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Tetzlaff B, Scherer M, Balzer K, Steyer L, Köpke S, Friede T, Maurer I, Weber CE, König HH, Konnopka A, Ruppel T, Mazur A, Hummers E, Mueller CA. Development of an interprofessional person-centred care concept for persons with care needs living in their own homes ( interprof HOME): study protocol for a mixed-methods study. BMJ Open 2023; 13:e069597. [PMID: 37451715 PMCID: PMC10351233 DOI: 10.1136/bmjopen-2022-069597] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 06/29/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION People receiving home care usually have complex healthcare needs requiring the involvement of informal caregivers and various health professionals. In this context, successful collaboration is an important element of person-centred care, which is often insufficiently implemented. Consequences might be found in avoidable hospitalisations. The aim of the study is to develop a care concept to improve person-centred interprofessional collaboration for people receiving home care considering the perspectives of all person groups involved. METHODS AND ANALYSIS This study uses a mixed-methods design consisting of a literature review, several qualitative inquiries, a cross-sectional quantitative study and a final structured workshop. After a literature review (work package (WP) 1), we will explore the perspectives of people receiving home care (n=20), their relatives (n=20) and representatives of statutory health insurances (n=5) in semistructured interviews (WP2). Moreover, 100 individuals of each group (people receiving home care, relatives, registered nurses, general practitioners and therapists) involved in home care will answer a survey on collaboration that will be analysed descriptively (WP3). Additionally, monoprofessional focus groups (n=9) of registered nurses, general practitioners and therapists, respectively, will discuss current practices. Data will be analysed by qualitative content analysis. Best practice cases (n=8) will be analysed by a case-based qualitative content analysis based on data of observations of home visits and interviews (WP4). The findings of WP2 will be discussed in mixed focus groups (n=4) with 10 participants each (WP5). Considering the results of joint displays of WP3, WP4 and WP5, the interprofessional care concept and its implementation will be elaborated in an expert workshop (WP6). ETHICS AND DISSEMINATION Ethical approval was obtained from all ethics committees of the project partners. Study results will be disseminated through publications, conference presentations, student education and advanced training of health professionals. TRIAL REGISTRATION NUMBER NCT05149937.
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Affiliation(s)
- Britta Tetzlaff
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katrin Balzer
- Institute for Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Lübeck, Germany
| | - Linda Steyer
- Institute for Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Lübeck, Germany
| | - Sascha Köpke
- Institute of Nursing Science, Medical Faculty & University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Indre Maurer
- Chair of Organization and Corporate Development, Faculty of Business and Economics, Georg-August-University Göttingen, Göttingen, Germany
| | - Clarissa E Weber
- Chair of Organization and Corporate Development, Faculty of Business and Economics, Georg-August-University Göttingen, Göttingen, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Konnopka
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Ruppel
- Kanzlei für Medizinrecht und Gesundheitsrecht Dr. Dr. Thomas Ruppel, Lübeck, Germany
| | - Ana Mazur
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
| | - Eva Hummers
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
| | - Christiane A Mueller
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
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Pokhilenko I, Kast T, Janssen LMM, Evers SMAA, Paulus ATG, Simon J, Mayer S, Berger M, Konnopka A, Muntendorf L, Brodszky V, García-Pérez L, Park A, Salvador-Carulla L, Drost RMWA. International comparability of reference unit costs of education services: when harmonizing methodology is not enough (PECUNIA project). Expert Rev Pharmacoecon Outcomes Res 2023; 23:135-141. [PMID: 36472303 DOI: 10.1080/14737167.2023.2152331] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Health problems can lead to costs in the education sector. However, these costs are rarely incorporated in health economic evaluations due to the lack of reference unit costs (RUCs), cost per unit of service, of education services and of validated methods to obtain them. In this study, a standardized unit cost calculation tool developed in the PECUNIA project, the PECUNIA RUC Template for services, was applied to calculate the RUCs of selected education services in five European countries. METHODS The RUCs of special education services and of educational therapy were calculated using the information collected via an exploratory gray literature search and contact with service providers. RESULTS The RUCs of special education services ranged from €55 to €189 per school day. The RUCs of educational therapy ranged from €6 to €25 per contact and from €5 to €35 per day. Variation was observed in the type of input data and measurement unit, among other. DISCUSSION The tool helped reduce variability in the RUCs related to costing methodology and gain insights into other aspects that contribute to the variability (e.g. data availability). Further research and efforts to generate high quality input data are required to reduce the variability of the RUCs.
