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Cost‐effectiveness of exercise as a therapy for behavioural and psychological symptoms of dementia within the EVIDEM‐E randomised controlled trial 下载免费PDF全文
Francesco D'Amico Amritpal Rehill Martin Knapp David Lowery Arlinda Cerga‐Pashoja Mark Griffin Steve Iliffe James Warner 《International journal of geriatric psychiatry》2016,31(6):656-665
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Judith Dams MSc Uwe Siebert MD MPH MSc ScD Bernhard Bornschein MD MPH Jens Volkmann MD Günther Deuschl MD Wolfgang H. Oertel MD Richard Dodel MD MPH Jens‐Peter Reese PhD MPH 《Movement disorders》2013,28(6):763-771
In addition to medical treatment, deep brain stimulation has become an alternative therapeutic option in advanced Parkinson's disease. High initial costs of surgery have to be weighted against long‐term gains in health‐related quality of life. The objective of this study was to assess the cost‐effectiveness of deep brain stimulation compared with long‐term medical treatment. We performed a cost‐utility analysis using a lifetime Markov model for Parkinson's disease. Health utilities were evaluated using the EQ‐5D generic health status measure. Data on effectiveness and adverse events were obtained from clinical studies, published reports, or meta‐analyses. Costs were assessed from the German health care provider perspective. Both were discounted at 3% per year. Key assumptions affecting costs and health status were investigated using one‐way and two‐way sensitivity analyses. The lifetime incremental cost‐utility ratio for deep brain stimulation was €6700 per quality‐adjusted life year (QALY) and €9800 and €2500 per United Parkinson's Disease Rating Scale part II (motor experiences of daily living) and part III (motor examination) score point gained, respectively. Deep brain stimulation costs were mainly driven by the cost of surgery and of battery exchange. Health status was improved and motor complications were reduced by DBS. Sensitivity analysis revealed that battery life time was the most influential parameter, with the incremental cost‐utility ratio ranging from €20,000 per QALY to deep brain stimulation dominating medical treatment. Deep brain stimulation can be considered cost‐effective, offering a value‐for‐money profile comparable to other well accepted health care technologies. Our data support adopting and reimbursing deep brain stimulation within the German health care system. © 2013 Movement Disorder Society 相似文献
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Mark Pennington Manuel Gomes Theti Chrysanthaki Jolijn Hendriks Raphael Wittenberg Martin Knapp Nick Black Sarah Smith 《International journal of geriatric psychiatry》2018,33(1):5-13
Objective
Recent research indicates considerable heterogeneity in the provision of memory assessment services (MAS). However, little is known on the extent of variation in the costs of the services MAS provide. We investigated the costs of supporting patients with suspected dementia, including assessment and support over the following 6 months.Methods
Clinic costs were estimated on the basis of an organisational survey reporting staff roll, grade and activities. Costs of primary health and social care were estimated from questionnaire data reported by carers of patients at baseline, 3 and 6 months after referral.Results
Mean monthly staff costs at MAS were £73 000. Imaging at assessment costs an additional £3500 per month. Monthly clinic cost per new patient assessed varied from £320 to £5400 across clinics. Additional primary health and social care costs of £130–220 a month between baseline and 6 months were reported by carers. Costs of pharmacological and non‐pharmacological treatments reported by carers were small. Informal care costs dwarfed health and social care costs when valued at a modest unit cost. The overall mean cost of supporting a patient for 6 months varied from £1600 to £2500 dependent on assumptions regarding the proportion of MAS intervention and review costs accrued at 6 months.Conclusions
There is considerable variation in the intensity and associated costs of services provided by MAS. Further research should ascertain to what extent such variation is associated with differences in patient outcomes. Copyright © 2016 John Wiley & Sons, Ltd. 相似文献8.
