab in two forms for intravenous (IV) administration and trastuzumab emtansine for subcutaneous (SC) administration in breast cancer by cost minimization method. The costs include the cost of used drugs according to the price-list of the unified national distributor SK Pharmacia as of January 1, 2018. At comparable efficacy and toxicity, the estimated cost-effectiveness of trastuzumab per 100 patients per year is KZT16,939,600 ($50,972) for SC administration in OCR and IV administration in DPD vs. KZT41,783,200 ($125,728) for SC administration in OCR and IV administration in a round-theclock hospital.

scholarly journals Pharmacoeconomic analysis of pertuzumab in treatment of HER2-positive breast cancer in Ukraine

2021 ◽  
Vol 29 (1) ◽  
pp. 21-31
Author(s):  
O. V. Muzhychuk ◽  
N. V. Bezdetko
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Targeted Therapy ◽  
Cost Effectiveness ◽  
Pharmacoeconomic Analysis ◽  
Phase Iii ◽  
Therapy Regimen ◽  
Her2 Breast Cancer ◽  
Frontline Therapy ◽  
The Cost

Background. The incidence of breast cancer tends to be increasing worldwide in recent years. It is characterized by various clinical manifestations and potential treatment approaches. The choice of treatment strategy, its sequence as well as the efficiency of administered chemotherapy is quite relevant these days. Purpose – assessing economic feasibility of targeted therapy with pertuzumab (Perjeta®) in patients with metastatic HER2+ BC from the perspective of the health care system of Ukraine. Materials and methods. The treatment outcomes as well as related costs were determined by means of Markov analytical modelling based on a randomized multicenter open clinical study of CLEOPATRA phase III [2]. The model time horizon was 20 years. The alternative schemes of frontline therapy of metastatic HER2+ breast cancer were compared: PTD regimen pertuzumab + trastuzumab + docetaxel and TD regimen trastuzumab + docetaxel. Based on Markov modelling, pharmacoeconomic analysis by means of cost-effectiveness and cost-utility methods was carried out. As an efficiency criterion, LYG amount was used, as a utility criterion − QALY indicator. Direct medical costs were counted, the structure of which had been determined according to the current Protocol. The cost of drugs was calculated in accordance with the Register of wholesale prices for pharmaceuticals of the Ministry of Health of Ukraine; the cost of treatment procedures was determined in accordance with the available price lists of paid medical services provided by licensed medical institutions. Discounting at the level of 3 % per year was applied. Sensitivity analysis of the outcomes was carried out before pertuzumab price changed. Results. According to the modelling, the average life expectancy of patients with HER2+ BC, receiving PTD scheme is 15.69 years compared to 13.95 years in the TD group. Along with prolonging life, associated with PTD scheme, its quality increases. Patients in the TD group gain 7.8 QALY on average, while in the PTD group it is 9.24. The total expenses for the simulated (involved into modeling) study period in the PTD group averaged UAH 1 970 369.6 per patient, in the TD group − UAH 732 517.7. ICER (cost of 1 additional life year) and ICUR (cost of 1 additional qualityadjusted life year) incremental coefficients amounted to UAH 710924.6 and UAH 861175.4 respectively. Conclusions. 1. Pertuzumab target drug is an effective pharmaceutical when administered to patients with metastatic HER2 + breast cancer. 2. The frontline therapy regimen for patients with metastatic HER2 + breast cancer with pertuzumab being included is more expensive in comparison with trastuzumab + docetaxel regimen; at the same time it makes it possible to achieve better results, i. e. to provide on average extra 1.74 life years and 1.44 QALY in 20-year perspective. 3. Pharmacoeconomic analysis based on Markov model and cost-effectiveness and cost-benefit calculations make it possible to consider pertuzumab (Perjeta®), included into frontline targeted therapy regimen of trastuzumab + docetaxel in patients with metastatic HER2+ breast cancer, as an economically feasible medical technology under current health care conditions in Ukraine.

scholarly journals Pharmacoeconomic analysis by the cost-minimization method of fluconazole drugs recommended for use in candidiosis

2020 ◽  
pp. 59-68
Author(s):  
O. V. Tkachova ◽  
L. V. Iakovlieva ◽  
T. I. Sheptak
Keyword(s):  
Cost Minimization ◽  
Pharmacoeconomic Analysis ◽  
Direct Costs ◽  
Antifungal Drugs ◽  
Vaginal Candidiasis ◽  
Oropharyngeal Candidiasis ◽  
Minimization Method ◽  
Mucous Membranes ◽  
Calculation Results ◽  
The Cost

