针对神经性厌食症儿童和青少年的专科饮食失调服务的成本效益：一项全国性监测研究。

Cost-effectiveness of specialist eating disorders services for children and adolescents with anorexia nervosa: a national surveillance study.

作者信息

Byford Sarah, Petkova Hristina, Barrett Barbara, Ford Tamsin, Nicholls Dasha, Simic Mima, Gowers Simon, Macdonald Geraldine, Stuart Ruth, Livingstone Nuala, Kelly Grace, Kelly Jonathan, Joshi Kandarp, Smith Helen, Eisler Ivan

机构信息

Institute of Psychiatry, Psychology & Neuroscience at King's College London, PO24 David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK.

Department of Psychiatry, University of Cambridge, Level 5 Clifford Allbutt Building, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0AH, UK.

出版信息

J Eat Disord. 2021 Jun 26;9(1):76. doi: 10.1186/s40337-021-00433-5.

DOI:10.1186/s40337-021-00433-5

PMID:34174952

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8235580/

Abstract

BACKGROUND

Evidence suggests specialist eating disorders services for children and adolescents with anorexia nervosa have the potential to improve outcomes and reduce costs through reduced hospital admissions. This study aimed to evaluate the cost-effectiveness of assessment and diagnosis in community-based specialist child and adolescent mental health services (CAMHS) compared to generic CAMHS for children and adolescents with anorexia nervosa.

METHOD

Observational, surveillance study of children and adolescents aged 8 to 17, in contact with community-based CAMHS in the UK or Republic of Ireland for a first episode of anorexia nervosa. Data were reported by clinicians at baseline, 6 and 12-months follow-up. Outcomes included the Children's Global Assessment Scale (CGAS) and percentage of median expected body mass for age and sex (%mBMI). Service use data included paediatric and psychiatric inpatient admissions, outpatient and day-patient attendances. A joint distribution of incremental mean costs and effects for each group was generated using bootstrapping to explore the probability that each service is the optimal choice, subject to a range of values a decision-maker might be willing to pay for outcome improvements. Uncertainty was explored using cost-effectiveness acceptability curves.

RESULTS

Two hundred ninety-eight children and adolescents met inclusion criteria. At 12-month follow-up, there were no significant differences in total costs or outcomes between specialist eating disorders services and generic CAMHS. However, adjustment for pre-specified baseline covariates resulted in observed differences favouring specialist services, due to significantly poorer clinical status of the specialist group at baseline. Cost-effectiveness analysis using CGAS suggests that the probability of assessment in a specialist service being cost-effective compared to generic CAMHS ranges from 90 to 50%, dependent on willingness to pay for improvements in outcome.

CONCLUSIONS

Assessment in a specialist eating disorders service for children and adolescents with anorexia nervosa may have a higher probability of being cost-effective than assessment in generic CAMHS.

TRIAL REGISTRATION

ISRCTN12676087 . Date of registration 07/01/2014.

摘要

背景

有证据表明，为患有神经性厌食症的儿童和青少年提供的专业饮食失调服务，有潜力通过减少住院次数来改善治疗效果并降低成本。本研究旨在评估社区专业儿童和青少年心理健康服务（CAMHS）对神经性厌食症儿童和青少年进行评估和诊断的成本效益，与普通CAMHS进行比较。

方法

对8至17岁首次患神经性厌食症且与英国或爱尔兰共和国社区CAMHS有接触的儿童和青少年进行观察性监测研究。数据由临床医生在基线、6个月和12个月随访时报告。结果包括儿童总体评估量表（CGAS）以及按年龄和性别计算的预期中位数体重百分比（%mBMI）。服务使用数据包括儿科和精神科住院、门诊和日间住院就诊情况。使用自抽样法生成每组增量平均成本和效果的联合分布，以探讨每种服务成为最优选择的概率，这取决于决策者可能愿意为改善结果支付的一系列价值。使用成本效益可接受性曲线探讨不确定性。

结果

298名儿童和青少年符合纳入标准。在12个月随访时，专业饮食失调服务与普通CAMHS在总成本或结果方面无显著差异。然而，对预先指定的基线协变量进行调整后，由于专业组在基线时临床状况明显较差，观察到有利于专业服务的差异。使用CGAS进行的成本效益分析表明，与普通CAMHS相比，在专业服务中进行评估具有成本效益的概率在90%至50%之间，这取决于为改善结果支付的意愿。