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Affiliation(s)
- I Pokhilenko
- Centre for Economics of Obesity, Health Economics Unit, Institute of Applied Health Research, College of Dental and Medical Sciences, University of Birmingham, Birmingham, The United Kingdom
| | - T Kast
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - L M M Janssen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - S M A A Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands.,Centre of Economic Evaluation & Machine Learning, Trimbos Institute, National Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - A T G Paulus
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands.,School of Health Professions Education, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - J Simon
- Department of Health Economics, Centre for Public Health, Medical University of Vienna, Vienna, Austria.,Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - S Mayer
- Department of Health Economics, Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - M Berger
- Department of Health Economics, Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - A Konnopka
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - L Muntendorf
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - V Brodszky
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - L García-Pérez
- Servicio de Evaluación, Servicio Canario de la Salud (SESCS), Santa Cruz de Tenerife, Spain
| | - A Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - L Salvador-Carulla
- Mental Health Policy Unit, Health Research Institute, University of Canberra, Canberra, Australia
| | - R M W A Drost
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
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Simon J, Konnopka A, Brodszky V, Evers S, Hakkaart-van Roijen L, Serrano-Pérez P, vador-Carulla LSAL, Park AL, Hollingworth W. (Pharmaco)economic evaluations for mental health related services: the PECUNIA project. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Mental health disorders affect large proportions of the general public resulting in serious cost consequences even beyond the health care sector. The PECUNIA project (EU H2020 grant agreement No 779292) aims to establish standardised costing and outcome assessment measures for optimised healthcare provision in the EU for multi-sectoral, multi-national and multi-person (pharmaco)economic evaluations using selected mental health disorders as illustrative examples.
Methods
Harmonised Identification, Definition, Measurement and Valuation of service costs in multiple sectors (health care, social care, criminal justice, education, productivity, patient, family). Reviews and surveys of mental health related services and other resource use in six European countries (AT, DE, ES, HU, NL, UK) to develop a new harmonised costing concept and related tools.
Results
We identified many taxonomical and conceptual discrepancies which currently hinder harmonized costing efforts and comparability of economic evaluations/HTAs across countries and sectors. The 'PECUNIA care atom', a new multi-sectoral costing concept forms the basis of resource item classification and international coding of mental health related services using the DESDE-PECUNIA system. Linked, harmonized tools such as the PECUNIA-European Resource Use Measurement instrument and the PECUNIA-European Reference Unit Costing Templates have been developed and are currently deployed in six countries to establish a PECUNIA-European Unit Cost Compendium alongside pan-European outcome evaluation methods.
Conclusions
The PECUNIA tools will lead to better understanding of the variations in costs and outcomes of mental health services/interventions within and across countries, and improve the feasibility, quality, comparability and transferability of (pharmaco)economic evaluations and HTAs in Europe. They also allow the harmonized measurement of broader economic and societal impacts of mental health services.
Key messages
The PECUNIA project developed compatible European multi-sectoral, multi-national and multi-person costing and outcome assessment tools. Methods & tools allow the harmonised measurement of broader economic & societal impacts of mental health related services, and improve the transferability & comparability of economic evaluations/HTAs.
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Affiliation(s)
- J Simon
- Department of Health Economics, Medical University of Vienna, Vienna, Austria
| | - A Konnopka
- Zentrum für Psychosoziale Medizin, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - V Brodszky
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - S Evers
- Department of Health Services Research, Maastricht University, Maastricht, Netherlands
| | - L Hakkaart-van Roijen
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - P Serrano-Pérez
- Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - L S a l vador-Carulla
- Centre for Mental Health Research, Australian National University, ANU College of Health and Medicine, Sydeny, Australia
| | - A L Park
- Department of Health Policy, London School of Economics, London, UK
| | - W Hollingworth
- Department of Population Health Sciences, University of Bristol, Bristol, UK
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Egger N, Wild B, Zipfel S, Junne F, Konnopka A, Schmidt U, de Zwaan M, Herpertz S, Zeeck A, Löwe B, von Wietersheim J, Tagay S, Burgmer M, Dinkel A, Herzog W, König HH. Cost-effectiveness of focal psychodynamic therapy and enhanced cognitive-behavioural therapy in out-patients with anorexia nervosa. Psychol Med 2016; 46:3291-3301. [PMID: 27609525 DOI: 10.1017/s0033291716002002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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] [Indexed: 11/05/2022]
Abstract
BACKGROUND Anorexia nervosa (AN) is a serious illness leading to substantial morbidity and mortality. The treatment of AN very often is protracted; repeated hospitalizations and lost productivity generate substantial economic costs in the health care system. Therefore, this study aimed to determine the differential cost-effectiveness of out-patient focal psychodynamic psychotherapy (FPT), enhanced cognitive-behavioural therapy (CBT-E), and optimized treatment as usual (TAU-O) in the treatment of adult women with AN. METHOD The analysis was conducted alongside the randomized controlled Anorexia Nervosa Treatment of OutPatients (ANTOP) study. Cost-effectiveness was determined using direct costs per recovery at 22 months post-randomization (n = 156). Unadjusted incremental cost-effectiveness ratios (ICERs) were calculated. To derive cost-effectiveness acceptability curves (CEACs) adjusted net-benefit regressions were applied assuming different values for the maximum willingness to pay (WTP) per additional recovery. Cost-utility and assumptions underlying the base case were investigated in exploratory analyses. RESULTS Costs of in-patient treatment and the percentage of patients who required in-patient treatment were considerably lower in both intervention groups. The unadjusted ICERs indicated FPT and CBT-E to be dominant compared with TAU-O. Moreover, FPT was dominant compared with CBT-E. CEACs showed that the probability for cost-effectiveness of FTP compared with TAU-O and CBT-E was ⩾95% if the WTP per recovery was ⩾€9825 and ⩾€24 550, respectively. Comparing CBT-E with TAU-O, the probability of being cost-effective remained <90% for all WTPs. The exploratory analyses showed similar but less pronounced trends. CONCLUSIONS Depending on the WTP, FPT proved cost-effective in the treatment of adult AN.
