Abstract:
BACKGROUND:Whilst evidence suggests cognitive behaviour therapy (CBT) may be effective for depressed older people in a primary care setting, few studies have examined its cost-effectiveness. The aim of this study was to compare the cost-effectiveness of cognitive behaviour therapy (CBT), a talking control (TC) and treatment as usual (TAU), delivered in a primary care setting, for older people with depression. METHODS:Cost data generated from a single blind randomised controlled trial of 204 people aged 65 years or more were offered only Treatment as Usual, or TAU plus up to twelve sessions of CBT or a talking control is presented. The Beck Depression Inventory II (BDI-II) was the main outcome measure for depression. Direct treatment costs were compared with reductions in depression scores. Cost-effectiveness analysis was conducted using non-parametric bootstrapping. The primary analysis focussed on the cost-effectiveness of CBT compared with TAU at 10 months follow up. RESULTS:Complete cost data were available for 198 patients at 4 and 10 month follow up. There were no significant differences between groups in baseline costs. The majority of health service contacts at follow up were made with general practitioners. Fewer contacts with mental health services were recorded in patients allocated to CBT, though these differences were not significant. Overall total per patient costs (including intervention costs) were significantly higher in the CBT group compared with the TAU group at 10 month follow up (difference £427, 95% CI: £56 - £787, p < 0.001). Reductions in BDI-II scores were significantly greater in the CBT group (difference 3.6 points, 95% CI: 0.7-6.5 points, p = 0.018). CBT is associated with an incremental cost of £120 per additional point reduction in BDI score and a 90% probability of being considered cost-effective if purchasers are willing to pay up to £270 per point reduction in the BDI-II score. CONCLUSIONS:CBT is significantly more costly than TAU alone or TAU plus TC, but more clinically effective. Based on current estimates, CBT is likely to be recommended as a cost-effective treatment option for this patient group if the value placed on a unit reduction in BDI-II is greater than £115. TRIAL REGISTRATION:isrctn.org Identifier: ISRCTN18271323.
journal_name
BMC Health Serv Resjournal_title
BMC health services researchauthors
Holman AJ,Serfaty MA,Leurent BE,King MBdoi
10.1186/1472-6963-11-33subject
Has Abstractpub_date
2011-02-11 00:00:00pages
33issn
1472-6963pii
1472-6963-11-33journal_volume
11pub_type
杂志文章,随机对照试验abstract:BACKGROUND:Recent developments have made screening tests for foetal abnormalities available earlier in pregnancy and women have a range of testing options accessible to them. It is now recommended that all women, regardless of their age, are provided with information on prenatal screening tests. General Practitioners (...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-8-114
更新日期:2008-05-28 00:00:00
abstract:BACKGROUND:Four social audits in 1998, 2003, 2006 and 2009 identified actions that Nicaragua could take to reduce corruption and public perception in primary health care and other key services. METHODS:In a 71-cluster sample, weighted according to the 1995 census and stratified by geographic region and settlement type...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-11-S2-S3
更新日期:2011-12-21 00:00:00
abstract:BACKGROUND:Performance-based financing (PBF) strategies are promoted as a supply-side, results-based financing mechanism to improve primary health care. This study estimated the effects of Rwanda's PBF program on less-incentivized child health services and examined the differential program impact by household poverty. ...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-015-1033-7
更新日期:2015-09-14 00:00:00
abstract:BACKGROUND:Among the important stress factors for physicians nowadays are poorly functioning, time consuming and inadequate information systems. The present study examined the predictors of physicians' stress related to information systems (SRIS) among Finnish physicians. The examined predictors were cognitive workload...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-018-3094-x
更新日期:2018-04-13 00:00:00
abstract:BACKGROUND:Reimbursement systems provide incentives to health care providers and may drive physician behaviour. This review assesses the impact of reimbursement system on socioeconomic and racial inequalities in access, utilization and quality of primary care. METHODS:A systematic search was performed in Web of Scienc...
