Le Long Khanh-Dao, Barendregt Jan J, Hay Phillipa, Sawyer Susan M, Paxton Susan J, Mihalopoulos Cathrine
Deakin Health Economics, School of Health and Social Development, Deakin University, Melbourne, Victoria, Australia.
Epigear International Pty Ltd, Queensland, Australia.
Int J Eat Disord. 2017 Jul;50(7):834-841. doi: 10.1002/eat.22703. Epub 2017 Mar 21.
Eating disorders (EDs), including anorexia nervosa (AN) and bulimia nervosa (BN), are prevalent disorders that carry substantial economic and social burden. The aim of the current study was to evaluate the modelled population cost-effectiveness of cognitive dissonance (CD), a school-based preventive intervention for EDs, in the Australian health care context.
A population-based Markov model was developed to estimate the cost per disability adjusted life-year (DALY) averted by CD relative to no intervention. We modelled the cases of AN and BN that could be prevented over a 10-year time horizon in each study arm and the subsequent reduction in DALYs associated with this. The target population was 15-18 year old secondary school girls with high body-image concerns. This study only considered costs of the health sector providing services and not costs to individuals. Multivariate probabilistic and one-way sensitivity analyses were conducted to test model assumptions.
Findings showed that the mean incremental cost-effectiveness ratio at base-case for the intervention was $103,980 per DALY averted with none of the uncertainty iterations falling below the threshold of AUD$50,000 per DALY averted. The evaluation was most sensitive to estimates of participant rates with higher rates associated with more favourable results. The intervention would become cost-effective (84% chance) if the effect of the intervention lasted up to 5 years.
As modelled, school-based CD intervention is not a cost-effective preventive intervention for AN and BN. Given the burden of EDs, understanding how to improve participation rates is an important opportunity for future research.
饮食失调症，包括神经性厌食症（AN）和神经性贪食症（BN），是普遍存在的疾病，带来了巨大的经济和社会负担。本研究的目的是在澳大利亚医疗保健背景下，评估认知失调（CD）这一针对饮食失调症的学校预防性干预措施的模拟人群成本效益。
开发了一个基于人群的马尔可夫模型，以估计相对于不进行干预，CD避免的每残疾调整生命年（DALY）成本。我们对每个研究组在10年时间范围内可预防的AN和BN病例以及与之相关的DALY后续减少情况进行了建模。目标人群是15 - 18岁对身体形象高度关注的中学女生。本研究仅考虑提供服务的卫生部门的成本，而非个人成本。进行了多变量概率分析和单因素敏感性分析以检验模型假设。
研究结果表明，干预措施在基础病例下的平均增量成本效益比为每避免一个DALY 103,980美元，所有不确定性迭代均未低于每避免一个DALY 50,000澳元的阈值。评估对参与者率的估计最为敏感，较高的率与更有利的结果相关。如果干预效果持续长达5年，该干预措施将具有成本效益（84%的可能性）。
如模型所示，基于学校的CD干预措施对于AN和BN并非具有成本效益的预防性干预措施。鉴于饮食失调症的负担，了解如何提高参与率是未来研究的一个重要机会。
