社区药剂师干预抑郁症患者的成本效益：一项随机对照试验（PRODEFAR 研究）。
Cost-effectiveness of a community pharmacist intervention in patients with depression: a randomized controlled trial (PRODEFAR Study).
机构信息
Research and Development Unit, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.
出版信息
PLoS One. 2013 Aug 12;8(8):e70588. doi: 10.1371/journal.pone.0070588. eCollection 2013.
BACKGROUND
Non-adherence to antidepressants generates higher costs for the treatment of depression. Little is known about the cost-effectiveness of pharmacist's interventions aimed at improving adherence to antidepressants. The study aimed to evaluate the cost-effectiveness of a community pharmacist intervention in comparison with usual care in depressed patients initiating treatment with antidepressants in primary care.
METHODS
Patients were recruited by general practitioners and randomized to community pharmacist intervention (87) that received an educational intervention and usual care (92). Adherence to antidepressants, clinical symptoms, Quality-Adjusted Life-Years (QALYs), use of healthcare services and productivity losses were measured at baseline, 3 and 6 months.
RESULTS
There were no significant differences between groups in costs or effects. From a societal perspective, the incremental cost-effectiveness ratio (ICER) for the community pharmacist intervention compared with usual care was €1,866 for extra adherent patient and €9,872 per extra QALY. In terms of remission of depressive symptoms, the usual care dominated the community pharmacist intervention. If willingness to pay (WTP) is €30,000 per extra adherent patient, remission of symptoms or QALYs, the probability of the community pharmacist intervention being cost-effective was 0.71, 0.46 and 0.75, respectively (societal perspective). From a healthcare perspective, the probability of the community pharmacist intervention being cost-effective in terms of adherence, QALYs and remission was of 0.71, 0.76 and 0.46, respectively, if WTP is €30,000.
CONCLUSION
A brief community pharmacist intervention addressed to depressed patients initiating antidepressant treatment showed a probability of being cost-effective of 0.71 and 0.75 in terms of improvement of adherence and QALYs, respectively, when compared to usual care. Regular implementation of the community pharmacist intervention is not recommended.
TRIAL REGISTRATION
ClinicalTrials.gov NCT00794196.
背景
抗抑郁药治疗依从性差会增加抑郁症的治疗成本。对于旨在提高抗抑郁药治疗依从性的药剂师干预措施的成本效益知之甚少。本研究旨在评估与常规护理相比，社区药剂师干预对在初级保健中开始使用抗抑郁药治疗的抑郁患者的成本效益。
方法
通过全科医生招募患者，并将其随机分配至社区药剂师干预组（87 人），该组接受了教育干预和常规护理（92 人）。在基线、3 个月和 6 个月时测量抗抑郁药的依从性、临床症状、健康调整生命年（QALYs）、医疗保健服务的使用和生产力损失。
结果
组间在成本或效果方面没有显著差异。从社会角度来看，与常规护理相比，社区药剂师干预的增量成本效益比（ICER）为每增加一名依从性患者 1866 欧元，每增加一个 QALY 为 9872 欧元。就抑郁症状的缓解而言，常规护理优于社区药剂师干预。如果每增加一名依从性患者的意愿支付（WTP）为 30000 欧元，那么社区药剂师干预在症状缓解或 QALYs 方面的成本效益的概率分别为 0.71、0.46 和 0.75（社会角度）。从医疗保健的角度来看，如果每增加一个 QALY 或症状缓解的意愿支付为 30000 欧元，那么社区药剂师干预在依从性、QALYs 和症状缓解方面具有成本效益的概率分别为 0.71、0.76 和 0.46。
结论
一项针对开始抗抑郁药治疗的抑郁患者的简短社区药剂师干预措施显示，与常规护理相比，在提高依从性和 QALYs 方面具有 0.71 和 0.75 的成本效益的可能性。不建议常规实施社区药剂师干预。
试验注册
ClinicalTrials.gov NCT00794196。
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