Cost-effectiveness of Treatments for Major Depression in Primary Care Practice

Lave, Judith R.; Frank, Richard G.; Schulberg, Herbert C.; Kamlet, Mark S.

doi:10.1001/archpsyc.55.7.645

Cited by 276 publications

(248 citation statements)

References 24 publications

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“…As originally designed, the trial used the Beck Depression Inventory as the primary outcome, and also collected data using the Beck Anxiety Inventory and the Work and Social Adjustment Scale. However, after data collection, QALYs were estimated using a method described by Lave et al (1998). QALY values were obtained by cross-walking from the estimate of the number of depression-free days, with a depression-free day scored as 1, and a day with depression scored as 0.59.…”

Section: Using Qalys In Mental Health Researchmentioning

confidence: 99%

“The trouble with QALYs…”

Knapp¹,

Mangalore²

2007

Epidemiol Psychiatr Sci

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Abstract. This paper summarises the use of QALYs in evaluating changes in mental health states, highlighting the benefits and challenges of their use in this field. The general principles underlying the QALY measure and the most common methods of measuring QALYs are discussed briefly. Evidence of the usefulness and problems of using this generic measure of health-related quality of life are provided from a sample of recent studies relating to depression, schizophrenia, attention deficit hyperactivity disorder and dementia. In each case, attempts were made to use QALYs to measure changes in health states. While in principle, the QALY is enormously attractive, its suitability for measuring changes in many mental health conditions remains open to doubt as existing tools for generating QALY scores such as the EQ-5D have tended not to perform sufficiently well in reflecting changes in many mental health states. New developmental work is needed to construct better QALY-measuring tools for use in the mental health field. Both the conceptualisation and measurement of QALYs need to be built on a valid, comprehensive model of quality of life specific to a mental health disorder, to ensure that the resultant tool is sensitive enough to pick up changes that would be expected and seen as relevant in the course of the illness. CHOOSING BETWEEN ALTERNATIVESObviously, the main aims of a mental health system are to alleviate symptoms and improve quality of life, but it is widely appreciated that regard must also be paid to the economic consequences of the treatments and support arrangements that are offered. One consequence has been the growing attention paid to the cost-effectiveness as well as the effectiveness of health care interventions. The underlying reason is scarcity: there are insufficient resources to meet all of a society's needs or demands, and so difficult choices have to be made between competing uses of those resources. In particular, decision makers with responsibility for allocating resources must weigh up the outcomes achieved in those various different uses of resources and the costs of achieving them. This is quite a challenge when the outcomes are measured in different ways. How, for example, is a decision maker to compare cancer treatment with a psychological intervention for depression or a health promotion campaign to reduce coronary heart disease? HEALTH ECONOMIC EVALUATIONS -BROADENING OUTWhen a new treatment is developed or introduced decision makers face two central questions. The clinical question is whether the intervention (say a new antidepressant) is more effective than existing interventions in alleviating depressive symptoms and generally improving health and quality of life. If the answer to the clinical question is that the new medication is no better than existing options, then there is usually no need to consider its use any further. But if it looks clinically effective, the decision maker will then want an answer to a second question: is it cost-effective? That is, does the treatment ach...

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Section: Using Qalys In Mental Health Researchmentioning

confidence: 99%

“The trouble with QALYs…”

Knapp¹,

Mangalore²

2007

Epidemiol Psychiatr Sci

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“…Research evidence has shown that there are effective programs available for people with mental illness, including assertive community treatment, supportive employment programs, programs for mentally ill, chemical abusers, as well as medications management regimes (Burns & Santos, 1995;Clark et al, 1998;Jerrell & Hu, 1989;Lave et al, 1998;Wolff et al, 1997). In addition, programs are developing that respond to the special needs of people with mental illness and criminal histories (Council of State Governments, 2002;Hartwell & Orr, 1999;Roskes & Feldman, 1999;The Thresholds, 2001;25-29).…”

Section: Implications For Practice Policy and Researchmentioning

confidence: 99%

“…Treatment is the most effective and efficient method for assuring the best set of health and justice outcomes for the individual and society. There is ample research evidence that underscores the need for continuity of treatment for persons with mental health problems (Burns & Santos, 1995;Dixon, 2000;Lave, Frank, Schulberg, & Kamlet, 1998). Active and continuous mental health treatment is the best defense against relapse, as well as the best offense for recovery.…”

Section: Introductionmentioning

confidence: 99%

Community reintegration of prisoners with mental illness: A social investment perspective

Wolff

2005

International Journal of Law and Psychiatry

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Responding effectively and efficiently to the needs of persons with mental illness returning to the community from prison requires identifying their differences in need and placement difficulties upon return and targeting reintegration investments to reflect these differences. This paper has three parts. The first part profiles the male special needs population in New Jersey prisons. These profiles describe behavioral health and criminal justice characteristics of 2715 male inmates with mental health problems, and are used to identify the scope and nature of the public's investment opportunity. The next part describes the costs associated with possible "investments." The special needs population is classified by need and placement difficulty, and then matched to reentry and community-based treatment programs. Costs are estimated for reentry planning and communitybased treatment for the first year post-release. The third part recommends an investment strategy and a set of operational changes that might minimize the loss and maximize the return on the public s investment dollar in mental health.

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“…In addition, a large proportion of depressed individuals are not diagnosed as such, but they frequently attend somatic health services, which contributes to depression placing a heavy financial burden on society (Lave et al, 1998;Panzarino, 1998). Depression is not only a powerful impediment to psychological well-being, but evidence is accumulating that it is an important risk factor for physical disease as well (Penninx et al, 1999;Stoltz et al, 1999).…”

Section: Introductionmentioning

confidence: 99%

Multiple assessments of depressive symptoms as an index of depression in population-based samples

Nyklı́ček

Scherders

Pop

2004

Psychiatry Research

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General rightsCopyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.-Users may download and print one copy of any publication from the public portal for the purpose of private study or research -You may not further distribute the material or use it for any profit-making activity or commercial gain -You may freely distribute the URL identifying the publication in the public portal Take down policy If you believe that this document breaches copyright, please contact us providing details, and we will remove access to the work immediately and investigate your claim. AbstractThe incremental validity of repeated measurements of a short depression questionnaire was examined regarding the clinical diagnosis of depression. Participants were 951 randomly selected women of around menopausal age. They completed the Edinburgh Depression Scale (EDS) at two time points, with approximately 18 months in between. At the second time point, they participated in a structured clinical interview for depression diagnosis based on the Research Diagnostic Criteria (RDC). With repeated assessments, specificity and negative predictive value (NPV) did not change much relative to a single assessment, with a specificity of 95.0% and a NPV of 91.7% at a cut-off score of 12 on the EDS. As expected, sensitivity dropped, from 87.9% to 58.8%. However, positive predictive value (PPV) increased from 42.0% to 49.1% at a cut-off of 12. When using a cutoff score of 15 on the EDS, the PPV based on both EDS measurements reached 61.8%, yielding a 25-fold probability of being a case for women scoring above 15 at both time points (OR = 24.54, 95% CI = 14.24 -42.28). In conclusion, the 10-item EDS is a reliable, valid and valuable screening instrument. When employed repeatedly, a more stable depression may be tapped, which can be of substantial value for both epidemiological research and clinical practice.

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Cost-effectiveness of Treatments for Major Depression in Primary Care Practice

Cited by 276 publications

References 24 publications

“The trouble with QALYs…”

“The trouble with QALYs…”

Community reintegration of prisoners with mental illness: A social investment perspective

Multiple assessments of depressive symptoms as an index of depression in population-based samples

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