Egger Nina, Konnopka Alexander, Beutel Manfred E, Herpertz Stephan, Hiller Wolfgang, Hoyer Juergen, Salzer Simone, Stangier Ulrich, Strauss Bernhard, Willutzki Ulrike, Wiltink Joerg, Leibing Eric, Leichsenring Falk, König Hans-Helmut
Department of Health Economics and Health Services Research, Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
Depress Anxiety. 2016 Dec;33(12):1114-1122. doi: 10.1002/da.22540. Epub 2016 Jul 18.
To determine the cost-effectiveness of cognitive behavioral therapy (CBT) versus psychodynamic therapy (PDT) in the treatment of social anxiety disorder after a follow-up of 30 months from a societal perspective.
This analysis was conducted alongside the multicenter SOPHO-NET trial; adults with a primary diagnosis of social anxiety disorder received CBT (n = 209) or PDT (n = 207). Data on health care utilization and productivity loss were collected at baseline, after 6 months (posttreatment), and three further follow-ups to calculate direct and indirect costs. Anxiety-free days (AFDs) calculated based on remission and response were used as measure of effect. The incremental cost-effectiveness ratio (ICER) was determined. Net benefit regressions, adjusted for comorbidities and baseline differences, were applied to derive cost-effectiveness acceptability curves.
In the descriptive analysis, the unadjusted ICER favored CBT over PDT and the adjusted analysis showed that CBT's cost-effectiveness relative to PDT depends on the willingness to pay (WTP) per AFD. As baseline costs differed substantially the unadjusted estimates might be deceptive. If additional WTPs for CBT of €0, €10, and €30 were assumed, the probability of CBT being cost-effective relative to PDT was 65, 83, and 96%. Direct costs increased compared to baseline across groups, whereas indirect costs did not change significantly. Results were sensitive to considered costs.
If the society is willing to pay ≥€30 per additional AFD, CBT can be considered cost-effective, relative to PDT, with certainty. To further increase the cost-effectiveness more knowledge regarding predictors of treatment outcome seems essential.
从社会角度出发，确定在30个月的随访期后，认知行为疗法（CBT）与心理动力疗法（PDT）治疗社交焦虑症的成本效益。
该分析与多中心SOPHO-NET试验同时进行；原发性诊断为社交焦虑症的成年人接受CBT（n = 209）或PDT（n = 207）。在基线、6个月（治疗后）以及另外三次随访时收集医疗保健利用和生产力损失的数据，以计算直接和间接成本。基于缓解和反应计算的无焦虑天数（AFD）用作疗效指标。确定增量成本效益比（ICER）。应用针对合并症和基线差异进行调整的净效益回归来得出成本效益可接受性曲线。
在描述性分析中，未经调整的ICER显示CBT优于PDT，调整后的分析表明CBT相对于PDT的成本效益取决于每AFD的支付意愿（WTP）。由于基线成本差异很大，未经调整的估计可能具有误导性。如果假设CBT的额外WTP分别为0欧元、10欧元和30欧元，那么CBT相对于PDT具有成本效益的概率分别为65%、83%和96%。与基线相比，各组的直接成本均有所增加，而间接成本没有显著变化。结果对所考虑的成本敏感。
如果社会愿意为每增加一个AFD支付≥30欧元，那么相对于PDT，CBT可以被确定为具有成本效益。为了进一步提高成本效益，似乎有必要更多地了解治疗结果的预测因素。
