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Raya-Tena A, Fernández-San-Martín MI, Martín-Royo J, Casajuana-Closas M, Jiménez-Herrera MF. Cost-effectiveness and cost-utility study of a psychoeducational group intervention for people with depression and physical comorbidity in primary care. Enferm Clin (Engl Ed) 2024; 34:108-119. [PMID: 38508236 DOI: 10.1016/j.enfcle.2024.03.005] [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] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 12/26/2023] [Indexed: 03/22/2024]
Abstract
OBJECTIVE To evaluate the cost-effectiveness and cost-utility of a psychoeducational group intervention led by primary care (PC) nurses in relation to customary care to prevent the depression and improve quality of life in patients with physical comorbidity. DESIGN Economic evaluation based on data from randomized, multicenter clinical trial with blind response variables and a one-year follow-up, carried in the context of the PSICODEP study. LOCATION 7 PC teams from Catalonia. PARTICIPANTS >50 year-old patients with depression and some physical comorbidity: diabetes mellitus type 2, ischemic heart disease, chronic obstructive pulmonary disease, and/or asthma. INTERVENTION 12 psychoeducational group sessions, 1 per week, led by 2 PC nurses with prior training. MEASUREMENTS Effectiveness: depression-free days (DFD) calculated from the BDI-II and quality-adjusted life years (QALYs) from the Euroqol-5D. Direct costs: PC visits, mental health, emergencies and hospitalizations, drugs. Indirect costs: days of temporary disability (TD). The incremental cost-effectiveness ratios (ICER), cost-effectiveness (ΔCost/ΔDLD) and cost-utility (ΔCost/ΔQALY) were estimated. RESULTS The study includes 380 patients (intervention group [IG] = 204; control group [CG] = 176). 81.6% women; mean age 68.4 (SD = 8.8). The IG had a higher mean cost of visits, less of hospitalizations and less TD than the CG. The difference in costs between the IG and the CG was -357.95€ (95% CI: -2026.96 to 1311.06) at one year of follow-up. There was a mean of 11.95 (95% CI: -15.98 to 39.88) more DFD in the IG than in the CG. QALYs were similar (difference -0.01, 95% CI -0.04 to 0.05). The ICERs were 29.95€/DLD and 35,795€/QALY. CONCLUSIONS Psychoeducational intervention is associated with an improvement in DFD, as well as a reduction in costs at 12 months, although not significantly. QALYs were very similar between groups.
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Affiliation(s)
- Antonia Raya-Tena
- Centre d'Atenció Primària Dr. Lluís Sayé, ABS Raval Nord, Institut Català de la Salut, Barcelona, Spain; Línea d'Investigació en Biomedicina, Epidemiologia i Pràctica Clínica Avançada, Facultat de Infermeria, Universitat Rovira i Virgili, Tarragona, Spain.
| | - María Isabel Fernández-San-Martín
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Unitat Docent Multiprofesional, Gerència Territorial Barcelona, Institut Català de la Salut, Barcelona, Spain
| | - Jaume Martín-Royo
- Unitat Bàsica de Prevenció, Gerència Territorial Barcelona, Institut Català de la Salut, Barcelona, Spain
| | - Marc Casajuana-Closas
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - María Francisca Jiménez-Herrera
- Línea d'Investigació en Biomedicina, Epidemiologia i Pràctica Clínica Avançada, Facultat de Infermeria, Universitat Rovira i Virgili, Tarragona, Spain
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Dickreuter J, Schmoor C, Bengel J, Jähne A, Leifert JA. Efficacy of a short-term residential smoking cessation therapy versus standard outpatient group therapy ('START-Study'): study protocol of a randomized controlled trial. Trials 2020; 21:562. [PMID: 32576275 PMCID: PMC7310333 DOI: 10.1186/s13063-020-04253-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/14/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In Germany, evidence-based outpatient smoking cessation therapies are widely available. Long-term abstinence rates, however, are limited. Studies suggest that short-term residential therapy enables a higher level of environmental control, more intense contact and greater support among patients and from therapists, which could result in higher abstinence rates. The aim of the current START-study is to investigate the long-term efficacy of a short-term residential therapy exclusively for smoking cessation, conducted by a mobile team of expert therapists. METHODS A randomized controlled trial (RCT) is conducted to examine the efficacy of residential behavior therapeutic smoking cessation therapy compared to standard outpatient behavior therapeutic smoking cessation group therapy. Adult smokers consuming 10 or more cigarettes per day, who are willing to stop smoking, are randomized in a ratio of 1:1 between therapy groups. The primary endpoint is sustained abstinence for 6-month and 12-month periods. Secondary endpoints include smoking status after therapy, 7-day point abstinence after the 6-month and 12-month follow-ups, level of physical dependence, cost-effectiveness, use of nicotine replacement products, health-related quality of life, self-efficacy expectation for tobacco abstinence, motivational and volitional determinants of behavior change, self-reported depressive symptom severity, adverse events and possible side effects. Assessments will take place at baseline, post-therapy, and at 6-month and 12-month intervals after smoking cessation. DISCUSSION There is a high demand for long-term effective smoking cessation therapies. This study represents the first prospective RCT to examine the long-term efficacy of a residential smoking cessation therapy program compared to standard outpatient group therapy as an active control condition. The residential therapeutic concept may serve as a new model to substantially enhance future cessation therapies and improve the understanding of therapeutic impact factors on tobacco abstinence. Utilizing a mobile team, the model could be applied efficiently to medical centers that do not have permanent and trained personnel for smoking cessation at their disposal. TRIAL REGISTRATION German Register for Clinical Trials (Deutsches Register für Klinische Studien), DRKS00013466. Retrospectively registered on 1 April 2019. https://www.drks.de/drks_web/navigate.do?navigationId=start.
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Affiliation(s)
- Jonas Dickreuter
- Comprehensive Cancer Center, Prevention Team CMPT, University Medical Center Freiburg, Elsässerstraße 2, 79110, Freiburg, Germany.
| | - Claudia Schmoor
- Clinical Trials Unit, Faculty of Medicine and Medical Center, University Medical Center Freiburg, Elsässerstraße 2, 79110 Freiburg, Germany
| | - Jürgen Bengel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, Albert-Ludwigs-University Freiburg, Engelberger Straße 41, 79085, Freiburg, Germany
| | - Andreas Jähne
- Rhein-Jura Klinik, Schneckenhalde 13, 79713, Bad Säckingen, Germany
| | - Jens A Leifert
- Comprehensive Cancer Center, Prevention Team CMPT, University Medical Center Freiburg, Elsässerstraße 2, 79110, Freiburg, Germany
- Breisgau-Klinik, Herbert-Hellmann-Allee 37, 79189, Bad Krozingen, Germany
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Dunlap LJ, O’Farrell TJ, Schumm JA, Orme SS, Murphy M, Murchowski PM. Group Versus Standard Behavioral Couples' Therapy for Alcohol Use Disorder Patients: Cost-Effectiveness. J Stud Alcohol Drugs 2020; 81:152-163. [PMID: 32359044 PMCID: PMC7201207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/21/2019] [Indexed: 03/29/2024] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the costs and cost-effectiveness of two treatments for 101 alcohol use disorder patients and their intimate partners--group behavioral couples' therapy plus individual-based treatment (G-BCT), or standard behavioral couples' therapy plus individual-based treatment (S-BCT). METHOD We estimated the per-patient cost of each intervention using a microcosting approach that allowed us to estimate costs of specific components in each intervention as well as the overall total costs. Using simple means analysis and multiple regression models, we estimated the incremental effectiveness of G-BCT relative to S-BCT. Immediately after treatment and 12 months after treatment, we computed incremental cost-effectiveness ratios (ICER) and cost-effectiveness acceptability curves for percentage days abstinent, adverse consequences of alcohol and drugs, and overall relationship functioning. RESULTS The average per-patient cost of delivering G-BCT was $674, significantly less than the cost of S-BCT ($831). However, 12 months after treatment, S-BCT participants performed better on all outcomes compared with those in G-BCT, and the calculated ICER moving from G-BCT to S-BCT ranged from $10 to $12 across these outcomes. The current findings indicated that, except at very low willingness-to-pay values, S-BCT is a cost-effective option relative to G-BCT when considering 12-month posttreatment outcomes. CONCLUSIONS As expected, G-BCT was delivered at a lower cost per patient than S-BCT; however, S-BCT performed better over time on the clinical outcomes studied. These economic findings indicate that alcohol use disorder treatment providers should seriously consider S-BCT over G-BCT when deciding what format to use in behavioral couples' therapy.
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Affiliation(s)
| | - Timothy J. O’Farrell
- Veterans Affairs Boston Healthcare System, Brockton, Massachusetts
- Harvard Medical School Department of Psychiatry, Boston, Massachusetts
| | - Jeremiah A. Schumm
- School of Professional Psychology, Wright State University, Ellis Human Development Institute, Dayton, Ohio
| | | | - Marie Murphy
- Veterans Affairs Boston Healthcare System, Brockton, Massachusetts
- Harvard Medical School Department of Psychiatry, Boston, Massachusetts
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Nakimuli-Mpungu E, Musisi S, Wamala K, Okello J, Ndyanabangi S, Birungi J, Nanfuka M, Etukoit M, Mayora C, Ssengooba F, Mojtabai R, Nachega JB, Harari O, Mills EJ. Effectiveness and cost-effectiveness of group support psychotherapy delivered by trained lay health workers for depression treatment among people with HIV in Uganda: a cluster-randomised trial. Lancet Glob Health 2020; 8:e387-e398. [PMID: 32035035 DOI: 10.1016/s2214-109x(19)30548-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/30/2019] [Accepted: 12/04/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND WHO recommends the use of psychological interventions as first-line treatment for depression in low-income and middle-income countries. However, evaluations of the effectiveness and cost-effectiveness of such interventions among people with HIV are scarce. Our aim was to establish the effectiveness of group support psychotherapy (GSP) delivered by lay health workers for depression treatment among people living with HIV in a rural area of Uganda on a large scale. METHODS In this cluster-randomised trial, we included 30 health centres offering HIV care. These were randomly assigned to deliver either GSP or group HIV education (GHE). Randomisation, in a ratio of 1:1, was achieved by health centre managers separately picking a paper containing the intervention allocation from a basket. Participants were people living with HIV, aged 19 years and older, with mild to moderate major depression assessed with the Mini International Neuropsychiatric Interview depression module, taking antiretroviral therapy, and antidepressant-naive. Group sessions were led by trained lay health workers once a week for 8 weeks. The primary outcomes were the proportion of participants with major depression and function scores at 6 months post-treatment, analysed by intention to treat by means of multilevel random effect regression analyses adjusting for clustering in health centres. This trial is registered with the Pan African Clinical Trials Registry, PACTR201608001738234. FINDINGS Between Sept 13 and Dec 15, 2016, we assessed 1473 individuals, of whom 1140 were recruited from health centres offering GSP (n=578 [51%]) or GHE (n=562 [49%]). Two (<1%) participants in the GSP group were diagnosed with major depression 6 months post-treatment compared with 160 (28%) in the GHE group (adjusted odds ratio=0·01, 95% CI 0·003-0·012, p<0·0001). The mean function scores 6 months post-treatment were 9·85 (SD 0·76) in the GSP group and 6·83 (2·85) in the GHE group (β=4·12; 95% CI 3·75-4·49, p<0·0001). 36 individuals had 63 serious adverse events, which included 25 suicide attempts and 22 hospital admissions for medical complications. The outcomes of these serious adverse events included 16 deaths, 4 of which were completed suicides (GSP=2; GHE=2), and 12 of which were HIV-related medical complications (GSP=8; GHE=4). Cost-effectiveness estimates showed an incremental cost-effectiveness ratio of US$13·0 per disability-adjusted life-year averted, which can be considered very cost-effective in Uganda. INTERPRETATION Integration of cost-effective psychological treatments such as group support psychotherapy into existing HIV interventions might improve the mental health of people living with HIV. FUNDING MQ Transforming Mental Health and Grand Challenges Canada.