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Affiliation(s)
- N Egger
- Department of Health Economics and Health Services Research,Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf,Hamburg,Germany
| | - B Wild
- Department of General Internal Medicine and Psychosomatics,Heidelberg University Hospital,Heidelberg,Germany
| | - S Zipfel
- Department of Psychosomatic Medicine and Psychotherapy,University Hospital Tübingen,Tübingen,Germany
| | - F Junne
- Department of Psychosomatic Medicine and Psychotherapy,University Hospital Tübingen,Tübingen,Germany
| | - A Konnopka
- Department of Health Economics and Health Services Research,Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf,Hamburg,Germany
| | - U Schmidt
- Section of Eating Disorders,Department of Psychological Medicine,King's College London,London,UK
| | - M de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy,Hannover Medical School,Hannover,Germany
| | - S Herpertz
- Department of Psychosomatic Medicine and Psychotherapy,LWL-University Clinic Bochum, Ruhr-University Bochum,Bochum,Germany
| | - A Zeeck
- Department of Psychosomatic Medicine and Psychotherapy,University Hospital Freiburg,Freiburg,Germany
| | - B Löwe
- Department of Psychosomatic Medicine and Psychotherapy,University Medical Center Hamburg-Eppendorf, and Schön Klinik Hamburg-Eilbek,Hamburg,Germany
| | - J von Wietersheim
- Department of Psychosomatic Medicine and Psychotherapy,University Hospital of Ulm,Ulm,Germany
| | - S Tagay
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR Hospital Essen, University of Duisburg-Essen,Essen,Germany
| | - M Burgmer
- Department of Psychosomatics and Psychotherapy,University Hospital Münster,Münster,Germany
| | - A Dinkel
- Department of Psychosomatic Medicine and Psychotherapy,Klinikum rechts der Isar, Technische Universität München,Munich,Germany
| | - W Herzog
- Department of General Internal Medicine and Psychosomatics,Heidelberg University Hospital,Heidelberg,Germany
| | - H-H König
- Department of Health Economics and Health Services Research,Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf,Hamburg,Germany
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Sonntag D, Ali S, Lehnert T, Konnopka A, Riedel-Heller S, König HH. Estimating the lifetime cost of childhood obesity in Germany: Results of a Markov Model. Pediatr Obes 2015; 10:416-22. [PMID: 25612250 DOI: 10.1111/ijpo.278] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [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: 03/14/2014] [Revised: 06/28/2014] [Accepted: 10/26/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Child obesity is a growing public health concern. Excess weight in childhood is known to be associated with a high risk of obesity and obesity-related comorbidities in adulthood. OBJECTIVES This study quantifies lifetime excess costs of overweight and obese adults in Germany taking the history of obesity in childhood into account. METHODS A two-stage Markov cohort state transition model was developed. At stage 1, the distribution of body mass index (BMI) categories was tracked from childhood (ages 3-17) to adulthood (age 17 and up). Based on these results, it was distinguished whether adults had been normal in weight or overweight/obese as child. At stage 2, age-specific and lifetime costs from age 18 onwards were simulated in two further Markov cohort models, one for each of the two BMI groups. Model parameter values were obtained from the German Interview and Examination Survey for Children and Adolescents (KiGGS), the German Microcensus 2009 and published literature. RESULTS When compared with normal weight adults, lifetime excess costs are higher among adults who had been overweight or obese at any point during childhood. For 18-year-old women (men), who have been overweight/obese during their childhood (ages 3-17), undiscounted lifetime excess costs are estimated at €19,479 (€14,524), with 60% (67%) occurring beyond age 60. Discounted (3%) lifetime excess costs are considerably lower, amounting to €4262 for men and €7028 for women. CONCLUSIONS Because childhood obesity determines healthcare costs occurring in adulthood, interventions preventing the persistence of child obesity and obesity-related comorbidities during adulthood could have a substantial impact on reducing the burden of the obesity epidemic.
