基层医疗中针对抑郁症患者的护理经理协作护理计划的成本效益：一项实用随机对照试验的12个月经济评估。
Cost-effectiveness of a care manager collaborative care programme for patients with depression in primary care: 12-month economic evaluation of a pragmatic randomised controlled trial.
作者信息
Holst Anna, Labori Frida, Björkelund Cecilia, Hange Dominique, Svenningsson Irene, Petersson Eva-Lisa, Westman Jeanette, Möller Christina, Svensson Mikael
机构信息
Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Allmänmedicin, Box 453, 405 30, Gothenburg, Sweden.
Health Economics and Policy/School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
出版信息
Cost Eff Resour Alloc. 2021 Aug 17;19(1):52. doi: 10.1186/s12962-021-00304-5.
OBJECTIVES
To study the cost-effectiveness of a care manager organization for patients with mild to moderate depression in Swedish primary care in a 12-month perspective.
METHODS
Cost-effectiveness analysis of the care manager organization compared to care as usual (CAU) in a pragmatic cluster randomised controlled trial including 192 individuals in the care manager group and 184 in the CAU group. Cost-effectiveness was assessed from a health care and societal perspectives. Costs were assessed in relation to two different health outcome measures: depression free days (DFDs) and quality adjusted life years (QALYs).
RESULTS
At the 12-month follow-up, patients treated at the intervention Primary Care Centres (PCCs) with a care manager organization had larger health benefits than the group receiving usual care only at control PCCs. Mean QALY per patient was 0.73 (95% CI 0.7; 0.75) in the care manager group compared to 0.70 (95% CI 0.66; 0.73) in the CAU group. Mean DFDs was 203 (95% CI 178; 229) in the care manager group and 155 (95% CI 131; 179) in the CAU group. Further, from a societal perspective, care manager care was associated with a lower cost than care as usual, resulting in a dominant incremental cost-effectiveness ratio (ICER) for both QALYs and DFDs. From a health care perspective care manager care was related to a low cost per QALY (36,500 SEK / €3,379) and DFD (31 SEK/€3).
LIMITATIONS
A limitation is the fact that QALY data was impaired by insufficient EQ-5D data for some patients.
CONCLUSIONS
A care manager organization at the PCC to increase quality of care for patients with mild-moderate depression shows high health benefits, with no decay over time, and high cost-effectiveness both from a health care and a societal perspective. Trial registration details: The trial was registered in ClinicalTrials.com ( https://clinicaltrials.gov/ct2/show/NCT02378272 ) in 02/02/2015 with the registration number NCT02378272. The first patient was enrolled in 11/20/2014.
目的
从12个月的视角研究瑞典初级保健中为轻至中度抑郁症患者设立护理经理组织的成本效益。
方法
在一项实用的整群随机对照试验中，将护理经理组织与常规护理（CAU）进行成本效益分析，护理经理组有192人，CAU组有184人。从医疗保健和社会角度评估成本效益。根据两种不同的健康结果指标评估成本：无抑郁天数（DFDs）和质量调整生命年（QALYs）。
结果
在12个月的随访中，在设有护理经理组织的干预初级保健中心（PCCs）接受治疗的患者，比仅在对照PCCs接受常规护理的组有更大的健康益处。护理经理组每位患者的平均QALY为0.73（95%CI 0.7；0.75），而CAU组为0.70（95%CI 0.66；0.73）。护理经理组的平均DFDs为203（95%CI 178；229），CAU组为155（95%CI 131；179）。此外，从社会角度看，护理经理护理的成本低于常规护理，在QALY和DFDs方面均产生了显著的增量成本效益比（ICER）。从医疗保健角度看，护理经理护理的每QALY成本较低（36,500瑞典克朗/3,379欧元），每DFD成本较低（31瑞典克朗/3欧元）。
局限性
一个局限性是部分患者的EQ-5D数据不足，影响了QALY数据。
结论
初级保健中心设立护理经理组织以提高轻至中度抑郁症患者的护理质量，显示出高健康效益，且不会随时间衰减，从医疗保健和社会角度看均具有高成本效益。试验注册详情：该试验于2015年2月2日在ClinicalTrials.com（https://clinicaltrials.gov/ct2/show/NCT02378272）注册，注册号为NCT02378272。首例患者于2014年11月20日入组。
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