Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Australia; National Ageing Research Institute, Parkville, Australia.
Deakin Health Economics, Deakin University, Geelong, Victoria, Australia.
J Psychosom Res. 2019 Oct;125:109812. doi: 10.1016/j.jpsychores.2019.109812. Epub 2019 Aug 13.
To evaluate the cost-effectiveness of stepped care compared to care as usual (CAU) for the treatment of adults with mild-to-moderate anxiety disorders from a health sector perspective in the Australian setting.
A decision tree model was constructed to estimate the cost per disability adjusted life year (DALY) averted over a 12-month time horizon. The model compared a three-step stepped care intervention to CAU. Stepped care included an initial phase of guided self-help, followed by face-to-face cognitive behavioural therapy, and pharmacotherapy as the final step. The model adopted a health sector perspective, used epidemiological parameters and disability weights obtained from the Global Burden of Disease Study 2013. Effect sizes were derived from a randomized trial of stepped care and a longitudinal cohort study. Costs were expressed in 2013 Australian dollars (A$). Multivariate probabilistic and univariate sensitivity analyses were performed.
Stepped care was found to be cost-effective compared to CAU with an incremental cost-effective ratio of A$3093 per DALY averted. One-hundred percent of the uncertainty iterations fell below the A$50,000 per DALY averted willingness-to-pay threshold commonly used in Australia. The evaluation was most sensitive to changes in diagnosis rates and effect sizes.
A three-step model of stepped care appears to be cost-effective for the treatment of adults with mild to moderate anxiety disorders from the Australian health sector perspective. These results can provide some assurance to decision-makers that stepped care represents an efficient use of health care resources.
从澳大利亚卫生部门的角度出发，评估阶梯式护理与常规护理（CAU）相比，在治疗轻中度焦虑障碍成年人方面的成本效益。
构建决策树模型，以估计 12 个月时间范围内每避免一个残疾调整生命年（DALY）的成本。该模型将三步阶梯式护理干预与 CAU 进行了比较。阶梯式护理包括初始阶段的指导自助，随后是面对面认知行为疗法，最后是药物治疗。该模型采用卫生部门的视角，使用来自 2013 年全球疾病负担研究的流行病学参数和残疾权重。效果大小源自阶梯式护理的随机试验和纵向队列研究。成本以 2013 年澳元（A$）表示。进行了多变量概率和单变量敏感性分析。
与 CAU 相比，阶梯式护理被认为是具有成本效益的，增量成本效益比为每避免一个 DALY 增加 3093 澳元。不确定性迭代的 100%都低于澳大利亚常用的每避免一个 DALY 50000 澳元的意愿支付阈值。评估对诊断率和效果大小的变化最为敏感。
从澳大利亚卫生部门的角度来看，三步式阶梯式护理模式似乎对治疗轻中度焦虑障碍的成年人具有成本效益。这些结果可以向决策者提供一些保证，即阶梯式护理代表了对医疗保健资源的有效利用。
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