上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2019, Vol. 39 ›› Issue (6): 622-.doi: 10.3969/j.issn.1674-8115.2019.06.010

• 论著·临床研究 • 上一篇    下一篇

网络认知行为疗法治疗强迫症的效果与卫生经济学分析

周雨鑫 1，高睿 1，王振 2，王纯 3，范青 4   

  1. 1. 上海交通大学医学院附属精神卫生中心，上海 200030；2. 上海交通大学医学院附属精神卫生中心临床心理科，上海 200030；3. 南京医科大学附属脑科医院精神四科，南京 210029；4. 上海交通大学医学院附属精神卫生中心康复一科，上海 200030
  • 出版日期:2019-06-28 发布日期:2019-07-26
  • 通讯作者: 范青，电子信箱：fanqing@smhc.org.cn。
  • 作者简介:周雨鑫 (1995—)，男，硕士生；电子信箱： vincentchaw@live.com。
  • 基金资助:
    国家自然科学基金（81771460）；上海市卫生和计划生育委员会科研课题（201740086）；上海市科学技术委员会临床医学领域项目（18411952000）

Efficacy and cost-effectiveness of internet-based cognitive behavioral therapy for obsessive-compulsive disorder

ZHOU Yu-xin1, GAO Rui1, WANG Zhen2, WANG Chun3, FAN Qing4   

  1. 1. Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; 2. Department of Clinical Psychology, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; 3. Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China; 4. Department of Rehabilitation, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
  • Online:2019-06-28 Published:2019-07-26
  • Supported by:
    National Natural Science Foundation of China, 81771460; Research Project of Shanghai Health and Family Planning Commission, 201740086; Clinical Medicine Project of Shanghai Science and Technology Commission, 18411952000）。

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摘要： 目的 ·比较网络认知行为疗法（internet-based cognitive behavioral therapy，ICBT）和认知行为团体疗法（cognitive behavioral group therapy，CBGT）对强迫症患者的治疗效果、成本、成本 -效果以及效用的差异。方法 ·选取符合《精神疾病诊断与统计手册（第五版）》诊断标准的强迫症患者 28例，按意愿分配进入 ICBT组（16例）、 CBGT组（12例）。 2组患者均进行 6周治疗。比较 2组患者在基线水平、治疗中、治疗后的强迫、焦虑和抑郁症状严重程度的差异，分析 2种治疗方式的成本、成本 -效果和效用的差异。结果 ·在基线水平， 2组患者在耶鲁布朗强迫量表（Yale-Brown Obsessive Compulsive Scale ,YBOCS）得分、抑郁自评量表（Self-rating Depression Scale，SDS）得分、焦虑自评量表（Self-rating Anxiety Scale，SAS）得分及欧洲五维健康量表（EuroQol Five Dimensions Questionnaire，EQ-5D）中视觉模拟量表（Visual Analogue Scale，VAS）得分上的差异均无统计学意义（P0.291， P0.114，P0.478，P0.799）。治疗后 2组患者的 YBOCS得分与治疗前相比均显著降低， 2组患者 YBOCS得分减分率的差异无统计学意义（P0.291）。治疗结束后，与基线水平相比， ICBT组的 SDS得分在治疗后显著降低（P0.003）。ICBT组较 CBGT组平均每名患者少花费 2 710.50元，ICBT组患者每多降低 1个单位的 YBOCS得分较 CBGT组少花费 281.33元；2组患者治疗后 VAS得分均显著提高，且 ICBT组 VAS得分的改善更为显著。结论 · ICBT与 CBGT均有显著的治疗效果且治疗效果相当。 ICBT是一种成本更低、更具成本 -效果和效用的治疗方式。

关键词: 强迫症, 认知行为团体疗法, 网络认知行为疗法, 成本 -效果, 效用

Abstract:

Objective · To compare the therapeutic effect, cost, cost-effectiveness and utility between internet-based cognitive behavioral therapy (ICBT) and cognitive behavioral group therapy (CBGT) in the patients with obsessive-compulsive disorder (OCD). Methods · Twenty-eight patients who met the OCD diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) were assigned to ICBT group (n16) and CBGT group (n12) according to the patients willingness. Both groups were treated for 6 weeks. The study compared differences in the severity of OCD and symptoms of anxiety and depressive at baseline, during treatment and after treatment, as well as differences in cost, cost-effectiveness and utility between two groups. Results · There was no significant difference in the scores of Yale-Brown Obsessive Compulsive Scale (YBOCS), Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS), and Visual Analog Scale (VAS) [a component of EuroQol Five Dimensions Questionnaire, (EQ-5D)]between the two groups at baseline (P0.291, P0.114, P0.478, P0.799). After treatment, the YBOCS scores decreased compared to pre-treatment in two groups. There was no statistical difference in subtraction rate of YBOCS between the two groups (P0.291). The SDS scores of ICBT group also decreased after treatment compared to pre-treatment (P0.003). The average cost per patient in ICBT group was 2 710.50 yuan less than that in CBGT group. When one YBOCS score per patient reduced, ICBT group spent 281.33 yuan less than CBGT group. The VAS scores were significantly improved after 6-week treatment and ICBT group has a more significant improvement. Conclusion · ICBT and CBGT have comparable and significant efficacy. And ICBT is a lower cost and more cost-effectiveness and utility treatment than CBGT.

Key words: obsessive-compulsive disorder (OCD), cognitive behavioral group therapy (CBGT), internet-based cognitive behavioral therapy (ICBT), cost-effectiveness, utility

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