Grochtdreis Thomas, Brettschneider Christian, Shedden-Mora Meike, Piontek Katharina, König Hans-Helmut, Löwe Bernd
Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany,
J Ment Health Policy Econ. 2018 Jun 1;21(2):59-69.
Somatoform disorders are highly prevalent mental disorders causing impairment and large economic burden. In order to improve the diagnosis and management of affected patients, a health care network for somatoform disorders (Sofu-Net) was implemented in primary care.
The aim of the study was to determine the cost-effectiveness of a stepped, collaborative and coordinated health care network for somatoform and functional disorders (Sofu-Net) compared with regular primary care physician (PCP) practices in German primary care from a societal perspective.
This study was part of a 6-month controlled, prospective, non-randomized, observer-blinded cluster cohort trial. Participants were recruited from 33 PCP practices in Hamburg, Germany. The health care network was a collaboration of PCPs, psychotherapists, inpatient clinics and a specialized outpatient clinic. Participants in the control group received usual care. A cost-effectiveness analysis, using treatment response as measure of effectiveness, was performed. Uncertainty in cost-effectiveness was analyzed using cost-effectiveness acceptability curves.
In total, n=218 patients (n=119 patients in the intervention group and n=99 patients in the control group) were included in the study. At 6 months, patients within the Sofu-Net group did not differ significantly from the control group with regard to costs (533; standard error 941) and treatment response (--10.3%). For Sofu-Net, the probability of being cost-effective at a willingness-to-pay (WTP) of 10,000 per additional response to treatment was only 31%.
Sofu-Net is unlikely to be cost-effective. Even for high WTP, the probability of cost-effectiveness was low. The results were robust to variation of costs included in the analysis as well as when only complete cases were included in the analysis. The most important limitations of the study were that randomization could not be established at patient level and at practice level and that the study design did not allow measurement of costs at baseline.
Patients with severe somatic symptoms did not benefit from the health care network. Sofu-Net might have reduced costs in patients with moderate somatic symptoms.
Owing to the limitations and due to a short follow-up of this study, further cost-effectiveness analyses with high methodological quality and a follow-up of at least one year are needed in order to produce results that are more reliable.
躯体形式障碍是高度流行的精神障碍，会导致功能损害并带来巨大经济负担。为改善对患病患者的诊断和管理，在初级保健中实施了躯体形式障碍医疗保健网络（Sofu-Net）。
本研究旨在从社会角度确定与德国初级保健中常规初级保健医生（PCP）诊疗相比，针对躯体形式和功能障碍的分级、协作及协调医疗保健网络（Sofu-Net）的成本效益。
本研究是一项为期6个月的对照、前瞻性、非随机、观察者盲法的整群队列试验的一部分。参与者从德国汉堡的33家初级保健医生诊所招募。该医疗保健网络由初级保健医生、心理治疗师、住院诊所和一家专科门诊诊所协作组成。对照组参与者接受常规护理。以治疗反应作为有效性指标进行成本效益分析。使用成本效益可接受性曲线分析成本效益的不确定性。
本研究共纳入n = 218例患者（干预组n = 119例患者，对照组n = 99例患者）。6个月时，Sofu-Net组患者在成本（533；标准误941）和治疗反应（-10.3%）方面与对照组无显著差异。对于Sofu-Net，每增加一次治疗反应，支付意愿（WTP）为10,000时具有成本效益的概率仅为31%。
Sofu-Net不太可能具有成本效益。即使对于高支付意愿，成本效益概率也很低。分析中纳入的成本变化以及仅纳入完整病例进行分析时，结果都很稳健。该研究最重要的局限性在于无法在患者层面和诊所层面进行随机分组，且研究设计不允许在基线时测量成本。
有严重躯体症状的患者未从该医疗保健网络中获益。Sofu-Net可能降低了有中度躯体症状患者的成本。
由于本研究存在局限性且随访时间短，需要进行方法学质量高且随访至少一年的进一步成本效益分析，以得出更可靠的结果。
