Department of Psychology the College of Management Academic Studies- Rishon Lezion, Israel.
Clalit Health Services - Jerusalem, Israel.
Psychother Res. 2022 Sep;32(7):874-885. doi: 10.1080/10503307.2022.2032861. Epub 2022 Feb 4.
Previous studies have established a connection between therapy and healthcare cost: an increase in cost prior to therapy and a maintained decrease post therapy. There is, however, a lack of studies examining the combined effects of psychotherapy and pharmacotherapy on healthcare cost.
Healthcare cost was examined quarterly in 1,213 patients (28,776 observations) in a naturalistic longitudinal design. Psychotherapy only was compared to combined treatment and to an addition of psychotherapy to preexisting pharmacotherapy. The comparisons were conducted with a multilevel piecewise model (LMLM) computed for three phases: pre-, during-, and post-therapy.
Significant interactions were found between the contrast comparing preexisting pharmacotherapy to the during-psychotherapy and no-pharmacotherapy groups and the three piecewise variables. The pre-therapy increase was larger for the preexisting-pharmacotherapy group than for the other groups. The during-therapy decrease was larger for the preexisting-pharmacotherapy group than for the other groups. In the post-therapy period, the increase was significant only for the prior-psychiatric-medication group.
Preexisting psychotropic treatment along with an increase in healthcare expenditure may serve as an indication of the need for additional psychotherapy treatment.
先前的研究已经证实了治疗与医疗保健成本之间的关系：治疗前成本增加，治疗后成本持续下降。然而，目前还缺乏研究来检验心理治疗和药物治疗联合对医疗保健成本的影响。
在自然纵向设计中，对 1213 名患者（28776 次观察）进行了季度医疗成本检查。仅进行心理治疗与联合治疗和在预先存在的药物治疗中增加心理治疗进行了比较。使用多水平分段模型（LMLM）对三个阶段进行了计算：治疗前、治疗中和治疗后。
在比较预先存在的药物治疗与治疗期间无药物治疗和无药物治疗组与三个分段变量的对比中，发现了显著的交互作用。预先存在的药物治疗组的治疗前增加幅度大于其他组。预先存在的药物治疗组的治疗期间下降幅度大于其他组。在治疗后期间，仅先前使用精神药物治疗组的增加具有统计学意义。
预先存在的精神药物治疗以及医疗保健支出的增加可能表明需要额外的心理治疗。
