英国治疗师辅助的互联网心理治疗PTSD创伤焦点不同的成本效益：基于STOP-PTSD试验的经济评估

Cost-effectiveness of therapist-assisted internet-delivered psychological therapies for PTSD differing in trauma focus in England: an economic evaluation based on the STOP-PTSD trial

——原载《柳叶刀- 精神病学》，2024年，第11卷，第5期——

<The Lancet - Psychiatry>, Volume 11, Issue 5, 2024

【摘要】背景：尽管有针对创伤后应激障碍（PTSD）的有效心理治疗方法，但对许多人来说仍然难以实现。数字化治疗是克服这个问题的一种方法。然而，几乎没有证据表明这些疗法的哪种形式对于治疗创伤后应激障碍（PTSD）最具成本效益。我们的目的是评估STOP-PTSD试验的成本效益。该试验评估了两种治疗师辅助、互联网提供的认知行为疗法：PTSD认知疗法 (iCT-PTSD) 和专注于压力管理的项目 (iStress-PTSD)。方法：在本次健康经济评估中，我们使用STOP-PTSD试验（n=217）的数据（一项单盲、随机对照试验）来比较iCT-PTSD和iStress-PTSD在资源利用和健康结果方面的情况。在该试验中，符合DSM-5的PTSD标准的参与者（年龄≥18岁）是从英格兰东南部的初级保健治疗服务机构招募的。干预措施在前12周内通过在线方式进行，并在治疗师的支持下进行，并在接下来的3个月内通过3次电话进行干预。参与者在随机分组后的基线、13周、26周和39周完成了有关症状、健康状况、生活质量和资源使用的调查问卷。我们从英国国民医疗服务体系 (NHS) 和个人社会服务的角度，并基于意向性，使用成本效益分析来评估随机化后39周的每个质量调整生命年 (QALY) 治疗完整病例的成本。治疗模块和平台设计是在服务用户的广泛参与下开发的：服务用户还就试验方案和方法（包括健康经济措施）提出建议。这是对STOP-PTSD试验的预先计划的分析；该试验已在ISRCTN登记处前瞻性注册（ISRCTN16806208)。结果：不同治疗组的NHS成本相似，但iCT-PTSD的临床结果优于iStress-PTSD。NHS成本和个人社会服务的增量成本效益比估计为每QALY为1921英镑。在每QALY阈值20,000英镑的情况下，iCT-PTSD估计有91·6%的机会具有成本效益。从社会角度来看，iCT-PTSD比iStress-PTSD节省了成本。解释：相对于iStress-PTSD，iCT-PTSD是一种具有成本效益的治疗师辅助、互联网提供的心理治疗形式，可以考虑临床实施。

[Summary] Background: Although there are effective psychological treatments for post-traumatic stress disorder (PTSD), they remain inaccessible for many people. Digitally enabled therapy is a way to overcome this problem; however, there is little evidence on which forms of these therapies are most cost effective in PTSD. We aimed to assess the cost-effectiveness of the STOP-PTSD trial, which evaluated two therapist-assisted, internet-delivered cognitive behavioural therapies: cognitive therapy for PTSD (iCT-PTSD) and a programme focusing on stress management (iStress-PTSD). Methods: In this health economic evaluation, we used data from the STOP-PTSD trial (n=217), a single-blind, randomised controlled trial, to compare iCT-PTSD and iStress-PTSD in terms of resource use and health outcomes. In the trial, participants (aged ≥18 years) who met DSM-5 criteria for PTSD were recruited from primary care therapy services in South East England. The interventions were delivered online with therapist support for the first 12 weeks, and three telephone calls over the next 3 months. Participants completed questionnaires on symptoms, wellbeing, quality of life, and resource use at baseline, 13 weeks, 26 weeks, and 39 weeks after randomisation. We used a cost-effectiveness analysis to assess cost per quality-adjusted life year (QALY) at 39 weeks post-randomisation, from the perspective of the English National Health Service (NHS) and personal social services and on the basis of intention-to-treat for complete cases. Treatment modules and the platform design were developed with extensive input from service users: service users also advised on the trial protocol and methods, including the health economic measures. This is a pre-planned analysis of the STOP-PTSD trial; the trial was registered prospectively on the ISRCTN Registry (ISRCTN16806208). Findings: NHS costs were similar across treatment groups, but clinical outcomes were superior for iCT-PTSD compared with iStress-PTSD. The incremental cost-effectiveness ratio for NHS costs and personal social services was estimated as £1921 per QALY. iCT-PTSD had an estimated 91·6% chance of being cost effective at the £20 000 per QALY threshold. From the societal perspective, iCT-PTSD was cost saving compared with iStress-PTSD. Interpretation: iCT-PTSD is a cost-effective form of therapist-assisted, internet-delivered psychological therapy relative to iStress-PTSD, and it could be considered for clinical implementation.

论文原文：Ed Penington, Jennifer Wild, Emma Warnock-Parkes, Nick Grey, Hannah Murray, Alice Kerr, et al. (2024). Cost-effectiveness of therapist-assisted internet-delivered psychological therapies for PTSD differing in trauma focus in England: an economic evaluation based on the STOP-PTSD trial. The Lancet - Psychiatry, Volume 11, Issue 5, P339-347, March 27, 2024.

https://doi.org/10.1016/S2215-0366(24)00055-5

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