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BACKGROUND: Calls for increased funding for mental health services require many lines of evidence in support, including estimates of economic impact. One understudied source of cost is violence perpetrated by individuals with severe mental illness. Estimating this economic impact can inform budget planning across several government sectors and emphasise the importance of violence prevention. Therefore, we aimed to provide a comprehensive estimate of the economic costs of violence perpetrated by people with severe mental illness. METHODS: For this retrospective analysis, we used a prevalence-based modelling approach to estimate the annual economic cost of violent incidents committed by people with severe mental illness in England and Wales during 2015–16. The model was based on secondary data, including the association between violence and severe mental illness, illness prevalence, recidivism, absolute numbers of violent incidents in 2015–16, and costs to society per violent crime, by area of spending. Uncertainty was addressed with probabilistic and deterministic sensitivity analyses that tested the effect of underreporting of domestic violence and distributions of crime types in individuals with severe mental illness. OUTCOMES: The estimated annual economic impact of violence perpetrated by people with severe mental illness was £2·5 (95% CI 1·4–4·5) billion in England and Wales in 2015–16, or 5·3% of the total estimated societal cost of violence. The largest contributors to the cost of violent crime perpetrated by individuals with severe mental illness were the cost of physical and emotional harm to victims (£1·4 [95% CI 0·8–2·5] billion), followed by lost productivity of victims (£348.0 [190·0–628·8] million), while the combined cost to the police and criminal justice system was £561·3 (305·9–1009·2) million and the cost to health services was £136·7 [74·3–246·3] million. The additional cost to secure forensic care was estimated to be £487·7 (302·0–709·1) million. INTERPRETATION: The economic impact of ...

Background Rare cancers account for 20–24% of all cancer diagnoses in Europe and have been recently recognized as a public health issue due to the lower survival compared to common cancers. However, the evidence about the cost-effectiveness of interventions for rare cancers remains unclear. The aim of this study was to review economic evaluation studies of these interventions, assess their quality, and provide policy-makers with summary estimates about the value-for-money of these interventions. Methods We systematically searched Medline, EMBASE and governmental reimbursement agencies by following the PRISMA guidance and selected economic evaluations of healthcare interventions for rare cancers based on predefined criteria. A template was developed to extract study and patient characteristics as well as reported outcomes and costs. The CHEERS checklist was used to assess the quality of the studies and costs were inflated to 2016 prices and converted to British Pound. A random effects meta-analysis, using study quality scores as weights, was performed to pool outcomes and costs and to explore differences between types of rare cancer and study origin. Results Out of 1991 screened studies, 32 economic evaluations of interventions for sarcoma, malignant pleural mesothelioma and thyroid carcinoma were selected. Almost all of them evaluated drug treatment and surgeries (n = 30; 94%) and were originated from North America (n = 8; 49%) and Europe (n = 7; 43%). Half of these studies were NICE reports and their results ranged from £20300 to £59000 per quality adjusted life year (QALY). The 16 published studies were assessed to be of mediocre quality, particularly in describing the assumptions underpinning decision-analytic models and the methods used to handle uncertainty or population heterogeneity. The meta-analysis of their results showed that the pooled incremental cost of these interventions was £3410 (95% CI £821–£7,642) per patient per year. In term of outcomes, the pooled incremental QALY was 0·20 (95% CI ...

Introduction Increased demand for child and adolescent mental health services (CAMHS), alongside concerns that services should be better commissioned to meet the needs of the most vulnerable, has contributed to a requirement to transform services to improve accessibility, quality of care and health outcomes. Following the submission of government-mandated transformation plans for CAMHS, services in England are changing in how, where and by whom they are delivered. This protocol describes the research methods to be applied to understand CAMHS transformations and evaluate the impact on the use of mental health services, patient care, satisfaction, health outcomes and health resource utilisation costs. Methods and analysis A mixed-methods approach will be taken in an observational retrospective study of CAMHS provided by a large NHS mental health trust in South East England (Oxford Health NHS Foundation Trust). Quantitative research will include descriptive analysis of routinely collected data, with difference-in-differences analysis supplemented with propensity score matching performed to assess the impact of CAMHS transformations from 2015 onwards. An economic evaluation will be conducted from a healthcare perspective to provide commissioners with indications of value-for-money. Qualitative research will include observations of services and interviews with key stakeholders including CAMHS staff, service users and guardians, to help identify mechanisms leading to changes in service delivery, as well as barriers and enabling factors in this phase of transformation. Ethics and Dissemination This project has been registered with NHS Oxford Health Foundation Trust as a service evaluation. Informed consent will be sought from all stakeholders partaking in interviews according to good clinical practice. A local data sharing protocol will govern the transfer of quantitative data. Study findings will be published in professional journals for NHS managers and peer-reviewed scientific journals. They will be discussed in ...

