Effectiveness and cost-effectiveness of cognitive behavior therapy-enhanced compared with treatment-as-usual for anorexia nervosa in an inpatient and outpatient routine setting: a consecutive cohort study

Background For anorexia nervosa, firm evidence of the superiority of specialized psychological treatments is limited and economic evaluations of such treatments in real world settings are scarce. This consecutive cohort study examined differential (cost-)effectiveness for adult inpatients and outpatients with anorexia nervosa, after implementing cognitive behavioral therapy-enhanced (CBT-E) throughout a routine setting. Methods Differences in remission, weight regain and direct eating disorder treatment costs were examined between one cohort (N = 75) receiving treatment-as-usual (TAU) between 2012–2014, and the other (N = 88) CBT-E between 2015–2017. The economic evaluation was performed from a health care perspective with a one-year time horizon, using EDE global score < 2.77, the absence of eating disorder behaviors combined with a BMI ≥ 18.5, as effect measure. Incremental cost-effectiveness ratios were calculated and cost-effectiveness planes and cost-effectiveness acceptability curves were displayed to assess the probability that CBT-E is cost effective compared to TAU. Results Using direct eating disorder treatment costs in the cost-effectiveness analysis, the cost-effectiveness plane of the base case scenario for all patients indicated a 84% likelihood of CBT-E generating better health gain at additional costs. The median ICER is €51,081, indicating a probable preference for CBT-E (> 50% probability of cost-effectiveness) assuming a WTP of €51,081 or more for each additional remission, On remission, no difference was found with 9.3% remission during TAU and 14.6% during CBT-E (p = .304). Weight regain was higher during CBT-E (EMD = 1.33 kg/m2, SE = .29, 95% CI [0.76–1.9], p < .001). Conclusions In this mixed inpatient and outpatient cohort study, findings indicate a probability of CBT-Ebeing more effective at higher costs. These findings may contribute to the knowledge of effectiveness and cost-effectiveness of specialized psychological treatments. Plain English Summary In this study, the effectiveness and treatment costs of a specialized psychological treatment for adult clients with anorexia nervosa were compared with a regular, non-specialist treatment. One group of inpatients and outpatients did receive non-specialist treatment, the next group of inpatients and outpatients received CBT-E, a specialized treatment, later on. CBT-E is recommended for clients with bulimia and with binge eating disorder, for clients with anorexia nervosa it is less clear which specialized psychological treatment should be recommended. Results indicate that at end-of-treatment, CBT-E was not superior on remission. When looking at weight regain, CBT-E seemed superior than the treatment offered earlier. Economic evaluation suggests that CBT-E generates better health gain, but at additional costs. This study contributes to the knowledge on the effectiveness and treatment costs of psychological treatments, as they are offered in routine practice, to adults with anorexia nervosa.

Comparing Health Gains, Costs and Cost-Effectiveness of 100s of Interventions in Australia and New Zealand: An Online Interactive League Table

Background This study compares the health gains, costs, and cost-effectiveness of hundreds of Australian and New Zealand (NZ) health interventions conducted with comparable methods in an online interactive league table designed to inform policy. Methods A literature review was conducted to identify peer-reviewed evaluations (2010 to 2018) arising from the Australia Cost-Effectiveness (ACE) research and NZ Burden of Disease Epidemiology, Equity and Cost-Effectiveness (BODE3) Programmes, or using similar methodology, with: health gains quantified as health-adjusted life years (HALYs); net health system costs and/or incremental cost-effectiveness ratio; time horizon of at least 10 years; and 3–5% discount rates. Results We identified 384 evaluations that met the inclusion criteria, covering 14 intervention domains: alcohol; cancer; cannabis; communicable disease; cardiovascular disease; diabetes; diet; injury; mental illness; other non-communicable disease; overweight and obesity; physical inactivity; salt; tobacco. There were large variations in health gain across evaluations: 33.9% gained less than 0.1 HALYs per 1000 people in the total population over the remainder of their lifespan, through to 13.0% gaining >10 HALYs per 1000 people. Over a third (38.8%) of evaluations were cost-saving. Conclusions League tables of comparably conducted evaluations illustrate the large health gain (and cost) variations per capita between interventions, in addition to cost-effectiveness. Further work can test the utility of this league table with policy makers and researchers.

