Department of Health Service and Population Research, King's Health Economics (KHE) Institute of Psychiatry, Psychology & Neuroscience, David Goldberg Centre, King's College London, De Crespigny Park, Denmark Hill, Box 24, London, SE5 8AF, UK.
Avon and Wiltshire Mental Health Partnership NHS Trust, Jenner House, Langley Park, Chippenham, SN15 1GG, UK.
Community Ment Health J. 2019 Jul;55(5):873-883. doi: 10.1007/s10597-019-00390-z. Epub 2019 Mar 8.
This is the first site level economic evaluation of the Improving Access to Psychological Therapies programme for severe mental illness (IAPT-SMI) that is funded by NHS England. It also aims to illustrate the challenges involved in evaluations based on routine data with low internal validity. Six IAPT-SMI pilot sites treated 1 of 2 clinical groups: (i) psychosis or bipolar disorder; (ii) personality disorder. A decision analytical model nested in a before-after framework- the same patients 12 months after treatment versus 12 months before treatment-was used to compare the cost-effectiveness of IAPT-SMI with treatment as usual (TAU). IAPT-SMI appears to be more costly overall but save non-psychological treatment costs. There is evidence it may improve function and lower incidence of harmful behaviour. However, there is a need for evaluations with a more conventional study design that measure a more comprehensive array of resource use and clinical outcomes.
这是由英国国家医疗服务体系（NHS England）资助的改善严重精神疾病心理治疗服务项目（IAPT-SMI）的首个现场层面经济评估。它还旨在说明基于常规数据和低内部有效性的评估所涉及的挑战。六个 IAPT-SMI 试点现场治疗了两个临床组之一：（i）精神病或双相情感障碍；（ii）人格障碍。在前后框架内嵌套决策分析模型——治疗后 12 个月与治疗前 12 个月的相同患者——用于比较 IAPT-SMI 与常规治疗（TAU）的成本效益。总体而言，IAPT-SMI 似乎更昂贵，但节省了非心理治疗成本。有证据表明，它可能会改善功能并降低有害行为的发生率。然而，需要进行更具传统研究设计的评估，以衡量更全面的资源利用和临床结果。
