Huajie Jin

Prevention and management of neutropenic sepsis in patients with cancer: summary of NICE guidance

Neutropenic sepsis is a potentially fatal complication of treatment for cancer, with mortality rates of 2-21%.1 An investigation by the National Confidential Enquiry into Patient Outcome and Death and a follow-up report by the National Chemotherapy Advisory Group highlighted problems in the management of neutropenic sepsis in adults receiving chemotherapy.2 3 The problems included inadequate management of neutropenic sepsis leading to avoidable deaths, and the lack of systems for urgent assessment and of policies at organisation level for dealing with neutropenic sepsis. This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the prevention and management of neutropenic sepsis in patients of any age with cancer.4 NICE recommendations are based on systematic reviews of the best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets. ### Information and support for patients and carers ### Training for healthcare professionals ### Reducing the risk of septic complications of anticancer treatment

The Societal Cost of Schizophrenia: A Systematic Review

BackgroundCost-of-illness (COI) studies provide useful information on the economic burden that schizophrenia imposes on a society.ObjectivesThis study aims to give a general overview of COI studies for schizophrenia and to compare the societal cost of schizophrenia across countries. It also aims to identify the main cost components of schizophrenia and factors associated with higher societal cost to improve the quality and reporting of COI studies for schizophrenia.MethodsWe performed an electronic search on multiple databases (MEDLINE, Embase, PsycINFO, Cochrane Database of Systematic Reviews, Health Management Information Consortium [HMIC] and the System for Information on Grey Literature [openSIGLE]) to identify COI studies of schizophrenia published between 1996 and 2016. The primary outcome of this review was societal cost per schizophrenia patient, by cost component. All costs were converted to

Clinical effectiveness and cost-effectiveness of tailored intensive liaison between primary and secondary care to identify individuals at risk of a first psychotic illness (the LEGs study): a cluster-randomised controlled trial

US, year 2015 values.ResultsWe included 19 studies in this review. The annual societal cost per patient varied from

Cost-of-Illness Studies for Bipolar Disorder: Systematic Review of International Studies

US5818 in Thailand to

Reducing outcome measures in mental health: a systematic review of the methods

US94,587 in Norway; whereas the lifetime societal cost per patient was estimated to be

Psychoeducation and Problem Solving (PEPS) Therapy for Adults With Personality Disorder: A Pragmatic Randomized-Controlled Trial

US988,264 in Australia (all year 2015 values). The main cost drivers were direct healthcare costs and productivity losses. Factors associated with higher individual costs included patient demographics, severity of disease and methods used to calculate the costs of productivity losses and comorbidities.ConclusionsThis review highlights the large economic burden of schizophrenia. The magnitude of the cost estimates differs considerably across countries, which might be caused by different economic conditions and healthcare systems and widespread methodological heterogeneity among COI studies. Proposed recommendations based on this review can be used to improve the consistency and comparability of COI studies for schizophrenia.

Psychoeducation with problem-solving (PEPS) therapy for adults with personality disorder: a pragmatic randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of a manualised intervention to improve social functioning.

Summary Background General practitioners are usually the first health professionals to be contacted by people with early signs of psychosis. We aimed to assess whether increased liaison between primary and secondary care improves the clinical effectiveness and cost-effectiveness of detection of people with, or at high risk of developing, a first psychotic illness. Methods Our Liaison and Education in General Practices (LEGs) study was a cluster-randomised controlled trial of primary care practices (clusters) in Cambridgeshire and Peterborough, UK. Consenting practices were randomly allocated (1:1) to a 2 year low-intensity intervention (a postal campaign, consisting of biannual guidelines to help identify and refer individuals with early signs of psychosis) or a high-intensity intervention, which additionally included a specialist mental health professional who liaised with every practice and a theory-based educational package. Practices were not masked to group allocation. Practices that did not consent to be randomly assigned comprised a practice-as-usual (PAU) group. The primary outcome was number of referrals of patients at high risk of developing psychosis to the early intervention service per practice site. New referrals were assessed clinically and stratified into those who met criteria for high risk or first-episode psychotic illness (FEP; together: psychosis true positives), and those who did not fulfil such criteria for psychosis (false positives). Referrals from PAU practices were also analysed. We assessed cost-effectiveness with decision analytic modelling in terms of the incremental cost per additional true positive identified. The trial is registered at the ISRCTN registry, number ISRCTN70185866. Findings Between Dec 22, 2009, and Sept 7, 2010, 54 of 104 eligible practices provided consent and between Feb 16, 2010, and Feb 11, 2011, these practices were randomly allocated to interventions (28 to low intensity and 26 to high intensity); the remaining 50 practices comprised the PAU group. Two high-intensity practices were excluded from the analysis. In the 2 year intervention period, high-intensity practices referred more FEP cases than did low-intensity practices (mean 1·25 [SD 1·2] for high intensity vs 0·7 [0·9] for low intensity; incidence rate ratio [IRR] 1·9, 95% CI 1·05–3·4, p=0·04), although the difference was not statistically significant for individuals at high risk of psychosis (0·9 [1·0] vs 0·5 [1·0]; 2·2, 0·9–5·1, p=0·08). For high risk and FEP combined, high-intensity practices referred both more true-positive (2·2 [1·7] vs 1·1 [1·7]; 2·0, 1·1–3·6, p=0·02) and false-positive (2·3 [2·4] vs 0·9 [1·2]; 2·6, 1·3–5·0, p=0·005) cases. Referral patterns did not differ between low-intensity and PAU practices. Total cost per true-positive referral in the 2 year follow-up was £26 785 in high-intensity practices, £27 840 in low-intensity practices, and £30 007 in PAU practices. Interpretation This intensive intervention to improve liaison between primary and secondary care for people with early signs of psychosis was clinically and cost effective. Funding UK National Institute for Health Research.

