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Jin H, Kolawole O, Wang Z. Cost-effectiveness analysis of physical activity interventions for people with schizophrenia or bipolar disorder: systematic review. Br J Psychiatry 2023; 223:362-376. [PMID: 37526007 PMCID: PMC10405045 DOI: 10.1192/bjp.2023.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/27/2023] [Accepted: 03/23/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Clinical guidelines recommend providing physical activity interventions (PAIs) to people with schizophrenia or bipolar disorder for weight management. However, the cost-effectiveness of PAIs is unknown. AIMS To evaluate the availability and methodological quality of economic evaluations of PAIs for people with schizophrenia or bipolar disorder. METHOD Four databases (MEDLINE, Embase, PsycInfo and Scopus) were searched on 5 July 2022. Based on the retrieved studies, forward and backward citation searches were conducted. Two reviewers independently selected studies for inclusion. Study quality was assessed using the Drummond checklist. Review results were presented using narrative synthesis. RESULTS Fourteen articles reporting nine studies were included. All included studies assessed PAIs within a multicomponent lifestyle intervention. Mixed findings were reported on the cost-effectiveness of multicomponent lifestyle intervention: three studies reported it as cost-effective; four studies reported it as not cost-effective; and two studies did not conclude whether it was cost-effective or not. Very limited evidence suggests that certain patient subgroups might be more likely to benefit from multicomponent lifestyle interventions with a PAI component: men; individuals with comorbid type 2 diabetes; and individuals who have been psychiatric hospital in-patients for ≥1 year. The quality of included studies ranged from moderate to high. CONCLUSIONS The current economic evidence suggests that not all modalities of multicomponent lifestyle intervention including a PAI component are cost-effective for people with schizophrenia or bipolar disorder; and not all people with schizophrenia or bipolar disorder would benefit equally from the intervention. Future research is urgently needed to identify the cost-effective modality of PAI for different patient subgroups.
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Affiliation(s)
- Huajie Jin
- King's Health Economics (KHE), Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Oluwafunso Kolawole
- King's Health Economics (KHE), Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Zhengwei Wang
- King's Health Economics (KHE), Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Burrows T, Teasdale S, Rocks T, Whatnall M, Schindlmayr J, Plain J, Roberton M, Latimer G, Harris D, Forsyth A. Cost effectiveness of dietary interventions for individuals with mental disorders: A scoping review of experimental studies. Nutr Diet 2021; 79:291-302. [PMID: 34510689 DOI: 10.1111/1747-0080.12703] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/12/2021] [Accepted: 08/17/2021] [Indexed: 11/28/2022]
Abstract
AIM This scoping review aimed to explore the extent of the evidence of experimental studies evaluating the cost effectiveness of dietary interventions in individuals with mental disorders. METHODS Five databases (CINAHL, EMBASE, MEDLINE, PsycINFO and Scopus) were searched to October 2020 for cost-analysis studies of interventions aiming to improve dietary intake in people with mental disorders. No restriction was placed on participant age, mental disorder type or intervention design. Results are presented narratively. RESULTS Of 2753 articles identified, 13 articles reporting on eight studies were included. Studies were RCTs (n = 5), cluster RCT (n = 1), cluster preference RCT (n = 1), and pre-post test (n = 1). Seven studies were in community settings (eg, outpatient clinics), and one study in the community housing setting. All studies were in adults, seven included male and female participants, and one included only females. Defined mental disorder diagnoses included serious/severe mental disorders (n = 3), major depression (n = 2), schizophrenia, schizoaffective disorder or first-episode psychosis (n = 1), any mental disorder (n = 1), and bulimia nervosa (n = 1). Five interventions were multi-behaviour, two were diet only and one was eating disorder treatment. Cost analyses included cost-utility (n = 3), cost-effectiveness (n = 1), cost-utility and cost-effectiveness (n = 3), and a costing study (n = 1). Two studies (25%) reported positive results in favour of cost effectiveness, and four studies reported a mix of positive and neutral results. CONCLUSIONS There is limited evidence evaluating the cost effectiveness of dietary interventions in individuals with mental disorders. Additional studies in various settings are needed to confirm cost effectiveness of different interventions.