journal_title:BMC health services research
pub_type: 杂志文章,评审
doi:10.1186/s12913-016-1805-8
更新日期:2016-10-04 00:00:00
abstract:BACKGROUND:Due to stagnating resources and an increase in staff workload, the quality of Finnish primary health care (PHC) is claimed to have deteriorated slowly. With a decentralised PHC organisation and lack of national stewardship, it is likely that municipalities have adopted different coping strategies, predisposi...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-019-4449-7
更新日期:2019-09-04 00:00:00
abstract:BACKGROUND:Perinatal depression is common in low and middle income countries (LAMICs). Task sharing interventions have been implemented to treat perinatal depression in these settings, as a way of dealing with staff shortages. Task sharing allows lay health workers to provide services for less complex cases while being...
journal_title:BMC health services research
pub_type: 杂志文章,meta分析,评审
doi:10.1186/s12913-018-3030-0
更新日期:2018-03-23 00:00:00
abstract:BACKGROUND:As one of the most populous metropolitan areas in the Pearl River Delta of South China, Shenzhen attracts millions of migrant workers annually. The objectives of this study were to compare health needs, self-reported health and healthcare utilisation of insured and uninsured migrant workers in Shenzhen, Chin...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-9-214
更新日期:2009-11-21 00:00:00
abstract:BACKGROUND:Recently arrived culturally and linguistically diverse migrant mothers in Western Industrialised Nations are less likely to access health care and are more likely to report negative healthcare experiences than more established migrant or non-migrant populations. This is particularly an issue in Australia whe...
journal_title:BMC health services research
pub_type: 杂志文章,评审
doi:10.1186/s12913-020-05157-x
更新日期:2020-04-15 00:00:00
abstract:BACKGROUND:Due to increasing bacterial resistance rates choosing a correct empiric antibiotic therapy is getting more and more complex. Often medical doctors use information tools to make the right treatment choice. METHODS:One hundred sixty six participants (77 medical doctors and 89 medical students) were asked to p...
journal_title:BMC health services research
pub_type: 杂志文章,随机对照试验
doi:10.1186/s12913-020-5045-6
更新日期:2020-03-06 00:00:00
abstract::An amendment to this paper has been published and can be accessed via the original article. ...
journal_title:BMC health services research
pub_type: 已发布勘误
doi:10.1186/s12913-020-05345-9
更新日期:2020-08-12 00:00:00
abstract:BACKGROUND:Patients' satisfaction is an important indicator for quality of care. Measuring healthcare quality and improving patient satisfaction have become increasingly prevalent, especially among healthcare providers and purchasers of healthcare. This is mainly due to the fact that consumers are becoming increasingly...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-10-149
更新日期:2010-06-02 00:00:00
abstract:BACKGROUND:Problem gambling and homelessness are recognized as important public health concerns that significantly impact individuals, their friends and families, communities and broader society. We aimed to explore the experiences with health and social services of men who had histories of problem gambling and housing...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-016-1583-3
更新日期:2016-08-02 00:00:00
abstract:BACKGROUND:While local context costing evidence is relevant for healthcare planning, budgeting and cost-effectiveness analysis, it continues to be scarce in Ethiopia. This study assesses the cost of providing a prevention of mother-to-child transmission of HIV/AIDS (PMTCT) service across heterogeneous prevalence (high,...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-019-3978-4
更新日期:2019-03-06 00:00:00
abstract:BACKGROUND:Wellbeing of healthcare workers is important for the effective functioning of health systems. The aim of this study was to explore the conceptualisations of wellbeing, stress and burnout among healthcare workers in primary healthcare settings in rural Ethiopia in order to inform the development of contextual...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-017-2370-5
更新日期:2017-06-19 00:00:00
abstract:BACKGROUND:As health systems evolve, it is essential to evaluate their impact on the delivery of health services to socially disadvantaged populations. We evaluated the delivery of primary health services for different socio-economic groups and assessed the performance of different organizational models in terms of equ...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-13-517
更新日期:2013-12-17 00:00:00
abstract:BACKGROUND:With increased international migration, language barriers are likely becoming more relevant in primary care. The aim of this study was to investigate the language barrier in paediatric and adult primary care, present its consequences, reveal how it is overcome, as well as highlight the use of and potential u...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-019-4164-4
更新日期:2019-06-27 00:00:00
abstract:BACKGROUND:The precipitous closure of rural maternity services in British Columbia (BC), Canada, and internationally has demanded a reevaluation of how to meet the perinatal surgical needs of rural women in accordance with the Triple Aim objectives of safety, cost-effectiveness, and satisfaction of all key stakeholders...