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Affiliation(s)
| | - Seggane Musisi
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Kizito Wamala
- Department of Psychology, Center for Victims of Torture, Gulu, Uganda
| | - James Okello
- Department of Mental Health, Faculty of Medicine, Gulu University, Gulu, Uganda
| | | | | | | | | | - Chrispus Mayora
- Department of Health Policy Planning and Management, School of Public Health, Makerere University, Kampala, Uganda
| | - Freddie Ssengooba
- Department of Health Policy Planning and Management, School of Public Health, Makerere University, Kampala, Uganda
| | - Ramin Mojtabai
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jean B Nachega
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA; Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA; Center for Infectious Disease, Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | | | - Edward J Mills
- MTEK Sciences, Vancouver, BC, Canada; Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
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Shumway M, Fisher L, Hessler D, Bowyer V, Polonsky WH, Masharani U. Economic costs of implementing group interventions to reduce diabetes distress in adults with type 1 diabetes mellitus in the T1-REDEEM trial. J Diabetes Complications 2019; 33:107416. [PMID: 31473079 PMCID: PMC6823162 DOI: 10.1016/j.jdiacomp.2019.107416] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/08/2019] [Accepted: 08/10/2019] [Indexed: 10/26/2022]
Abstract
AIMS This study evaluated the implementation costs of two group interventions, one focused on diabetes education (KnowIt) and one focused directly on diabetes distress (OnTrack), that reduced diabetes distress and HbA1C in adults with poorly controlled type 1 diabetes (T1DM) in the T1-REDEEM trial. METHODS Resources used to provide interventions were enumerated using activity-based micro-costing methods. Costs were assigned to resources in 2017 US dollars. US median wage and benefit rates were used to calculate costs of staff time. Cost per unit change was calculated for diabetes distress and HbA1C. RESULTS For both interventions, per participant implementation costs were approximately $250 and cost per 1.0 percentage point (11 mmol/mol) change in HbA1C was $1400. Cost per unit change in diabetes distress was $364 for KnowIt and $335 for OnTrack. No statistically significant differences in costs were observed. CONCLUSIONS This is the first study to examine the costs of implementing interventions targeting diabetes distress in the context of T1DM. Both interventions had per participant implementation costs in the lower end of the range of previously examined diabetes self-management interventions ($219 to $5390). These inventions and their costs merit further attention because reducing diabetes distress may impact long term T1DM outcomes. CLINICAL TRIALS REGISTRATION ClinicalTrials.govNCT02175732.
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MESH Headings
- Adult
- Anxiety/economics
- Anxiety/etiology
- Anxiety/therapy
- Cost-Benefit Analysis
- Depression/economics
- Depression/etiology
- Depression/therapy
- Diabetes Mellitus, Type 1/economics
- Diabetes Mellitus, Type 1/epidemiology
- Diabetes Mellitus, Type 1/psychology
- Diabetes Mellitus, Type 1/therapy
- Group Processes
- Health Care Costs
- Humans
- Implementation Science
- Middle Aged
- Patient Acceptance of Health Care/statistics & numerical data
- Patient Education as Topic/economics
- Patient Education as Topic/methods
- Psychological Distress
- Psychotherapy, Group/economics
- Psychotherapy, Group/methods
- Self Care/economics
- Self Care/methods
- Stress, Psychological/economics
- Stress, Psychological/epidemiology
- Stress, Psychological/etiology
- Stress, Psychological/therapy
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Affiliation(s)
- Martha Shumway
- Department of Psychiatry, University of California, San Francisco, Box 0884, San Francisco, CA 94143-0884, USA.
| | - Lawrence Fisher
- Department of Family and Community Medicine, University of California, San Francisco, Box 0900, San Francisco, CA 94143-0900, USA
| | - Danielle Hessler
- Department of Family and Community Medicine, University of California, San Francisco, Box 0900, San Francisco, CA 94143-0900, USA
| | - Vicky Bowyer
- Department of Family and Community Medicine, University of California, San Francisco, Box 0900, San Francisco, CA 94143-0900, USA
| | - William H Polonsky
- Behavioral Diabetes Institute, 5405 Oberlin Drive #100, San Diego, CA 92121, USA
| | - Umesh Masharani
- Department of Medicine, University of California, San Francisco, Box 1222, San Francisco, CA 94143-1222, USA
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das Nair R, Bradshaw LE, Day FEC, Drummond A, Harris SRS, Fitzsimmons D, Montgomery AA, Newby G, Sackley C, Lincoln NB. Clinical and cost effectiveness of memory rehabilitation following traumatic brain injury: a pragmatic cluster randomized controlled trial. Clin Rehabil 2019; 33:1171-1184. [PMID: 30977398 PMCID: PMC6585159 DOI: 10.1177/0269215519840069] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 02/28/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the clinical and cost effectiveness of a group-based memory rehabilitation programme for people with traumatic brain injury. DESIGN Multicentre, pragmatic, observer-blinded, randomized controlled trial in England. SETTING Community. PARTICIPANTS People with memory problems following traumatic brain injury, aged 18-69 years, able to travel to group sessions, communicate in English, and give consent. INTERVENTIONS A total of 10 weekly group sessions of manualized memory rehabilitation plus usual care (intervention) vs. usual care alone (control). MAIN MEASURES The primary outcome was the patient-reported Everyday Memory Questionnaire (EMQ-p) at six months post randomization. Secondary outcomes were assessed at 6 and 12 months post randomization. RESULTS We randomized 328 participants. There were no clinically important differences in the primary outcome between arms at six-month follow-up (mean EMQ-p score: 38.8 (SD 26.1) in intervention and 44.1 (SD 24.6) in control arms, adjusted difference in means: -2.1, 95% confidence interval (CI): -6.7 to 2.5, p = 0.37) or 12-month follow-up. Objectively assessed memory ability favoured the memory rehabilitation arm at the 6-month, but not at the 12-month outcome. There were no between-arm differences in mood, experience of brain injury, or relative/friend assessment of patient's everyday memory outcomes, but goal attainment scores favoured the memory rehabilitation arm at both outcome time points. Health economic analyses suggested that the intervention was unlikely to be cost effective. No safety concerns were raised. CONCLUSION This memory rehabilitation programme did not lead to reduced forgetting in daily life for a heterogeneous sample of people with traumatic brain injury. Further research will need to examine who benefits most from such interventions.
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Affiliation(s)
- Roshan das Nair
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Lucy E Bradshaw
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Florence EC Day
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Avril Drummond
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Shaun RS Harris
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | | | - Alan A Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Gavin Newby
- Newby Psychological Services Ltd, Northwich, UK
| | - Catherine Sackley
- School of Population Health & Environmental Sciences, King’s College London, London, UK
| | - Nadina B Lincoln
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
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Johnson JE, Stout RL, Miller TR, Zlotnick C, Cerbo LA, Andrade JT, Nargiso J, Bonner J, Wiltsey-Stirman S. Randomized cost-effectiveness trial of group interpersonal psychotherapy (IPT) for prisoners with major depression. J Consult Clin Psychol 2019; 87:392-406. [PMID: 30714749 PMCID: PMC6482450 DOI: 10.1037/ccp0000379] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study tested the effectiveness and cost-effectiveness of interpersonal psychotherapy (IPT) for major depressive disorder (MDD) among prisoners. It is the first fully powered randomized trial of any treatment (pharmacological or psychosocial) targeting MDD among incarcerated individuals. METHOD One hundred eighty-one male (n = 117) and female (n = 64) prisoners from prison facilities in 2 states were randomized to group IPT (delivered by master's-level and nonspecialist prison counselors) for MDD plus prison treatment as usual (TAU) or to TAU alone. Participants' average age was 39 (range = 20-61); 20% were African American and 19% were Hispanic. Outcomes assessed at posttreatment and 3-month follow-up included depressive symptoms (primary; assessed using the Hamilton Rating Scale for Depression), suicidality (assessed with the Beck Scale for Suicide Ideation and Beck Hopelessness Scale), in-prison functioning (i.e., enrollment in correctional programs; discipline reports; aggression/victimization; and social support), remission from MDD, and posttraumatic stress disorder symptoms. RESULTS IPT reduced depressive symptoms, hopelessness, and posttraumatic stress disorder symptoms, and increased rates of MDD remission relative to prison TAU alone. Effects on hopelessness were particularly strong. Cost per patient was $2,054 including costs for IPT training and supervision or $575 without these costs. For providers running their second or subsequent IPT group, cost per additional week in remission from MDD (relative to TAU alone) was $524 ($148 excluding training and supervision costs, which would not be needed for established programs). CONCLUSIONS IPT is effective and cost-effective and we recommend its use for MDD among prisoners. It is currently the only treatment for MDD evaluated among incarcerated individuals. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Jennifer E. Johnson
- National Center for PTSD, Dissemination and Training Division, 795 Willow Road (NC-PTSD 334), Menlo Park, CA 94025.
| | - Robert L. Stout
- Decision Sciences Institute, 1005 Main Street Unit 8120, Pawtucket, RI 02860.
| | - Ted R. Miller
- Pacific Institute for Research and Evaluation, 11720 Beltsville Drive, Suite 900, Calverton, MD 20705; School of Public Health, Curtin University, Perth, Australia.
| | - Caron Zlotnick
- Butler Hospital and Brown University, 345 Blackstone Blvd, Providence, RI 02906; University of Cape Town, South Africa.
| | - Louis A. Cerbo
- Rhode Island Department of Corrections, 39 Howard Avenue, Cranston, RI 02920.
| | - Joel T. Andrade
- MHM Services, Inc. 110 Turnpike Road, Suite 308, Westborough, MA 01581.
| | - Jessica Nargiso
- Massachusetts General Hospital, 6th floor, 151 Merrimac St, Boston MA 02114.
| | - Joseph Bonner
- Division of Public Health, Michigan State University College of Human Medicine, 200 East 1st St, Flint, MI 48502.
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van Dijk SDM, Veenstra MS, Bouman R, Peekel J, Veenstra DH, van Dalen PJ, van Asselt ADI, Boshuisen ML, van Alphen SPJ, van den Brink RHS, Oude Voshaar RC. Group schema-focused therapy enriched with psychomotor therapy versus treatment as usual for older adults with cluster B and/or C personality disorders: a randomized trial. BMC Psychiatry 2019; 19:26. [PMID: 30646879 PMCID: PMC6334382 DOI: 10.1186/s12888-018-2004-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 12/26/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Several types of psychotherapy have been proven successful in the treatment of personality disorders in younger age groups, however studies among older patients are lacking. We developed a group schema-focused therapy (SFT) enriched with psychomotor therapy (PMT) for older adults with cluster B and/or C personality disorders. This paper describes the design of a randomized controlled trial (RCT). We will evaluate the (cost-)effectiveness of this therapy protocol in specialized mental health care. We hypothesize that our treatment program is cost-effective and superior to treatment as usual (TAU) in reducing psychological distress and improving quality of life in older adults treated to specialized mental healthcare. METHODS A multicenter RCT with a one-year follow-up comparing group schema-focused therapy enriched with psychomotor therapy (group SFT + PMT) and TAU for adults aged 60 years and older who suffer from either a cluster B and/or C personality disorder. The primary outcome is general psychological distress measured with the 53-item Brief Symptom Inventory. Secondary outcomes are the Schema Mode Inventory (118-item version) and the Young Schema Questionnaire. Cost-effectiveness analysis will be performed from a societal perspective with the EuroQol five dimensions questionnaire and structured cost-interviews. DISCUSSION This study will add to the knowledge of psychotherapy in later life. The study specifically contributes to the evidence on (cost-) effectiveness of group SFT enriched with PMT adapted to the needs of for older adults with cluster b and/or c personality. TRIAL REGISTRATION Netherlands Trial Register NTR 6621 . Registered on 20 August 2017.
