基于Markov模型评价老年人认知损害合并抑郁的远期经济负担

Long-term Economic Burden Evaluation for Cognitive Impairment and Depression Co-existing Based on Markov Model

目的将疾病病程与其费用相结合,评价随着疾病进展,认知损害合并抑郁的远期疾病经济负担的变化情况及疾病的发展结局。方法构建认知损害合并抑郁疾病进展的Markov模型,运用模型进行队列模拟分别获得认知损害患者与认知损害合并抑郁症患者的远期累计成本和健康效果,并计算成本效果比。结果与仅认知损害组相比,认知损害合并抑郁症组损失了0. 1127个质量调整生命年,且直接医疗费用和直接非医疗费用的成本效果比分别高出了6590元/QALYs和1808元/QALYs。结论认知损害合并抑郁症组的疾病发展结局及远期经济负担均重于仅认知损害组,提示抑郁可能加重认知损害的疾病经济负担,加快疾病进展速度。

Objective Combining the course of disease with its cost,the aim of this study was to evaluate the long-term changes of the economic burden of patients with the cognitive impairment and depression co-existing and the outcomes with disease progression.Methods A Markov model of disease progression of the cognitive impairment and depression co-existing was built to obtain the lifetime cost,quality-adjusted life year(QALY)and cost-effectiveness ratio of patients with only cognitive impairment and patients with cognitive impairment and depression co-existing by cohort simulation.Results Compared with only cognitive impairment group,the cognitive impairment and depression co-existing group decreased 0.1127 QALY,and increased the cost-effectiveness ratio of the direct medical expense of 6590 RMB/QALYs and increased the cost-effectiveness ratio of the direct non medical expense of 1808 RMB/QALYs.Conclusion Compared with only cognitive impairment group,the cognitive impairment and depression co-existing group had higher long-term economic burden and more severe outcomes.Depression may increase the economic burden of cognitive impairment and speed up the disease progression.