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Affiliation(s)
- D Sonntag
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics (HCHE), Hamburg, Germany.,IFB Adiposity Diseases, University Medical Center Leipzig, Leipzig, Germany.,Mannheim Institute of Public Health, Social and Preventive Medicine, University Medicine Mannheim, Heidelberg University, Mannheim, Germany
| | - S Ali
- Department of Health Sciences and Centre for Health Economics, University of York, York, UK
| | - T Lehnert
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics (HCHE), Hamburg, Germany.,IFB Adiposity Diseases, University Medical Center Leipzig, Leipzig, Germany
| | - A Konnopka
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics (HCHE), Hamburg, Germany
| | - S Riedel-Heller
- IFB Adiposity Diseases, University Medical Center Leipzig, Leipzig, Germany.,Department of Social Medicine, Occupational Medicine and Public Health, University of Leipzig, Leipzig, Germany
| | - H-H König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics (HCHE), Hamburg, Germany.,IFB Adiposity Diseases, University Medical Center Leipzig, Leipzig, Germany
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Löbner M, Luppa M, Konnopka A, König HH, Günther L, Meixensberger J, Meisel HJ, Stengler K, Riedel-Heller SG. Soziale Unterstützung und Lebensqualität im Rehabilitationsprozess in der Mitteldeutschen Bandscheibenkohorte. Gesundheitswesen 2014. [DOI: 10.1055/s-0034-1386953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Karow A, Bock T, Naber D, Löwe B, Schulte-Markwort M, Schäfer I, Gumz A, Degkwitz P, Schulte B, König HH, Konnopka A, Bauer M, Bechdolf A, Correll C, Juckel G, Klosterkötter J, Leopold K, Pfennig A, Lambert M. [Mental health of children, adolescents and young adults--part 2: burden of illness, deficits of the German health care system and efficacy and effectiveness of early intervention services]. Fortschr Neurol Psychiatr 2013; 81:628-38. [PMID: 24194056 DOI: 10.1055/s-0033-1355840] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Numerous birth-control studies, epidemiological studies, and observational studies investigated mental health and health care in childhood, adolescence and early adulthood, including prevalence, age at onset, adversities, illness persistence, service use, treatment delay and course of illness. Moreover, the impact of the burden of illness, of deficits of present health care systems, and the efficacy and effectiveness of early intervention services on mental health were evaluated. According to these data, most mental disorders start during childhood, adolescence and early adulthood. Many children, adolescents and young adults are exposed to single or multiple adversities, which increase the risk for (early) manifestations of mental diseases as well as for their chronicity. Early-onset mental disorders often persist into adulthood. Service use of children, adolescents and young adults is low, even lower than in adult patients. Moreover, there is often a long delay between onset of illness and first adequate treatment with a variety of linked consequences for poorer psychosocial prognosis. This leads to a large burden of illness with respect to disability and costs. As a consequence several countries have implemented so-called "early intervention services" at the border of child and adolescent and adult psychiatry. Emerging studies show that these health care structures are effective and efficient. Part 2 of the present review focuses on illness burden including disability and costs, deficits of the present health care system in Germany, and efficacy and efficiency of early intervention services.
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Affiliation(s)
- A Karow
- Arbeitsbereich Psychosen, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf (UKE)
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Lambert M, Bock T, Naber D, Löwe B, Schulte-Markwort M, Schäfer I, Gumz A, Degkwitz P, Schulte B, König HH, Konnopka A, Bauer M, Bechdolf A, Correll C, Juckel G, Klosterkötter J, Leopold K, Pfennig A, Karow A. [Mental health of children, adolescents and young adults--part 1: prevalence, illness persistence, adversities, service use, treatment delay and consequences]. Fortschr Neurol Psychiatr 2013; 81:614-27. [PMID: 24194055 DOI: 10.1055/s-0033-1355843] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Numerous birth-control studies, epidemiological studies, and observational studies have investigated mental health and health care in childhood, adolescence and early adulthood, including prevalence, age at onset, adversities, illness persistence, service use, treatment delay and course of illness. Moreover, the impact of the burden of illness, of deficits of present health care systems, and the efficacy and effectiveness of early intervention services on mental health were evaluated. According to these data, most mental disorders start during childhood, adolescence and early adulthood. Many children, adolescents and young adults are exposed to single or multiple adversities, which increase the risk for (early) manifestations of mental diseases as well as for their chronicity. Early-onset mental disorders often persist into adulthood. Service use by children, adolescents and young adults is low, even lower than for adult patients. Moreover, there is often a long delay between onset of illness and first adequate treatment with a variety of linked consequences for a poorer psychosocial prognosis. This leads to a large burden of illness with respect to disability and costs. As a consequence several countries have implemented so-called "early intervention services" at the interface of child and adolescent and adult psychiatry. Emerging studies show that these health-care structures are effective and efficient. Part 1 of the present review summarises the current state of mental health in childhood, adolescence and early adulthood, including prevalence, age at onset, adversities, illness persistence, service use, and treatment delay with consequences.