AbstractChild safeguarding services intervene when a child is at risk of serious emotional or physical harm. Oxfordshire County Council is implementing a new approach to child safeguarding (Family Solutions Plus [FSP]) with a greater focus on whole family support and reducing the need for foster care. We sampled two cohorts of children closed within 1 year and examined the time spent in services. The sample included 474 children entering services before the new model's implementation and 561 children after. A greater proportion of children receiving FSP required a single care plan before their case was closed (85.9%; 69.4%, p < 0.001) and only experienced the lowest level plan (74.5%; 61.8%, p < 0.001). On average, this group spent less time in services for the period being observed (MD = 17.58, 95% confidence interval = 6.19, 28.96). At this early stage, no significant reduction in the number of children requiring foster care was seen (5.5%; 3.9%, p = 0.23). These initial findings suggest a potential association of FSP with a reduced number and level of care plans as well as length of time. Local authorities in England may investigate further whether FSP is a potentially useful model in improving safeguarding services.

Background: The rise of multi-morbidity constitutes a serious challenge in health and social care organisation that requires a shift from disease- towards person-centred integrated care. The aim of the current study was to develop a conceptual framework that can aid the development, implementation, description, and evaluation of integrated care programmes for multi-morbidity. Methods: A scoping review and expert discussions were used to identify and structure concepts for integrated care for multi-morbidity. A search of scientific and grey literature was conducted. Discussion: meetings were organised within the SELFIE research project with representatives of five stakeholder groups (5Ps): patients, partners, professionals, payers, and policy makers. Results: In the scientific literature 11,641 publications were identified, 92 were included for data extraction. A draft framework was constructed that was adapted after discussion with SELFIE partners from 8 EU countries and 5P representatives. The core of the framework is the holistic understanding of the person with multi-morbidity in his or her environment. Around the core, concepts were grouped into adapted WHO components of health systems: service delivery, leadership & governance, workforce, financing, technologies & medical products, and information & research. Within each component micro, meso, and macro levels are distinguished. Conclusion: The framework structures relevant concepts in integrated care for multi-morbidity and can be applied by different stakeholders to guide development, implementation, description, and evaluation.

Background The rise of multi-morbidity constitutes a serious challenge in health and social care organisation that requires a shift from disease- towards person-centred integrated care. The aim of the current study was to develop a conceptual framework that can aid the development, implementation, description, and evaluation of integrated care programmes for multi-morbidity. Methods A scoping review and expert discussions were used to identify and structure concepts for integrated care for multi-morbidity. A search of scientific and grey literature was conducted. Discussion meetings were organised within the SELFIE research project with representatives of five stakeholder groups (5Ps): patients, partners, professionals, payers, and policy makers. Results In the scientific literature 11,641 publications were identified, 92 were included for data extraction. A draft framework was constructed that was adapted after discussion with SELFIE partners from 8 EU countries and 5P representatives. The core of the framework is the holistic understanding of the person with multi-morbidity in his or her environment. Around the core, concepts were grouped into adapted WHO components of health systems: service delivery, leadership & governance, workforce, financing, technologies & medical products, and information & research. Within each component micro, meso, and macro levels are distinguished. Conclusion The framework structures relevant concepts in integrated care for multi-morbidity and can be applied by different stakeholders to guide development, implementation, description, and evaluation. ; EC/H2020/634288/EU/Sustainable intEgrated care modeLs for multi-morbidity: delivery, FInancing and performancE/SELFIE

Background: The rise of multi-morbidity constitutes a serious challenge in health and social care organisation that requires a shift from disease- towards person-centred integrated care. The aim of the current study was to develop a conceptual framework that can aid the development, implementation, description, and evaluation of integrated care programmes for multi-morbidity. Methods: A scoping review and expert discussions were used to identify and structure concepts for integrated care for multi-morbidity. A search of scientific and grey literature was conducted. Discussion: meetings were organised within the SELFIE research project with representatives of five stakeholder groups (5Ps): patients, partners, professionals, payers, and policy makers. Results: In the scientific literature 11,641 publications were identified, 92 were included for data extraction. A draft framework was constructed that was adapted after discussion with SELFIE partners from 8 EU countries and 5P representatives. The core of the framework is the holistic understanding of the person with multi-morbidity in his or her environment. Around the core, concepts were grouped into adapted WHO components of health systems: service delivery, leadership & governance, workforce, financing, technologies & medical products, and information & research. Within each component micro, meso, and macro levels are distinguished. Conclusion: The framework structures relevant concepts in integrated care for multi-morbidity and can be applied by different stakeholders to guide development, implementation, description, and evaluation.