基层医疗中实践团队支持的惊恐障碍和广场恐惧症暴露疗法的成本效益：一项整群随机试验

Cost-effectiveness of Practice Team-Supported Exposure Training for Panic Disorder and Agoraphobia in Primary Care: a Cluster-Randomized Trial.

作者信息

Brettschneider Christian, Gensichen Jochen, Hiller Thomas S, Breitbart Jörg, Schumacher Ulrike, Lukaschek Karoline, Teismann Tobias, Margraf Jürgen, König Hans-Helmut

机构信息

Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Institute of General Practice and Family Medicine, University Hospital of Ludwig-Maximilians-University Munich, Munich, Germany.

出版信息

J Gen Intern Med. 2020 Apr;35(4):1120-1126. doi: 10.1007/s11606-020-05658-9. Epub 2020 Jan 21.

DOI:10.1007/s11606-020-05658-9

PMID:31965532

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7174430/

Abstract

BACKGROUND

Primary care is the main treatment setting for panic disorder and should be supplemented by collaborative care programs. However, shortage of mental health professionals prevents collaborative care programs from being effectively implemented. The PARADISE study showed the efficacy of a self-managed, cognitive-behavioural therapy (CBT)-oriented exposure training for patients with panic disorder with or without agoraphobia in primary care delivered by the family practice team.

OBJECTIVE

To assess the cost-effectiveness of the PARADISE intervention.

DESIGN

Cost-effectiveness analysis from the societal perspective based on data from a cluster-randomized controlled trial over a time horizon of 12 months.

PARTICIPANTS

Four hundred nineteen adult panic disorder patients with or without agoraphobia.

INTERVENTIONS

A self-managed, CBT-oriented exposure training for patients with panic disorder with or without agoraphobia in primary care delivered by the primary care practice team in comparison to routine care.

MAIN MEASURES

Total costs from the societal perspective. Direct costs and disease-specific costs. Quality-adjusted life years based on the EQ-5D-3L. Incremental cost-effectiveness ratios and cost-effectiveness acceptability curves.

KEY RESULTS

Patients in the intervention group caused lower costs (mean, €1017; 95% confidence interval [-€3306; €1272]; p = 0.38) and gained on average more QALY (mean, 0.034 QALY (95% confidence interval [0.005; 0.062]; p = 0.02). Therefore, the intervention dominated the control treatment. The probability of cost-effectiveness of the intervention at a willingness-to-pay margin of €50,000 per QALY was 96%. Results from supplementary analyses considering direct or disease-specific costs instead of total costs showed comparable results.

CONCLUSION

The PARADISE intervention is cost effective. This conclusion is valid for total costs, generic health care (direct) costs, disease-specific health care costs.

TRIAL REGISTRATION

German Clinical Trials Register: DRKS00004386 Current Controlled Trials: ISRCTN64669297.

摘要

背景

初级保健是惊恐障碍的主要治疗场所，应由协作护理计划予以补充。然而，心理健康专业人员的短缺阻碍了协作护理计划的有效实施。PARADISE研究显示了由家庭医疗团队在初级保健中为伴有或不伴有广场恐惧症的惊恐障碍患者提供的自我管理、以认知行为疗法（CBT）为导向的暴露训练的疗效。

目的

评估PARADISE干预措施的成本效益。

设计

基于一项为期12个月的整群随机对照试验的数据，从社会角度进行成本效益分析。

参与者

419名伴有或不伴有广场恐惧症的成年惊恐障碍患者。

干预措施

与常规护理相比，由初级保健实践团队在初级保健中为伴有或不伴有广场恐惧症的惊恐障碍患者提供自我管理、以CBT为导向的暴露训练。

主要测量指标

从社会角度计算的总成本、直接成本和疾病特定成本。基于EQ-5D-3L的质量调整生命年。增量成本效益比和成本效益可接受性曲线。

主要结果

干预组患者的成本较低（均值为1017欧元；95%置信区间[-3306欧元；1272欧元]；p = 0.38），平均获得更多的质量调整生命年（均值为0.034个质量调整生命年（95%置信区间[0.005；0.062]；p = 0.02）。因此，该干预措施优于对照治疗。在每质量调整生命年支付意愿边际为50000欧元时，干预措施具有成本效益的概率为96%。考虑直接成本或疾病特定成本而非总成本的补充分析结果显示了类似的结果。