Economic evaluation of a dietary intervention for adults with major depression (the "SMILES" trial).
Economic evaluation of a dietary intervention for adults with major depression (the "SMILES" trial).
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DOI：
10.1186/s12889-018-5504-8
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发表时间：
2018-05-22
影响因子：
4.5
通讯作者：
Jacka F
中科院分区：
文献类型：
--
作者：
Chatterton ML;Mihalopoulos C;O'Neil A;Itsiopoulos C;Opie R;Castle D;Dash S;Brazionis L;Berk M;Jacka F
最近，在一项随机对照试验中评估了饮食改善作为中重度抑郁症治疗干预措施的疗效。SMILES试验表明，与对照组相比，饮食支持组在12周内的蒙哥马利-卡斯伯格抑郁量表评分有显著改善。我们使用试验中收集的数据来评估这种新型干预措施的成本效益。在这项前瞻性经济评估中，67名符合DSM-IV标准的重度抑郁发作并报告饮食质量差的成年人被随机分配到7个阶段，由营养师进行饮食支持或强度匹配的社会支持（交友）控制条件。主要结局是通过AQoL-8D测量的质量调整生命年（QOL），在基线和12周随访（终点）评估时完成。从卫生部门和社会的角度对成本进行了评估。提供干预措施所需的时间是使用适用于咨询会议时间的小时工资率计算的。食物和旅行费用也被纳入社会视角。药物，医疗服务，工作场所缺勤和出勤（有偿和无偿）的数据收集从研究参与者使用的资源使用问卷。采用了2013/2014年度澳大利亚标准单位成本。增量成本效果比（ICER）计算为组间平均成本的差异除以平均QER的差异。使用非参数bootstrap程序计算置信区间。与社会支持条件相比，接受饮食支持的人的平均卫生部门总成本低856美元（95% CI -1247至160），平均社会成本低2591美元（95% CI -3591至198）。造成这些差异的原因是，由于联合和其他保健专业人员就诊减少，费用降低，以及无报酬生产力费用降低。两组之间的平均Q值无显著差异。然而，68%和69%的自助迭代显示，从卫生部门和社会角度来看，饮食支持干预占主导地位（以更低的成本增加QALs）。从卫生部门和社会的角度来看，这种新的饮食支持干预可能是一种具有成本效益的抑郁症预防治疗方法。澳大利亚和新西兰临床试验注册中心（ANZCTR）：ACTRN 12612000251820。2012年2月29日登记。本文的在线版本（10.1186/s12889-018-5504-8）包含补充材料，可供授权用户使用。
Recently, the efficacy of dietary improvement as a therapeutic intervention for moderate to severe depression was evaluated in a randomised controlled trial. The SMILES trial demonstrated a significant improvement in Montgomery–Åsberg Depression Rating Scale scores favouring the dietary support group compared with a control group over 12 weeks. We used data collected within the trial to evaluate the cost-effectiveness of this novel intervention. In this prospective economic evaluation, sixty-seven adults meeting DSM-IV criteria for a major depressive episode and reporting poor dietary quality were randomised to either seven sessions with a dietitian for dietary support or to an intensity matched social support (befriending) control condition. The primary outcome was Quality Adjusted Life Years (QALYs) as measured by the AQoL-8D, completed at baseline and 12 week follow-up (endpoint) assessment. Costs were evaluated from health sector and societal perspectives. The time required for intervention delivery was costed using hourly wage rates applied to the time in counselling sessions. Food and travel costs were also included in the societal perspective. Data on medications, medical services, workplace absenteeism and presenteesim (paid and unpaid) were collected from study participants using a resource-use questionnaire. Standard Australian unit costs for 2013/2014 were applied. Incremental cost-effectiveness ratios (ICERs) were calculated as the difference in average costs between groups divided by the difference in average QALYs. Confidence intervals were calculated using a non-parametric bootstrap procedure. Compared with the social support condition, average total health sector costs were $856 lower (95% CI -1247 to − 160) and average societal costs were $2591 lower (95% CI -3591 to − 198) for those receiving dietary support. These differences were driven by lower costs arising from fewer allied and other health professional visits and lower costs of unpaid productivity. Significant differences in mean QALYs were not found between groups. However, 68 and 69% of bootstrap iterations showed the dietary support intervention was dominant (additional QALYs at less cost) from the health sector and societal perspectives. This novel dietary support intervention was found to be likely cost-effective as an adjunctive treatment for depression from both health sector and societal perspectives. Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12612000251820. Registered on 29 February 2012. The online version of this article (10.1186/s12889-018-5504-8) contains supplementary material, which is available to authorized users.
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对重度抑郁症的成年人（“微笑”试验）饮食改善的随机对照试验。
影响因子：
9.3
作者：
Jacka FN;O'Neil A;Opie R;Itsiopoulos C;Cotton S;Mohebbi M;Castle D;Dash S;Mihalopoulos C;Chatterton ML;Brazionis L;Dean OM;Hodge AM;Berk M
通讯作者：
Berk M
影响因子：
4.4
作者：
O'Neil A;Berk M;Itsiopoulos C;Castle D;Opie R;Pizzinga J;Brazionis L;Hodge A;Mihalopoulos C;Chatterton ML;Dean OM;Jacka FN
通讯作者：
Jacka FN
影响因子：
6.7
作者：
Furukawa, T. A.;Noma, H.;Churchill, R.
通讯作者：
Churchill, R.
DOI：
10.1017/s0266462300012095
发表时间：
1998-09-01
影响因子：
3.2
作者：
Jacobs, P;Fassbender, K
通讯作者：
Fassbender, K
DOI：
10.1146/annurev-clinpsy-032210-104601
发表时间：
2011-01-01
影响因子：
18.4
作者：
Mihalopoulos, Cathrine;Vos, Theo;Carter, Rob
通讯作者：
Carter, Rob