Duevel Juliane Andrea, Hasemann Lena, Peña-Longobardo Luz María, Rodríguez-Sánchez Beatriz, Aranda-Reneo Isaac, Oliva-Moreno Juan, López-Bastida Julio, Greiner Wolfgang
AG 5 - Department of Health Economics and Health Care Management, Bielefeld University, School of Public Health, Universitaetsstrasse 25, 33615, Bielefeld, Germany.
Faculty of Law and Social Sciences, Economic Analysis Department, Research Group in Economics and Health, University of Castilla-La Mancha, Cobertizo San Pedro Mártir, S/N, 45002, Toledo, Spain.
Health Econ Rev. 2020 Sep 22;10(1):32. doi: 10.1186/s13561-020-00288-7.
Depressive disorders are associated with a high burden of disease. However, due to the burden posed by the disease on not only the sufferers, but also on their relatives, there is an ongoing debate about which costs to include and, hence, which perspective should be applied. Therefore, the aim of this paper was to examine whether the change between healthcare payer and societal perspective leads to different conclusions of cost-utility analyses in the case of depression.
A systematic literature search was conducted to identify economic evaluations of interventions in depression, launched on Medline and the Cost-Effectiveness Registry of the Tufts University using a ten-year time horizon (2008-2018). In a two-stepped screening process, cost-utility studies were selected by means of specified inclusion and exclusion criteria. Subsequently, relevant findings was extracted and, if not fully stated, calculated by the authors of this work.
Overall, 53 articles with 92 complete economic evaluations, reporting costs from healthcare payer/provider and societal perspective, were identified. More precisely, 22 estimations (24%) changed their results regarding the cost-effectiveness quadrant when the societal perspective was included. Furthermore, 5% of the ICURs resulted in cost-effectiveness regarding the chosen threshold (2% of them became dominant) when societal costs were included. However, another four estimations (4%) showed the opposite result: these interventions were no longer cost-effective after the inclusion of societal costs.
Summarising the disparities in results and applied methods, the results show that societal costs might alter the conclusions in cost-utility analyses. Hence, the relevance of the perspectives chosen should be taken into account when carrying out an economic evaluation. This systematic review demonstrates that the results of economic evaluations can be affected by different methods available for estimating non-healthcare costs.
抑郁症与沉重的疾病负担相关。然而，由于该疾病不仅给患者本人，也给其亲属带来负担，因此对于应纳入哪些成本以及应采用何种视角存在持续的争论。所以，本文的目的是研究在抑郁症案例中，从医疗保健支付方视角转变为社会视角是否会导致成本效用分析得出不同结论。
进行了一项系统的文献检索，以确定对抑郁症干预措施的经济评估，在Medline和塔夫茨大学成本效益登记处进行检索，时间跨度为十年（2008 - 2018年）。在一个两步筛选过程中，根据指定的纳入和排除标准选择成本效用研究。随后，提取相关结果，若未完全陈述，则由本文作者进行计算。
总体而言，确定了53篇文章，包含92项完整的经济评估，报告了从医疗保健支付方/提供者和社会视角的成本。更确切地说，当纳入社会视角时，22项评估（24%）在成本效益象限方面改变了结果。此外，当纳入社会成本时，5%的增量成本效果比在所选择的阈值方面产生了成本效益（其中2%变为占优）。然而，另外四项评估（4%）显示了相反的结果：纳入社会成本后，这些干预措施不再具有成本效益。
总结结果和应用方法上的差异，结果表明社会成本可能会改变成本效用分析的结论。因此，在进行经济评估时应考虑所选择视角的相关性。这项系统评价表明，经济评估的结果可能会受到可用于估计非医疗保健成本的不同方法的影响。
