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Background: Major depression represents a pressing challenge for health care. In England, Increasing Access to Psychological Therapies (IAPT) services provide evidence-based psychological therapies in a stepped-care approach to patients with depression. While introduction of these services has successfully increased access to therapy, estimates suggest that about 50% of depressed patients who have come to the end of the IAPT pathway still show significant levels of symptoms. This study will investigate whether Mindfulness-Based Cognitive Therapy (MBCT), a group intervention combining training in mindfulness meditation and elements from cognitive therapy, can have beneficial effects in depressed patients who have not responded to high-intensity therapy in IAPT. It will seek to establish the effectiveness and cost-effectiveness of MBCT as compared to the treatment these patients would usually receive. Methods: In a 2-arm randomised controlled trial, patients who currently meet the criteria for major depressive disorder and who have not sufficiently responded to at least 12 sessions of IAPT high-intensity therapy will be allocated, at a ratio of 1:1, to receive either MBCT (in addition to treatment as usual [TAU]) or continue with TAU only. Assessments will take place at baseline, 10 weeks and 34 weeks post-randomisation. The primary outcome will be reduction in depression symptomatology 34 weeks post-randomisation as assessed using the Public Health Questionnaire-9 (PHQ-9). Secondary outcomes will include depressive symptomatology at 10 weeks post-randomisation and other clinical outcomes measured at 10-week and 34-week follow-up, along with a series of binarised outcomes to indicate clinically significant and reliable change. Evaluations of cost-effectiveness will be based on assessments of service use costs collected using the Adult Service Use Schedule and health utilities derived from the EQ-5D. Discussion: This trial will add to the evidence base for the use of MBCT in depressed treatment non-responders. It will constitute the first trial to test MBCT following non-response to psychological therapy, with results providing a direct estimate of efficacy within the IAPT pathway. As such, its results will offer an important basis for decisions regarding the adoption of MBCT for non-responders within IAPT. Trial registration: ClinicalTrials.gov NCT05236959. Registered on 11 February 2022. ISRCTN 17755571. Registered on 2 February 2021. [ABSTRACT FROM AUTHOR]

Objective: The authors examined whether lamotrigine is a clinically effective and cost-effective treatment for people with borderline personality disorder.Method: This was a multicenter, double-blind, placebo-controlled randomized trial. Between July 2013 and November 2016, the authors recruited 276 people age 18 or over who met diagnostic criteria for borderline personality disorder. Individuals with coexisting bipolar affective disorder or psychosis, those already taking a mood stabilizer, and women at risk of pregnancy were excluded. A web-based randomization service was used to allocate participants randomly in a 1:1 ratio to receive either an inert placebo or up to 400 mg/day of lamotrigine. The primary outcome measure was score on the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD) at 52 weeks. Secondary outcome measures included depressive symptoms, deliberate self-harm, social functioning, health-related quality of life, resource use and costs, side effects of treatment, and adverse events.Results: A total of 195 (70.6%) participants were followed up at 52 weeks, at which point 49 (36%) of those in the lamotrigine group and 58 (42%) of those in the placebo group were taking study medication. The mean ZAN-BPD score was 11.3 (SD=6.6) among those in the lamotrigine group and 11.5 (SD=7.7) among those in the placebo group (adjusted difference in means=0.1, 95% CI=-1.8, 2.0). There was no evidence of any differences in secondary outcomes. Costs of direct care were similar in the two groups.Conclusions: The results suggest that treating people with borderline personality disorder with lamotrigine is not a clinically effective or cost-effective use of resources. [ABSTRACT FROM AUTHOR]

Background The NOURISHED study: Nice OUtcomes for Referrals with Impulsivity, Self Harm and Eating Disorders. Eating Disorders (ED) and Borderline Personality Disorder (BPD) are both difficult to treat and the combination presents particular challenges. Both are associated with vulnerability to loss of mentalization (awareness of one's own and others' emotional state) In BPD, Mentalization Based therapy (MBT) has been found effective in reducing symptoms. In this trial we investigate the effectiveness and cost-effectiveness of MBT adapted for Eating disorders (Mentalization Based Therapy for Eating Disorders (MBT-ED))compared to a standard comparison treatment, Specialist Supportive Clinical Management SSCM-ED) in patients with a combination of an Eating Disorder and either a diagnosis of BPD or a history of self-harm and impulsivity in the previous 12 months. Methods/Design We will complete a multi-site single-blind randomized controlled trial of MBT-ED vs SSCM-ED. Participants will be recruited from 3 Eating Disorder Services and 2 Borderline Personality Disorder Services in London. Participants allocated to MBT-ED will receive one year of weekly group and individual therapy and participants allocated to SSCM-ED will receive 20 sessions of individual therapy over 1 year. In addition, participants in both groups will have access to up to 5 hours of dietetic advice. The primary outcome measure is the global score on the Eating Disorders Examination. Secondary outcome measures include total score on the Zanarini BPD scale, the Object Relations Inventory, the Depression Anxiety Stress Scales, quality of life and cost-effectiveness. Measures are taken at recruitment and at 6 month intervals up to 18 months. Discussion This is the first RCT of MBT-ED in patients with eating disorders and symptoms of BPD and will provide evidence to inform therapy decisions in this group of patients. During MBT-ED mentalization is encouraged, while in SSCM-ED it is not overtly addressed. Study of proposed moderating factors will help elucidate mechanisms of change in the two therapies and analysis of therapy and interview transcripts will provide qualitative information about the conduct of therapy and changes in mentalization and object relations. Trial registration ISRCTN51304415 [ABSTRACT FROM AUTHOR]

