荷兰具有成本效益的人格障碍心理治疗：进一步研究和积极实施的价值。
Cost-effective psychotherapy for personality disorders in the Netherlands: the value of further research and active implementation.
机构信息
Viersprong Institute for Studies on Personality Disorders (VISPD), Halsteren, The Netherlands.
出版信息
Value Health. 2011 Mar-Apr;14(2):229-39. doi: 10.1016/j.jval.2010.10.020. Epub 2011 Feb 5.
OBJECTIVE
In a budget-constrained health care system, decisions regarding resource allocation towards research and implementation are critical and can be informed by cost-effectiveness analysis. The objective of this study was to assess the societal value of conducting further research to inform reimbursement decisions and implementation of cost-effective psychotherapy for clusters B and C personality disorders (PDs).
METHODS
Value of information and value of implementation analyses were conducted using previously developed cost-effectiveness models for clusters B and C PDs to evaluate the parameters that contribute to most of the decision uncertainty, and to calculate the population expected values of perfect information (pEVPI) and perfect implementation (pEVPIM).
RESULTS
The pEVPI was estimated to be €425 million for cluster B PDs and €315 million for cluster C PDs, indicating that gathering additional evidence is expected to be cost-effective. The categories of parameters for which reduction of uncertainty would be most valuable were transition probabilities and health state costs. The pEVPIM was estimated to be €595 million for cluster B PDs and €1,372 million for cluster C PDs, suggesting that investing in implementation of cost-effective psychotherapy is likely to be worthwhile.
CONCLUSIONS
The societal value of additional research on psychotherapy for clusters B and C PDs is substantial, especially when prioritizing information on transition probabilities and health state costs. Active implementation of cost-effective treatment strategies into clinical practice is likely to improve the efficiency of health care provision in The Netherlands.
目的
在资源有限的医疗保健系统中，决策资源分配以支持研究和实施至关重要，可以通过成本效益分析来提供信息。本研究旨在评估进一步研究以告知报销决策和实施具有成本效益的心理治疗的社会价值，这些研究针对 B 类和 C 类人格障碍（PD）。
方法
使用先前为 B 类和 C 类 PD 开发的成本效益模型进行信息价值和实施价值分析，以评估对决策不确定性贡献最大的参数，并计算完全信息（pEVPI）和完全实施（pEVPIM）的人群预期值。
结果
B 类 PD 的 pEVPI 估计为 4.25 亿欧元，C 类 PD 的 pEVPI 估计为 3.15 亿欧元，这表明收集更多证据有望具有成本效益。不确定性降低最有价值的参数类别是转移概率和健康状态成本。B 类 PD 的 pEVPIM 估计为 5.95 亿欧元，C 类 PD 的 pEVPIM 估计为 13.72 亿欧元，这表明投资实施具有成本效益的心理治疗可能是值得的。
结论
针对 B 类和 C 类 PD 的心理治疗进行额外研究的社会价值巨大，尤其是在优先考虑转移概率和健康状态成本信息时。积极将具有成本效益的治疗策略实施到临床实践中，可能会提高荷兰医疗保健的效率。
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