| 1. |
|
|
| 2. |
|
|
| 3. |
- Andrén, Daniela, Associate Professor, 1968-
(författare)
-
Prioritizing Suicide Prevention through the Lens of the Individual's Well-Being
- 2023
-
Ingår i: Journal of Mental Health Policy and Economics. - : John Wiley & Sons. - 1091-4358 .- 1099-176X. ; 26:Suppl. 1, s. S4-S4
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: The need for priority setting in healthcare became evident during the Covid-19 pandemic, when planned care was postponed facilitating emergency treatment of Covid-19 patients, raisinquestions about the population’s preferences.Aim: To estimate the population values interventions reducing the number of suicides in comparison to treatments reducing the number of deaths due to other causes in a country where healthcare system has a pronounced public character and a declared emphasis on equity and solidarity during a time when the limited healthcare resources were predominantly allocated for the treatment of Covid patients.Data and Methods: The data was collected via a web survey sent to members of the web panel Userneeds during a tree-week period starting with the last week of December 2021, when media was informing the population about global experts and politicians’ huge concern about the extremely high infection risk of the Omicron. The survey was designed to identify the populations’ preferences for the allocation of the limited health care resources to save lives. An online discrete choice experiment was conducted among a sample of 1000 respondents to elicit the relative importance placed on reducing the number of deaths due to suicide in comparison to deaths due to pancreatic cancer, breast cancer and acute heart attack. The sample is representative with respect age, gender, and geographical region for the adult population of Sweden.Results: Respondents with high value of life satisfaction and no experience of any of the four health conditions chose to allocate a given limited healthcare budget for relatively young people but not to suicide. When not controlling for the individual’s life satisfaction, the respondents seem to prioritize the interventions that reduce the risk of young people to die due to suicide and breast cancer.Discussion: Even though the derived value of suicide prevention is near the average willingness to pay for suicide prevention, in general, a value derived using Wellbeing Valuation should not be seen as the actual amount that people would be willing to pay.
|
|
| 4. |
- Andrén, Daniela, Associate Professor, 1968-
(författare)
-
Valuing Mental Illness by Using the Well-Being Valuation Method
- 2022
-
Ingår i: Journal of Mental Health Policy and Economics. - : John Wiley & Sons. - 1091-4358 .- 1099-176X. ; 25:Suppl. 1, s. S2-S2
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Each year, near one million individuals worldwide commit suicide, and several more make suicide attempts. Both suicide and suicide attempts are a source of tremendous grief among friends and relatives of the victim, which generate large costs for society. This has prompted calls for more research on interventions that prevent suicide and self-harm behaviors, their costs and the society willingness to pay (WTP) for such interventions. Suicide screening followed by an intervention may identify suicidal individuals and prevent recurring self-harm, but few cost-effectiveness studies have been conducted.Aims of the Study: We aim to derive the value of suicide prevention by using the wellbeing valuation method.Methods: We use data collected from a representative sample of 1038 Swedish residents aged 18-80, who were randomly selected from a web-panel. They answered questions about the importance of interventions aimed prevent suicide and their WTP for these interventions. They also reported their life-satisfaction, their direct and indirect experience with mental disorders, including knowing someone who committed suicide or suicide attempt, variable needed to apply the well-being approach. In a first step, we estimate life satisfaction equations, controlling additionally to the well-known determinants such as satisfaction with health, income, and martial satisfaction, for variables related to suicide (e.g., the individual’s awareness about suicide because a close friend or relative committed suicide or had a suicide attempt and the individual’s s willingness to pay for suicide prevention). In the second step, we derive the value of suicide prevention by using the estimates of awareness about suicide and income from the life satisfaction equations.Results: Our preliminary estimates show that knowing someone who committed suicide or suicide attempt has positive significant effect on the individual’s life satisfaction, and the preliminary derived value of suicide prevention is near the average willingness to pay for suicide prevention.Discussion: Even though the derived value of suicide prevention is near the average willingness to pay for suicide prevention, in general, a value derived using Wellbeing Valuation should not be seen as the actual amount that people would be willing to pay.
|
|
| 5. |
- Beckman, Linda, 1980-, et al.
