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首页> 外文期刊>Journal of medical Internet research >Preventing Depression in Adults With Subthreshold Depression: Health-Economic Evaluation Alongside a Pragmatic Randomized Controlled Trial of a Web-Based Intervention
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Preventing Depression in Adults With Subthreshold Depression: Health-Economic Evaluation Alongside a Pragmatic Randomized Controlled Trial of a Web-Based Intervention

机译：预防患有阈下抑郁症的成年人的抑郁症：基于网络干预的务实随机对照试验以及健康经济评估

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Background: Psychological interventions for the prevention of depression might be a cost-effective way to reduce the burden associated with depressive disorders.Objective: To evaluate the cost-effectiveness of a Web-based guided self-help intervention to prevent major depressive disorder (MDD) in people with subthreshold depression (sD).Methods: A pragmatic randomized controlled trial was conducted with follow-up at 12 months. Participants were recruited from the general population via a large statutory health insurance company and an open access website. Participants were randomized to a Web-based guided self-help intervention (ie, cognitive-behavioral therapy and problem-solving therapy assisted by supervised graduate students or health care professionals) in addition to usual care or to usual care supplemented with Web-based psycho-education (enhanced usual care). Depression-free years (DFYs) were assessed by blinded diagnostic raters using the telephone-administered Structured Clinical Interview for DSM-IV Axis Disorders at 6- and 12-month follow-up, covering the period to the previous assessment. Costs were self-assessed through a questionnaire. Costs measured from a societal and health care perspective were related to DFYs and quality-adjusted life years (QALYs).Results: In total, 406 participants were enrolled in the trial. The mean treatment duration was 5.84 (SD 4.37) weeks. On average, participants completed 4.93 of 6 sessions. Significantly more DFYs were gained in the intervention group (0.82 vs 0.70). Likewise, QALY health gains were in favor of the intervention, but only statistically significant when measured with the more sensitive SF-6D. The incremental per-participant costs were €136 (￡116). Taking the health care perspective and assuming a willingness-to-pay of €20,000 (￡17,000), the intervention’s likelihood of being cost-effective was 99% for gaining a DFY and 64% or 99% for gaining an EQ-5D or a SF-6D QALY.Conclusions: Our study supports guidelines recommending Web-based treatment for sD and adds that this not only restores health in people with sD, but additionally reduces the risk of developing a MDD. Offering the intervention has an acceptable likelihood of being more cost-effective than enhanced usual care and could therefore reach community members on a wider scale.Trial registration: German Clinical Trials Register: DRKS00004709; http://www.drks.de/DRKS00004709 (Archived by WebCite at http://www.webcitation.org/6kAZVUxy9)
机译：背景：预防抑郁症的心理干预可能是减轻与抑郁症相关的负担的一种经济有效的方法。目的：评价基于网络的自助式预防性抑郁症（MDD）的成本效益方法：进行了一项实用的随机对照试验，随访12个月。参与者是通过大型法定健康保险公司和开放访问网站从一般人群中招募的。除了常规护理或补充了基于网络的心理治疗的常规护理外，参与者被随机分配到基于网络的指导性自助干预（即由受指导的研究生或医疗保健专业人员协助的认知行为疗法和解决问题的疗法） -教育（加强日常护理）。在6个月和12个月的随访中，由盲人诊断评估者使用电话管理的DSM-IV轴结构性临床访谈对无抑郁年（DFYs）进行评估，涵盖了先前评估的时期。成本通过问卷调查进行自我评估。从社会和卫生保健角度衡量的成本与DFY和质量调整生命年（QALY）有关。结果：共有406名参与者参加了该试验。平均治疗时间为5.84（SD 4.37）周。平均而言，参与者完成了6节课的4.93。干预组明显增加了DFY（0.82 vs 0.70）。同样，QALY的健康改善也有利于干预，但仅当使用更敏感的SF-6D进行测量时，才具有统计学意义。每位参与者的增量成本为136欧元（116英镑）。从医疗保健的角度出发，并假设支付意愿为20,000欧元（17,000英镑），则该干预措施具有成本效益的可能性是：获得DFY的成本为99％，获得EQ-5D或DQ的64％或99％。 SF-6D QALY。结论：我们的研究支持指南，建议对sD进行基于Web的治疗，并补充说，这不仅可以恢复sD人群的健康，还可以降低罹患MDD的风险。提供干预措施具有比增强常规照护更具成本效益的可能性，因此可以更广泛地覆盖社区成员。试验注册：德国临床试验注册：DRKS00004709; http://www.drks.de/DRKS00004709（由WebCite存档，网址为http://www.webcitation.org/6kAZVUxy9）

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