Eirini-Christina Saloniki

Effectiveness of systemic family therapy versus treatment as usual for young people after self-harm: a pragmatic, phase 3, multicentre, randomised controlled trial

Summary Background Self-harm in adolescents is common and repetition occurs in a high proportion of these cases. Scarce evidence exists for effectiveness of interventions to reduce self-harm. Methods This pragmatic, multicentre, randomised, controlled trial of family therapy versus treatment as usual was done at 40 UK Child and Adolescent Mental Health Services (CAMHS) centres. We recruited young people aged 11–17 years who had self-harmed at least twice and presented to CAMHS after self-harm. Participants were randomly assigned (1:1) to receive manualised family therapy delivered by trained and supervised family therapists or treatment as usual by local CAMHS. Participants and therapists were aware of treatment allocation; researchers were masked. The primary outcome was hospital attendance for repetition of self-harm in the 18 months after group assignment. Primary and safety analyses were done in the intention-to-treat population. The trial is registered at the ISRCTN registry, number ISRCTN59793150. Findings Between Nov 23, 2009, and Dec 31, 2013, 3554 young people were screened and 832 eligible young people consented to participation and were randomly assigned to receive family therapy (n=415) or treatment as usual (n=417). Primary outcome data were available for 795 (96%) participants. Numbers of hospital attendances for repeat self-harm events were not significantly different between the groups (118 [28%] in the family therapy group vs 103 [25%] in the treatment as usual group; hazard ratio 1·14 [95% CI 0·87–1·49] p=0·33). Similar numbers of adverse events occurred in both groups (787 in the family therapy group vs 847 in the treatment as usual group). Interpretation For adolescents referred to CAMHS after self-harm, having self-harmed at least once before, our family therapy intervention conferred no benefits over treatment as usual in reducing subsequent hospital attendance for self-harm. Clinicians are therefore still unable to recommend a clear, evidence-based intervention to reduce repeated self-harm in adolescents. Funding National Institute for Health Research Health Technology Assessment programme.

Correction of misclassification error in disability rates.

This paper examines misclassification error in survey estimates of disability. The results suggest that a significant number of those with a disability fail to be recorded as such in the British Household Panel Survey. In addition, the probability of a false positive is estimated as being very close to zero in all socio-demographic groups. There is a strong bias in estimates of differences in rates of disability across groups but only a small effect on estimates of the difference in employment rates by disability status.

Mode comparison in eliciting preferences for care-related quality of life: evidence from England using the ASCOT service user measure

PHASE 2 OPEN-LABEL EXTENSION (OLE) STUDY OF PATISIRAN, AN INVESTIGATIONAL RNA INTERFERENCE (RNAI) THERAPEUTIC FOR THE TREATMENT OF HEREDITARY ATTR AMYLOIDOSIS WITH POLYNEUROPATHYOBJECTIVES Maturity onset diabetes of the young (MODY) is a genetic form of diabetes for which 13 genes are known to be responsible. Many subtypes of MODY can be treated with oral medication instead of insulin injections, which results in improved metabolic control, quality of life and cost savings. Massively parallel sequencing (MPS) enables the simultaneous sequencing of all 13 genes for a fraction of the cost of traditional Sanger sequencing. We conducted a cost utility analysis of genetic screening (targeted MPS) for MODY in a paediatric population presumed to have type 1 diabetes (T1D), where the underlying prevalence of MODY has been calculated as 2.6%. METHODS A Markov decision model was developed to estimate the incremental costs and quality-adjusted life years (QALYs) of genetic screening for MODY compared with standard care over 50 years’ follow up. The probabilities and quality of life weightings (utility) of long term diabetic complications were estimated from published data and population statistics. Costs were estimated from the perspective of the Australian health care system. RESULTS Genetic screening for MODY at diabetes diagnosis was more effective and less costly than standard care, with 1.39 QALYs gained and AU

Carer social care-related quality of life outcomes: establishing preference weights for the Adult Social Care Outcomes Toolkit for carers

