School of Health and Social Development, Deakin Health Economics, Deakin University, Locked Bag 20001, Geelong, VIC, 3220, Australia.
School of Public Health, The University of Queensland, Herston, QLD, 4006, Australia.
Qual Life Res. 2018 Jul;27(7):1815-1825. doi: 10.1007/s11136-018-1843-2. Epub 2018 Apr 9.
High prevalence mental disorders including depression, anxiety and substance use disorders are associated with high economic and disease burden. However, there is little information regarding the health state utility values of such disorders according to their clinical severity using comparable instruments across all disorders. This study reports utility values for high prevalence mental disorders using data from the 2007 Australian National Survey of Mental Health and Wellbeing (NSMHWB).
Utility values were derived from the AQoL-4D and analysed by disorder classification (affective only (AD), anxiety-related only (ANX), substance use only (SUB) plus four comorbidity groups), severity level (mild, moderate, severe), symptom recency (reported in the past 30 days), and comorbidity (combination of disorders). The adjusted Wald test was applied to detect statistically significant differences of weighted means and the magnitude of difference between groups was presented as a modified Cohen's d.
In total, 1526 individuals met criteria for a 12-month mental disorder. The mean utility value was 0.67 (SD = 0.27), with lower utility values associated with higher severity levels and some comorbidities. Utility values for AD, ANX and SUB were 0.64 (SD = 0.25), 0.71 (SD = 0.25) and 0.81 (SD = 0.19), respectively. No differences in utility values were observed between disorders within disorder groups. Utility values were significantly lower among people with recent symptoms (within past 30 days) than those without; when examined by diagnostic group, this pattern held for people with SUB, but not for people with ANX or AD.
Health state utility values of people with high prevalence mental disorders differ significantly by severity level, number of mental health comorbidities and the recency of symptoms, which provide new insights on the burden associated with high prevalence mental disorders in Australia. The derived utility values can be used to populate future economic models.
包括抑郁、焦虑和物质使用障碍在内的高患病率精神障碍与高经济和疾病负担相关。然而，根据所有障碍的临床严重程度，使用可比工具，关于这些障碍的健康状态效用值的信息很少。本研究使用 2007 年澳大利亚国家心理健康和幸福感调查 (NSMHWB) 的数据报告了高患病率精神障碍的效用值。
效用值是从 AQoL-4D 中得出的，并根据疾病分类（仅情感障碍 (AD)、仅焦虑相关障碍 (ANX)、仅物质使用障碍 (SUB) 加四个合并症组）、严重程度（轻度、中度、重度）、症状近期性（在过去 30 天内报告）和合并症（障碍组合）进行分析。应用调整后的 Wald 检验检测加权均值的统计学显著差异，并用修正后的 Cohen's d 表示组间差异的大小。
共有 1526 人符合 12 个月精神障碍标准。平均效用值为 0.67（SD=0.27），较高的严重程度水平和一些合并症与较低的效用值相关。AD、ANX 和 SUB 的效用值分别为 0.64（SD=0.25）、0.71（SD=0.25）和 0.81（SD=0.19）。在各障碍组内，各障碍之间的效用值无差异。与无症状者相比，近期有症状（过去 30 天内）者的效用值明显较低；当按诊断组检查时，这种模式适用于 SUB 患者，但不适用于 ANX 或 AD 患者。
高患病率精神障碍患者的健康状态效用值在严重程度、心理健康合并症数量和症状近期性方面存在显著差异，为澳大利亚高患病率精神障碍相关负担提供了新的见解。得出的效用值可用于填充未来的经济模型。
