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Case identification and formal assessmenthave significantly affected the results of the economic analysis. People under activemonitoring (10% of people identified as GAD positive) were all assumed to improvebecause the GDG considered that initially a higher proportion of people who wereidentified as GAD positive would be assigned to active monitoring in UK routineclinical practice; however, some people would not improve and would, in reality, beoffered one of the other treatment options described in the model. For simplicity, themodel assumed that a lower percentage of people were offered active monitoringcompared with routine practice, but all of them improved. The remaining people, whoin routine practice would be transferred from active monitoring to other treatmentsfollowing non-improvement, were assumed in the model to be initiated on other treatmentoptions immediately following the identification of GAD.Utility data and estimation of QALYsTo express outcomes in the form of QALYs, the health states of the economic modelneeded to be linked to appropriate utility scores. Utility scores represent the HRQoLassociated with specific health states on a scale from 0 (death) to 1 (perfect health);they are estimated using preference-based measures that capture people’s preferenceson the HRQoL experienced in the health states under consideration. The utility scoresfor specific health states associated with GAD were obtained from Allgulander andcolleagues (2007), consistent with the Generalised Anxiety Disorder in Adults guideline(NCCMH, 2011a).Cost dataCosts associated with the identification methods were calculated by combiningresource use estimates (GP time) with respective national unit costs (Curtis, 2009). Itwas assumed that administration of GAD-2 and GAD-7 required 10 and 15 minutes,respectively, whereas routine GP assessment required on average one GP visit.Costs of psychological treatments (low- and high-intensity psychological interventions)were estimated using average estimates of the respective costs from theGeneralised Anxiety Disorder in Adults guideline (NCCMH, 2011a). Costs of pharmacologicaltreatment were also based on the NICE guideline (NCCMH, 2011a),using treatment with sertraline as reference. People who were falsely detected ashaving GAD were assumed to incur 20% of the treatment cost of a true positiveperson, according to the GDG’s estimate. Health and social care costs of peoplefalsely negative (that is, people having GAD but not identified by the methodsassessed in the model), as well as the respective costs of people not responding totreatment, were taken from the NICE guideline (NCCMH, 2011a), based on resourceuse data reported in the most recent adult psychiatric morbidity survey in England(McManus et al., 2009), further expert opinion (GDG for the Generalised AnxietyDisorder in Adults guideline) and national unit costs (Curtis, 2009).All costs were expressed in 2009 prices. Discounting of costs and outcomes wasnot necessary since the time horizon of the analysis was shorter than 1 year.Table 17 reports the values of all input parameters utilised in the economic model,and provides details on the sources of data and methods that were used at the estimationof input parameters.111
Case identification and formal assessmentTable 17: Input parameters utilised in the economic model of pharmacological treatments for people with GADInput parameter Deterministic Source of data – commentsvalueSensitivity of identification methods:GAD-2 (cut off 3) 0.86 KROENKE2007GAD-7 (cut off 8) 0.92 KROENKE2007GP assessment 0.34 Wittchen and colleagues (2002); Davidson and colleagues (2010)Specificity of identification methods:GAD-2 (cut off 3) 0.83 KROENKE2007GAD-7 (cut off 8) 0.76 KROENKE2007GP assessment 0.9 GDG assumptionProbability of treatment response:Active monitoring 1.00 GDG estimate – see text for more detailsLow-intensity interventions 0.635 Titov and colleagues (2009) – CCBT (low-intensityintervention) for people with GADNCCMH (2011a) – guideline meta-analysisHigh-intensity intervention 0.40 NCCMH (2011a) – network meta-analysisDrug therapy with sertraline 0.63 of data included in the guideline systematic reviewof pharmacological treatmentsUtilities:Response 0.760 Allgulander and colleagues (2007)Non-response 0.630 Allgulander and colleagues (2007)No relapse following response (remission) 0.790 Allgulander and colleagues (2007)112
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Commonmental healthdisordersTHE NIC
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© The British Psychological Societ
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Contents6 FURTHER ASSESSMENT OF RIS
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Guideline development group members
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Preface1 PREFACEThis guideline has
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Prefacecollaborative manner using t
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PrefaceThe experience of people wit
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Common mental health disorders2.2 T
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Common mental health disordersto ho
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Common mental health disordersManua
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Common mental health disordershighe
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Common mental health disordersNegat
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Common mental health disorderscours
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Common mental health disordersover
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Common mental health disorders2.2.6
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Common mental health disordersTable
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Common mental health disorders1996)
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Common mental health disordersSumma
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Common mental health disordersTable
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Common mental health disordersappli
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Methods used to develop this guidel
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Access to healthcare4. ACCESS TO HE
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Summary of recommendations8.1.1.6 S
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Summary of recommendationsFigure 12
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Summary of recommendations●Genera
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Summary of recommendations8.4 STEPS
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Summary of recommendations●●a g
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Summary of recommendationsDiscuss w
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Summary of recommendationsinclude p
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Appendices9 APPENDICESAppendix 1: S
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Appendix 1of a depressive disorder
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Appendix 1b) Assessment of anxiety
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Appendix 2APPENDIX 2:DECLARATIONS O
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Appendix 2Mr Mike BessantEmployment
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Appendix 2Personal non-pecuniary in
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Appendix 2Actions takenMr Rupert Su
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Appendix 2Personal family interestN
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Appendix 3APPENDIX 3:STAKEHOLDERS A
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Appendix 4ClinicalpopulationPeople
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Appendix 4Case identificationNo. Pr
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Appendix 5APPENDIX 5:REVIEW PROTOCO
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Appendix 7APPENDIX 7:METHODOLOGY CH
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Appendix 9APPENDIX 9:METHODOLOGY CH
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Appendix 92.10 Are all important pa
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Appendix 9case also excludes costs
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Appendix 9For consistency, the EQ-5
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Appendix 9Answer ‘yes’ if the a
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Appendix 9Answer ‘yes’ if the e
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Appendix 9Answer ‘yes’ if appro
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Appendix 10APPENDIX 10: EVIDENCE TA
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Appendix 11APPENDIX 11:HIGH PRIORIT
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Appendix 11discussion of options bu
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Appendix 13APPENDIX 13:GENERALIZED
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ReferencesAndlin-Sobocki, P., Jöns
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ReferencesBower, P., Gilbody, S., R
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ReferencesCooper, S., Smiley, E., M
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ReferencesEhlers A., Gene-Cos N. &
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ReferencesGiles, D. E., Jarrett, R.
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ReferencesHorowitz, M. J., Wilner,
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ReferencesKnapp, M. & Ilson, S. (20
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ReferencesMarks, J., Goldberg, D. P
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ReferencesNCCMH (forthcoming) Self-
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ReferencesOzer, E. J., Best, S. R.,
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ReferencesSartorius, N. (2002) Eine
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ReferencesTiemens, B. G., Ormel, J.
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ReferencesWilkinson, M. J. B. & Bar
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Glossarybeliefs and interpretations
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Glossaryto learn to become more awa
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Abbreviations12 ABBREVIATIONSADDADS
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AbbreviationsOASISOCDONSORPHQ (-A,
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