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McCrone P, Young AH, Zahn R, Eberhard J, Wasserman D, Brambilla P, Balazs J, Caldas-de-Almeida J, Ulrichsen A, Carli V, Antunes A, Schiena G, Quoidbach V, Boyer P, Strawbridge R. Economic impact of reducing treatment gaps in depression. Eur Psychiatry 2023; 66:e57. [PMID: 37309907 PMCID: PMC10486252 DOI: 10.1192/j.eurpsy.2023.2415] [Citation(s) in RCA: 1] [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: 10/21/2022] [Revised: 04/03/2023] [Accepted: 05/04/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is highly prevalent across Europe. While evidence-based treatments exist, many people with MDD have their condition undetected and/or untreated. This study aimed to assess the cost-effectiveness of reducing treatment gaps using a modeling approach. METHODS A decision-tree model covering a 27-month time horizon was used. This followed a care pathway where MDD could be detected or not, and where different forms of treatment could be provided. Expected costs pertaining to Germany, Hungary, Italy, Portugal, Sweden, and the UK were calculated and quality-adjusted life years (QALYs) were estimated. The incremental costs per QALY of reducing detection and treatment gaps were estimated. RESULTS The expected costs with a detection gap of 69% and treatment gap of 50% were €1236 in Germany, €476 in Hungary, €1413 in Italy, €938 in Portugal, €2093 in Sweden, and €1496 in the UK. The incremental costs per QALY of reducing the detection gap to 50% ranged from €2429 in Hungary to €10,686 in Sweden. The figures for reducing the treatment gap to 25% ranged from €3146 in Hungary to €13,843 in Sweden. CONCLUSIONS Reducing detection and treatment gaps, and maintaining current patterns of care, is likely to increase healthcare costs in the short term. However, outcomes are improved, and reducing these gaps to 50 and 25%, respectively, appears to be a cost-effective use of resources.
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Affiliation(s)
- Paul McCrone
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Allan H. Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
| | - Roland Zahn
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Jonas Eberhard
- Division of Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Judit Balazs
- Department of Developmental & Clinical Child Psychology, Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
- Department of Psychology, Oslo New University College, Oslo, Norway
| | - Jose Caldas-de-Almeida
- Chronic Diseases Research Center, Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - Andrea Ulrichsen
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Vladmir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden
| | - Ana Antunes
- Chronic Diseases Research Center, Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - Giandomenico Schiena
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | - Rebecca Strawbridge
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Ulrichsen A, Hampsey E, Taylor RH, Gadelrab R, Strawbridge R, Young AH. Comparing measurements of lithium treatment efficacy in people with bipolar disorder: systematic review and meta-analysis. BJPsych Open 2023; 9:e98. [PMCID: PMC10228238 DOI: 10.1192/bjo.2023.64] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 02/04/2023] [Revised: 03/22/2023] [Accepted: 04/10/2023] [Indexed: 09/29/2023] Open
Abstract
Background Lithium has long been recognised as an effective treatment for bipolar disorder. Its relative efficacy has been measured with a diverse range of clinical outcomes, resulting in differences in efficacy reporting that have not been systematically reviewed. Aims We aimed to identify and compare the various measures of lithium efficacy employed in interventional studies for people with bipolar disorder. Method Database (PubMed, Web of Science) and hand searches were performed to identify studies that assessed a clinical response in patients with bipolar disorder who received lithium, up to the end of 2021. We included primary human interventional studies without excluding specific study designs, bipolar disorder subtypes, duration or dosage of lithium treatment. Continuous outcome effects were meta-analysed; binary outcomes were synthesised visually and narratively. The Cochrane risk-of-bias tool was used to assess study-level risk of bias. Results Seventy-one studies were included (N = 30 542 ). Approximately two-thirds of participants attained a clinically significant improvement in manic or depressive symptoms, and over 50% achieved remission. About a third required hospital admission (study length 2–12 years) and around 50% needed further treatment to stay well or had recurrence of symptoms; the latter two outcomes tended to be assessed over long-term maintenance periods. Conclusions An abundance of measurements have been used to assess lithium's clinical effects, across several study designs. Despite the resultant high heterogeneity, an overall picture of lithium's effects emerges that supports previous literature; between half and two-thirds of patients respond well to lithium across varying outcome measures, baseline mood states, study durations and bipolar disorder subtypes.