journal_title:BMC health services research
pub_type: 杂志文章,评审
doi:10.1186/s12913-016-1629-6
更新日期:2016-08-13 00:00:00
abstract:BACKGROUND:Acute myocardial infarction (AMI) is one of the more frequent reasons diabetic patients are admitted to hospital, and there are reports that the long-term prognosis after an AMI is much worse in these patients than in non-diabetic patients. This study aims to compare hospital admissions and costs in Spanish ...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-10-59
更新日期:2010-03-08 00:00:00
abstract:BACKGROUND:Reablement is a time-limited intervention that aims to support people to regain independence and enable them to resume their daily activities after they return home from an in-patient care setting, or to maintain independence to enable them to remain at home. There is some evidence that reablement can enhanc...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-016-1600-6
更新日期:2016-08-11 00:00:00
abstract:BACKGROUND:Quality Improvement Interventions require significant financial investments, and therefore demand careful consideration in their design in order to maximize potential benefits. In this correspondence we present the methodological approach of a multifaceted quality improvement intervention aiming to improve q...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-8-181
更新日期:2008-08-27 00:00:00
abstract:BACKGROUND:Technology-based self-assessment (TB-SA) benefits patients and providers and has shown feasibility, ease of use, efficiency, and cost savings. A promising TB-SA, the VA eScreening program, has shown promise for the efficient and effective collection of mental and physical health information. To assist adopti...
journal_title:BMC health services research
pub_type: 杂志文章,多中心研究
doi:10.1186/s12913-019-4436-z
更新日期:2019-08-28 00:00:00
abstract:BACKGROUND:Rotavirus has been identified as the most common pathogen associated with severe diarrhoea. Two effective vaccines against the pathogen have been licensed. However, many countries including Indonesia have yet to introduce the vaccine into their national immunisation programs. This study aimed to examine the ...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-015-1187-3
更新日期:2015-11-30 00:00:00
abstract:BACKGROUND:Although heart disease is a major cause of morbidity and mortality the majority of patients do not access existing rehabilitation programs and patient resources are not designed to facilitate patient choice and decision-making. The objective of this study was to develop and test a series of risk factor modul...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-6-95
更新日期:2006-08-06 00:00:00
abstract:BACKGROUND:The number of HIV-related hospitalizations has decreased worldwide in recent years owing to the availability of highly active antiretroviral therapy. However, the change in HIV-related hospitalizations in Portugal has not been studied. Using comprehensive hospital discharge data from mainland Portuguese hosp...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-015-0801-8
更新日期:2015-04-08 00:00:00
abstract:BACKGROUND:Individuals with severe disability often require personal assistance and help from informal caregivers, in addition to conventional health care. The utilization of assistance dogs may decrease the need for health and social care and increase the independence of these individuals. Service and hearing dogs are...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-018-3014-0
更新日期:2018-06-27 00:00:00
abstract:BACKGROUND:The decreased life expectancy and care costs of mental disorders could be enormous. However, research that compares mortality and utilization concurrently across the major category of mental disorders is absent. This study investigated all-cause mortality and medical utilization among patients with and witho...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-020-05089-6
更新日期:2020-03-18 00:00:00
abstract:BACKGROUND:Statins are among the most commonly prescribed drugs worldwide in the prevention of cardiovascular diseases and their effectiveness is largely acknowledged. The consumption of statins increased four-fold during the 2000-2010 decade in Italy and national and regional control policies were developed. Restricti...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-14-6
更新日期:2014-01-06 00:00:00
abstract:BACKGROUND:Global coronary heart disease (CHD) risk assessment is recommended to guide primary preventive pharmacotherapy. However, little is known about physicians' understanding and use of global CHD risk assessment. Our objective was to examine US physicians' awareness, use, and attitudes regarding global CHD risk a...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-12-20
更新日期:2012-01-24 00:00:00
abstract:BACKGROUND:Guidelines recommend shared decision making (SDM) for determining whether to use statins to prevent cardiovascular events in at-risk patients. We sought to develop a toolkit to facilitate the cross-organizational spread and scale of a SDM intervention called the Statin Choice Conversation Aid (SCCA) by (i) a...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-019-4055-8
更新日期:2019-04-24 00:00:00