A Markov Model Approach Assessing the Cost of Illness of Generalized Anxiety Disorder in Canada

Abstract

IntroductionGeneralized anxiety disorder (GAD) is a chronic disease with waxing and waning of symptoms. This is the first comprehensive economic model developed to reflect the nature and course of GAD.MethodsAn incidence-based probabilistic Markov model was developed reflecting nine GAD health states (HS): clinical assessments (three HS), maintenance therapies (four HS), discontinuation (one HS), and death (one HS). A probability curve of the GAD onset (ages 18–80) determined entry into the model and assumed patients retained the diagnoses until death. Canadian Psychiatric Association (CPA) guidelines determined pharmacotherapy, with revisions/validation by an expert panel. Direct costs (clinician, pharmacotherapy, hospitalization) were retrieved from government publications. Remission was based on pooled-analysis of CPA-cited evidence. Remaining clinical rates, absenteeism, and hospitalization were retrieved from the literature. Direct costs were attributed throughout the model except for the discontinuation and death HS. Indirect costs (wage rate) were retrieved from government publications and the literature (absenteeism), and were attributed to patients with GAD ≤65 years of age. Results were discounted at 5% and results expressed in 2008 Canadian dollars.ResultsThe mean lifetime cost of illness (COI) was estimated to be $31,213 (SD $9,100) per patient. The cost of absenteeism accounted for 96% of the mean COI. The mean age of onset was 31 years and approximately 19% did not respond to pharmacotherapy. Over 85% of patients discontinued treatment by the fourth cycle (2nd year of therapy). Over the course of the model, a mean of 53% of patients relapsed, with an average rate of 0.79 relapses per patient. On average and over a lifetime, the disorder went unmanaged over a period of 14 (SD 9) years. The model was most sensitive to absenteeism.ConclusionGAD is a costly disease with a lifetime COI <$32k/patient, with absenteeism exerting a significant impact.

Markerless motion capture systems as training device in neurological rehabilitation: a systematic review of their use, application, target population and efficacy

“…Six out of 18 studies included a control group, consisting of five RCTs and one CCT [ 31 ]. Although five of the 18 included studies were RCT’s [ 2 , 3 , 21 , 32 , 33 ], only one study was single blinded [ 21 ]. No studies were double blinded.…”

“…Three different types of MCS were used, as shown in Table 1 . Sixteen studies involved training with Microsoft Kinect system [ 1 , 3 , 5 , 6 , 21 , 23 , 31 – 34 , 36 – 41 ], one study used Gesture Xtreme (which was not described in detail in the original publication) [ 2 ] and one study used a motion capture platform but did not further specify the system [ 35 ].…”

“…VR, on the other hand, is a computer-based technology that allows users to interact with simulated environments and receive feedback on performance. VR also stimulates the increase of intensity of movements, therefore it may facilitate motor learning and neuroplasticity through repetition and increased intensity during task-oriented training [ 2 – 4 ]. Compared to the traditional methods used in motor rehabilitation of patients with neurological disorders, VR has some advantages: 1) patients can perform different rehabilitation exercises, recreated in a virtual way (i.e.…”

Cross-Cultural Adaptation and Validation of the Jebsen-Taylor Hand Function Test in an Italian Population

“…We conducted a MEDLINE search for articles regarding the “Jebsen Taylor hand function test” and found more than 174 publications using this test as a mean to evaluate the outcome. Among these publications, 32 deal with cerebral stroke [ 7 , 8 ], 26 with unilateral cerebral palsy [ 9 , 10 ], 15 with hemiparesis [ 11 , 12 ], 2 with Parkinson's disease [ 13 , 14 ], 5 with tetraplegia [ 15 , 16 ], 2 with spinal cord injury [ 17 , 18 ], 3 with carpal tunnel syndrome [ 19 – 21 ], 6 with fractures [ 22 , 23 ], 9 with rheumatic arthropathies [ 24 , 25 ], 4 with prosthetic rehabilitation [ 26 , 27 ], 3 with virtual rehabilitation [ 28 , 29 ], 5 with diabetes [ 30 , 31 ], 5 with burns [ 32 , 33 ], 14 with manual dexterity [ 34 , 35 ], 6 with splints [ 36 , 37 ], and many other articles with individual diseases such as spina bifida cystica [ 38 ], Duchenne muscular dystrophy [ 39 ], and Huntington disease [ 40 ].…”

A Fresh Perspective on a Familiar Problem

“…We assumed that after treatment was completed, patients were able to recoup 80% of their lost earnings. 42 We also assumed that patients participated in the workforce between the ages of 45 and 65 and retired above age 65.…”