Journal of Mental Health Policy and Economics最新文献

{"title":"Cost-Effectiveness of Digital Preventive Parent Training for Early Childhood Disruptive Behaviour.","authors":"Elisa Rissanen, Virpi Kuvaja-Köllner, Eila Kankaanpää","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Childhood disruptive behaviour disorder associates with various, also costly problems. Parent training is effective in reducing childhood disruptive behaviour. Only a few studies have evaluated the cost-effectiveness of digital parent training in reducing children's disruptive behaviour.</p><p><strong>Aims of the study: </strong>We evaluated the two-year cost-effectiveness of an Internet and telephone assisted parent training intervention called the Strongest Families Smart Website (SFSW) for prevention of children's disruptive behaviour compared to education control (EC) from the combined perspective of the health care funder and parents.</p><p><strong>Methods: </strong>This study used data from a randomized controlled trial (RCT). The trial screened a population-based sample of 4,656 four-year-olds at annual child health clinic check-ups in Finnish primary care. A total of 464 disruptively behaving children participated in the RCT; half received the SFSW and half EC. We evaluated intention-to-treat based incremental net monetary benefit with a range of willingness to pay values. Costs contained the interventions' and parents' time-use costs. The effectiveness measure was the Child Behavior Checklist (CBCL/1.5-5) externalizing score. The trial is registered at Clinicaltrials.gov (NCT01750996).</p><p><strong>Results: </strong>From the health care funder's perspective, SFSW costs per family were €1,982 and EC €661, and from the parents' perspective SFSW costs per family were €462 and EC €77. From the combined health care funder and parents' perspective, costs were €1,707 higher in the SFSW intervention than in EC. The SFSW decreased the CBCL externalizing score (1.94, SE=0.78, p=0.01) more in comparison to the EC group. In cost-effectiveness analysis using the combined perspective, the incremental net monetary benefit was zero [95% CI €-1,524 to €1,524] if the willingness to pay for one extra point of CBCL externalizing score reduced was €879. If the willingness to pay was more than €879, the average incremental net monetary benefit was positive.</p><p><strong>Discussion: </strong>The cost-effectiveness of the SFSW depends on the decision makers' willingness to pay, which is not stated for CBCL outcomes. Also, the decision maker should consider the uncertainty of cost-effectiveness estimates. The lack of other service use information and micro-costing of SFSW and EC intervention costs weakens our conclusions. However, our study had multiple strengths, such as population-based screening, high sample size, 2-year follow-up, and use of proper methods to conduct a full economic evaluation.</p><p><strong>Implications for health care provision and use: </strong>The SFSW is effective in reducing children's disruptive behaviour. Although digitally provided, the SFSW intervention included professional time and, thus, costs. The costs of intervention to the healthcare provider and time cost to families should be taken into ac","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship of Cryptocurrency Trading to Quality of Life, Sleep and Stress Levels in Academics","authors":"Mehmet Uçar, Metin Yildiz, Necmettin Çiftci, Rukuye Aylaz","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Cryptocurrency trading has become popular with a large section of society, and the number of investors is increasing daily. It is critical to address the health impacts of cryptocurrency trading. Of particular importance is the issue of how such trading affects mental health. Research should be conducted on this topic, and where necessary, national governments should develop policies to combat these effects.</p><p><strong>Aims: </strong>This study was conducted to examine the relationship of cryptocurrency trading to quality of life, sleep, and stress levels in academics.</p><p><strong>Methods: </strong>This descriptive and cross-sectional study was conducted with 437 academics working at a state university in Turkey. A Personal Information Form, the SF-12 Quality of Life Scale, the Scopa Sleep Scale, and the Perceived Stress Scale were used to collect data. These data were analyzed using SPSS 25.0 and G*Power 3.1 programs.</p><p><strong>Results: </strong>The data obtained in this study were analyzed using SPSS program (SPSS-25). The effect size and r-effect size were calculated with Cohen’s d value. It was found that the mean scores for the SF-12 Quality of Life Scale were statistically lower in academics who traded cryptocurrency than in those who did not. The results showed that the mean scores for the Scopa Sleep Scale and Perceived Stress Scale were statistically higher in academics who traded cryptocurrency than in those who did not (p<0.05).</p><p><strong>Discussion: </strong>The academics who traded cryptocurrency had more negative health outcomes when compared to those who did not. Social awareness should be raised on the negative effects of cryptocurrency trading. A limitation of the study is that only data obtained from the statements of the participants were included in the study. The study may have some generalizability to other academics, but has less generalizability to populations other than academics.</p><p><strong>Implications for health care provision and use: </strong>Cryptocurrency trading is a significant public health problem. Although cryptocurrency trading has been found to profoundly affect mental health (sleep, stress, and quality of life), the current policies that address these problems are generally inadequate in terms of implementing and sustaining mental healthcare systems. The limitations of these health policies prevent many individuals in society from receiving high quality services.