Chatterton Mary Lou, Lee Yong Yi, Le Long Khanh-Dao, Nichols Melanie, Berk Michael, Mihalopoulos Cathrine
School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Institute for Health Transformation, Deakin University, Geelong, Australia.
BJPsych Open. 2025 Jul 21;11(4):e156. doi: 10.1192/bjo.2025.10068.
There are few economic evaluations of adjunctive psychosocial therapies for bipolar disorder.
Estimate the cost-utility of in-person psychosocial therapies for adults with bipolar disorder added to treatment as usual (TAU), from an Australian Government perspective.
We developed an economic model, estimating costs in 2021 Australian dollars (A$) and outcomes using quality-adjusted life-years (QALYs) gained and disability-adjusted life-years (DALYs) averted. The model compared psychoeducation, brief psychoeducation, carer psychoeducation, cognitive-behavioural therapy (CBT) and family therapy when added to TAU (i.e. pharmacotherapy) over a year for adults (18-65 years) with bipolar disorder. The relative risk of relapse was sourced from two network meta-analyses and applied to the depressive phase in the base case. Probabilistic sensitivity analysis and one-way sensitivity analyses were conducted, assessing robustness of results.
Carer psychoeducation was preferred in the base case when the willingness-to-pay (WTP) threshold is below A$1000 per QALY gained and A$1500 per DALY averted. Brief psychoeducation was preferred when WTP is between A$1000 and A$300 000 per QALY gained and A$1500 and A$450 000 per DALY averted. Family therapy was only preferred at WTP thresholds above A$300 000 per QALY gained or A$450 000 per DALY averted. In sensitivity analyses, brief psychoeducation was the preferred therapy. Psychoeducation and CBT were dominated (more costly and less effective) in base-case and sensitivity analyses.
Carer and brief psychoeducation were found to be the most cost-effective psychosocial therapies, supporting use as adjunctive treatments for adults with bipolar disorder and their families in Australia.
针对双相情感障碍的辅助心理社会治疗的经济评估较少。
从澳大利亚政府的角度，估计为双相情感障碍成人患者在常规治疗基础上增加面对面心理社会治疗的成本效益。
我们开发了一个经济模型，以2021澳元（A$）估算成本，并使用获得的质量调整生命年（QALY）和避免的伤残调整生命年（DALY）来评估结果。该模型比较了针对18至65岁双相情感障碍成人患者，在一年的常规治疗（即药物治疗）基础上增加心理教育、简短心理教育、照顾者心理教育、认知行为疗法（CBT）和家庭治疗的情况。复发的相对风险来自两项网络荟萃分析，并应用于基础病例的抑郁期。进行了概率敏感性分析和单因素敏感性分析，以评估结果的稳健性。
在基础病例中，当支付意愿（WTP）阈值低于每获得一个QALY 1000澳元以及每避免一个DALY 1500澳元时，照顾者心理教育是首选。当WTP为每获得一个QALY 1000至300000澳元以及每避免一个DALY 1500至450000澳元时，简短心理教育是首选。只有当WTP阈值高于每获得一个QALY 300000澳元或每避免一个DALY 450000澳元时，家庭治疗才是首选。在敏感性分析中，简短心理教育是首选治疗方法。在基础病例和敏感性分析中，心理教育和CBT处于劣势（成本更高且效果更差）。
发现照顾者心理教育和简短心理教育是最具成本效益的心理社会治疗方法，支持将其作为澳大利亚双相情感障碍成人患者及其家庭的辅助治疗方法。
