TY - JOUR
T1 - A personalized intervention to prevent depression in primary care
T2 - Cost-effectiveness study nested into a clustered randomized trial
AU - Fernández, Anna
AU - Mendive, Juan M.
AU - Conejo-Cerón, Sonia
AU - Moreno-Peral, Patricia
AU - King, Michael
AU - Nazareth, Irwin
AU - Martín-Pérez, Carlos
AU - Fernández-Alonso, Carmen
AU - Rodríguez-Bayón, Antonina
AU - Aiarzaguena, Jose Maria
AU - Montón-Franco, Carmen
AU - Serrano-Blanco, Antoni
AU - Ibañez-Casas, Inmaculada
AU - Rodríguez-Sánchez, Emiliano
AU - Salvador-Carulla, Luis
AU - Garay, Paola Bully
AU - Ballesta-Rodríguez, María Isabel
AU - LaFuente, Pilar
AU - del Mar Muñoz-García, María
AU - Mínguez-Gonzalo, Pilar
AU - Araujo, Luz
AU - Palao, Diego
AU - Gómez, María Cruz
AU - Zubiaga, Fernando
AU - Navas-Campaña, Desirée
AU - Aranda-Regules, Jose Manuel
AU - Rodriguez-Morejón, Alberto
AU - de Dios Luna, Juan
AU - Bellón, Juan Ángel
N1 - Funding Information:
This work was supported by grants from the Spanish Ministry of Health, the Institute of Health Carlos III (ISCIII) and the European Regional Development Fund (ERDF) ’A way to build Europe’(grant references PS09/02272, PS09/02147, PS09/01095, PS09/00849 and PS09/00461); the Andalusian Council of Health (grant reference PI-0569-2010); the Spanish Network of Primary Care Research ’redIAPP’ (RD06/0018, RD12/0005/0001); the ’Aragón group’ (RD06/0018/0020, RD12/0005/0006); the ’Bizkaya group’ (RD06/0018/0018, RD12/0005/0010); the Castilla-León Group (RD06/0018/0027); the Mental Health (SJD) Barcelona Group (RD06/0018/0017, RD12/0005/0008); and the Mental-Health, Services and Primary Care (SAMSERAP) MálagaGroup (RD06/0018/0039, RD12/0005/0005).
Funding Information:
The PredictD-CCRT study has been approved by the relevant ethics committees in each participating Spanish city: Ethics Committee on Human Research of the University of Granada, Ethics and Research Committee of Primary Health District of Malaga, Ethics Committee for Clinical Research of Sant Joan de Deu Foundation (Barcelona) (PIC CEIC-62-09), Ethics Committee for Clinical Research of Aragon (CEICA) (CP06/05/2009), Ethics Committee for Health Research of the Jaen Hospital, Ethics Committee for Clinical Research of Euskadi (CEIC-E) (03/2009) and Ethics Committee for Clinical Research of the Rio Hortega Hospital of Valladolid (04/2009).
Publisher Copyright:
© 2018 The Author(s).
PY - 2018/2/23
Y1 - 2018/2/23
N2 - 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.
AB - 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.
KW - Cost-effectiveness
KW - Depression
KW - Risk assessment
UR - http://www.scopus.com/inward/record.url?scp=85042424138&partnerID=8YFLogxK
U2 - 10.1186/s12916-018-1005-y
DO - 10.1186/s12916-018-1005-y
M3 - Article
C2 - 29471877
AN - SCOPUS:85042424138
SN - 1741-7015
VL - 16
SP - 1
EP - 12
JO - BMC Medicine
JF - BMC Medicine
IS - 1
M1 - 28
ER -