Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Mitte, Germany.
J Affect Disord. 2011 Nov;134(1-3):249-56. doi: 10.1016/j.jad.2011.05.053. Epub 2011 Jul 14.
The German Algorithm Project, Phase 2 (GAP2) revealed that a standardized stepwise treatment regimen (SSTR) results in better treatment outcomes than treatment as usual (TAU) in depressed inpatients. The objective of this study was a health economic evaluation of SSTR based on a cost effectiveness analysis (CEA).
GAP2 was a randomized controlled study with 148 patients. In an intention to treat (ITT) analysis direct treatment costs for study duration (SD) and total time in hospital (TTH; enrolment to discharge) were calculated based on daily hospital charges followed by a CEA to calculate cost expenditure per remitted patient.
Treatment costs in SSTR compared to TAU were significantly lower for SD (SSTR: 10 830 € ± 8 632 €, TAU: 15 202 € ± 12 483 €; p = 0.026) and did not differ significantly for TTH (SSTR: 21 561 € ± 16 162 €; TAU: 18 248 € ± 13 454; p = 0.208). CEA revealed that the costs per remission in SSTR were significantly lower for SD (SSTR: 20 035 € ± 15 970 €; SSTR: 38 793 € ± 31 853 €; p<0.0001) and TTH (SSTR: 31 285 € ± 23 451 €; TAU: 38 581 € ± 28 449 €, p = 0.041).
Indirect costs were not assessed. Different dropout rates in TAU and SSTR complicated interpretation of data.
An SSTR-based algorithm results in a superior cost effectiveness at no significant extra costs. Implementation of treatment algorithms in inpatient-care may help reduce treatment costs.
德国算法项目第二阶段（GAP2）显示，与常规治疗（TAU）相比，标准化逐步治疗方案（SSTR）可改善抑郁症住院患者的治疗效果。本研究的目的是基于成本效益分析（CEA）对 SSTR 进行健康经济评估。
GAP2 是一项随机对照研究，纳入 148 例患者。意向治疗（ITT）分析中，根据每日住院费用计算研究期间（SD）和总住院时间（TTH；入组至出院）的直接治疗费用，然后进行 CEA 以计算每位缓解患者的成本支出。
SSTR 的治疗费用明显低于 TAU 的 SD（SSTR：10830 欧元±8632 欧元，TAU：15202 欧元±12483 欧元；p=0.026），但 TTH 无显著差异（SSTR：21561 欧元±16162 欧元，TAU：18248 欧元±13454 欧元；p=0.208）。CEA 显示，SSTR 的 SD（SSTR：20035 欧元±15970 欧元，TAU：38793 欧元±31853 欧元；p<0.0001）和 TTH（SSTR：31285 欧元±23451 欧元，TAU：38581 欧元±28449 欧元；p=0.041）的缓解成本显著降低。
未评估间接成本。TAU 和 SSTR 不同的辍学率使数据解释复杂化。
基于 SSTR 的算法在不增加显著成本的情况下可获得更好的成本效益。在住院治疗中实施治疗算法可能有助于降低治疗成本。
