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Depression is a prevalent long-term condition that is associated with substantial resource use. Telehealth may offer a cost-effective means of supporting the management of people with depression.
To investigate the cost-effectiveness of a telehealth intervention (‘Healthlines’) for patients with depression.
A prospective patient-level economic evaluation conducted alongside a randomised controlled trial. Patients were recruited through primary care, and the intervention was delivered via a telehealth service. Participants with a confirmed diagnosis of depression and PHQ-9 score ≥10 were recruited from 43 English general practices. A series of up to 10 scripted, theory-led, telephone encounters with health information advisers supported participants to effect a behaviour change, use online resources, optimise medication and improve adherence. The intervention was delivered alongside usual care and was designed to support rather than duplicate primary care. Cost-effectiveness from a combined health and social care perspective was measured by net monetary benefit at the end of 12 months of follow-up, calculated from incremental cost and incremental quality-adjusted life years (QALYs). Cost–consequence analysis included cost of lost productivity, participant out-of-pocket expenditure and the clinical outcome.
A total of 609 participants were randomised – 307 to receive the Healthlines intervention plus usual care and 302 to receive usual care alone. Forty-five per cent of participants had missing quality of life data, 41% had missing cost data and 51% of participants had missing data on either cost or utility, or both. Multiple imputation was used for the base-case analysis. The intervention was associated with incremental mean per-patient National Health Service/personal social services cost of £168 (95% CI £43 to £294) and an incremental QALY gain of 0.001 (95% CI −0.023 to 0.026). The incremental cost-effectiveness ratio was £132 630. Net monetary benefit at a cost-effectiveness threshold of £20 000 was –£143 (95% CI –£164 to –£122) and the probability of the intervention being cost-effective at this threshold value was 0.30. Productivity costs were higher in the intervention arm, but out-of-pocket expenses were lower.
The Healthlines service was acceptable to patients as a means of condition management, and response to treatment after 4 months was higher for participants randomised to the intervention. However, the positive average intervention effect size was modest, and incremental costs were high relative to a small incremental QALY gain at 12 months. The intervention is not likely to be cost-effective in its current form.
To explore shoppers’ responses to the taste of different types of cow’s milk in a blind taste test and to examine their willingness to purchase lower-fat milk as part of an in-store marketing intervention.
Participants were recruited on-site in the supermarket to participate in a blind taste test of three varieties of cow’s milk and asked to guess what type they sampled.
The taste testing was conducted as part of the Healthy Retail Solution (HRS) intervention that took place in four large supermarkets in Philadelphia, PA, USA over the course of six months.
Adults (n 444) at participating Philadelphia supermarkets.
The majority of participants at all stores reported typically purchasing higher-fat milk. Forty per cent of participants reported buying whole milk, 38 % purchased milk with 2 % fat. Very few participants correctly identified all three milk samples during the taste test (6·9 %) and a majority of participants were unable to identify the type of milk they self-reported typically purchased.
Most consumers could not accurately distinguish between various types of milk. Taste testing is a promising strategy to introduce lower-fat milks to consumers who have not tried them before. Campaigns to purchase skimmed, 1 % or 2 % milk may result in significant energy reduction over time and can serve as a simple way to combat overweight and obesity.
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