在初级保健中预防抑郁症的个性化干预：嵌套在聚类随机试验中的成本效益研究。
A personalized intervention to prevent depression in primary care: cost-effectiveness study nested into a clustered randomized trial.
机构信息
ParcSanitariSant Joan de Déu, FundacióSant Joan de Déu, C/Dr. AntoniPujadas, 42, 08830, SantBoi de Llobregat, Barcelona, Spain.
Mental Health Policy Unit, Brain and Mind Centre, Faculty of Health Sciences, University of Sydney, Sydney, Australia.
出版信息
BMC Med. 2018 Feb 23;16(1):28. doi: 10.1186/s12916-018-1005-y.
BACKGROUND
Depression is viewed as a major and increasing public health issue, as it causes high distress in the people experiencing it and considerable financial costs to society. Efforts are being made to reduce this burden by preventing depression. A critical component of this strategy is the ability to assess the individual level and profile of risk for the development of major depression. This paper presents the cost-effectiveness of a personalized intervention based on the risk of developing depression carried out in primary care, compared with usual care.
METHODS
Cost-effectiveness analyses are nested within a multicentre, clustered, randomized controlled trial of a personalized intervention to prevent depression. The study was carried out in 70 primary care centres from seven cities in Spain. Two general practitioners (GPs) were randomly sampled from those prepared to participate in each centre (i.e. 140 GPs), and 3326 participants consented and were eligible to participate. The intervention included the GP communicating to the patient his/her individual risk for depression and personal risk factors and the construction by both GPs and patients of a psychosocial programme tailored to prevent depression. In addition, GPs carried out measures to activate and empower the patients, who also received a leaflet about preventing depression. GPs were trained in a 10- to 15-h workshop. Costs were measured from a societal and National Health care perspective. Qualityadjustedlife years were assessed using the EuroQOL five dimensions questionnaire. The time horizon was 18 months.
RESULTS
With a willingness-to-pay threshold of €10,000 (£8568) the probability of cost-effectiveness oscillated from 83% (societal perspective) to 89% (health perspective). If the threshold was increased to €30,000 (£25,704), the probability of being considered cost-effective was 94% (societal perspective) and 96%, respectively (health perspective). The sensitivity analysis confirmed these results.
CONCLUSIONS
Compared with usual care, an intervention based on personal predictors of risk of depression implemented by GPs is a cost-effective strategy to prevent depression. This type of personalized intervention in primary care should be further developed and evaluated.
TRIAL REGISTRATION
ClinicalTrials.gov, NCT01151982. Registered on June 29, 2010.
背景
抑郁症被视为一个主要且日益严重的公共卫生问题，因为它给患者带来了高度的痛苦，并给社会带来了可观的经济成本。人们正在努力通过预防抑郁症来减轻这种负担。该策略的一个关键组成部分是评估个体发展为重度抑郁症的风险水平和特征的能力。本文介绍了在初级保健中实施基于抑郁风险的个性化干预措施的成本效益，与常规护理相比。
方法
成本效益分析嵌套在一项预防抑郁的个性化干预多中心、聚类、随机对照试验中。该研究在西班牙七个城市的 70 个初级保健中心进行。从每个中心准备参与的全科医生（GP）中随机抽取 2 名全科医生（即 140 名 GP），有 3326 名参与者同意并符合参与条件。干预措施包括 GP 向患者传达其个人抑郁风险和个人风险因素，以及由 GP 和患者共同制定针对预防抑郁的心理社会计划。此外，GP 采取措施激活和赋予患者权力，患者还收到一份关于预防抑郁的传单。GP 接受了 10-15 小时的培训。成本从社会和国家医疗保健的角度进行衡量。使用 EuroQOL 五维问卷评估质量调整生命年。时间范围为 18 个月。
结果
如果支付意愿阈值为 10,000 欧元（8568 英镑），成本效益的概率从社会角度的 83%（社会角度）到 89%（健康角度）波动。如果阈值增加到 30,000 欧元（25704 英镑），则从社会角度来看，被认为具有成本效益的概率为 94%，从健康角度来看，这一概率分别为 96%。敏感性分析证实了这些结果。
结论
与常规护理相比，由 GP 实施的基于抑郁风险个人预测因素的干预措施是预防抑郁症的一种具有成本效益的策略。这种在初级保健中的个性化干预措施应进一步开发和评估。
试验注册
ClinicalTrials.gov，NCT01151982。于 2010 年 6 月 29 日注册。
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