Journal of Mental Health Policy and Economics最新文献

{"title":"An Economic Evaluation of Coordinated Specialty Care (CSC) Services for First-Episode Psychosis in the U.S. Public Sector.","authors":"Sean M Murphy,&nbsp;Suat Kucukgoncu,&nbsp;Yuhua Bao,&nbsp;Fangyong Li,&nbsp;Cenk Tek,&nbsp;Nicholas J K Breitborde,&nbsp;Sinan Guloksuz,&nbsp;Vivek H Phutane,&nbsp;Banu Ozkan,&nbsp;Jessica M Pollard,&nbsp;John D Cahill,&nbsp;Scott W Woods,&nbsp;Robert A Cole,&nbsp;Michael Schoenbaum,&nbsp;Vinod H Srihari","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Schizophrenia spectrum disorders exert a large and disproportionate economic impact. Early intervention services may be able to alleviate the burden of schizophrenia spectrum disorders on diagnosed individuals, caregivers, and society at large. Economic analyses of observational studies have supported investments in specialized team-based care for early psychosis; however, questions remain regarding the economic viability of first-episode services in the fragmented U.S. healthcare system. The clinic for Specialized Treatment Early in Psychosis (STEP) was established in 2006, to explicitly model a nationally-relevant U.S. public-sector early intervention service. The purpose of this study was to conduct an economic evaluation of STEP, a Coordinated Specialty Care service (CSC) based in a U.S. State-funded community mental health center, relative to usual treatment (UT).</p><p><strong>Methods: </strong>Eligible patients were within 5 years of psychosis onset and had no more than 12 weeks of lifetime antipsychotic exposure. Participants were randomized to STEP or UT. The annual per-patient cost of the STEP intervention per se was estimated assuming a steady-state caseload of 30 patients. A cost-offset analysis was conducted to estimate the net value of STEP from a third-party payer perspective. Participant healthcare service utilization was evaluated at 6 months and over the entire 12 months post randomization. Generalized linear model multivariable regressions were used to estimate the effect of STEP on healthcare costs over time, and generate predicted mean costs, which were combined with the per-patient cost of STEP.</p><p><strong>Results: </strong>The annual per-patient cost of STEP was $1,984. STEP participants were significantly less likely to have any inpatient or ED visits; among individuals who did use such services in a given period, the associated costs were significantly lower for STEP participants at month 12. We did not observe a similar effect with regard to other healthcare services. The predicted average total costs were lower for STEP than UT, indicating a net benefit for STEP of $1,029 at month 6 and $2,991 at month 12; however, the differences were not statistically significant.</p><p><strong>Conclusions: </strong>Our findings are promising with regard to the value of STEP to third-party payers.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"21 3","pages":"123-130"},"PeriodicalIF":1.6,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6314808/pdf/nihms-1003367.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36764553","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":"A Cost-effectiveness Study of the Impact of the Affordable Care Act on Depression Outcomes in the United States.","authors":"Babak Mohit","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>Two separate changes in insurance regulation have altered mental health delivery to Americans: (i) the Mental Health Parity and Addiction Equity Act (MHPA 2008) and (ii) the Patient Protection and Affordable Care Act (ACA 2010). This study aims to model and provide estimates for the costs and effects of depression that are impacted by these regulations.</p><p><strong>Method: </strong>Literature exists on the effectiveness of insurance coverage in reducing the prevalence, the costs of treatment and lost productivity time, as well as the health related quality of life (HRQL) associated with depression. Data from this literature is employed in a Markov model to obtain costs and effects associated with depression under both the MHPA and the ACA regulations as compared to without either one.</p><p><strong>Results: </strong>The implementation of these regulations may reduce the per capita lifetime costs of depression treatment and lost productivity by USD 215 and enhance life expectancy by 0.01 Quality Adjusted Life Years (QALY) per capita.</p><p><strong>Conclusions: </strong>If the savings of these regulations are expanded over the entire cohort of Americans adults, the potential cost savings from treated depression are estimated at USD 47.30 billion in addition to 2.2 million QALYs saved.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"21 2","pages":"71-78"},"PeriodicalIF":1.6,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36273284","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":"Child Labor Hazard on Mental Health: Evidence from Brazil.","authors":"Temidayo James Aransiola,&nbsp;Marcelo Justus","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Child labor has been usually claimed to produce negative effects on health. However, most of the studies that investigated this hypothesis examined only its impact on child laborers' physical health. This study formulates the hypothesis that child labor may have an impact on the mental health of these individuals.</p><p><strong>Aims of study: </strong>The aim of this study was to investigate the risk of child laborers to develop symptoms of depression in adulthood and to examine the role of physical and mental health of the family members on their risk of developing depression.</p><p><strong>Data and methods: </strong>We used the 2008 National Household Sample Survey (PNAD, Pesquisa Nacional por Amostra de Domicilios) and its special supplements to estimate probit models.