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Affiliation(s)
- Tracy Burrows
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New South Wales, Australia
| | - Scott Teasdale
- School of Psychiatry, UNSW Sydney, Kensington, New South Wales, Australia
| | - Tetyana Rocks
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food and Mood Centre, Deakin University, Geelong, Victoria, Australia
| | - Megan Whatnall
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New South Wales, Australia
| | - Julia Schindlmayr
- Dietitians Australia, Deakin, Australian Capital Territory, Australia
| | - Janice Plain
- Macquarie Hospital, North Ryde, New South Wales, Australia
| | - Michelle Roberton
- Victorian Centre of Excellence in Eating Disorders, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Georgina Latimer
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University, Hawthorn, Victoria, Australia
| | - Deanne Harris
- Tamworth Rural Referral Hospital, Hunter New England Health, Tamworth, New South Wales, Australia
| | - Adrienne Forsyth
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
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Freeman MP, Goez-Mogollon L, Sosinsky AZ, Church TR, McElheny SA, Viguera AC, Cohen LS. The impact of obesity on pregnancy outcomes among women with psychiatric disorders: Results from a prospective pregnancy registry. J Psychosom Res 2019; 123:109735. [PMID: 31376871 DOI: 10.1016/j.jpsychores.2019.109735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 05/30/2019] [Accepted: 06/03/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Obesity is associated with an increased risk of adverse pregnancy outcomes. As individuals with psychiatric disorders are at a higher risk of obesity than the general population, we aimed to examine the effect of obesity on neonatal and maternal outcomes in this population. METHODS Pregnant women with psychiatric disorders were enrolled in the Massachusetts General Hospital National Pregnancy Registry for Psychiatric Medications (NCT01246765) and followed prospectively until 6 months postpartum. Pre-pregnancy body mass index was used to categorize participants as normal-weight, overweight, and obese to assess comparative risk of adverse outcomes. RESULTS Within our sample of 584 participants (N = 252 normal-weight; N = 170 overweight; N = 162 obese), obesity was not significantly associated with higher risk for birth defects (OR: 3.19; 95% CI:0.79,12.95; p = 0.10; unadjusted due to the rarity of this outcome in the sample). After adjustment, women with obesity were at higher risk for gestational diabetes (p = 0.011; OR:3.23; 95% CI:1.30,7.98), as were women in the overweight BMI category (p = 0.003; OR:3.77; 95% CI:1.58,9.00). Among women with obesity, there was a tendency for a higher C-section rate (p = 0.07) compared to women in the normal-weight BMI category. Other outcomes were not significantly different among groups. CONCLUSIONS Peripartum complications associated with obesity are common among women with psychiatric illness; thus, it is important to develop antenatal weight management interventions for this population.
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Affiliation(s)
- Marlene P Freeman
- Massachusetts General Hospital, Ammon-Pinizzotto Center for Women's Mental Health, 185 Cambridge Street, Suite 2200, Boston, MA 02114, USA.
