Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
Bull World Health Organ. 2012 Nov 1;90(11):813-21. doi: 10.2471/BLT.12.104133. Epub 2012 Sep 14.
To carry out an economic evaluation of a task-shifting intervention for the treatment of depressive and anxiety disorders in primary-care settings in Goa, India.
Cost-utility and cost-effectiveness analyses based on generalized linear models were performed within a trial set in 24 public and private primary-care facilities. Subjects were randomly assigned to an intervention or a control arm. Eligible subjects in the intervention arm were given psycho-education, case management, interpersonal psychotherapy and/or antidepressants by lay health workers. Subjects in the control arm were treated by physicians. The use of health-care resources, the disability of each subject and degree of psychiatric morbidity, as measured by the Revised Clinical Interview Schedule, were determined at 2, 6 and 12 months.
Complete data, from all three follow-ups, were collected from 1243 (75.4%) and 938 (81.7%) of the subjects enrolled in the study facilities from the public and private sectors, respectively. Within the public facilities, subjects in the intervention arm showed greater improvement in all the health outcomes investigated than those in the control arm. Time costs were also significantly lower in the intervention arm than in the control arm, whereas health system costs in the two arms were similar. Within the private facilities, however, the effectiveness and costs recorded in the two arms were similar.
Within public primary-care facilities in Goa, the use of lay health workers in the care of subjects with common mental disorders was not only cost-effective but also cost-saving.
在印度果阿邦的基层医疗保健环境中，对治疗抑郁和焦虑障碍的任务转移干预进行经济评估。
在一项试验中进行了基于广义线性模型的成本-效用和成本-效果分析，该试验在 24 家公立和私立基层医疗保健机构中进行。受试者被随机分配到干预组或对照组。干预组的合格受试者接受了由非专业卫生工作者提供的心理教育、病例管理、人际心理治疗和/或抗抑郁药。对照组的受试者由医生治疗。在 2、6 和 12 个月时，确定了卫生保健资源的使用、每个受试者的残疾程度以及修订后的临床访谈时间表测量的精神疾病发病率。
在公共和私人部门的研究机构中，分别从 1243 名（75.4%）和 938 名（81.7%）登记入组的受试者中收集了所有三个随访的完整数据。在公共设施中，干预组的受试者在所有调查的健康结果方面都比对照组有更大的改善。干预组的时间成本也明显低于对照组，而两组的卫生系统成本相似。然而，在私人设施中，两组的效果和成本记录相似。
在果阿邦的公共基层医疗保健机构中，在照顾常见精神障碍患者时使用非专业卫生工作者不仅具有成本效益，而且还具有成本节约效果。
