阶梯式护理管理儿童焦虑障碍的经济学评价：一项随机试验的结果。

Economic evaluation of stepped care for the management of childhood anxiety disorders: Results from a randomised trial.

机构信息

1 Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, VIC, Australia.

2 Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia.

出版信息

Aust N Z J Psychiatry. 2019 Jul;53(7):673-682. doi: 10.1177/0004867418823272. Epub 2019 Jan 18.

DOI:10.1177/0004867418823272

PMID:30658546

Abstract

BACKGROUND

Stepped care has been promoted for the management of mental disorders; however, there is no empirical evidence to support the cost-effectiveness of this approach for the treatment of anxiety disorders in youth.

METHOD

This economic evaluation was conducted within a randomised controlled trial comparing stepped care to a validated, manualised treatment in 281 young people, aged 7-17, with a diagnosed anxiety disorder. Intervention costs were determined from therapist records. Administrative data on medication and medical service use were used to determine additional health care costs during the study period. Parents also completed a resource use questionnaire to collect medications, services not captured in administrative data and parental lost productivity. Outcomes included participant-completed quality of life, Child Health Utility - nine-dimension and parent-completed Assessment of Quality of Life - eight-dimension to calculate quality-adjusted life years. Mean costs and quality-adjusted life years were compared between groups at 12-month follow-up.

RESULTS

Intervention delivery costs were significantly less for stepped care from the societal perspective (mean difference -$198, 95% confidence interval -$353 to -$19). Total combined costs were less for stepped care from both societal (-$1334, 95% confidence interval -$2386 to $510) and health sector (-$563, 95% confidence interval -$1353 to $643) perspectives but did not differ significantly from the manualised treatment. Youth and parental quality-adjusted life years were not significantly different between groups. Sensitivity analysis indicated that the results were robust.

CONCLUSION

For youth with anxiety, this three-step model provided comparable outcomes and total health sector costs to a validated face-to-face programme. However, it was less costly to deliver from a societal perspective, making it an attractive option for some parents. Future economic evaluations comparing various models of stepped care to treatment as usual are recommended.

摘要

背景

阶梯式护理已被推广用于精神障碍的管理；然而，尚无实证证据支持这种方法在治疗青少年焦虑症方面具有成本效益。

方法

本项经济评价是在一项随机对照试验中进行的，该试验比较了阶梯式护理与经过验证的、规范化治疗在 281 名年龄在 7-17 岁之间、被诊断患有焦虑症的年轻人中的疗效。干预成本是根据治疗师的记录确定的。药物和医疗服务使用的行政数据用于确定研究期间的额外医疗保健费用。父母还填写了资源使用问卷，以收集药物、行政数据未涵盖的服务以及父母的生产力损失。结果包括参与者完成的生活质量、儿童健康效用-九维度和父母完成的生活质量评估-八维度，以计算质量调整生命年。在 12 个月的随访中，比较了两组的平均成本和质量调整生命年。

结果

从社会角度来看，阶梯式护理的干预提供成本明显更低（平均差值-198 美元，95%置信区间-353 美元至-19 美元）。从社会角度来看，阶梯式护理的总综合成本更低（-1334 美元，95%置信区间-2386 美元至 510 美元），从卫生部门角度来看也更低（-563 美元，95%置信区间-1353 美元至 643 美元），但与规范化治疗无显著差异。青年和父母的质量调整生命年在组间无显著差异。敏感性分析表明结果稳健。