PubMed · 7795936
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I Marks, M Başoglo, I H Noshirvani. 1995. Cognitive therapy for panic.. https://doi.org/10.1192/bjp.166.4.541
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BACKGROUND: Seasonal affective disorder (SAD) episodes will recur annually without effective intervention. Effectiveness of such interventions is traditionally measured with depression-specific tools (e.g., Beck Depression Inventory 2nd Edition; BDI-II). In a climate of potentially scarce resources, generic outcomes, such as Quality Adjusted Life Years (QALYs), are recommended for cost-effectiveness research. For treatments to be deemed cost-effective, they must show effectiveness relative to each other and relative to interventions across other disorders. To date, QALYs have not been used to determine effectiveness of SAD treatments. Given the recurrent nature of SAD, QALYs, which weight quality of life with time, are an ideal SAD treatment outcome. METHOD: A method to assess QALYs for SAD was developed using pilot clinical trial data. The method estimated health utilities, a measure of quality of life for a QALY, by anchoring pilot BDI-II data from the SAD clinical trial with previously derived health utilities for nonseasonal depression. RESULTS: Relative to no treatment, median QALYs gained ranged from 0.11-0.18 over 1 year, depending on the intervention assessed. DISCUSSION: Any treatment for SAD must compete with spontaneous spring remission, as illness severity attenuates in the spring. LIMITATIONS: Health utilities were estimated from the depression literature, and potential side effects from SAD treatments were not included in the estimates. The clinical trial time horizon was limited to 1-year. CONCLUSIONS: The proposed method offers researchers a tool to transform SAD efficacy data into a generic outcome for use in cost-effectiveness analysis of SAD treatments.
In the last few years, the chronic-fatigue syndrome has been recognised as an important health problem. In a recent report, the Health Council of the Netherlands suggested that the capacity for treatment be increased. Cognitive behavioural therapy and graded exercise training are treatment options of first choice. A recently published, uncontrolled evaluation of a Dutch clinical rehabilitation programme based partly on these methods proved to be successful. Unfortunately, due to the uncontrolled character of the study, it remains unclear which elements in the treatment were responsible for the success. Which patients should be included in a costly clinical rehabilitation programme also remains unclear. More in general, there is room for empirical studies of treatment allocation, not in the least because of the frequently occurring comorbidity. Good progress has been made in the treatment of the chronic-fatigue syndrome, but we are still far removed from evidence-based, stepped care, treatment programmes.
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