Creed Francis, Fernandes Lakshmi, Guthrie Elspeth, Palmer Stephen, Ratcliffe Joy, Read Nicholas, Rigby Christine, Thompson David, Tomenson Barbara
School of Psychiatry and Behavioural Science, University of Manchester, England.
Gastroenterology. 2003 Feb;124(2):303-17. doi: 10.1053/gast.2003.50055.
BACKGROUND & AIMS: Psychotherapy and antidepressants are effective in patients with severe irritable bowel syndrome (IBS), but the cost-effectiveness of either treatment in routine practice has not been established.
Patients with severe IBS were randomly allocated to receive 8 sessions of individual psychotherapy, 20 mg daily of the specific serotonin reuptake inhibitor (SSRI) antidepressant, paroxetine, or routine care by a gastroenterologist and general practitioner. Primary outcome measures of abdominal pain, health-related quality of life, and health care costs were determined after 3 months of treatment and 1 year later.
A total of 257 subjects (81% response rate) from 7 hospitals were recruited; 59 of 85 patients (69%) randomized to psychotherapy and 43 of 86 (50%) of the paroxetine group completed the full course of treatment. Both psychotherapy and paroxetine were superior to treatment as usual in improving the physical aspects of health-related quality of life (SF-36 physical component score improvement, 5.2 [SEM, 1.26], 5.8 [SEM, 1.0], and -0.3 [SEM, 1.17]; P < 0.001), but there was no difference in the psychological component. During the follow-up year, psychotherapy but not paroxetine was associated with a significant reduction in health care costs compared with treatment as usual (psychotherapy, $976 [SD, $984]; paroxetine, $1252 [SD, $1616]; and treatment as usual, $1663 [SD, $3177]).
For patients with severe IBS, both psychotherapy and paroxetine improve health-related quality of life at no additional cost.
心理治疗和抗抑郁药对重度肠易激综合征（IBS）患者有效，但这两种治疗方法在常规临床实践中的成本效益尚未明确。
重度IBS患者被随机分配接受8次个体心理治疗、每日20毫克的特异性5-羟色胺再摄取抑制剂（SSRI）抗抑郁药帕罗西汀，或由胃肠病学家和全科医生提供的常规护理。在治疗3个月后及1年后，测定腹痛、健康相关生活质量和医疗费用等主要结局指标。
来自7家医院的257名受试者（应答率81%）被纳入研究；随机分配至心理治疗组的85名患者中有59名（69%）、帕罗西汀组的86名患者中有43名（50%）完成了整个疗程。心理治疗和帕罗西汀在改善健康相关生活质量的身体方面均优于常规治疗（SF-36身体成分得分改善分别为5.2[标准误，1.26]、5.8[标准误，1.0]和-0.3[标准误，1.17]；P<0.001），但在心理方面无差异。在随访的一年中，与常规治疗相比，心理治疗而非帕罗西汀与医疗费用显著降低相关（心理治疗，976美元[标准差，984美元]；帕罗西汀，1252美元[标准差，1616美元]；常规治疗，1663美元[标准差，3177美元]）。
对于重度IBS患者，心理治疗和帕罗西汀均可改善健康相关生活质量且无需额外费用。