Applying Salutogenesis in Healthcare Settings

The chapters of Part VI demonstrate for different services of health or disease care that applying the salutogenic orientation, the salutogenic model and the concept, and instrument of the sense of coherence (SOC) has the potential to improve the health-promoting quality of structures, processes, and outcomes of these services for enhancing health gain and well-being of different stakeholders. There already exists impressive research-based evidence for this, but also quite a potential for further more systematic and complex research.

The Application of Salutogenesis in Hospitals

Hospitals, in developed countries the center of curative health care in practice, research, and education, still have a dominantly pathogenic orientation. Therefore, salutogenic principles definitely have to offer quality improvement of cure and care in hospitals. But salutogenesis also is a considerable challenge to be implemented in hospitals, and hospitals are challenging for health and salutogenesis promoters. In this chapter, the authors first demonstrate how salutogenesis, if understood as a specific dimension of hospital quality, could considerably contribute to better health gain for patients and hospital staff. Second, drawing on a comprehensive literature search, it is highlighted which aspects of salutogenesis in relation to hospitals already are covered in descriptive and intervention research focusing on patients (and family members), staff, and the hospital as an organization.

Monetary valuation of a Quality-Adjusted Life Year (QALY) for depressive disorders among patients and non-patient respondents: A matched willingness to pay study

Background As estimated by the World Health Organization, depressive disorders will be the leading contributor to the Global Burden of Disease by 2030. In light of this fact, we designed a study whose aim was to investigate whether the value placed on health-related quality of life (HRQoL) for a depressive disorder is higher in patients diagnosed with a major depressive disorder (MDD) compared to non-patients in a matched sample. Method We collected data on willingness to pay (WTP) for a total of four health-gain scenarios, which were presented to 18 outpatients diagnosed with a MDD versus 18 matched non-patient respondents with no symptoms of depression. Matching characteristics included age, income, level of education, and type of health insurance. Respondents were presented with different HRQoL scenarios in which they could choose to pay money to regain their initial health state through various treatment options (e.g., inpatient treatment, electroconvulsive therapy). To test whether the probability of stating a positive WTP differed significantly between the two samples, Fisher’s exact test was used. Differences regarding stated WTP between the samples were investigated using the Mann-Whitney U-test. Results For most of the health scenarios, the probability of stating a positive WTP did not differ between the two samples. However, patient respondents declared WTP values up to 7.4 times higher than those stated by matched non-patient respondents. Conclusion Although the perceived necessity to pay for mental-HRQoL gains did not differ between respondents with MDD and respondents with no symptoms of depression, patient respondents stated higher values.

Cost-effectiveness Analysis of Breast and Lung Cancer- A Review Study

According to estimation from the World Health Organization (WHO) in 2019, cancer is the first or second leading cause of death before the age of 70 years in 112 of 183 countries and ranks third or fourth in a further 23 countries. Cancer is a group of more than 100 different and distinctive diseases. Cancer is the second leading cause of death globally and is responsible for about 10 million deaths per year .Various studies have estimated that reduction in treatment costs through early screening detection may be 30% to 100% or more of the cost of screening. The basic cost-effectiveness calculation appears to be simple, choices about units of measurement, definitions of interventions, scope of costs, and prices to be included not only will alter the numerical results but also will affect the interpretation of the cost-effectiveness ratio. If the cost-effectiveness analysis uses number of deaths averted as its measure of health gain, then allocating resources to more cost-effective interventions will avert the most deaths. Cost-effectiveness analysis helps identify neglected opportunities by highlighting interventions that are relatively inexpensive, yet have the potential to reduce the disease burden substantially.

