使用随机对照试验数据评估经验抽样方法干预抑郁症与常规治疗的经济学评价。
Economic evaluation of an experience sampling method intervention in depression compared with treatment as usual using data from a randomized controlled trial.
机构信息
Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands.
GGzE, Institute for Mental Health Care Eindhoven and De Kempen, Eindhoven, The Netherlands.
出版信息
BMC Psychiatry. 2017 Dec 29;17(1):415. doi: 10.1186/s12888-017-1577-7.
BACKGROUND
Experience sampling, a method for real-time self-monitoring of affective experiences, holds opportunities for person-tailored treatment. By focussing on dynamic patterns of positive affect, experience sampling method interventions (ESM-I) accommodate strategies to enhance personalized treatment of depression-at potentially low-costs. This study aimed to investigate the cost-effectiveness of an experience sampling method intervention in patients with depression, from a societal perspective.
METHODS
Participants were recruited between January 2010 and February 2012 from out-patient mental health care facilities in or near the Dutch cities of Eindhoven and Maastricht, and through local advertisements. Out-patients diagnosed with major depression (n = 101) receiving pharmacotherapy were randomized into: (i) ESM-I consisting of six weeks of ESM combined with weekly feedback regarding the individual's positive affective experiences, (ii) six weeks of ESM without feedback, or (iii) treatment as usual only. Alongside this randomised controlled trial, an economic evaluation was conducted consisting of a cost-effectiveness and a cost-utility analysis, using Hamilton Depression Rating Scale (HDRS) and quality adjusted life years (QALYs) as outcome, with willingness-to-pay threshold for a QALY set at €50,000 (based on Dutch guidelines for moderate severe to severe illnesses).
RESULTS
The economic evaluation showed that ESM-I is an optimal strategy only when willingness to pay is around €3000 per unit HDRS and around €40,500 per QALY. ESM-I was the least favourable treatment when willingness to pay was lower than €30,000 per QALY. However, at the €50,000 willingness-to-pay threshold, ESM-I was, with a 46% probability, the most favourable treatment (base-case analysis). Sensitivity analyses confirmed the robustness of these results.
CONCLUSIONS
We may tentatively conclude that ESM-I is a cost-effective add-on intervention to pharmacotherapy in outpatients with major depression.
TRIAL REGISTRATION
Netherlands Trial register, NTR1974 .
背景
体验采样法是一种实时自我监测情感体验的方法，为量身定制的治疗提供了机会。通过关注积极情绪的动态模式，体验采样方法干预（ESM-I）适应了增强抑郁个体化治疗的策略——具有潜在的低成本效益。本研究旨在从社会角度探讨体验采样方法干预对抑郁症患者的成本效益。
方法
参与者于 2010 年 1 月至 2012 年 2 月期间从荷兰埃因霍温市和马斯特里赫特市或附近的门诊精神保健机构以及当地广告中招募。诊断为重度抑郁症的门诊患者（n=101）接受药物治疗，随机分为三组：（i）ESM-I，包括六周的 ESM 加上每周反馈个人积极情感体验；（ii）六周 ESM 无反馈；（iii）仅接受常规治疗。在这项随机对照试验的同时，还进行了一项经济评估，包括成本效益和成本效用分析，使用汉密尔顿抑郁量表（HDRS）和质量调整生命年（QALY）作为结果，意愿支付阈值为 QALY 设定为 50,000 欧元（基于荷兰中度至重度疾病指南）。
结果
经济评估表明，只有当每单位 HDRS 的意愿支付为 3000 欧元左右，每 QALY 的意愿支付为 40,500 欧元左右时，ESM-I 才是一种最优策略。当意愿支付低于每 QALY 30,000 欧元时，ESM-I 是最不利的治疗方法。然而，在 50,000 欧元的意愿支付阈值下，ESM-I 有 46%的可能性是最有利的治疗方法（基础案例分析）。敏感性分析证实了这些结果的稳健性。
结论
我们可以初步得出结论，ESM-I 是一种针对重度抑郁症门诊患者药物治疗的具有成本效益的附加干预措施。
试验注册
荷兰试验注册处，NTR1974。
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