</p><p><strong>Implications for health policies: </strong>Health systems alone cannot solve the systemic problems that lead to the population’s dependence of mental health services and institutions. In order to solve this basic problem, it may be necessary for governments to increase individuals’ basic incomes and develop specific mental health policies for people engaged in cryptocurrency trading.</p><p><strong>Implications for further research: </strong>Future studies should examine expert perspectiv","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental Health Expenditure in Canada.","authors":"Olga Milliken, Hui Wang, Marie-Chantal Benda, Thy Dinh, Alan Diener","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Mental ill-health-illness or conditions related to mental health, including dementia, schizophrenia, mood (affective) disorders, and mental and behaviour disorders due to psychoactive substance and alcohol use - places a significant burden on society in terms of economic, health, and social costs. Focusing on direct health care costs, estimated expenditures on treating mental health conditions accounted for up to 14% of total health expenditures across 12 OECD countries over the period of 2003 to 2010.</p><p><strong>Aims of the study: </strong>The purpose of this study was to estimate the direct health care costs associated with the treatment of mental ill-health in Canada for the year 2019 using currently available guidelines. A consistent and systematic method, such as that used in the OECD guidelines on expenditure by disease, age and gender under the System of Health Accounts, can provide valuable information for policy makers and improve comparability of Canadian estimates with those of peer countries.</p><p><strong>Methods: </strong>To derive comprehensive, and internationally comparable estimates of mental health care expenditures, the results were classified according to the OECD System of Health Accounts 2011 for the following cost components: hospitals, physicians, psychologists in private practice, prescription drugs, and community mental health care. Based on data availability, both public and private expenditures were captured. Where data were lacking, estimates were based on the published literature.</p><p><strong>Results: </strong>Total expenditure for mental health care was estimated at $17.1 billion in Canada in 2019. Hospital services (inpatient and outpatient) represent the largest component totaling $5.5 billion or 32% of total mental health spending. They are followed by expenditures on prescribed pharmaceutical drugs of $4.3 billion (25%), community-based care of $3.6 billion (21%), physician services of $2.7 billion (16%) and services of psychologists in private practice of $1.1 billion (6%).</p><p><strong>Discussion: </strong>The study provided the most recent and comprehensive estimate of mental health expenditure in Canada. The results for similar cost components, are comparable to those found in the previous studies. Expenditures directed towards mental health treatment accounted for 6.4% of total health expenditures, and 6.9% of public health expenditures, in 2019, on par with the OECD average of 6.7% for twenty-three countries. Among considered cost components, community-based mental health and addiction services remain an area where further work is needed the most, including a standardized list of services reported by each Canadian province/territory regardless of care setting, service administrator or funder.  In Canada, data challenges are considerable to assess private spending out-of-pocket or through third-party insurance for services by psychologists or psychotherapists, as well ","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal Depression and Physical Health of Under-Five Children in Turkey.","authors":"Gokben Aydilek, Deniz Karaoğlan","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Maternal depression is the most prevalent mental health problem worldwide, especially in low- and middle-income countries. It impairs the cognitive, physical, and social abilities of mothers and disturbs effective parenting practices. Therefore, the consequences of mental, physical, and social suffering are not limited to the mother herself but are transmitted to future generations by negatively affecting the child's health.</p><p><strong>Aim of the study: </strong>This study aims to analyse the relationship between maternal depression and child's physical health in Turkey, a middle-income, developing country.</p><p><strong>Methods: </strong>By using the 2019 round of the \"Turkish Health Survey\" dataset prepared by the Turkish Statistical Institute (TurkStat), we focus on the general health status, anaemia prevalence, morbidity of acute respiratory infections (ARI) and diarrhoea along with other common short-term childhood illnesses among under-five children. Maternal depression is assessed by the standardised eight-item version of the Patient Health Questionnaire (PHQ-8). We employ a linear probability model to examine the relationship between maternal depression and the physical health of under-five children. In addition, we investigate the potential protective role of maternal education against the detrimental effects of maternal depression on child health. Since we are simultaneously analysing several outcome measures, in order to avoid any Type I error, we use the novel Romano-Wolf multiple hypothesis testing method.</p><p><strong>Results: </strong>We find that children whose mothers suffer from mild to severe depression are at a 12 percentage points higher risk of contracting infectious diseases. Similarly, the total number of non-chronic illnesses a child falls victim to increases by one-third if the mother portrays depressive symptoms. In addition, our results suggest that completing at least high school reduces the burdens of maternal depression on children's physical health by 8 percentage points.