A cost-effectiveness analysis of cognitive behavior therapy and fluoxetine (prozac) in the treatment of depression
A cost-effectiveness analysis of cognitive behavior therapy and fluoxetine (prozac) in the treatment of depression
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DOI：
10.1016/s0005-7894(97)80043-3
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发表时间：
1997-03-01
期刊：
影响因子：
3.7
通讯作者：
Danton, WG
中科院分区：
文献类型：
--
作者：
Antonuccio, DO;Thomas, M;Danton, WG
抑郁症每年至少影响1100万美国人，并且估计每年给美国经济造成440亿美元的损失。对现有科学证据的综合综述表明，心理治疗，尤其是认知行为疗法（CBT），在治疗抑郁症方面即使是针对重度抑郁症，其效果至少与药物治疗相同（安东尼西奥、丹顿和德内尔斯基，1995年）。这些结论适用于植物性症状和社会适应症状，尤其是当使用患者自评的测量方法并考虑长期随访时。此外，几项有长期随访的严格对照研究（埃文斯等人，1992年；谢伊等人，1992年；西蒙斯、墨菲、莱文和韦策尔，1986年）表明，在预防复发方面，认知行为疗法可能比药物治疗更有效。心理治疗对抑郁症的相对有效性，尤其是认知行为疗法，已被精神病学（霍伦、谢尔顿和卢森，1991年；韦克斯勒和奇凯蒂，1992年）和心理学杂志（多布森，1989年；罗宾逊、伯曼和内迈耶，1990年；斯坦布鲁克、麦克斯韦和霍华德，1983年）上报道的元分析所强化。在管理式医疗的时代，有效是不够的；治疗必须具有成本效益。本文将结果研究作为单相抑郁症治疗中药物和心理治疗成本效益比较的基础。分析表明，在两年期间，仅氟西汀可能导致比个体认知行为疗法治疗预期成本高33%，联合治疗可能导致比单独使用认知行为疗法成本高23%。补充分析表明，与个体治疗相比，团体认知行为疗法可能仅节省2%（596美元）的成本。
Depression affects at least 11 million Americans per year and costs the U.S. economy an estimated 44 billion dollars annually. Comprehensive review of the existing scientific evidence suggests that psychotherapy, particularly cognitive behavior therapy (CBT), is at least as effective as medication in the treatment of depression, even if severe (Antonuccio, Danton, & DeNelsky, 1995). These conclusions hold for both vegetative and social adjustment symptoms, especially when patient-rated measures are used and long-term follow-up is considered. In addition, several well-controlled studies with long-term follow-up (Evans et al., 1992; Shea et al., 1992; Simons, Murphy, Levine, & Wetzel, 1986) suggest that CBT may be more effective than drug treatment at preventing relapse. The relative effectiveness of psychotherapy for depression, particularly CBT, has been reinforced by meta-analyses reported in both psychiatry (Hollon, Shelton, & Loosen, 1991; Wexler & Cicchetti, 1992) and psychology journals (Dobson, 1989; Robinson, Berman, & Neimeyer, 1990; Steinbrueck, Maxwell, & Howard, 1983). In the era of managed care, it is not enough to be effective; treatments must be cost-effective. This paper considers the outcome studies as the basis for a cost-effectiveness comparison of drugs and psychotherapy in the treatment of unipolar depression. The analysis shows that over a 2-year period, fluoxetine alone may result in 33% higher expected costs than individual CBT treatment and the combination treatment may result in 23% higher costs than CBT alone. Supplemental analysis shows that group CBT may only result in a 2% ($596) cost savings as compared to individual treatment.