Mosweu I, Moss-Morris R, Dennison L, Chalder T, McCrone P
King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Box 024, The David Goldberg Centre, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
Department of Psychology, Institute of Psychiatry Psychology & Neuroscience, King's College London, London, UK.
Health Econ Rev. 2017 Oct 10;7(1):36. doi: 10.1186/s13561-017-0172-4.
Cognitive Behavioural Therapy (CBT) reduces distress in multiple sclerosis, and helps manage adjustment, but cost-effectiveness evidence is lacking.
An economic evaluation was conducted within a multi-centre trial. 94 patients were randomised to either eight sessions of nurse-led CBT or supportive listening (SL). Costs were calculated from the health, social and indirect care perspectives, and combined with additional quality-adjusted life years (QALY) or improvement on the GHQ-12 score, to explore cost-effectiveness at 12 months.
CBT had higher mean health costs (£1610, 95% CI, -£187 to 3771) and slightly better QALYs (0.0053, 95% CI, -0.059 to 0.103) compared to SL but these differences were not statistically significant. This yielded £301,509 per QALY improvement, indicating that CBT is not cost-effective according to established UK NHS thresholds. The extra cost per patient improvement on the GHQ-12 scale was £821 from the same perspective. Using a £20,000, threshold, CBT in this format has a 9% probability of being cost effective. Although subgroup analysis of patients with clinical levels of distress at baseline showed an improvement in the position of CBT compared to SL, CBT was still not cost-effective.
Nurse delivered CBT is more effective in reducing distress among MS patients compared to SL, but is highly unlikely to be cost-effective using a preference-based measure of health (EQ-5D). Results from a disease-specific measure (GHQ-12) produced comparatively lower Incremental Cost-Effectiveness Ratios, but there is currently no acceptable willingness-to-pay threshold for this measure to guide decision-making.
认知行为疗法（CBT）可减轻多发性硬化症患者的痛苦，并有助于应对适应问题，但缺乏成本效益方面的证据。
在一项多中心试验中进行了经济评估。94名患者被随机分为接受八节由护士主导的CBT治疗或支持性倾听（SL）。从健康、社会和间接护理角度计算成本，并与额外的质量调整生命年（QALY）或GHQ-12评分的改善情况相结合，以探讨12个月时的成本效益。
与SL相比，CBT的平均健康成本更高（1610英镑，95%置信区间，-187至3771英镑），QALY略好（0.0053，95%置信区间，-0.059至0.103），但这些差异无统计学意义。这意味着每改善一个QALY的成本为301,509英镑，表明根据英国国家医疗服务体系（NHS）既定的阈值，CBT不具有成本效益。从相同角度来看，在GHQ-12量表上每位患者改善的额外成本为821英镑。使用20,000英镑的阈值，这种形式的CBT具有9%的成本效益概率。尽管对基线时处于临床痛苦水平的患者进行亚组分析显示，与SL相比CBT的情况有所改善，但CBT仍然不具有成本效益。
与SL相比，护士提供的CBT在减轻MS患者的痛苦方面更有效，但使用基于偏好的健康衡量指标（EQ-5D）时极不可能具有成本效益。特定疾病衡量指标（GHQ-12）的结果产生的增量成本效益比相对较低，但目前该指标尚无可接受的支付意愿阈值来指导决策。
