Cost-effectiveness of a primary care treatment program for depression in low-income women in Santiago, Chile
Cost-effectiveness of a primary care treatment program for depression in low-income women in Santiago, Chile
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DOI：
10.1176/appi.ajp.163.8.1379
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发表时间：
2006-08-01
影响因子：
17.7
通讯作者：
Simon, Greg
中科院分区：
文献类型：
--
作者：
Araya, Ricardo;Flynn, Terry;Simon, Greg
目的：作者比较了增量的成本效益的一个阶梯式护理，多成分的程序与通常的治疗抑郁症的妇女在初级保健在圣地亚哥，Chile.Method：一个成本效益研究进行了一个先前的随机对照试验，涉及240名符合条件的妇女与DSM-IV抑郁症谁是从一个连续的样本成年妇女参加初级保健诊所。患者被随机分配到常规护理或由非医疗卫生保健工作者领导的多组分阶梯式护理计划。在3个月和6个月后评估了来自当地的无抑郁天数和医疗保健费用。结果：80%的随机分配患者获得了完整的数据。在我们调整了最初的严重程度后，相对于分配到常规护理的患者，接受阶梯式护理计划的妇女在6个月内平均增加了50天的无抑郁天数。分级护理计划比常规护理稍微贵一些（无抑郁症的一天要多花216智利比索）。有90%的可能性，获得额外的抑郁症免费一天与干预的增量成本不会超过300比索（1.04美元）。结论：阶梯式护理程序是显着更有效的，稍微更昂贵的比通常的治疗抑郁症的妇女在初级保健。改善抑郁症的小投资似乎在较贫穷的环境中产生更大的收益。在发展中国家测试的简单和廉价的治疗方案可能为发达国家提供良好的研究模式。
Objective: The authors compared the incremental cost-effectiveness of a stepped-care, multicomponent program with usual care for the treatment of depressed women in primary care in Santiago, Chile.Method: A cost-effectiveness study was conducted of a previous randomized controlled trial involving 240 eligible women with DSM-IV major depression who were selected from a consecutive sample of adult women attending primary care clinics. The patients were randomly allocated to usual care or a multicomponent stepped-care program led by a nonmedical health care worker. Depression-free days and health care costs derived from local sources were assessed after 3 and 6 months. A health service perspective was used in the economic analysis.Results: Complete data were determined for 80% of the randomly assigned patients. After we adjusted for initial severity, women receiving the stepped-care program had a mean of 50 additional depression-free days over 6 months relative to patients allocated to usual care. The stepped-care program was marginally more expensive than usual care (an extra 216 Chilean pesos per depression-free day). There was a 90% probability that the incremental cost of obtaining an extra depression-free day with the intervention would not exceed 300 pesos ($ 1.04 U.S).Conclusions: The stepped-care program was significantly more effective and marginally more expensive than usual care for the treatment of depressed women in primary care. Small investments to improve depression appear to yield larger gains in poorer environments. Simple and inexpensive treatment programs tested in developing countries might provide good study models for developed countries.