Revicki D A, Simon G E, Chan K, Katon W, Heiligenstein J
Center for Health Outcomes Research, MEDTAP International, Bethesda, MD 20814-4805, USA.
J Fam Pract. 1998 Dec;47(6):446-52.
We evaluated depression severity, health-related quality of life (HRQL), and medical cost outcomes of primary care patients receiving recommended and less-than-recommended levels of antidepressant treatment.
We performed a secondary analysis of clinical trial data from primary care clinics in a staff-model managed care organization. The trial included patients with Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R) criteria for major depression who were starting antidepressant treatment. The primary outcomes measures used were the 17-item Hamilton Depression Rating Scale (HDRS), Hopkins Symptom Checklist depression scores, the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) mental and physical component summary scores, and the total outpatient and inpatient medical costs.
Of 358 patients starting antidepressant treatment, 195 (54.5%) received doses recommended by the Agency for Health Care Policy and Research for 90 days or more. Mean HDRS score decreased from 14.1 to 8.8 in patients receiving less-than-recommended treatment and decreased from 13.8 to 8.9 in patients with minimum recommended treatment (P = .761). No significant differences in improvement of HRQL outcomes during 6 months were observed between patients receiving recommended or less-than-recommended antidepressant therapy. Mean total medical costs over 6 months for patients taking the recommended levels of antidepressant treatment were $1872 +/- 140 compared with $2622 +/- 413 for patients taking less-than-recommended treatment (P = .032). The differences in total medical costs were attributable to significantly lower nonmental health-related inpatient costs in the recommended antidepressant treatment group ($104 vs $785, P = .004).
Patients receiving minimum recommended levels of antidepressant therapy for 3 months showed improvement in depression severity and HRQL comparable with patients receiving less-than-recommended treatment. Patients receiving minimum recommended treatment had lower total costs and nonmental health-related inpatient costs. Antidepressant treatment in primary care patients may have the greatest impact on the frequency of health care visits and on costs for medical conditions and impairments.
我们评估了接受推荐剂量及低于推荐剂量抗抑郁治疗的初级保健患者的抑郁严重程度、健康相关生活质量（HRQL）和医疗费用结果。
我们对一家员工模式管理式医疗组织中初级保健诊所的临床试验数据进行了二次分析。该试验纳入了符合《精神疾病诊断与统计手册》第三版修订版（DSM-III-R）重度抑郁标准且开始接受抗抑郁治疗的患者。所使用的主要结局指标包括17项汉密尔顿抑郁评定量表（HDRS）、霍普金斯症状清单抑郁得分、医学结局研究36项简短健康调查（SF-36）心理和身体成分汇总得分，以及门诊和住院医疗总费用。
在358名开始接受抗抑郁治疗的患者中，195名（54.5%）接受了医疗保健政策与研究机构推荐的剂量达90天或更长时间。接受低于推荐治疗的患者，其平均HDRS得分从14.1降至8.8；接受最低推荐治疗的患者，其平均HDRS得分从13.8降至8.9（P = 0.761）。在6个月期间，接受推荐或低于推荐剂量抗抑郁治疗的患者在HRQL结局改善方面未观察到显著差异。接受推荐剂量抗抑郁治疗的患者6个月的平均医疗总费用为1872美元±140美元，而接受低于推荐剂量治疗的患者为2622美元±413美元（P = 0.032）。总医疗费用的差异归因于推荐抗抑郁治疗组中非心理健康相关住院费用显著更低（104美元对785美元，P = 0.004）。
接受最低推荐剂量抗抑郁治疗3个月的患者，其抑郁严重程度和HRQL的改善情况与接受低于推荐剂量治疗的患者相当。接受最低推荐治疗的患者总费用及非心理健康相关住院费用更低。初级保健患者的抗抑郁治疗可能对医疗就诊频率以及医疗状况和损伤的费用产生最大影响。
