在初级保健中，对患有抑郁症和躯体共病的人群进行心理教育团体干预的成本效益和成本效用研究。

Cost-effectiveness and cost-utility study of a psychoeducational group intervention for people with depression and physical comorbidity in primary care.

机构信息

Centre d'Atenció Primària Dr. Lluís Sayé, ABS Raval Nord, Institut Català de la Salut, Barcelona, Spain; Línea d'Investigació en Biomedicina, Epidemiologia i Pràctica Clínica Avançada, Facultat de Infermeria, Universitat Rovira i Virgili, Tarragona, Spain.

Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Unitat Docent Multiprofesional, Gerència Territorial Barcelona, Institut Català de la Salut, Barcelona, Spain.

出版信息

Enferm Clin (Engl Ed). 2024 Mar-Apr;34(2):108-119. doi: 10.1016/j.enfcle.2024.03.005. Epub 2024 Mar 18.

DOI:10.1016/j.enfcle.2024.03.005

PMID:38508236

Abstract

OBJECTIVE

To evaluate the cost-effectiveness and cost-utility of a psychoeducational group intervention led by primary care (PC) nurses in relation to customary care to prevent the depression and improve quality of life in patients with physical comorbidity.

DESIGN

Economic evaluation based on data from randomized, multicenter clinical trial with blind response variables and a one-year follow-up, carried in the context of the PSICODEP study.

LOCATION

7 PC teams from Catalonia.

PARTICIPANTS

50 year-old patients with depression and some physical comorbidity: diabetes mellitus type 2, ischemic heart disease, chronic obstructive pulmonary disease, and/or asthma.

INTERVENTION

12 psychoeducational group sessions, 1 per week, led by 2 PC nurses with prior training.

MEASUREMENTS

Effectiveness: depression-free days (DFD) calculated from the BDI-II and quality-adjusted life years (QALYs) from the Euroqol-5D. Direct costs: PC visits, mental health, emergencies and hospitalizations, drugs. Indirect costs: days of temporary disability (TD). The incremental cost-effectiveness ratios (ICER), cost-effectiveness (ΔCost/ΔDLD) and cost-utility (ΔCost/ΔQALY) were estimated.

RESULTS

The study includes 380 patients (intervention group [IG] = 204; control group [CG] = 176). 81.6% women; mean age 68.4 (SD = 8.8). The IG had a higher mean cost of visits, less of hospitalizations and less TD than the CG. The difference in costs between the IG and the CG was -357.95€ (95% CI: -2026.96 to 1311.06) at one year of follow-up. There was a mean of 11.95 (95% CI: -15.98 to 39.88) more DFD in the IG than in the CG. QALYs were similar (difference -0.01, 95% CI -0.04 to 0.05). The ICERs were 29.95€/DLD and 35,795€/QALY.

CONCLUSIONS

Psychoeducational intervention is associated with an improvement in DFD, as well as a reduction in costs at 12 months, although not significantly. QALYs were very similar between groups.

摘要

目的

评估初级保健护士主导的心理教育团体干预与常规护理相比，在预防抑郁和改善躯体共病患者生活质量方面的成本效益和成本效用。

设计

基于随机、多中心临床试验数据的经济评价，该试验采用盲法应答变量和为期一年的随访，在 PSICODEP 研究中进行。

地点

加泰罗尼亚的 7 个初级保健团队。

参与者

年龄>50 岁、患有抑郁症和某些躯体共病的患者：2 型糖尿病、缺血性心脏病、慢性阻塞性肺疾病和/或哮喘。

干预措施

12 次心理教育团体课程，每周 1 次，由经过培训的 2 名初级保健护士主导。

测量

有效性：从 BDI-II 计算无抑郁天数（DFD），从 Euroqol-5D 计算质量调整生命年（QALY）。直接成本：初级保健就诊、心理健康、急诊和住院、药物。间接成本：临时残疾天数（TD）。估计增量成本效益比（ICER）、成本效益（ΔCost/ΔDLD）和成本效用（ΔCost/ΔQALY）。

结果

该研究纳入了 380 名患者（干预组 [IG] = 204 名；对照组 [CG] = 176 名）。81.6%为女性；平均年龄 68.4（SD = 8.8）。IG 的就诊平均费用较高，住院和 TD 较少。IG 和 CG 之间的成本差异为 -357.95 欧元（95%CI：-2026.96 至 1311.06），随访一年。IG 比 CG 平均多 11.95（95%CI：-15.98 至 39.88）个 DFD。QALYs 相似（差异 -0.01，95%CI：-0.04 至 0.05）。ICER 分别为 29.95 欧元/DFD 和 35795 欧元/QALY。