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智利圣地亚哥针对低收入女性抑郁症的初级保健治疗项目的成本效益

Cost-effectiveness of a primary care treatment program for depression in low-income women in Santiago, Chile.

作者信息

Araya Ricardo, Flynn Terry, Rojas Graciela, Fritsch Rosemarie, Simon Greg

机构信息

Division of Psychiatry, University of Bristol, Cotham House, Cotham Hill, Bristol BS6 6UJ.

出版信息

Am J Psychiatry. 2006 Aug;163(8):1379-87. doi: 10.1176/ajp.2006.163.8.1379.

Abstract

OBJECTIVE

The authors compared the incremental cost-effectiveness of a stepped-care, multicomponent program with usual care for the treatment of depressed women in primary care in Santiago, Chile.

METHOD

A cost-effectiveness study was conducted of a previous randomized controlled trial involving 240 eligible women with DSM-IV major depression who were selected from a consecutive sample of adult women attending primary care clinics. The patients were randomly allocated to usual care or a multicomponent stepped-care program led by a nonmedical health care worker. Depression-free days and health care costs derived from local sources were assessed after 3 and 6 months. A health service perspective was used in the economic analysis.

RESULTS

Complete data were determined for 80% of the randomly assigned patients. After we adjusted for initial severity, women receiving the stepped-care program had a mean of 50 additional depression-free days over 6 months relative to patients allocated to usual care. The stepped-care program was marginally more expensive than usual care (an extra 216 Chilean pesos per depression-free day). There was a 90% probability that the incremental cost of obtaining an extra depression-free day with the intervention would not exceed 300 pesos (1.04 US dollars).

CONCLUSIONS

The stepped-care program was significantly more effective and marginally more expensive than usual care for the treatment of depressed women in primary care. Small investments to improve depression appear to yield larger gains in poorer environments. Simple and inexpensive treatment programs tested in developing countries might provide good study models for developed countries.

摘要

目的

作者比较了阶梯式多成分项目与常规护理对智利圣地亚哥初级保健中抑郁女性的增量成本效益。

方法

对之前一项随机对照试验进行成本效益研究,该试验纳入了240名符合条件的患有DSM-IV重度抑郁症的女性,她们选自连续就诊于初级保健诊所的成年女性样本。患者被随机分配至常规护理组或由非医疗保健工作者主导的多成分阶梯式护理项目组。在3个月和6个月后评估无抑郁天数以及来自当地的医疗保健成本。经济分析采用卫生服务视角。

结果

确定了80%随机分组患者的完整数据。在对初始严重程度进行调整后,接受阶梯式护理项目的女性在6个月内相对于分配至常规护理的患者平均多了50个无抑郁天数。阶梯式护理项目比常规护理略贵(每无抑郁一天额外多216智利比索)。采用该干预措施获得额外一个无抑郁天数的增量成本不超过300比索(1.04美元)的概率为90%。

结论

对于初级保健中抑郁女性的治疗,阶梯式护理项目比常规护理显著更有效且成本略高。在较差环境中,为改善抑郁症进行的小额投资似乎能带来更大收益。在发展中国家测试的简单且低成本的治疗项目可能为发达国家提供良好的研究模式。

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