Candidiasis is a group of fungal diseases of the skin, mucous membranes and internal organs caused by fungi of the genus Candida. Candidiasis treatment is mainly carried out with antifungal agents for systemic use. Fluconazole preparations, which have proven clinical efficacy and safety, and are also most often used in Ukraine, are presented in the largest number of TN in the pharmaceutical market. The aim of the work is to analyze cost minimization when using fluconazole preparations for pharmacotherapy of three different pharmacotherapy schemes for candidiasis. The analysis of minimizing the costs of fluconazole preparations was carried out using the retail cost of medicines according to the Morion company Pharmexplorer analytical market research system (as of February 2019). In the process of calculating the cost of the course of treatment of patients with candidiasis, fluconazole preparations used for pharmacotherapy of 1) vaginal candidiasis were used; 2) dermatomycosis, atrophic candidiasis of the mucous membranes, oropharyngeal candidiasis; 3) candidiasis of the esophagus, candiduria. The study evaluated only the direct costs of treating patients with candidiasis with fluconazole preparations. Calculation of the cost of pharmacotherapy with fluconazole was carried out taking into account the price per package of drugs, the daily dose of drugs with the determination of the cost of one unit (tablets, capsules), one day of treatment and the course of treatment. Based on the results obtained, using the pharmacoeconomic method of «cost minimization», the least costly drugs were selected for the course of treatment with fluconazole. The calculation results showed that the minimum direct costs for the course of pharmacotherapy of the vaginal candidiasis are 9.88 UAH; the minimum direct costs for the treatment of dermatomycoses, atrophic candidiasis of the mucous membranes, oropharyngeal candidiasis are UAH 26.01, and for the treatment of candidiasis of the esophagus and candiduria – UAH 50.28. In a difficult socio-economic situation in Ukraine, the use of the least expensive representatives of antifungal drugs for systemic use is economically feasible. The results of this study will allow the doctor or pharmacist to choose fluconazole preparations in various doses and dosage forms for patients with low solvency.

A Pharmacoeconomic Analysis of Phosphate Binders Cost-Effectiveness in the RISCAVID Study

2015 ◽  
Vol 39 (1-3) ◽  
pp. 174-180 ◽  
Author(s):  
Vincenzo Panichi ◽  
Alberto Rosati ◽  
Adriana Di Giorgio ◽  
Alessia Scatena ◽  
Roberto Bigazzi ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Pharmacoeconomic Analysis ◽  
Phosphate Binders ◽  
Effectiveness Evaluation ◽  
C Reactive Protein ◽  
Stroke Incidence ◽  
Mortality And Morbidity ◽  
Reactive Protein ◽  
The Cost ◽  
Hospital Days

Background: A pharmacoeconomic analysis of the RISCAVID database aimed at assessing the cost effectiveness of phosphate binders in preventing CV mortality and morbidity over 7 years was performed. Methods: Morbid or fatal events occurring in 750 chronic HD patients were recorded. Statistical analysis evaluated the distribution of variables and the effect of sevelamer on survival. A cost-effectiveness evaluation was performed using a probabilistic model based on a Markov chain. Results: Multivariate analysis showed that treatment with sevelamer was associated with a reduced stroke incidence by 52% (p = 0.04) and reduced levels of C-reactive protein (p < 0.01). Cost-effectiveness evaluation evidenced a 33% decrease in hospital-days for patients treated with sevelamer, with and without comorbidities compared to patients undergoing calcium binders treatment. Conclusion: Treatment with sevelamer was associated with a reduced risk of stroke in HD patients, with a clear saving on disease-related costs for the Italian National Healthcare System.

scholarly journals Pharmacoeconomic analysis of using typical and atypical antipsychotics in schizophrenia

2018 ◽  
Vol 11 (2) ◽  
pp. 9-24
Author(s):  
I. A. Vilyum ◽  
B. V. Andreev ◽  
M. A. Proskurin ◽  
Yu. E. Balykina
Keyword(s):  
Cost Effectiveness ◽  
Atypical Antipsychotics ◽  
Impact Analysis ◽  
Pharmacoeconomic Analysis ◽  
Cost Effectiveness Analysis ◽  
Resource Saving ◽  
Antipsychotic Therapy ◽  
Healthcare Budget ◽  
Effectiveness Analysis ◽  
The Cost

