常規篩檢產後憂鬱症不符經濟效益


  【24drs.com】December 30, 2009 — 一項新的英國研究結果顯示,初級照護中,遵照最近英國指引的建議,常規篩檢產後憂鬱症顯然不符合經濟效益。
  
  根據一項於12月22日線上發表在英國醫學期刊的研究,這樣的篩檢對於英國國家健康服務的經費來說並未展現其價值,主要是因為處理誤診為憂鬱症病患的花費。
  
  主要研究者英國約克大學精神醫學與健康服務研究教授Simon Gilbody醫學士同事們表示,產後憂鬱症是一個重要的臨床、經濟與社會問題,這個問題通常是被低估的,且有有效的治療。然而,是否進行篩檢的決定引起了許多爭議,因此這樣的政策決定應該由臨床與經濟學證據做系統性的考量。
  
  據估計,超過11%的女性在產後6週後有重大或輕微產後憂鬱症狀。根據這項研究結果,證據顯示,產後憂鬱對於母親、伴侶、家人、還有母嬰互動、以及長期情緒與認知功能發展有很大影響,特別是當產後憂鬱發生在產後第一年之間。
  
  正式的確認方法,例如產後或一般憂鬱問卷已經被大家廣為採用。除此之外,最近國家衛生與臨床卓越機構(NICE)─英國國家健康服務的一個顧問機構─提出的臨床指引建議,以簡短的病例尋找問題配合自我通報評量,例如愛丁堡產後憂鬱評量表來確認可能的產後憂鬱。然而,作者們指出,這項做法的經濟效益目前仍然不清楚。
  
  以電腦模式來評量產後憂鬱常規篩檢於初級照護的經濟效益,研究者們發現常規應用產後或一般憂鬱問卷,相較於常規照護,看起來並沒有更具經濟效益。
  
  舉例來說,研究者們發現,以愛丁堡產後憂鬱評量表評估,其增加經濟效益比值,相較於常規照護為41,403品質校正年(QALY),這是一種結合生活質與量的指標。
  
  其他方法的比值相較於常規照護,介於49,928到272,463品質校正年(QALY)。相對的,僅提供常規照更可能是符合經濟效益的。
  
  作者們表示已無相關資金上的往來。

Routine Screening for Postnatal Depression Not Cost-Effective

By Caroline Cassels
Medscape Medical News

December 30, 2009 — Routine screening for postnatal depression in primary care, as recommended by recent UK guidelines, does not appear to be cost-effective, a new British study suggests.

According to research published online December 22 in the British Medical Journal, such screening does not represent value for money for the UK's National Health Service, primarily because of the cost of managing patients misdiagnosed with depression.

"Postnatal depression is an important clinical, economic, and social problem which is under-recognized and for which effective treatments are available. Decisions to screen, however, have attracted considerable controversy, and such policy decision should be informed by systematic consideration of the clinical and economic evidence," principal investigator Simon Gilbody, MBChB, MSc, MRCPsych, professor of psychological medicine and health services research, University of York, United Kingdom, and colleagues write.

It is estimated that more than 11% of women experience major or minor postnatal depression 6 weeks after giving birth. According to the study, evidence shows that postnatal depression has a major effect on the mother, her partner, the family, and mother–baby interactions, as well as the long-term emotional and cognitive development of the baby, especially when maternal depression occurs in the first year of life.

Formal identification methods, such as postnatal or general depression questionnaires, have been advocated. Further, recent clinical guidelines issued by the National Institute for Health and Clinical Excellence, a UK advisory agency to the National Health Service, recommend the use of brief case-finding questions to identify possible postnatal depression with the use of self-report measures such as the Edinburgh Postnatal Depression Scale. However, the authors point out that the cost-effectiveness of such a strategy is uncertain.

Using a computer model to evaluate the cost-effectiveness of routine screening for postnatal depression in primary care, the investigators found that the routine application of either postnatal or general depression questionnaires did not seem to be cost-effective compared with routine care only.

For example, investigators found the Edinburgh Postnatal Depression Scale had an incremental cost effectiveness ratio of £41,103 per quality-adjusted life-year — a combined measure of quantity and quality of life — compared with routine care only.

The ratio for all other strategies ranged from £49,928 to £272,463 per quality-adjusted life-year compared with routine care only. In contrast, the strategy of administering only routine care was most likely to be cost-effective.

The authors have disclosed no relevant financial relationships.

BMJ. Published online December 22, 2009.

    
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