Department of Psychiatry and Psychotherapy II, University of Ulm and BKH Günzburg, Ulm, Germany.
Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom.
JAMA Netw Open. 2022 May 2;5(5):e2211489. doi: 10.1001/jamanetworkopen.2022.11489.
The cost-effectiveness of the Self-Help Plus (SH+) program, a group-based, guided, self-help psychological intervention developed by the World Health Organization for people affected by adversity, is unclear.
To investigate the cost-utility of providing the SH+ intervention combined with enhanced usual care vs enhanced usual care alone for Syrian refugees or asylum seekers hosted in Turkey.
DESIGN, SETTING, AND PARTICIPANTS: This economic evaluation was performed as a prespecified part of an assessor-blinded randomized clinical trial conducted between October 1, 2018, and November 30, 2019, with 6-month follow-up. A total of 627 adults with psychological distress but no diagnosed psychiatric disorder were randomly assigned to the intervention group or the enhanced usual care group.
The SH+ program was a 5-session (2 hours each), group-based, stress management course in which participants learned self-help skills for managing stress by listening to audio sessions. The SH+ sessions were facilitated by briefly trained, nonspecialist individuals, and an illustrated book was provided to group members. Th intervention group received the SH+ intervention plus enhanced usual care; the control group received only enhanced usual care from the local health care system. Enhanced usual care included access to free health care services provided by primary and secondary institutions plus details on nongovernmental organizations and freely available mental health services, social services, and community networks for people under temporary protection of Turkey and refugees.
The primary outcome measure was incremental cost per quality-adjusted life-year (QALY) gained from the perspective of the Turkish health care system. An intention-to-treat analysis was used including all participants who were randomized and for whom baseline data on costs and QALYs were available. Data were analyzed September 30, 2020, to July 30, 2021.
Of 627 participants (mean [SD] age, 31.3 [9.0] years; 393 [62.9%] women), 313 were included in the analysis for the SH+ group and 314 in the analysis for the enhanced usual care group. An incremental cost-utility ratio estimate of T£6068 ($1147) per QALY gained was found when the SH+ intervention was provided to groups of 10 Syrian refugees. At a willingness to pay per QALY gained of T£14 831 ($2802), the SH+ intervention had a 97.5% chance of being cost-effective compared with enhanced usual care alone.
This economic evaluation suggests that implementation of the SH+ intervention compared with enhanced usual care alone for adult Syrian refugees or asylum seekers hosted in Turkey is cost-effective from the perspective of the Turkish health care system when both international and country-specific willingness-to-pay thresholds were applied.
世界卫生组织开发的一种基于小组、指导、自助的心理干预措施，名为自助加（SH+）计划，用于帮助受逆境影响的人群，但其成本效益尚不清楚。
研究为在土耳其接待的叙利亚难民或寻求庇护者提供 SH+干预措施联合强化常规护理与仅强化常规护理相比的成本效用。
设计、地点和参与者：这是一项经济评估，作为一项评估者盲法随机临床试验的预设部分进行，该试验于 2018 年 10 月 1 日至 2019 年 11 月 30 日进行，并进行了 6 个月的随访。共有 627 名有心理困扰但无诊断性精神障碍的成年人被随机分配到干预组或强化常规护理组。
SH+计划是一个 5 节（每节 2 小时）的小组式压力管理课程，参与者通过收听音频课程学习自我帮助技能来管理压力。SH+课程由经过简短培训的非专业人员进行，为小组成员提供一本插图书。干预组接受 SH+干预措施联合强化常规护理；对照组仅接受土耳其当地卫生保健系统提供的强化常规护理。强化常规护理包括免费获得初级和二级机构提供的医疗服务，以及有关临时受土耳其保护和难民的非政府组织和免费提供的心理健康服务、社会服务和社区网络的详细信息。
主要结局指标是从土耳其医疗保健系统的角度衡量每获得一个质量调整生命年（QALY）的增量成本。采用意向治疗分析，包括所有接受随机分组且基线成本和 QALY 数据可用的参与者。数据于 2020 年 9 月 30 日至 2021 年 7 月 30 日进行分析。
在 627 名参与者（平均[标准差]年龄 31.3[9.0]岁；393[62.9%]名女性）中，313 名被纳入 SH+组分析，314 名被纳入强化常规护理组分析。当向 10 名叙利亚难民群体提供 SH+干预措施时，增量成本-效用比估计为 T£6068（$1147）/获得的 QALY。在 T£14831（$2802）/获得的 QALY 支付意愿下，SH+干预措施与单独强化常规护理相比，有 97.5%的可能性具有成本效益。
这项经济评估表明，从土耳其医疗保健系统的角度来看，与单独强化常规护理相比，为在土耳其接待的叙利亚难民或寻求庇护者实施 SH+干预措施具有成本效益，当应用国际和国家特定的支付意愿阈值时。
