NIHR CLAHRC for Cambridgeshire and Peterborough, Cambridge Institute of Public Health, University of Cambridge Forvie Site, Robinson Way, Cambridge CB2 0SR, UK.
Behav Res Ther. 2013 Jan;51(1):37-45. doi: 10.1016/j.brat.2012.10.001. Epub 2012 Oct 16.
Recent literature on Improving Access to Psychological Therapies (IAPT) has reported on improvements in clinical outcomes, changes in employment status and the concept of recovery attributable to IAPT treatment, but not on the costs of the programme. This article reports the costs associated with a single session, completed course of treatment and recovery for four treatment courses (i.e., remaining in low or high intensity treatment, stepping up or down) in IAPT services in 5 East of England region Primary Care Trusts. Costs were estimated using treatment activity data and gross financial information, along with assumptions about how these financial data could be broken down. The estimated average cost of a high intensity session was £177 and the average cost for a low intensity session was £99. The average cost of treatment was £493 (low intensity), £1416 (high intensity), £699 (stepped down), £1514 (stepped up) and £877 (All). The cost per recovered patient was £1043 (low intensity), £2895 (high intensity), £1653 (stepped down), £2914 (stepped up) and £1766 (All). Sensitivity analysis revealed that the costs are sensitive to cost ratio assumptions, indicating that inaccurate ratios are likely to influence overall estimates. Results indicate the cost per session exceeds previously reported estimates, but cost of treatment is only marginally higher. The current cost estimates are supportive of the originally proposed IAPT model on cost-benefit grounds. The study also provides a framework to estimate costs using financial data, especially when programmes have block contract arrangements. Replication and additional analyses along with evidence-based discussion regarding alternative, cost-effective methods of intervention is recommended.
近期关于改善心理治疗机会（IAPT）的文献报告了临床结果的改善、就业状况的变化以及归因于 IAPT 治疗的康复概念，但没有报告该计划的成本。本文报告了在英格兰东部 5 个初级保健信托机构的 IAPT 服务中，单次治疗、完成疗程和康复的成本，共涉及四个疗程（即留在低或高强度治疗、升级或降级）。成本是根据治疗活动数据和财务总信息，以及对如何细分这些财务数据的假设进行估算的。高强度治疗单次的平均费用估计为 177 英镑，低强度治疗单次的平均费用为 99 英镑。治疗的平均费用为 493 英镑（低强度）、1416 英镑（高强度）、699 英镑（降级）、1514 英镑（升级）和 877 英镑（全部）。每位康复患者的费用为 1043 英镑（低强度）、2895 英镑（高强度）、1653 英镑（降级）、2914 英镑（升级）和 1766 英镑（全部）。敏感性分析表明，成本对成本比率假设很敏感，这表明不准确的比率可能会影响总体估计。结果表明，每个疗程的成本高于之前报告的估计，但治疗成本仅略高。从成本效益的角度来看，当前的成本估算支持最初提出的 IAPT 模型。该研究还提供了一个使用财务数据估算成本的框架，特别是当项目有固定合同安排时。建议进行复制和额外分析，并就干预的替代、具有成本效益的方法进行循证讨论。
