Department of Health Sciences and EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands.
Int J Geriatr Psychiatry. 2014 Feb;29(2):182-90. doi: 10.1002/gps.3987. Epub 2013 Jun 13.
Depression and anxiety are common in residents of elderly homes. Both disorders have negative effects on functioning, well-being and health-care utilisation. Besides treatment, prevention can be an option to reduce the burden of mental disorders. The objective of this study was to evaluate the cost-effectiveness of a stepped care programme to prevent the onset of depression and anxiety disorders in residents of elderly homes compared with usual care from a societal perspective.
Outcomes were incidence of depression and/or anxiety, severity of depressive and anxiety symptoms and quality-adjusted life years. Health-care utilisation was measured during interviews. Multiple imputation was used to impute missing cost and effect data. Uncertainty around cost differences and incremental cost-effectiveness ratios was estimated using bootstrapping. Cost-effectiveness planes and acceptability curves were created.
The incidence of depression and anxiety combined in the intervention group was not reduced in comparison with the usual care group. There was also no effect on the other outcomes. Mean total costs in the intervention group were €838 higher than in the usual care group, but this difference was not statistically significant (95% confidence interval, -593 to 2420). Cost-effectiveness planes showed that there was considerable uncertainty. Cost-effectiveness acceptability curves showed that the maximum probability of the intervention being cost-effective in comparison with usual care was 0.46 for reducing the incidence of depression and anxiety combined.
A stepped care programme to prevent depression and anxiety in older people living in elderly homes was not considered cost-effective in comparison with usual care.
养老院居民中常见抑郁和焦虑。这两种疾病都会对功能、幸福感和医疗保健的利用产生负面影响。除了治疗，预防也可以作为减少精神疾病负担的一种选择。本研究旨在从社会角度评估预防养老院居民抑郁和焦虑障碍发生的阶梯式护理方案与常规护理相比的成本效益。
结果是抑郁和/或焦虑的发生率、抑郁和焦虑症状的严重程度以及质量调整生命年。在访谈期间测量了医疗保健的利用情况。采用多重插补法对缺失的成本和效果数据进行了插补。采用自举法估计成本差异和增量成本效益比的不确定性。绘制成本效益平面和可接受性曲线。
与常规护理组相比，干预组的抑郁和焦虑综合发生率没有降低。其他结果也没有影响。干预组的总费用平均比常规护理组高 838 欧元，但这一差异没有统计学意义（95%置信区间，-593 至 2420）。成本效益平面显示存在较大的不确定性。成本效益接受性曲线表明，与常规护理相比，干预措施在降低抑郁和焦虑综合发生率方面具有成本效益的最大概率为 0.46。
与常规护理相比，预防养老院老年人抑郁和焦虑的阶梯式护理方案被认为不具有成本效益。
