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1.

Preventing Depression in Adults With Subthreshold Depression: Health-Economic Evaluation Alongside a Pragmatic Randomized Controlled Trial of a Web-Based Intervention.

Buntrock, Claudia; Berking, Matthias; Smit, Filip; Lehr, Dirk; Nobis, Stephanie; Riper, Heleen; Cuijpers, Pim; Ebert, David
| Idioma(s): Inglés
BACKGROUND: Psychological interventions for the prevention of depression might be a cost-effective way to reduce the burden associated with depressive disorders. OBJECTIVE: To evaluate the cost-effectiveness of a Web-based guided self-help intervention to prevent major depressive disorder (MDD) in people with subthreshold depression (sD). METHODS: A pragmatic randomized controlled trial was conducted with follow-up at 12 months. Participants were recruited from the general population via a large statutory health insurance company and an open access website. Participants were randomized to a Web-based guided self-help intervention (ie, cognitive-behavioral therapy and problem-solving therapy assisted by supervised graduate students or health care professionals) in addition to usual care or to usual care supplemented with Web-based psycho-education (enhanced usual care). Depression-free years (DFYs) were assessed by blinded diagnostic raters using the telephone-administered Structured Clinical Interview for DSM-IV Axis Disorders at 6- and 12-month follow-up, covering the period to the previous assessment. Costs were self-assessed through a questionnaire. Costs measured from a societal and health care perspective were related to DFYs and quality-adjusted life years (QALYs). RESULTS: In total, 406 participants were enrolled in the trial. The mean treatment duration was 5.84 (SD 4.37) weeks. On average, participants completed 4.93 of 6 sessions. Significantly more DFYs were gained in the intervention group (0.82 vs 0.70). Likewise, QALY health gains were in favor of the intervention, but only statistically significant when measured with the more sensitive SF-6D. The incremental per-participant costs were €136 (£116). Taking the health care perspective and assuming a willingness-to-pay of €20,000 (£17,000), the intervention's likelihood of being cost-effective was 99% for gaining a DFY and 64% or 99% for gaining an EQ-5D or a SF-6D QALY. CONCLUSIONS: Our study supports guidelines recommending Web-based treatment for sD and adds that this not only restores health in people with sD, but additionally reduces the risk of developing a MDD. Offering the intervention has an acceptable likelihood of being more cost-effective than enhanced usual care and could therefore reach community members on a wider scale. TRIAL REGISTRATION: German Clinical Trials Register: DRKS00004709; http://www.drks.de/DRKS00004709 (Archived by WebCite at http://www.webcitation.org/6kAZVUxy9).
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2.

The economic burden of dementia in China, 1990-2030: implications for health policy.

Xu, Junfang; Wang, Jian; Wimo, Anders; Fratiglioni, Laura; Qiu, Chengxuan
| Idioma(s): Inglés
OBJECTIVE: To quantify and predict the economic burden of dementia in China for the periods 1990-2010 and 2020-2030, respectively, and discuss the potential implications for national public health policy. METHODS: Using a societal, prevalence-based, gross cost-of-illness approach and data from multiple sources, we estimated or predicted total annual economic costs of dementia in China. We included direct medical costs in outpatient and inpatient settings, direct non-medical costs - e.g. the costs of transportation - and indirect costs due to loss of productivity. We excluded comorbidity-related costs. FINDINGS: The estimated total annual costs of dementia in China increased from 0.9 billion United States dollars (US$) in 1990 to US$ 47.2 billion in 2010 and were predicted to reach US$ 69.0 billion in 2020 and US$ 114.2 billion in 2030. The costs of informal care accounted for 94.4%, 92.9% and 81.3% of the total estimated costs in 1990, 2000 and 2010, respectively. In China, population ageing and the increasing prevalence of dementia were the main drivers for the increasing predicted costs of dementia between 2010 and 2020, and population ageing was the major factor contributing to the growth of dementia costs between 2020 and 2030. CONCLUSION: In China, demographic and epidemiological transitions have driven the growth observed in the economic costs of dementia since the 1990s. If the future costs of dementia are to be reduced, China needs a nationwide dementia action plan to develop an integrated health and social care system and to promote primary and secondary prevention.
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3.

Over-reaching beyond disease activity: the influence of anxiety and medical economic burden on health-related quality of life in patients with inflammatory bowel disease.

