Meuldijk Denise, Carlier Ingrid V E, van Vliet Irene M, van Hemert Albert M, Zitman Frans G, van den Akker-van Marle M Elske
Leiden University Medical Centre, Department of Psychiatry, P.O. Box 9600, 2300 RC, Leiden, the Netherlands,
J Ment Health Policy Econ. 2015 Dec;18(4):175-83.
Depressive and anxiety disorders cause great suffering and disability and are associated with high health care costs. In a previous conducted pragmatic randomised controlled trial, we have shown that a concise format of cognitive behavioural- and/or pharmacotherapy is as effective as standard care in reducing depressive and anxiety symptoms and in improving subdomains of general health and quality of life in secondary care psychiatric outpatients.
In this economic evaluation, we examined whether a favourable cost-utility of concise care compared to standard care was attained.
The economic evaluation was performed alongside a pragmatic randomised controlled trial. Health-related quality of life was measured using the Short-Form (SF-36) questionnaire. Cost of healthcare utilization and productivity loss (absenteeism and presenteeism) were assessed using the Trimbos/iMTA questionnaire for Costs associated with Psychiatric Illness (TiC-P). A cost-utility analysis, using cost-effectiveness acceptability curves, comparing differences in societal costs and Quality-Adjusted Life Years (QALYs) at 1 year was performed.
One year after study entry, the difference in mean cost per patient of the two primary treatments was not significant between both groups. No significant differences in other healthcare and non- healthcare costs could be detected between patients receiving concise care and standard care. Also, QALYs were not statistically different between the groups during the study period. From both the societal and healthcare perspective, the probability that concise care is more cost-effective compared to standard care remains below the turning point of 0.5 for all acceptable values of the willingness to pay for a QALY. The economic evaluation suggests that concise care is unlikely to be cost-effective compared to standard care in the treatment for depressive- and anxiety disorders in secondary mental health care during a one year follow up period.
Total costs and QALYs were not significantly different between standard and concise care, with no evidence for cost-effectiveness of concise care in the first year. The longer impact of concise care for patients with mild to moderate symptoms of depressive and/or anxiety disorders compared to standard care in secondary care needs to be further studied.
This economic evaluation failed to find significant differences in cost between concise and standard care over the study period of one year. Replication of our economic evaluation might benefit from an extended follow-up period and strict adherence to the study protocol. If concise care will be found to be cost-effective in the long term, this would have major implications for recommendations how to optimize secondary mental health care in the treatment of depressive -- and anxiety disorders.
抑郁和焦虑症会带来巨大痛苦和残疾，且与高昂的医疗费用相关。在之前进行的一项实用随机对照试验中，我们已表明，简洁形式的认知行为疗法和/或药物疗法在减轻抑郁和焦虑症状以及改善二级护理精神科门诊患者的总体健康和生活质量子领域方面，与标准护理同样有效。
在这项经济评估中，我们考察了与标准护理相比，简洁护理是否实现了有利的成本效益。
经济评估与一项实用随机对照试验同时进行。使用简短健康调查问卷（SF - 36）来测量与健康相关的生活质量。使用Trimbos/iMTA精神疾病相关成本问卷（TiC - P）评估医疗保健利用成本和生产力损失（旷工和出勤主义）。进行了一项成本效益分析，使用成本效益可接受性曲线，比较一年时社会成本和质量调整生命年（QALYs）的差异。
在研究入组一年后，两组主要治疗方法的每位患者平均成本差异不显著。在接受简洁护理和标准护理的患者之间，未发现其他医疗保健和非医疗保健成本存在显著差异。此外，在研究期间两组的质量调整生命年在统计学上也无差异。从社会和医疗保健角度来看，对于所有可接受的每质量调整生命年支付意愿值，简洁护理比标准护理更具成本效益的概率仍低于转折点0.5。经济评估表明，在一年的随访期内，与标准护理相比，简洁护理在二级心理健康护理中治疗抑郁和焦虑症不太可能具有成本效益。
标准护理和简洁护理之间的总成本和质量调整生命年无显著差异，且没有证据表明简洁护理在第一年具有成本效益。与标准护理相比，简洁护理对二级护理中轻度至中度抑郁和/或焦虑症患者的长期影响需要进一步研究。
这项经济评估未能发现在一年的研究期间简洁护理和标准护理在成本上有显著差异。重复我们的经济评估可能受益于延长随访期并严格遵守研究方案。如果从长期来看简洁护理被发现具有成本效益，这将对如何优化二级心理健康护理中抑郁和焦虑症的治疗建议产生重大影响。