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Affiliation(s)
- S. D. M. van Dijk
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Post office box 30.001, 9700 RB Groningen, The Netherlands
| | - M. S. Veenstra
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Post office box 30.001, 9700 RB Groningen, The Netherlands
| | - R. Bouman
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Post office box 30.001, 9700 RB Groningen, The Netherlands
| | - J. Peekel
- Mediant Geestelijke Gezondheidszorg, Enschede, The Netherlands
| | - D. H. Veenstra
- Van Andel Ouderenpsychiatrie (GGZ Friesland), Leeuwarden, The Netherlands
| | - P. J. van Dalen
- Dimence, Mental Health Organization, Deventer, The Netherlands
| | - A. D. I. van Asselt
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M. L. Boshuisen
- Lentis, Mental Health Organization, Groningen, The Netherlands
| | | | - R. H. S. van den Brink
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Post office box 30.001, 9700 RB Groningen, The Netherlands
| | - R. C. Oude Voshaar
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Post office box 30.001, 9700 RB Groningen, The Netherlands
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Wortman MSH, Lokkerbol J, van der Wouden JC, Visser B, van der Horst HE, olde Hartman TC. Cost-effectiveness of interventions for medically unexplained symptoms: A systematic review. PLoS One 2018; 13:e0205278. [PMID: 30321193 PMCID: PMC6188754 DOI: 10.1371/journal.pone.0205278] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 09/22/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In primary and secondary care medically unexplained symptoms (MUS) or functional somatic syndromes (FSS) constitute a major burden for patients and society with high healthcare costs and societal costs. Objectives were to provide an overview of the evidence regarding the cost-effectiveness of interventions for MUS or FSS, and to assess the quality of these studies. METHODS We searched the databases PubMed, PsycINFO, the National Health Service Economic Evaluation Database (NHS-EED) and the CEA registry to conduct a systematic review. Articles with full economic evaluations on interventions focusing on adult patients with undifferentiated MUS or fibromyalgia (FM), irritable bowel syndrome (IBS) and chronic fatigue syndrome (CFS), with no restrictions on comparators, published until 15 June 2018, were included. We excluded preventive interventions. Two reviewers independently extracted study characteristics and cost-effectiveness data and used the Consensus on Health Economic Criteria Checklist to appraise the methodological quality. RESULTS A total of 39 studies out of 1,613 articles met the inclusion criteria. Twenty-two studies reported costs per quality-adjusted life year (QALY) gained and cost-utility analyses (CUAs). In 13 CUAs the intervention conditions dominated the control conditions or had an incremental cost-effectiveness ratio below the willingness-to-pay threshold of € 50,000 per QALY, meaning that the interventions were (on average) cost-effective in comparison with the control condition. Group interventions focusing on MUS (n = 3) or FM (n = 4) might be more cost-effective than individual interventions. The included studies were heterogeneous with regard to the included patients, interventions, study design, and outcomes. CONCLUSION This review provides an overview of 39 included studies of interventions for patients with MUS and FSS and the methodological quality of these studies. Considering the limited comparability due to the heterogeneity of the studies, group interventions might be more cost-effective than individual interventions. REGISTRATION Study methods were documented in an international prospective register of systematic reviews (PROSPERO) protocol, registration number: CRD42017060424.
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Affiliation(s)
- Margreet S. H. Wortman
- ACHIEVE – Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department of General Practice and Elderly Care Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- * E-mail:
| | - Joran Lokkerbol
- Centre of Economic Evaluation, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Johannes C. van der Wouden
- Department of General Practice and Elderly Care Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Bart Visser
- ACHIEVE – Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Henriëtte E. van der Horst
- Department of General Practice and Elderly Care Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Tim C. olde Hartman
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
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van der Spek N, Vos J, van Uden-Kraan CF, Breitbart W, Cuijpers P, Knipscheer-Kuipers K, Willemsen V, Tollenaar RAEM, van Asperen CJ, Leeuw IMVD. Cost-utility analysis of meaning-centered group psychotherapy for cancer survivors. Psychooncology 2018; 27:1772-1779. [PMID: 29624807 PMCID: PMC6043397 DOI: 10.1002/pon.4726] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 03/20/2018] [Accepted: 03/21/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Meaning-centered group psychotherapy for cancer survivors (MCGP-CS) improves meaning, psychological well-being, and mental adjustment to cancer and reduces psychological distress. This randomized controlled trial was conducted to investigate the cost-utility of MCGP-CS compared with supportive group psychotherapy (SGP) and care-as-usual (CAU). METHODS In total, 170 patients were randomized to MCGP-CS, SGP, or CAU. Intervention costs, direct medical and nonmedical costs, productivity losses, and health-related quality of life were measured until 6 months follow-up, using the TIC-P, PRODISQ, data from the hospital information system, and the EQ-5D. The cost-utility was calculated by comparing mean cumulative costs and quality-adjusted life years (QALYs). RESULTS Mean total costs ranged from €4492 (MCGP-CS) to €5304 (CAU). Mean QALYs ranged .507 (CAU) to .540 (MCGP-CS). MCGP-CS had a probability of 74% to be both less costly and more effective than CAU, and 49% compared with SGP. Sensitivity analyses showed these findings are robust. If society is willing to pay €0 for one gained QALY, MCGP-CS has a 78% probability of being cost-effective compared with CAU. This increases to 85% and 92% at willingness-to-pay thresholds of €10 000 and €30 000, which are commonly accepted thresholds. CONCLUSIONS MCGP-CS is highly likely a cost-effective intervention, meaning that there is a positive balance between the costs and gains of MCGP-CS, in comparison with SGP and CAU.
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Affiliation(s)
- Nadia van der Spek
- Department of Clinical Psychology, VU University, VdBoechorststraat 1, room 2B-64, Amsterdam 1081 BT, The Netherlands
| | - Joël Vos
- Department of Psychology, University of Roehampton, London, UK
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Cornelia F van Uden-Kraan
- Department of Clinical Psychology, VU University, VdBoechorststraat 1, room 2B-64, Amsterdam 1081 BT, The Netherlands
- Department of Otolaryngology – Head & Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - William Breitbart
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Pim Cuijpers
- Department of Clinical Psychology, VU University, VdBoechorststraat 1, room 2B-64, Amsterdam 1081 BT, The Netherlands
| | - Kitty Knipscheer-Kuipers
- Ingeborg Douwes Centrum, Center for psychological care for cancer patients, Amsterdam, The Netherlands
| | - Vincent Willemsen
- Ingeborg Douwes Centrum, Center for psychological care for cancer patients, Amsterdam, The Netherlands
| | - Rob AEM Tollenaar
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Christi J van Asperen
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Clinical Psychology, VU University, VdBoechorststraat 1, room 2B-64, Amsterdam 1081 BT, The Netherlands
- Department of Otolaryngology – Head & Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
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Church D, House D. Borrowing Benefits: Group Treatment With Clinical Emotional Freedom Techniques Is Associated With Simultaneous Reductions in Posttraumatic Stress Disorder, Anxiety, and Depression Symptoms. J Evid Based Integr Med 2018; 23:2156587218756510. [PMID: 29468884 PMCID: PMC5871035 DOI: 10.1177/2156587218756510] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 08/04/2017] [Accepted: 09/08/2017] [Indexed: 12/24/2022] Open
Abstract
Clinical Emotional Freedom Techniques (EFT) is an evidence-based treatment for depression and anxiety. The current study sought to elucidate the relationship between posttraumatic stress disorder (PTSD), depression, and anxiety in a nonclinical population. The sample (N = 81) comprised participants at five 2-day EFT workshops. All groups used an EFT protocol called Borrowing Benefits, in which the group facilitator works with a single client while other participants self-apply EFT. Participants were assessed on 9 specific conditions as well as on the breadth (Positive Symptom Total [PST]) and depth (General Symptom Index [GSI]) of psychological distress. Physical pain and addictive cravings were also assessed. Significant reductions were observed in all measures (P < .03). Associations between PST, GSI, and PTSD were significant (P < .026). Participants maintained all gains at 6-month follow-up (P < .02) with the exception of the Hostility subscale, while Cohen's d = 0.54 indicated a moderate treatment effect for PTSD. The relationship between psychological and physiological conditions identified in this study is consistent with that found in other studies. Group treatment is cost-effective and efficient, and the efficacy of EFT in groups indicates the utility of the Borrowing Benefits technique.
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Affiliation(s)
- Dawson Church
- National Institute for Integrative Healthcare, Fulton, CA, USA
| | - Dennis House
- National Institute for Integrative Healthcare, Fulton, CA, USA
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McBain RK, Salhi C, Hann K, Salomon JA, Kim JJ, Betancourt TS. Costs and cost-effectiveness of a mental health intervention for war-affected young persons: decision analysis based on a randomized controlled trial. Health Policy Plan 2015; 31:415-24. [PMID: 26345320 DOI: 10.1093/heapol/czv078] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND One billion children live in war-affected regions of the world. We conducted the first cost-effectiveness analysis of an intervention for war-affected youth in sub-Saharan Africa, as well as a broader cost analysis. METHODS The Youth Readiness Intervention (YRI) is a behavioural treatment for reducing functional impairment associated with psychological distress among war-affected young persons. A randomized controlled trial was conducted in Freetown, Sierra Leone, from July 2012 to July 2013. Participants (n = 436, aged 15-24) were randomized to YRI (n = 222) or care as usual (n = 214). Functional impairment was indexed by the World Health Organization Disability Assessment Scale; scores were converted to quality-adjusted life years (QALYs). An 'ingredients approach' estimated financial and economic costs, assuming a societal perspective. Incremental cost-effectiveness ratios (ICERs) were also expressed in terms of gains across dimensions of mental health and schooling. Secondary analyses explored whether intervention effects were largest among those worst-off (upper quartile) at baseline. RESULTS Retention at 6-month follow-up was 85% (n = 371). The estimated economic cost of the intervention was $104 per participant. Functional impairment was lower among YRI recipients, compared with controls, following the intervention but not at 6-month follow-up, and yielded an ICER of $7260 per QALY gained. At 8-month follow-up, teachers' interviews indicated that YRI recipients observed higher school enrolment [P < 0.001, odds ratio (OR) 8.9], denoting a cost of $431 per additional school year gained, as well as better school attendance (P = 0.007, OR 34.9) and performance (P = 0.03, effect size = -1.31). Secondary analyses indicated that the intervention was cost-effective among those worst-off at baseline, yielding an ICER of $3564 per QALY gained. CONCLUSIONS The YRI is not cost-effective at a willingness-to-pay threshold of three times average gross domestic product per capita. However, results indicate that the YRI translated into a range of benefits, such as improved school enrolment, not captured by cost-effectiveness analysis. We also outline areas for modification to improve cost-effectiveness in future trials. TRIAL REGISTRATION clinicaltrials.gov Identifier: RPCGA-YRI-21003.
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Affiliation(s)
- Ryan K McBain
- Department of Global Health and Population, Harvard School of Public Health, 651 Huntington Avenue, 7th Floor, Boston, 02115 MA, USA, Research Center on Children and Global Adversity, FXB Center for Health and Human Rights, Harvard University, Boston, MA, USA and
| | - Carmel Salhi
- Department of Global Health and Population, Harvard School of Public Health, 651 Huntington Avenue, 7th Floor, Boston, 02115 MA, USA
| | - Katrina Hann
- Research Center on Children and Global Adversity, FXB Center for Health and Human Rights, Harvard University, Boston, MA, USA and
| | - Joshua A Salomon
- Department of Global Health and Population, Harvard School of Public Health, 651 Huntington Avenue, 7th Floor, Boston, 02115 MA, USA
| | - Jane J Kim
- Department of Health Policy and Management, Harvard School of Public Health, 617 Huntington Avenue, 7th, Boston, 02115 MA, USA
| | - Theresa S Betancourt
- Department of Global Health and Population, Harvard School of Public Health, 651 Huntington Avenue, 7th Floor, Boston, 02115 MA, USA, Research Center on Children and Global Adversity, FXB Center for Health and Human Rights, Harvard University, Boston, MA, USA and
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Rondags SMPA, de Wit M, van Tulder MW, Diamant M, Snoek FJ. HypoAware-a brief and partly web-based psycho-educational group intervention for adults with type 1 and insulin-treated type 2 diabetes and problematic hypoglycaemia: design of a cost-effectiveness randomised controlled trial. BMC Endocr Disord 2015; 15:43. [PMID: 26292674 PMCID: PMC4546185 DOI: 10.1186/s12902-015-0035-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 07/24/2015] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Problematic hypoglycaemia is a significant problem among people with insulin-treated type 1 and 2 diabetes mellitus, which adversely affects quality of life and leads to high societal costs. Blood glucose awareness training (BGAT) is a psycho-educational group intervention that has shown to be effective but difficult to implement in clinical practice, due to its demanding nature. The aim of this study is to evaluate the cost-effectiveness of the HypoAware intervention that has its roots in BGAT and helps patients to effectively recognize, treat and prevent hypoglycaemia, while also focussing on the psychosocial consequences of living with the constant risk of hypoglycaemia, both for patients and their significant others. METHODS/DESIGN An economic evaluation will be conducted alongside a cluster-randomised controlled trial in eight hospitals in the Netherlands. We aim to include 154 participants who will either receive HypoAware or care as usual. HypoAware consists of three group sessions and is combined with two online modules. The primary clinical outcome is severe hypoglycaemia. Secondary outcomes include mild hypoglycaemia, hypoglycaemia awareness, fear of hypoglycaemia, diabetes distress, anxiety and depression, health-related quality of life, diabetes-specific self-efficacy and HbA1c. Utilities will be measured using the EQ-5D-5 L questionnaire. Costs will be measured from a societal perspective and include health care utilization, medication and lost productivity costs. Measurements will be performed at baseline, 2, 4, and 6 months to compare both groups, and an additional 12 months for the intervention group only. Process outcomes will be gathered after every group meeting via telephone/email contact with health care professionals and via the online environment. DISCUSSION HypoAware is expected to significantly reduce episodes of severe hypoglycaemia, with subsequent beneficial effects on psychosocial outcomes and health care costs. When proven cost-effective, HypoAware will be incorporated in the clinical guidelines of Dutch diabetes care. TRIAL REGISTRATION Dutch Trial Register NTR4538.