</p><p><strong>Results: </strong>Individuals who started working between the age group of 15-17 have about 0.6 percentage points lesser risk of developing depression as compared to those who started working between the age group of 10-14. Further reduction of this risk was observed for the age groups of 18-19 and 20-24. No statistical evidence was found regarding older age groups. Individuals with a mother with depression have about 3.2 percentage points higher risk of presenting symptoms of depression. Chronic physical illness in mothers increases the risk of depression in child laborers by 0.3 percentage points.</p><p><strong>Discussion and conclusion: </strong>Our study supports the hypothesis that work during childhood increases the risk of developing depression in adulthood. Family mental health status and chronic physical illness play a substantial role in the risk that child laborers have to develop depression.</p><p><strong>Implications for health policies: </strong>The results of the study indicate the need of basic mental health services aimed to the assessment and care for child laborers who withdraw from work, with the aim of reducing the risk of depression in adulthood. The results underline also the importance of mental health assessment and care for those children with a family member with depression or chronic physical illness.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"21 2","pages":"49-58"},"PeriodicalIF":1.6,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36273282","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":"Cost-effectiveness Analysis of a Stepped, Collaborative and Coordinated Health Care Network for Patients with Somatoform Disorders (Sofu-Net).","authors":"Thomas Grochtdreis,&nbsp;Christian Brettschneider,&nbsp;Meike Shedden-Mora,&nbsp;Katharina Piontek,&nbsp;Hans-Helmut König,&nbsp;Bernd Löwe","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Somatoform disorders are highly prevalent mental disorders causing impairment and large economic burden. In order to improve the diagnosis and management of affected patients, a health care network for somatoform disorders (Sofu-Net) was implemented in primary care.</p><p><strong>Aims of the study: </strong>The aim of the study was to determine the cost-effectiveness of a stepped, collaborative and coordinated health care network for somatoform and functional disorders (Sofu-Net) compared with regular primary care physician (PCP) practices in German primary care from a societal perspective.</p><p><strong>Methods: </strong>This study was part of a 6-month controlled, prospective, non-randomized, observer-blinded cluster cohort trial. Participants were recruited from 33 PCP practices in Hamburg, Germany. The health care network was a collaboration of PCPs, psychotherapists, inpatient clinics and a specialized outpatient clinic. Participants in the control group received usual care. A cost-effectiveness analysis, using treatment response as measure of effectiveness, was performed. Uncertainty in cost-effectiveness was analyzed using cost-effectiveness acceptability curves.</p><p><strong>Results: </strong>In total, n=218 patients (n=119 patients in the intervention group and n=99 patients in the control group) were included in the study. At 6 months, patients within the Sofu-Net group did not differ significantly from the control group with regard to costs (533; standard error 941) and treatment response (--10.3%). For Sofu-Net, the probability of being cost-effective at a willingness-to-pay (WTP) of 10,000 per additional response to treatment was only 31%.</p><p><strong>Discussion: </strong>Sofu-Net is unlikely to be cost-effective. Even for high WTP, the probability of cost-effectiveness was low. The results were robust to variation of costs included in the analysis as well as when only complete cases were included in the analysis. The most important limitations of the study were that randomization could not be established at patient level and at practice level and that the study design did not allow measurement of costs at baseline.</p><p><strong>Conclusion: </strong>Patients with severe somatic symptoms did not benefit from the health care network. Sofu-Net might have reduced costs in patients with moderate somatic symptoms.</p><p><strong>Implications for further research: </strong>Owing to the limitations and due to a short follow-up of this study, further cost-effectiveness analyses with high methodological quality and a follow-up of at least one year are needed in order to produce results that are more reliable.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"21 2","pages":"59-69"},"PeriodicalIF":1.6,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36273283","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":"Measuring Efficiency at the Interface of Behavioral and Physical Health Care.","authors":"Parashar Pravin Ramanuj, Deborah M Scharf, Erin Ferenchick, Brigitta Spaeth-Rublee, Harold Alan Pincus","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Measures of efficiency in healthcare delivery, particularly between different parts of the healthcare system could potentially improve health resource utilization. We use a typology adapted from the Agency for Healthcare Research and Quality to characterize current measures described in the literature by stakeholder perspective (payer, provider, patient, policy-maker), type of output (reduced utilization or improved outcomes) and input (physical, financial or both).</p><p><strong>Aims of the study: </strong>To systematically describe measures of healthcare efficiency at the interface of behavioral and physical healthcare and identify gaps in the literature base that could form the basis for further measure development.</p><p><strong>Methods: </strong>We searched the Medline database for studies published in English in the last ten years with the terms 'efficiency', 'inefficiency', 'productivity', 'cost' or 'QALY' and 'mental' or 'behavioral' in the title or abstract. Studies on healthcare resource utilization, costs of care, or broader healthcare benefits to society, related to the provision of behavioral health care in physical health care settings or to people with physical health conditions or vice versa were included.