扩大氯胺酮治疗难治性抑郁症的影响分析。

IF 1.9 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES
Thanh Lu, Sophia D'Angelo, Zohra Tayebali, Matthew Dempsey, Kristen Giombi, Olga Khavjou
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引用次数: 0

摘要

目的:本研究旨在通过向美国非精神病性治疗难治性抑郁症(TRD)和中重度抑郁症患者静脉注射氯胺酮,评估相对于电休克治疗(ECT)扩大氯胺酮可及性的经济影响。材料和方法:使用随机试验的关键参数的人口水平马尔可夫模拟模型来模拟静脉注射氯胺酮与ECT治疗TRD在5年内的经济影响。健康状态包括急性治疗期的抑郁反应和维持期的持续治疗和复发。该模型从患者、护理人员、付款人和社会的角度估计了与医疗保健利用(直接成本)和时间损失(间接成本)相关的成本。采用单向敏感性、概率敏感性和情景分析评估模型不确定性。结果:在第一年,我们的模型纳入了35万名符合条件的患者。在第2年至第5年,我们的模型每年增加11,296名符合条件的患者。扩大氯胺酮的可及性以管理TRD,预计将使第一年接受治疗的患者人数增加75,000名,随后每年增加4292名患者。在5年的时间里,扩大氯胺酮的可及性将使社会每年净节省8.282亿美元(患者节省9530万美元,付款人节省7.437亿美元)。然而,扩大氯胺酮的使用将给护理人员每年带来1080万美元的额外负担。结论:对于美国TRD合并中重度抑郁症患者,氯胺酮可能是改善抑郁症状的一种优于ECT的治疗方法。扩大氯胺酮治疗的可及性将为患者、付款人和社会带来净节省。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Impact analysis of expanded access to ketamine for treatment-resistant depression.

Aim: This study aimed to estimate the economic impacts of expanded access to ketamine relative to electroconvulsive therapy (ECT) by offering intravenous ketamine to US patients with nonpsychotic treatment-resistant depression (TRD) and moderate-to-severe depression. Materials & methods: A population-level Markov simulation model with key parameters from a randomized trial was used to simulate the economic impacts of managing TRD with intravenous ketamine versus ECT over a 5-year horizon. Health states included response of depression in the acute treatment phase and continued treatment and relapse in the maintenance phase. The model estimated costs associated with healthcare utilization (direct costs) and time loss (indirect costs) from patient, caregiver, payer and societal perspectives. Model uncertainty was assessed with one-way sensitivity, probabilistic sensitivity and scenario analyses. Results: In year 1, our model included 350,000 eligible patients. In years 2 through 5, our model added 11,296 eligible patients annually. Expanded access to ketamine to manage TRD was projected to increase the number of patients receiving treatment by 75,000 patients in year 1 and 4292 patients annually in subsequent years. Over 5 years, expanded access to ketamine would result in a net positive societal savings of $828.2 million annually ($95.3 million to patients and $743.7 million to payers). However, expanded ketamine access would impose an additional $10.8 million burden on caregiver time annually. Conclusion: For US patients with TRD and moderate-to-severe depression, ketamine may be a noninferior treatment relative to ECT to improve depression symptoms. Expanded access to ketamine treatment would result in net savings to the patients, payers and society.

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来源期刊
Journal of comparative effectiveness research
Journal of comparative effectiveness research HEALTH CARE SCIENCES & SERVICES-
CiteScore
3.50
自引率
9.50%
发文量
121
期刊介绍: Journal of Comparative Effectiveness Research provides a rapid-publication platform for debate, and for the presentation of new findings and research methodologies. Through rigorous evaluation and comprehensive coverage, the Journal of Comparative Effectiveness Research provides stakeholders (including patients, clinicians, healthcare purchasers, and health policy makers) with the key data and opinions to make informed and specific decisions on clinical practice.
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