The Cost of Illness Associated with Stepped Care for Obsessive-Compulsive Disorder.
The Cost of Illness Associated with Stepped Care for Obsessive-Compulsive Disorder.
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DOI：
10.1016/j.jocrd.2012.12.005
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发表时间：
2013-04-01
影响因子：
1.8
通讯作者：
Tolin DF
中科院分区：
文献类型：
--
作者：
Diefenbach GJ;Tolin DF
强迫症（OCD）的阶梯式护理是一种很有前途的方法，可以提高暴露和反应预防（ERP）的可及性和成本效益。先前的研究表明，与标准的治疗师指导的ERP相比，阶梯式护理的成本更低，这主要是因为大约三分之一的患者对低强度的指导自助（GSH）做出反应。本研究的目的是重新计算阶梯式护理与标准护理的治疗成本，同时还包括疾病成本;定义为与强迫症症状导致的工作、学校和家庭功能障碍相关的成本。结果发现，当疾病的成本被包括在内时，阶梯式护理的成本节省减少到中等效果（d = 0.66）。数据还表明，如果确定了患者与治疗匹配的变量，可能会节省大量成本。探索性分析表明，在未来的GSH治疗结果研究中，注意力问题可能是一个重要的变量，可以作为一个潜在的治疗调节剂进行调查。这些数据强调了在成本效益分析中包括疾病成本的重要性，以及确定预测因素的重要性，这些预测因素将促进匹配的护理，并防止大约三分之二对GSH治疗OCD没有反应的患者出现不必要的治疗延误。
Stepped care for obsessive-compulsive disorders (OCD) is a promising approach for improving the accessibility and cost-effectiveness of exposure and response prevention (ERP). Previous research has shown that stepped care is less costly compared with standard, therapist-directed ERP, owing largely to the roughly one-third of patients who respond to lower intensity guided self-help (GSH). The aim of this study was to recalculate the costs of treatment in stepped versus standard care when also including the cost of illness; defined as costs related to functional disability in work, school, and home functioning attributed to OCD symptoms. It was found that the cost savings of stepped care was reduced to a moderate effect (d = 0.66) when the cost of illness was included. Data also indicated substantial potential cost savings if patient-to-treatment matching variables are identified. Exploratory analyses suggested that problems with attention may be an important variable to investigate as a potential treatment moderator in future GSH treatment outcome research. These data highlight the importance of including the cost of illness in cost-effectiveness analyses, and of identifying predictors that will facilitate matched care and prevent unnecessary treatment delay for the roughly two-thirds of patients who will not respond to GSH for OCD.
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