Luo, Xia-Peng; Mao, Ren; Chen, Bai-Li; Qiu, Yun; Zhang, Sheng-Hong; He, Yao; Chen, Jie; Zeng, Zhi-Rong; Ben-Horin, Shomron; Chen, Min-Hu
| Idioma(s): Inglés
PURPOSE: Many patients with inflammatory bowel disease (IBD) have impaired health-related quality of life (HRQOL). The influence of psychological and economic factors on HRQOL has not been fully elucidated in IBD. Therefore, we aimed to identify the predictors of HRQOL in an IBD cohort. PATIENTS AND METHODS: This was a cross-sectional cohort study of patients presenting to our tertiary IBD center. HRQOL was measured using the 36-item Short Form Health Survey (SF-36) and the Inflammatory Bowel Disease Questionnaire (IBDQ). Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS). Perceived stress and perceived social support were also assessed by standardized scales. Demographic, socioeconomic and clinical data were obtained from a prespecified questionnaire and patients' medical records. Univariate analyses and multiple regression analysis were performed to identify predictors of HRQOL. RESULTS: A total of 242 IBD patients were recruited, and the questionnaire return rate was 90.5% (219/242). The prevalence rates of anxiety and depression were 24.7% and 17.4%, respectively. In all, 30.6% of the patients spent over half of their income to cover medical costs. Multivariate analysis revealed that anxiety symptoms ( <0.001), active disease ( <0.001) and higher medical expenditures ( =0.001) were strong and independent predictors of reduced HRQOL. CONCLUSION: Psychological factors and costs of medical care strongly impair HRQOL in IBD, independent of the disease activity. Psychological counseling and socioeconomic support programs should be considered for integration into the management of IBD patients.
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4.

Attitudes of health professionals towards the stigma surrounding depression in times of economic crisis.

Saridi, Maria; Kordosi, Aikaterini; Toska, Aikaterini; Peppou, Lily Evangelia; Economou, Marina; Souliotis, Kyriakos
| Idioma(s): Inglés
INTRODUCTION: The stigma of mental illness and the ensuing social exclusion are due to the lack of knowledge on the causality of mental illness. AIM: The purpose of this study was to record the stigmatic attitudes of health professionals towards depression, patients suffering from it and the available therapeutic approaches. MATERIAL AND METHODS: The sample of the study included 609 health professionals working in the General Hospital of Corinth. The collection of the empirical material was performed using an anonymous questionnaire. The statistical analysis was performed with the statistical program SPSS 17.0. RESULTS: Although the health professionals showed more optimistic attitudes towards the abilities of the mentally ill, they seem to maintain stereotypes, proving that stigmatization of the mentally ill and prejudice around mental illness continue to exist. Participants identified psychosocial and psychotherapeutic interventions as the most effective forms of therapy, such as supportive social destination (74.4%), healthy eating and physical activity (67.9%), psychoanalysis (60.6%), relaxation techniques (60.5%) and counselling (53.2%), recording ambivalent attitudes towards psychiatric medicines, questioning their effectiveness. The economic crisis has had a direct impact on health professionals as well burdened their psyche (78.3%) and created problems in everyday work (86.7%). CONCLUSION: Health professionals must be protagonists, free from the stigma attached to mental illness as only in this way will they be able to transmit optimism and feelings of acceptance.
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5.

Ethical imperatives of timely access to orphan drugs: is possible to reconcile economic incentives and patients' health needs?

Rodriguez-Monguio, R; Spargo, T; Seoane-Vazquez, E
| Idioma(s): Inglés
BACKGROUND: More than 6,800 rare diseases and conditions have been identified in the US, which affect 25-30 million Americans. In 1983, the US Congress enacted the Orphan Drug Act (ODA) to encourage the development and marketing of drugs to treat rare diseases and conditions. This study analyzed all orphan designations and FDA approvals since 1983 through 2015, discussed the effectiveness of incentives for the development of treatments for rare diseases, and reflected on the ethical imperatives for timely access to orphan drugs. METHODS: Study data were derived from the Food and Drug Administration (FDA) Orange Book and the Office of Orphan Drugs Development. A search was conducted to assess literature on the ethical principles and economic incentives for the development of orphan drugs. RESULTS: In the period 1983-2015, the FDA granted 3,647 orphan drug designations and 554 orphan drug approvals. The orphan drug approvals corresponded to 438 different brand names. Cancer was the therapeutic area with the highest number of approvals. The increased number of patients with rare diseases and the growth in the cost of orphan drugs pose a significant economic burden for patients, public programs and private third party payers. Regulatory differences to qualify for orphan designation and various population thresholds employed by the FDA and the European Medicines Agency lead to further unmet health needs for patients with rare diseases and aggravate health inequities. There is no societal consensus on the population and economic thresholds, the drug effectiveness indicator(s), or the societal value to be placed for the approval and reimbursement of orphan drugs. CONCLUSION: Orphan drug development and marketing in the US concentrate in few therapeutic areas. Despite the increase in the number of FDA approved orphan drugs, the unmet needs of patients with rare diseases evidence that the current incentives are not efficiently stimulating orphan drug development. There is need to balance economic incentives to stimulate the development and marketing of orphan drugs without jeopardizing patients' access to treatment. Thus, aligning pharmaceutical companies' incentives with societal budgetary constraints is necessary and the ethical imperatives of timely access to orphan drugs need to be agreed upon.
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6.

