No abstract

Background: Anxiety disorders are common in children and youth. Also, in prevention, be it universal, selective or indicated, economic evaluation supports decision-making in the allocation of scarce resources. This review identified and summarised the existing evidence of economic evaluations for the prevention of anxiety disorders in children and adolescents. Methods: A systematic search was conducted on the EBSCO, Scopus, Web of Science, ProQuest, Cochrane and PubMed databases. We included studies that focused on children and adolescents under 18 years of age, aimed to prevent anxiety disorders and presented an incremental analysis of costs and effectiveness. A registered checklist was used that assessed the quality of the included articles. Results: The search yielded 1697 articles. Five articles were included in this review. Three were RCT-based, and two were model-based studies. Out of five included interventions, one was a universal school-based intervention, two selective interventions and two indicated interventions. Universal school-based prevention of anxiety was not cost-effective compared with usual teaching. Selective parent training and indicative child-and parentfocused CBT prevention were likely cost-effective compared with usual care or doing nothing. Conclusion: Parent education and cognitive behaviour therapy interventions can be cautiously interpreted as being a costeffective way of preventing anxiety in children and adolescents. However, the evidence is weakly related to cost-effectiveness as there are only a few studies, with relatively small sample sizes and short follow-ups. Key Practitioner Message• Anxiety disorders in children and adolescents can have long-term health effects. Furthermore, they have significant economic repercussions on families, healthcare providers, societies and nations. Prevention would be the preferred option, but very little is known about the cost-effectiveness of the different prevention strategies.• Decision makers need information about the economic evaluation of anxiety prevention to allocate scarce resources.• The evidence suggests that selective and indicated prevention such as parent education and cognitive behaviour therapy interventions are likely cost-effective. Universal prevention in anxiety is not costeffective use of limited resources. However, current empirical evidence on the cost-effectiveness of anxiety prevention programmes among children and adolescents is weak due to the paucity of studies, small sample sizes and short follow-up periods.

Background Educational interventions can reduce potentially inappropriate medication (PIM) use in older people. Their effectiveness has been measured mainly as changes in PIM use. In this economic evaluation, we analyse the impact of an educational intervention in terms of costs and quality-adjusted life years (QALYs). Methods The educational intervention consisted of activating and interactive training sessions for nursing staff and consulting physicians, and was compared with treatment as usual (TAU). Participants (n = 227) in a cluster randomised trial (cRCT) were residents living permanently in assisted living facilities (n = 20 wards). For economic evaluation, participants’ healthcare service use costs and costs for the intervention were estimated for a 12 month period. Incremental cost-effectiveness ratios (ICERs) were estimated for QALYs per participant. Cost-effectiveness analysis was conducted from a healthcare perspective. A bootstrapped cost-effectiveness plane and one-way sensitivity analysis were undertaken to analyse the uncertainty surrounding the estimates. Results The educational intervention was estimated to be less costly and less effective in terms of QALYs than TAU at the 12 month follow-up [incremental costs –€1,629, confidence interval (CI) –€5,489 to €2,240; incremental effect −0.02, CI –0.06 to 0.02]. The base case ICER was >€80,000/QALY. Conclusion The educational intervention was estimated to be less costly and less effective in terms of QALYs compared with TAU, but the results are subject to some uncertainties. Reduction in PIM use or benefits in quality of life did not seem to translate into improvements in QALYs. Our findings emphasise the need for better understanding of the impact of decreasing PIM use on health outcomes.

Varhaisella diagnoosilla ja lääkehoidolla pystytään hidastamaan muistisairauksien etenemistä ja parantamaan sairastuneiden toimintakykyä sekä elämänlaatua. Tämän tutkimuksen tavoitteena on selvittää, toteutuuko yhdenvertaisuus uuden muistisairauslääkkeen käytön aloituksessa sosioekonomisten ryhmien välillä. Tutkimuksen paneeliaineisto on 10 prosentin satunnaisotos vuonna 2000 65 vuotta täyttäneistä kotona asuvista suomalaisista (n=64 250), joita on seurattu vuosien 2000–2013 ajan. Tässä kansallisiin rekisteritietoihin perustuvassa kohorttitutkimuksessa tarkasteltiin ensiksi AKE-estäjien uusien käyttäjien (n=6 977) uuden muistisairauslääkkeen (memantiini) käytön aloitusta vuosien 2002–2013 aikana. Toisessa analyysissä tarkasteltiin osa-aineistossa sairaalahoitodiagnoosin saaneita muistisairauslääkkeiden uusia käyttäjiä (n=3 475) vuosien 2003–2013 aikana. Coxin suhteellisten riskitiheyksien mallin avulla tarkasteltiin sosioekonomisen aseman yhteyttä 1) memantiinin käytön aloitukseen AKE-estäjän käytön aloittaneilla, ja 2) muistisairauslääkkeen käytön aloitukseen ensimmäisestä kognitiivisiin oireisiin liittyvästä sairaalahoitodiagnoosista. AKE-estäjien käyttäjillä ylempi sosioekonominen asema lisäsi memantiinin käytön aloitusta (suhteellinen riskitiheys (hazard ratio (HR)) 1,43, 95% luottamusväli (LV) 1,23-1,68, p< 0,001). Sairaalahoitodiagnoosin saaneilla sosioekonominen asema ei ollut yhteydessä muistisairauslääkkeen käytön aloitukseen. Lääkehoidon innovaatioiden käyttöönottoon liittyy tämän tutkimuksen mukaan eriarvoisuutta sosioekonomisten ryhmien välillä. Tulevaisuudessa tulisi tutkia, mitkä taustalla olevat tekijät johtavat terveydenhuollon innovaatioihin liittyvään eriarvoisuuteen.

Objective To investigate the effect of an educational intervention of nursing staff on change in psychotropic use and related costs among older long-term care residents. Design A secondary analysis of a randomized controlled intervention study with 12 months of follow-up. Setting Assisted living facilities in Helsinki, Finland. Subjects Older (≥65 years) residents ( N = 227) living in assisted living facility wards ( N = 20) in Helsinki in 2011. Intervention The wards were randomized into two groups. In one group, the nursing staff received training on appropriate medication therapy and guidance to recognize potentially harmful medications and adverse effects (intervention group); in the other group, the nursing staff did not receive any additional training (control group). Main outcome measures Change of psychotropic use counted as relative proportions of WHO ATC-defined daily doses (rDDDs) among older long-term care residents. In addition, the change in drug costs was considered. Comparable assessments were performed at 0, 6, and 12 months. Results A significant decrease in both rDDDs and the cost of psychotropics was observed in the intervention group at 6 months follow-up. However, at 12 months, the difference between the intervention and control group had diminished. Conclusions Educational training can be effective in reducing the doses and costs of psychotropics. Further studies are warranted to investigate whether long-term effects can also be achieved by various educational interventions. Registration number ACTRN 12611001078943 KEY POINTS We explored the effect of staff training on psychotropic use and associated costs among older long-term care residents. Educational training of nursing staff was beneficial as regards the actual drug doses of psychotropics, and cost savings in psychotropic medication were achieved. Educational training was efficient in the short-term, but further research is warranted to achieve long-term effects.