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Introduction: This study examined whether factors related to general practice mental health professionals (GP-MHPs), that is, characteristics of the professional, the function, and the care provided, were associated with short-term effectiveness and efficiency of the care provided by GP-MHPs to adults in Dutch general practice. Methods: A prospective cohort study was conducted among 320 adults with anxiety or depressive symptoms who had an intake consultation with GP-MHPs (n = 64). Effectiveness was measured in terms of change in quality-adjusted life years (QALYs) 3 months after intake; and efficiency in terms of net monetary benefit (NMB) at 3-month follow-up. A range of GP-MHP-related predictors and patient-related confounders was considered. Results: Patients gained on average 0.022 QALYs at 3-month follow-up. The mean total costs per patient during the 3-month follow-up period (€3,864; 95% confidence interval [CI]: €3,196-€4,731) decreased compared to that during the 3 months before intake (€5,220; 95% CI: €4,639–€5,925), resulting largely from an increase in productivity. Providing mindfulness and/or relaxation exercises was associated with QALY decrement. Having longer work experience as a GP-MHP (≥2 years) and having 10-20 years of work experience as a mental health care professional were negatively associated with NMB. Furthermore, a higher number of homework exercises tended to be related to less efficient care. Finally, being self-employed and being seconded from an organization in which primary care and mental health care organizations collaborate were related to a positive NMB, while being seconded from a mental health organization tended towards such a relationship. Conclusions: Findings seem to imply that the care provided by GP-MHPs contributes to improving patients’ functioning. Some GP-MHP-related characteristics appear to influence short-term effectiveness and efficiency of the care provided. Further research is needed to confirm and better explain these findings and to examine longer-term effects.

Background Atopic dermatitis (AD) is a chronic, multifactorial, inflammatory skin disease with significant impact on patients’ quality of life. Objective The objective of this analysis was to estimate the incremental cost-effectiveness ratio (ICER) of dupilumab, administered every other week, vs supportive care (SC), in the Italian adult population with severe AD, for whom ciclosporin treatment is contraindicated, ineffective or not tolerated. Methods Simulation of outcomes and costs was undertaken using a 1-year decision tree, followed by a 20-year time horizon Markov model. Clinical data were derived from a pooled analysis of two studies. Given the uncertainty on final National Health Service (NHS) cost of dupilumab in Italy (confidential discount might be applied) multiple cost-utility analyses were conducted using different price hypotheses, starting from dupilumab published ex-manufacturer price, and progressively reducing it up to 50%. Model robustness were tested using sensitivity analyses. Results In the base-case, dupilumab was more effective than SC (+1.92 quality adjusted life years, QALYs). In Analysis A (NHS perspective), -8.0% discount on dupilumab ex-manufacturer price was required to achieve an ICER

Background: Atopic dermatitis (AD) is a chronic, multifactorial, inflammatory skin disease with significant impact on patients' quality of life. Objective: The objective of this analysis was to estimate the incremental cost-utility ratio (ICUR) of dupilumab, administered every other week, plus supportive care (SC), vs SC, in the Italian adult population with severe AD, for whom ciclosporin treatment is contraindicated, ineffective or not tolerated. Methods: Simulation of outcomes and costs was conducted using a 1-year decision tree, followed by a lifetime horizon Markov model. Clinical data were derived from a pooled analysis of two studies. The analysis was conducted adopting the Italian National Health Service (NHS) perspective. In the model, the following costs were considered: i) Drug acquisition costs; ii) Disease management costs; iii) Costs of adverse events. Robustness of findings was tested using both one-way deterministic and probabilistic sensitivity analyses. Results: In the base case, dupilumab plus SC was more effective than SC (+2.42 quality adjusted life years, QALYs). The total lifetime cost per patient treated with dupilumab was higher than SC (€ 137,267 and € 56,744, respec- tively). Dupilumab plus SC was cost-effective vs. SC, with an ICUR of € 33,263 per QALY gained. The ICUR fell in the informal range of ICUR acceptability proposed for Italy (range: € 25,000-€ 40,000 per QALY gained). Sensitivity analyses confirmed robustness and reliability of base case results. Conclusions: Dupilumab plus SC is a cost-effective option for the treatment of patients with severe AD in Italy, compared with SC, when NHS perspective is considered. [ABSTRACT FROM AUTHOR]

This paper presents the ongoing methodological debate concerning whose preferences should be taken into account in the health care priority setting based on QALYs. Moreover, by means of an empirical study involving 100 patients, evidence is offered of how the experience of illness may produce contrasting effects on the evaluation of health states, showing that adaptation effects may coexist with effects of opposite sign. [ABSTRACT FROM AUTHOR]