低收入家庭的老年人由于他们的家庭状态和老年精神卫生劳动力短缺,获得社会心理治疗的机会有限。对非专业顾问提供的成本效益知之甚少,视频会议,本研究人群的短期行为激活。这项研究的目的是评估非专业顾问交付的成本效益,视频会议,与临床医生提供的短期行为激活(Tele-BA)相比,针对低收入家庭老年人的视频会议解决问题疗法(Tele-PST)和电话支持电话(注意力控制;AC)。
我们根据最近完成的数据进行了成本效益分析,3组(Tele-BA,远程PST,和AC)随机对照试验,共277名50岁以上的参与者。我们测量了(1)干预和(2)门诊护理的总费用,ED访问,以及使用康奈尔服务指数的住院护理。有效性结果为质量调整生命年(QALY)。我们使用EuroQol的EQ-5D-5L在基线和12、24和36周时评估每位参与者的健康相关生活质量(HRQoL)。成本效益的终点衡量标准是(1)Tele-BA与AC的增量成本效益比(ICER),(2)远程PST与AC,(3)远程-BA与远程-PST。
相对于AC,Tele-BA和Tele-PST都是节省成本的治疗选择。Tele-BA和Tele-PST的ICER均远低于50,000美元,这是成本效益的下限。相对于AC,都是远程PST,Tele-BA是节省成本的治疗选择(即更低的成本和更多的QALY)。
与提供电话支持相比,电话和外行顾问提供的抑郁症治疗的成本适中且具有成本效益。尽管我们的结果表明,相对于Tele-PST,Tele-BA可能不具成本效益,临床医生提供的心理治疗,当使用5万美元的低约束ICER门槛时,外行辅导员可以填补专业的老年心理健康劳动力短缺的差距,外行辅导员的Tele-BA可以改善居家老年人获得证据和技能的机会,具有成本效益的抑郁症护理。
ClinicalTrials.gov标识符:NCT02600754(11/09/2015)。
Low-income homebound older adults have limited access to psychosocial treatments because of their homebound state and geriatric mental health workforce shortages. Little is known about cost effectiveness of lay-counselor-delivered, videoconferenced, short-term behavioral activation on this study population. The objective of this study was to assess the cost-effectiveness of lay-counselor-delivered, videoconferenced, short-term behavioral activation (Tele-BA) compared to clinician-delivered, videoconferenced problem-solving therapy (Tele-PST) and telephone support calls (attention control; AC) for low-income homebound older adults.
We performed a cost-effectiveness analysis based on data from a recently completed, 3-group (Tele-BA, Tele-PST, and AC) randomized controlled trial with 277 participants aged 50+. We measured total costs of (1) intervention and (2) outpatient care, ED visits, and inpatient care using the Cornell Services Index. The effectiveness outcome was quality-adjusted life-years (QALY). We used EuroQol\'s EQ-5D-5L to assess each participant\'s health-related quality of life (HRQoL) at baseline and at 12, 24, and 36 weeks. The end-point measure of cost-effectiveness was the incremental cost-effectiveness ratio (ICER) of (1) Tele-BA versus AC, (2) Tele-PST versus AC, and (3) Tele-BA versus Tele-PST.
Relative to AC, both Tele-BA and Tele-PST are cost-saving treatment options. The ICERs for both Tele-BA and Tele-PST were well below $50,000, the lower-bound threshold for cost-effectiveness. Relative to AC, both Tele-PST, Tele-BA are cost-saving treatment options (i.e. lower costs and more QALYs).
Costs of tele- and lay-counselor-delivered depression treatment are modest and cost effective relative to providing telephone support. Though our results show that Tele-BA may not be cost effective relative to Tele-PST, a clinician-delivered psychotherapy, when a low bound ICER threshold of $50,000 would be used, lay counselors can fill the professional geriatric mental health workforce shortage gap and Tele-BA by lay counselors can improve homebound older adults\' access to evidence-and skills-based, cost effective depression care.
ClinicalTrials.gov identifier: NCT02600754 (11/09/2015).