1.4 million (US

Shaping dental contract reform: a clinical and cost-effective analysis of incentive-driven commissioning for improved oral health in primary dental care

1.05 million) saved per 1,000 patients. The costs of the screening program were fully offset within four years. A sensitivity analysis revealed that genetic screening remained dominant until the MODY prevalence fell below 0.7%. CONCLUSIONS Screening for MODY in the paediatric diabetes population would reduce health system costs and improve patient quality of life. Our results were robust to assumptions around the underlying MODY prevalence and make a compelling argument for routine genetic screening in all children with presumed T1D.Poster Presentations Session IV - CCardiovascular Disorders - Clinical Outcomes Studies - no. PCV27OBJECTIVES: Traditionally, researchers relied on eliciting preferences through face-to-face interviews. Recently, there has been a shift towards using alternative modes, such as the internet, to gather such data. These different modes may be a source of variation in the results. In health services research, preferences are important as they provide an estimate of the value of each quality of life state, and can be used as weights to reflect the differential utility of each state. In this study, we compare the preferences elicited from two modes of administration (internet versus face-to-face) for the best-worst scaling (BWS) technique using the Adult Social Care Outcomes Toolkit service user measure (ASCOT-S). METHODS: Data were collected from a representative sample of the general population in England. The respondents (face-to-face: n=500; online: n=1,001) completed a survey which included the BWS experiment involving the ASCOT-S, consisted of 32 tasks which were blocked into 4 segments. Multinomial logistic regressions were undertaken to analyse the data. To allow for direct comparisons between the modes, model coefficients were standardised. RESULTS: Respondents in the face-to-face survey placed lower value on the lower levels of all ASCOT-S domains, except social participation, than those in the internet survey. The highest point difference of 0.12 was observed in Level 2 of the occupation domain. For the highest level of all ASCOT-S domains, except social participation, preference weights were higher in the face-to-face survey than the internet with point differences of up to 0.10. CONCLUSIONS: This study compared utility weights obtained from a BWS exercise using two modes of administration for the ASCOTS. The findings showed variation of responses between the two modes. Most differences were not significant and were low in absolute value. This suggests that preference weights are similar across the different modes of administration. We reflect on the implications of these findings for cost-effectiveness research.

The INCENTIVE study: a mixed-methods evaluation of an innovation in commissioning and delivery of primary dental care compared with traditional dental contracting

PHASE 2 OPEN-LABEL EXTENSION (OLE) STUDY OF PATISIRAN, AN INVESTIGATIONAL RNA INTERFERENCE (RNAI) THERAPEUTIC FOR THE TREATMENT OF HEREDITARY ATTR AMYLOIDOSIS WITH POLYNEUROPATHYOBJECTIVES Maturity onset diabetes of the young (MODY) is a genetic form of diabetes for which 13 genes are known to be responsible. Many subtypes of MODY can be treated with oral medication instead of insulin injections, which results in improved metabolic control, quality of life and cost savings. Massively parallel sequencing (MPS) enables the simultaneous sequencing of all 13 genes for a fraction of the cost of traditional Sanger sequencing. We conducted a cost utility analysis of genetic screening (targeted MPS) for MODY in a paediatric population presumed to have type 1 diabetes (T1D), where the underlying prevalence of MODY has been calculated as 2.6%. METHODS A Markov decision model was developed to estimate the incremental costs and quality-adjusted life years (QALYs) of genetic screening for MODY compared with standard care over 50 years’ follow up. The probabilities and quality of life weightings (utility) of long term diabetic complications were estimated from published data and population statistics. Costs were estimated from the perspective of the Australian health care system. RESULTS Genetic screening for MODY at diabetes diagnosis was more effective and less costly than standard care, with 1.39 QALYs gained and AU

A pragmatic randomised controlled trial and economic evaluation of family therapy versus treatment as usual for young people seen after second or subsequent episodes of self-harm: the Self-Harm Intervention - Family Therapy (SHIFT) trial

1.4 million (US

Family health spillovers in cost-effectiveness analysis: evidence from self-harming adolescents in England

