一项针对重度抑郁症患者的混合认知行为疗法随机对照试验的经济学评估。

Economic evaluation alongside a randomized controlled trial of blended cognitive-behavioral therapy for patients suffering from major depressive disorder.

作者信息

Langergaard Astrid, Mathiasen Kim, Søndergaard Jesper, Sørensen Sabrina S, Laursen Sidsel L, Xylander Alexander A P, Lichtenstein Mia B, Ehlers Lars H

机构信息

Danish Center for Healthcare Improvements, Department of Clinical Medicine, Aalborg University, Denmark.

Department of Clinical Research, University of Southern Denmark, Denmark.

出版信息

Internet Interv. 2022 Feb 19;28:100513. doi: 10.1016/j.invent.2022.100513. eCollection 2022 Apr.

DOI:10.1016/j.invent.2022.100513

PMID:35242594

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8886051/

Abstract

OBJECTIVE

This study aimed to investigate the cost-effectiveness of blended cognitive-behavioral therapy (CBT) compared to standard CBT for adult patients suffering from major depressive disorder (MDD).

DESIGN

A cost-utility analysis alongside the randomized controlled ENTER trial.

SETTING

Center for Telepsychiatry, Mental Health Services in the Region of Southern Denmark, Denmark.

PARTICIPANTS

The study included 76 patients suffering from MDD.

INTERVENTIONS

The patients in the intervention group received blended CBT treatment comprising a combination of online modules and face-to-face consultations with a psychologist. The patients in the control group received standard CBT treatment, that is, solely face-to-face consultations with a psychologist. The treatment period was 12 weeks.

OUTCOME MEASURES

Cost-effectiveness was reported as incremental cost-effectiveness ratio. A micro-costing approach was applied to evaluate the savings derived. Changes in quality-adjusted life-years (QALYs) were estimated using the EuroQol 5-Dimensions 5-Levels questionnaire at the baseline and the six-month follow-up.

RESULTS

Data for 74 patients were included in the primary analysis. The adjusted QALY difference between blended CBT and standard CBT was -0.0291 (95% CI: -0.0535 to -0.0047), and the adjusted difference in costs was -£226.32 (95% CI: -300.86 to -151.77). Blended CBT was estimated to have a 6.6% and 3.1% probability of being cost-effective based on thresholds of £20,000 and £30,000.

CONCLUSION

Compared to standard CBT, blended CBT represents a cost-saving but also a loss in QALYs for patients suffering from MDD. However, results should be carefully interpreted, given the small sample size. Future research involving larger replication studies focusing on other aspects of blended CBT with more patient involvement is advised.

TRIAL REGISTRATION NUMBER

ClinicalTrial.gov: S-20150150.

摘要

目的

本研究旨在调查与标准认知行为疗法（CBT）相比，混合认知行为疗法对成年重度抑郁症（MDD）患者的成本效益。

设计

与随机对照的ENTER试验同时进行成本效用分析。

设置

丹麦南丹麦地区远程精神病学中心心理健康服务部。

参与者

该研究纳入了76名患有重度抑郁症的患者。

干预措施

干预组患者接受混合认知行为疗法治疗，包括在线模块和与心理学家面对面咨询相结合。对照组患者接受标准认知行为疗法治疗，即仅与心理学家进行面对面咨询。治疗期为12周。

结果指标

成本效益以增量成本效益比报告。采用微观成本核算方法评估节省的费用。使用欧洲五维度五级问卷在基线和六个月随访时估计质量调整生命年（QALY）的变化。

结果

74名患者的数据纳入了主要分析。混合认知行为疗法与标准认知行为疗法之间调整后的QALY差异为-0.0291（95%可信区间：-0.0535至-0.0047），成本调整差异为-226.32英镑（95%可信区间：-300.86至-151.77）。基于20,000英镑和30,000英镑的阈值，估计混合认知行为疗法具有成本效益的概率分别为6.6%和3.1%。