Wolff N, Helminiak T W, Tebes J K
Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ 08903, USA.
Am J Psychiatry. 1997 Jun;154(6):736-43. doi: 10.1176/ajp.154.6.736.
The authors examined different ways of measuring unit costs and how methodological assumptions can affect the magnitude of cost estimates and the ratio of treatment costs in comparative studies of mental health interventions. Four methodological choices may bias cost estimates: study perspective, definition of the opportunity cost of resources, cost allocation rules, and measurement of service units.
Unit costs for outpatient services, individual therapy, and group therapy were calculated under different assumptions for a single community mental health center (CMHC). Using hypothetical service utilization profiles, the authors used the unit costs to calculate the costs of mental health treatments provided by two programs of the CMHC.
The unit costs for an hour of outpatient services ranged from $108 to $538. The unit costs for an hour of therapy varied by 156%; unit costs were lowest if the management perspective was assumed and highest if the economist perspective was assumed. The ratio of the outpatient costs in the two treatment programs ranged from 0.6 to 1.8.
The potential errors introduced by methodological choices can bias cost-effectiveness findings based on randomized control trials. These errors go undetected because crucial methodological information is not reported.
作者研究了衡量单位成本的不同方法，以及在心理健康干预比较研究中，方法学假设如何影响成本估计的幅度和治疗成本的比率。四种方法学选择可能会使成本估计产生偏差：研究视角、资源机会成本的定义、成本分配规则和服务单位的计量。
针对单个社区心理健康中心（CMHC），在不同假设下计算门诊服务、个体治疗和团体治疗的单位成本。作者利用假设的服务利用概况，使用单位成本来计算CMHC两个项目提供的心理健康治疗成本。
一小时门诊服务的单位成本在108美元至538美元之间。一小时治疗的单位成本相差156%；如果采用管理层视角，单位成本最低；如果采用经济学家视角，单位成本最高。两个治疗项目的门诊成本比率在0.6至1.8之间。
方法学选择所引入的潜在误差可能会使基于随机对照试验的成本效益研究结果产生偏差。由于关键的方法学信息未被报告，这些误差未被发现。