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MESH Headings
- Adolescent
- Adult
- Anxiety/economics
- Anxiety/psychology
- Awareness
- Cost-Benefit Analysis
- Depression/economics
- Depression/psychology
- Diabetes Mellitus, Type 1/economics
- Diabetes Mellitus, Type 1/psychology
- Diabetes Mellitus, Type 1/therapy
- Diabetes Mellitus, Type 2/economics
- Diabetes Mellitus, Type 2/psychology
- Diabetes Mellitus, Type 2/therapy
- Female
- Health Care Costs
- Humans
- Hypoglycemia/chemically induced
- Hypoglycemia/economics
- Hypoglycemia/psychology
- Hypoglycemic Agents/adverse effects
- Insulin/adverse effects
- Internet
- Male
- Netherlands
- Patient Education as Topic/economics
- Patient Education as Topic/methods
- Psychotherapy, Group/economics
- Psychotherapy, Group/methods
- Stress, Psychological/economics
- Stress, Psychological/psychology
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Stefanie M P A Rondags
- Department of Medical Psychology, VU University Medical Centre, Van der Boechorststraat 7 (D-342), Amsterdam, 1081 BT, The Netherlands.
- EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
| | - Maartje de Wit
- Department of Medical Psychology, VU University Medical Centre, Van der Boechorststraat 7 (D-342), Amsterdam, 1081 BT, The Netherlands.
- EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
| | - Maurits W van Tulder
- EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands.
| | - Michaela Diamant
- Department of Internal Medicine & Diabetes Center, VU University Medical Centre, Amsterdam, The Netherlands
| | - Frank J Snoek
- Department of Medical Psychology, VU University Medical Centre, Van der Boechorststraat 7 (D-342), Amsterdam, 1081 BT, The Netherlands.
- EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
- Department of Medical Psychology, Academic Medical Center (AMC), Amsterdam, The Netherlands.
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Visser MS, Zonneveld LNL, Van't Spijker A, Hunink MG, Busschbach JJV. The Cost-Effectiveness of Cognitive-Behavioral Group Training for Patients with Unexplained Physical Symptoms. Value Health 2015; 18:570-577. [PMID: 26297084 DOI: 10.1016/j.jval.2015.03.1791] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 12/03/2014] [Accepted: 03/12/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The aim of the study was to evaluate the cost-effectiveness of a cognitive-behavioral group training compared with a wait-list control for patients with unexplained physical symptoms (UPS). METHODS A probabilistic decision-analytic Markov model was developed with three health states (poor health, average health, and death) based on a cutoff score of the Physical Component Summary of the short-form 36 health survey. To assess the cost-effectiveness in terms of cost per quality-adjusted life-year (QALY), a societal perspective was adopted. The model consisted of cycles of 3 months and a time horizon of 4 years. Data for the model were derived from a randomized controlled trial, in which 162 patients with UPS were randomized either to cognitive-behavioral group training or to the wait-list control. Data were assessed at baseline and after the training of 3 months or after a wait-list period of 3 months. In addition, the training group was followed in an uncontrolled phase and assessed at 3 months and 1 year after the training. RESULTS After 4 years, the group training was in terms of cost-effectiveness "dominant" compared with the wait-list control; there was a positive effect of 0.06 QALYs and a €828 reduction in costs. The cost-effectiveness improved with a longer time horizon. A threshold of €30,000/QALY was passed after 18 months. The group training was cost saving after 33 months. CONCLUSIONS Cognitive-behavioral group training is a cost-effective treatment compared with the wait-list control for patients with UPS.
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Affiliation(s)
- Martijn S Visser
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Lyonne N L Zonneveld
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus Medical Center, Rotterdam, The Netherlands; Departments of Anesthesiology and Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
| | - Adriaan Van't Spijker
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Myriam G Hunink
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jan J V Busschbach
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus Medical Center, Rotterdam, The Netherlands
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15
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Watkins KE, Cuellar AE, Hepner KA, Hunter SB, Paddock SM, Ewing BA, de la Cruz E. The cost-effectiveness of depression treatment for co-occurring disorders: a clinical trial. J Subst Abuse Treat 2013; 46:128-33. [PMID: 24094613 DOI: 10.1016/j.jsat.2013.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 07/15/2013] [Accepted: 08/01/2013] [Indexed: 11/18/2022]
Abstract
The authors aimed to determine the economic value of providing on-site group cognitive behavioral therapy (CBT) for depression to clients receiving residential substance use disorder (SUD) treatment. Using a quasi-experimental design and an intention-to-treat analysis, the incremental cost-effectiveness and cost-utility ratio of the intervention were estimated relative to usual care residential treatment. The average cost of a treatment episode was $908, compared to $180 for usual care. The incremental cost effectiveness ratio was $131 for each point improvement of the BDI-II and $49 for each additional depression-free day. The incremental cost-utility ratio ranged from $9,249 to $17,834 for each additional quality adjusted life year. Although the intervention costs substantially more than usual care, the cost effectiveness and cost-utility ratios compare favorably to other depression interventions. Health care reform should promote dissemination of group CBT to individuals with depression in residential SUD treatment.
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White A, Richardson M, Richmond P, Freedman J, Bevis M. Group acupuncture for knee pain: evaluation of a cost-saving initiative in the health service. Acupunct Med 2012; 30:170-5. [PMID: 22914300 PMCID: PMC3470298 DOI: 10.1136/acupmed-2012-010151] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 05/28/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Acupuncture has been provided in nurse-led group clinics in St Albans since 2008. It is funded by a commissioning group within the National Health Service, on a trial basis, for patients with knee osteoarthritis who would otherwise be referred to an orthopaedic surgeon. AIM To evaluate the patients seen in the service's first year of operation and their outcome up to the end of 2010. METHODS Service evaluation was made of patient data from the referral centre and the acupuncture clinics, including baseline characteristics, attendance data and Measure Yourself Medical Outcome Profile (MYMOP) symptom, function and well-being scores over at least 2 years. RESULTS 114 patients were offered acupuncture, of whom 90 patients were assessed in the acupuncture clinics. 41 of these were still attending after 1 year and 31 (34%) after 2 years. MYMOP scores showed clinically significant improvements at 1 month for pain (4.2 (SD 1.2) to 2.9 (SD 1.4)), stiffness (4.1 (SD 1.3) to 2.9 (SD 1.3)) and function (4.5 (SD 1.1) to 3.3 (SD 1.2)) which continued up to 2 years. Well-being scores did not change. CONCLUSIONS This is the first evaluation of nurse-led group (multibed) acupuncture clinics for patients with knee osteoarthritis to include a 2 year follow-up. It shows the practicability of offering a low-cost acupuncture service as an alternative to knee surgery and the service's success in providing long-term symptom relief in about a third of patients. Using realistic assumptions, the cost consequences for the local commissioning group are an estimated saving of £100 000 a year. Sensitivity analyses are presented using different assumptions.
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Affiliation(s)
- Adrian White
- Department of Primary Care, Peninsula Medical School, Plymouth University, UK.
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Furlong M, McGilloway S, Bywater T, Hutchings J, Smith SM, Donnelly M. Behavioural and cognitive-behavioural group-based parenting programmes for early-onset conduct problems in children aged 3 to 12 years. Cochrane Database Syst Rev 2012:CD008225. [PMID: 22336837 DOI: 10.1002/14651858.cd008225.pub2] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [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] [Indexed: 12/18/2022]
Abstract
BACKGROUND Early-onset child conduct problems are common and costly. A large number of studies and some previous reviews have focused on behavioural and cognitive-behavioural group-based parenting interventions, but methodological limitations are commonplace and evidence for the effectiveness and cost-effectiveness of these programmes has been unclear. OBJECTIVES To assess the effectiveness and cost-effectiveness of behavioural and cognitive-behavioural group-based parenting programmes for improving child conduct problems, parental mental health and parenting skills. SEARCH METHODS We searched the following databases between 23 and 31 January 2011: CENTRAL (2011, Issue 1), MEDLINE (1950 to current), EMBASE (1980 to current), CINAHL (1982 to current), PsycINFO (1872 to current), Social Science Citation Index (1956 to current), ASSIA (1987 to current), ERIC (1966 to current), Sociological Abstracts (1963 to current), Academic Search Premier (1970 to current), Econlit (1969 to current), PEDE (1980 to current), Dissertations and Theses Abstracts (1980 to present), NHS EED (searched 31 January 2011), HEED (searched 31 January 2011), DARE (searched 31 January 2011), HTA (searched 31 January 2011), mRCT (searched 29 January 2011). We searched the following parent training websites on 31 January 2011: Triple P Library, Incredible Years Library and Parent Management Training. We also searched the reference lists of studies and reviews. SELECTION CRITERIA We included studies if: (1) they involved randomised controlled trials (RCTs) or quasi-randomised controlled trials of behavioural and cognitive-behavioural group-based parenting interventions for parents of children aged 3 to 12 years with conduct problems, and (2) incorporated an intervention group versus a waiting list, no treatment or standard treatment control group. We only included studies that used at least one standardised instrument to measure child conduct problems. DATA COLLECTION AND ANALYSIS Two authors independently assessed the risk of bias in the trials and the methodological quality of health economic studies. Two authors also independently extracted data. We contacted study authors for additional information. MAIN RESULTS This review includes 13 trials (10 RCTs and three quasi-randomised trials), as well as two economic evaluations based on two of the trials. Overall, there were 1078 participants (646 in the intervention group; 432 in the control group). The results indicate that parent training produced a statistically significant reduction in child conduct problems, whether assessed by parents (standardised mean difference (SMD) -0.53; 95% confidence interval (CI) -0.72 to -0.34) or independently assessed (SMD -0.44; 95% CI -0.77 to -0.11). The intervention led to statistically significant improvements in parental mental health (SMD -0.36; 95% CI -0.52 to -0.20) and positive parenting skills, based on both parent reports (SMD -0.53; 95% CI -0.90 to -0.16) and independent reports (SMD -0.47; 95% CI -0.65 to -0.29). Parent training also produced a statistically significant reduction in negative or harsh parenting practices according to both parent reports (SMD -0.77; 95% CI -0.96 to -0.59) and independent assessments (SMD -0.42; 95% CI -0.67 to -0.16). Moreover, the intervention demonstrated evidence of cost-effectiveness. When compared to a waiting list control group, there was a cost of approximately $2500 (GBP 1712; EUR 2217) per family to bring the average child with clinical levels of conduct problems into the non-clinical range. These costs of programme delivery are modest when compared with the long-term health, social, educational and legal costs associated with childhood conduct problems. AUTHORS' CONCLUSIONS Behavioural and cognitive-behavioural group-based parenting interventions are effective and cost-effective for improving child conduct problems, parental mental health and parenting skills in the short term. The cost of programme delivery was modest when compared with the long-term health, social, educational and legal costs associated with childhood conduct problems. Further research is needed on the long-term assessment of outcomes.
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Affiliation(s)
- Mairead Furlong
- Department of Psychology, John Hume Building, National University of Ireland Maynooth, Maynooth, Ireland.
