Von Korff M, Katon W, Bush T, Lin E H, Simon G E, Saunders K, Ludman E, Walker E, Unutzer J
Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, WA 98101, USA.
Psychosom Med. 1998 Mar-Apr;60(2):143-9. doi: 10.1097/00006842-199803000-00005.
The report estimates the treatment costs, cost-offset effects, and cost-effectiveness of Collaborative Care of depressive illness in primary care.
Treatment costs, cost-offset effects, and cost-effectiveness were assessed in two randomized, controlled trials. In the first randomized trail (N = 217), consulting psychiatrists provide enhanced management of pharmacotherapy and brief psychoeducational interventions to enhance adherence. In the second randomized trial (N = 153). Collaborative Care was implemented through brief cognitive-behavioral therapy and enhanced patient education. Consulting psychologist provided brief psychotherapy supplemented by educational materials and enhanced pharmacotherapy management.
Collaborative Care increased the costs of treating depression largely because of the extra visits required to provide the interventions. There was a modest cost offset due to reduced use of specialty mental health services among Collaborative Care patients, but costs of ambulatory medical care services did not differ significantly between the intervention and control groups. Among patients with major depression there was a modest increase in cost-effectiveness. The cost per patient successfully treated was lower for Collaborative Care than for Usual Care patients. For patients with minor depression. Collaborative Care was more costly and not more cost-effective than Usual Care.
Collaborative Care increased depression treatment costs and improved the cost-effectiveness of treatment for patients with major depression. A cost offset in specialty mental health costs, but not medical care costs, was observed. Collaborative Care may provide a means of increasing the value of treatment services for major depression.
本报告估计了初级保健中抑郁症协作护理的治疗成本、成本抵消效应和成本效益。
在两项随机对照试验中评估了治疗成本、成本抵消效应和成本效益。在第一项随机试验（N = 217）中，咨询精神科医生加强了药物治疗管理并进行简短的心理教育干预以提高依从性。在第二项随机试验（N = 153）中，通过简短的认知行为疗法和加强患者教育实施协作护理。咨询心理学家提供简短的心理治疗，并辅以教育材料和加强药物治疗管理。
协作护理增加了抑郁症的治疗成本，主要是因为提供干预措施需要额外就诊。协作护理患者中专科心理健康服务使用减少，从而产生了适度的成本抵消，但干预组和对照组之间门诊医疗服务成本没有显著差异。在重度抑郁症患者中，成本效益有适度提高。协作护理成功治疗每位患者的成本低于常规护理患者。对于轻度抑郁症患者，协作护理比常规护理成本更高且成本效益不更高。
协作护理增加了抑郁症治疗成本，并提高了重度抑郁症患者治疗的成本效益。观察到专科心理健康成本有成本抵消，但医疗护理成本没有。协作护理可能提供一种提高重度抑郁症治疗服务价值的方法。
