PDF(Pubmed)
Abstract：
The cost-effectiveness of the Self-Help Plus (SH+) program, a group-based, guided, self-help psychological intervention developed by the World Health Organization for people affected by adversity, is unclear.
To investigate the cost-utility of providing the SH+ intervention combined with enhanced usual care vs enhanced usual care alone for Syrian refugees or asylum seekers hosted in Turkey.
This economic evaluation was performed as a prespecified part of an assessor-blinded randomized clinical trial conducted between October 1, 2018, and November 30, 2019, with 6-month follow-up. A total of 627 adults with psychological distress but no diagnosed psychiatric disorder were randomly assigned to the intervention group or the enhanced usual care group.
The SH+ program was a 5-session (2 hours each), group-based, stress management course in which participants learned self-help skills for managing stress by listening to audio sessions. The SH+ sessions were facilitated by briefly trained, nonspecialist individuals, and an illustrated book was provided to group members. Th intervention group received the SH+ intervention plus enhanced usual care; the control group received only enhanced usual care from the local health care system. Enhanced usual care included access to free health care services provided by primary and secondary institutions plus details on nongovernmental organizations and freely available mental health services, social services, and community networks for people under temporary protection of Turkey and refugees.
The primary outcome measure was incremental cost per quality-adjusted life-year (QALY) gained from the perspective of the Turkish health care system. An intention-to-treat analysis was used including all participants who were randomized and for whom baseline data on costs and QALYs were available. Data were analyzed September 30, 2020, to July 30, 2021.
Of 627 participants (mean [SD] age, 31.3 [9.0] years; 393 [62.9%] women), 313 were included in the analysis for the SH+ group and 314 in the analysis for the enhanced usual care group. An incremental cost-utility ratio estimate of T£6068 ($1147) per QALY gained was found when the SH+ intervention was provided to groups of 10 Syrian refugees. At a willingness to pay per QALY gained of T£14 831 ($2802), the SH+ intervention had a 97.5% chance of being cost-effective compared with enhanced usual care alone.
This economic evaluation suggests that implementation of the SH+ intervention compared with enhanced usual care alone for adult Syrian refugees or asylum seekers hosted in Turkey is cost-effective from the perspective of the Turkish health care system when both international and country-specific willingness-to-pay thresholds were applied.
To investigate the cost-utility of providing the SH+ intervention combined with enhanced usual care vs enhanced usual care alone for Syrian refugees or asylum seekers hosted in Turkey.
This economic evaluation was performed as a prespecified part of an assessor-blinded randomized clinical trial conducted between October 1, 2018, and November 30, 2019, with 6-month follow-up. A total of 627 adults with psychological distress but no diagnosed psychiatric disorder were randomly assigned to the intervention group or the enhanced usual care group.
The SH+ program was a 5-session (2 hours each), group-based, stress management course in which participants learned self-help skills for managing stress by listening to audio sessions. The SH+ sessions were facilitated by briefly trained, nonspecialist individuals, and an illustrated book was provided to group members. Th intervention group received the SH+ intervention plus enhanced usual care; the control group received only enhanced usual care from the local health care system. Enhanced usual care included access to free health care services provided by primary and secondary institutions plus details on nongovernmental organizations and freely available mental health services, social services, and community networks for people under temporary protection of Turkey and refugees.
The primary outcome measure was incremental cost per quality-adjusted life-year (QALY) gained from the perspective of the Turkish health care system. An intention-to-treat analysis was used including all participants who were randomized and for whom baseline data on costs and QALYs were available. Data were analyzed September 30, 2020, to July 30, 2021.
Of 627 participants (mean [SD] age, 31.3 [9.0] years; 393 [62.9%] women), 313 were included in the analysis for the SH+ group and 314 in the analysis for the enhanced usual care group. An incremental cost-utility ratio estimate of T£6068 ($1147) per QALY gained was found when the SH+ intervention was provided to groups of 10 Syrian refugees. At a willingness to pay per QALY gained of T£14 831 ($2802), the SH+ intervention had a 97.5% chance of being cost-effective compared with enhanced usual care alone.
