以正念为基础的认知疗法与用于主要抑郁障碍复发预防的认知行为疗法的成本效益分析在初级保健中
Waseem Abu-Ashour1, Rick Audas2, John-Michael Gamble3
1School of Pharmacy, Memorial University, Health Sciences Centre, St. John's, NL, A1B 3V6, Canada.
Psychiatry research
|February 11, 2026
概括
认知行为疗法 (CBT) 对于预防严重抑郁症 (MDD) 复发而言,比基于正念的认知疗法 (MBCT) 更具成本效益. 虽然差异很小,但CBT为患者和卫生系统提供了更好的价值.
科学领域:
- 卫生经济学 卫生经济学
- 精神病学是一个精神病学.
- 临床心理学 临床心理学
背景情况:
- 大型抑郁症 (MDD) 是一种慢性疾病,具有显著的复发率.
- 认知行为疗法 (CBT) 和基于正念的认知疗法 (MBCT) 用于预防复发.
- 对于预防MDD复发的CBT和MBCT的长期成本效益的比较尚未得到充分证实.
研究的目的:
- 为了比较CBT与MBCT的长期成本效益,用于预防MDD成年人的复发.
- 从医疗保健支付者和社会角度来评估哪种疗法提供了更好的价值.
主要方法:
- 一个基于队列的马尔科夫模型被开发出来,其中包括抑郁症发作,缓解和死亡的状态.
- 该模型利用了终身时间和六个月周期,并纳入了直接的医疗成本和生产力损失.
- 增量成本效益比率 (ICER) 和净货币收益 (NMB) 在各种支付意愿 (WTP) 门下计算,并进行敏感性分析.
主要成果:
- 与MBCT相比,CBT与质量调整寿命年 (QALYs) 略高,成本略高.
- 对CBT的ICER为每QALY获得的15,266美元,低于典型的WTP值.
- 净货币收益 (NMB) 支持CBT,概率灵敏度分析表明CBT是超过56%的模拟中最优的策略.
结论:
- 在预防MDD复发方面,CBT似乎比MBCT更具成本效益,尽管观察到的差异并不显著.
- 复杂的CBT仍然是一个可行的替代方案,特别是在CBT的访问有限的环境中.
- 研究结果表明,CBT可能为治疗复发性抑郁症提供更好的长期经济价值.
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