Department of Health Sciences, Brunel University London, Uxbridge, UK
Department of Health Sciences, Brunel University London, Uxbridge, UK.
BMJ Open. 2023 Feb 28;13(2):e069270. doi: 10.1136/bmjopen-2022-069270.
Economic evaluations of interventions for people with mental-physical multimorbidity, including a depressive disorder, are sparse. This study examines whether such interventions in adults are cost-effective.
A systematic review.
MEDLINE, CINAHL Plus, PsycINFO, Cochrane CENTRAL, Scopus, Web of Science and NHS EED databases were searched until 5 March 2022.
We included studies involving people aged ≥18 with two or more chronic conditions (one being a depressive disorder). Economic evaluation studies that compared costs and outcomes of interventions were included, and those that assessed only costs or effects were excluded.
Two authors independently assessed risk of bias in included studies using recommended checklists. A narrative analysis of the characteristics and results by type of intervention and levels of healthcare provision was conducted.
A total of 19 studies, all undertaken in high-income countries, met inclusion criteria. Four intervention types were reported: collaborative care, self-management, telephone-based and antidepressant treatment. Most (14 of 19) interventions were implemented at the organisational level and were potentially cost-effective, particularly, the collaborative care for people with depressive disorder and diabetes, comorbid major depression and cancer and depression and multiple long-term conditions. Cost-effectiveness ranged from £206 per quality-adjusted life year (QALY) for collaborative care programmes for older adults with diabetes and depression at primary care clinics (USA) to £79 723 per QALY for combining collaborative care with improved opportunistic screening for adults with depressive disorder and diabetes (England). Conclusions on cost-effectiveness were constrained by methodological aspects of the included studies: choice of perspectives, time horizon and costing methods.
Economic evaluations of interventions to manage multimorbidity with a depressive disorder are non-existent in low-income and middle-income countries. The design and reporting of future economic evaluations must improve to provide robust conclusions.
CRD42022302036.
针对患有精神-躯体共病（包括抑郁症）的人群的干预措施的经济评估较为匮乏。本研究旨在评估此类干预措施对成年人是否具有成本效益。
系统综述。
截至 2022 年 3 月 5 日，我们检索了 MEDLINE、CINAHL Plus、PsycINFO、Cochrane 中心数据库、Scopus、Web of Science 和 NHS EED 数据库。
纳入研究对象为年龄≥18 岁且患有两种或两种以上慢性疾病（其中一种为抑郁症）的成年人。我们纳入了比较干预措施成本和效果的经济评估研究，排除了仅评估成本或效果的研究。
两位作者使用推荐的清单独立评估了纳入研究的偏倚风险。根据干预类型和医疗保健提供水平对特征和结果进行了叙述性分析。
共有 19 项研究符合纳入标准，均在高收入国家开展。报告了 4 种干预类型：协作式护理、自我管理、电话式和抗抑郁治疗。大多数（19 项研究中的 14 项）干预措施在组织层面实施，具有潜在的成本效益，特别是针对糖尿病和抑郁症老年患者的协作式护理、癌症合并重度抑郁症和多种长期疾病患者的协作式护理。成本效益比从美国初级保健诊所针对糖尿病和抑郁症老年患者的协作式护理方案每获得 1 个质量调整生命年（QALY）的成本为 206 英镑，到英国针对合并糖尿病和抑郁症患者的协作式护理方案联合改进机会性筛查的每获得 1 个 QALY 的成本为 79723 英镑不等。纳入研究的方法学方面限制了成本效益的结论：观点选择、时间范围和成本计算方法。
在低收入和中等收入国家，针对伴有抑郁症的共病患者的干预措施的经济评估尚属空白。未来经济评估的设计和报告必须改进，以提供可靠的结论。
PROSPERO 注册号：CRD42022302036。