</p><p><strong>Discussion: </strong>Considering both the individual and societal burden of infectious disease prevalence, we conclude that the development of worldwide policies and initiatives aimed at decreasing maternal depression as much as increasing maternal education is essential for safeguarding the rights of both women and children, especially in developing countries.</p><p><strong>Limitations of the study: </strong>The findings of this research provide a linear association between maternal mental health and under-five child's physical health, rather than a causal effect.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141433056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PERSPECTIVE: Implications of Recent Health Policies for Women's Reproductive Mental Health.","authors":"Kara Zivin, Anna Courant","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The economic cost of perinatal mood and anxiety disorders (PMADs) is high and includes the cost of reduced maternal economic productivity, more preterm births, and increases in other maternal mental health expenditures. PMADs also substantially contribute the cost of maternal morbidity. This paper offers a discussion of the quality-of-care cascade model of PMADs, which outlines care pathways that people typically face as well as gaps and unmet needs that frequently happen along the way. The model uses the US health system as an example. A discussion of international implications follows.</p><p><strong>Discussion: </strong>The quality-of-care cascade model outlines downward dips in quality of care along the perinatal mental health treatment continuum, including access (many Americans do not have access to affordable health insurance), enrollment (even when individuals are offered health insurance, some do not enroll), coverage (even if individuals have health insurance, some needed services or providers may not be covered), choice (even if services and providers are covered, patients may not be able to choose among plans, institutions, or clinicians), consistency (even if patients have a choice of plan or provider, a consistent source of care may not be accessible), referral (even if care is available and accessible, referral services may not be), quality (even if patients have access to both care and referral services, there may be gaps in the quality of care provided), adherence (even if patients receive high-quality care, they may not be adherent to treatment), barriers (societal forces that may influence people's choices and behaviors), and shocks (unanticipated events that could disrupt care pathways). In describing the quality-of-care cascade model, this paper uses the US healthcare system as the primary example. However, the model can extend to examine quality-of-care dips along the perinatal mental health treatment continuum within the international context. Although the US healthcare system may differ from other healthcare systems in many respects, shared commonalities lead to quality-of-care dips in countries with healthcare systems structured differently than in the US.</p><p><strong>Implications for health policies: </strong>The global cost of PMADs remains substantial, and addressing the costs of these conditions could have a significant impact on overall cost and quality of care internationally. The quality-of-care cascade model presented in this paper could help identify, understand, and address the complex contributing factors that lead to dips in quality-of-care for perinatal mental health conditions across the world.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141433081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PERSPECTIVE: A Fireside Chat about Global Mental Health with Dr. Esther Duflo, Nobel Laureate in Economics.","authors":"Benjamin Lê Cook, Esther Duflo","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Dr. Esther Duflo, Nobel Laureate in Economics, and co-founder and co-director of the Abdul Latif Jameel Poverty Action Lab (J-PAL) sat down with Dr. Benjamin Cook for a \"fireside chat\" at the 12th National Institute of Mental Health Global Mental Health Research Without Borders Conference. Dr. Duflo discussed J-PAL's efforts to develop and test interventions for improving mental health and how cash transfer programs can be used to improve mental health. She also discussed the importance of using randomized control trials (RCTs) in shaping global mental health initiatives. Dr. Duflo shared insights from projects addressing loneliness among older individuals in India, secondary school scholarships in Ghana, and other studies that have informed social policies. Looking forward, she discusses climate change as a threat to the reductions in poverty realized in the last 30 years and encourages the expansion of networks of research and policy collaborations to improve global health.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141433080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PERSPECTIVE: Health Economic Interests at NIMH and NIDA to Improve Delivery of Behavioral Health Services.","authors":"Jennifer L Humensky, Sarah Q Duffy, Leonardo Cubillos, Michael C Freed, Agnes Rupp","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Effective financing mechanisms are essential to ensuring that people can access and utilize effective treatments and services. Financing mechanisms are needed not only to pay for the delivery of those treatments and services, but also ancillary costs, while also keeping care affordable.