Mavranezouli Ifigeneia, Mayo-Wilson Evan, Dias Sofia, Kew Kayleigh, Clark David M, Ades A E, Pilling Stephen
National Collaborating Centre for Mental Health, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational & Health Psychology, University College London, London, United Kingdom.
School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
PLoS One. 2015 Oct 27;10(10):e0140704. doi: 10.1371/journal.pone.0140704. eCollection 2015.
Social anxiety disorder is one of the most persistent and common anxiety disorders. Individually delivered psychological therapies are the most effective treatment options for adults with social anxiety disorder, but they are associated with high intervention costs. Therefore, the objective of this study was to assess the relative cost effectiveness of a variety of psychological and pharmacological interventions for adults with social anxiety disorder.
A decision-analytic model was constructed to compare costs and quality adjusted life years (QALYs) of 28 interventions for social anxiety disorder from the perspective of the British National Health Service and personal social services. Efficacy data were derived from a systematic review and network meta-analysis. Other model input parameters were based on published literature and national sources, supplemented by expert opinion.
Individual cognitive therapy was the most cost-effective intervention for adults with social anxiety disorder, followed by generic individual cognitive behavioural therapy (CBT), phenelzine and book-based self-help without support. Other drugs, group-based psychological interventions and other individually delivered psychological interventions were less cost-effective. Results were influenced by limited evidence suggesting superiority of psychological interventions over drugs in retaining long-term effects. The analysis did not take into account side effects of drugs.
Various forms of individually delivered CBT appear to be the most cost-effective options for the treatment of adults with social anxiety disorder. Consideration of side effects of drugs would only strengthen this conclusion, as it would improve even further the cost effectiveness of individually delivered CBT relative to phenelzine, which was the next most cost-effective option, due to the serious side effects associated with phenelzine. Further research needs to determine more accurately the long-term comparative benefits and harms of psychological and pharmacological interventions for social anxiety disorder and establish their relative cost effectiveness with greater certainty.
社交焦虑障碍是最持久且常见的焦虑症之一。针对患有社交焦虑障碍的成年人，个体化心理治疗是最有效的治疗选择，但这些治疗伴随着高昂的干预成本。因此，本研究的目的是评估针对患有社交焦虑障碍的成年人的各种心理和药物干预措施的相对成本效益。
构建了一个决策分析模型，从英国国家医疗服务体系和个人社会服务的角度比较28种社交焦虑障碍干预措施的成本和质量调整生命年（QALY）。疗效数据来自系统评价和网状荟萃分析。其他模型输入参数基于已发表的文献和国家来源，并辅以专家意见。
个体认知疗法是治疗患有社交焦虑障碍成年人最具成本效益的干预措施，其次是一般个体认知行为疗法（CBT）、苯乙肼和无支持的基于书籍的自助疗法。其他药物、基于团体的心理干预措施和其他个体化心理干预措施的成本效益较低。结果受到有限证据的影响，这些证据表明心理干预措施在保持长期效果方面优于药物。该分析未考虑药物的副作用。
各种形式的个体化CBT似乎是治疗患有社交焦虑障碍成年人的最具成本效益的选择。考虑药物副作用只会强化这一结论，因为由于苯乙肼存在严重副作用，这将进一步提高个体化CBT相对于苯乙肼（下一个最具成本效益的选择）的成本效益。需要进一步研究以更准确地确定社交焦虑障碍心理和药物干预措施的长期比较益处和危害，并更确定地确定它们的相对成本效益。
