首发精神病患者认知增强干预措施的成本效用：一项自然主义评估。
Cost Utility of cognition-enhancing interventions for individuals with first-episode psychosis: a naturalistic evaluation.
作者信息
Breitborde Nicholas J K, Bell Emily K, Woolverton Cindy, Pine Jacob G, Waslter Heather, Moe Aubrey M
机构信息
Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, USA.
Department of Psychology, The Ohio State University, Columbus, USA.
出版信息
Cost Eff Resour Alloc. 2021 Jul 1;19(1):36. doi: 10.1186/s12962-021-00292-6.
BACKGROUND
Although effective treatments are available to address the cognitive deficits experienced by individuals with first-episode psychosis, provision of such treatments within Coordinated Specialty Care (CSC) programs is rare. One factor that may contribute to this is uncertainty about the cost implications of providing cognitive-enhancing treatments within the American mental healthcare system. The aim of this study is to complete a naturalistic evaluation of the cost utility of incorporating two different cognitive-enhancing interventions within an American CSC program.
METHODS
Participants included 66, predominately white (75.38%), individuals with first-episode psychosis (19 women and 47 men) with a mean age of 22.71 years. Quality adjusted life years (QALYs) and cost of care were tracked among these individuals during their participation in a CSC program. These data were compared among three groups of participants during their first six months of care: (i) individuals who participated in metacognitive remediation therapy (MCR), (ii) individuals who participated in computerized cognitive remediation (CCR), and (iii) individuals who participated in no cognitive-enhancing intervention.
RESULTS
Participation in MCR, but not CCR, was associated with larger gains in QALYs than participation in no cognitive-enhancing intervention within a CSC program. Moreover, data support the cost utility of MCR as compared to CCR or no-cognitive enhancing intervention within a CSC program. Conversely, CCR did not appear to be a cost-effective addition to CSC services.
CONCLUSIONS
Our results highlight the potential cost utility of incorporating MCR within CSC programs for individuals with first-episode psychosis. However, given study limitations, these results should be interpreted cautiously until replicated by large, randomized controlled trials. Trial Registration ClinicalTrials.gov Identifier NCT01570972, registered April 4, 2012, Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT01570972?term=breitborde&draw=2&rank=6 .
背景
尽管有有效的治疗方法可用于解决首发精神病患者所经历的认知缺陷，但在协调专科护理（CSC）项目中提供此类治疗的情况却很少见。造成这种情况的一个因素可能是，在美国精神卫生保健系统中提供认知增强治疗的成本影响存在不确定性。本研究的目的是对在美国CSC项目中纳入两种不同的认知增强干预措施的成本效用进行自然主义评估。
方法
参与者包括66名首发精神病患者（19名女性和47名男性），主要为白人（75.38%），平均年龄22.71岁。在这些个体参与CSC项目期间，对其质量调整生命年（QALYs）和护理成本进行跟踪。在护理的前六个月期间，对三组参与者的数据进行了比较：（i）参加元认知补救疗法（MCR）的个体；（ii）参加计算机化认知补救（CCR）的个体；（iii）未参加认知增强干预的个体。
结果
与在CSC项目中未参加认知增强干预相比，参加MCR而非CCR与更大的QALYs增益相关。此外，数据支持在CSC项目中，MCR与CCR或无认知增强干预相比的成本效用。相反，CCR似乎并不是CSC服务中具有成本效益的补充。
结论
我们的结果突出了在CSC项目中为首发精神病患者纳入MCR的潜在成本效用。然而，鉴于研究的局限性，在大型随机对照试验进行重复验证之前，这些结果应谨慎解释。试验注册ClinicalTrials.gov标识符NCT01570972，于2012年4月4日注册，追溯注册，https://clinicaltrials.gov/ct2/show/NCT01570972?term=breitborde&draw=2&rank=6 。
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