Goorden Maartje, van der Feltz-Cornelis Christina M, van Steenbergen-Weijenburg Kirsten M, Horn Eva K, Beekman Aartjan Tf, Hakkaart-van Roijen Leona
Institute of Health Policy and Management (iBMG)/Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam.
Tranzo Department, Tilburg University.
Neuropsychiatr Dis Treat. 2017 Jul 18;13:1881-1893. doi: 10.2147/NDT.S134008. eCollection 2017.
Major depressive disorder (MDD) is highly prevalent in patients with a chronic physical condition, and this comorbidity has a negative influence on quality of life, health care costs, self-care, morbidity, and mortality. Research has shown that collaborative care (CC) may be a cost-effective treatment. However, its cost-effectiveness in this patient group has not yet been established. Therefore, the aim of this study was to evaluate the cost-utility of CC for the treatment of comorbid MDD in chronically ill patients in the outpatient general hospital setting. The study was conducted from a health care and societal perspective.
In this randomized controlled trial, 81 patients with moderate-to-severe MDD were included; 42 were randomly assigned to the CC group and 39 to the care as usual (CAU) group. We applied the TiC-P, short-form Health-Related Quality of Life questionnaire, and EuroQol EQ-5D 3 level version, measuring the use of health care, informal care, and household work, respectively, at baseline and at 3, 6, 9, and 12 months follow-up.
The mean annual direct medical costs in the CC group were €6,718 (95% confidence interval [CI]: 3,541 to 10,680) compared to €4,582 (95% CI: 2,782 to 6,740) in the CAU group. The average quality-adjusted life years (QALYs) gained were 0.07 higher in the CC group, indicating that CC is more costly but also more effective than CAU. From a societal perspective, the incremental cost-effectiveness ratio was €24,690/QALY.
This first cost-utility analysis in chronically ill patients with comorbid MDD shows that CC may be a cost-effective treatment depending on willingness-to-pay levels. Nevertheless, the low utility scores emphasize the need for further research to improve the cost-effectiveness of CC in this highly prevalent and costly group of patients.
重度抑郁症（MDD）在慢性身体疾病患者中高度流行，这种共病对生活质量、医疗保健成本、自我护理、发病率和死亡率有负面影响。研究表明，协作护理（CC）可能是一种具有成本效益的治疗方法。然而，其在该患者群体中的成本效益尚未确定。因此，本研究的目的是评估在门诊综合医院环境中，CC治疗慢性病患者合并MDD的成本效用。该研究是从医疗保健和社会角度进行的。
在这项随机对照试验中，纳入了81例中度至重度MDD患者；42例被随机分配到CC组，39例被分配到常规护理（CAU）组。我们应用TiC-P、健康相关生活质量简表问卷和欧洲五维度健康量表3级版本，分别在基线以及随访3、6、9和12个月时测量医疗保健使用情况、非正式护理和家务劳动。
CC组的年均直接医疗成本为6718欧元（95%置信区间[CI]：3541至10680），而CAU组为4582欧元（95%CI：2782至6740）。CC组获得的平均质量调整生命年（QALY）高0.07，这表明CC比CAU成本更高，但也更有效。从社会角度来看，增量成本效益比为24690欧元/QALY。
这项针对合并MDD的慢性病患者的首次成本效用分析表明，根据支付意愿水平，CC可能是一种具有成本效益的治疗方法。尽管如此，效用得分较低强调需要进一步研究，以提高CC在这一高度流行且成本高昂的患者群体中的成本效益。
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