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Affiliation(s)
- M Lambert
- Arbeitsbereich Psychosen, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf (UKE)
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9
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Singer S, Szalai C, Briest S, Brown A, Dietz A, Einenkel J, Jonas S, Konnopka A, Papsdorf K, Langanke D, Löbner M, Schiefke F, Stolzenburg JU, Weimann A, Wirtz H, König HH, Riedel-Heller S. Co-morbid mental health conditions in cancer patients at working age--prevalence, risk profiles, and care uptake. Psychooncology 2013; 22:2291-7. [PMID: 23494948 DOI: 10.1002/pon.3282] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 02/16/2013] [Accepted: 02/18/2013] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study examined the prevalence of mental health conditions in cancer patients, the role of socioeconomic position in relation to that, and the use of professional mental health care. METHODS Prospective cohort with measurements at the beginning of inpatient treatment (baseline) and 3, 9, and 15 months after baseline using structured clinical interviews based on DSM-IV, questionnaires, and medical records. RESULTS At baseline, 149 out of 502 cancer patients (30%) were diagnosed with a mental health condition. Prevalence was associated with unemployment (odds ratio [OR] 2.0), fatigue (OR 1.9), and pain (OR 1.7). Of those with mental health conditions, 9% saw a psychotherapist within 3 months of the diagnosis, 19% after 9 months, and 11% after 15 months. Mental health care use was higher in patients with children ≤18 years (OR 3.3) and somatic co-morbidity (OR 2.6). There was no evidence for an effect of sex on the use of mental health care. CONCLUSION Few cancer patients with psychiatric disorders receive professional mental health care early enough. If patients are unemployed or if they suffer from fatigue or pain, special attention should be paid because the risk of having a mental health condition is increased in these patients.
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Affiliation(s)
- S Singer
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre, Johannes Gutenberg University, Mainz, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
- Division of Psychosocial Oncology, University of Leipzig, Leipzig, Germany
| | - C Szalai
- Division of Psychosocial Oncology, University of Leipzig, Leipzig, Germany
| | - S Briest
- Breast Cancer Centre, University of Leipzig, Leipzig, Germany
| | - A Brown
- Cancer Epidemiology Unit, University of Oxford, Oxford, UK
| | - A Dietz
- Department of Otolaryngology, University of Leipzig, Leipzig, Germany
| | - J Einenkel
- Department of Obstetrics and Gynecology, University of Leipzig, Leipzig, Germany
| | - S Jonas
- Department of Surgery, University of Leipzig, Leipzig, Germany
| | - A Konnopka
- Department of Medical Sociology and Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K Papsdorf
- Department of Radiation-Oncology, University of Leipzig, Leipzig, Germany
| | - D Langanke
- Breast Cancer Centre, Hospital St. Elisabeth, Leipzig, Germany
| | - M Löbner
- Department of Social Medicine, Occupational Health, and Public Health, University of Leipzig, Leipzig, Germany
| | - F Schiefke
- Department of Maxillofacial Surgery, University of Leipzig, Leipzig, Germany
| | - J-U Stolzenburg
- Department of Urology, University of Leipzig, Leipzig, Germany
| | - A Weimann
- Cancer Centre, Hospital St. Georg, Leipzig, Germany
| | - H Wirtz
- Department of Pulmonology, University of Leipzig, Leipzig, Germany
| | - H H König
- Department of Medical Sociology and Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Riedel-Heller
- Department of Social Medicine, Occupational Health, and Public Health, University of Leipzig, Leipzig, Germany
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Bleibler F, Konnopka A, Benzinger P, Rapp K, König HH. The health burden and costs of incident fractures attributable to osteoporosis from 2010 to 2050 in Germany--a demographic simulation model. Osteoporos Int 2013; 24:835-47. [PMID: 22797490 DOI: 10.1007/s00198-012-2020-z] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 05/01/2012] [Indexed: 10/28/2022]
Abstract
UNLABELLED To predict the burden of incident osteoporosis attributable fractures (OAF) in Germany, an economic simulation model was built. The burden of OAF will sharply increase until 2050. Future demand for hospital and long-term care can be expected to substantially rise and should be considered in future healthcare planning. INTRODUCTION The aim of this study was to develop an innovative simulation model to predict the burden of incident OAF occurring in the German population, aged >50, in the time period of 2010 to 2050. METHODS A Markov state transition model based on five fracture states was developed to estimate costs and loss of quality adjusted life years (QALYs). Demographic change was modelled using individual generation life tables. Direct (inpatient, outpatient, long-term care) and indirect fracture costs attributable to osteoporosis were estimated by comparing Markov cohorts with and without osteoporosis. RESULTS The number of OAF will rise from 115,248 in 2010 to 273,794 in 2050, cumulating to approximately 8.1 million fractures (78 % women, 22 % men) during the period between 2010 and 2050. Total undiscounted incident OAF costs will increase from around 1.0 billion Euros in 2010 to 6.1 billion Euros in 2050. Discounted (3 %) cumulated costs from 2010 to 2050 will amount to 88.5 billion Euros (168.5 undiscounted), with 76 % being direct and 24 % indirect costs. The discounted (undiscounted) cumulated loss of QALYs will amount to 2.5 (4.9) million. CONCLUSIONS We found that incident OAF costs will sharply increase until the year 2050. As a consequence, a growing demand for long-term care as well as hospital care can be expected and should be considered in future healthcare planning. To support decision makers in managing the future burden of OAF, our model allows to economically evaluate population- and risk group-based interventions for fracture prevention in Germany.
