The aim of this study was to compare the effectiveness of work-related cognitive-behavioral treatment (W-CBT) with that of cognitive-behavioral treatment as usual (CBT-AU) for employees on sick leave as a result of a major depressive disorder (MDD). We collected data for 26 matched outpatients at pre- and posttreatment, as well as at 1-year follow-up. Outcome measures were the days of incapacity to work (DIW) as well as self-report measures (Beck Depression Inventory [BDI], Symptom Checklist 90-R [GSI], Life Satisfaction Questionnaire [FLZ]). We analyzed data with hierarchical linear modeling in a 2-level model. Therapy effects were defined in 3 ways: effect size (ES), response (based on the reliable change index), and remission compared with the general population's symptom level. The DIW were reduced significantly after both types of treatment, but employees showed even fewer DIW after W-CBT. At follow-up, significantly more employees were working as a result of W-CBT than with CBT-AU. Significant improvements on scores of self-rating measures corresponded with moderate-to-large effect sizes for both treatment types. Approximately 2 thirds of the treated employees were categorized as unimpaired on BDI scores at posttreatment and at follow-up. At least 1 half of the employees were classified as unimpaired on GSI scores at both assessment points. In future research, a randomized controlled trial should be conducted using a larger sample size to investigate the impact of moderators (e.g., employees at different branches of the company). Findings provided support for using common CBT techniques to enhance return to work without losing expected improvements at the symptom level.
Strengthened interdisciplinary cooperation can improve the utilization of an employee group that usually does not seek out specific diagnostic examinations and psychotherapeutic treatment.
Previous research has shown that anorexia nervosa (AN) and bulimia nervosa (BN) are expensive illnesses to treat. To reduce their economic burden, adequate interventions need to be established. Our objective was to conduct cost-offset analyses for evidence-based treatment of eating disorders using outcome data from a psychotherapy trial involving cognitive behavioral therapy (CBT) and focal psychodynamic therapy (FPT) for AN and a trial involving CBT for BN. Assuming a currently running, ideal healthcare system using a 12-month, prevalence-based approach and varying the willingness to participate in treatment, we investigated whether the potential financial benefits of AN- and BN-related treatment outweigh the therapy costs at the population level. We elaborated on a formula that allows calculating cost-benefit relationships whereby the calculation of the parameters is based on estimates from data of health institutions within the German healthcare system. Additional intangible benefits were calculated with the aid of Quality-Adjusted Life Years. The annual costs of an untreated eating disorder were 2.38 billion EUR for AN and 617.69 million EUR for BN. Independent of the willingness to participate in treatment, the cost-benefit relationships for the treatment remained constant at 2.51 (CBT) and 2.33 (FPT) for AN and 4.05 (CBT) for BN. This consistency implies that for each EUR invested in the treatment, between 2.33 and 4.05 EUR could be saved each year. Our findings suggest that the implementation of evidence-based psychotherapy treatments for AN and BN may achieve substantial cost savings at the population level.
Psychische Störungen, insbesondere Angst- und affektive Störungen, kommen in der Allgemeinbevölkerung häufig vor und verursachen erhebliche direkte und indirekte Kosten. Ziel der vorliegenden Analyse ist es, Kosten-Nutzen-Relationen unter der Bedingung zu ermitteln, dass alle behandlungswilligen, von einer Angst- oder affektiven Störung Betroffenen in Deutschland psychotherapeutisch behandelt werden würden. Zu diesem Zweck wurden mithilfe zahlreicher Quellen statistische Kosten- und Nutzenberechnungen für unterschiedliche Ausprägungen von Therapiewilligkeit, -effektivität und -dauer vorgenommen. Bei einer mittleren Ausprägung der Behandlungswilligkeit könnten durch die zusätzliche Behandlung bis zu 100-mal so viele Personen wie aktuell durch eine Psychotherapie als remittiert gelten. Die Kosten-Nutzen-Bilanzen zeigten, dass der finanzielle Nutzen in den meisten Fällen die Behandlungskosten übersteigen würde. Vor allem der erhebliche Hinzugewinn an Lebensqualität spricht für eine breitere psychotherapeutische Versorgung von Betroffenen. Um die Ergebnisse zu validieren, wurde mithilfe der Brogden-Cronbach-Gleser-Formel eine Gewinnschätzung vorgenommen. Die Ergebnisse aus der Anwendung dieser Formel wichen am wenigsten von unseren eigenen Schätzungen ab, wenn die Formel auf konservative Art und Weise eingesetzt wurde. Dieses spricht dafür, dass die eigene Schätzung insgesamt eher konservativ ausgefallen ist. Die Ergebnisse sollten anhand von longitudinalen Psychotherapiestudien überprüft werden. Gesundheitspolitische Implikationen werden diskutiert.
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