Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon.
Department of Psychology, University of Denver, Denver, Colorado.
JAMA Netw Open. 2021 Mar 1;4(3):e211778. doi: 10.1001/jamanetworkopen.2021.1778.
Youth anxiety and depression are common and undertreated. Pediatric transdiagnostic interventions for anxiety and/or depression may be associated with improved access to treatment among youths.
To evaluate the cost-effectiveness of a pediatric transdiagnostic brief behavioral therapy (BBT) program for anxiety and/or depression compared with assisted referral to community outpatient mental health care (ARC).
DESIGN, SETTING, AND PARTICIPANTS: In this economic evaluation, an incremental cost-effectiveness analysis was performed from the societal perspective using data from a randomized clinical trial of youths with full or probable diagnoses of anxiety or depression who were recruited from pediatric clinics in San Diego, California, and Pittsburgh, Pennsylvania. The trial was conducted from October 6, 2010, through December 5, 2014, and this analysis was performed from January 1, 2019, through October 20, 2020.
In the randomized clinical trial, youths were randomized to BBT (n = 95) or ARC (n = 90). The BBT program consisted of 8 to 12 weekly 45-minute sessions of behavioral therapy delivered in pediatric clinics by master's-level therapists. Families randomized to ARC received personalized referrals to mental health care and telephone calls to support access to care.
Anxiety-free days, depression-free days, quality-adjusted life-years (QALYs), and costs based on incremental cost-effectiveness ratios from intake through 32-week follow-up. A cost-effectiveness acceptability curve for QALYs was used to assess the probability that BBT was cost-effective compared with ARC over a range of amounts that a decision-maker might be willing to pay for an additional outcome.
Enrolled patients included 185 youths (mean [SD] age, 11.3 [2.6] years; 107 [57.8%] female; 144 [77.8%] White; and 38 [20.7%] Hispanic). Youths who received BBT experienced significantly more anxiety-free days (difference, 28.63 days; 95% CI, 5.86-50.71 days; P = .01) and QALYs (difference, 0.026; 95% CI, 0.009-0.046; P = .007) compared with youths who received ARC. Youths who received BBT experienced more depression-free days than did youths who received ARC (difference, 10.52 days; 95% CI, -4.50 to 25.76 days; P = .18), but the difference was not statistically significant. The mean incremental cost-effectiveness ratio was -$41 414 per QALY (95% CI, -$220 601 to $11 468). The cost-effectiveness acceptability curve analysis indicated that, at a recommended willingness-to-pay threshold of $50 000 per QALY, the probability that BBT would be cost-effective compared with ARC at 32 weeks was 95.6%.
In this economic evaluation, BBT in primary care was significantly associated with better outcomes and a greater probability of cost-effectiveness at 32 weeks compared with ARC. The findings suggest that transdiagnostic BBT may be associated with improved youth anxiety and functioning at a reasonable cost.
重要性：青少年焦虑和抑郁很常见，但治疗不足。儿科焦虑和/或抑郁的跨诊断干预措施可能与增加青少年获得治疗的机会有关。
目的：评估与社区门诊精神卫生保健辅助转诊（ARC）相比，针对焦虑和/或抑郁的儿科跨诊断简短行为疗法（BBT）方案的成本效益。
设计、地点和参与者：在这项经济评估中，使用来自加利福尼亚州圣地亚哥和宾夕法尼亚州匹兹堡儿科诊所招募的患有全面或可能焦虑或抑郁诊断的青少年的随机临床试验数据，从社会角度进行了增量成本效益分析。该试验于 2010 年 10 月 6 日至 2014 年 12 月 5 日进行，本分析于 2019 年 1 月 1 日至 2020 年 10 月 20 日进行。
干预措施：在随机临床试验中，青少年被随机分配到 BBT（n=95）或 ARC（n=90）。BBT 方案由在儿科诊所由硕士水平的治疗师提供的 8 到 12 次每周 45 分钟的行为治疗组成。随机分配到 ARC 的家庭收到个性化的精神卫生保健转介和电话支持获得护理。
主要结果和措施：焦虑无天、抑郁无天、质量调整生命年（QALY）和基于从摄入到 32 周随访的增量成本效益比的成本。使用 QALY 的成本效益接受曲线来评估 BBT 在一定范围内相对于 ARC 的成本效益，该范围是决策者可能愿意为额外结果支付的金额。
结果：入组患者包括 185 名青少年（平均[SD]年龄 11.3[2.6]岁；107[57.8%]为女性；144[77.8%]为白人；38[20.7%]为西班牙裔）。接受 BBT 的青少年经历的焦虑无天（差异，28.63 天；95%CI，5.86-50.71 天；P=.01）和 QALY（差异，0.026；95%CI，0.009-0.046；P=.007）明显多于接受 ARC 的青少年。接受 BBT 的青少年经历的抑郁无天天数多于接受 ARC 的青少年（差异，10.52 天；95%CI，-4.50 至 25.76 天；P=.18），但差异无统计学意义。平均增量成本效益比为每 QALY 减少 41414 美元（95%CI，-220601 美元至 11468 美元）。成本效益接受曲线分析表明，在推荐的每 QALY 50000 美元的支付意愿阈值下，与 ARC 相比，BBT 在 32 周时具有成本效益的概率为 95.6%。
结论和相关性：在这项经济评估中，与 ARC 相比，初级保健中的跨诊断 BBT 与更好的结果和更高的 32 周成本效益概率显著相关。研究结果表明，跨诊断 BBT 可能以合理的成本与改善青少年焦虑和功能相关。