(författare)
-
Economic Costs of Antidepressant Use: A Population-Based Study in Sweden
- 2019
-
Ingår i: Journal of Mental Health Policy and Economics. - Italy. - 1091-4358 .- 1099-176X. ; 22:4, s. 125-130
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Prescription of antidepressant drugs (ADs) has increased in recent decades, with rising costs for patients as well as for the health care system. There is sparse evidence of which factors explain the high economic costs and financial burden for the general population. Aims of the study: The aim was to assess individual-level determinants of out-of-pocket and total health care costs of AD use in the Swedish general population. Methods: We randomly sampled 400,000 individuals aged 18+ from Statistics Sweden's population register from 2010 to 2013. Two-part regression models were used for our two primary outcome variables: (i) total health care costs for AD use per year and individual, and (ii) total out-of-pocket costs of AD use per year and individual. Results: Women, the unemployed, unmarried people and residents of big cities have both higher use of ADs and higher associated total health care and out-of-pocket costs. Today, ADs are relatively inexpensive and average cost differences among all groups are therefore minor. The elderly have higher use of ADs, but are more commonly low-volume users and do not have higher total health care or out-of-pocket costs. Discussion and limitations: Groups with relatively low socioeconomic status are at risk of higher costs for antidepressant use. However, given the Swedish system of drug subsidies, differences in financial burden for individuals are minor. The limitations of this study included that we lacked data on diagnosis and could therefore not categorize the reasons for AD consumption. Furthermore, our results may not be generalized to other countries with a lower AD prevalence then Sweden's, since our estimates are dependent on the point prevalence of antidepressant use in the population. Implications for health care provision and use: Groups with higher AD consumption and economic costs may suffer from more severe depression owing to more risk factors and less social support in their surroundings, and may be in greater need of additional treatment and support than other groups. Implications for health policies and further research: Our results offer insight at an aggregate level, and more information on the underlying causes of higher costs is needed to discern the policy implications.
|
|
| 6. |
|
|
| 7. |
- Ekman, M., et al.
(författare)
-
The Societal Cost of Schizophrenia in Sweden
- 2013
-
Ingår i: Journal of Mental Health Policy and Economics. - 1091-4358. ; 16:1, s. 13-25
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Schizophrenia is a disabling psychiatric disorder that has severe consequences for patients and their families. Moreover, the expensive treatment of schizophrenia imposes a burden on health care providers and the wider society. Existing cost estimates for Sweden, however, are based on relatively small patient populations and need to be confirmed in a large register-based study. Aims of the Study: To investigate the health care resource utilization and cost-of-illness in patients with schizophrenia in Sweden and to relate the costs to hospitalizations and global assessment of functioning (GAF). Methods: Hospital-based registry data were combined with national registry data from a large patient population to get reliable estimates of the costs of schizophrenia in Sweden. Schizophrenia was defined by ICD-10 codes F20; F21; F23.1,2,8,9; F25.1,8,9. Registry data on socio-demographics and disease-related healthcare resource use in outpatient and inpatient care were obtained from Northern Stockholm Psychiatry. Data on pharmaceuticals were obtained from the National Board of Health and Welfare, and data on sick leave and early retirement were obtained from the Swedish Social Insurance Agency. Costs for community mental health care were not available at the individual level, but were estimated based on previous studies and aggregate cost data from Stockholm. Resource use data from the registries were combined with unit costs from publicly available sources. The study was conducted from a societal perspective, with indirect costs valued according to the human capital method. Results: The average annual psychiatric cost per patient with schizophrenia in 2008 was 42 700 (95% CI: 41 500 44 000), based on a sample of 2 161 patients. To this should be added costs for community mental health care of 12 400 per patient, giving a total cost of 55 100 per patient. The two largest cost items in the total costs were indirect costs due to lost productivity (60%) and community mental health care (22% of the total cost). Patients who were hospitalized in 2008 had greater psychiatric costs than those who were not, (sic)71 700 vs. (sic)37 700 (p<0.0001). Psychiatric costs were significantly and negatively correlated with GAF (p<0.001). Discussion: The major strengths of the study are the relatively large sample, and the linkage of patient-level clinical data on inpatient and outpatient care with national registry data on prescription pharmaceuticals, and days on social insurance. A limitation was that costs for informal care and primary care were not included in the data, but previous studies suggest that these costs items are small compared to other costs for schizophrenia. Implications for Health Policies and Future Research: Costs were strongly related to hospitalization and GAF, suggesting that attempts to improve global functioning and avoid hospitalizations by means of effective treatment and rehabilitation might not only decrease suffering for patients and relatives, but also reduce the societal cost of schizophrenia. A detailed knowledge of the societal costs can also be helpful in evaluating the cost-effectiveness of new treatment strategies to improve the care for patients with schizophrenia.
|
|
| 8. |
|
|
| 9. |
|
|
| 10. |
- Hjortsberg, Catharina, et al.
