Department of Medical Sociology and Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. a.konnopka @ uke.de
Psychother Psychosom. 2012;81(5):265-75. doi: 10.1159/000337349. Epub 2012 Jul 20.
To review cost-of-illness studies (COI) and economic evaluations (EE) conducted for medically unexplained symptoms and to analyze their methods and results.
We searched the databases PubMed, PsycINFO and National Health Service Economic Evaluations Database of the University of York. Cost data were inflated to 2006 using country-specific gross domestic product inflators and converted to 2006 USD purchasing power parities.
We identified 5 COI and 8 EE, of which 6 were cost-minimization analyses and 2 were cost-effectiveness analyses. All studies used patient level data collected between 1980 and 2004 and were predominantly conducted in the USA (n = 10). COI found annual excess health care costs of somatizing patients between 432 and 5,353 USD in 2006 values. Indirect costs were estimated by only one EE and added up to about 18,000 USD per year. In EE, educational interventions for physicians as well as cognitive-behavioral therapy approaches for patients were evaluated. For both types of interventions, effectiveness was either shown within EE or by previous studies. Most EE found (often insignificant) cost reductions resulting from the interventions, but only two studies explicitly combined changes in costs with data on effectiveness to cost-effectiveness ratios (ratio of additional costs to additional effects).
Medically unexplained symptoms cause relevant annual excess costs in health care that are comparable to mental health problems like depression or anxiety disorders and which may be reduced by interventions targeting physicians as well as patients. More extensive research on indirect costs and cost-effectiveness is needed.
回顾针对无法用医学解释的症状进行的疾病成本研究（COI）和经济评估（EE），并分析其方法和结果。
我们在 PubMed、PsycINFO 和约克大学国家卫生服务经济评估数据库中进行了检索。使用特定国家的国内生产总值膨胀率将成本数据膨胀到 2006 年，并转换为 2006 年的美元购买力平价。
我们确定了 5 项 COI 和 8 项 EE，其中 6 项是成本最小化分析，2 项是成本效益分析。所有研究均使用 1980 年至 2004 年间收集的患者层面数据，且主要在美国进行（n = 10）。COI 发现，2006 年，躯体化患者的年度额外医疗保健费用为 432 至 5353 美元。仅有一项 EE 估算了间接成本，每年约为 18000 美元。在 EE 中，评估了针对医生的教育干预和针对患者的认知行为疗法方法。对于这两种干预措施，其有效性在 EE 中或通过先前的研究得到了证实。大多数 EE 发现（通常不显著）干预措施带来了成本降低，但只有两项研究明确将成本变化与有效性数据结合起来计算成本效益比（附加成本与附加效果的比值）。
无法用医学解释的症状导致了相当可观的年度医疗保健额外成本，这些成本与抑郁症或焦虑症等心理健康问题相当，且针对医生和患者的干预措施可能会降低这些成本。需要对间接成本和成本效益进行更广泛的研究。
