Goorden Maartje, Vlasveld Moniek C, Anema Johannes R, van Mechelen Willem, Beekman Aartjan T F, Hoedeman Rob, van der Feltz-Cornelis Christina M, Hakkaart-van Roijen Leona
Institute for Medical Technology Assessment, Institute of Health Policy and Management, Burgermeester Oudlaan 50, PO Box 1738, 3000 DR, Rotterdam, The Netherlands,
J Occup Rehabil. 2014 Sep;24(3):555-62. doi: 10.1007/s10926-013-9483-4.
Major depression is associated with high levels of absence and reduced productivity. Therefore the costs to society are high. The aim of this study was to evaluate the cost-utility of collaborative care for major depressive disorder (MDD) compared to care as usual in an occupational healthcare setting. A societal perspective was taken.
In this randomised controlled trial, 126 sick-listed workers with MDD were included (65 collaborative care, 61 care as usual). Baseline measurements and follow up measures (3, 6, 9 and 12 months) were assessed by questionnaire. We applied the Trimbos/iMTA questionnaire for costs associated with psychiatric illness, the SF-HQL and the EQ-5D respectively measuring the health care utilization, production losses and general health related quality of life.
The average annual healthcare costs in the collaborative care group were €3,874 (95 % CI €2,778-€ 5,718) compared to €4,583 (95 % CI €3,108-€6,794) in the care as usual group. The average quality of life years (QALY's) gained were lower in the collaborative care group, 0.05 QALY. The majority of the ICERS (69 %) indicate that collaborative care is less costly but also less effective than care as usual. Including the productivity costs did not change this result.
The cost-utility analysis showed that collaborative care generated reduced costs and a reduction in effects compared to care as usual and was therefore not a cost-effective intervention.
重度抑郁症与高缺勤率和生产力下降相关。因此，社会成本很高。本研究的目的是评估在职业医疗环境中，与常规护理相比，协作式护理对重度抑郁症（MDD）的成本效益。本研究采用社会视角。
在这项随机对照试验中，纳入了126名患有MDD的病假员工（65名接受协作式护理，61名接受常规护理）。通过问卷调查评估基线测量和随访测量（3、6、9和12个月）。我们分别应用Trimbos/iMTA问卷来评估与精神疾病相关的成本、SF-HQL和EQ-5D来测量医疗保健利用率、生产损失和与一般健康相关的生活质量。
协作式护理组的平均年度医疗保健成本为3874欧元（95%可信区间2778欧元-5718欧元），而常规护理组为4583欧元（95%可信区间3108欧元-6794欧元）。协作式护理组获得的平均生活质量年数（QALY's）较低，为0.05 QALY。大多数增量成本效果比（ICERS，69%）表明，协作式护理成本更低，但效果也比常规护理差。纳入生产力成本并没有改变这一结果。
成本效益分析表明，与常规护理相比，协作式护理成本降低但效果也降低因此不是一种具有成本效益的干预措施。