| | - Lina Goez-Mogollon
- Massachusetts General Hospital, Ammon-Pinizzotto Center for Women's Mental Health, 185 Cambridge Street, Suite 2200, Boston, MA 02114, USA
| | - Alexandra Z Sosinsky
- Massachusetts General Hospital, Ammon-Pinizzotto Center for Women's Mental Health, 185 Cambridge Street, Suite 2200, Boston, MA 02114, USA
| | - Taylor R Church
- Massachusetts General Hospital, Ammon-Pinizzotto Center for Women's Mental Health, 185 Cambridge Street, Suite 2200, Boston, MA 02114, USA
| | - Sara A McElheny
- Massachusetts General Hospital, Ammon-Pinizzotto Center for Women's Mental Health, 185 Cambridge Street, Suite 2200, Boston, MA 02114, USA
| | - Adele C Viguera
- Massachusetts General Hospital, Ammon-Pinizzotto Center for Women's Mental Health, 185 Cambridge Street, Suite 2200, Boston, MA 02114, USA; Cleveland Clinic, Cleveland Clinic Neurological Institute, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Lee S Cohen
- Massachusetts General Hospital, Ammon-Pinizzotto Center for Women's Mental Health, 185 Cambridge Street, Suite 2200, Boston, MA 02114, USA
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Meenan RT, Stumbo SP, Yarborough MT, Leo MC, Yarborough BJ, Green CA. An Economic Evaluation of a Weight Loss Intervention Program for People with Serious Mental Illnesses Taking Antipsychotic Medications. Adm Policy Ment Health 2016; 43:604-15. [PMID: 26149243 DOI: 10.1007/s10488-015-0669-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Individuals with serious mental illnesses suffer from obesity and cardiometabolic diseases at high rates, and antipsychotic medications exacerbate these conditions. While studies have shown weight loss and lifestyle interventions can be effective in this population, few have assessed intervention cost-effectiveness. We present results from a 12-month randomized controlled trial that reduced weight, fasting glucose, and medical hospitalizations in intervention participants. Costs per participant ranged from $4365 to $5687. Costs to reduce weight by one kilogram ranged from $1623 to $2114; costs to reduce fasting glucose by 1 mg/dL ranged from $467 to $608. Medical hospitalization costs were reduced by $137,500.
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Pratt SI, Jerome GJ, Schneider KL, Craft LL, Buman MP, Stoutenberg M, Daumit GL, Bartels SJ, Goodrich DE. Increasing US health plan coverage for exercise programming in community mental health settings for people with serious mental illness: a position statement from the Society of Behavior Medicine and the American College of Sports Medicine. Transl Behav Med 2017; 6:478-81. [PMID: 27146275 DOI: 10.1007/s13142-016-0407-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Adults with serious mental illness die more than 10 years earlier than the average American. Premature mortality is due to the high prevalence of preventable diseases including cardiovascular disease and diabetes. Poor lifestyle behaviors including lack of exercise and physical inactivity contribute to the epidemic levels of obesity, diabetes, and cardiovascular disease observed among adults with serious mental illness. Not surprisingly, people with serious mental illness are among the most costly consumers of health services due to increased visits for poorly managed mental and physical health. Recent studies have demonstrated that exercise interventions based on community mental health settings can significantly improve physical and mental health in people with serious mental illness. However, current funding regulations limit the ability of community mental health settings to offer exercise programming services to people with serious mental illness. Policy efforts are needed to improve the dissemination and sustainability of exercise programs for people with serious mental illness.
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Affiliation(s)
- Sarah I Pratt
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, 105 Pleasant Street, Main Building, Dartmouth College, Concord, NH, 03301, USA.
| | - Gerald J Jerome
- Department of Kinesiology, Towson University, Towson, MD, USA.,Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Matthew P Buman
- School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ, USA
| | - Mark Stoutenberg
- American College of Sports Medicine, Indianapolis, IN, USA.,Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - Gail L Daumit
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephen J Bartels
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, 105 Pleasant Street, Main Building, Dartmouth College, Concord, NH, 03301, USA
| | - David E Goodrich
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, 48105, USA
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Janssen EM, Jerome GJ, Dalcin AT, Gennusa JV, Goldsholl S, Frick KD, Wang NY, Appel LJ, Daumit GL. A cost analysis of implementing a behavioral weight loss intervention in community mental health settings: Results from the ACHIEVE trial. Obesity (Silver Spring) 2017; 25:1006-1013. [PMID: 28398006 PMCID: PMC5445002 DOI: 10.1002/oby.21836] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 03/01/2017] [Accepted: 03/08/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE In the ACHIEVE randomized controlled trial, an 18-month behavioral intervention accomplished weight loss in persons with serious mental illness who attended community psychiatric rehabilitation programs. This analysis estimates costs for delivering the intervention during the study. It also estimates expected costs to implement the intervention more widely in a range of community mental health programs. METHODS Using empirical data, costs were calculated from the perspective of a community psychiatric rehabilitation program delivering the intervention. Personnel and travel costs were calculated using time sheet data. Rent and supply costs were calculated using rent per square foot and intervention records. A univariate sensitivity analysis and an expert-informed sensitivity analysis were conducted. RESULTS With 144 participants receiving the intervention and a mean weight loss of 3.4 kg, costs of $95 per participant per month and $501 per kilogram lost in the trial were calculated. In univariate sensitivity analysis, costs ranged from $402 to $725 per kilogram lost. Through expert-informed sensitivity analysis, it was estimated that rehabilitation programs could implement the intervention for $68 to $85 per client per month. CONCLUSIONS Costs of implementing the ACHIEVE intervention were in the range of other intensive behavioral weight loss interventions. Wider implementation of efficacious lifestyle interventions in community mental health settings will require adequate funding mechanisms.
