Coste-efectividad y coste-utilidad de una intervención grupal psicoeducativa para personas con depresión y comorbilidad física en atención primaria

IF 0.7 Q4 NURSING

Enfermeria Clinica Pub Date : 2024-03-01 DOI:10.1016/j.enfcli.2023.12.001

Antonia Raya-Tena , María Isabel Fernández-San-Martín , Jaume Martín-Royo , Marc Casajuana-Closas , María Francisca Jiménez-Herrera

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Abstract

Objective

To evaluate the cost-effectiveness and cost-utility of a psychoeducational group intervention led by primary care (PC) nurses in relation to customary care to prevent the depression and improve quality of life in patients with physical comorbidity.

Design

Economic evaluation based on data from randomized, multicenter clinical trial with blind response variables and a one-year follow-up, carried in the context of the PSICODEP study. Location: 27 PC teams from Catalonia. Participants: > 50 year-old patients with depression and some physical comorbidity: diabetes mellitus type 2, ischemic heart disease, chronic obstructive pulmonary disease, and/or asthma. Intervention: 12 psychoeducational group sessions, 1 per week, led by 2 PC nurses with prior training.

Measurements

Effectiveness: depression-free days (DFD) calculated from the BDI-II and quality-adjusted life years (QALYs) from the Euroqol-5D. Direct costs: PC visits, mental health, emergencies and hospitalizations, drugs. Indirect costs: days of temporary disability (TD). The incremental cost-effectiveness ratios (ICER), cost-effectiveness (ΔCost/ΔDLD) and cost-utility (ΔCost/ΔQALY) were estimated.

Results

The study includes 380 patients (intervention group [IG] = 204; control group [CG] = 176). 81.6% women; mean age 68.4 (SD = 8.8). The IG had a higher mean cost of visits, less of hospitalizations and less TD than the CG. The difference in costs between the IG and the CG was −357.95€ (95% CI: −2026.96 to 1311.06) at one year of follow-up. There was a mean of 11.95 (95% CI: −15.98 to 39.88) more DFD in the IG than in the CG. QALYs were similar (difference −0.01, 95% CI −0.04 to 0.05). The ICERs were 29.95€/DLD and 35,795€/QALY.

Conclusions

Psychoeducational intervention is associated with an improvement in DFD, as well as a reduction in costs at 12 months, although not significantly. QALYs were very similar between groups.

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针对基层医疗机构中抑郁症和躯体并发症患者的心理教育小组干预的成本效益和成本效用

目的评估由初级保健（PC）护士领导的心理教育小组干预的成本效益和成本效用，以及与常规护理的比较，以预防抑郁症并改善有身体合并症的患者的生活质量。设计根据 PSICODEP 研究中进行的随机、多中心临床试验的数据进行经济评估，该试验具有盲反应变量和为期一年的随访。地点：加泰罗尼亚地区的 27 个 PC 小组。参与者：50 岁的抑郁症患者，同时患有某些身体合并症：2 型糖尿病、缺血性心脏病、慢性阻塞性肺病和/或哮喘。干预措施疗效测量：根据 BDI-II 计算的无抑郁天数（DFD）和根据 Euroqol-5D 计算的质量调整生命年（QALYs）。直接成本：PC 访问、精神健康、急诊和住院、药物。间接成本：暂时性残疾（TD）天数。对增量成本效益比（ICER）、成本效益（ΔCost/ΔDLD）和成本效用（ΔCost/ΔQALY）进行了估算。结果该研究包括 380 名患者（干预组 [IG] = 204 人；对照组 [CG] = 176 人）。81.6%为女性；平均年龄为 68.4 岁（SD = 8.8）。与对照组相比，干预组的平均就诊费用更高，住院费用更低，TD 更少。随访一年后，IG 与 CG 的费用差异为-357.95 欧元（95% CI：-2026.96 至 1311.06）。IG 比 CG 的 DFD 平均多 11.95（95% CI：-15.98 至 39.88）。QALY相似（差异为-0.01，95% CI为-0.04至0.05）。ICER为29.95欧元/DLD和35,795欧元/QALY。结论心理教育干预与DFD的改善以及12个月费用的降低有关，但效果并不显著。各组的 QALY 非常相似。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Enfermeria Clinica NURSING-

CiteScore

2.00

自引率

0.00%

发文量

期刊介绍： Enfermería Clínica is a peer-reviewed scientific journal that is a useful and necessary tool for nursing professionals from the different areas of nursing (healthcare, administration, education and research) as well as for healthcare professionals involved in caring for persons, families and the community. It is the only Spanish nursing journal that mainly publishes original research. The aim of the Journal is to promote increased knowledge through the publication of original research and other studies that may help nursing professionals improve their daily practice. This objective is pursued throughout the different sections that comprise the Journal: Original Articles and Short Original Articles, Special Articles, Patient Care and Letters to the Editor. There is also an Evidence-Based Nursing section that includes comments about original articles of special interest written by experts.