Alexander Konnopka

Age- and gender-specific prevalence of depression in latest-life – Systematic review and meta-analysis

OBJECTIVE The objective of the study is to systematically analyze the prevalence of depression in latest life (75+), particularly focusing on age- and gender-specific rates across the latest-life age groups. DESIGN Relevant articles were identified by systematically searching the databases MEDLINE, Web of Science, Cochrane Library and Psycinfo and relevant literature from 1999 onwards was reviewed. Studies based on the community-based elderly population aged 75 years and older were included. Quality of studies was assessed. Meta-analysis was performed using random effects model. RESULTS 24 studies reporting age- and gender-specific prevalence of depression were found. 13 studies had a high to moderate methodical quality. The prevalence of major depression ranged from 4.6% to 9.3%, and that of depressive disorders from 4.5% to 37.4%. Pooled prevalence was 7.2% (95% CI 4.4-10.6%) for major depression and 17.1% (95% CI 9.7-26.1%) for depressive disorders. Potential sources of high heterogeneity of prevalence were study design, sampling strategy, study quality and applied diagnostics of latest life depression. CONCLUSIONS Despite the wide variation in estimates, it is evident that latest life depression is common. To reduce variability of study results, particularly sampling strategies (inclusion of nursing home residents and severe cognitively impaired individuals) for the old age study populations should be addressed more thoroughly in future research.

Economic costs of overweight and obesity

Obesity has substantially increased in recent decades and is now one of the major global health problems. The large obesity-related health burden negatively impacts many relevant health outcomes (e.g. quality of life, disability, mortality) and leads to increased healthcare utilization. This excess service use is the main driver behind high healthcare costs of obese individuals. Findings indicate that costs rise curvilinearly with increasing body mass index, especially among the obese. As more individuals of a countrys population become obese, a larger share of total annual national healthcare expenditure is spent on obesity and obesity-related health problems. In addition to escalating healthcare costs, obesity goes along with indirect costs through decreases in workforce productivity. The empirical evidence has shown beyond doubt that obesity negatively impacts individuals, healthcare systems, employers, and the economy as a whole. This article provides a brief overview of selected economic consequences associated with excess-weight.

Cost-of-illness studies and cost-effectiveness analyses in anxiety disorders: A systematic review

AIMS To review cost-of-illness studies (COI) and cost-effectiveness analyses (CEA) conducted for anxiety disorders. METHODS Based on a database search in Pubmed, PsychINFO and NHS EED, studies were classified according to various criteria. Cost data were inflated and converted to 2005 US-

Health burden and costs of obesity and overweight in Germany

purchasing power parities (PPP). RESULTS We finally identified 20 COI and 11 CEA of which most concentrated on panic disorder (PD) and generalized anxiety disorder (GAD). Differing inclusion of cost categories limited comparability of COI. PD and GAD tended to show higher direct costs per case, but lower direct cost per inhabitant than social and specific phobias. Different measures of effectiveness severely limited comparability of CEA. Overall CEA analysed 26 therapeutic or interventional strategies mostly compared to standard treatment, 8 of them resulting in lower better effectiveness and costs than the comparator. CONCLUSIONS Anxiety disorders cause considerable costs. More research on phobias, more standardised inclusion of cost categories in COI and a wider use of comparable effectiveness measures (like QALYs) in CEA is needed.

Economics of Medically Unexplained Symptoms: A Systematic Review of the Literature

This study aimed to estimate the health burden and the direct as well as indirect costs of morbidity and mortality attributable to obesity and overweight in Germany for the year 2002. We used the concept of attributable fractions based on German prevalence data and relative risks from US studies as well as routine statistics. We estimated obesity- and overweight-attributable deaths, years of potential life lost (YPLL) and quality-adjusted life years lost (QALY) for various diseases associated with obesity and overweight. Direct costs were estimated for inpatient and outpatient treatment, rehabilitation and non-medical costs. Indirect costs were estimated for sickness absence, early retirement and mortality using the human capital approach. We estimated 36,653 obesity- and overweight-attributable deaths with 428,093 consecutive YPLL and 367,772 QALYs lost. Obesity caused 4,854 million EUR in direct costs corresponding to 2.1% of the overall German health expenditures in 2002 and 5,019 million EUR in indirect costs. Forty-three percent of direct costs resulted from endocrinological diseases like diabetes and obesity itself, followed by cardiovascular diseases (38%), neoplasms (14%) and digestive diseases (6%). Sixty percent of indirect costs resulted from unpaid work, and 67% of overall indirect costs were due to mortality. Obesity and overweight are connected to considerable morbidity and mortality as well as societal costs. Improvement and further development of effective strategies for preventing and dealing with obesity and overweight are necessary.

The long-term cost-effectiveness of obesity prevention interventions: systematic literature review.