The aim: to provide a comprehensive pharmacoeconomic evaluation of the maintenance therapy with antipsychotics in outpatients diagnosed with schizophrenia.Materials and methods. The analysis was conducted by two mutually complementary steps: an epidemiological study on outpatients with schizophrenia, and a subsequent pharmacoeconomic modeling. Two medical technologies were evaluated and compared: treatment with classical antipsychotics (kA) and treatment with atypical antipsychotics (AA). For the clinical and economic analysis of these treatments, we used a number of indices derived from our retrospective study of patients’ medical records. The cost-effectiveness analysis, incremental analysis, and «budget impact» analysis were performed taking into account the direct and indirect costs of the treatments.Results. We determined the costs of managing outpatients with schizophrenia from the perspective of the healthcare budget and the social burdens; we also looked into the relevance and effectiveness of the current costs at various time intervals – 6, 12 and 24 months. As shown, the treatment strategies involving AA were more budget-consumptive than the kA treatments. even if the treatments were switched to the reproduced AA (up to 100% replacement), the costs would remain to be higher than those for the kA. The «cost-effectiveness» analysis related to «the proportion of stable patients» for the horizons of 6 and 12 months indicated that the reproduced AA would be more economically effective than the kA. However, when the observation period was increased to 24 months, this economic advantage of AA diminished, and the kA drugs had a lower CeR instead. For the «number of hospitalization-free days per year», the use of AA was more cost-effective only versus the 100% use of reproduced AA at the simulated horizon of 12 months. When the use of 100% reference AA or the combined use of reference + reproduced AA was simulated, the treatment with kA remained more economically effective, regardless of the simulated period.Conclusion. The pharmacoeconomic simulation of the antipsychotic therapy in outpatients with schizophrenia suggests the ways to optimize the treatment. Among them, (a) using AA for the treatment of at least 15.6% of patients (those who are employed); keeping the ≥60% use of kA to ensure the optimal resource-saving effect of the treatment; (b) using reproduced AA at the level of ≥70% (instead of the reference AA similar in efficacy and safety) to keep the treatment economically feasible. 

scholarly journals Comparative pharmacoeconomic analysis of the use of erythropoiesis-stimulating drugs for the treatment of anemia in cancer patients

2021 ◽  
pp. 174-182
Author(s):  
I. S. Krysanov ◽  
E. V. Makarova ◽  
V. Yu. Ermakova
Keyword(s):  
Cost Effectiveness ◽  
Cancer Patients ◽  
Clinical Efficacy ◽  
Pharmacoeconomic Analysis ◽  
Care Organization ◽  
Epoetin Alfa ◽  
Patients Rights ◽  
Epoetin Beta ◽  
Level Increase ◽  
The Cost

Introduction. Currently, a number of pharmacoeconomic studies describing use of erythropoietin stimulating agent (ESA) in cancer patients with anemia have been published, however, most of the publications on this topic are foreign. At the same time, there are practically no studies comparing the economic efficiency of various ESA preparations with each other. Some of works by foreign colleagues reflect that the clinical efficacy of using ESA namely the degree of increase in Hb, significantly depends on the patient’s body weight: the higher the weight, the greater the dose of EPO is required for a single administration and a course of therapy.Aim. Сomparative pharmacoeconomic analysis of epoetin alfa usage for the treatment of anemia in adult cancer patients with weight 80 kg.Materials and methods. The following drugs were selected for comparative analysis: epoetin alfa, epoetin beta, darbepoetin. Clinical efficacy was assessed in terms of the rate of in Hb level increase. Pharmacoeconomic analysis was carried out using the cost-effectiveness method (CEA).Results. Тhe usage of epoetin alfa 12,000 IU for 8 weeks therapy course in cancer patients weighting over 80 kg had a better cost-effectiveness ratio compared to epoetin alfa (10,000 IU, 30,000 IU, 40,000 IU) and darbepoetin, giving way in price only to the cheapest epoetin beta which can be administered 4 injections simultaneously. Its the infringement of patients rights to avoid additional pain. Its the infringement of patients rights to avoid additional pain. At the 16th week of therapy, the usage of epoetin alfa 12,000 IU had an advantage over all ESA.Conclusions. Тhe usage of russian epoetin alfa 12,000 IU for the treatment of anemia in adult cancer patients weighing over 80 kg approximately in real clinical practice in Russian Federation is an economically justified approach to the medical care organization. 