(författare)
-
Costs for patients with psychotic illness : differences depending upon state of remission
- 2011
-
Ingår i: The Journal of Mental Health Policy and Economics. - Milano. - 1091-4358. ; 14:2, s. 87-93
-
Tidskriftsartikel (refereegranskat)abstract
- Psychotic illnesses have a substantial economic burden on patients, family members, friends, and society in general, still there have been limited attempts to estimate the costs associated with this condition. Moreover, nothing is known about the differences in costs between patients depending on disease severity, i.e. state of remission.AIM:Estimate the direct and indirect costs for a defined patient population with psychotic illness in Sweden, and demonstrate differences in direct costs depending on disease severity (state of remission).MATERIALS AND METHODS:The cost analyses are based on data from the Clinical Long-term Investigation of Psychosis in Sweden (CLIPS), which is an ongoing, single-centre, epidemiological study. Resource use and disease severity were captured for the patients during one year, 2007. Total costs per patients are estimated and cost differences between patients, depending on state of remission, are considered.RESULTS:199 patients with a mean age of 51 (63% men) were followed for 12 months. They had a mean of 6.4 inpatient-days, 1.4 physician visits, 18.6 nurse visits, 1.2 counsellor visits and 6.3 visits to other staff including tests and diagnostic procedures per patient- year. The mean total cost (direct and indirect) amounted to 62,500 per patient and year. Patients in steady state of remission had lower direct costs compared to other patients. Moreover, the size of the various cost items differed between patients' depending on state of remission. Patients in steady remission had almost no inpatient costs.DISCUSSION:For a comprehensive assessment of treatment of psychotic illnesses it is necessary to provide evidence of the costs related to disease severity. We find that patients suffering from psychotic illness have varying costs depending on their disease severity, and this study indicates that if patients can be kept in remission direct costs will decrease. We can also confirm that reallocation has taken place the last 15 years, between different cost items, from in-patient care at hospitals to out-patient care and assistance at home.LIMITATIONS:Information about informal care was collected from patients and not from informal carers themselves.IMPLICATIONS FOR HEALTH CARE PROVISION AND USE:Costs have been reallocated from in-patient care to costs for assistance at home, which is a reflection of the change in care of patients with mental problems that has taken place during the last 15 years. Patients in steady remission have lower costs compared to patients in steady non-remission or patients switching between the two states. A better surveillance of the disorder would lead to lower direct, as well as indirect, costs.
|
|
| 11. |
|
|
| 12. |
|
|
| 13. |
- Martínez de Alva, Patricio, et al.
(författare)
-
The cost-effectiveness of a virtual intervention to prevent eating disorders in young women in Sweden
- 2023
-
Ingår i: International Journal of Eating Disorders. - : John Wiley & Sons. - 0276-3478 .- 1098-108X. ; 26, s. S20-S20
-
Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo determine the cost-effectiveness of a virtual version of the Body Project (vBP), a cognitive dissonance-based program, to prevent eating disorders (ED) among young women with a subjective sense of body dissatisfaction in the Swedish context.MethodA decision tree combined with a Markov model was developed to estimate the cost-effectiveness of the vBP in a clinical trial population of 149 young women (mean age 17 years) with body image concerns. Treatment effect was modeled using data from a trial investigating the effects of vBP compared to expressive writing (EW) and a do-nothing alternative. Population characteristics and intervention costs were sourced from the trial. Other parameters, including utilities, treatment costs for ED, and mortality were sourced from the literature. The model predicted the costs and quality-adjusted life years (QALYs) related to the prevention of incidence of ED in the modeled population until they reached 25 years of age. The study used both a cost-utility and return on investment (ROI) framework.ResultsIn total, vBP yielded lower costs and larger QALYs than the alternatives. The ROI analysis denoted a return of US $152 for every USD invested in vBP over 8 years against the do-nothing alternative and US $105 against EW.DiscussionvBP is likely to be cost-effective compared to both EW and a do-nothing alternative. The ROI from vBP is substantial and could be attractive information for decision makers for implementation of this intervention for young females at risk of developing ED.Public SignificanceThis study estimates that the vBP is cost-effective for the prevention of eating disorders among young women in the Swedish setting, and thus is a good investment of public resources.
|
|
| 14. |
- Ryen, Linda, 1974-, et al.
