Pirraglia Paul A, Rosen Allison B, Hermann Richard C, Olchanski Natalia V, Neumann Peter
Rhode Island Hospital, 593 Eddy St., MPB-1, Providence, RI 02903, USA.
Am J Psychiatry. 2004 Dec;161(12):2155-62. doi: 10.1176/appi.ajp.161.12.2155.
Depression is common, costly, treatable, and a major influence on quality of life. Cost-utility analysis combines costs with quantity and quality of life into a metric that is meaningful for studies of interventions or care strategies and is directly comparable to measures in other such studies. The objectives of this study were to identify published cost-utility analyses of depression screening, pharmacologic treatment, nonpharmacologic therapy, and care management; to summarize the results of these studies in an accessible format; to examine the analytic methods employed; and to identify areas in the depression literature that merit cost-utility analysis.
The authors selected articles regarding cost-utility analysis of depression management from the Harvard Center for Risk Analysis Cost-Effectiveness Registry. Characteristics of the publications, including study methods and analysis, were examined. Cost-utility ratios for interventions were arranged in a league table.
Of the 539 cost-utility analyses in the registry, nine (1.7%) were of depression management. Methods for determining utilities and the source of the data varied. Markov models or cohort simulations were the most common analytic techniques. Pharmacologic interventions generally had lower costs per quality-adjusted life year than nonpharmacologic interventions. Psychotherapy alone, care management alone, and psychotherapy plus care management all had lower costs per quality-adjusted life year than usual care. Depression screening and treatment appeared to fall within the cost-utility ranges accepted for common nonpsychiatric medical conditions.
There is a paucity of literature on cost-utility analysis of depression management. High-quality cost-utility analysis should be considered for further research in depression management.
抑郁症很常见，代价高昂，可治疗，且对生活质量有重大影响。成本效用分析将成本与生活质量和数量结合为一个指标，这对于干预措施或护理策略的研究具有重要意义，并且可以直接与其他此类研究中的指标进行比较。本研究的目的是识别已发表的关于抑郁症筛查、药物治疗、非药物治疗和护理管理的成本效用分析；以易于理解的形式总结这些研究的结果；检查所采用的分析方法；并确定抑郁症文献中值得进行成本效用分析的领域。
作者从哈佛风险分析中心成本效益登记处选取了关于抑郁症管理成本效用分析的文章。对出版物的特征，包括研究方法和分析进行了检查。将干预措施的成本效用比整理成排行榜。
登记处的539项成本效用分析中，有9项（1.7%）是关于抑郁症管理的。确定效用的方法和数据来源各不相同。马尔可夫模型或队列模拟是最常见的分析技术。药物干预通常比非药物干预每质量调整生命年的成本更低。单独的心理治疗、单独的护理管理以及心理治疗加护理管理每质量调整生命年的成本均低于常规护理。抑郁症筛查和治疗似乎处于常见非精神科疾病可接受的成本效用范围内。
关于抑郁症管理成本效用分析的文献较少。在抑郁症管理的进一步研究中应考虑进行高质量的成本效用分析。
