Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
Centre of Economic Evaluation, Trimbos Institute (Netherlands Institute for Mental Health and Addiction), Utrecht, The Netherlands.
PLoS One. 2018 Feb 21;13(2):e0193338. doi: 10.1371/journal.pone.0193338. eCollection 2018.
Panic disorder (PD) is associated with impaired functioning and reduced quality of life. In the Netherlands, almost 2% of the population experiences clinically relevant panic symptoms without meeting the diagnostic criteria for PD, which is referred to as subthreshold PD (STHPD). Evidence suggests that subthreshold mental disorders may have a similar impact on quality of life and functioning in comparison with full-blown mental disorders, which draws attention to the need for interventions for STHPD. These interventions are currently not systematically provided in clinical practice. This study aims to investigate the population cost-effectiveness of adding a CBT-based early intervention for adults with STHPD to the existing health care for people with PD in the Netherlands.
A health-economic Markov model was constructed in order to compare quality adjusted life-years (QALYs) and societal costs of adding an early intervention to usual care for PD. The model compares usual care with an alternative program in which usual care is supplemented with a CBT-based early intervention. Input parameters for the model were derived from national sources and published literature where possible, and based on expert opinion otherwise. Probabilistic and deterministic sensitivity analyses were conducted to evaluate the uncertainty of the model input parameters.
On average, the added CBT-based early intervention was dominant in comparison with usual care, meaning that the early intervention yielded more QALYs at lower costs. At a willingness-to-pay threshold of €20,000 per QALY, the cost-effectiveness probability of the added early intervention was 98%. Sensitivity analyses showed that the results were robust.
This study showed that offering an early intervention in addition to usual care for PD is potentially cost-effective, but it should be further investigated to what extent trial results can be extrapolated to the level of the population before such interventions are implemented on a large scale.
恐慌症（PD）与功能障碍和生活质量下降有关。在荷兰，近 2%的人口经历了临床相关的恐慌症状，但不符合 PD 的诊断标准，这被称为亚阈值 PD（STHPD）。有证据表明，亚阈值精神障碍对生活质量和功能的影响可能与全面精神障碍相似，这引起了人们对 STHPD 干预措施的关注。目前，这些干预措施在临床实践中并未系统提供。本研究旨在调查在荷兰，为 STHPD 成年人提供基于认知行为疗法的早期干预措施，以补充现有的 PD 保健服务，从人群角度评估其成本效益。
构建了一个健康经济学 Markov 模型，以比较为 PD 患者提供的常规护理中增加基于认知行为疗法的早期干预与常规护理的质量调整生命年（QALYs）和社会成本。该模型将常规护理与替代方案进行比较，在替代方案中，常规护理辅以基于认知行为疗法的早期干预。模型的输入参数来自国家来源和已发表的文献，在可能的情况下，否则根据专家意见得出。进行了概率和确定性敏感性分析，以评估模型输入参数的不确定性。
平均而言，与常规护理相比，添加的基于认知行为疗法的早期干预具有优势，这意味着早期干预以较低的成本产生了更多的 QALYs。在每 QALY 支付 20,000 欧元的意愿支付阈值下，添加早期干预的成本效益概率为 98%。敏感性分析表明，结果具有稳健性。
本研究表明，为 PD 患者提供常规护理之外的早期干预具有潜在的成本效益，但在大规模实施此类干预措施之前，应进一步研究试验结果在多大程度上可以外推到人群水平。
