Shawyer Frances, Enticott Joanne C, Özmen Mehmet, Inder Brett, Meadows Graham N
Southern Synergy, Department of Psychiatry, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
Southern Synergy, Department of Psychiatry, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia Department of Econometrics and Business Statistics, Faculty of Business and Economics, Monash University, Melbourne, VIC, Australia.
Aust N Z J Psychiatry. 2016 Oct;50(10):1001-13. doi: 10.1177/0004867416642847. Epub 2016 Apr 19.
While mindfulness-based cognitive therapy is effective in reducing depressive relapse/recurrence, relatively little is known about its health economic properties. We describe the health economic properties of mindfulness-based cognitive therapy in relation to its impact on depressive relapse/recurrence over 2 years of follow-up.
Non-depressed adults with a history of three or more major depressive episodes were randomised to mindfulness-based cognitive therapy + depressive relapse active monitoring (n = 101) or control (depressive relapse active monitoring alone) (n = 102) and followed up for 2 years. Structured self-report instruments for service use and absenteeism provided cost data items for health economic analyses. Treatment utility, expressed as disability-adjusted life years, was calculated by adjusting the number of days an individual was depressed by the relevant International Classification of Diseases 12-month severity of depression disability weight from the Global Burden of Disease 2010. Intention-to-treat analysis assessed the incremental cost-utility ratios of the interventions across mental health care, all of health-care and whole-of-society perspectives. Per protocol and site of usual care subgroup analyses were also conducted. Probabilistic uncertainty analysis was completed using cost-utility acceptability curves.
Mindfulness-based cognitive therapy participants had significantly less major depressive episode days compared to controls, as supported by the differential distributions of major depressive episode days (modelled as Poisson, p < 0.001). Average major depressive episode days were consistently less in the mindfulness-based cognitive therapy group compared to controls, e.g., 31 and 55 days, respectively. From a whole-of-society perspective, analyses of patients receiving usual care from all sectors of the health-care system demonstrated dominance (reduced costs, demonstrable health gains). From a mental health-care perspective, the incremental gain per disability-adjusted life year for mindfulness-based cognitive therapy was AUD83,744 net benefit, with an overall annual cost saving of AUD143,511 for people in specialist care.
Mindfulness-based cognitive therapy demonstrated very good health economic properties lending weight to the consideration of mindfulness-based cognitive therapy provision as a good buy within health-care delivery.
虽然基于正念的认知疗法在减少抑郁复发方面有效，但对其健康经济学特性了解相对较少。我们描述了基于正念的认知疗法在2年随访期间对抑郁复发的影响方面的健康经济学特性。
有三次或更多次重度抑郁发作史的非抑郁成年人被随机分为基于正念的认知疗法+抑郁复发主动监测组（n = 101）或对照组（仅抑郁复发主动监测）（n = 102），并随访2年。用于服务使用和缺勤的结构化自我报告工具提供了健康经济分析的成本数据项。治疗效用以伤残调整生命年表示，通过将个体抑郁天数乘以2010年全球疾病负担中相关国际疾病分类12个月抑郁严重程度伤残权重来计算。意向性分析评估了跨精神卫生保健、所有卫生保健和全社会视角的干预措施的增量成本效用比。还进行了符合方案分析和常规护理地点亚组分析。使用成本效用可接受性曲线完成概率不确定性分析。
与对照组相比，基于正念的认知疗法参与者的重度抑郁发作天数显著减少，重度抑郁发作天数的差异分布（建模为泊松分布，p < 0.001）支持了这一点。与对照组相比，基于正念的认知疗法组的平均重度抑郁发作天数一直较少，例如分别为31天和55天。从全社会角度来看，对接受卫生保健系统所有部门常规护理的患者的分析显示出优势（成本降低，健康效益明显）。从精神卫生保健角度来看，基于正念的认知疗法每伤残调整生命年的增量收益为净效益83,744澳元，专科护理人群每年总体节省成本143,511澳元。
基于正念的认知疗法显示出非常好的健康经济学特性，这使得在卫生保健服务中考虑提供基于正念的认知疗法是一项划算的选择。
