针对冠心病患者的抑郁症干预措施——从爱尔兰视角进行的成本效益计算。

Depression interventions for individuals with coronary artery disease - Cost-effectiveness calculations from an Irish perspective.

作者信息

Jabakhanji Samira Barbara, Sorensen Jan, Carney Robert M, Dickens Chris, Dempster Martin, Gallagher Jonathan, Caramlau Isabela, Doyle Frank

机构信息

Healthcare Outcomes Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland.

出版信息

J Psychosom Res. 2022 Apr;155:110747. doi: 10.1016/j.jpsychores.2022.110747. Epub 2022 Jan 31.

DOI:10.1016/j.jpsychores.2022.110747

PMID:35124528

Abstract

BACKGROUND

A substantial proportion of individuals with coronary artery disease experience moderate or severe acute depression that requires treatment. We assessed the cost-effectiveness of four interventions for depression in individuals with coronary artery disease.

METHODS

We assessed effectiveness of pharmacotherapy, psychotherapy, collaborative care and exercise as remission rate after 8 and 26 weeks using estimates from a recent network meta-analysis. The cost assessment included standard doses of antidepressants, contact frequency, and staff time per contact. Unit costs were calculated as health services' purchase price for pharmaceuticals and mid-point staff salaries obtained from the Irish Health Service Executive and validated by clinical staff. Incremental cost-effectiveness ratios were calculated as the incremental costs over incremental remissions compared to usual care. High- and low-cost scenarios and sensitivity analysis were performed with changed contact frequencies, and assuming individual vs. group psychotherapy or exercise.

RESULTS

After 8 weeks, the estimated incremental cost-effectiveness ratio was lowest for group exercise (€526 per remission), followed by pharmacotherapy (€589), individual psychotherapy (€3117) and collaborative care (€4964). After 26 weeks, pharmacotherapy was more cost-effective (€591) than collaborative care (€7203) and individual psychotherapy (€9387); no 26-week assessment for exercise was possible. Sensitivity analysis showed that group psychotherapy could be most cost-effective after 8 weeks (€519) and cost-effective after 26 weeks (€1565); however no group psychotherapy trials were available investigating its effectiveness.

DISCUSSION

Large variation in incremental cost-effectiveness ratios was seen. With the current assumptions, the most cost-effective depression intervention for individuals with coronary artery disease after 8 weeks was group exercise.

摘要

背景

相当一部分冠心病患者经历中度或重度急性抑郁症，需要进行治疗。我们评估了四种针对冠心病患者抑郁症的干预措施的成本效益。

方法

我们使用近期网络荟萃分析的估计值，评估药物治疗、心理治疗、协作护理和运动作为8周和26周后缓解率的有效性。成本评估包括抗抑郁药的标准剂量、接触频率以及每次接触的工作人员时间。单位成本计算为医疗服务机构购买药品的价格以及从爱尔兰卫生服务执行机构获得并经临床工作人员验证的工作人员平均工资。增量成本效益比计算为与常规护理相比，增量缓解情况下的增量成本。采用改变接触频率的方式进行高成本和低成本情景以及敏感性分析，并假设为个体心理治疗或团体心理治疗或运动。

结果

8周后，估计增量成本效益比最低的是团体运动（每缓解一例526欧元），其次是药物治疗（589欧元）、个体心理治疗（3117欧元）和协作护理（4964欧元）。26周后，药物治疗（591欧元）比协作护理（7203欧元）和个体心理治疗（9387欧元）更具成本效益；无法对运动进行26周的评估。敏感性分析表明，团体心理治疗在8周后可能最具成本效益（519欧元），在26周后具有成本效益（1565欧元）；然而，没有可用的团体心理治疗试验来研究其有效性。