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Woods RT, Bruce E, Edwards RT, Elvish R, Hoare Z, Hounsome B, Keady J, Moniz-Cook ED, Orgeta V, Orrell M, Rees J, Russell IT. REMCARE: reminiscence groups for people with dementia and their family caregivers - effectiveness and cost-effectiveness pragmatic multicentre randomised trial. Health Technol Assess 2012; 16:v-xv, 1-116. [PMID: 23211271 DOI: 10.3310/hta16480] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The aim of the REMiniscence groups for people with dementia and their family CAREgivers (REMCARE) study was to assess the effectiveness and cost-effectiveness of joint reminiscence groups for people with dementia and their family caregivers as compared with usual care. DESIGN A multicentre, pragmatic randomised controlled trial with two parallel arms - an intervention group and a usual-care control group - was carried out. A restricted dynamic method of randomisation was used with an overall allocation ratio of 1 : 1, restricted to ensure intervention groups of a viable size. Assessments, blind to treatment allocation, were carried out at baseline, 3 months and 10 months (primary end point). SETTING Most participants were recruited through NHS Memory Clinics and Community Mental Health Teams for older people. Assessments were usually carried out in the person's home, and treatment groups were held in a variety of community settings. PARTICIPANTS A total of 488 individuals (mean age 77.5 years) with mild to moderate dementia (meeting Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition criteria), who were initially living in the community, and who had a relative or other caregiver maintaining regular contact, who could act as an informant and was willing and able to participate in the intervention, were recruited to the study. Most carers were spouses (71%). A total of 350 dyads completed the study. INTERVENTIONS The intervention consisted of joint reminiscence groups held weekly for 12 consecutive weeks, followed by monthly maintenance sessions for a further 7 months. The sessions followed a treatment manual, and were led by two trained facilitators in each centre, supported by a number of volunteers. Up to 12 dyads were invited to attend each group. MAIN OUTCOME MEASURES The primary outcome measures were self-reported quality of life for the person with dementia and psychological distress for the carer [General Health Questionnaire-28 item version (GHQ-28)]. Secondary outcome measures included autobiographical memory and activities of daily living for the person with dementia, carer stress for the carer and mood, relationship quality and service use and costs for both parties. RESULTS The intention-to-treat analysis identified no differences in outcome between the intervention and control conditions on primary or secondary outcomes [self-reported quality of life in Alzheimer's disease: mean difference 0.07, standard error (SE) 0.65; F = 0.48; p = 0.53]. Carers of people with dementia allocated to the reminiscence intervention reported a significant increase in anxiety on a subscale of the GHQ-28 at the 10-month end point (mean difference 1.25, SE 0.5; F = 8.28; p = 0.04). Compliance analyses suggested some benefits for people with dementia who attended more reminiscence sessions; however, carers attending more groups showed increased caregiving stress. Use of health- and social-care services was modest, with no significant difference in service use between conditions. Owing to negligible difference in quality-adjusted life-year gains (derived from European Quality of Life-5 Dimensions) between the conditions the planned full economic analysis was curtailed. CONCLUSIONS This trial does not provide support for the effectiveness or cost-effectiveness of joint reminiscence groups for people with dementia and their carers. Although there may be some beneficial effects for people with dementia who attend sessions as planned, this must be viewed in the context of raised anxiety and stress in their carers. The reasons for these discrepant outcomes need to be explored further, and may necessitate reappraisal of the movement towards joint interventions. TRIAL REGISTRATION Current Controlled Trials ISRCTN42430123. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 16, No. 48. See the HTA programme website for further project information.
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Affiliation(s)
- R T Woods
- Dementia Services Development Centre Wales, Institute of Medical and Social Care Research, Bangor University, Bangor, UK
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McMurran M, Crawford MJ, Reilly JG, McCrone P, Moran P, Williams H, Adams CE, Duggan C, Delport J, Whitham D, Day F. Psycho-education with problem solving (PEPS) therapy for adults with personality disorder: a pragmatic multi-site community-based randomised clinical trial. Trials 2011; 12:198. [PMID: 21864370 PMCID: PMC3171716 DOI: 10.1186/1745-6215-12-198] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 08/24/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Impairment in social functioning is a key component of personality disorder. Therefore psycho-education and problem solving (PEPS) therapy may benefit people with this disorder. Psycho-education aims to educate, build rapport, and motivate people for problem solving therapy. Problem solving therapy aims to help clients solve interpersonal problems positively and rationally, thereby improving social functioning and reducing distress. PEPS therapy has been evaluated with community adults with personality disorder in an exploratory trial. At the end of treatment, compared to a wait-list control group, those treated with PEPS therapy showed better social functioning, as measured by the Social Functioning Questionnaire (SFQ). A definitive evaluation is now being conducted to determine whether PEPS therapy is a clinically and cost-effective treatment for people with personality disorder METHODS This is a pragmatic, two-arm, multi-centre, parallel, randomised controlled clinical trial. The target population is community-dwelling adults with one or more personality disorder, as identified by the International Personality Disorder Examination (IPDE). Inclusion criteria are: Living in the community (including residential or supported care settings); presence of one or more personality disorder; aged 18 or over; proficiency in spoken English; capacity to provide informed consent. Exclusion criteria are: Primary diagnosis of a functional psychosis; insufficient degree of literacy, comprehension or attention to be able to engage in trial therapy and assessments; currently engaged in a specific programme of psychological treatment for personality disorder or likely to start such treatment during the trial period; currently enrolled in any other trial. Suitable participants are randomly allocated to PEPS therapy plus treatment as usual (TAU) or TAU only. We aim to recruit 340 men and women. The primary outcome is social functioning as measured by the SFQ. A reduction (i.e., an improvement) of 2 points or more on the SFQ at follow-up 72 weeks post-randomisation is our pre-specified index of clinically significant change. Secondary outcomes include a reduction of unscheduled service usage and an increase in scheduled service usage; improved quality of life; and a reduction in mental distress. DISCUSSION PEPS therapy has potential as an economical, accessible, and acceptable intervention for people with personality disorder. The results from this randomised controlled trial will tell us if PEPS therapy is effective and cost-effective. If so, then it will be a useful treatment for inclusion in a broader menu of treatment options for this group of service users. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number - ISRCTN70660936.
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Affiliation(s)
- Mary McMurran
- Institute of Mental Health, University of Nottingham, Sir Colin Campbell Building, Triumph Road, Nottingham NG7 2TU, UK
| | - Mike J Crawford
- Centre for Mental Health, Imperial College London, 37 Claybrook Road, London W6 8LN, UK
| | - Joseph G Reilly
- Wolfson Research Institute, University of Durham, Queen's Campus, Stockton on Tees TS17 6BH, UK
| | - Paul McCrone
- King's College London (Institute of Psychiatry), King's College London, London SE5 8AF, UK
| | - Paul Moran
- King's College London (Institute of Psychiatry), King's College London, London SE5 8AF, UK
| | - Hywel Williams
- Clinical Trials Unit, Nottingham Health Science Partners, C Floor, South Block, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - Clive E Adams
- Institute of Mental Health, University of Nottingham, Sir Colin Campbell Building, Triumph Road, Nottingham NG7 2TU, UK
| | - Conor Duggan
- Institute of Mental Health, University of Nottingham, Sir Colin Campbell Building, Triumph Road, Nottingham NG7 2TU, UK
| | - Juan Delport
- Psychological Therapies Centre, St Tydfil's Hospital, Merthyr Tydfil, CF47 0SJ, UK
| | - Diane Whitham
- Clinical Trials Unit, Nottingham Health Science Partners, C Floor, South Block, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - Florence Day
- Clinical Trials Unit, Nottingham Health Science Partners, C Floor, South Block, Queen's Medical Centre, Nottingham NG7 2UH, UK
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Hering T. [Smoking cessation--assistance for the general practitioner]. MMW Fortschr Med 2011; 153:67-69. [PMID: 21966874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Green JM, Wood AJ, Kerfoot MJ, Trainor G, Roberts C, Rothwell J, Woodham A, Ayodeji E, Barrett B, Byford S, Harrington R. Group therapy for adolescents with repeated self harm: randomised controlled trial with economic evaluation. BMJ 2011; 342:d682. [PMID: 21459975 PMCID: PMC3069684 DOI: 10.1136/bmj.d682] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2010] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To examine the effectiveness and cost-effectiveness of group therapy for self harm in young people. DESIGN Two arm, single (assessor) blinded parallel randomised allocation trial of a group therapy intervention in addition to routine care, compared with routine care alone. Randomisation was by minimisation controlling for baseline frequency of self harm, presence of conduct disorder, depressive disorder, and severity of psychosocial stress. PARTICIPANTS Adolescents aged 12-17 years with at least two past episodes of self harm within the previous 12 months. Exclusion criteria were: not speaking English, low weight anorexia nervosa, acute psychosis, substantial learning difficulties (defined by need for specialist school), current containment in secure care. Setting Eight child and adolescent mental health services in the northwest UK. INTERVENTIONS Manual based developmental group therapy programme specifically designed for adolescents who harm themselves, with an acute phase over six weekly sessions followed by a booster phase of weekly groups as long as needed. Details of routine care were gathered from participating centres. MAIN OUTCOME MEASURES Primary outcome was frequency of subsequent repeated episodes of self harm. Secondary outcomes were severity of subsequent self harm, mood disorder, suicidal ideation, and global functioning. Total costs of health, social care, education, and criminal justice sector services, plus family related costs and productivity losses, were recorded. RESULTS 183 adolescents were allocated to each arm (total n = 366). Loss to follow-up was low (<4%). On all outcomes the trial cohort as a whole showed significant improvement from baseline to follow-up. On the primary outcome of frequency of self harm, proportional odds ratio of group therapy versus routine care adjusting for relevant baseline variables was 0.99 (95% confidence interval 0.68 to 1.44, P = 0.95) at 6 months and 0.88 (0.59 to 1.33, P = 0.52) at 1 year. For severity of subsequent self harm the equivalent odds ratios were 0.81 (0.54 to 1.20, P = 0.29) at 6 months and 0.94 (0.63 to 1.40, P = 0.75) at 1 year. Total 1 year costs were higher in the group therapy arm (£21,781) than for routine care (£15,372) but the difference was not significant (95% CI -1416 to 10782, P = 0.132). CONCLUSIONS The addition of this targeted group therapy programme did not improve self harm outcomes for adolescents who repeatedly self harmed, nor was there evidence of cost effectiveness. The outcomes to end point for the cohort as a whole were better than current clinical expectations. Trial registration ISRCTN 20496110.
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Affiliation(s)
- J M Green
- Psychiatry Research Group, University of Manchester, Manchester M13 9PL, UK.
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Stevenson MD, Scope A, Sutcliffe PA. The cost-effectiveness of group cognitive behavioral therapy compared with routine primary care for women with postnatal depression in the UK. Value Health 2010; 13:580-584. [PMID: 20384978 DOI: 10.1111/j.1524-4733.2010.00720.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To assess the cost-effectiveness of group cognitive behavior therapy (gCBT) in comparison with routine primary care for women with postnatal depression in the UK. METHODS Our analysis was based on a systematic literature review of the relative clinical effectiveness of gCBT compared with routine primary care and further reviews, supplemented with expert opinion of the likely cost of providing gCBT and the duration of comparative advantage for gCBT. Raw data were used to estimate a statistical relationship between changes in the Edinburgh Postnatal Depression Score (EPDS) values and changes in short-form six dimensions' (SF-6D) values. A mathematical model was constructed, and probabilistic sensitivity analyses were undertaken to estimate the mean cost per quality-adjusted life-year (QALY) and to evaluate the expected value of perfect information (EVPI). RESULTS The mean cost per QALY from the stochastic analysis was estimated to be pound36,062; however, there was considerable uncertainty around this value. The EVPI was estimated to be greater than pound64 million; the key uncertainties were in the cost per woman of providing treatment and in the statistical relationship between changes in EPDS values and changes in SF-6D values. The expected value of perfect partial information for both of these parameters was in excess of pound25 million. CONCLUSIONS Given the current information, the use of gCBT does not appear to be cost-effective; however, this decision is uncertain. The value of information analyses conducted indicates that further research to provide robust information on key parameters is needed and appears justified in cost-effective terms.
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Affiliation(s)
- Matt D Stevenson
- School of Health and Related Research, University of Sheffield, Sheffield, UK.
