Centre for the Economics of Mental and Physical Health, King's College London, UK.
J Affect Disord. 2013 Jul;149(1-3):307-12. doi: 10.1016/j.jad.2013.01.044. Epub 2013 Mar 13.
Although there is some evidence on the effectiveness and cost-effectiveness of computerised cognitive behavioural therapy (CCBT) for treating anxiety and depression in primary care, alternative low-cost psychosocial interventions have not been investigated.
The cost-effectiveness of an audio based resilience training (Positive Mental Training, PosMT) was examined using a decision model. Patient level cost and effectiveness data from a trial comparing a CCBT treatment and usual care and effectiveness data from a study on PosMT were used to inform this.
Net benefits of CCBT and PosMT were approximately equal in individuals with 'moderate' depression at baseline and markedly in favour of PosMT for the 'severe' depression subgroup. With only four observations in the 'mild' depression category for PosMT, the existing evidence base remains unaltered.
Efficacy data for the PosMT arm was derived from a study using a partially randomised preference design and the model structure contains simplifications due to lack of data availability.
PosMT may represent good value for money in treatment of depression for certain groups of patients. More research in this area may be warranted.
虽然有一些证据表明计算机化认知行为疗法(CCBT)在初级保健中治疗焦虑和抑郁的有效性和成本效益,但尚未研究替代的低成本心理社会干预措施。
使用决策模型研究了基于音频的韧性训练(积极心理训练,PosMT)的成本效益。该模型使用了一项比较 CCBT 治疗和常规护理的试验中的患者水平成本和效果数据,以及一项关于 PosMT 的效果数据,以提供信息。
在基线时患有“中度”抑郁症的个体中,CCBT 和 PosMT 的净效益大致相等,而对于“重度”抑郁症亚组,PosMT 的效益明显更高。对于 PosMT 的“轻度”抑郁症类别,仅有四个观察结果,因此现有的证据基础没有改变。
PosMT 臂的疗效数据来自一项使用部分随机偏好设计的研究,并且由于数据可用性有限,模型结构包含简化。
对于某些患者群体,PosMT 可能具有良好的成本效益。在该领域可能需要进一步研究。