Treatment-Refractory Obsessive-Compulsive Disorder in Adults: A Cost-Effectiveness Analysis of Treatment Strategies.

Autor:	Gregory ST; Department of Politics and International Affairs, Northern Arizona University, 5 E McConnell Dr, Flagstaff, AZ 86011 (sean.gregory@nau.edu).; Department of Politics and International Affairs, College of Social and Behavioral Sciences, Northern Arizona University, Flagstaff, Arizona, USA., Kay B; Rogers Memorial Hospital, Oconomowoc, Wisconsin, USA., Smith J; Department of Health Policy & Management, College of Public Health, University of South Florida, Tampa, Florida, USA., Hall K; Department of Health Policy & Management, College of Public Health, University of South Florida, Tampa, Florida, USA., De Nadai AS; Department of Psychology, University of South Florida, Tampa, Florida, USA.; Department of Psychiatry, University of Mississippi Medical Center, Jackson, Mississippi, USA.; Department of Psychology, Texas State University, San Marcos, Texas, USA., Quast T; Department of Health Policy & Management, College of Public Health, University of South Florida, Tampa, Florida, USA., Riemann BC; Rogers Memorial Hospital, Oconomowoc, Wisconsin, USA., Storch EA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA.
Jazyk:	angličtina
Zdroj:	The Journal of clinical psychiatry [J Clin Psychiatry] 2018 Mar/Apr; Vol. 79 (2).
DOI:	10.4088/JCP.17m11552
Abstrakt:	Objective: This study sought to assess the cost-effectiveness of 7 treatment strategies for treatment-refractory obsessive-compulsive disorder (OCD) in adults. Methods: A model was developed to evaluate treatment alternatives for adults (18-64 years old) that consisted of 2 parts: a decision analytic model and a Markov model. The decision analytic model stratified 7 outpatient treatment strategies, and the Markov model accumulated benefits and costs across the life expectancy of a simulated cohort of individuals. The model was parameterized with probabilistic and deterministic parameters from the literature and an outcomes database to perform a Monte Carlo simulation of a hypothetical cohort of 100,000 adults with OCD to estimate net health benefits (NHBs), costs, and incremental cost-effectiveness ratio (ICER) for each treatment strategy. OCD was considered treatment refractory in adults with an OCD diagnosis who failed first-line therapies. Encounters took place from 2012 to 2015, and the analyses were performed from November 2016 to February 2017. Results: Partial hospitalization with step-down to intensive outpatient treatment was the most cost-effective of the 7 strategies, with an estimated ICER of $7,983 and mean (SD) NHB of 10.96 (0.53) quality-adjusted life-years (QALYs) remaining. This result was 2.2 QALYs greater than that of the trial-based antidepressant and cognitive-behavioral therapy (ADM + CBT) strategy. Three additional ADM + CBT strategies were estimated not to be statistically significantly different from each other. These 4 ADM + CBT strategies outperformed both pharmacotherapy-only strategies. Conclusions: Treatment strategies that include higher-intensity CBT, with effectiveness outcomes that approached efficacy estimates, were superior to real-world CBT strategies. However, given the limited availability of high-quality CBT, especially through use of commercial insurance networks, specialized treatment programs offer greater effectiveness than real-world therapies in achieving wellness for this severe patient population. (© Copyright 2018 Physicians Postgraduate Press, Inc.)
Databáze:	MEDLINE
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