</p><p><strong>Results: </strong>85 of 6,454 studies met inclusion criteria. These 85 studies described 126 measures of efficiency. 100 of these measured efficiency according to the perspective of the purchaser or provider, whilst 13 each considered efficiency from the perspective of society or the consumer. Most measures counted physical resources (such as numbers of therapy sessions) rather than the costs of these resources as inputs. Three times as many measures (95) considered service outputs as did quality outcomes (31).</p><p><strong>Discussion: </strong>Measuring efficiency at the interface of behavioral and physical care is particularly difficult due to the number of relevant stakeholders involved, ambiguity over the definition of efficiency and the complexity of providing care for people with multimorbidity. Current measures at this interface concentrate on a limited range of outcomes.</p><p><strong>Limitations: </strong>We only searched one database and did not review the gray literature, nor solicit a call for relevant but unpublished work. We did not assess the methodological quality of the studies identified.</p><p><strong>Implication for health care provision and use: </strong>Most measures of healthcare efficiency are currently viewed from the perspective of payers and providers, with very few studies addressing the benefits of healthcare to society or the individual interest of the consumer. One way this imbalance could be addressed is through much stronger involvement of consumers in measurement-development, for example, by an expansion in patient-reported outcome measures in assessing quality of care.</p><p><strong>Implications for health policies: </strong>Integrating behavioral ","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"21 2","pages":"79-86"},"PeriodicalIF":1.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36273285","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":"Changes in the Utilization of Mental Health Care Services and Mental Health at the Onset of Medicare.","authors":"Jordan H Rhodes","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The onset of Medicare eligibility at age 65 in the U.S. is accompanied by significant changes in health insurance coverage rates. This presents a unique opportunity to study the interaction among health insurance, health care utilization, and health outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;This study examines if changes in mental health outcomes accompany the changes in health insurance coverage rates at age 65.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;2006-2013 data from the Sample Adult and Person File components of the National Health Insurance Survey are used to explore the link between the onset of Medicare and the utilization of mental health care services and mental health. A regression discontinuity design is employed to test for changes in perceived financial barriers to mental health care, visits with mental health professionals, and self-reported mental health. In addition to identifying the overall effect, analysis is also conducted on samples that are stratified by level of education to test for heterogeneous treatment effects across socioeconomic groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The coverage changes that occur at age 65 are associated with a substantial decline in self-reported financial barriers to receiving mental health care. This effect is greatest among individuals from lower socioeconomic backgrounds. Despite the decline in the percentage of adults claiming they did not obtain mental health care services because of prohibitive costs, no significant changes in mental health visits or self-reported mental health are identified. The implementation of lower cost-sharing requirements for outpatient mental health care through the Medicare Patients and Providers Act of 2008 (MIPPA) has had no statistically significant effect on mental health visits at the age 65 cutoff for Medicare eligibility.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;There is no estimated change in mental health visits, yet prohibitive costs of mental health care decline, especially among individuals from lower socioeconomic groups. These findings may be the result of newly eligible Medicare enrollees either increasing their utilization of mental health visits on the intensive margin, obtaining alternative sources of treatment for mental illness, or facing other barriers to care that are unrelated to costs. Additionally, estimates pertaining to mental health visits are imprecise, and large changes relative to age 64 means cannot be ruled out.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health care provision and use: &lt;/strong&gt;There is no evidence that gaining health insurance coverage at age 65 results in increased visits with mental health professionals on the extensive margin.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health policy: &lt;/strong&gt;For the previously uninsured and under-insured, the onset of Medicare coverage at age 65 results in a reduction in cost-sharing requirements for mental health care. These reductions have no clear effect on overall mental health v","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"21 1","pages":"29-41"},"PeriodicalIF":1.6,"publicationDate":"2018-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35998592","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":"Thirty-day Readmission Rates and Associated Factors: A Multilevel Analysis of Practice Variations in French Public Psychiatry.","authors":"Coralie Gandré,&nbsp;Jeanne Gervaix,&nbsp;Julien Thillard,&nbsp;Jean-Marc Macé,&nbsp;Jean-Luc Roelandt,&nbsp;Karine Chevreul","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Inpatient psychiatric readmissions are often used as an indicator of the quality of care and their reduction is in line with international recommendations for mental health care. Research on variations in inpatient readmission rates among mental health care providers is therefore of key importance as these variations can impact equity, quality and efficiency of care when they do not result from differences in patients' needs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims of the study: &lt;/strong&gt;Our objectives were first to describe variations in inpatient readmission rates between public mental health care providers in France on a nationwide scale, and second, to identify their association with patient, health care providers and environment characteristics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We carried out a study for the year 2012 using data from ten administrative national databases. 