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Lamb SE, Hansen Z, Lall R, Castelnuovo E, Withers EJ, Nichols V, Potter R, Underwood MR. Group cognitive behavioural treatment for low-back pain in primary care: a randomised controlled trial and cost-effectiveness analysis. Lancet 2010; 375:916-23. [PMID: 20189241 DOI: 10.1016/s0140-6736(09)62164-4] [Citation(s) in RCA: 243] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Low-back pain is a common and costly problem. We estimated the effectiveness of a group cognitive behavioural intervention in addition to best practice advice in people with low-back pain in primary care. METHODS In this pragmatic, multicentre, randomised controlled trial with parallel cost-effectiveness analysis undertaken in England, 701 adults with troublesome subacute or chronic low-back pain were recruited from 56 general practices and received an active management advisory consultation. Participants were randomly assigned by computer-generated block randomisation to receive an additional assessment and up to six sessions of a group cognitive behavioural intervention (n=468) or no further intervention (control; n=233). Primary outcomes were the change from baseline in Roland Morris disability questionnaire and modified Von Korff scores at 12 months. Assessment of outcomes was blinded and followed the intention-to-treat principle, including all randomised participants who provided follow-up data. This study is registered, number ISRCTN54717854. FINDINGS 399 (85%) participants in the cognitive behavioural intervention group and 199 (85%) participants in the control group were included in the primary analysis at 12 months. The most frequent reason for participant withdrawal was unwillingness to complete questionnaires. At 12 months, mean change from baseline in the Roland Morris questionnaire score was 1.1 points (95% CI 0.39-1.72) in the control group and 2.4 points (1.89-2.84) in the cognitive behavioural intervention group (difference between groups 1.3 points, 0.56-2.06; p=0.0008). The modified Von Korff disability score changed by 5.4% (1.99-8.90) and 13.8% (11.39-16.28), respectively (difference between groups 8.4%, 4.47-12.32; p<0.0001). The modified Von Korff pain score changed by 6.4% (3.14-9.66) and 13.4% (10.77-15.96), respectively (difference between groups 7.0%, 3.12-10.81; p<0.0001). The additional quality-adjusted life-year (QALY) gained from cognitive behavioural intervention was 0.099; the incremental cost per QALY was 1786 pound sterling, and the probability of cost-effectiveness was greater than 90% at a threshold of 3000 pound sterling per QALY. There were no serious adverse events attributable to either treatment. INTERPRETATION Over 1 year, the cognitive behavioural intervention had a sustained effect on troublesome subacute and chronic low-back pain at a low cost to the health-care provider. FUNDING National Institute for Health Research Health Technology Assessment Programme.
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Affiliation(s)
- Sarah E Lamb
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK.
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Rash CJ, Olmstead TA, Petry NM. Income does not affect response to contingency management treatments among community substance abuse treatment-seekers. Drug Alcohol Depend 2009; 104:249-53. [PMID: 19586727 PMCID: PMC2746932 DOI: 10.1016/j.drugalcdep.2009.05.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [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: 03/17/2009] [Revised: 05/08/2009] [Accepted: 05/11/2009] [Indexed: 11/18/2022]
Abstract
The present study examined a commonly held belief that contingency management (CM) may be less effective for substance abusers with relatively more economic resources compared to those with relatively few resources. Using a combined sample of 393 treatment-seeking cocaine abusers from three clinical trials involving randomization to standard care or standard care plus CM conditions, we assessed the impact of past year income, alone and in combination with treatment condition, as well as income type (i.e., earned, illegal, unstable) on the longest duration of continuous verified abstinence (LDA) achieved during treatment. Results suggested that income had no effect on LDA in either condition, and that CM's effectiveness did not deteriorate among those with better economic resources in the present sample. This finding may be of value to clinicians and administrators who are considering the addition of CM to standard care treatments in community outpatient substance abuse clinics and have concerns about the generalizability of CM across clients with various economic resources.
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Affiliation(s)
| | | | - Nancy M. Petry
- Please address correspondence to Dr. Nancy M. Petry, Professor, Calhoun Cardiology Center, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT USA 06030-3944; Phone 860-679-2593, Fax 860-679-1312,
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Siskind D, Baingana F, Kim J. Cost-effectiveness of group psychotherapy for depression in Uganda. J Ment Health Policy Econ 2008; 11:127-133. [PMID: 18806302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/09/2007] [Accepted: 06/09/2008] [Indexed: 05/26/2023]
Abstract
BACKGROUND Low and middle-income countries are increasingly acknowledging the potential health and economic benefits associated with treatment of depression. To aid countries in making resource-allocation decisions, there is a need for cost-effectiveness analysis of treatments for depression in developing countries. Although there are a limited number of studies from developing countries that report data on treatment efficacy and costs, these data can be leveraged to tailor mathematical models that are used to evaluate the cost-effectiveness of depression treatments in specific settings. AIMS OF THE STUDY Using data from depression studies in the published literature, as well as two studies in Uganda, we developed a decision-analytic model to evaluate the cost-effectiveness of group psychotherapy in the setting of Uganda. METHODS We developed a Markov cohort model of depression and evaluated the health benefits and costs associated with group psychotherapy with and without booster sessions for recurrent depressive episodes. We synthesized published data on the epidemiology of depression, treatment efficacy, and costs to parameterize our model, and used data from developing countries where available. Outcomes included quality-adjusted life expectancy (QALY), lifetime costs, and incremental cost-effectiveness ratios (ICER). Costs were expressed in international dollars (I$) to facilitate comparisons across settings and studies. RESULTS In Uganda, group psychotherapy without booster sessions decreased average number of depressive episodes by 6.2%, compared to no intervention; with booster sessions, reduction in number of episodes increased to 15.8%. Although group psychotherapy alone was less costly than psychotherapy with booster sessions, the ICER was higher, and therefore, group psychotherapy without booster sessions was dominated. The ICER associated with psychotherapy with booster sessions was I$ 1,150 per QALY, compared to no intervention. Although higher than previously published cost-effectiveness estimates of treatments for depression, HIV and cardiovascular disease in the developing world, the ICER of psychotherapy with booster sessions falls below Uganda's per-capita GDP, a suggested threshold for cost-effectiveness. The results were most sensitive to cost of the booster sessions and health state utility for depression. DISCUSSION Our results suggest that group psychotherapy treatment with booster sessions for recurrent depressive episodes may be cost-effective in developing countries such as Uganda. These findings can assist in a global campaign for developing countries to provide and upscale appropriate depression treatment programs. However, there are only a limited number of studies on treatments for depression in the developing world with small numbers of enrolled subjects; most inputs to our Markov model relied on data from developed countries. Cultural, political, economic, and social differences between countries may limit the generalizability of our findings. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE This study suggests a promising role for group psychotherapy in treating depression. Integration of this service into primary care may result in cost-effective treatment for depression. IMPLICATIONS FOR HEALTH POLICIES In developing countries with limited health care budgets, group psychotherapy can be a cost-effective treatment option for patients with depression. IMPLICATIONS FOR FURTHER RESEARCH There are a limited number of clinical studies evaluating efficacy and costs of treatments for depression in developing countries. Research on depression in such settings can further assist in providing accurate and country-contextualized estimates of cost-effectiveness.
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Affiliation(s)
- Dan Siskind
- Program in Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, 718 Huntington Ave, 2nd Floor, Boston, MA 02115, USA.
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Oei TPS, Dingle G. The effectiveness of group cognitive behaviour therapy for unipolar depressive disorders. J Affect Disord 2008; 107:5-21. [PMID: 17716745 DOI: 10.1016/j.jad.2007.07.018] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [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: 07/21/2006] [Revised: 07/12/2007] [Accepted: 07/15/2007] [Indexed: 11/30/2022]
Abstract
This paper evaluates the effectiveness of group cognitive behaviour therapy (GCBT) as an intervention for unipolar depressive disorders. PsychINFO and PubMed databases were selected to generate the 34 papers used for this review. Our results showed that effect sizes for GCBT over the control conditions range from small (0.1) to large (2.87) with the mean effect size of 1.10. The pre-post treatment effect sizes for GCBT range from 0.30 to 3.72 with a mean of 1.30. Convergent evidence was demonstrated across different outcome measures of GCBT. Our findings indicated that GCBT yielded outcomes better than no-treatment controls and was comparable with other treatments (including both bona fide and non-bona fide comparison treatments). It was concluded that GCBT was effective for the treatment of Unipolar depression and thus can be used with confidence. There is now an urgent need to develop and evaluate a coherent GCBT theory, in particular the roles of group processes in GCBT, before further major advancement in this area can be made.
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Affiliation(s)
- Tian P S Oei
- School of Psychology, CBT Unit, Toowong Private Hospital, University of Queensland, Brisbane, Australia, 4072.
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Bird M, Jones RHL, Korten A, Smithers H. A controlled trial of a predominantly psychosocial approach to BPSD: treating causality. Int Psychogeriatr 2007; 19:874-91. [PMID: 17234041 DOI: 10.1017/s1041610206004790] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [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: 04/26/2006] [Accepted: 12/07/2006] [Indexed: 12/20/2022]
Abstract
BACKGROUND The adverse effects of behavioral and psychological symptoms of dementia (BPSD) are well described but treatment remains problematical, including overuse of psychotropic medication. This study aims to compare the outcome of two approaches to BPSD, one focusing on causality and using predominantly psychosocial interventions, the other relying predominantly on psychotropic medication. METHODS Thirty-three residential care clients manifesting BPSD who had been referred to a community psychogeriatric service (intervention group) were assessed and treated, with the focus placed on the causes of the behavior and why it was perceived as a problem by nursing staff. Cases were managed primarily by psychosocial means with psychopharmacology as an adjunct. A control group was made up of 22 referrals to an adjacent service, which used primarily psychopharmacology with psychosocial methods as an occasional adjunct. RESULTS Measures of behavior and staff response showed significant improvement in both groups at two- and five-months' follow-up. Antipsychotic use in the intervention group decreased over time while in the control group it increased. Service measures showed both groups required approximately the same number of clinical visits but the intervention group experienced fewer medication changes, fewer drug side effects, and all but one case could be treated in situ. Five control group participants spent extended periods as inpatients in a psychogeriatric unit. Minor sampling differences did not affect the results, and neither they nor the nature of the behavior explained the difference in clinical approach. CONCLUSION The causality-focused approach appears to be as effective as the more common predominantly pharmacological approach, and appears to involve lower human and financial costs.
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Affiliation(s)
- Michael Bird
- Australian National University and NSW Greater Southern Area Health Service, Queanbeyan, NSW 2620, Australia.
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Abstract
The authors evaluated hospitalization cost offset of hostility management group therapy for patients with coronary heart disease (CHD) from a previously published randomized controlled trial (Y. Gidron, K. Davidson, & I. Bata, 1999). Twenty-six male patients with myocardial infarction or unstable angina were randomized to either 2 months of cognitive-behavioral group therapy or an information (control) session. Therapy patients had a shorter average length of hospital stay (n = 13, M = 0.38 days, SD = 0.96) than did control patients (n = 13, M = 2.15 days, SD = 2.6), t(15.2) = -2.29, p = .04, over 6 months following therapy. The average hospitalization costs were significantly lower for therapy patients (M = 245(dollars), SD = 627(dollars)) than for control patients (M = 1,333(dollars), SD = 1,609(dollars)), t(15.6) = -2.27, p = .04. The cost-offset ratio is calculated by dividing the 1,088(dollars) of hospitalization savings by the 560(dollars) of therapy expense (1.00:1.94(dollars)), indicating that for every 1.00(dollars) spent on therapy, there is an approximate savings of 2.00(dollars) in hospitalization costs in the following 6 months. These findings support the hospitalization cost offset of hostility-reduction in CHD patients.
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Affiliation(s)
- Karina W Davidson
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY10032, USA.
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Dunn NJ, Rehm LP, Schillaci J, Souchek J, Mehta P, Ashton CM, Yanasak E, Hamilton JD. A randomized trial of self-management and psychoeducational group therapies for comorbid chronic posttraumatic stress disorder and depressive disorder. J Trauma Stress 2007; 20:221-37. [PMID: 17598141 DOI: 10.1002/jts.20214] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [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] [Indexed: 11/06/2022]
Abstract
The authors randomized 101 male veterans with chronic combat-related posttraumatic stress disorder (PTSD) and depressive disorder to an evidence-based depression treatment (self-management therapy; n = 51) or active-control therapy (n = 50). Main outcome measures for efficacy, using intention-to-treat analyses, were subjective and objective PTSD and depression scales at pretest, posttest, and 3-, 6-, and 12-month follow-up. Other measures included treatment compliance, satisfaction, treatment-targeted constructs, functioning, service utilization, and costs. Self-management therapy's modestly greater improvement on depression symptoms at treatment completion disappeared on follow-up. No other differences on symptoms or functioning appeared, although psychiatric outpatient utilization and overall outpatient costs were lower with self-management therapy. Despite success in other depressed populations, self-management therapy produced no clinically significant effect in depression with chronic PTSD.
