Economic evaluation of a task-shifting intervention for common mental disorders in India
Economic evaluation of a task-shifting intervention for common mental disorders in India
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DOI：
10.2471/blt.12.104133
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发表时间：
2012-11-01
期刊：
影响因子：
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通讯作者：
Patel, Vikram
中科院分区：
文献类型：
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作者：
Buttorff, Christine;Hock, Rebecca S;Patel, Vikram
目的对印度果阿初级保健机构中任务转移干预治疗抑郁症和焦虑症进行经济学评价。方法在24家公立和私立初级保健机构进行基于广义线性模型的成本效用和成本效果分析。受试者被随机分配到干预组或控制组。在干预组中，符合条件的受试者由非专业卫生工作者进行心理教育、病例管理、人际心理治疗和/或抗抑郁药物。对照组的受试者接受医生的治疗。在2、6和12个月时确定卫生保健资源的使用情况、每个受试者的残疾程度和精神疾病的程度，并从公共和私营部门分别收集1243名(75.4%)和938名(81.7%)的研究机构登记的受试者的完整数据。在公共设施内，干预组的受试者在所调查的所有健康结果方面比对照组的受试者表现出更大的改善。干预组的时间成本也明显低于对照组，而两组的卫生系统成本相似。然而，在私营机构中，两个部门记录的效果和成本是相似的。结论在果阿的公共初级保健设施中，使用非专业卫生工作者护理常见精神障碍患者不仅具有成本效益，而且还节省成本。
Objective To carry out an economic evaluation of a task-shifting intervention for the treatment of depressive and anxiety disorders in primary-care settings in Goa, India.Methods Cost utility and cost effectiveness analyses based on generalized linear models were performed within a trial set in 24 public and private primary-care facilities. Subjects were randomly assigned to an intervention or a control arm. Eligible subjects in the intervention arm were given psycho-education, case management, interpersonal psychotherapy and/or antidepressants by lay health workers. Subjects in the control arm were treated by physicians. The use of health-care resources, the disability of each subject and degree of psychiatric morbidity, as measured by the Revised Clinical Interview Schedule, were determined at 2, 6 and 12 months.Findings Complete data, from all three follow-ups, were collected from 1243 (75.4%) and 938 (81.7%) of the subjects enrolled in the study facilities from the public and private sectors, respectively. Within the public facilities, subjects in the intervention arm showed greater improvement in all the health outcomes investigated than those in the control arm. Time costs were also significantly lower in the intervention arm than in the control arm, whereas health system costs in the two arms were similar. Within the private facilities, however, the effectiveness and costs recorded in the two arms were similar.Conclusion Within public primary-care facilities in Goa, the use of lay health workers in the care of subjects with common mental disorders was not only cost effective but also cost-saving.