30-day readmissions in inpatient care were identified in the French national psychiatric discharge database. Variations were described numerically and graphically between French psychiatric sectors and factors associated with these variations were identified by carrying out a multi-level logistic regression accounting for the hierarchical structure of the data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Significant practice variations in 30-day inpatient readmission rates were observed with a coefficient of variation above 50%. While a majority of those variations was related to differences within sectors, individual patient characteristics explained a lower part of the variations resulting from differences between sectors than the characteristics of sectors and of their environment. In particular, an increase in the mortality rate and in the acute admission rate for somatic disorders in sectors' catchment area was associated with a decrease in the probability of 30-day readmission. Similarly, an increase in the number of psychiatric inpatient beds in private for-profit hospitals per 1,000 inhabitants in sectors' catchment area was associated with a decrease in this probability, which also varied with overall sectors' case-mix characteristics and with the level of urbanisation of the area.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;The extent of the variations and the factors associated with it question the adequacy of care and suggest that some of them may be unwarranted. Our findings should however be interpreted in consideration of several limits inherent to data quality and availability as we relied on information from administrative databases. While we considered a wide range of factors potentially associated with variations in 30-day readmissions, our model indeed only explained a limited part of the variations resulting from differences between sectors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health policies: &lt;/strong&gt;Our findings underscored that practice variations in psychiatry are a reality that merits the full attention of decision makers as they can impact the quality, equity an","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"21 1","pages":"17-28"},"PeriodicalIF":1.6,"publicationDate":"2018-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35998591","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":"How does Economic Recession Affect Substance Use? A Reality Check with Clients of Drug Treatment Centres.","authors":"Pol Bruguera,&nbsp;Jillian Reynolds,&nbsp;Eilish Gilvarry,&nbsp;Fleur Braddick,&nbsp;Abdul Latheef Marath-Veettil,&nbsp;Peter Anderson,&nbsp;Zofia Mielecka-Kubien,&nbsp;Eileen Kaner,&nbsp;Antoni Gual","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>The relationship between economic downturns and substance use has been studied in numerous economic crises occurring worldwide, but the precise relationship between the two remains unclear.</p><p><strong>Aims: </strong>The aim of the present study was to undertake a survey on behaviour and perspectives related to the latest European economic crisis among illegal drug users attending substance treatment services.</p><p><strong>Design and methods: </strong>We conducted a questionnaire-based survey in drug dependence treatment settings, in three geographically different jurisdictions (England, Catalonia and Poland), including 180 drug users.</p><p><strong>Results: </strong>Most of the participants of the survey (58.3%) reported an increase in drug use during the crisis, compared with only 25.6% of the sample who reported a decrease in drug use. The main reason given for increasing drug use was greater amount of free time available. Other important reasons were greater substance availability during this period, more stress at work and seeking comfort in response to the loss of a stable source of income, social status and/or family. Those who reported cutting down on the amount of drug use during the economic recession, reported economic difficulties as the main reason. Other important factors were family and friends' economic problems and the fear of losing their job. Illegal drug use reduction was compensated by increased smoking in 46.3% of the patients, and increased alcohol use in 39.4%.</p><p><strong>Discussion and conclusions: </strong>While this result has potential interest for those developing policies and interventions to reduce drug-related harm, longitudinal studies and future research involving a broader population of drug-users (including those not in treatment) could shed further light on these behavioural mechanisms linking changes in drug use with economic recessions.