Transcript Quality of life Assessment

The burden of disease in patients with personality
disorder indicated for psychotherapy:
Arguments for necessity of care
• Djøra Soeteman, MSc
– [email protected]
– +31 164 632200
• Psychotherapeutic Centre ‘De Viersprong’, P.O.box 7,
4660 AA Halsteren, The Netherlands
• In cooperation with the Erasmus University, Rotterdam
– Reinier Timman, MSc
Introduction
• ‘Necessity’ (of treatment) is 1 of the 4 criteria of
reimbursement policy in The Netherlands
– Also internationally
• YAVIS
– Young, Attractive, Verbal, Intelligent and Successful
• Young, Attractive, Verbal, Intelligent, and Successful
• Young, Attractive, Verbal, Insightful, and Successful
• Young, Attractive, Vital, Intelligent, and Successful
• Young, Affluent, Verbal, Insured, and Single
Introduction
• Burden of disease versus cost-effectiveness
– Necessary care defined in terms of burden of disease
– The higher the burden of disease, the more willing we are to accept
a poor cost-effectiveness
• Example
– Prostate problems low burden, reasonable cost-effectiveness
– Lungtransplantation high burden, extreme poor cost-effectiveness
• Measuring burden of disease
– Consequences for Quality of Life
– Quality of Life questionnaires
Quality of life
• “…. Health is physical, mental and social wellbeing and not merely the absence of disease or
infirmity...”
– World Health Organization, 1947
• Extending health to well-being: Quality of Life
• What is the definition of Quality of Life?
Definitions of Quality of Life
• Quality of life is the degree of need and satisfaction within the physical,
psychological, social, activity, material and structural area (Hörnquist,
1982).
• Quality of life is the subjective evaluation of good and satisfactory character
of life as a whole (De Haes, 1988).
• Health related quality of life is the subjective experiences or preferences
expressed by an individual, or members of a particular group of persons, in
relation to specified aspects of health status that are meaningful, in
definable ways, for that individual or group (Till, 1992).
• Quality of life is a state of well-being which is a composite of two
components: 1) the ability to perform everyday activities which reflects
physical psychological, and social well-being and 2) patient satisfaction with
levels of functioning and the control of disease and/or treatment related
symptoms (Gotay et al., 1992).
How to measure Quality of Life?
• Quality of Life is subjective….
– “Given its inherently subjective nature,
consensus was quickly reached that quality of
life ratings should, whenever possible, be
elicited directly from patients themselves”.
Aaronson, in B Spilker (Ed): Quality of life and
Pharmacoeconomics in Clinical Trails, 1996, page 180
How to measure Quality of Life?
• EuroQol-5D
– Developed by EuroQol Group (1987)
– Self-report questionnaire
– Generic instrument
• Yields the possibility to compare between different
diagnostic groups
Descriptive system
• 5 questions covering 5 dimensions:
– Mobility, self-care, usual activities, pain/discomfort,
anxiety/depression
• 3 levels
– No problems (1), some or moderate problems (2), extreme
problems or unable (3)
• 243 health states (35)
– Values available for all 243 health states
Value a health state
• 22113
–
–
–
–
‘Some problems in walking about’
‘Some problems washing and dressing myself’
‘No problems with performing usual activities’
‘No pain or discomfort’
– ‘Extremely anxious or depressed’
• Value: 0.25
The present study
• Standard Evaluation Project (STEP)
– Standard quality monitoring system
– Patients who received a clinical therapy of at least two days a week
were included
• 861 patients were included during the
admissison for psychotherapy
• 19 institutes
Results SCL-90
250
200
SCL-90
216,9
150
203,55
100
118,28
50
0
Normal population
Psychiatric outpatients
Personality disorder
Compared to (somatic) illnesses
EQ-5D scores
0,9
0,8
0,7
0,6
0,5
0,4
0,3
0,2
0,1
0
Personality disorder
Intermittent claudication
Parkinson's disease
Low back pain
Type II diabetes
Schizophrenia outpatients
Hypertension
Asthma
Normal population
Conclusion
• Patients with personality disorder who search
for therapy, are patients with a severe burden
of disease
– Contradictory to the YAVIS argument
• Any cost-effective treatment of personality
disorder must be seen as necessary care for a
serious illness
– This statement favours the reimbursement of
psychotherapy
General conclusion
• There is a legitimate need of care
– A considerable burden of disease
• Research questions
– Effectiveness (in terms of dose-effect
relationships)
– Cost-effectiveness
– Patient-treatment matching