CG123 Common mental health disorders - National Institute for ...

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Appendix 10Hakkaartet al., 2006NetherlandsCost-utilityanalysisInterventions:Brief therapy: aformalisedstepped-careapproachCBT: maximumnumber ofsessions 15Care as usual, notformalised. Amultidisciplinaryteam can choosethe suitable therapyfrom a varietyof treatmentoptions. Thenumber ofsessions dependson the therapychosenPeople with DSM-IVdiagnoses of MDD,dysthymic disorder,panic disorder, socialphobia and GADSource of clinicaleffectiveness data:multicentrerandomised trialSource of resourceuse: actual data usingthe TiC-PSource of unit costs:published sourcesCosts:Contacts with healthcareproviders (GPs, psychiatrists,medical specialist, physiotherapist,alternative health practitioner),day care andhospitalisation and medications.Productivity losses dueto absenteeism from workTotal costs per person:Direct medical costs:Care as usual 3,360€CBT: 3,127€Brief therapy: 3,679€Indirect costs:Care as usual 6,151€CBT: 6,621€Brief therapy: 6,537€Primary outcome: number ofQALYsCare as usual: 0.91 QALYsBrief therapy: 0.94 QALYsCBT: 0.94 QALYsUsual care isdominated by CBTas it is moreexpensive and lesseffectiveICER of brief therapyversus CBT:€222 956 perQALY gainedSensitivity analysis– of the missingdata using linearextrapolation andcomplete caseanalysis:No significantchangesPerspective:societalCurrency:Euros (€)Cost year:2002Time horizon:18monthsDiscounting:not neededApplicability:nonapplicable271
Appendix 11APPENDIX 11:HIGH PRIORITY RESEARCH RECOMMENDATIONS1. GAD-2 for people with suspected anxiety disordersIn people with suspected anxiety disorders: What is the clinical utility of usingthe GAD-2 compared with routine case identification to accurately identifydifferent anxiety disorders? Should an avoidance question be added to improve caseidentification?Why this is importantThere is good evidence of poor detection and under-recognition in primary care ofanxiety disorders. Case identification questions for anxiety disorders are not welldeveloped. There is reasonable evidence that the GAD-2 may have clinical utility asa case identification tool for anxiety disorders, in particular GAD, but there is greateruncertainly about its utility for other anxiety disorders, in particular those with anelement of phobic avoidance. Understanding whether the GAD-2 plus or minus anadditional phobia question would improve case identification for different anxietydisorders would be an important contribution to their identification.These questions should be answered by a well-designed cohort study in which theGAD-2 is compared with a diagnostic gold-standard for a range of anxiety disorders.The cost-effectiveness of this approach should also be assessed.2. Comprehensive assessment versus a brief assessmentFor people with a suspected common mental health disorder, what is the clinical andcost effectiveness of using a comprehensive assessment (conducted by a mentalhealth professional) versus a brief assessment (conducted by a paraprofessional)?Why this is importantUncertainty remains about the accuracy and consequent identification of appropriatetreatment by paraprofessionals in primary care. An assessment by a mental healthprofessional is likely to result in more accurate identification of problems and appropriatetreatment, but is likely to entail greater cost and potentially significant longerwait times for interventions, both of which can have deleterious effects on care.This question should be answered using a randomised controlled design thatreports short- and medium-term outcomes (including cost-effectiveness outcomes) ofat least 12 months’ duration.3. ‘Walking across’ from one assessment instrument to anotherWhat methodology should be used to allow ‘walking across’ from one assessmentinstrument for common mental health disorders to another?272
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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 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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Access to healthcare4. ACCESS TO HE
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Access to healthcareunder the Menta
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Access to healthcare4.2.3 Studies c
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Access to healthcareIndividual-leve
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Access to healthcareJUNG2003 review
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Access to healthcare70Table 8: Clin
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Access to healthcare4.4 SERVICE DEV
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Access to healthcareTable 12: Summa
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Access to healthcareAll studies wer
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Access to healthcarefrom such popul
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Access to healthcarestructure and d
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Summary of recommendations8.1.1.6 S
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Summary of recommendationsFigure 12
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Page 231 and 232: Appendices9 APPENDICESAppendix 1: S
Page 233 and 234: Appendix 1of a depressive disorder
Page 235 and 236: Appendix 1b) Assessment of anxiety
Page 237 and 238: Appendix 2APPENDIX 2:DECLARATIONS O
Page 239 and 240: Appendix 2Mr Mike BessantEmployment
Page 241 and 242: Appendix 2Personal non-pecuniary in
Page 243 and 244: Appendix 2Actions takenMr Rupert Su
Page 245 and 246: Appendix 2Personal family interestN
Page 247 and 248: Appendix 3APPENDIX 3:STAKEHOLDERS A
Page 249 and 250: Appendix 4ClinicalpopulationPeople
Page 251 and 252: Appendix 4Case identificationNo. Pr
Page 253 and 254: Appendix 5APPENDIX 5:REVIEW PROTOCO
Page 255 and 256: Appendix 7APPENDIX 7:METHODOLOGY CH
Page 257 and 258: Appendix 9APPENDIX 9:METHODOLOGY CH
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Page 261 and 262: Appendix 9case also excludes costs
Page 263 and 264: Appendix 9For consistency, the EQ-5
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Page 275 and 276: Appendix 11discussion of options bu
Page 277 and 278: Appendix 13APPENDIX 13:GENERALIZED
Page 279 and 280: ReferencesAndlin-Sobocki, P., Jöns
Page 281 and 282: ReferencesBower, P., Gilbody, S., R
Page 283 and 284: ReferencesCooper, S., Smiley, E., M
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Page 287 and 288: ReferencesGiles, D. E., Jarrett, R.
Page 289 and 290: ReferencesHorowitz, M. J., Wilner,
Page 291 and 292: ReferencesKnapp, M. & Ilson, S. (20
Page 293 and 294: ReferencesMarks, J., Goldberg, D. P
Page 295 and 296: ReferencesNCCMH (forthcoming) Self-
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Page 299 and 300: ReferencesSartorius, N. (2002) Eine
Page 301 and 302: ReferencesTiemens, B. G., Ormel, J.
Page 303 and 304: ReferencesWilkinson, M. J. B. & Bar
Page 305 and 306: Glossarybeliefs and interpretations
Page 307 and 308: Glossaryto learn to become more awa
Page 309 and 310: Abbreviations12 ABBREVIATIONSADDADS
Page 311 and 312: AbbreviationsOASISOCDONSORPHQ (-A,
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