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Affiliation(s)
- Ellen M. Janssen
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Gerald J. Jerome
- Towson University, Department of Kinesiology, Baltimore, Maryland, USA
- Johns Hopkins University School of Medicine, Division of General Internal Medicine, Baltimore, Maryland, USA
| | - Arlene T Dalcin
- Johns Hopkins University School of Medicine, Division of General Internal Medicine, Baltimore, Maryland, USA
- Johns Hopkins University, Welch Center for Prevention, Epidemiology, and Clinical Research Baltimore, Maryland, USA
| | - Joseph V. Gennusa
- Johns Hopkins University School of Medicine, Division of General Internal Medicine, Baltimore, Maryland, USA
| | - Stacy Goldsholl
- Johns Hopkins University School of Medicine, Division of General Internal Medicine, Baltimore, Maryland, USA
| | - Kevin D. Frick
- Johns Hopkins Carey Business School, Baltimore, Maryland, USA
| | - Nae-Yuh Wang
- Johns Hopkins University School of Medicine, Division of General Internal Medicine, Baltimore, Maryland, USA
- Johns Hopkins University, Welch Center for Prevention, Epidemiology, and Clinical Research Baltimore, Maryland, USA
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lawrence J. Appel
- Johns Hopkins University School of Medicine, Division of General Internal Medicine, Baltimore, Maryland, USA
- Johns Hopkins University, Welch Center for Prevention, Epidemiology, and Clinical Research Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Gail L. Daumit
- Johns Hopkins University School of Medicine, Division of General Internal Medicine, Baltimore, Maryland, USA
- Johns Hopkins University, Welch Center for Prevention, Epidemiology, and Clinical Research Baltimore, Maryland, USA
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Bhardwaj NN, Wodajo B, Gochipathala K, Paul DP, Coustasse A. Can mHealth Revolutionize the Way We Manage Adult Obesity? Perspect Health Inf Manag 2017; 14:1a. [PMID: 28566984 PMCID: PMC5430129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Obesity is the largest driver of chronic preventable diseases, accounting for an estimated $147 billion or 10 percent of total US healthcare costs in 2008. It has been forecasted that 42 percent of Americans will be obese by 2030. Mobile health (mHealth) technologies target and may modify the behavioral factors that lead to obesity to promote a healthy lifestyle. These technologies could potentially reduce the cost and the morbidity and mortality burden of obesity because of their inexpensive and portable nature. This study aimed to analyze the efficacy and cost-effectiveness of mHealth interventions for adult obesity in the United States. The methodology used in this study was a literature review of 54 articles. Weight, body mass index (BMI), waist circumference reductions, and favorable lifestyle behavior changes were noted across most studies. Existing data and research on efficacy and linked costs indicated that mHealth technologies were more effective than other methods and could be inexpensively delivered remotely to manage adult obesity, offering significant benefits over conventional care. Further studies on the costs and benefits of adapting such mHealth interventions in clinical settings are needed.
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