(författare)
-
Economic Evaluations of Suicide Prevention - A Review of the Empirical Literature with Focus on How to Value Suicide Prevention
- 2023
-
Ingår i: Journal of Mental Health Policy and Economics. - : John Wiley & Sons. - 1091-4358 .- 1099-176X. ; 26:Suppl. 1, s. S28-S28
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: In Sweden, suicide is the most common external cause of death and is accounting for a growing share of potential years of life lost due to injuries. To help policymakers in how to prioritize interventions to reduce the number of the suicides, there is a need for economic evaluations. However, the number of economic evaluations of suicide prevention is scarce. One reason for this can be an insecurity about how to include a reduction in the suicide rate.Aims of the Study: The aim of this paper is to review the literature of economic evaluations for suicide prevention, with a specific focus on the methods used to value the benefits from the intervention.Methods: A literature review based on searches in the electronic bibliographic databases: PubMed, Web of Science and Google Scholar, from 2000 until October 2022. The search was independently conducted by two separate researchers. The goal was to identify papers which contained an original economic evaluation of an intervention aimed at preventing suicides that was published in a peer-reviewed journal.Results: Our final search resulted in 515 hits, including duplicates. Most studies were excluded after the first screening of the abstracts and titles. The most common reason for exclusion was that the study did not evaluate an intervention for suicide prevention. A total of 13 papers was included in the final analysis.Discussion and Conclusion: We find that there is a lack of economic evaluations of interventions to reduce the number of suicides. Furthermore, the ones that do exist varies both in quality and in which methods that are being used to measure and value the outcome.Implications for Further Research: For the economic evaluations to be comparable and thereby helping policymakers to answer the question which intervention that is most cost-effective to reduce the number of suicides there is a need for standardization and methodological improvements.
|
|
| 15. |
|
|
| 16. |
- Sampaio, Filipa, et al.
(författare)
-
Cost-Effectiveness of Four Parenting Programs and Bibliotherapy for Parents of Children with Conduct Problems
- 2016
-
Ingår i: Journal of Mental Health Policy and Economics. - 1091-4358 .- 1099-176X. ; 19:4, s. 201-212
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Parenting programs and self-help parenting interventions employing written materials are effective in reducing child conduct problems (CP) in the short-term compared to control groups, however evidence on the cost-effectiveness of such interventions is insufficient. Few studies have looked at the differences in effects between interventions in the same study design.AIM: This study aimed to determine the cost-effectiveness of four parenting programs: Comet, Incredible Years (IY), Cope and Connect, and bibliotherapy, compared to a waitlist control (WC), with a time horizon of 4 months, targeting CP in children aged 3-12 years.METHODS: This economic evaluation was conducted alongside an RCT of the four parenting interventions and bibliotherapy compared to a WC. The study sample consisted of 961 parents of 3-12 year-old children with CP. CP was measured by the Eyberg Child Behavior Inventory. Effectiveness was expressed as the proportion of "recovered" cases of CP. The time horizon of the study was four months with a limited health sector perspective, including parents' time costs. We performed an initial comparative cost analysis for interventions whose outcomes differed significantly from the WC, and later a cost-effectiveness analysis of interventions whose outcomes differed significantly from both the WC and each other. Secondary analyses were performed: (i) joint outcome "recovered and improved", (ii) intervention completers, (iii) exclusion of parents' time costs, (iv) exclusion of training costs.RESULTS: All interventions apart from Connect significantly reduced CP compared to the WC. Of the other interventions Comet resulted in a significantly higher proportion of recovered cases compared to bibliotherapy. A comparative cost analysis of the effective interventions rendered an average cost per recovered case for bibliotherapy of USD 483, Cope USD 1972, Comet USD 3741, and IY USD 6668. Furthermore, Comet had an ICER of USD 8375 compared to bibliotherapy. Secondary analyses of "recovered and improved" and of intervention completers held Cope as the cheapest alternative. Exclusion of parents' time and training costs did not change the cost-effectiveness results.DISCUSSION: The time horizon for this evaluation is very short. This study also had a limited costing perspective. Results may be interpreted with caution when considering decision-making about value for money. The inclusion of a multi-attribute utility instrument sensitive to domains of quality-of-life impacted by CP in children would be valuable so that pragmatic value for money estimations can be made.IMPLICATIONS FOR FUTURE RESEARCH: Further studies are needed with longer follow-up periods to ascertain on the sustainability of the effects, and fuller economic evaluations and economic modeling to provide insights on longer-term cost-effectiveness. These results also raise the need to investigate the cost-effectiveness of the provision of these interventions as a "stepped care" approach.CONCLUSIONS: The results suggest the delivery of different programs according to budget constraints and the outcome desired. In the absence of a WTP threshold, bibliotherapy could be a cheap and effective option to initially target CP within a limited budget, whereas Comet could be offered to achieve greater effects based on decision-makers' willingness to make larger investments. In its turn, Cope could be offered when targeting broader outcomes, such as symptom improvement, rather than clinical caseness.
