Community interventions for people with complex emotional needs that meet the criteria for personality disorder diagnoses: systematic review of economic evaluations and expert commentary

Background: Diagnoses of personality disorder are prevalent among people using community secondary mental health services. Identifying cost-effective community-based interventions is important when working with finite resources. / Aims: To assess the cost-effectiveness of primary or secondary care community-based interventions for people with complex emotional needs who meet criteria for a diagnosis of personality disorder to inform healthcare policy-making. / Method: Systematic review (PROSPERO: CRD42020134068) of databases. We included economic evaluations of interventions for adults with complex emotional needs associated with a diagnosis of personality disorder in community mental health settings published before 18 September 2019. Study quality was assessed using the CHEERS statement. / Results: Eighteen studies were included. The studies mainly evaluated psychotherapeutic interventions. Studies were also identified that evaluated altering the setting in which care was delivered and joint crisis plans. No strong economic evidence to support a single intervention or model of community-based care was identified. / Conclusions: Robust economic evidence to support a single intervention or model of community-based care for people with complex emotional needs is lacking. The strongest evidence was for dialectical behaviour therapy, with all three identified studies indicating that it is likely to be cost-effective in community settings compared with treatment as usual. More robust evidence is required on the cost-effectiveness of community-based interventions on which decision makers can confidently base guidelines or allocate resources. The evidence should be based on consistent measures of costs and outcomes with sufficient sample sizes to demonstrate impacts on these

Prognostic factors in Hodgkin lymphoma

During the last decades, the prognosis of Hodgkin lymphoma (HL) has been improved significantly with the introduction of effective chemotherapy and the implementation of risk-adapted treatment approaches. Identification of reliable risk factors is crucial to guide treatment over the course of disease. Both clinical and biological factors have been implicated in the prognosis of HL and are often used in prognostic scores to discriminate risk groups. To prevent under- or overtreatment, patients are usually assigned to one of the three widely established risk groups for first-line treatment, based solely on clinical risk factors. To further individualize therapeutic approaches, functional imaging with positron emission tomography (PET) is becoming more widely implemented and precisely investigated within clinical trials. Biological prognostic factors have been widely evaluated but are still not a part of standard prognostication. This review will discuss the currently established factors and risk models at first diagnosis and in the setting of relapsed/refractory disease and also focus on biological factors and PET, summarizing current standards and future perspectives. (C) 2016 Elsevier Inc. All rights reserved

Treatment of early stage Hodgkin lymphoma. Discussion of current trials and treatment recommendations

In early stage Hodgkin lymphoma (HL) the majority of patients can be cured using a risk-adapted combined modality treatment (CMT) strategy. However, treatment-associated toxicity significantly contributes to morbidity and mortality. Current trials hence aim at reducing treatment-associated toxicity, while maintaining or even improving tumor control. Review of the available data and development of current treatment recommendations for early stage favorable and unfavorable HL. Evaluation of results of current randomized trials, meta-analyses and relevant retrospective analyses. Because of the excellent survival rates (HD10) and the establishment of involved site (IS)-RT, two cycles of ABVD (adriamycin, bleomycin, vinblastine, dacarbazine) and 20aEuroGy IS-RT are regarded as standard in early stage favorable HL, while four cycles of ABVD and 30aEuroGy IF-RT result in progression-free survival (PFS) rates of up to 83% (HD11) is used in early stage unfavorable disease. A significant improvement of tumor control at the cost of increased acute toxicity was documented with two cycles of BEACOPP(escalated) (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone) followed by two cycles of ABVD (2aEuro+ 2; HD14). A (18F)FDG-PET-based chemotherapy with two cycles of BEACOPP(escalated) applied in PET-positive patients after two cycles of ABVD (H10) might allow a reduction of treatment intensity in a relevant number of patients and provide favorable PFS; however, further data is required. Therefore, 2aEuro+ 2aEuro+ 30aEuroGy IS-RT is currently recommended as standard in patients < 60 years of age. The available data support consolidative RT for optimal disease control. But, omission of RT might be discussed in selected patients with PET-negative disease