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Affiliation(s)
- F Bleibler
- Department for Medical Sociology and Health Economics, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr 52, 20246 Hamburg, Germany.
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Löbner M, Luppa M, Konnopka A, König HH, Riedel-Heller SG. Ambulant oder stationär? – Erwartungen, Motivationen und subjektive Beweggründe für die Wahl des Rehabilitationssettings. Dtsch Med Wochenschr 2012. [DOI: 10.1055/s-0032-1323361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Löbner M, Luppa M, Matschinger H, Konnopka A, König HH, Riedel-Heller SG. The course of depression and anxiety in patients undergoing disc surgery. Dtsch Med Wochenschr 2012. [DOI: 10.1055/s-0032-1323359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Löbner M, Luppa M, Konnopka A, König HH, Riedel-Heller SG. Rehabilitationspräferenz, Rehabilitationsteilnahme und Rehabilitationsergebnis in Abhängigkeit vom Rehabilitationssetting bei der mitteldeutschen Bandscheibenkohorte. Dtsch Med Wochenschr 2012. [DOI: 10.1055/s-0032-1323360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Luppa M, Sikorski C, Motzek T, Konnopka A, König HH, Riedel-Heller SG. Health Service Utilization and Costs of Depression in Late Life – A Systematic Review. Dtsch Med Wochenschr 2012. [DOI: 10.1055/s-0032-1323368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Löbner M, Luppa M, Konnopka A, König HH, Günther L, Meixensberger J, Meisel HJ, Riedel-Heller SG. Ambulant oder stationär? - Erwartungen, Motivationen und subjektive Beweggründe für die Wahl des Rehabilitationssettings. Gesundheitswesen 2012. [DOI: 10.1055/s-0032-1322053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Luppa M, Sikorski C, Motzek T, Konnopka A, König HH, Riedel-Heller SG. Health Service Utilization and Costs of Depression in Late Life - A Systematic Review. Gesundheitswesen 2012. [DOI: 10.1055/s-0032-1322056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
In the past decades medical progress in the treatment of fatal diseases has led to substantial improvement of survival. This long-term survival has financial consequences for health care and society. In this article methodological challenges of measuring the costs of long-term survival are presented. In this regard the costs of long-term treatment, indirect costs, unrelated future health care costs and discounting of costs are highlighted and illustrated by examples. A methodological challenge related to the economic evaluation of therapies leading to long-term survival is the consideration of unrelated future health care costs occurring in life years gained. In the literature the issue of unrelated future health care costs is discussed comprehensively on a methodological-theoretical basis. In economic evaluations published in the literature, these costs have rarely been considered so far, which may cause biased results. Concerning the comparability of study results, a standardization of the methods of measuring costs is desirable.
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Affiliation(s)
- C Brettschneider
- Institut für Medizinische Soziologie, Sozialmedizin und Gesundheitsökonomie, Hamburg Center for Health Economics, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
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Löbner M, Luppa M, Konnopka A, König HH, Günther L, Meixensberger J, Meisel HJ, Riedel-Heller SG. Rehabilitationspräferenz, Rehabilitationsteilnahme und Rehabilitationsergebnis in Abhängigkeit vom Rehabilitationssetting bei der mitteldeutschen Bandscheibenkohorte. Gesundheitswesen 2012. [DOI: 10.1055/s-0032-1322054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Löbner M, Luppa M, Matschinger H, Konnopka A, König HH, Günther L, Meixensberger J, Meisel HJ, Riedel-Heller SG. The course of depression and anxiety in patients undergoing disc surgery. Gesundheitswesen 2012. [DOI: 10.1055/s-0032-1322055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
Obesity prevention provides a major opportunity to improve population health. As health improvements usually require additional and scarce resources, novel health technologies (interventions) should be economically evaluated. In the prevention of obesity, health benefits may slowly accumulate over time and it can take many years before an intervention has reached full effectiveness. Decision-analytic simulation models (DAMs), which combine evidence from diverse sources, can be utilized to evaluate the long-term cost-effectiveness of such interventions. This literature review summarizes long-term economic findings (defined as ≥ 40 years) for 41 obesity prevention interventions, which had been evaluated in 18 cost-utility analyses, using nine different DAMs. Interventions were grouped according to their method of delivery, setting and risk factors targeted into behavioural (n=21), community (n=12) and environmental interventions (n=8). The majority of interventions offered good value for money, while seven were cost-saving. Ten interventions were not cost-effective (defined as >50,000 US dollar), however. Interventions that modified a target population's environment, i.e. fiscal and regulatory measures, reported the most favourable cost-effectiveness. Economic findings were accompanied by a large uncertainty though, which complicates judgments about the comparative cost-effectiveness of interventions.
