Department of Clinical Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, Assistance Publique - Hôpitaux de Marseille, Marseille, France.
Health Service Research and Quality of Life Center (UR 3279), Aix-Marseille University, School of Medicine, Marseille, France.
Epidemiol Psychiatr Sci. 2023 Apr 25;32:e27. doi: 10.1017/S2045796023000197.
We aimed to assess the cost-effectiveness of psychiatric advance directives (PAD) facilitated by peer workers (PW-PAD) in the management of patients with mental disorders in France.
In a prospective multicentre randomized controlled trial, we randomly assigned adults with a Diagnostic and Statistical Manual of Mental Disorders, fifth edition diagnosis of schizophrenia, bipolar I disorder or schizoaffective disorders, who were compulsorily hospitalized in the past 12 months, to either fill out a PAD form and meet a peer worker for facilitation or receive usual care. We assessed differences in societal costs in euros (€) and quality-adjusted life-years (QALYs) over a year-long follow-up to estimate the incremental cost-effectiveness ratio of the PW-PAD strategy. We conducted multiple sensitivity analyses to assess the robustness of our results.
Among the 394 randomized participants, 196 were assigned to the PW-PAD group and 198 to the control group. Psychiatric inpatient costs were lower in the PW-PAD group than the control group (relative risk, -0.22; 95% confidence interval, [-0.33 to -0.11]; < 0.001), and 1-year cumulative savings were obtained for the PW-PAD group (mean difference, -€4,286 [-4,711 to -4,020]). Twelve months after PW-PAD implementation, we observed improved health utilities (difference, 0.040 [0.003-0.077]; = 0.032). Three deaths occurred. QALYs were higher in the PW-PAD group (difference, 0.045 [0.040-0.046]). In all sensitivity analyses, taking into account sampling uncertainty and unit variable variation, PW-PAD was likely to remain a cost-effective use of resources.
PW-PAD was strictly dominant, that is, less expensive and more effective compared with usual care for people living with mental illness.
我们旨在评估由同伴工作人员（PW-PAD）协助制定的精神科预先指示（PAD）在法国管理精神障碍患者方面的成本效益。
在一项前瞻性多中心随机对照试验中，我们将过去 12 个月内强制住院的精神障碍患者（符合精神疾病诊断与统计手册第五版的精神分裂症、双相 I 障碍或分裂情感障碍诊断）随机分为填写 PAD 表格并与同伴工作人员会面以获得协助或接受常规护理。我们评估了一年随访期间社会成本（欧元）和质量调整生命年（QALY）的差异，以估算 PW-PAD 策略的增量成本效益比。我们进行了多次敏感性分析，以评估我们结果的稳健性。
在 394 名随机参与者中，196 名被分配到 PW-PAD 组，198 名被分配到对照组。PW-PAD 组的精神科住院费用低于对照组（相对风险，-0.22；95%置信区间，[-0.33 至-0.11]；<0.001），PW-PAD 组在 1 年内获得了累计储蓄（平均差异，-4286 欧元[-4711 至-4020 欧元]）。在 PW-PAD 实施 12 个月后，我们观察到健康效用得到了改善（差异，0.040 [0.003-0.077]；=0.032）。有 3 人死亡。PW-PAD 组的 QALYs 更高（差异，0.045 [0.040-0.046]）。在所有敏感性分析中，考虑到抽样不确定性和单位变量变化，PW-PAD 很可能仍然是一种具有成本效益的资源利用方式。
与常规护理相比，PW-PAD 对患有精神疾病的人来说更具成本效益，因为 PW-PAD 更便宜且更有效。