Objective: To review cost-of-illness studies (COI) and economic evaluations (EE) conducted for medically unexplained symptoms and to analyze their methods and results. Methods: We searched the databases PubMed, PsycINFO and National Health Service Economic Evaluations Database of the University of York. Cost data were inflated to 2006 using country-specific gross domestic product inflators and converted to 2006 USD purchasing power parities. Results: We identified 5 COI and 8 EE, of which 6 were cost-minimization analyses and 2 were cost-effectiveness analyses. All studies used patient level data collected between 1980 and 2004 and were predominantly conducted in the USA (n = 10). COI found annual excess health care costs of somatizing patients between 432 and 5,353 USD in 2006 values. Indirect costs were estimated by only one EE and added up to about 18,000 USD per year. In EE, educational interventions for physicians as well as cognitive-behavioral therapy approaches for patients were evaluated. For both types of interventions, effectiveness was either shown within EE or by previous studies. Most EE found (often insignificant) cost reductions resulting from the interventions, but only two studies explicitly combined changes in costs with data on effectiveness to cost-effectiveness ratios (ratio of additional costs to additional effects). Conclusions: Medically unexplained symptoms cause relevant annual excess costs in health care that are comparable to mental health problems like depression or anxiety disorders and which may be reduced by interventions targeting physicians as well as patients. More extensive research on indirect costs and cost-effectiveness is needed.

Direct and Indirect Costs Attributable to Alcohol Consumption in Germany

Obesity prevention provides a major opportunity to improve population health. As health improvements usually require additional and scarce resources, novel health technologies (interventions) should be economically evaluated. In the prevention of obesity, health benefits may slowly accumulate over time and it can take many years before an intervention has reached full effectiveness. Decision‐analytic simulation models (DAMs), which combine evidence from diverse sources, can be utilized to evaluate the long‐term cost‐effectiveness of such interventions. This literature review summarizes long‐term economic findings (defined as ≥40 years) for 41 obesity prevention interventions, which had been evaluated in 18 cost‐utility analyses, using nine different DAMs. Interventions were grouped according to their method of delivery, setting and risk factors targeted into behavioural (n = 21), community (n = 12) and environmental interventions (n = 8). The majority of interventions offered good value for money, while seven were cost‐saving. Ten interventions were not cost‐effective (defined as >50,000 US dollar), however. Interventions that modified a target populations environment, i.e. fiscal and regulatory measures, reported the most favourable cost‐effectiveness. Economic findings were accompanied by a large uncertainty though, which complicates judgments about the comparative cost‐effectiveness of interventions.

Validity and responsiveness of the EQ-5D in assessing and valuing health status in patients with somatoform disorders

AimTo estimate the direct and indirect costs of morbidity and mortality attributable to alcohol consumption in Germany from a societal perspective in 2002.MethodsUsing the concept of attributable risks and the prevalence-based approach, age- and gender-specific alcohol-attributable fractions for morbidity and mortality were calculated for alcoholic disorder, neoplasms, endocrinological, nervous, circulatory, digestive, skin and perinatal disorders, and injuries and poisonings. The literature provided data on alcohol consumption in Germany by age, gender and dose amount, and relative risks. Direct costs were calculated based on routine resource utilisation and expenditure statistics. Indirect costs were calculated based on the human capital approach using a discount rate of 5%.ResultsAlcohol consumption accounted for 5.5% of all deaths and 970 000 years of potential life lost. Total costs were €24 398 million, amounting to 1.16% of Germany’s GDP, or €296 per person. Direct medical and non-medical costs were €8441 million. Indirect costs were €15 957 million (69% mortality and 31% morbidity costs). In contrast, protective health effects of alcohol consumption saved €4839 million.ConclusionsThe magnitude of alcohol-attributable morbidity and mortality and associated costs demands more preventive efforts.

Estimating the lifetime cost of childhood obesity in Germany: Results of a Markov Model

BackgroundThe EQ-5D is a generic questionnaire providing a preference-based index score applicable to cost-utility analysis. This is the first study to validate the EQ-5D in patients with somatoform disorders.MethodsData of the EQ-5D descriptive system, the British and the German EQ-5D index and the EQ Visual Analogue Scale, the Patient Health Questionnaire 15, the Patient Health Questionnaire 9, the Whiteley Index 7 and the Short Form 36 were collected from 294 patients at baseline, 244 at 6 months and 256 at 12 months after baseline.The discriminative ability of the EQ-5D was evaluated by comparison with a general population sample and by the ability to distinguish between different symptom severities. Convergent validity was analysed by assessing associations between the EQ-5D and the other instruments. Responsiveness was evaluated by analysing the effects on scores between two measurements in groups of patients reporting worse, same or better health. The Bonferroni correction was employed.ResultsFor all items of the EQ-5D except ‘self-care’, patients with somatoform disorders reported more problems than the general population. The EQ-5D showed discriminative ability in patients with different symptom severities. For nearly all reference instruments there were significant differences in mean scores between respondents with and without problems in the various EQ-5D items and strong correlations with the EQ Visual Analogue Scale and the EQ-5D index scores. Evidence for the responsiveness of the EQ-5D could only be found for patients with better health; effects were medium at the utmost.ConclusionsThe EQ-5D showed a considerable validity and a limited responsiveness in patients with somatoform disorders.Trial registrationCurrent Controlled Trials ISRCTN55280791

Determinants of direct and indirect costs in anorexia nervosa

Child obesity is a growing public health concern. Excess weight in childhood is known to be associated with a high risk of obesity and obesity‐related comorbidities in adulthood.