Hunter Rachael Maree, Vickerstaff Victoria, Poppe Michaela, Strydom Andre, King Michael, Hall Ian, Crabtree Jason, Omar Rumana, Cooper Vivien, Biswas Asit, Hassiotis Angela
Associate Professor, Research Department of Primary Care and Population Health, University College London, UK.
Senior Research Fellow, PRIMENT Clinical Trials Unit, University College London, UK.
BJPsych Open. 2020 Feb 5;6(2):e15. doi: 10.1192/bjo.2020.1.
Behaviour that challenges in people with intellectual disability is associated with higher healthcare, social care and societal costs. Although behavioural therapies are widely used, there is limited evidence regarding the cost and quality-adjusted life-years (QALYs).
We aimed to assess the incremental cost per QALY gained of therapist training in positive behaviour support (PBS) and treatment as usual (TAU) compared with TAU using data from a cluster randomised controlled trial (Clinical Trials.gov registration: NCT01680276).
We conducted a cost-utility analysis (cost per QALY gained) of 23 teams randomised to PBS or TAU, with a total of 246 participants followed up over 36 months. The primary analysis was from a healthcare cost perspective with a secondary analysis from a societal cost perspective.
Over 36 months the intervention resulted in an additional 0.175 QALYs (discounted and adjusted 95% CI -0.068 to 0.418). The total cost of training in and delivery of PBS is £1598 per participant plus an additional cost of healthcare of £399 (discounted and adjusted 95% CI -603 to 1724). From a healthcare cost perspective there is an 85% probability that the intervention is cost-effective compared with TAU at a £30 000 willingness to pay for a QALY threshold.
There was a high probability that training in PBS is cost-effective as the cost of training and delivery of PBS is balanced out by modest improvements in quality of life. However, staff training in PBS is not supported given we found no evidence for clinical effectiveness.
智力残疾者的挑战性行为会带来更高的医疗、社会护理和社会成本。尽管行为疗法被广泛使用，但关于成本和质量调整生命年（QALY）的证据有限。
我们旨在利用一项整群随机对照试验的数据（临床试验.gov注册号：NCT01680276），评估与常规治疗（TAU）相比，治疗师接受积极行为支持（PBS）培训加TAU的每获得一个QALY的增量成本。
我们对23个随机分为PBS组或TAU组的团队进行了成本效用分析（每获得一个QALY的成本），共有246名参与者随访36个月。主要分析从医疗成本角度进行，次要分析从社会成本角度进行。
在36个月内，干预措施带来了额外的0.175个QALY（贴现并调整后的95%置信区间为-0.068至0.418）。PBS培训和实施的总成本为每位参与者1598英镑，外加399英镑的医疗额外成本（贴现并调整后的95%置信区间为-603至1724）。从医疗成本角度来看，在愿意为一个QALY阈值支付30000英镑的情况下，与TAU相比，干预措施具有成本效益的概率为85%。
PBS培训很有可能具有成本效益，因为PBS培训和实施的成本因生活质量的适度改善而得到平衡。然而，鉴于我们没有发现临床有效性的证据，PBS的员工培训不被支持。