|
|
| 17. |
|
|
| 18. |
|
|
| 19. |
|
|
| 20. |
|
|
| 21. |
|
|
| 22. |
- Sobocki, P, et al.
(författare)
-
Cost of depression in Europe
- 2006
-
Ingår i: The journal of mental health policy and economics. - 1091-4358. ; 9:2, s. 87-98
-
Tidskriftsartikel (refereegranskat)
|
|
| 23. |
|
|
| 24. |
|
|
| 25. |
|
|
| 26. |
- Wellander, Lisa, et al.
(författare)
-
Does Prevention Pay? : Costs and Potential Cost-savings of School Interventions Targeting Children with Mental Health Problems
- 2016
-
Ingår i: Journal of Mental Health Policy and Economics. - 1091-4358 .- 1099-176X. ; 19:2, s. 91-101
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In Sweden, the local government is responsible for funding schools in their district. One funding initiative is for schools to provide students with mental health problems with additional support via extra teachers, personal assistants, and special education classes. There are evidence-based preventive interventions delivered in schools, which have been shown to decrease the levels of students' mental health problems. However, little is known about how much the local government currently spends on students' mental health support and if evidence-based interventions could be financially beneficial. AIMS OF THE STUDY: The aim of this study was to estimate the costs of providing additional support for students' mental health problems and the potential cost-offsets, defined as reduced school-based additional support, if two evidence-based school interventions targeting children's mental health problems were implemented in routine practice. METHODS: This study uses data on the additional support students with mental health problems received in schools. Data was collected from one school district for students aged 6 to 16 years. We modeled two Swedish school interventions, Comet for Teachers and Social and Emotional Training (SET), which both had evidence of reducing mental health problems. We used a cost-offset analysis framework, assuming both interventions were fully implemented throughout the whole school district. Based on the published studies, the expected effects and the costs of the interventions were calculated. We defined the cost-offsets as the amount of predicted averted additional support for students with ongoing mental health problems who might no longer require receiving services such as one-on-one time with an extra teacher, a personal assistant, or to be placed in a special education classroom. A cost-offset analysis, from a payer's perspective (the local government responsible for school financing), was conducted comparing the costs of both interventions with the potential cost-savings due to a reduction in the prevalence of mental health problems and averted additional support required. RESULTS: The school district was comprised of 6,256 students, with 310 students receiving additional support for their mental health problems. Of these, 143 received support in their original school due to either having ADHD (n = 111), psychosocial problems (n = 26), or anxiety/depression (n = 6). The payers' total cost of additional support was 2,637,850 Euro per school year (18,447 Euro per student). The cost of running both interventions for the school district was 953,643 Euro for one year, while the potential savings for these interventions were estimated to be 627,150 Euro. The estimated effects showed that there would be a reduction of students needing additional support (25 for ADHD, eight for psychosocial problems, and one for anxiety/depression), and the payer would receive a return on their invested resources in less than two years (1.5 years) after implementation. DISCUSSION: Preventive school interventions can both improve some children's mental health problems and be financially beneficial for the payer. However, they are still limited in their scope of reducing all students' mental health statuses to below clinical cut-offs; therefore, the preventive school interventions should be used as a supplement, but not a replacement, to current practices. IMPLICATIONS FOR HEALTH POLICIES: The findings have political and societal implications, in that payers can reallocate their funds toward preventive measures targeting students' mental health problems, while reducing the costs. IMPLICATIONS FOR FUTURE RESEARCH: When evaluating public health actions, it is necessary to consider their economic impact. The resources are scarce and the decision makers need knowledge on how to allocate their resources in an efficient way. Cost-offset analysis is seen as one way for decision makers to comprehend research findings; however, such analyses tend to not include the full benefits of the interventions, and actual impacts need to be fully evaluated in routine implementation.
|
|
| 27. |
|
|