1.05 million) saved per 1,000 patients. The costs of the screening program were fully offset within four years. A sensitivity analysis revealed that genetic screening remained dominant until the MODY prevalence fell below 0.7%. CONCLUSIONS Screening for MODY in the paediatric diabetes population would reduce health system costs and improve patient quality of life. Our results were robust to assumptions around the underlying MODY prevalence and make a compelling argument for routine genetic screening in all children with presumed T1D.Poster Presentations Session IV - CCardiovascular Disorders - Clinical Outcomes Studies - no. PCV27OBJECTIVES: Traditionally, researchers relied on eliciting preferences through face-to-face interviews. Recently, there has been a shift towards using alternative modes, such as the internet, to gather such data. These different modes may be a source of variation in the results. In health services research, preferences are important as they provide an estimate of the value of each quality of life state, and can be used as weights to reflect the differential utility of each state. In this study, we compare the preferences elicited from two modes of administration (internet versus face-to-face) for the best-worst scaling (BWS) technique using the Adult Social Care Outcomes Toolkit service user measure (ASCOT-S). METHODS: Data were collected from a representative sample of the general population in England. The respondents (face-to-face: n=500; online: n=1,001) completed a survey which included the BWS experiment involving the ASCOT-S, consisted of 32 tasks which were blocked into 4 segments. Multinomial logistic regressions were undertaken to analyse the data. To allow for direct comparisons between the modes, model coefficients were standardised. RESULTS: Respondents in the face-to-face survey placed lower value on the lower levels of all ASCOT-S domains, except social participation, than those in the internet survey. The highest point difference of 0.12 was observed in Level 2 of the occupation domain. For the highest level of all ASCOT-S domains, except social participation, preference weights were higher in the face-to-face survey than the internet with point differences of up to 0.10. CONCLUSIONS: This study compared utility weights obtained from a BWS exercise using two modes of administration for the ASCOTS. The findings showed variation of responses between the two modes. Most differences were not significant and were low in absolute value. This suggests that preference weights are similar across the different modes of administration. We reflect on the implications of these findings for cost-effectiveness research.

Comparing Preferences for Social Care-Related Quality of Life Using the Adult Social Care Outcomes Toolkit (ASCOT-SCT4) Service User Measure in Austria, England and Finland

Objective To evaluate the clinical and cost-effectiveness of a new blended dental contract incentivising improved oral health compared with a traditional dental contract based on units of dental activity (UDAs). Design Non-randomised controlled study. Setting Six UK primary care dental practices, three working under a new blended dental contract; three matched practices under a traditional contract. Participants 550 new adult patients. Interventions A new blended/incentive-driven primary care dentistry contract and service delivery model versus the traditional contract based on UDAs. Main outcome measures Primary outcome was as follows: percentage of sites with gingival bleeding on probing. Secondary outcomes were as follows: extracted and filled teeth (%), caries (International Caries Detection and Assessment System (ICDAS)), oral health-related quality of life (Oral Health Impact Profile-14 (OHIP-14)). Incremental cost-effective ratios used OHIP-14 and quality adjusted life years (QALYs) derived from the EQ-5D-3L. Results At 24 months, 291/550 (53%) patients returned for final assessment; those lost to follow-up attended 6.46 appointments on average (SD 4.80). The primary outcome favoured patients in the blended contract group. Extractions and fillings were more frequent in this group. Blended contracts were financially attractive for the dental provider but carried a higher cost for the service commissioner. Differences in generic health-related quality of life were negligible. Positive changes over time in oral health-related quality of life in both groups were statistically significant. Conclusions This is the first UK study to assess the clinical and cost-effectiveness of a blended contract in primary care dentistry. Although the primary outcome favoured the blended contract, the results are limited because 47% patients did not attend at 24 months. This is consistent with 39% of adults not being regular attenders and 27% only visiting their dentist when they have a problem. Promotion of appropriate attendance, especially among those with high need, necessitates being factored into recruitment strategies of future studies.