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Affiliation(s)
- T Lehnert
- Department for Medical Sociology and Health Economics, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Luppa M, Sikorski C, Luck T, Ehreke L, Konnopka A, Wiese B, Weyerer S, König HH, Riedel-Heller SG. Age- and gender-specific prevalence of depression in latest-life--systematic review and meta-analysis. J Affect Disord 2012; 136:212-21. [PMID: 21194754 DOI: 10.1016/j.jad.2010.11.033] [Citation(s) in RCA: 484] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 11/09/2010] [Accepted: 11/30/2010] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The objective of the study is to systematically analyze the prevalence of depression in latest life (75+), particularly focusing on age- and gender-specific rates across the latest-life age groups. DESIGN Relevant articles were identified by systematically searching the databases MEDLINE, Web of Science, Cochrane Library and Psycinfo and relevant literature from 1999 onwards was reviewed. Studies based on the community-based elderly population aged 75 years and older were included. Quality of studies was assessed. Meta-analysis was performed using random effects model. RESULTS 24 studies reporting age- and gender-specific prevalence of depression were found. 13 studies had a high to moderate methodical quality. The prevalence of major depression ranged from 4.6% to 9.3%, and that of depressive disorders from 4.5% to 37.4%. Pooled prevalence was 7.2% (95% CI 4.4-10.6%) for major depression and 17.1% (95% CI 9.7-26.1%) for depressive disorders. Potential sources of high heterogeneity of prevalence were study design, sampling strategy, study quality and applied diagnostics of latest life depression. CONCLUSIONS Despite the wide variation in estimates, it is evident that latest life depression is common. To reduce variability of study results, particularly sampling strategies (inclusion of nursing home residents and severe cognitively impaired individuals) for the old age study populations should be addressed more thoroughly in future research.
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Affiliation(s)
- M Luppa
- Institute of Social Medicine, Occupational Health and Public Health, Public Health Research Unit, University of Leipzig, Leipzig, Germany.
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Konnopka A, Bödemann M, König HH. Health burden and costs of obesity and overweight in Germany. Eur J Health Econ 2011; 12:345-352. [PMID: 20401679 DOI: 10.1007/s10198-010-0242-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Accepted: 03/25/2010] [Indexed: 05/29/2023]
Abstract
This study aimed to estimate the health burden and the direct as well as indirect costs of morbidity and mortality attributable to obesity and overweight in Germany for the year 2002. We used the concept of attributable fractions based on German prevalence data and relative risks from US studies as well as routine statistics. We estimated obesity- and overweight-attributable deaths, years of potential life lost (YPLL) and quality-adjusted life years lost (QALY) for various diseases associated with obesity and overweight. Direct costs were estimated for inpatient and outpatient treatment, rehabilitation and non-medical costs. Indirect costs were estimated for sickness absence, early retirement and mortality using the human capital approach. We estimated 36,653 obesity- and overweight-attributable deaths with 428,093 consecutive YPLL and 367,772 QALYs lost. Obesity caused 4,854 million EUR in direct costs corresponding to 2.1% of the overall German health expenditures in 2002 and 5,019 million EUR in indirect costs. Forty-three percent of direct costs resulted from endocrinological diseases like diabetes and obesity itself, followed by cardiovascular diseases (38%), neoplasms (14%) and digestive diseases (6%). Sixty percent of indirect costs resulted from unpaid work, and 67% of overall indirect costs were due to mortality. Obesity and overweight are connected to considerable morbidity and mortality as well as societal costs. Improvement and further development of effective strategies for preventing and dealing with obesity and overweight are necessary.
