Cost-effectiveness and cost offset of a collaborative care intervention for primary care patients with panic disorder
Cost-effectiveness and cost offset of a collaborative care intervention for primary care patients with panic disorder
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DOI：
10.1001/archpsyc.59.12.1098
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发表时间：
2002-12-01
影响因子：
--
通讯作者：
Cowley, D
中科院分区：
文献类型：
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作者：
Katon, WJ;Roy-Byrne, P;Cowley, D
背景资料：对惊恐障碍患者进行协作护理（CC）干预，增加患者教育，并将精神科医生纳入初级保健，与改善症状和功能结局相关。本报告从支付者的角度评估了惊恐障碍患者的初级保健CC治疗计划的增量成本效益和潜在成本抵消。方法：我们将115名惊恐障碍的初级保健患者随机分配到CC干预组，与常规初级保健相比，CC干预组包括系统的患者教育和约2次现场咨询精神科医生的访问，在3、6、9和12个月时进行临床结局的电话评估。使用的医疗保健服务和成本进行了评估，使用行政数据从初级保健诊所和自我报告data.Results：接受CC的患者经历了平均74.2个以上的无焦虑天在12个月的干预（95%置信区间[CI]，15.8-122.0）。CC干预的增量心理健康成本为205美元（95%CI，-135美元至501美元），抗抑郁药物和门诊心理健康访视的支出解释了干预的额外心理健康成本。总门诊费用为325美元（95%CI，-1460美元至448美元），低于CC比常规护理组。总门诊费用的增量成本效益比为-4美元（95% CI，-23美元至14美元）/无焦虑日。自助分析的结果表明，CC干预占主导地位的概率为0.70（例如，降低成本，提高效率）。对惊恐障碍患者进行CC干预与显著更多的无焦虑天数相关，总门诊费用无显著差异，基于门诊总费用的成本-效果比的分布表明，与常规治疗相比，干预占主导地位的概率为70%。
Background: A collaborative care (CC) intervention for patients with panic disorder that provided increased patient education and integrated a psychiatrist into primary care was associated with improved symptomatic and functional outcomes. This report evaluates the incremental cost-effectiveness and potential cost offset of a CC treatment program for primary care patients with panic disorder from the perspective of the payer.Methods: We randomly assigned 115 primary care patients with panic disorder to a CC intervention that included systematic patient education and approximately 2 visits with an on-site consulting psychiatrist, compared with usual primary care, Telephone assessments of clinical outcomes were performed at 3, 6, 9, and 12 months. Use of health care services and costs were assessed using administrative data from the primary care clinics and self-report data.Results: Patients receiving CC experienced a mean of 74.2 more anxiety-free days during the 12-month intervention (95% confidence interval [CI], 15.8-122.0). The incremental mental health cost of the CC intervention was $205 (95% Cl, -$135 to $501), with the additional mental health costs of the intervention explained by expenditures for antidepressant medication and outpatient mental health visits. Total outpatient cost was $325 (95% Cl, -$1460 to $448) less for the CC than for the usual care group. The incremental cost-effectiveness ratio for total ambulatory cost was -$4 (95% Cl, -$23 to $14) per anxiety-free day. Results of a bootstrap analysis suggested a 0.70 probability that the CC intervention was dominant (eg, lower costs and greater effectiveness).Conclusion: A CC intervention for patients with panic disorder was associated with significantly more anxiety-free days, no significant differences in total outpatient costs, and a distribution of the cost-effectiveness ratio based on total outpatient costs that suggests a 70% probability that the intervention was dominant, compared with usual care.