This economic evaluation suggests that implementation of the SH+ intervention compared with enhanced usual care alone for adult Syrian refugees or asylum seekers hosted in Turkey is cost-effective from the perspective of the Turkish health care system when both international and country-specific willingness-to-pay thresholds were applied.
摘要：
自助加(SH+)计划的成本效益，以群体为基础，引导,世界卫生组织为受逆境影响的人开发的自助心理干预，不清楚。
调查为在土耳其收容的叙利亚难民或寻求庇护者提供SH+干预措施并结合增强常规护理与仅增强常规护理的成本效用。
这项经济学评估是在2018年10月1日至2019年11月30日之间进行的评估者盲法随机临床试验的预定部分，并进行了6个月的随访。共有627名患有心理困扰但未诊断出精神疾病的成年人被随机分配到干预组或强化常规护理组。
SH+程序是5个疗程（每个2小时），基于群体，压力管理课程，参与者通过听音频会话学习管理压力的自助技能。通过短暂的培训，促进了SH+会议，非专业人士，并向小组成员提供了一本插图书。干预组接受SH干预加强化常规护理；对照组仅接受当地卫生保健系统的强化常规护理。加强的日常护理包括获得初级和中级机构提供的免费保健服务，以及关于非政府组织和免费提供的心理健康服务的详细信息，社会服务,以及受土耳其和难民临时保护的人的社区网络。
主要结果指标是从土耳其医疗保健系统的角度获得的每质量调整生命年（QALY）的增量成本。使用了意向治疗分析，包括所有随机分配的参与者，并且可以获得有关成本和QALY的基线数据。数据进行了2020年9月30日至2021年7月30日的分析。
627名参与者(平均[SD]年龄，31.3[9.0]岁；393[62.9%]女性)，SH+组的分析中包括313个，增强常规护理组的分析中包括314个。当将SH干预措施提供给10名叙利亚难民时，发现每QALY增加的成本效用比估计为6068泰铢（1147美元）。在每QALY收益为14831泰铢(2802美元)的情况下，与单纯强化常规治疗相比,SH+干预有97.5%的机会具有成本效益.
这项经济评估表明，从土耳其医疗保健系统的角度来看，当采用国际和特定国家的支付意愿阈值时，与仅对在土耳其收容的成年叙利亚难民或寻求庇护者的常规护理相比，实施SH+干预措施具有成本效益。
调查为在土耳其收容的叙利亚难民或寻求庇护者提供SH+干预措施并结合增强常规护理与仅增强常规护理的成本效用。
这项经济学评估是在2018年10月1日至2019年11月30日之间进行的评估者盲法随机临床试验的预定部分，并进行了6个月的随访。共有627名患有心理困扰但未诊断出精神疾病的成年人被随机分配到干预组或强化常规护理组。
SH+程序是5个疗程（每个2小时），基于群体，压力管理课程，参与者通过听音频会话学习管理压力的自助技能。通过短暂的培训，促进了SH+会议，非专业人士，并向小组成员提供了一本插图书。干预组接受SH干预加强化常规护理；对照组仅接受当地卫生保健系统的强化常规护理。加强的日常护理包括获得初级和中级机构提供的免费保健服务，以及关于非政府组织和免费提供的心理健康服务的详细信息，社会服务,以及受土耳其和难民临时保护的人的社区网络。
主要结果指标是从土耳其医疗保健系统的角度获得的每质量调整生命年（QALY）的增量成本。使用了意向治疗分析，包括所有随机分配的参与者，并且可以获得有关成本和QALY的基线数据。数据进行了2020年9月30日至2021年7月30日的分析。
627名参与者(平均[SD]年龄，31.3[9.0]岁；393[62.9%]女性)，SH+组的分析中包括313个，增强常规护理组的分析中包括314个。当将SH干预措施提供给10名叙利亚难民时，发现每QALY增加的成本效用比估计为6068泰铢（1147美元）。在每QALY收益为14831泰铢(2802美元)的情况下，与单纯强化常规治疗相比,SH+干预有97.5%的机会具有成本效益.
这项经济评估表明，从土耳其医疗保健系统的角度来看，当采用国际和特定国家的支付意愿阈值时，与仅对在土耳其收容的成年叙利亚难民或寻求庇护者的常规护理相比，实施SH+干预措施具有成本效益。
