Medication and rehabilitation of persons applying for disability pension due to depression: a register-based retrospective study from Finland.

PURPOSE: To investigate how drug therapies and rehabilitation options have been utilised before applying for a disability pension due to depression. METHODS: A retrospective register-based study of the 3604 persons who applied for a disability pension from the Social Insurance Institution of Finland (Kela) in 2019. In Finland, disability pension is usually preceded by an incapacity for work lasting for 1 year, during which time therapeutic procedures, which were analysed here, are applied. RESULTS: Approximately half (56.0%) of the applicants had reimbursed purchases of two or more antidepressants during the 12 months preceding the disability pension application. Psychotherapy was received by 13.8% and 19.2% of the applicants 1 and 5 years before application, respectively. The share of applicants receiving some form of rehabilitation 1 year before application was 24.8% and 39.0% in the 5 years preceding application. During the 4 months before application, 19.6% of the applicants had no antidepressant purchases. In total, 12.2% of the applicants had both antidepressant treatment and psychotherapy in the year preceding the application, and 9.9% had neither psychotherapy nor antidepressant treatment. CONCLUSION: Before applying for disability pension, only a minority of the applicants had received effective treatment for depression in the form of psychotherapy and antidepressants. However, most of the applicants had received some form of treatment, but it appears to have been insufficient.

Cost-effectiveness of anorexia nervosa in QALYs.

BACKGROUND: The costs of treating eating disorders are often considered high. AIMS: The objective was to perform a cost-utility analysis to estimate the cost-effectiveness of treatment of anorexia nervosa (AN). METHODS: Thirty-nine patients entering treatment of AN completed the 15D health-related quality-of-life (HRQoL) questionnaire before and 2 years after the start of treatment. Direct hospital costs were obtained. Quality-adjusted life years (QALYs) gained were calculated and cost-utility assessed. RESULTS: Patients' baseline HRQoL was severely impaired. During follow-up, mean HRQoL improved statistically significantly. The cost per QALY gained was €5296 (best-case scenario) or €64 440 (base-case scenario) (€11 559 or €71 600 discounted 3%) depending on the assumptions used in the analysis. CONCLUSIONS: The cost per QALY was in the same range as that of many other interventions provided in specialized medical care and within the limits usually considered acceptable, indicating that the treatment of AN is cost-effective.

Long-term health-related quality of life in eating disorders.

OBJECTIVE: There is limited evidence on the long-term development of health-related quality of life (HRQoL) in eating disorders and its relation to eating disorder symptoms. Our objective was to measure long-term change in the HRQoL of eating disorder patients and compare it to normal population. METHODS: Fifty-four bulimia nervosa (BN) and forty-seven anorexia nervosa (AN) patients (ICD-10 diagnosis) entering treatment completed the 15D HRQoL questionnaire and the Eating Disorder Inventory (EDI) before and approximately 8 years after the start of treatment. RESULTS: Baseline HRQoL was severely impaired in the patients. During follow-up, mean HRQoL, body mass index (BMI) and EDI improved statistically significantly in both groups. BMI of AN patients reached normal values, but HRQoL was still severely impaired in both AN and BN compared to general population. CONCLUSIONS: The long-term HRQoL after treatment continues to improve, but is still after 8 years poor. Eating disorders are very serious conditions with long-lasting impact on quality of life even after symptom remission.

Bayesian prediction of treatment outcome in anorexia nervosa: a preliminary study.

BACKGROUND: Knowledge of the prognostic factors predicting treatment outcome in anorexia nervosa (AN) measured with health-related quality of life (HRQoL) is limited. AIMS: We performed a novel statistical analysis to identify factors predicting treatment outcome in AN. METHODS: 39 patients entering treatment of an ICD-10-defined AN completed the 15D HRQoL survey, the Eating Disorder Inventory (EDI) and a questionnaire evaluating self reported health status and eating habits before and 2 years after the start of treatment. The analysis was based on a Bayesian approach, which allows analyses of small data sets, and was performed using a naïve Bayes classifier. RESULTS: An impaired follow-up HRQoL score was associated with three baseline risk factors: low self-reported vitality, high scores in eating control and a poor reported health status. Low baseline body mass index (BMI) and a high score in the eating dimension of the 15D predicted low follow-up BMI. CONCLUSIONS: In our preliminary study, we identified a set of variables predicting poor HRQoL in AN. An effort to treat these symptoms effectively in the beginning of AN treatment may influence the outcome.

Cost-utility of treatment of bulimia nervosa.

OBJECTIVE: The costs of treating eating disorders are high. Our objective was to perform a cost-utility analysis of treatment of bulimia nervosa. METHOD: 72 patients entering treatment of bulimia nervosa (ICD-10 diagnosis) completed the 15D health-related quality of life (HRQoL) questionnaire and the Eating Disorder Inventory (EDI) before and 6 months after the start of treatment. Quality-adjusted life years (QALYs) gained were calculated and cost-utility was assessed within the time horizon of 10 years. RESULTS: Baseline HRQoL was severely impaired in the patients. As a consequence of treatment, mean HRQoL improved clinically and statistically significantly. The cost per QALY gained varied from €1,455 to €16,481 (from €4,428 to €19,663 discounted at 5%) depending on the assumptions used in the analysis. DISCUSSION: HRQoL of bulimia nervosa patients is severely impaired, but treatment has a clear positive effect on HRQoL. The cost per QALY gained is comparable to many other treatments.