Clinical and economic evaluation of the effectiveness of the use of Riociguat for the treatment of patients with inoperable, recurrent or persistent chronic thromboembolic pulmonary hypertension under the conditions of the Republic of Kazakhstan

2020 ◽  
Vol 3-4 (213-214) ◽  
pp. 8-16
Author(s):  
Andrey Avdeyev ◽  
◽  
Murat Mukarov ◽  
Sabira Zhaugasheva ◽  
Lubov Piven ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Cost Effectiveness ◽  
Pharmacoeconomic Analysis ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Medication Therapy ◽  
First Choice ◽  
Hospitalization Costs ◽  
Thromboembolic Pulmonary Hypertension ◽  
The Cost ◽  
The Impact

Riociguat is included in international guidelines and local clinical protocols for the treatment of pulmonary hypertension (PH) and chronic thromboembolic pulmonary hypertension (CTEPH), where it is the first choice drug for the treatment of patients with inoperable, persistent and recurrent forms of CTEPH. Therefore, it is necessary to include this drug in the GVoFMC (The Guaranteed Volume of Free Medical Care) reimbursement lists and the CSHI (Compulsory Social Health Insurance) system, which will alleviate access to medication for patients suffering from PH and CTEPH. Purpose of the study. Determination of the cost effectiveness parameters of using riociguat in comparison with bosentan and combined therapy of bosentan/sildenafil in medication therapy of CTEPH. Material and methods. A Markov model of CTEPH dynamics in patients with riociguat prescription was developed in comparison with application of bosentan and sildenafil. Modeling step was 16 weeks, modeling horizon – 10 years. Direct medical costs per patient were taken into account in the model, including the cost of drug therapy, costs of outpatient visits due to CTEPH, hospitalization costs due to clinical deterioration of CTEPH, emergency calls. Results and discussion. The results of “cost-effectiveness” Markov pharmacoeconomic modeling showed that riociguat application reveals a dominant position in comparison with the practice of using bosentan with addition of sildenafil for specific therapy at deterioration of patient's condition up to III-IV functional class (FC). Riociguat is characterized by the best values of “cost effectiveness” coefficients according to efficiency criterion of FC increase and the “value of 6-min walk distance test”. The results of analysis of the impact on budget showed that inclusion of riociguat in GVoFMC/CSHI will lead to budget savings of 154 million tenge in the first year, 294 million tenge in the second year and 415 million tenge in the third year compared to the existing clinical practice without riociguat use. Conclusions. On the basis of conducted complex pharmacoeconomic analysis, the application of riociguat in patients with inoperable or persistent/ recurrent form of CTEPH is a more preferable strategy in comparison with the strategy of application of bosentan with addition of sildenafil and will allow to reduce budget expenses within the framework of GVoFMC and CSHI system. Keywords: pulmonary hypertension, chronic thromboembolic pulmonary hypertension, riociguat.

scholarly journals PHARMACOECONOMIC ANALYSIS OF STATIN TABLETS - IN VITRO PERFORMANCE PERSPECTIVE

2018 ◽  
Vol 11 (7) ◽  
pp. 210
Author(s):  
Vidyavathi M ◽  
Koteswaramma L ◽  
Krishnaveni A ◽  
Madhuri T ◽  
Sarada B
Keyword(s):  
Cost Benefit Analysis ◽  
Cost Minimization ◽  
Pharmacoeconomic Analysis ◽  
Cost Benefit ◽  
Scientific Discipline ◽  
Pharmaceutical Drugs ◽  
Weight Variation ◽  
The Cost ◽  
In Vitro Performance

Objective: Pharmacoeconomics refers to the scientific discipline that compares the value of pharmaceutical drugs or drug therapies. The pharmacoeconomic analysis includes the research methods related to cost minimization, cost-effectiveness, and cost-benefit analysis. The present study concerned with the pharmacoeconomic analysis of statin tablets (simvastatin [S1-S5], atorvastatin [A1-A5], and rosuvastatin [R1-R5]) of different brands which are varying in their prices using in vitro evaluation methods of tablets.Methods: Weight variation, friability, hardness, disintegration, and dissolution tests of all selected statin tablets were performed as per official procedure for the pharmacoeconomic comparative analysis.Results: It was found the least T90% with S5 and high T90% with S1 tablets among simvastatin tablets, the least T90% was observed with A1 and A5 and high T90% with A2 tablets among atorvastatin tablets, and least T 90% was observed with R5 and high T90% with R2 was found among rosuvastatin tablets without any relation with their order of prices. Hence, the study concluded that there is no significant correlation between cost and in vitro performance as there is no excellent in vitro performance found from the costliest tablets and vice versa.Conclusion: The range of the cost of different marketed statin tablets is from Rs.17.5 to Rs.127.0 per a strip of 10 tablets. All brands of three drugs have equal strength which are assumed to produce the same outcomes. As there is no significant correlation between cost and results of some of in vitro parameters of the tablets, the cost minimization analysis can be ruled out for these brands of S1 to

