| 1. |
- Alaie, Iman, et al.
(author)
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Adolescent depression, early psychiatric comorbidities, and adulthood welfare burden : a 25-year longitudinal cohort study
- 2021
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In: Social Psychiatry and Psychiatric Epidemiology. - : Springer. - 0933-7954 .- 1433-9285. ; 56:11, s. 1993-2004
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Journal article (peer-reviewed)abstract
- PURPOSE: Depression at all ages is recognized as a global public health concern, but less is known about the welfare burden following early-life depression. This study aimed to (1) estimate the magnitude of associations between depression in adolescence and social transfer payments in adulthood; and (2) address the impact of major comorbid psychopathology on these associations.METHODS: This is a longitudinal cohort study of 539 participants assessed at age 16-17 using structured diagnostic interviews. An ongoing 25-year follow-up linked the cohort (n = 321 depressed; n = 218 nondepressed) to nationwide population-based registries. Outcomes included consecutive annual data on social transfer payments due to unemployment, work disability, and public assistance, spanning from age 18 to 40. Parameter estimations used the generalized estimating equations approach.RESULTS: Adolescent depression was associated with all forms of social transfer payments. The estimated overall payment per person and year was 938 USD (95% CI 551-1326) over and above the amount received by nondepressed controls. Persistent depressive disorder was associated with higher recipiency across all outcomes, whereas the pattern of findings was less clear for subthreshold and episodic major depression. Moreover, depressed adolescents presenting with comorbid anxiety and disruptive behavior disorders evidenced particularly high recipiency, exceeding the nondepressed controls with an estimated 1753 USD (95% CI 887-2620).CONCLUSION: Adolescent depression is associated with considerable public expenditures across early-to-middle adulthood, especially for those exposed to chronic/persistent depression and psychiatric comorbidities. This finding suggests that the clinical heterogeneity of early-life depression needs to be considered from a longer-term societal perspective.
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| 2. |
- Feldman, Inna, Docent, 1951-, et al.
(author)
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Economic Evaluations of Public Health Interventions to Improve Mental Health and Prevent Suicidal Thoughts and Behaviours : A Systematic Literature Review.
- 2021
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In: Administration and Policy in Mental Health and Mental Health Services Research. - : Springer Nature. - 0894-587X .- 1573-3289. ; 48:2, s. 299-315
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Journal article (peer-reviewed)abstract
- To review the literature on economic evaluations of public health interventions targeting prevention of mental health problems and suicide, to support evidence based societal resource allocation. A systematic review of economic evaluations within mental health and suicide prevention was conducted including studies published between January 2000 and November 2018. The studies were identified through Medline, PsychINFO, Web of Science, the National Health Service Economic Evaluation Database and Health Technology Assessment. The quality of relevant studies and the transferability of their results were assessed using a criterion set out by the Swedish Agency for Health Technology Assessment. Nineteen studies of moderate to high quality were included in this review, which evaluated 18 interventions in mental health and four interventions in suicide prevention. Fourteen (63%) of all interventions were cost-effective based on the conclusions from original papers. None of the studies that evaluated suicide prevention was of high quality. The interventions largely focused on psychological interventions at school, the workplace and within elderly care as well as screening and brief interventions in primary care. Nine studies (around 50% of included articles) had a high potential for transferability to the Swedish context. Public health interventions aiming to improve mental health have a high potential to be economically beneficial to society, but high-quality evidence on the cost-effectiveness of suicide prevention is limited.
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| 3. |
- Nystrand, Camilla, et al.
(author)
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A systematic review of economic evaluations of public health interventions targeting alcohol, tobacco, illicit drug use and problematic gambling : Using a case study to assess transferability.
