精神分裂症和双相情感障碍的心理治疗的成本效益评估：系统评价。
Cost-Effectiveness Evaluations of Psychological Therapies for Schizophrenia and Bipolar Disorder: A Systematic Review.
机构信息
Centre for Health Economics, Division of Population Health, University of Manchester.
Personal and Social Services Research Unit, University of Manchester.
出版信息
Int J Technol Assess Health Care. 2019;35(4):317-326. doi: 10.1017/S0266462319000448. Epub 2019 Jul 22.
OBJECTIVES
This review aims to assess the cost-effectiveness of psychological interventions for schizophrenia/bipolar disorder (BD), to determine the robustness of current evidence and identify gaps in the available evidence.
METHODS
Electronic searches (PsycINFO, MEDLINE, Embase) identified economic evaluations relating incremental cost to outcomes in the form of an incremental cost-effectiveness ratio published in English since 2000. Searches were concluded in November 2018. Inclusion criteria were: adults with schizophrenia/BD; any psychological/psychosocial intervention (e.g., psychological therapy and integrated/collaborative care); probability of cost-effectiveness at explicitly defined thresholds reported. Comparators could be routine practice, no intervention, or alternative psychological therapies. Screening, data extraction, and critical appraisal were performed using pre-specified criteria and forms. Results were summarized qualitatively. The protocol was registered on the PROSPERO database (CRD42017056579).
RESULTS
Of 3,864 studies identified, 12 met the criteria for data extraction. All were integrated clinical and economic randomized controlled trials. The most common intervention was cognitive behavioral therapy (CBT, 6/12 studies). The most common measure of health benefit was the quality-adjusted life-year (6/12). Follow-up ranged from 6 months to 5 years. Interventions were found to be cost-effective in most studies (9/12): the probability of cost-effectiveness ranged from 35-99.5 percent. All studies had limitations and demonstrated uncertainty (particularly related to incremental costs).
CONCLUSIONS
Most studies concluded psychological interventions for schizophrenia/BD are cost-effective, including CBT, although there was notable uncertainty. Heterogeneity across studies makes it difficult to reach strong conclusions. There is a particular need for more evidence in the population with BD and for longer-term evidence across both populations.
目的
本综述旨在评估精神分裂症/双相情感障碍（BD）心理干预的成本效益，以确定当前证据的稳健性，并确定现有证据中的空白。
方法
电子检索（PsycINFO、MEDLINE、Embase）以增量成本效益比的形式，从 2000 年以来发表的英文文献中确定了与结果相关的经济评估。搜索于 2018 年 11 月结束。纳入标准为：患有精神分裂症/BD 的成年人；任何心理/心理社会干预（例如心理治疗和综合/协作护理）；明确界定的阈值下成本效益的可能性报告。对照可以是常规治疗、无干预或替代心理治疗。使用预先指定的标准和表格进行筛选、数据提取和关键评估。结果以定性方式进行总结。该方案已在 PROSPERO 数据库（CRD42017056579）中注册。
结果
从 3864 项研究中，有 12 项符合数据提取标准。所有研究均为综合临床和经济随机对照试验。最常见的干预措施是认知行为疗法（CBT，6/12 项研究）。最常见的健康效益衡量标准是质量调整生命年（6/12 项）。随访时间从 6 个月到 5 年不等。大多数研究发现干预措施具有成本效益（9/12）：成本效益的可能性范围为 35-99.5%。所有研究都有局限性和不确定性（特别是与增量成本有关）。
结论
大多数研究认为精神分裂症/BD 的心理干预具有成本效益，包括 CBT，尽管存在显著的不确定性。研究之间的异质性使得难以得出强有力的结论。在 BD 人群中尤其需要更多的证据，并且在这两个人群中都需要更长期的证据。
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