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Affiliation(s)
- A Konnopka
- Department of Medical Sociology and Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
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König HH, Lehnert T, Riedel-Heller S, Konnopka A. Prävention und Therapie von Übergewicht und Adipositas im Kindes- und Jugendalter aus gesundheitsökonomischer Sicht. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2011; 54:611-20. [DOI: 10.1007/s00103-011-1262-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Konnopka A, König H. Direct and indirect costs attributable to alcohol consumption in Germany in 2002. Gesundheitswesen 2009. [DOI: 10.1055/s-0029-1239264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Konnopka A, Bödemann M, König H. Health burden and costs of obesity and overweight in Germany in 2002. Gesundheitswesen 2009. [DOI: 10.1055/s-0029-1239262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Konnopka A, Jerusel N, König H. The health and economic consequences of osteopenia- and osteoporosis-attributable hip fractures in Germany: estimation for 2002 and projection until 2050. Gesundheitswesen 2009. [DOI: 10.1055/s-0029-1239263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Konnopka A, Jerusel N, König HH. The health and economic consequences of osteopenia- and osteoporosis-attributable hip fractures in Germany: estimation for 2002 and projection until 2050. Osteoporos Int 2009; 20:1117-29. [PMID: 19048180 DOI: 10.1007/s00198-008-0781-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Accepted: 09/19/2008] [Indexed: 10/21/2022]
Abstract
SUMMARY The health and economic burden of osteopenia- and osteoporosis-attributable hip fractures (OHF) in Germany was estimated for 2002 and projected until 2050. We found 108,341 OHF resulting in 2,998 million Euros cost, which will more than double by the year 2050, calling for improvement and development of prevention strategies for OHF. INTRODUCTION This study aimed to estimate the health impact and the societal costs of OHF in Germany in the year 2002 and to extrapolate these estimates to the years 2020 and 2050. METHODS We estimated OHF-attributable deaths, years of potential life lost (YPLL) and quality-adjusted life years lost (QALYs) using attributable fractions. Direct costs for acute treatment, rehabilitation, nursing care, non-medical costs and indirect costs for sickness absence, early retirement and mortality were estimated. All estimates were extrapolated to 2020 and 2050 using an estimation of future population composition and life expectancy. RESULTS We found 108,341 OHF resulting in 3,485 deaths, 22,724 YPLL, 114,058 QALYs, 2,736 millions of Euros direct cost and 262 millions of Euros indirect costs. Projection to 2020 showed corresponding increases of 44%, 62%, 56%, 49%, 47% and 33%, whereas the projection to 2050 resulted in changes of 128%, 215%, 196%, 152%, 138% and 90%, respectively. CONCLUSIONS OHF have considerable impact on health and direct costs in the elderly. Both may strongly increase in future decades due to demographic changes, calling for improvement and development of effective strategies for preventing and dealing with OHF.
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Affiliation(s)
- A Konnopka
- Department of Psychiatry, University of Leipzig, Leipzig, Germany.
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Konnopka A, Conrad K, Baerwald C, König HH. Cost effectiveness of the determination of autoantibodies against cyclic citrullinated peptide in the early diagnosis of rheumatoid arthritis. Ann Rheum Dis 2008; 67:1399-405. [PMID: 18192304 DOI: 10.1136/ard.2007.077792] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To estimate the incremental cost-effectiveness ratio (ICER) of antibodies against cyclic citrullinated peptides (aCCP) in the early diagnosis of rheumatoid arthritis (RA). METHODS A Markov model was used to model 10-year progression of RA in patients first diagnosed with undifferentiated arthritis (UA) and to estimate the incremental costs and quality-adjusted life years (QALYs) of using aCCP additionally to American College of Rheumatology (ACR) criteria. The impact of later diagnosis and treatment due to non-use of aCCP was modelled as increased Health Assessment Questionnaire (HAQ) progression. Utilities were assigned to HAQ states for calculating QALYs. Uncertainty was analysed using univariate and probabilistic sensitivity analyses (Monte Carlo simulation). RESULTS Baseline ICER was euro 930/QALY. Univariate sensitivity analyses identified the impact of later diagnosis on HAQ progression as a major source of uncertainty, resulting in an ICER range from "dominance" to euro 153 092/QALY, compared with a maximum ICER of euro4870/QALY for other variables. Monte Carlo simulation resulted in a 95% uncertainty interval from euro 3537/QALY (dominance) to euro 5429/QALY; when indirect costs were considered, Monte Carlo simulation resulted in a 95% uncertainty interval from euro 78 115/QALY (dominance) to -euro 23 444/QALY (dominance). CONCLUSIONS Using aCCP in the diagnosis of RA in patients with UA is likely to be cost effective compared with using ACR criteria alone. When indirect costs are incorporated, aCCP seems to save costs. Clearly, more research is needed relating the effects of diagnosis and treatment on the long-term course and the resulting functional impairment of RA as measured by the HAQ.
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Affiliation(s)
- A Konnopka
- Health Economics Research Unit, Department of Psychiatry, University of Leipzig, Leipzig, Germany.
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