预防复发性抑郁症维持治疗策略的经济评估
Economic assessment of a maintenance treatment strategy in prevention of recurrent depressive disorder.
作者信息
Dardennes R M, Lafuma A, Fagnani F, Pribil C, Bisserbe J C, Berdeaux G
机构信息
Centre Hospitalier Sainte-Anne, Paris, France.
出版信息
Value Health. 2000 Jan-Feb;3(1):40-7. doi: 10.1046/j.1524-4733.2000.31005.x.
OBJECTIVE
To compare the 12-month cost-effectiveness of milnacipran in maintenance treatment of depression to that of medical follow-up without antidepressant.
METHOD
A Markov model with transition probabilities from a double blind clinical trial demonstrating the prophylactic efficacy of milnacipran was used. Other parameters were obtained from published sources.
RESULTS
Base-case incremental cost for preventive treatment was 1,191 FF. It was reduced to 685 FF when using a 25% hospitalization rate in case of recurrence. Patients with a high initial response had extra cost of 191 FF and cost-utility was estimated to be 23,875 FF per QALY gained. For those patients, using a 25% hospitalization rate in case of recurrence, costs were lower at 1,174 FF and preventive strategy was dominating.
CONCLUSION
Cost of maintenance therapy is partially balanced by the gain from recurrence prevention. It should be focused on patients with few residual symptoms or a high probability of hospitalization in case of recurrence.
目的
比较米那普明维持治疗抑郁症与无抗抑郁药的医学随访在12个月内的成本效益。
方法
使用了一个马尔可夫模型，其转移概率来自一项双盲临床试验，该试验证明了米那普明的预防效果。其他参数取自已发表的资料。
结果
预防性治疗的基础病例增量成本为1191法郎。在复发时采用25%的住院率时，成本降至685法郎。初始反应良好的患者额外成本为191法郎，成本效益估计为每获得一个质量调整生命年23875法郎。对于这些患者，在复发时采用25%的住院率，成本较低，为1174法郎，预防策略占主导地位。
结论
维持治疗的成本部分被预防复发的收益所平衡。应关注残留症状少或复发时住院可能性高的患者。
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