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"21 1","pages":"11-16"},"PeriodicalIF":1.6,"publicationDate":"2018-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35998590","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":"Health State Utilities for Patient's Current Health from Bipolar Type I Disorder.","authors":"Masoumeh Banihashemian,&nbsp;Arash Rashidian,&nbsp;Faeze Gholamian,&nbsp;Mahboubeh Parsaeian,&nbsp;Najmeh Moradi,&nbsp;Homayoun Amini","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Bipolar Type I Disorder (BID) is a disabling mental disorder among young adults that places enormous psychological, social, and economic burdens on patients, their families, and health care systems and decreases quality of life (QOL). Few studies have investigated the quality-adjusted life-years (QALY), health state preferences, and utilities in patients with BID.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim of study: &lt;/strong&gt;The aim of this study was to elicit health state utilities for current health among a sample of individuals with BID irrespective of their clinical conditions at the time of evaluation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;One hundred individuals with BID were consecutively enrolled in this cross-sectional study. Preferences were elicited from patients with visual analogous scale (VAS) and time trade-off (TTO). To assess quality of life, the Farsi version of the World Health Organization's QOL Instrument-Short Version (WHOQOL-BREF) was used. In addition, health state was assessed with the Short Form-36 (SF-36) health survey, and then a specially- derived reduced version of the SF-36 (the `SF-6D') was calculated as an alternative to existing preference-based measures of health for conducting economic evaluation of various interventions. Moreover, several clinical measures were administered to participants.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The mean (S.D.) VAS, TTO, and SF-6D utility scores were 0.59 (0.21), 0.44 (0.33), and 0.61 (0.11), respectively. There were significant associations of most selected clinical characteristics with VAS and TTO scores. Additionally, there were strong correlations between all domains of WHOQOL-BREF and VAS scores as well as moderate to strong correlations with TTO scores. Furthermore, there were strong correlations between all scales of SF-36 scores and VAS scores as well as moderate to strong correlations between the scales of SF-36 scores and TTO scores.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;The current study showed that even unstable patients could evaluate their own health states. Furthermore, the present study showed substantial decrements in health-related life preferences among persons with BID. Additionally, the patients with most recent depressive or mixed episodes reported lower VAS scores than those with most recent manic episodes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;This study was performed on a group of patients with BID in a referral psychiatric center. This sample can potentially make a selection bias. Furthermore, this study was cross-sectional.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health care provision and use: &lt;/strong&gt;Generally, clinical features could explain more than half of the variances in VAS utility scores. Among all clinical features, severity of symptoms and duration of disease were among the main factors significantly associated with the utility decreases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implication for health policies: &lt;/strong&gt;The present study data provide health state preferences useful fo","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"21 1","pages":"3-10"},"PeriodicalIF":1.6,"publicationDate":"2018-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35998589","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 Cost-effectiveness of the Online MindSpot Clinic for the Treatment of Depression and Anxiety in Australia.","authors":"Yu-Chen Lee,&nbsp;Lan Gao,&nbsp;Blake F Dear,&nbsp;Nickolai Titov,&nbsp;Cathrine Mihalopoulos","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The MindSpot Clinic (MindSpot) offers internet-delivered cognitive behavior therapy (iCBT) courses for people with anxiety and depressive disorders in Australia. The efficacy credentials of the courses offered at MindSpot are now well established but not the credentials of cost-effectiveness. The current study is aimed to evaluate the cost-effectiveness of the Wellbeing Course offered in MindSpot in comparison with the routine/usual care (defined as care in the absence of MindSpot) for people with symptoms of depression or/and anxiety from the perspective of Australian Department of Health.</p><p><strong>Methods: </strong>An economic model using a one-year decision-tree framework was constructed. The four health states in the model included: fully recovered; partially recovered; no improvement; and deteriorated. The probabilities between the four health states in the model were derived from a series of individual client datasets and from the Australian National Survey of Mental Health and Wellbeing. The EuroQol Five Dimension -- Five Level was used to derive the utilities, and costs were expressed in 2014 Australian dollars. Sensitivity analyses were conducted to examine the robustness of results to key model parameters.</p><p><strong>Results: </strong>In the base case analysis, for people seeking treatment, care offered at Mindspot cost less and achieved greater benefits compared to the comparator. By adopting MindSpot, an additional 505 of fully recovered and 223 of partially recovered clients can be achieved per annum compared to routine/usual care. The result of the sensitivity analyses indicated the result of the analysis were robust.</p><p><strong>Conclusions: </strong>This study found that the iCBT treatments provided by MindSpot were highly cost-effective in comparison with current routine/usual care in the Australia setting. However, future research using a prospective matched comparator that comprehensively assesses all the respective costs is required to verify the current study findings.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"20 4","pages":"155-166"},"PeriodicalIF":1.6,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35708476","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}