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Affiliation(s)
- Andrea Ulrichsen
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Elliot Hampsey
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Rosie H. Taylor
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Romayne Gadelrab
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and South London and Maudsley NHS Foundation Trust, UK
| | - Rebecca Strawbridge
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Allan H. Young
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and South London and Maudsley NHS Foundation Trust, UK
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Strawbridge R, McCrone P, Ulrichsen A, Zahn R, Eberhard J, Wasserman D, Brambilla P, Schiena G, Hegerl U, Balazs J, Caldas de Almeida J, Antunes A, Baltzis S, Carli V, Quoidbach V, Boyer P, Young AH. Care pathways for people with major depressive disorder: a European Brain Council Value of Treatment study. Eur Psychiatry 2022; 65:1-21. [PMID: 35703080 PMCID: PMC9280921 DOI: 10.1192/j.eurpsy.2022.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/19/2022] [Accepted: 05/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background Despite well-established guidelines for managing major depressive disorder, its extensive disability burden persists. This Value of Treatment mission from the European Brain Council aimed to elucidate the nature and extent of “gaps” between best-practice and current-practice care, specifically to:Identify current treatment gaps along the care pathway and determine the extent of these gaps in comparison with the stepped-care model and Recommend policies intending to better meet patient needs (i.e., minimize treatment gaps). Methods After agreement upon a set of relevant treatment gaps, data pertaining to each gap were gathered and synthesized from several sources across six European countries. Subsequently, a modified Delphi approach was undertaken to attain consensus among an expert panel on proposed recommendations for minimizing treatment gaps. Results Four recommendations were made to increase the depression diagnosis rate (from ~50% episodes), aiming to both increase the number of patients seeking help, and the likelihood of a practitioner to correctly detect depression. These should reduce time to treatment (from ~1 to ~8 years after illness onset) and increase rates of treatment; nine further recommendations aimed to increase rates of treatment (from ~25 to ~50% of patients currently treated), mainly focused on targeting the best treatment to each patient. To improve follow-up after treatment initiation (from ~30 to ~65% followed up within 3 months), seven recommendations focused on increasing continuity of care. For those not responding, 10 recommendations focused on ensuring access to more specialist care (currently at rates of ~5–25% of patients). Conclusions The treatment gaps in depression care are substantial and concerning, from the proportion of people not entering care pathways to those stagnating in primary care with impairing and persistent illness. A wide range of recommendations can be made to enhance care throughout the pathway.
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Affiliation(s)
- Rebecca Strawbridge
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Paul McCrone
- Centre for Mental Health, University of Greenwich, London, United Kingdom
| | - Andrea Ulrichsen
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Roland Zahn
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Jonas Eberhard
- Division of Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giandomenico Schiena
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ulrich Hegerl
- Department of Psychiatry, Psychosomatics and Psychotherapy, Goethe University, Frankfurt, Germany
| | - Judit Balazs
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
- Department of Psychology, Bjørknes University College, Oslo, Norway
| | - Jose Caldas de Almeida
- Chronic Diseases Research Center, Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - Ana Antunes
- Chronic Diseases Research Center, Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - Spyridon Baltzis
- Division of Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Vladmir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Allan H. Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
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Taylor RH, Ulrichsen A, Young AH, Strawbridge R. Affective lability as a prospective predictor of subsequent bipolar disorder diagnosis: a systematic review. Int J Bipolar Disord 2021; 9:33. [PMID: 34719775 PMCID: PMC8558129 DOI: 10.1186/s40345-021-00237-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/02/2021] [Indexed: 11/10/2022] Open
Abstract
Objectives The early pathogenesis and precursors of Bipolar Disorder (BD) are poorly understood. There is some cross-sectional and retrospective evidence of affective lability as a predictor of BD, but this is subject to recall biases. The present review synthesises the prospective evidence examining affective lability and the subsequent development of BD at follow-up. Methods The authors performed a systematic search of PubMed, PsycInfo and Embase (1960–June 2020) and conducted hand searches to identify studies assessing affective lability (according to a conceptually-inclusive definition) at baseline assessment in individuals without a BD diagnosis, and a longitudinal follow-up assessment of bipolar (spectrum) disorders. Results are reported according to the PRISMA guidelines, and the synthesis without meta-analysis (SWiM) reporting guidelines were used to strengthen the narrative synthesis. The Newcastle–Ottawa Scale was used to assess risk of bias (ROB). Results 11 articles describing 10 studies were included. Being identified as having affective lability at baseline was associated with an increased rate of bipolar diagnoses at follow-up; this association was statistically significant in six of eight studies assessing BD type I/II at follow-up and in all four studies assessing for bipolar spectrum disorder (BSD) criteria. Most studies received a ‘fair’ or ‘poor’ ROB grade. Conclusions Despite a paucity of studies, an overall association between prospectively-identified affective lability and a later diagnosis of BD or BSD is apparent with relative consistency between studies. This association and further longitudinal studies could inform future clinical screening of those who may be at risk of BD, with the potential to improve diagnostic accuracy and facilitate early intervention. Supplementary Information The online version contains supplementary material available at 10.1186/s40345-021-00237-1.
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Affiliation(s)
- Rosie H Taylor
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Andrea Ulrichsen
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK.,South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Rebecca Strawbridge
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK.
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Ulrichsen A, Sandvik A, Stefansen D. [Treatment of cardiac arrhythmias with imipramine]. Tidsskr Nor Laegeforen 1982; 102:1156-7. [PMID: 7167888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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