Preventing Depression in Adults With Subthreshold Depression: Health-Economic Evaluation Alongside a Pragmatic Randomized Controlled Trial of a Web-Based Intervention.
Preventing Depression in Adults With Subthreshold Depression: Health-Economic Evaluation Alongside a Pragmatic Randomized Controlled Trial of a Web-Based Intervention.
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预防阈下抑郁症成人的抑郁症：健康经济学评估以及基于网络干预的务实随机对照试验。
DOI：
10.2196/jmir.6587
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发表时间：
2017-01-04
影响因子：
7.4
通讯作者：
Ebert D
中科院分区：
文献类型：
--
作者：
Buntrock C;Berking M;Smit F;Lehr D;Nobis S;Riper H;Cuijpers P;Ebert D
预防抑郁症的心理干预可能是减轻抑郁症相关负担的一种经济有效的方法。评估基于网络的自助干预预防阈下抑郁症（sD）患者重度抑郁障碍（MDD）的成本效益。一项实用的随机对照试验进行了12个月的随访。参与者是通过一家大型法定健康保险公司和一个开放获取网站从普通人群中招募的。参与者被随机分配到常规护理之外的基于网络的指导自助干预（即，认知行为治疗和由监督的研究生或卫生保健专业人员辅助的问题解决治疗）或常规护理补充基于网络的心理教育（增强常规护理）。在6个月和12个月的随访中，通过电话管理的DSM-IV轴障碍结构化临床访谈，盲法诊断评分者评估无抑郁年（dfy），涵盖之前评估的时期。费用是通过问卷自行评估的。从社会和卫生保健角度测量的成本与DFYs和质量调整生命年（QALYs）有关。总共有406名参与者参加了试验。平均治疗时间为5.84周（SD 4.37）。参与者平均完成了6次训练中的4.93次。干预组获得的dfy明显更多（0.82 vs 0.70）。同样，QALY健康收益有利于干预，但只有在用更敏感的SF-6D测量时才具有统计学意义。每位参与者的增量成本为136欧元（116英镑）。从医疗保健的角度来看，假设支付意愿为20,000欧元（17,000英镑），获得DFY的干预措施具有成本效益的可能性为99%，获得EQ-5D或SF-6D QALY的干预措施具有成本效益的可能性为64%或99%。我们的研究支持推荐网络治疗sD的指南，并补充说，这不仅可以恢复sD患者的健康，还可以降低患重度抑郁症的风险。提供干预措施有可能比加强常规护理更具成本效益，因此可以在更大范围内覆盖社区成员。德国临床试验注册：DRKS00004709；http://www.drks.de/DRKS00004709（由WebCite在http://www.webcitation.org/6kAZVUxy9存档）
Psychological interventions for the prevention of depression might be a cost-effective way to reduce the burden associated with depressive disorders. To evaluate the cost-effectiveness of a Web-based guided self-help intervention to prevent major depressive disorder (MDD) in people with subthreshold depression (sD). A pragmatic randomized controlled trial was conducted with follow-up at 12 months. Participants were recruited from the general population via a large statutory health insurance company and an open access website. Participants were randomized to a Web-based guided self-help intervention (ie, cognitive-behavioral therapy and problem-solving therapy assisted by supervised graduate students or health care professionals) in addition to usual care or to usual care supplemented with Web-based psycho-education (enhanced usual care). Depression-free years (DFYs) were assessed by blinded diagnostic raters using the telephone-administered Structured Clinical Interview for DSM-IV Axis Disorders at 6- and 12-month follow-up, covering the period to the previous assessment. Costs were self-assessed through a questionnaire. Costs measured from a societal and health care perspective were related to DFYs and quality-adjusted life years (QALYs). In total, 406 participants were enrolled in the trial. The mean treatment duration was 5.84 (SD 4.37) weeks. On average, participants completed 4.93 of 6 sessions. Significantly more DFYs were gained in the intervention group (0.82 vs 0.70). Likewise, QALY health gains were in favor of the intervention, but only statistically significant when measured with the more sensitive SF-6D. The incremental per-participant costs were €136 (£116). Taking the health care perspective and assuming a willingness-to-pay of €20,000 (£17,000), the intervention’s likelihood of being cost-effective was 99% for gaining a DFY and 64% or 99% for gaining an EQ-5D or a SF-6D QALY. Our study supports guidelines recommending Web-based treatment for sD and adds that this not only restores health in people with sD, but additionally reduces the risk of developing a MDD. Offering the intervention has an acceptable likelihood of being more cost-effective than enhanced usual care and could therefore reach community members on a wider scale. German Clinical Trials Register: DRKS00004709; http://www.drks.de/DRKS00004709 (Archived by WebCite at http://www.webcitation.org/6kAZVUxy9)