Deenik Jeroen, van Lieshout Chris, van Driel Harold F, Frederix Geert W J, Hendriksen Ingrid J M, van Harten Peter N, Tenback Diederik E
Scientific Research Department, GGz Centraal, Amersfoort, The Netherlands.
School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
Schizophr Bull Open. 2022 Feb 23;3(1):sgac022. doi: 10.1093/schizbullopen/sgac022. eCollection 2022 Jan.
Economic evaluations of lifestyle interventions for people with mental illness are needed to inform policymakers and managers about implementing such interventions and corresponding reforms in routine mental healthcare. We aimed to evaluate changes in healthcare costs 18 months after the implementation of a multidisciplinary lifestyle-enhancing treatment for inpatients with severe mental illness (MULTI) versus treatment as usual (TAU). In a cohort study ( = 114; 65 MULTI, 49 TAU), we retrospectively retrieved cost data in Euros on all patient sessions, ward stay, medication use, and hospital referrals in the quarter year at the start of MULTI (Q1 2014) and after its evaluation (Q3 2015). We used linear regression analyses correcting for baseline values and differences between groups, calculated deterministic incremental cost-effectiveness ratios for previously shown changes in physical activity, metabolic health, psychosocial functioning, and additionally quality of life, and performed probabilistic sensitivity analyses including cost-effectiveness planes. Adjusted regression showed reduced total costs per patient per quarter year in favor of MULTI (B = -736.30, 95%CI: -2145.2 to 672.6). Corresponding probabilistic sensitivity analyses accounting for uncertainty surrounding the parameters showed statistically non-significant cost savings against health improvements for all health-related outcomes in MULTI compared to TAU. It is concluded that MULTI did not increase healthcare costs while improving health outcomes. This indicates that starting lifestyle interventions does not need to be hampered by costs. Potential societal and economic value may justify investment to support implementation and maintenance. Further research is needed to study this hypothesis.
需要对针对精神疾病患者的生活方式干预措施进行经济评估，以便为政策制定者和管理人员提供信息，使其了解在常规精神卫生保健中实施此类干预措施及相应改革的情况。我们旨在评估对重度精神疾病住院患者实施多学科生活方式强化治疗（MULTI）与常规治疗（TAU）18个月后医疗费用的变化。在一项队列研究中（n = 114；65例接受MULTI治疗，49例接受TAU治疗），我们回顾性检索了以欧元计的成本数据，这些数据涉及MULTI开始时（2014年第一季度）及其评估后（2015年第三季度）这两个季度中所有患者的诊疗、病房停留、药物使用和医院转诊情况。我们使用线性回归分析对基线值和组间差异进行校正，针对先前显示的身体活动、代谢健康、心理社会功能以及生活质量的变化计算确定性增量成本效益比，并进行包括成本效益平面在内的概率敏感性分析。校正后的回归显示，支持MULTI治疗的每季度每位患者的总成本有所降低（B = -736.30，95%CI：-2145.2至672.6）。考虑到参数周围不确定性的相应概率敏感性分析表明，与TAU相比，MULTI在所有与健康相关的结果方面，相对于健康改善而言，成本节约在统计学上并不显著。得出的结论是，MULTI在改善健康结果的同时并未增加医疗费用。这表明启动生活方式干预措施无需受到成本的阻碍。潜在的社会和经济价值可能证明投资支持实施和维持是合理的。需要进一步的研究来验证这一假设。
