Tiffany Atkins, Darryn Marks, Caroline Dowsett, Paul Glasziou, Loai Albarqouni
{"title":"澳大利亚皇家全科医师学院（RACGP）初级保健非药物干预手册中基于试验的非药物干预经济评估：系统回顾。","authors":"Tiffany Atkins, Darryn Marks, Caroline Dowsett, Paul Glasziou, Loai Albarqouni","doi":"10.1136/fmch-2025-003312","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>This systematic review assessed trial-based economic evaluations to provide empirical evidence on the cost-effectiveness of non-drug interventions (NDIs) that are currently recommended within the Royal Australian College of General Practitioners Handbook of Non-Drug Interventions (HANDI).</p><p><strong>Methods: </strong>Medline, CINAHL and PsycINFO along with clinical trial registries (clinicaltrials.gov and WHO International Clinical Trials Registry Platform) were searched from inception to 1 July 2025. Randomised controlled trials (RCTs) that reported cost effectiveness for a prescribed non-drug intervention (NDI) from HANDI were included in the study. The primary outcome was the incremental cost-utility ratio (ICUR) derived from cost-utility analyses (CUAs).</p><p><strong>Results: </strong>A total of 11 187 citations were identified, from which 156 RCTs were included. These RCTs enrolled a total of 66 926 participants (median=214, IQR 139-342), with a median follow-up duration of 12 months (IQR 6-12 months). Over half of the CUA NDIs were for mental health conditions (n=81; 54.0%), one-third were for were for musculoskeletal conditions (n=44; 29.3%), while only 16.0% (n=24) were for those with cardiovascular/metabolic conditions. Out of the 150 NDIs that reported CUAs, 40% were deemed to be in the south-east (SE) quadrant (cheaper and more effective) and 49.3% fell in the north-east (NE) quadrant (more costly but more effective), with 70% considered cost effective against a £25 000/quality-adjusted life-year (QALY) willingness to pay threshold. The overall median ICUR was £2400/QALY (IQR -18 986 to 20 027).</p><p><strong>Conclusions: </strong>Most of the HANDI NDIs that were included within this systematic review are cost-effective compared with a variety of alternatives including usual care or waiting list controls. HANDI NDIs warrant use as a first line of treatment when clinically appropriate.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"13 3","pages":""},"PeriodicalIF":4.3000,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406924/pdf/","citationCount":"0","resultStr":"{\"title\":\"Trial-based economic evaluations of non-drug interventions in the Royal Australian College of General Practitioners (RACGP) Handbook of Non-Drug Interventions in primary care: a systemic review.\",\"authors\":\"Tiffany Atkins, Darryn Marks, Caroline Dowsett, Paul Glasziou, Loai Albarqouni\",\"doi\":\"10.1136/fmch-2025-003312\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>This systematic review assessed trial-based economic evaluations to provide empirical evidence on the cost-effectiveness of non-drug interventions (NDIs) that are currently recommended within the Royal Australian College of General Practitioners Handbook of Non-Drug Interventions (HANDI).</p><p><strong>Methods: </strong>Medline, CINAHL and PsycINFO along with clinical trial registries (clinicaltrials.gov and WHO International Clinical Trials Registry Platform) were searched from inception to 1 July 2025. Randomised controlled trials (RCTs) that reported cost effectiveness for a prescribed non-drug intervention (NDI) from HANDI were included in the study. The primary outcome was the incremental cost-utility ratio (ICUR) derived from cost-utility analyses (CUAs).</p><p><strong>Results: </strong>A total of 11 187 citations were identified, from which 156 RCTs were included. These RCTs enrolled a total of 66 926 participants (median=214, IQR 139-342), with a median follow-up duration of 12 months (IQR 6-12 months). Over half of the CUA NDIs were for mental health conditions (n=81; 54.0%), one-third were for were for musculoskeletal conditions (n=44; 29.3%), while only 16.0% (n=24) were for those with cardiovascular/metabolic conditions. Out of the 150 NDIs that reported CUAs, 40% were deemed to be in the south-east (SE) quadrant (cheaper and more effective) and 49.3% fell in the north-east (NE) quadrant (more costly but more effective), with 70% considered cost effective against a £25 000/quality-adjusted life-year (QALY) willingness to pay threshold. The overall median ICUR was £2400/QALY (IQR -18 986 to 20 027).</p><p><strong>Conclusions: </strong>Most of the HANDI NDIs that were included within this systematic review are cost-effective compared with a variety of alternatives including usual care or waiting list controls. 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Trial-based economic evaluations of non-drug interventions in the Royal Australian College of General Practitioners (RACGP) Handbook of Non-Drug Interventions in primary care: a systemic review.
Objective: This systematic review assessed trial-based economic evaluations to provide empirical evidence on the cost-effectiveness of non-drug interventions (NDIs) that are currently recommended within the Royal Australian College of General Practitioners Handbook of Non-Drug Interventions (HANDI).
Methods: Medline, CINAHL and PsycINFO along with clinical trial registries (clinicaltrials.gov and WHO International Clinical Trials Registry Platform) were searched from inception to 1 July 2025. Randomised controlled trials (RCTs) that reported cost effectiveness for a prescribed non-drug intervention (NDI) from HANDI were included in the study. The primary outcome was the incremental cost-utility ratio (ICUR) derived from cost-utility analyses (CUAs).
Results: A total of 11 187 citations were identified, from which 156 RCTs were included. These RCTs enrolled a total of 66 926 participants (median=214, IQR 139-342), with a median follow-up duration of 12 months (IQR 6-12 months). Over half of the CUA NDIs were for mental health conditions (n=81; 54.0%), one-third were for were for musculoskeletal conditions (n=44; 29.3%), while only 16.0% (n=24) were for those with cardiovascular/metabolic conditions. Out of the 150 NDIs that reported CUAs, 40% were deemed to be in the south-east (SE) quadrant (cheaper and more effective) and 49.3% fell in the north-east (NE) quadrant (more costly but more effective), with 70% considered cost effective against a £25 000/quality-adjusted life-year (QALY) willingness to pay threshold. The overall median ICUR was £2400/QALY (IQR -18 986 to 20 027).
Conclusions: Most of the HANDI NDIs that were included within this systematic review are cost-effective compared with a variety of alternatives including usual care or waiting list controls. HANDI NDIs warrant use as a first line of treatment when clinically appropriate.
期刊介绍：
Family Medicine and Community Health (FMCH) is a peer-reviewed, open-access journal focusing on the topics of family medicine, general practice and community health. FMCH strives to be a leading international journal that promotes ‘Health Care for All’ through disseminating novel knowledge and best practices in primary care, family medicine, and community health. FMCH publishes original research, review, methodology, commentary, reflection, and case-study from the lens of population health. FMCH’s Asian Focus section features reports of family medicine development in the Asia-pacific region. FMCH aims to be an exemplary forum for the timely communication of medical knowledge and skills with the goal of promoting improved health care through the practice of family and community-based medicine globally. FMCH aims to serve a diverse audience including researchers, educators, policymakers and leaders of family medicine and community health. We also aim to provide content relevant for researchers working on population health, epidemiology, public policy, disease control and management, preventative medicine and disease burden. FMCH does not impose any article processing charges (APC) or submission charges.
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