</p><p><strong>Aims: </strong>This article highlights key areas of the interest of the National Institute of Mental Health (NIMH) and the National Institute on Drug Abuse (NIDA) in supporting applied health economics and health care financing research. Specifically, this article discusses the long-range impact of NIH's earlier investments in applied health economics research, and NIH's ongoing efforts to communicate its interests in health economics research. We discuss the 2023 NIMH-NIDA-sponsored health economics conference, and the ideas presented there for developing and assessing innovative behavioral health care financing models; three of the presented papers were recently published in the Journal of Mental Health Policy and Economics.</p><p><strong>Methods: </strong>We describe the history and impact of NIMH- and NIDA-sponsored economic research and identify current research interests as identified in the NIMH and NIDA Strategic Plans and recent funding announcements. We examine themes presented at the NIMH-NIDA Health Economics conference. The conference included over 300 participants from 20 countries, from six continents.</p><p><strong>Results: </strong>The topics highlighted at the conference highlight the ways in which NIH-funded research has promoted the development of innovative health care financing methods, both from the supply side (e.g., providers and payers) and demand side (e.g., service users and families). Invited speakers discussed the findings from NIH-supported research in the topic areas of payment and financing, behavioral economics and social determinants of health. Keynote speakers highlighted emerging topics in the field, including the economics of health equity, biases in mental health models in health care, and value-based insurance design.</p><p><strong>Discussion: </strong>We demonstrate a resurgence of and explicit interest in health economics and policy research at NIMH and NIDA. However, more work is needed in order to design funding mechanisms that fully provide access to and facilitate use of effective evidence-based practices to improve mental health outcomes. For example, it is important that policy and health economic research projects include decision makers who will be the end users of data and study results, to ensure that results can be meaningfully put into practice.</p><p><strong>Implications for health care: </strong>Designing effective and efficient funding mechanisms can help ensure that service users have access to effective treatments and that clinicians and provider organizations are adequately compensated for their work.</p><p><strong>Implications for health policies: </strong>Fe","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11268881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140869947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PERSPECTIVE: A Path to Value-Based Insurance Design for Mental Health Services.","authors":"Michael C Freed, Jennifer L Humensky, Patricia A Arean","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Aligning cost of mental health care with expected clinical and functional benefits of that care would incentivize the delivery of high value treatments and services. In turn, ineffective or untested care could still be offered but at costs high enough to offset the delivery of high value care.</p><p><strong>Aims: </strong>The authors comment on Benson and Fendrick's paper on Value-Based Insurance Design (VBID) for mental health in the September 2023 special issue of this journal. The authors also present a preliminary framework of key ingredients needed to consider VBID for mental health treatments and services.</p><p><strong>Methods: </strong>The authors briefly review current and past efforts to contain costs and improve quality of mental health care, which include (for example) use of carve-out and carve-in programs, evaluation of cost sharing models, impact of accountable care organizations, and studying other benefit designs and impact of federal and state policies.</p><p><strong>Results: </strong>Using PTSD as an example, key ingredients of VBID for mental health services were identified and include the following: tools for case identification and monitoring progress over time at the population level; specific treatments and services with evidence of clinical effectiveness, cost-effectiveness, and health equity; and an approach to document the specific treatment or service was delivered (versus another treatment or service that may lack evidence).</p><p><strong>Discussion: </strong>The inability to afford mental health care is a top barrier to treatment seeking. People who do elect to spend time and money on mental health care are further disadvantaged by accessing care that is not well regulated and the quality at best is questionable. VBID could be an important lever for increasing access to and use of high value mental health care. Partnerships among the research, practice, and policy communities can help ensure research solutions meet needs of these two communities.</p><p><strong>Implications for health care: </strong>VBID holds promise to make high value mental health care more affordable while discouraging low value treatments and services.</p><p><strong>Implications for health policies: </strong>While evidence gaps remain, these gaps can be filled concurrently with pursuit of VBID for mental health services.</p><p><strong>Implications for future research: </strong>This paper identifies important research opportunities to help make VBID a reality for mental health care.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11062318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140869244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Antidepressants in Combination with Psychotherapy.","authors":"Farrokh Alemi, Tulay G Soylu, Mary Cannon, Conor McCandless","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Consensus-guidelines for prescribing antidepressants recommend that clinicians should be vigilant to match antidepressants to patient's medical history but provide no specific advice on which antidepressant is best for a given medical history.