Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
Department of Psychology, Harvard University, Cambridge, Massachusetts.
JAMA Psychiatry. 2020 Mar 1;77(3):256-264. doi: 10.1001/jamapsychiatry.2019.3639.
Brief cognitive behavioral therapy (BCBT) is a clinically effective intervention for reducing risk of suicide attempts among suicidal US Army soldiers. However, because specialized treatments can be resource intensive, more information is needed on costs and benefits of BCBT compared with existing treatments.
To evaluate the cost-effectiveness of BCBT compared with treatment as usual for suicidal soldiers in the US Army.
DESIGN, SETTING, AND PARTICIPANTS: A decision analytic model compared effects and costs of BCBT vs treatment as usual from a US Department of Defense (DoD) perspective. Model input data were drawn from epidemiologic data sets and a clinical trial among suicidal soldiers conducted from January 31, 2011, to April 3, 2014. Data were analyzed from July 3, 2018, to March 25, 2019.
The strategies compared were treatment as usual alone vs treatment as usual plus 12 individual BCBT sessions. Treatment as usual could include a range of pharmacologic and psychological treatment options.
Costs in 2017 US dollars, suicide attempts averted (self-directed behavior with intent to die, but with nonfatal outcome), suicide deaths averted, and incremental cost-effectiveness ratios, assuming a 2-year time horizon for treatment differences but including lifetime costs.
In the base-case analysis, BCBT was expected to avert approximately 23 to 25 more suicide attempts and 1 to 3 more suicide deaths per 100 patients treated than treatment as usual. Sensitivity analyses assuming a range of treatment effects showed BCBT to be cost saving in most scenarios. Using the federal discount rate, the DoD was estimated to save from $15 000 to $16 630 per patient with BCBT vs treatment as usual. In a worst-case scenario (ie, assuming the weakest plausible BCBT effect sizes), BCBT cost an additional $1910 to $2250 per patient compared with treatment as usual.
Results suggest BCBT may be a cost-saving intervention for suicidal active-duty soldiers. The costs of ensuring treatment fidelity would also need to be considered when assessing the implications of disseminating BCBT across the entire DoD.
简短的认知行为疗法（BCBT）是一种临床有效的干预措施，可以降低美国军队自杀士兵自杀企图的风险。然而，由于专门的治疗方法可能需要大量资源，因此需要更多关于 BCBT 与现有治疗方法相比的成本效益信息。
评估 BCBT 与美国陆军中自杀士兵的常规治疗相比的成本效益。
设计、环境和参与者：从美国国防部（DoD）的角度，通过决策分析模型比较了 BCBT 与常规治疗对自杀士兵的效果和成本。模型输入数据来自于 2011 年 1 月 31 日至 2014 年 4 月 3 日期间对自杀士兵进行的流行病学数据集和临床试验。数据分析于 2018 年 7 月 3 日至 2019 年 3 月 25 日进行。
比较的策略是单独常规治疗与常规治疗加 12 次个体 BCBT 治疗。常规治疗可以包括一系列药物和心理治疗选择。
2017 年美元成本、避免的自杀企图（有自杀意图但未造成死亡的自我伤害行为）、避免的自杀死亡人数以及增量成本效益比，假设治疗差异的 2 年时间范围，但包括终生成本。
在基础案例分析中，BCBT 预计每 100 名接受治疗的患者可避免约 23 至 25 次更多的自杀企图和 1 至 3 次更多的自杀死亡。在假设一系列治疗效果的敏感性分析中，BCBT 在大多数情况下具有成本效益。使用联邦贴现率，与常规治疗相比，DoD 预计每例 BCBT 可节省 15000 至 16630 美元。在最坏的情况下（即假设最合理的 BCBT 效果大小），与常规治疗相比，BCBT 的每位患者额外增加 1910 至 2250 美元。
结果表明，BCBT 可能是一种对现役自杀士兵具有成本效益的干预措施。在评估在整个 DoD 传播 BCBT 的影响时，还需要考虑确保治疗一致性的成本。