34.3 IMPROVING THE DETECTION OF INDIVIDUALS AT RISK OF DEVELOPING PSYCHOSIS IN PRIMARY MENTAL HEALTH CARE

Background and ObjectivesBipolar disorder (BD) may result in a greater burden than all forms of cancer, Alzheimer’s disease and epilepsy. Cost-of-illness (COI) studies provide useful information on the economic burden that BD imposes on a society. Furthermore, COI studies are pivotal sources of evidence used in economic evaluations. This study aims to give a general overview of COI studies for BD and to discuss methodological issues that might potentially influence results. This study also aims to provide recommendations to improve practice in this area, based on the review.MethodsA search was performed to identify COI studies of BD. The following electronic databases were searched: MEDLINE, EMBASE, PsycInfo, Cochrane Database of Systematic Reviews, HMIC and openSIGLE. The primary outcome of this review was the annual cost per BD patient. A narrative assessment of key methodological issues was also included. Based on these findings, recommendations for good practice were drafted.ResultsFifty-four studies were included in this review. Because of the widespread methodological heterogeneity among included studies, no attempt has been made to pool results of different studies. Potential areas for methodological improvement were identified. These were: description of the disease and population, the approach to deal with comorbidities, reporting the rationale and impact for choosing different cost perspectives, and ways in which uncertainty is addressed.ConclusionsThis review showed that numerous COI studies have been conducted for BD since 1995. However, these studies employed varying methods, which limit the comparability of findings. The recommendations provided by this review can be used by those conducting COI studies and those critiquing them, to increase the credibility and reporting of study results.

Clinical and cost-effectiveness of tailored, intensive liaison between primary and secondary care to detect individuals at risk of a first psychotic illness: a theory-based, cluster-randomised controlled trial

Abstract Background: Traditionally, classical test theory (CTT) has been used for instrument development and various methods have since been proposed for reducing outcome measures to shorter versions. These reduction methods have not previously been compared in mental or physical health. Aim: To identify and compare the various methods used to develop brief versions of outcome measures from existing measures in mental health. Method: A systematic review of the literature in Embase, Medline, PsychInfo and from a grey literature was done. Search strategies were developed in each database to identify all relevant literature based on the inclusion criteria. Each paper identified was briefly described and then assessed using a bespoke assessment checklist developed by the authors. Methods for reducing outcome measures found across all studies were compared. Results: Ten papers were identified. Five methods were used for scale reduction: Rasch analysis (RA), exploratory factor analysis (EFA), graded response models (GRMs), all-subset regression, and regression. RA was the most widely used process. Conclusion: The Rasch model (RM) is the only model where “‘specific objectivity”‘ is a defining property of the model. This property is necessary for constructing scales in line with the fundamental principles of measurement.

The Societal Cost of Schizophrenia: New Evidence From the US

We compared psychoeducation and problem solving (PEPS) therapy against usual treatment in a multisite randomized-controlled trial. The primary outcome was social functioning. We aimed to recruit 444 community-dwelling adults with personality disorder; however, safety concerns led to an early cessation of recruitment. A total of 154 people were randomized to PEPS and 152 to usual treatment. Follow-up at 72 weeks was completed for 68%. PEPS therapy was no more effective than usual treatment for improving social functioning (adjusted difference in mean Social Functioning Questionnaire scores = -0.73; 95% CI [-1.83, 0.38]; p = 0.19). PEPS therapy is not an effective treatment for improving social functioning of adults with personality disorder living in the community.