The Contribution of Nursing to the Health of New Zealand

<p>Nursing in New Zealand, has been a recognised profession for one hundred years. Throughout this time the profession has made a significant contribution to the health of communities, nationally and internationally. Despite the obvious effort and achievement, the evidence of this contribution is not well known, is documented in a few literature sources only although it is talked about widely as part of 'myth and legend'. Nurses, now as never before, are challenged to show how they 'add value' and to explain why nursing expertise is essential to safe service delivery. Finding a way to communicate this contribution has been identified as one of the most important issues facing the profession. This thesis explores the concept of contribution and presents a model, the 'Contribution Model', to show how nursing can articulate the action and achievements that show how nursing professionals have and will continue to contribute to health gain in New Zealand. Through the application of the 'Contribution Model' and framework presented in this thesis, nursing is shown to have made a contribution to health gain by using the broad range of knowledge, skills and experiences in a wide range of settings, to provide care wherever and whenever required. Case studies and scenarios from history, observation and prediction are used to show how the actions and achievements of nursing meet the expectations of individuals, the community and society: past, present and future.</p>

The Contribution of Nursing to the Health of New Zealand

<p>Nursing in New Zealand, has been a recognised profession for one hundred years. Throughout this time the profession has made a significant contribution to the health of communities, nationally and internationally. Despite the obvious effort and achievement, the evidence of this contribution is not well known, is documented in a few literature sources only although it is talked about widely as part of 'myth and legend'. Nurses, now as never before, are challenged to show how they 'add value' and to explain why nursing expertise is essential to safe service delivery. Finding a way to communicate this contribution has been identified as one of the most important issues facing the profession. This thesis explores the concept of contribution and presents a model, the 'Contribution Model', to show how nursing can articulate the action and achievements that show how nursing professionals have and will continue to contribute to health gain in New Zealand. Through the application of the 'Contribution Model' and framework presented in this thesis, nursing is shown to have made a contribution to health gain by using the broad range of knowledge, skills and experiences in a wide range of settings, to provide care wherever and whenever required. Case studies and scenarios from history, observation and prediction are used to show how the actions and achievements of nursing meet the expectations of individuals, the community and society: past, present and future.</p>

Strategies for health services

Strategies for health services need to take into account the complex nature and contexts of healthcare. Key contextual factors that need to be considered include norms and values, macroeconomics, demographic pressures, changing disease patterns, technological changes, the quest for quality and reducing waste, and rising patient expectations. Healthcare systems have responded to the evolving environment by reassessing the relationship between the state and the market, the way health services are organized and financed, and the involvement of patients in their own care. These developments bring new opportunities to reorient health services towards the maximization of health gain. This chapter discusses strategies where public health professionals can play a potentially vital role in translating these opportunities into reality. It starts by looking at the needs assessment and priority-setting process to ensure that the health services provided reflect the health needs of the population that they serve. Following that, it reviews the design and organization of health services to enhance the efficiency with which services are delivered. It concludes by discussing the enablers (i.e. intelligent purchasing, a workforce with the appropriate capacity and capability, and a robust information and knowledge management system) that are necessary to implement, sustain, and enhance these services.

Expanding Neonatal Bloodspot Screening: A Multi-Stakeholder Perspective

Neonatal bloodspot screening (NBS) aims to detect treatable disorders in newborns. The number of conditions included in the screening is expanding through technological and therapeutic developments, which can result in health gain for more newborns. NBS expansion, however, also poses healthcare, ethical and societal challenges. This qualitative study explores a multi-stakeholders' perspective on current and future expansions of NBS. Semi-structured interviews were conducted with 22 Dutch professionals, including healthcare professionals, test developers and policy makers, and 17 parents of children with normal and abnormal NBS results. Addressed themes were (1) benefits and challenges of current expansion, (2) expectations regarding future developments, and (3) NBS acceptance and consent procedures. Overall, participants had a positive attitude toward NBS expansion, as long as it is aimed at detecting treatable disorders and achieving health gain. Concerns were raised regarding an increase in results of uncertain significance, diagnosing asymptomatic mothers, screening of subgroups (“males only”), finding untreatable disorders, along with increasingly complex consent procedures. Regarding the scope of future NBS expansions, two types of stakeholder perspectives emerged. Stakeholders with a “targeted-scope” perspective saw health gain for the neonate as the exclusive NBS aim. They thought pre-test information could be limited, and parents should be protected against too much options or information. Stakeholders with a “broad-scope” perspective thought the NBS aim should be formulated broader, for example, also taking (reproductive) life planning into account. They put more emphasis on individual preferences and parental autonomy. Policy-makers should engage with both perspectives when making further decisions about NBS.