The journal of mental health policy and economics
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J Ment Health Policy Econ · Mar 2009
Randomized Controlled Trial Multicenter StudyA comparison of SF-6D and EQ-5D utility scores in a study of patients with schizophrenia.
Economic evaluations of healthcare interventions increasingly measure outcomes using quality-adjusted life years (QALYs). The SF-6D and the EQ-5D are alternative ways of generating utility scores for use in QALY estimations, but it is unclear which is most sensitive to change in psychiatric symptom severity. There are also limited data on the sensitivity of these measures to changes in existing clinical indicators in long-term mental health conditions like schizophrenia. ⋯ Further comparisons of the EQ-5D and SF-6D are required.
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J Ment Health Policy Econ · Dec 2008
Insurance coverage and the treatment of mental illness: effect on medication and provider use.
Canada's public health insurance system fully covers medically necessary hospital and physician services, but does not cover community-based non-physician mental health provider services or prescription drugs. Almost 2/3 of Canadians have private supplemental insurance for extended health benefits, typically through their employer, so its distribution is skewed to higher-income, employed Canadians, and typically features substantial cost-sharing and coverage limits. A recent national survey suggests only one-third of Canadians with selected mental disorders talked to a health professional during the previous 12 months and only a minority (19.3%) receive drug treatment. Financial barriers to care constitute a potentially important contributor to this under-use of mental health treatments. ⋯ Future research should incorporate insurance measures which capture details of coverage among all survey respondents. Linking survey to utilization data will help to overcome issues of recall bias.
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Little is known about racial and ethnic disparities in health care utilization, expenditures and drug choice in the antidepressant market. ⋯ Reducing differences in observable characteristics such as health insurance and education will mitigate racial and ethnic disparities in expenditures on antidepressant drug use and in the types of antidepressant used (e.g., generics vs. brands; new vs old). But these factors will have less influence in reducing racial and ethnic disparities in overall antidepressant drug utilization. To limit differences in overall antidepressant drug use, policymakers must take into account cultural factors and other sources of heterogeneity.
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J Ment Health Policy Econ · Sep 2008
Cost-effectiveness of group psychotherapy for depression in Uganda.
Low and middle-income countries are increasingly acknowledging the potential health and economic benefits associated with treatment of depression. To aid countries in making resource-allocation decisions, there is a need for cost-effectiveness analysis of treatments for depression in developing countries. Although there are a limited number of studies from developing countries that report data on treatment efficacy and costs, these data can be leveraged to tailor mathematical models that are used to evaluate the cost-effectiveness of depression treatments in specific settings. ⋯ There are a limited number of clinical studies evaluating efficacy and costs of treatments for depression in developing countries. Research on depression in such settings can further assist in providing accurate and country-contextualized estimates of cost-effectiveness.
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J Ment Health Policy Econ · Jun 2008
Effectiveness and cost of atypical versus typical antipsychotic treatment for schizophrenia in routine care.
In two recent randomised clinical trials, a meta-analysis and in an effectiveness study analysing routine data from the U.S. Veterans Administration the superiority of the newer atypical drugs over typical antipsychotic drugs, concerning both their efficacy and their side-effect profile, has been questioned. ⋯ The non-significant differences in the effectiveness of atypical compared to typical antipsychotics according to severity of disease should be investigated in a prospective observational study or in a randomised clinical trial.