- 2021
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In: Health Policy. - : Elsevier. - 0168-8510 .- 1872-6054. ; 125:1, s. 54-74
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Journal article (peer-reviewed)abstract
- AIMS: To identify and assess the cost-effectiveness of public health interventions targeting the use of alcohol, illicit drugs and tobacco, as well as problematic gambling behavior (ANDTS), and consider whether the results from these evaluations are transferable to the Swedish setting.METHODS: A systematic review of economic evaluations within the area of ANDTS was conducted including studies published between January 2000 and November 2018, identified through Medline, PsychINFO, Web of Science, the National Health Service Economic Evaluation Database and Health Technology Assessment. The quality of relevant studies and the possibilities of transferring results were assessed using criteria set out by the Swedish Agency for Health Technology Assessment.RESULTS: Out of 54 relevant studies, 39 were of moderate to high quality and included in the review, however none for problematic gambling. Eighty-one out of a total of 91 interventions were cost-effective. The interventions largely focusing on taxed-based policies or screening and brief interventions. Thirteen of these studies were deemed to have high potential for transferability, with effect estimates considered relevant, and with good feasibility for implementation in Sweden.CONCLUSIONS: Interventions targeting alcohol- and illicit-drug use and tobacco use are cost-effective approaches, and results may be transferred to the Swedish setting. Caution must be taken regarding cost estimates and the quality of the evidence which the studies are based upon.
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| 4. |
- Sampaio, Filipa, PhD, 1985-, et al.
(author)
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A model for evaluating the economic value of prevention programs for illicit use of anabolic androgenic steroids
- 2021
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In: Health Policy. - : Elsevier. - 0168-8510 .- 1872-6054. ; 125:6, s. 807-813
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Journal article (peer-reviewed)abstract
- Background: The illicit use of anabolic androgenic steroids (AAS) has become a societal concern. We developed a decision-analytic model for assessing the cost-effectiveness of preventive interventions targeting AAS-use. We used scenario analyses to demonstrate: a) the potential health economic consequences of AAS use in Sweden, and b) the cost-effectiveness of a hypothetical preventive intervention.Methods: A population-based cohort model compared a hypothetical preventive intervention targeting AAS with a 'no intervention' scenario, from a limited societal perspective. The model simulated how a cohort of 18 year-old males transitioned between different states and predicted their health status and complications until the age of 41. Health outcomes were estimated as quality-adjusted life-years (QALY). Costs included intervention costs, drug costs, and costs of complications.Results: Total yearly costs related to AAS use amounted to nearly half a million US$, with the largest cost borne by the healthcare sector. Results suggest that AAS prevention could entail large costs and benefits with a mean incremental cost-effectiveness ratio of $550 per QALY, in a scenario where the intervention would decrease the probability of initiating AAS use by 5%.Conclusion: Results show large AAS related costs, and suggest that the implementation of a preventive intervention could offer good value for money given different effectiveness scenarios. This model can be used to estimate the value of interventions targeting AAS use.
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| 5. |
- Wijana, Moa Bråthén, et al.
(author)
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A pilot study of the impact of an integrated individual- and family therapy model for self-harming adolescents on overall healthcare consumption
- 2021
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In: BMC Psychiatry. - : BioMed Central. - 1471-244X. ; 21:1
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Journal article (peer-reviewed)abstract
- Background: Self-harming behaviors in adolescents cause great suffering and can lead to considerable costs to the healthcare system. The aim of the current study was to investigate the cost of an integrated individual and family therapy (Intensive Contextual Treatment: ICT) and to compare the adolescent’s healthcare consumption 1 year before and 1 year after treatment.Method: The study had a within group design with repeated measures. The clinical outcomes and the cost of ICT treatment are based on a sample of 49 participants who were previously enrolled in an intervention trial. Participants with significantly improved clinical outcomes (self-harm behavior, or general mental health symptoms) were defined as treatment responders. Calculation of changes in healthcare consumption is based on 25 participants who gave their consent to participate in a retrospective collection of healthcare data from medical records, including inpatient and outpatient care, and prescribed medication.Results: The average estimated cost of ICT per person was €5293. There were no significant differences between the cost of healthcare consumption 1 year before and after ICT, but the results suggested that the adolescents consumed less inpatient and specialized care after treatment. There was a significantly higher cost of psychotropic medication after treatment explained by a higher consumption of central stimulants. Treatment responders (general mental health problems) reduced their consumption of healthcare resources significantly more than non-responders, especially regarding hospital visits and total health care costs.Conclusions: Good response to the ICT in terms of improved general mental health symptoms seems to be associated with reduced healthcare consumption during the post-treatment period. However, controlled studies with larger sample sizes are needed to draw causal conclusions. The results of this study should be interpreted with caution as it is based on a small sample and attrition rate was high. Trial registration: This study has been registered with the ISRCTN: 15885573.
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