Prevalence and socio-economic factors determining use of modern contraception among married men in Kyrgyzstan: evidence from a demographic and health survey.

Kogay, V; Itua, I
| Idioma(s): Inglés
OBJECTIVES: This study aimed to estimate the prevalence of modern contraceptive use (MCU), and to identify socio-economic factors that are associated with MCU among married men in Kyrgyzstan. STUDY DESIGN: A cross-sectional study based on the 2012 Kyrgyzstan Demographic and Health Survey data. METHODS: This study used data from 460 married men aged 20-49 years. Descriptive statistics, Pearson's Chi-squared test and logistic regression were used to estimate the prevalence of MCU, and to define factors that influence MCU among married men in Kyrgyzstan. RESULTS: The prevalence of MCU among married men aged 20-49 years was 22.2%. Men in the richer quintile were less likely to use modern contraceptives than men in the poorest quintile (adjusted odds ratio [aOR] 0.267, 95% confidence interval [CI] 0.100-0.715). Men with three living children had higher odds of MCU than men with no children or one child (aOR 3.534, 95% CI 1.221-10.229). Men who were unemployed were more likely to use modern contraceptives than men who were employed as manual labourers (aOR 4.511, 95% CI 1.104-18.442). CONCLUSION: Top priority should be given to strengthening family planning communication programmes among married men and male education. There is a need to pay attention to the socio-economic determinants of MCU among men in the development of family planning programmes. Emphasis should be placed on increasing MCU among men with high socio-economic status.
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8.

Estimation of the health and economic burden of neurocysticercosis in India.

Singh, B B; Khatkar, M S; Gill, J P S; Dhand, N K
| Idioma(s): Inglés
Taenia solium is an endemic parasite in India which occurs in two forms in humans: cysticercosis (infection of soft tissues) and taeniosis (intestinal infection). Neurocysticercosis (NCC) is the most severe form of cysticercosis in which cysts develop in the central nervous system. This study was conducted to estimate health and economic impact due to human NCC-associated active epilepsy in India. Input data were sourced from published research literature, census data and other official records. Economic losses due to NCC-associated active epilepsy were estimated based on cost of treatment, hospitalisation and severe injury as well as loss of income. The disability-adjusted life years (DALYs) due to NCC were estimated by combining years of life lost due to early death and the number of years compromised due to disability taking the disease incidence into account. DALYs were estimated for five age groups, two genders and four regions, and then combined. To account for uncertainty, probability distributions were used for disease incidence data and other input parameters. In addition, sensitivity analyses were conducted to determine the impact of certain input parameters on health and economic estimates. It was estimated that in 2011, human NCC-associated active epilepsy caused an annual median loss of Rupees 12.03 billion (uncertainty interval [95% UI] Rs. 9.16-15.57 billion; US $ 185.14 million) with losses of Rs. 9.78 billion (95% UI Rs. 7.24-13.0 billion; US $ 150.56 million) from the North and Rs. 2.22 billion (95% UI Rs. 1.58-3.06 billion; US $ 34.14 million) from the South. The disease resulted in a total of 2.10 million (95% UI 0.99-4.10 million) DALYs per annum without age weighting and time discounting with 1.81 million (95% UI 0.84-3.57 million) DALYs from the North and 0.28 million (95% UI 0.13-0.55 million) from the South. The health burden per thousand persons per year was 1.73 DALYs (95% UI 0.82-3.39). The results indicate that human NCC causes significant health and economic impact in India. Programs for controlling the disease should be initiated to reduce the socio-economic impact of the disease in India.
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10.

Benefits, Challenges and Potential Strategies of Open Source Health Economic Models.

Dunlop, William C N; Mason, Nicola; Kenworthy, James; Akehurst, Ron L
| Idioma(s): Inglés
Resultados  1-10 de 88.115