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Affiliation(s)
- Nancy Jo Dunn
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA.
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Schene AH, Koeter MWJ, Kikkert MJ, Swinkels JA, McCrone P. Adjuvant occupational therapy for work-related major depression works: randomized trial including economic evaluation. Psychol Med 2007; 37:351-362. [PMID: 17112401 DOI: 10.1017/s0033291706009366] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.1] [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] [Indexed: 11/06/2022]
Abstract
BACKGROUND Major depression has far-reaching consequences for work functioning and absenteeism. In most cases depression is treated by medication and clinical management. The addition of occupational therapy (OT) might improve outcome. We determined the cost-effectiveness of the addition of OT to treatment as usual (TAU). METHOD Sixty-two adults with major depression and a mean absenteeism of 242 days were randomized to TAU (out-patient psychiatric treatment) or TAU+OT [6 months, including (i) diagnostic phase with occupational history and work reintegration plan, and (ii) therapeutic phase with individual sessions and group sessions]. Main outcome domains were depression, work resumption, work stress and costs. Assessments were at baseline and at 3, 6, 12 and 42 months. RESULTS The addition of OT to TAU: (i) did not improve depression outcome, (ii) resulted in a reduction in work-loss days during the first 18 months, (iii) did not increase work stress, and (iv) had a 75.5% probability of being more cost-effective than TAU alone. CONCLUSION Addition of OT to good clinical practice does not improve depression outcome, improves productivity without increasing work stress and is superior to TAU in terms of cost-effectiveness.
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Affiliation(s)
- Aart H Schene
- Department of Psychiatry, Programme for Mood Disorders, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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Craigie MA, Saulsman LM, Lampard AM. MCMI-III personality complexity and depression treatment outcome following group-based cognitive–behavioral therapy. J Clin Psychol 2007; 63:1153-70. [PMID: 17972295 DOI: 10.1002/jclp.20406] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Mark A Craigie
- Centre for Clinical Interventions, Northbridge, WA, Australia
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Lemieux J, Topp A, Chappell H, Ennis M, Goodwin PJ. Economic Analysis of Psychosocial Group Therapy in Women with Metastatic Breast Cancer. Breast Cancer Res Treat 2006; 100:183-90. [PMID: 16773438 DOI: 10.1007/s10549-006-9249-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2006] [Accepted: 04/12/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE Metastatic breast cancer is associated with psychological distress in one-third of patients. We examined the impact of group psychosocial support on health care costs in metastatic breast cancer. Psychosocial interventions have been shown to reduce psychological distress in these patients. In other diseases, depression and anxiety have been associated with higher health care system resource utilization. METHODS Data on health care system resources utilization were collected as part of a Canadian multicenter randomized controlled trial of a supportive-expressive group support in metastatic breast cancer. Costs were obtained from one tertiary care hospital in Toronto. A cost minimization analysis was conducted since there was no survival difference; the primary endpoint of the study. Cost-effectiveness analyses were conducted for mood and pain. RESULTS Total health care utilization costs (including costs of the group therapy intervention) for the intervention and control groups were $31,715 and $28,189, respectively per patient. The difference in total costs between groups ($3,526) was not statistically significant (P = 0.53). The cost-effectiveness analysis for mood showed the intervention group to have an increased cost of $5,550 per patient for an effect size of 0.5 on the POMS scale. The corresponding cost for pain was $4,309. An exploratory analysis on patients who were more distressed at baseline showed a non-significant decrease in cost in favor of the intervention arm (difference of $3,911 P = 0.66). CONCLUSION Psychosocial intervention, in the form of supportive-expressive group support for metastatic breast cancer, does not lower health care system resource utilization.
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Affiliation(s)
- Julie Lemieux
- Samuel Lunenfeld Research Institute of the Mount Sinai Hospital, University of Toronto, 1284-600 University Ave, M5G 1X5 Toronto, ON, Canada.
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Sigmon SC, Stitzer ML. Use of a low-cost incentive intervention to improve counseling attendance among methadone-maintained patients. J Subst Abuse Treat 2006; 29:253-8. [PMID: 16311177 DOI: 10.1016/j.jsat.2005.08.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2005] [Revised: 08/01/2005] [Accepted: 08/01/2005] [Indexed: 11/29/2022]
Abstract
Despite the importance of counseling in methadone maintenance treatment, many patients do not take advantage of these services. Incentives for attending group counseling were offered to methadone-maintained patients during an orientation phase of treatment or during required attendance at a relapse group later in treatment. Upon attending each counseling session, patients could draw for prizes under an escalating draw system with a 50% probability that draws would result in a prize. Incentives included small (1dollar), moderate (5 dollars), and large (20 dollars) prizes, with chances of winning inversely related to prize costs, and a maximum possible total of 160 dollars per patient. It was anticipated that this policy would provide a relatively low-cost approach to improving counseling attendance in our methadone clinic. The incentive policy significantly increased the percent of counseling sessions attended (52% vs. 76%) and promoted periods of continuous attendance. These data further support the effectiveness of low-cost incentive programs in enhancing counseling attendance among methadone patients.
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Affiliation(s)
- Stacey C Sigmon
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA.
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Abstract
CONTEXT Despite the availability of efficacious treatments, the long-term course of bipolar disorder is often unfavorable. OBJECTIVE To test the effectiveness of a multicomponent intervention program to improve the quality of care and long-term outcomes for persons with bipolar disorder. DESIGN Randomized controlled trial with allocation concealment and blinded outcome assessment. SETTING Mental health clinics of a group-model prepaid health plan. PATIENTS Of 785 patients in treatment for bipolar disorder who were invited to participate, 509 attended an evaluation appointment, 450 were found eligible to participate, and 441 enrolled in the trial. INTERVENTIONS Participants were randomly assigned to a multicomponent intervention program or to continued care as usual. Three nurse care managers provided a 2-year systematic intervention program, including the following: a structured group psychoeducational program, monthly telephone monitoring of mood symptoms and medication adherence, feedback to treating mental health providers, facilitation of appropriate follow-up care, and as-needed outreach and crisis intervention. MAIN OUTCOME MEASURES In-person blinded research interviews every 3 months assessed mood symptoms using the Longitudinal Interval Follow-up Examination. Health plan administrative records were used to assess the use and cost of mental health services. RESULTS Intent-to-treat analyses demonstrated that the intervention significantly reduced the mean level of mania symptoms (z = 2.09, P = .04) and the time with significant mania symptoms (19.2 vs 24.7 weeks; F(1) = 6.0, P = .01). There was no significant intervention effect on mean level of depressive symptoms (z = 0.19, P = .85) or time with significant depressive symptoms (47.6 vs 50.7 weeks; F(1) = 0.56, P = .45). Benefits of the intervention were found only in a subgroup of 343 persons with clinically significant mood symptoms at the baseline assessment. The incremental cost (adjusted) of the intervention was 1251 dollars (95% confidence interval, 55-2446 dollars), including approximately 800 dollars for the intervention program services and an approximate 500 dollars increase in the costs of other mental health services. CONCLUSIONS Population-based systematic care programs can significantly reduce the frequency and severity of mania in bipolar disorder, and cost increases are modest considering the clinical gains. The incorporation of more specific cognitive and behavioral content or more effective medication regimens may be necessary to significantly reduce the symptoms of depression.
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Affiliation(s)
- Gregory E Simon
- Center for Health Studies, Group Health Cooperative, and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle 98101, USA.
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Hall SM, Lightwood JM, Humfleet GL, Bostrom A, Reus VI, Muñoz R. Cost-effectiveness of bupropion, nortriptyline, and psychological intervention in smoking cessation. J Behav Health Serv Res 2005; 32:381-92. [PMID: 16215448 DOI: 10.1007/bf02384199] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Sustained-release bupropion and nortriptyline have been shown to be efficacious in treating cigarette smoking. Psychological intervention is also recognized as efficacious. The cost and cost-effectiveness of the 2 drug therapies have not been estimated. It was hypothesized that nortriptyline would be more cost-effective than bupropion. Hypotheses were not originally proposed concerning the cost-effectiveness of psychological versus drug treatment, but the 2 were compared using exploratory analyses. This was a 3 (bupropion versus nortriptyline versus placebo) by 2 (medical management alone versus medical management plus psychological intervention) randomized trial. Participants were 220 cigarette smokers. Outcome measures were cost and cost-effectiveness computed at week 52. Nortriptyline cost less than bupropion. Nortriptyline was more cost-effective than bupropion; the difference was not statistically significant. Psychological intervention cost less than the 2 drug treatments, and was more cost-effective, but not significantly so. Prospective investigations of the cost and cost-effectiveness of psychological and pharmacological intervention, using adequate sample sizes, are warranted.
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Affiliation(s)
- Sharon M Hall
- Department of Psychiatry, University of California, San Francisco, 94143, USA.
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Abstract
AIMS To compare the performance of competing and complementary interventions for prevention or treatment of problem drinking and alcohol dependence. To provide an example of how health maximising decision-makers might use performance measures such as cost per quality adjusted life year (QALY) league tables to formulate an optimal package of interventions for problem drinking and alcohol dependence. METHODS A time-dependent state-transition model was used to estimate QALYs gained per person for each intervention as compared to usual care in the relevant target population. RESULTS Cost per QALY estimates for each of the interventions fall below any putative funding threshold for developed economies. Interventions for problem drinkers appear to offer better value than interventions targeted at those with a history of severe physical dependence. CONCLUSIONS Formularies such as Australia's Medicare should include a comprehensive package of interventions for problem drinking and alcohol dependence.
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Affiliation(s)
- Duncan Mortimer
- Centre for Health Economics, Faculty of Business and Economics, Monash University, VIC 3800, Australia.
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Abstract
This article presents a three-module intervention based on social action theory that focuses on health promotion and social identity formation for seropositive youth. The modules are designed to reduce transmission of HIV by reducing sexual and substance abuse acts, increasing healthy acts and adherence to care, and maintaining positive behavioral routines. Components of the modules are described, including examples of how these components are implemented in the actual intervention sessions. The importance of using successive approximation to consolidate changes in behavior by defining social roles and personal identities that are consistent with positive behavioral routines is demonstrated. Outcomes of the intervention are presented as well as issues of cost-effectiveness, feasibility, and alternative implementation strategies.
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Affiliation(s)
- Marguerita Lightfoot
- Center for Community Health, Neuropsychiatric Institute, University of California-Los Angeles, USA
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Bittman BB, Snyder C, Bruhn KT, Liebfreid F, Stevens CK, Westengard J, Umbach PO. Recreational Music-making: An Integrative Group Intervention for Reducing Burnout and Improving Mood States in First Year Associate Degree Nursing Students: Insights and Economic Impact. Int J Nurs Educ Scholarsh 2004; 1:Article12. [PMID: 16646877 DOI: 10.2202/1548-923x.1044] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The challenges of providing exemplary undergraduate nursing education cannot be underestimated in an era when burnout and negative mood states predictably lead to alarming rates of academic as well as career attrition. While the multi-dimensional nature of this complex issue has been extensively elucidated, few rational strategies exist to reverse a disheartening trend recognizable early in the educational process that subsequently threatens to undermine the future viability of quality healthcare. This controlled prospective crossover study examined the impact of a 6-session Recreational Music-making (RMM) protocol on burnout and mood dimensions as well as Total Mood Disturbance (TMD) in first year associate level nursing students. A total of 75 first year associate degree nursing students from Allegany College of Maryland (ACM) participated in a 6-session RMM protocol focusing on group support and stress reduction utilizing a specific group drumming protocol. Burnout and mood dimensions were assessed with the Maslach Burnout Inventory and the Profile of Mood States respectively. Statistically significant reductions of multiple burnout and mood dimensions as well as TMD scores were noted. Potential annual cost savings for the typical associate degree nursing program ($16,800) and acute care hospital ($322,000) were projected by an independent economic analysis firm. A cost-effective 6-session RMM protocol reduces burnout and mood dimensions as well as TMD in associate degree nursing students.
