Sobocki Patrik, Ekman Mattias, Agren Hans, Jönsson Bengt, Rehnberg Clas
Department of Learning, Informatics, Management and Ethics, Karolinska Institutet and European Health Economics AB, Stockholm, Sweden.
Int J Technol Assess Health Care. 2006 Fall;22(4):469-77. doi: 10.1017/S0266462306051397.
The objective of this study was to develop a model to assess the cost-effectiveness of a new treatment for patients with depression.
A Markov simulation model was constructed to evaluate standard care for depression as performed in clinical practice compared with a new treatment for depression. Costs and effects were estimated for time horizons of 6 months to 5 years. A naturalistic longitudinal observational study provided data on costs, quality of life, and transition probabilities. Data on long-term consequences of depression and mortality risks were collected from the literature. Cost-effectiveness was quantified as quality-adjusted life-years (QALYs) gained from the new treatment compared with standard care, and the societal perspective was taken. Probabilistic analyses were conducted to present the uncertainty in the results, and sensitivity analyses were conducted on key parameters used in the model.
Compared with standard care, the new hypothetical therapy was predicted to substantially decrease costs and was also associated with gains in QALYs. With an improved treatment effect of 50 percent on achieving full remission, the net cost savings were 20,000 Swedish kronor over a 5-year follow-up time, given equal costs of treatments. Patients gained .073 QALYs over 5 years. The results are sensitive to changes in assigned treatment effects.
The present study provides a new model for assessing the cost-effectiveness of treatments for depression by incorporating full remission as the treatment goal and QALYs as the primary outcome measure. Moreover, we show the usefulness of naturalistic real-life data on costs and quality of life and transition probabilities when modeling the disease over time.
本研究的目的是开发一种模型，以评估一种抑郁症新疗法的成本效益。
构建了一个马尔可夫模拟模型，用于评估临床实践中对抑郁症的标准治疗与一种抑郁症新疗法的效果。对6个月至5年的时间范围估计成本和效果。一项自然主义纵向观察性研究提供了关于成本、生活质量和转移概率的数据。从文献中收集了抑郁症长期后果和死亡风险的数据。成本效益被量化为与标准治疗相比，新疗法获得的质量调整生命年（QALY），并采用社会视角。进行概率分析以呈现结果的不确定性，并对模型中使用的关键参数进行敏感性分析。
与标准治疗相比，新的假设疗法预计会大幅降低成本，并且还与QALY的增加相关。在实现完全缓解方面治疗效果提高50%的情况下，在5年的随访期内，在治疗成本相同的情况下，净成本节省为20,000瑞典克朗。患者在5年内获得了0.073个QALY。结果对指定治疗效果的变化敏感。
本研究通过将完全缓解作为治疗目标并将QALY作为主要结局指标，提供了一种评估抑郁症治疗成本效益的新模型。此外，我们展示了在对疾病随时间进行建模时，关于成本、生活质量和转移概率的自然主义现实生活数据的有用性。
