Janssen Noortje P, Hendriks Gert-Jan, Sens Renate, Lucassen Peter, Oude Voshaar Richard C, Ekers David, van Marwijk Harm, Spijker Jan, Bosmans Judith E
Behavioural Science Institute, Radboud University, 6525 XZ Nijmegen, the Netherlands; Department of Primary and Community Care, Research Institute of Health Sciences, Radboud University Medical Centre Nijmegen, 6525 EZ Nijmegen, the Netherlands; Institute for Integrated Mental Health Care Pro Persona, 6525 DX Nijmegen, the Netherlands.
Behavioural Science Institute, Radboud University, 6525 XZ Nijmegen, the Netherlands; Institute for Integrated Mental Health Care Pro Persona, 6525 DX Nijmegen, the Netherlands.
J Affect Disord. 2024 Apr 1;350:665-672. doi: 10.1016/j.jad.2024.01.109. Epub 2024 Jan 19.
Depression in older adults is associated with decreased quality of life and increased utilization of healthcare services. Behavioral activation (BA) is an effective treatment for late-life depression, but the cost-effectiveness compared to treatment as usual (TAU) is unknown.
An economic evaluation was performed alongside a cluster randomized controlled multicenter trial including 161 older adults (≥65 years) with moderate to severe depressive symptoms (PHQ-9 ≥ 10). Outcome measures were depression (response on the QIDS-SR), quality-adjusted life-years (QALYs) and societal costs. Missing data were imputed using multiple imputation. Cost and effect differences were estimated using bivariate linear regression models, and statistical uncertainty was estimated with bootstrapping. Cost-effectiveness acceptability curves showed the probability of cost-effectiveness at different ceiling ratios.
Societal costs were statistically non-significantly lower in BA compared to TAU (mean difference (MD) -€485, 95 % CI -3861 to 2792). There were no significant differences in response on the QIDS-SR (MD 0.085, 95 % CI -0.015 to 0.19), and QALYs (MD 0.026, 95 % CI -0.0037 to 0.055). On average, BA was dominant over TAU (i.e., more effective and less expensive), although the probability of dominance was only 0.60 from the societal perspective and 0.85 from the health care perspective for both QIDS-SR response and QALYs.
Although the results suggest that BA is dominant over TAU, there was considerable uncertainty surrounding the cost-effectiveness estimates which precludes firm conclusions.
老年人抑郁症与生活质量下降及医疗服务利用率增加有关。行为激活（BA）是治疗老年抑郁症的一种有效方法，但与常规治疗（TAU）相比，其成本效益尚不清楚。
在一项整群随机对照多中心试验中进行了经济评估，该试验纳入了161名年龄≥65岁、有中度至重度抑郁症状（患者健康问卷-9≥10）的老年人。结局指标包括抑郁（QIDS-SR反应）、质量调整生命年（QALY）和社会成本。使用多重填补法对缺失数据进行填补。使用双变量线性回归模型估计成本和效果差异，并通过自抽样法估计统计不确定性。成本效益可接受性曲线显示了在不同上限比率下成本效益的概率。
与TAU相比，BA的社会成本在统计学上无显著降低（平均差异（MD）-485欧元，95%可信区间-3861至2792）。QIDS-SR反应（MD 0.085，95%可信区间-0.015至0.19）和QALY（MD 0.026，95%可信区间-0.0037至0.055）无显著差异。平均而言，BA优于TAU（即更有效且成本更低），尽管从社会角度看，对于QIDS-SR反应和QALY，优势概率仅为0.60，从医疗角度看为0.85。
尽管结果表明BA优于TAU，但成本效益估计存在相当大的不确定性，这使得无法得出确凿结论。