K. Malmivaara R. Kivisaari J. Hernesniemi J. Siironen 《European journal of neurology》2011,18(4):656-662
Background and purpose: Decompressive craniectomy (DC) is used regularly in traumatic brain injury (TBI). There are, however, no cost‐effectiveness studies of the procedure. Methods: We evaluated the outcomes and treatment costs of all decompressive craniectomies performed between the 2000 and 2006 in a single institution to lower intractable intracranial pressure after TBI. The health‐related quality of life was evaluated on the Euroqol (EQ‐5D) questionnaire and on the visual‐analogue scale (VAS), and cost of a quality‐adjusted life year (QALY) was calculated. Results: In this study of 54 patients, the median follow‐up time was 5.6 years. Overall mortality rate was 41%. Of the 22 non‐survivors, 73% died within 30 days. For 32 survivors, the median EQ‐5D index value was 0.85, which is equal to the normal population. The median VAS value was 73, whilst normal population’s value is 80. Of the survivors, 81% (26/32) were able to live at home and 31% (10/32) returned to work. The cost of neurosurgical treatment for one QALY was 2400€. Estimation for all medical costs, including rehabilitation and anticipated future costs, resulted cost of a QALY 17 900 €. Conclusion Mortality after severe TBI leading to DC was high, but amongst the survivors, the health‐related quality of life was equal to normal population. Most survivors were able to live at home and were almost as satisfied with their health as in general people are. Cost of neurosurgical treatment was low, and also including all evaluated costs, cost of a QALY gained was acceptable. 相似文献
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Cost‐effectiveness analysis of epilepsy surgery in a controlled cohort of adult patients with intractable partial epilepsy: A 5‐year follow‐up study 下载免费PDF全文
Marie‐Christine Picot Audrey Jaussent Dorine Neveu Philippe Kahane Arielle Crespel Philippe Gelisse Edouard Hirsch Philippe Derambure Sophie Dupont Elizabeth Landré Francine Chassoux Luc Valton Jean‐Pierre Vignal Cécile Marchal Catherine Lamy Franck Semah Arnaud Biraben Alexis Arzimanoglou Jérôme Petit Pierre Thomas Valérie Macioce Pierre Dujols Philippe Ryvlin 《Epilepsia》2016,57(10):1669-1679
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Cost‐effectiveness of early intervention services for psychosis and fidelity to national policy implementation guidance 下载免费PDF全文
Muralikrishnan Radhakrishnan Paul McCrone Louise Lafortune Linda Everard David Fowler Tim Amos Nick Freemantle Swaran P. Singh Max Marshall Vimal Sharma Anna Lavis Peter B. Jones Max Birchwood 《Early intervention in psychiatry》2018,12(4):747-756
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Brodaty H Thomson C Thompson C Fine M 《International journal of geriatric psychiatry》2005,20(6):537-546
OBJECTIVES: To develop a typography of the characteristics of caregivers of community dwelling people with dementia or memory loss who do not use services and empirically investigate the reasons for service non-use. METHOD: The findings of a literature review were used to develop a typography of caregivers' non-use of services. This typography was applied to a sample of community-based caregivers. RESULTS: One in three caregivers were using no services and one in four only one service. Despite considerable proportions reporting low levels of life satisfaction and high levels of overload and resentment the main reasons caregivers gave for not using services were that they did not consider they needed the services. Other reasons for service non-use included care recipient reluctance to use services, lack of knowledge of services or being in the process of applying for services. Service availability or affordability were not identified as major impediments to service use. Presence of a physical disability and contact with a social worker were associated with service use. CONCLUSIONS: Caregivers of people with dementia incur significant strain and have substantial need for a variety of services. Nevertheless many caregivers were not using support services, mainly because of perceived lack of need or lack of awareness. Better public promotion of services, destigmatising dementia and encouraging referrals from health professionals could help overcome the barriers to service use. 相似文献
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Cost‐effectiveness of donepezil and memantine in moderate to severe Alzheimer's disease (the DOMINO‐AD trial) 下载免费PDF全文
Martin Knapp Derek King Renée Romeo Jessica Adams Ashley Baldwin Clive Ballard Sube Banerjee Robert Barber Peter Bentham Richard G Brown Alistair Burns Tom Dening David Findlay Clive Holmes Tony Johnson Cornelius Katona James Lindesay Ajay Macharouthu Ian McKeith Rupert McShane John T O'Brien Patrick P J Phillips Bart Sheehan Robert Howard 《International journal of geriatric psychiatry》2017,32(12):1205-1216
Objective
Most investigations of pharmacotherapy for treating Alzheimer's disease focus on patients with mild‐to‐moderate symptoms, with little evidence to guide clinical decisions when symptoms become severe. We examined whether continuing donepezil, or commencing memantine, is cost‐effective for community‐dwelling, moderate‐to‐severe Alzheimer's disease patients.Methods
Cost‐effectiveness analysis was based on a 52‐week, multicentre, double‐blind, placebo‐controlled, factorial clinical trial. A total of 295 community‐dwelling patients with moderate/severe Alzheimer's disease, already treated with donepezil, were randomised to: (i) continue donepezil; (ii) discontinue donepezil; (iii) discontinue donepezil and start memantine; or (iv) continue donepezil and start memantine.Results
Continuing donepezil for 52 weeks was more cost‐effective than discontinuation, considering cognition, activities of daily living and health‐related quality of life. Starting memantine was more cost‐effective than donepezil discontinuation. Donepezil–memantine combined is not more cost‐effective than donepezil alone.Conclusions
Robust evidence is now available to inform clinical decisions and commissioning strategies so as to improve patients' lives whilst making efficient use of available resources. Clinical guidelines for treating moderate/severe Alzheimer's disease, such as those issued by NICE in England and Wales, should be revisited. © 2016 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd. 相似文献17.
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Cost‐effectiveness of neurostimulation in Parkinson's disease with early motor complications 下载免费PDF全文
Judith Dams PhD Monika Balzer‐Geldsetzer PhD Uwe Siebert MD MPH MSc ScD Günther Deuschl MD W.M. Michael Schuepbach MD Paul Krack MD PhD Lars Timmermann MD PhD Alfons Schnitzler MD PhD Jens‐Peter Reese PhD MPH Richard Dodel MD MPH for the EARLYSTIM‐investigators 《Movement disorders》2016,31(8):1183-1191