Columbia University, New York, NY 10032, USA.
Med Care Res Rev. 2010 Jun;67(3):251-74. doi: 10.1177/1077558709356357. Epub 2010 Jan 21.
Depression is often diagnosed and treated in primary care settings. Organizational and systems interventions that restructure primary care practices and train staff have been shown to be cost-effective strategies for treating depression. Funders are increasingly calling for a cost-benefit assessment of such programs. In this study, the authors review existing cost-effectiveness studies of primary care depression treatments, classify them into categories, translate the results into net benefit terms, and assess whether more costly programs generate greater net benefit. The authors find that interventions that provide training to primary care teams in how to manage depression most consistently produce net benefits, with more costly interventions of this type generating larger net benefits than less costly interventions. Collaborative care interventions, which add specialized staff to primary care practices, and therapy interventions, in which clinicians are trained to provide therapy, also generate net social benefits at conventional valuations of quality-adjusted life years.
抑郁症通常在初级保健环境中进行诊断和治疗。已经证明，组织和系统干预措施可以重组初级保健实践并培训工作人员，这是治疗抑郁症的具有成本效益的策略。资助者越来越多地要求对这些计划进行成本效益评估。在这项研究中，作者回顾了现有的初级保健抑郁症治疗的成本效益研究，将它们分类，将结果转换为净收益，并评估更昂贵的计划是否会产生更大的净收益。作者发现，为初级保健团队提供管理抑郁症培训的干预措施最能产生净收益，而此类成本更高的干预措施比成本较低的干预措施产生的净收益更大。协作式护理干预措施为初级保健实践增加了专门的工作人员，而治疗干预措施则培训临床医生提供治疗，在常规质量调整生命年的估值下，也能产生净社会效益。
