Goorden Maartje, Muntingh Anna, van Marwijk Harm, Spinhoven Philip, Adèr Herman, van Balkom Anton, van der Feltz-Cornelis Christina, Hakkaart-van Roijen Leona
Institute for Medical Technology Assessment, Institute of Health Policy & Management, PO Box 1783, Rotterdam, The Netherlands.
Netherlands Institute of Mental Health and Addiction (Trimbos Institute), PO Box 725, Utrecht, The Netherlands; Faculty of Social Sciences, Tranzo Department, Tilburg University, PO Box 90153, Tilburg, The Netherlands; Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands.
J Psychosom Res. 2014 Jul;77(1):57-63. doi: 10.1016/j.jpsychores.2014.04.005. Epub 2014 Apr 26.
Generalized anxiety and panic disorders are a burden on the society because they are costly and have a significant adverse effect on quality of life. The aim of this study was to evaluate the cost-utility of a collaborative stepped care intervention for panic disorder and generalized anxiety disorder in primary care compared to care as usual from a societal perspective.
The design of the study was a two armed cluster randomized controlled trial. In total 43 primary care practices in the Netherlands participated in the study. Eventually, 180 patients were included (114 collaborative stepped care, 66 care as usual). Baseline measures and follow-up measures (3, 6, 9 and 12 months) were assessed using questionnaires. We applied the TiC-P, the SF-HQL and the EQ-5D respectively measuring health care utilization, production losses and health related quality of life.
The average annual direct medical costs in the collaborative stepped care group were 1854 Euro (95% C.I., 1726 to 1986) compared to €1503 (95% C.I., 1374 to 1664) in the care as usual group. The average quality of life years (QALYs) gained was 0.05 higher in the collaborative stepped care group, leading to an incremental cost effectiveness ratio (ICER) of 6965 Euro per QALY. Inclusion of the productivity costs, consequently reflecting the full societal costs, decreased the ratio even more.
The study showed that collaborative stepped care was a cost effective intervention for panic disorder and generalized anxiety disorder and was even dominant when a societal perspective was taken.
trialregister.nl, Netherlands Trial Register NTR107.
广泛性焦虑症和惊恐障碍给社会带来了负担，因为它们成本高昂且对生活质量有重大负面影响。本研究的目的是从社会角度评估在初级保健中针对惊恐障碍和广泛性焦虑症的协作式阶梯护理干预措施与常规护理相比的成本效益。
该研究设计为双臂整群随机对照试验。荷兰共有43家初级保健机构参与了该研究。最终，纳入了180名患者（114名接受协作式阶梯护理，66名接受常规护理）。使用问卷评估基线测量和随访测量（3、6、9和12个月）。我们分别应用TiC-P、SF-HQL和EQ-5D来测量医疗保健利用率、生产损失和与健康相关的生活质量。
协作式阶梯护理组的平均年度直接医疗成本为1854欧元（95%置信区间，1726至1986），而常规护理组为1503欧元（95%置信区间，1374至1664）。协作式阶梯护理组获得的平均生活质量年（QALY）高出0.05，导致每QALY的增量成本效益比（ICER）为6965欧元。纳入生产力成本，从而反映全部社会成本，使该比率进一步降低。
该研究表明，协作式阶梯护理是针对惊恐障碍和广泛性焦虑症的一种具有成本效益的干预措施，从社会角度来看甚至具有优势。
trialregister.nl，荷兰试验注册NTR107 。