Background: Despite evidence of the effectiveness of injectable opioid treatment compared with oral methadone for chronic heroin addiction, the additional cost of injectable treatment is considerable, and cost-effectiveness uncertain.Aims: To compare the cost-effectiveness of supervised injectable heroin and injectable methadone with optimised oral methadone for chronic refractory heroin addiction.Method: Multisite, open-label, randomised controlled trial. Outcomes were assessed in terms of quality-adjusted life-years (QALYs). Economic perspective included health, social services and criminal justice resources.Results: Intervention costs over 26 weeks were significantly higher for injectable heroin (mean £8995 v. £4674 injectable methadone and £2596 oral methadone; P<0.0001). Costs overall were highest for oral methadone (mean £15 805 v. £13 410 injectable methadone and £10 945 injectable heroin; P = n.s.) due to higher costs of criminal activity. In cost-effectiveness analysis, oral methadone was dominated by injectable heroin and injectable methadone (more expensive and less effective). At willingness to pay of £30 000 per QALY, there is a higher probability of injectable methadone being more cost-effective (80%) than injectable heroin.Conclusions: Injectable opioid treatments are more cost-effective than optimised oral methadone for chronic refractory heroin addiction. The choice between supervised injectable heroin and injectable methadone is less clear. There is currently evidence to suggest superior effectiveness of injectable heroin but at a cost that policy makers may find unacceptable. Future research should consider the use of decision analytic techniques to model expected costs and benefits of the treatments over the longer term. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Much resource (c £500M) has been spent in setting up the programme of treatment for those deemed to be suffering from dangerous and severe personality disorder (DSPD). It has now begun to contract, and it is an appropriate time to evaluate its cost-effectiveness. Aims The aim of the study was to review all published and known unpublished material, examining the cost, cost function and cost-effectiveness of the DSPD programme since its introduction in 1999. Methods Narrative review of studies was used. Results Four studies, one unpublished, were identified. The costs of treating people in the DSPD programme are considerably higher than those in other parts of the prison service. This could be justified if the gains justified this increased investment, but the evidence suggests that the outcomes in the short term are not good, and the monetary value of reductions in serious offences is very small compared with the extent of the higher costs incurred. There is a dearth of randomised trials that would allow an adequate assessment of cost-effectiveness. Implications for practice Future plans for expansion or development of DSPD and similar services need to have cost-effectiveness of agreed outcomes assessed as a central element. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: The dangerous severe personality disorder programme was developed in high secure prisons and hospitals at great expense to identify and treat the most dangerous offenders with personality disorders.Aims: To evaluate whether the long-term costs of the programme are greater or less than the long-term outcomes.Method: We used a Markov decision model with a cost-effectiveness analysis to determine the incremental cost of the programme per serious offence prevented and a cost-offset analysis to consider whether monetary benefits were greater than costs.Results: Costs were consistently higher for the intervention programme and the cost per serious offence prevented was over £2 million, although there was some evidence that adjustments to the programme could lead to similar interventions becoming cost-effective.Conclusions: Little evidence was found to support the cost-effectiveness of the intervention programme for offenders with personality disorders, although delivery of the programme in a lower-cost prison would probably yield greater benefits than costs. There are frequent calls for mentally disordered offenders to be detained in secure hospitals rather than prisons; however, if reoffending remains the outcome of interest for policy makers, it is likely that the costs of detention in hospital will remain greater than the benefits for dangerous offenders with a personality disorder. [ABSTRACT FROM AUTHOR]

The article focuses on economic evaluations, its importance, and the reasons for its implementation in evidence-based healthcare. It states that the said evaluation is being conducted along with clinical evaluations to allow clinicians have knowledge on effectiveness and cost-effectiveness of alternative treatment. It discusses the two reasons of seeing the said evaluation along with clinical evaluation in theoretical and political aspect.

Background: Young people with anorexia nervosa are often admitted to hospital for treatment. As well as being disruptive to school, family and social life, in-patient treatment is expensive, yet cost-effectiveness evidence is lacking.Aims: Cost-effectiveness analysis of three treatment strategies for adolescents with anorexia nervosa.Method: UK multicentre randomised, controlled trial comparing in-patient psychiatric treatment, specialist out-patient treatment and general out-patient treatment. Outcomes and costs assessed at baseline, 1 and 2 years.Results: There were 167 young people in the trial. There were no statistically significant differences in clinical outcome between the three groups at 2 years. The specialist out-patient group was less costly over the 2-year follow-up (mean total cost 26 738 UK pounds) than the in-patient (34 531 UK pounds) and general out-patient treatment (40 794 UK pounds) groups, but this result was not statistically significant. Exploration of the uncertainty associated with the costs and effects of the three treatments suggests that specialist out-patient treatment has the highest probability of being cost-effective.Conclusions: On the basis of cost-effectiveness, these results support the provision of specialist out-patient services for adolescents with anorexia nervosa. [ABSTRACT FROM AUTHOR]

Background Economic evaluation of the Dangerous and Severe Personality Disorder Programme is essential to ensure value for money. The collection of individual level service use information is crucial to any such evaluation, but the best way to collect these data in secure facilities is unclear. Aims To develop a method for the collection of individual-level service use information for prisoners/patients in secure facilities. Methods Services provided within secure facilities were identified through examination of facility and policy literature, and discussions with managerial and clinical staff. Appropriate methods of measuring the quantities of services used were then explored and a new research tool capable of capturing all relevant services was developed and pilot tested. Results The Secure Facilities Service Use Schedule (SF-SUS) records service use information from records and is capable of capturing data on the use of all individual-level services provided within a secure facility plus external services commonly accessed by occupants. Discussion The SF-SUS is able to collect meaningful individual-level service use information for the economic evaluation of services provided within secure facilities. [ABSTRACT FROM AUTHOR]