</p><p><strong>Aims of the study: </strong>For patients with major depression who are in psychotherapy, this study provides an empirically derived guideline for prescribing antidepressant medications that fit patients' medical history.</p><p><strong>Methods: </strong>This retrospective, observational, cohort study analyzed a large insurance database of 3,678,082 patients. Data was obtained from healthcare providers in the U.S. between January 1, 2001, and December 31, 2018. These patients had 10,221,145 episodes of antidepressant treatments. This study reports the remission rates for the 14 most commonly prescribed single antidepressants (amitriptyline, bupropion, citalopram, desvenlafaxine, doxepin, duloxetine, escitalopram, fluoxetine, mirtazapine, nortriptyline, paroxetine, sertraline, trazodone, and venlafaxine) and a category named \"Other\" (other antidepressants/combination of antidepressants). The study used robust LASSO regressions to identify factors that affected remission rate and clinicians' selection of antidepressants. The selection bias in observational data was removed through stratification. We organized the data into 16,770 subgroups, of at least 100 cases, using the combination of the largest factors that affected remission and selection bias. This paper reports on 2,467 subgroups of patients who had received psychotherapy.</p><p><strong>Results: </strong>We found large, and statistically significant, differences in remission rates within subgroups of patients. Remission rates for sertraline ranged from 4.5% to 77.86%, for fluoxetine from 2.86% to 77.78%, for venlafaxine from 5.07% to 76.44%, for bupropion from 0.5% to 64.63%, for desvenlafaxine from 1.59% to 75%, for duloxetine from 3.77% to 75%, for paroxetine from 6.48% to 68.79%, for escitalopram from 1.85% to 65%, and for citalopram from 4.67% to 76.23%. Clearly these medications are ideal for patients in some subgroups but not others. If patients are matched to the subgroups, clinicians can prescribe the medication that works best in the subgroup. Some medications (amitriptyline, doxepin, nortriptyline, and trazodone) always had remission rates below 11% and therefore were not suitable as single antidepressant therapy for any of the subgroups.</p><p><strong>Discussions: </strong>This study provides an opportunity for clinicians to identify an optimal antidepressant for their patients, before they engage in repeated trials of antidepressants.</p><p><strong>Implications for health care provision and use: </strong>To facilitate the matching of patients to the most effective antidepressants, this study provides access to a free, non-commercial, decision aid at http://MeAgainMeds.com.</p><p><strong>Implicati","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140863732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Economic Burden of Chronic Psychotic Disorders: An Incidence-based Cost-of-Illness Approach.","authors":"Claire de Oliveira, Bryan Tanner","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The economic burden of chronic psychotic disorders is substantial. However, few studies have employed an incidence based approach to estimate the economic burden of chronic psychotic disorders. Furthermore, the existing work has mainly used models populated with data obtained from published literature, making several assumptions to estimate incidence-based costs.</p><p><strong>Aims of the study: </strong>The objective of this study was to estimate the direct cumulative mean health care costs of chronic psychotic disorders, using an incidence-based, cost-of-illness approach and real-world data from a single-payer health care system.</p><p><strong>Methods: </strong>Using health records from Ontario, Canada, all individuals with a valid health card number, residing in the province, and diagnosed with a chronic psychotic disorder between the ages of 16 and 45 from April 1st, 2006, to March 31st, 2021, were included in the analysis. Using a mix of bottom-up and top-down methodologies and a robust cost estimator, cumulative mean health care costs were estimated from diagnosis to death or the end of observation period. Cumulative mean health care costs, and respective 95% confidence intervals (CIs), were estimated for the 1-year period (i.e., first year post-diagnosis), overall, by sex, age groups and health service, and for the 5-, 10- and 15-periods, overall and by sex.</p><p><strong>Results: </strong>One-, 5-, 10- and 15-year total discounted cumulative mean health care costs were estimated at USD 24,441.16, 95% CI (USD 24,166.13, USD 24,716.19), USD 70,754.69, 95% CI (USD 69,827.48-USD 71,681.89), USD 117,136.88, 95% CI (USD 115,370.40-USD 118,903.35), and USD 157,829.01 95% CI (USD 155,599.32.-USD 160,058.70), respectively. Total mean 1-year costs post-diagnosis were higher for younger individuals. Although females had higher 1-year costs, males had higher 5-, 10- and 15-year costs. Psychiatric hospitalisations made up the largest component of total costs across all cost estimates.</p><p><strong>Discussion: </strong>These results suggest that the costs of chronic psychotic disorders are high in the year of diagnosis and then increase at a decreasing rate thereafter. Compared to previous work, the cost estimates from the present study suggest that the use of real-world data produces lower estimates of cumulative costs, albeit likely more accurate ones. However, these estimates do not account for costs of care provided in community-based agencies.</p><p><strong>Implications for health policies: </strong>These estimates will serve as important inputs for policymakers looking to make decisions around resource allocation.</p><p><strong>Implications for future research: </strong>Future research should seek to follow incident cases in administrative data over a longer time period to obtain cumulative costs of longer duration.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140856280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}