Pharmacoeconomic Analysis of Using Sinemet CR over Standard Sinemet in Parkinsonian Patients with Motor Fluctuations

1998 ◽  
Vol 32 (9) ◽  
pp. 878-883 ◽  
Author(s):  
Alan G Hempel ◽  
Mary L Wagner ◽  
Mohamed A Maaty ◽  
Jacob I Sage
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cost Effectiveness ◽  
Pharmacoeconomic Analysis ◽  
Tertiary Care ◽  
Motor Fluctuations ◽  
University Teaching ◽  
Total Cost ◽  
Medication Costs ◽  
The Cost

OBJECTIVE: To compare the costs of pharmacotherapy in patients with Parkinson's disease before and after converting from standard Sinemet to extended-release Sinemet CR. DESIGN: Investigators retrospectively reviewed records of patients converting from Sinemet to Sinemet CR for efficacy and total drug costs. Cost-effectiveness was evaluated retrospectively from data collected in prospective Sinemet CR efficacy trials. SETTING: Parkinson's disease clinic at a tertiary care university teaching hospital. PATIENTS: 100 patients with motor fluctuations who had undergone an initial 6-month course of Sinemet therapy, followed by a 6-month course of Sinemet CR. MAIN OUTCOME MEASURES: Total cost was measured as the cost of Sinemet formulations plus the costs of other antiparkinson medications. Differences in pre- and postconversion costs were compared by using the paired, two-tailed Student's t-test. A substudy of 39 patients on the cost-effectiveness of conversion measured the ratio of daily medication costs to the daily hours “on” without chorea. RESULTS: While total daily medication costs after conversion increased by 21%, patients experienced either a comparable or an improved degree of disease control with Sinemet CR. Patients who were also taking selegiline were able to decrease selegiline expense by 20%. The costs of other adjunctive medications did not differ significantly after conversion. The cost-effectiveness analysis revealed an increase in postconversion on time by 2.2 hours (p = 0.0001), accompanied by a $2.85 decrease in total cost per hour on without chorea (p = 0.11). CONCLUSIONS: Although Sinemet CR is more costly, it may be more cost-effective in patients with motor fluctuations. Some patients may be able to reduce adjunctive medications.

scholarly journals Economic evaluation of online computerised cognitive–behavioural therapy without support for depression in primary care: randomised trial

2010 ◽  
Vol 196 (4) ◽  
pp. 310-318 ◽  
Author(s):  
S. A. H. Gerhards ◽  
L. E. de Graaf ◽  
L. E. Jacobs ◽  
J. L. Severens ◽  
M. J. H. Huibers ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Cognitive Behavioural Therapy ◽  
Behavioural Therapy ◽  
Cost Utility ◽  
Significant Group ◽  
Efficient Treatment ◽  
Cognitive Behavioural ◽  
The Cost

BackgroundEvidence about the cost-effectiveness and cost utility of computerised cognitive–behavioural therapy (CCBT) is still limited. Recently, we compared the clinical effectiveness of unsupported, online CCBT with treatment as usual (TAU) and a combination of CCBT and TAU (CCBT plus TAU) for depression. The study is registered at the Netherlands Trial Register, part of the Dutch Cochrane Centre (ISRCTN47481236).AimsTo assess the cost-effectiveness of CCBT compared with TAU and CCBT plus TAU.MethodCosts, depression severity and quality of life were measured for 12 months. Cost-effectiveness and cost-utility analyses were performed from a societal perspective. Uncertainty was dealt with by bootstrap replications and sensitivity analyses.ResultsCosts were lowest for the CCBT group. There are no significant group differences in effectiveness or quality of life. Cost-utility and cost-effectiveness analyses tend to be in favour of CCBT.ConclusionsOn balance, CCBT constitutes the most efficient treatment strategy, although all treatments showed low adherence rates and modest improvements in depression and quality of life.

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