I am interested in the fields of psychosomatic medicine and cardiovascular disease, in particular the impact of depression on cardiovascular prognosis and on health behaviours such as smoking, physical activity and medication adherence. Other research interests include type I diabetes, systematic reviews, psychometrics (particularly item response theory), quality of life (a HeartQol investigator), pain, cardiac rehabilitation. My publications are available here:
http://tinyurl.com/FDoyle-publications
Being diagnosed with coronary artery disease can have a major psychological impact on patients, a... more Being diagnosed with coronary artery disease can have a major psychological impact on patients, and individual and condition-specific differences have been reported in the literature. What is clear overall is that psychological disorders are more prevalent among patients with coronary artery disease than equivalent general population samples without chronic conditions. Coronary artery disease severity does not seem to completely account for this higher prevalence. Depressive and anxiety disorders are the most common to impact patients with coronary artery disease, and will be the main focus of this chapter.
BACKGROUND A substantial proportion of individuals with coronary artery disease experience modera... more BACKGROUND A substantial proportion of individuals with coronary artery disease experience moderate or severe acute depression that requires treatment. We assessed the cost-effectiveness of four interventions for depression in individuals with coronary artery disease. METHODS We assessed effectiveness of pharmacotherapy, psychotherapy, collaborative care and exercise as remission rate after 8 and 26 weeks using estimates from a recent network meta-analysis. The cost assessment included standard doses of antidepressants, contact frequency, and staff time per contact. Unit costs were calculated as health services' purchase price for pharmaceuticals and mid-point staff salaries obtained from the Irish Health Service Executive and validated by clinical staff. Incremental cost-effectiveness ratios were calculated as the incremental costs over incremental remissions compared to usual care. High- and low-cost scenarios and sensitivity analysis were performed with changed contact frequencies, and assuming individual vs. group psychotherapy or exercise. RESULTS After 8 weeks, the estimated incremental cost-effectiveness ratio was lowest for group exercise (€526 per remission), followed by pharmacotherapy (€589), individual psychotherapy (€3117) and collaborative care (€4964). After 26 weeks, pharmacotherapy was more cost-effective (€591) than collaborative care (€7203) and individual psychotherapy (€9387); no 26-week assessment for exercise was possible. Sensitivity analysis showed that group psychotherapy could be most cost-effective after 8 weeks (€519) and cost-effective after 26 weeks (€1565); however no group psychotherapy trials were available investigating its effectiveness. DISCUSSION Large variation in incremental cost-effectiveness ratios was seen. With the current assumptions, the most cost-effective depression intervention for individuals with coronary artery disease after 8 weeks was group exercise.
Being diagnosed with coronary artery disease can have a major psychological impact on patients, a... more Being diagnosed with coronary artery disease can have a major psychological impact on patients, and individual and condition-specific differences have been reported in the literature. What is clear overall is that psychological disorders are more prevalent among patients with coronary artery disease than equivalent general population samples without chronic conditions. Coronary artery disease severity does not seem to completely account for this higher prevalence. Depressive and anxiety disorders are the most common to impact patients with coronary artery disease, and will be the main focus of this chapter.
BACKGROUND A substantial proportion of individuals with coronary artery disease experience modera... more BACKGROUND A substantial proportion of individuals with coronary artery disease experience moderate or severe acute depression that requires treatment. We assessed the cost-effectiveness of four interventions for depression in individuals with coronary artery disease. METHODS We assessed effectiveness of pharmacotherapy, psychotherapy, collaborative care and exercise as remission rate after 8 and 26 weeks using estimates from a recent network meta-analysis. The cost assessment included standard doses of antidepressants, contact frequency, and staff time per contact. Unit costs were calculated as health services' purchase price for pharmaceuticals and mid-point staff salaries obtained from the Irish Health Service Executive and validated by clinical staff. Incremental cost-effectiveness ratios were calculated as the incremental costs over incremental remissions compared to usual care. High- and low-cost scenarios and sensitivity analysis were performed with changed contact frequencies, and assuming individual vs. group psychotherapy or exercise. RESULTS After 8 weeks, the estimated incremental cost-effectiveness ratio was lowest for group exercise (€526 per remission), followed by pharmacotherapy (€589), individual psychotherapy (€3117) and collaborative care (€4964). After 26 weeks, pharmacotherapy was more cost-effective (€591) than collaborative care (€7203) and individual psychotherapy (€9387); no 26-week assessment for exercise was possible. Sensitivity analysis showed that group psychotherapy could be most cost-effective after 8 weeks (€519) and cost-effective after 26 weeks (€1565); however no group psychotherapy trials were available investigating its effectiveness. DISCUSSION Large variation in incremental cost-effectiveness ratios was seen. With the current assumptions, the most cost-effective depression intervention for individuals with coronary artery disease after 8 weeks was group exercise.
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Papers by Frank Doyle