Dataset Information

Sustainability of Community-Based Specialized Mental Health Services in Five European Countries: Protocol for Five Randomized Controlled Trial-Based Health-Economic Evaluations Embedded in the RECOVER-E Program.

ABSTRACT: BACKGROUND:Community-based recovery-oriented mental health services for people with severe mental disorders have not been fully implemented in Bulgaria, Croatia, Macedonia, Montenegro, and Romania. The RECOVER-E project facilitates the implementation of specialized mental health care delivered by setting up services, implementing the services, and evaluating multidisciplinary community mental health teams. The outcomes of the RECOVER-E project are assessed in a trial-based outcome evaluation in each of the participating countries with a health-economic evaluation linked to these trials. OBJECTIVE:The aim of this protocol paper is to describe the methodology that will be used for the health-economic evaluation alongside the trials. METHODS:Implementation sites have been selected in each of the five countries where hospital-based mental health services are available (care as usual [CAU]) for patients with severe mental disorders (severe depression, bipolar disorder, schizophrenia, and other psychotic disorders). The newly implemented health care system will involve community-based recovery-oriented mental health care (CMHC). At each site, 180 consenting patients will be randomized to either CAU or CMHC. Patient-level outcomes are personal and social functioning and quality-adjusted life years (QALYs). Data on participants' health care use will be collected and corresponding health care costs will be computed. This enables evaluation of health care costs of CMHC as compared with CAU, and these costs can be related to patient-level outcomes (functioning and QALY gains) in health-economic evaluation. RESULTS:Data collection was started in December 2018 (Croatia), February 2019 (Montenegro), April 2019 (Romania), June 2019 (North Macedonia), and October 2019 (Bulgaria). The findings of the outcome evaluations will be reported for each of the five countries separately, and the five trials will be pooled for multilevel analysis on a combined dataset. CONCLUSIONS:The results of the health-economic evaluation of the RECOVER-E project will contribute to the growing evidence base on the health and economic benefits of recovery-oriented and community-based service models for health systems in transition. TRIAL REGISTRATION:(1) ClinicalTrials.gov NCT03922425 (Bulgaria); https://clinicaltrials.gov/ct2/show/NCT03922425 (2) ClinicalTrials.gov NCT03862209 (Croatia); https://clinicaltrials.gov/ct2/show/NCT03862209 (3) ClinicalTrials.gov NCT03892473 (Macedonia); https://clinicaltrials.gov/ct2/show/NCT03892473 (4) ClinicalTrials.gov NCT03837340 (Montenegro); https://clinicaltrials.gov/ct2/show/NCT03837340 (5) ClinicalTrials.gov NCT03884933 (Romania); https://clinicaltrials.gov/ct2/show/NCT03884933. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):DERR1-10.2196/17454.

SUBMITTER: Wijnen BFM

PROVIDER: S-EPMC7296406 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Sustainability of Community-Based Specialized Mental Health Services in Five European Countries: Protocol for Five Randomized Controlled Trial-Based Health-Economic Evaluations Embedded in the RECOVER-E Program.

Wijnen Ben F M BFM Smit Filip F Uhernik Ana Ivičević AI Istvanovic Ana A Dedovic Jovo J Dinolova Roumyana R Nica Raluca R Velickovski Robert R Wensing Michel M Petrea Ionela I Shields-Zeeman Laura L

JMIR research protocols 20200601 6

<h4>Background</h4>Community-based recovery-oriented mental health services for people with severe mental disorders have not been fully implemented in Bulgaria, Croatia, Macedonia, Montenegro, and Romania. The RECOVER-E project facilitates the implementation of specialized mental health care delivered by setting up services, implementing the services, and evaluating multidisciplinary community mental health teams. The outcomes of the RECOVER-E project are assessed in a trial-based outcome evalua ...[more]

PMID: 32476658

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Project description:To systematically review and appraise the quality of economic evaluations assessing centralisation of specialised healthcare services.A systematic review to identify economic evaluations on centralisation of any specialised healthcare service. Full economic evaluations comparing costs and consequences of centralisation of any specialised healthcare service were eligible for inclusion. Methodological characteristics of included studies were appraised using checklists adapted from recommended guidelines.A total of 64 full-text articles met the inclusion criteria. Two studies were conducted in the UK. Most of the studies used volume of activity as a proxy measure of centralisation. The methods used to assess centralisation were heterogeneous. Studies differed in terms of study design used and aspect of centralisation they considered. There were major limitations in studies. Only 12 studies reported the study perspective. Charges which are not true representation of costs were used by 17 studies to assess cost outcomes. Only 10 reported the detailed breakdown of the cost components used in their analysis. Discounting was necessary in 14 studies but was reported only in 7 studies. Sensitivity analyses were included by less than one-third of the studies. The applicability of the identified studies to a setting other than the one they were conducted in is questionable, given variations in the organisation of services and healthcare costs. Centralisation as a concept has also been variably and narrowly defined as activity of specific services which may not reflect the wider aspects of centralisation.Confounded and biased information coming from studies without standardised methods may mislead decision-makers towards making wrong decisions on centralisation. It is important to improve the methodology and reporting of economic evaluations in order to provide more robust and transferable evidence. Wider aspects of healthcare centralisation should be considered in the estimates of costs and health outcomes.

Project description:IntroductionScaling science aims to help roll out evidence-based research results on a wide scale to benefit more individuals. Yet, little is known on how to evaluate economic aspects of scaling up strategies of evidence-based health interventions.Methods and analysisUsing the Joanna Briggs Institute guidance on systematic reviews, we will conduct a systematic review of characteristics and methods applied in economic evaluations in scaling up strategies. To be eligible for inclusion, studies must include a scaling up strategy of an evidence-based health intervention delivered and received by any individual or organisation in any country and setting. They must report costs and cost-effectiveness outcomes. We will consider full or partial economic evaluations, modelling and methodological studies. We searched peer-reviewed publications in Medline, Web of Science, Embase, Cochrane Library Database, PEDE, EconLIT, INHATA from their inception onwards. We will search grey literature from international organisations, bilateral agencies, non-governmental organisations, consultancy firms websites and region-specific databases. Two independent reviewers will screen the records against the eligibility criteria and extract data using a pretested extraction form. We will extract data on study characteristics, scaling up strategies, economic evaluation methods and their components. We will appraise the methodological quality of included studies using the BMJ Checklist. We will narratively summarise the studies' descriptive characteristics, methodological strengths/weaknesses and the main drivers of cost-effectiveness outcomes. This study will help identify what are the trade-offs of scaling up evidence-based interventions to allocate resources efficiently.Ethics and disseminationNo ethics approval is required as no primary data will be collected. The results will be published in a peer-reviewed, international journal and presented at national and international conferences.

Dataset Information

Sustainability of Community-Based Specialized Mental Health Services in Five European Countries: Protocol for Five Randomized Controlled Trial-Based Health-Economic Evaluations Embedded in the RECOVER-E Program.

Publications

Sustainability of Community-Based Specialized Mental Health Services in Five European Countries: Protocol for Five Randomized Controlled Trial-Based Health-Economic Evaluations Embedded in the RECOVER-E Program.

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