A personalized intervention to prevent depression in primary care: Cost-effectiveness study nested into a clustered randomized trial

Anna Fernández, Juan M. Mendive, Sonia Conejo-Cerón, Patricia Moreno-Peral, Michael King, Irwin Nazareth, Carlos Martín-Pérez, Carmen Fernández-Alonso, Antonina Rodríguez-Bayón, Jose Maria Aiarzaguena, Carmen Montón-Franco, Antoni Serrano-Blanco, Inmaculada Ibañez-Casas, Emiliano Rodríguez-Sánchez, Luis Salvador-Carulla, Paola Bully Garay, María Isabel Ballesta-Rodríguez, Pilar LaFuente, María del Mar Muñoz-García, Pilar Mínguez-GonzaloLuz Araujo, Diego Palao, María Cruz Gómez, Fernando Zubiaga, Desirée Navas-Campaña, Jose Manuel Aranda-Regules, Alberto Rodriguez-Morejón, Juan de Dios Luna, Juan Ángel Bellón

Research output: Contribution to journalArticlepeer-review

21 Citations (Scopus)
16 Downloads (Pure)

Abstract

Background: Depression is viewed as a major and increasing public health issue, as it causes high distress in the people experiencing it and considerable financial costs to society. Efforts are being made to reduce this burden by preventing depression. A critical component of this strategy is the ability to assess the individual level and profile of risk for the development of major depression. This paper presents the cost-effectiveness of a personalized intervention based on the risk of developing depression carried out in primary care, compared with usual care. Methods: Cost-effectiveness analyses are nested within a multicentre, clustered, randomized controlled trial of a personalized intervention to prevent depression. The study was carried out in 70 primary care centres from seven cities in Spain. Two general practitioners (GPs) were randomly sampled from those prepared to participate in each centre (i.e. 140 GPs), and 3326 participants consented and were eligible to participate. The intervention included the GP communicating to the patient his/her individual risk for depression and personal risk factors and the construction by both GPs and patients of a psychosocial programme tailored to prevent depression. In addition, GPs carried out measures to activate and empower the patients, who also received a leaflet about preventing depression. GPs were trained in a 10- to 15-h workshop. Costs were measured from a societal and National Health care perspective. Qualityadjustedlife years were assessed using the EuroQOL five dimensions questionnaire. The time horizon was 18months. Results: With a willingness-to-pay threshold of €10,000 (£8568) the probability of cost-effectiveness oscillated from 83% (societal perspective) to 89% (health perspective). If the threshold was increased to €30,000 (£25,704), the probability of being considered cost-effective was 94% (societal perspective) and 96%, respectively (health perspective). The sensitivity analysis confirmed these results. Conclusions: Compared with usual care, an intervention based on personal predictors of risk of depression implemented by GPs is a cost-effective strategy to prevent depression. This type of personalized intervention in primary care should be further developed and evaluated.

Original languageEnglish
Article number28
Pages (from-to)1-12
Number of pages12
JournalBMC Medicine
Volume16
Issue number1
DOIs
Publication statusPublished - 23 Feb 2018
Externally publishedYes

Fingerprint

Dive into the research topics of 'A personalized intervention to prevent depression in primary care: Cost-effectiveness study nested into a clustered randomized trial'. Together they form a unique fingerprint.

Cite this