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Dzator JA, Hendrie D, Burke V, Gianguilio N, Gillam HF, Beilin LJ, Houghton S. A randomized trial of interactive group sessions achieved greater improvements in nutrition and physical activity at a tiny increase in cost. J Clin Epidemiol 2004; 57:610-9. [PMID: 15246129 DOI: 10.1016/j.jclinepi.2003.10.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2003] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Weight gain may follow altered eating habits and decreased physical activity in couples beginning to live together. Mutual support and willingness to accept changes in lifestyle at this stage may facilitate positive responses to health promotion. We aimed to compare the effects of a diet and physical activity program in couples using a randomized controlled trial. STUDY DESIGN AND SETTING Couples were randomized to a control group or to one of two intervention groups in whom the program was either delivered mainly by mail or with a combination of mail-outs and interactive group sessions. RESULTS Diets, physical fitness, and blood cholesterol improved up to 12 months after beginning the 4-month program, mainly in the interactive group. In that group, at the end of the program, the estimated cost was 445.30 dollars (111.33 dollars/month) per participant per unit change in outcome variables, only 0.03 dollars per participant per month more than the group receiving the program mainly by mail. One year after beginning the program, costs per participant per month were 38.37 dollars in the interactive group and 38.22 dollars in the group receiving the program mainly by mail-out. CONCLUSION The changes observed in cardiovascular risk factors could translate to a substantial cost-savings relating to health.
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Affiliation(s)
- J A Dzator
- School of Policy, University of Newcastle, Newcastle, NSW, Australia
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Bleichhardt G, Timmer B, Rief W. Cognitive-behavioural therapy for patients with multiple somatoform symptoms--a randomised controlled trial in tertiary care. J Psychosom Res 2004; 56:449-54. [PMID: 15094031 DOI: 10.1016/s0022-3999(03)00630-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.0] [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: 05/29/2002] [Accepted: 10/08/2002] [Indexed: 11/25/2022]
Abstract
OBJECTIVE (a) To evaluate the effect of a cognitive-behavioural inpatient treatment and (b) to analyse the differential efficacy of an additional ("soma") group management training of somatisation. METHODS The final sample consisted of 191 patients with somatisation syndrome (patients with at least eight DSM-IV somatoform symptoms). Patients were randomly assigned to (I) "standard treatment + soma" or (II) "standard treatment + relaxation training." A waiting control group consisted of 34 patients. All patients were diagnosed with a structured clinical interview for DSM-IV and received an interview on medical consulting behaviour and questionnaires concerning somatoform symptoms, general psychopathology, subjective health status, and life satisfaction. RESULTS Results show high impairment of the sample prior to treatment. At the 1-year follow-up, all outcome criteria were significantly reduced. The differential effect of the additional soma treatment was significant only for a reduction of visits to the doctor. Greatest longitudinal effect sizes were found for the reduction of somatoform symptoms. CONCLUSION Considering the subjects' high initial impairment, the outcome results are encouraging. The specific effect on health care use highlights the socioeconomic relevance.
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Affiliation(s)
- Gaby Bleichhardt
- Roseneck-Centre for Behavioural Medicine, Prien am Chiemsee, Germany.
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Abstract
Psychiatric day care has a long tradition. However, psychotherapeutic day care institutions specialising in particular disorders or certain therapeutic approaches are still the exception. A day care unit for behaviour therapy was established at the Clinic for Psychiatry and Psychotherapy, University Hospital Hamburg-Eppendorf in 1998 as part of a complex inpatient, day care, and outpatient behaviour therapy unit. The immediate and high acceptance by patients and their doctors indicates a strong need of such a treatment setting. We present how this day care unit works and how it differs from the traditional psychiatric day care.
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Affiliation(s)
- A Mundt
- Arbeitsbereich Verhaltenstherapie der Klinik für Psychiatrie und Psychotherapie des Universitätsklinikums Hamburg-Eppendorf, Germany
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Montero I, Asencio A, Hernández I, Masanet MJ, Lacruz M, Bellver F, Iborra M, Ruiz I. Two strategies for family intervention in schizophrenia: a randomized trial in a Mediterranean environment. Schizophr Bull 2002; 27:661-70. [PMID: 11824492 DOI: 10.1093/oxfordjournals.schbul.a006905] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [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] [Indexed: 11/12/2022]
Abstract
Controlled intervention studies carried out in families of schizophrenia patients have been shown to have a positive impact in relapse prevention, but it remains to be seen whether different forms of family intervention affect outcomes other than relapse and hospital readmission in different ways. This study compared the outcome profile of relevant clinical variables after two different family intervention strategies for schizophrenia patients in public health care in a Spanish sample. We conducted a randomized controlled study comparing (1) a relatives group (RG) and (2) a single-family behavioral family therapy (BFT), both offered as standard treatment in one catchment area in Valencia. All randomized patients were included in the main analysis, and all cases remained in the therapy group to which they were originally assigned regardless of whether they suffered a relapse. The relapse rate at 12 months for the 87 cases studied was not significantly different in the two groups, but the two approaches did affect outcomes other than relapse and rehospitalization (such as social functioning, dose of antipsychotic medication, "delusions" and "thought disorder") in different ways. The BFT approach offered more advantages than the RG approach. The results suggest that these approaches should always be implemented in a clinical environment in a Mediterranean setting.
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Affiliation(s)
- I Montero
- Department of Psychiatry, Valencia University School of Medicine, Spain.
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Abstract
Developmental concerns and sociocultural expectations may keep female patients and therapists from addressing financial issues openly in group psychotherapy. Interpersonal theory provides a different view of nurturing that may help women leaders deal better with financial discussions in group. This paper includes a review of the literature on group psychotherapy and fees; feminist literature relevant to leadership; money management in group therapy; countertransference; and case examples.
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Goldfield GS, Epstein LH, Kilanowski CK, Paluch RA, Kogut-Bossler B. Cost-effectiveness of group and mixed family-based treatment for childhood obesity. Int J Obes (Lond) 2001; 25:1843-9. [PMID: 11781766 DOI: 10.1038/sj.ijo.0801838] [Citation(s) in RCA: 121] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2001] [Revised: 06/05/2001] [Accepted: 06/25/2001] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Family-based, behavioral treatment has been shown to be an effective intervention for the management of pediatric obesity. The goal of this study was to compare the cost-effectiveness of two protocols for the delivery of family-based behavioral treatment. RESEARCH METHODS AND PROCEDURES Thirty-one families with obese children were randomized to groups in which families were provided mixed treatment incorporating both group and individualized treatment vs group treatment only. Cost-effectiveness of treatment was defined as the magnitude of reduction in standardized BMI and percentage overweight per dollar spent for recruitment and treatment. Anthropometric data were assessed at baseline, 6 months and 12 months post-randomization. RESULTS Results for the 24 families with complete data showed the group intervention was significantly more cost-effective than the mixed treatment. This was due to the similarity between the two groups in Z-BMI or percentage overweight change for children and their parents, while the mixed treatment was significantly more expensive to deliver than the group treatment. DISCUSSION These findings suggest that a family-based, behavioral intervention employing group treatment alone is a more cost-effective approach to treating pediatric obesity than a mixed group plus individual format.
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Affiliation(s)
- G S Goldfield
- Mental Health Research, Children's Hospital of Eastern Ontario Research Institute, Ontario, Canada
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Taylor NT, Burlingame GM, Kristensen KB, Fuhriman A, Johansen J, Dahl D. A survey of mental health care provider's and managed care organization attitudes toward, familiarity with, and use of group interventions. Int J Group Psychother 2001; 51:243-63. [PMID: 11321903 DOI: 10.1521/ijgp.51.2.243.49848] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Managed Care has had a significant impact on delivery systems for mental health services. Direct and indirect persuasion to provide more cost-effective treatments has been one consequence. The cost-saving qualities and the effectiveness of group interventions have produced clear expectations for an increased use of therapy groups. This study compared perceptions and uses of group treatments on a national sample of managed care organizations and mental health providers. Because group psychotherapy encompasses such a broad definition, five specific types of group interventions were defined: problem-focused homogenous, process-oriented heterogeneous, psycho-educational, self-help, and short-term groups. Implications of differences and similarities between directors of managed care organizations and treatment providers are examined and discussed across five response categories (familiarity/training, perceived effectiveness, likelihood of reimbursement/referral, daily use, and expectation for future use).
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Affiliation(s)
- N T Taylor
- Taylor Behavioral Health, 1681 East Niagara Road, Montrose, CO 81401, USA
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Abstract
In this study, we describe the types and amounts of psychiatric treatment received by a well-defined sample of borderline personality disorder (BPD) inpatients, and compare these parameters with those of a group of carefully diagnosed personality-disordered controls. Finally, we assess the risk factors associated with a history of intensive, high-cost treatment, which we defined as having had two or more prior psychiatric hospitalizations. The treatment histories of 290 borderline inpatients and 72 axis II controls were assessed using a reliable semistructured interview. All nine forms of treatment studied except electroconvulsive therapy (ECT) were common among borderline patients (36% to 96%). In addition, a significantly higher percentage of borderline patients than axis II controls reported a history of individual and group therapy, day and residential treatment, psychiatric hospitalization, participating in self-help groups, and taking standing medications. They were also significantly younger when they first entered individual therapy and began to take standing medications. In addition, borderline patients spent more time than axis II controls in individual therapy and psychiatric hospitals, and were on standing medications for a significantly longer period of time. They also reported a significantly higher number of psychiatric hospitalizations, lifetime number of standing medications, and number of psychotropic medications taken at the same time. In addition, we found a highly significant multivariate predictive model for multiple prior hospitalizations. The six significant predictors were age 26 or older, a history of quasi psychotic thought, lifetime number of self-mutilative efforts and suicide attempts, a childhood history of reported sexual abuse, and an adult history of being physically and/or sexually assaulted. Taken together, these results confirm clinical impressions concerning the high rates of mental health services used by borderline patients. They also suggest that particularly high rates of costly inpatient treatment are associated with a complex admixture of older age, BPD symptoms in the cognitive and impulse realms, and traumatic life experiences occurring in both childhood and adulthood.
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Affiliation(s)
- M C Zanarini
- Laboratory for the Study of Adult Development, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA
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Abstract
The changes in health-care financing that have taken place over the last decade have spurred interest in finding innovative ways of delivering services at manageable cost levels. It comes as no surprise that increased interest and research have focused on group therapies as a major vehicle for reaching large numbers of people in need of psychological care that is brief, effective, and cost-efficient. More specifically, practitioners in the field of substance abuse have long recognized the value of group experiences as an integral part of the recovery and rehabilitative process. The influence of managed care to contain costs has added new incentives to expand the existing knowledge base in group treatment of addictions to comply with reduced funding and time constraints.
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Affiliation(s)
- H I Spitz
- Columbia University College of Physicians and Surgeons, USA
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Albrecht M, Krauth C, Rieger J, Lamprecht F, Kersting A, Schwartz FW. [Concept for a health care economic evaluation of short- and long-term costs and effectiveness parameters of an expanded ambulatory psychosomatic rehabilitation program]. Gesundheitswesen 2000; 62:156-60. [PMID: 10815342 DOI: 10.1055/s-2000-10485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
There are only few ambulatory rehabilitation concepts for mothers with psychosomatic disorders (prevalence 5%). Also, only little is known about the evaluation of these programmes. This study compares the socioeconomic evaluations of an ambulatory rehabilitation programme with a post-assistance programme and one without a post-assistance programme. The superior programme should be determined by weighing all relevant costs and benefits. The intensive phase of the ambulatory rehabilitation programme consists of an eight-week treatment with group, single, body and art therapy. The post-assistance programme spans a period of nine-months with 36 sessions of psychoanalytic group therapy. The evaluation of both programme alternatives is made by with the evaluation tool of socioeconomic analyses. For consideration and pricing of costs all direct medical costs, direct non-medical costs and indirect costs are being monitored. Outcomes assessment is realised by cost-effectiveness analysis, cost-utility analysis and cost-benefit analysis. Utilisation of the health care system is being assessed with questionnaires. Measurements are being performed at the beginning and the end of the rehabilitation programme and three, six, nine and twelve months later. Mothers with children aged six years and younger and suffering from various psychosomatic disorders were included in this study. The costs identified for the rehabilitation programme are DM 5571.10 (intensive care and post-assistance programme) and DM 1512.40 (intensive care) per patient. Further progress of the study will show if future cost will differ between the two alternatives. For the comparison of both alternatives all costs will be linked with outcomes. It remains to be seen that additional costs of the post-assistance programme will be compensated with positive outcomes. A sensitivity analysis will show if variation of assumptions will influence the cost-benefit-ratio of the different alternatives.
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Affiliation(s)
- M Albrecht
- Abt. Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Medizinische Hochschule Hannover
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