TY - JOUR
T1 - Cost-effectiveness analysis of a collaborative care programme for depression in primary care
AU - Aragonès, Enric
AU - López-Cortacans, Germán
AU - Sánchez-Iriso, Eduardo
AU - Piñol, Josep Lluís
AU - Caballero, Antonia
AU - Salvador-Carulla, Luis
AU - Cabasés, Juan
N1 - Funding Information:
This study has been funded by grants from the Carlos III Health Institute of the Spanish Ministry for Health and Consumption (FIS Exp. PI060176), the IDIAP Jordi Gol (2007), and has received the 18th Ferran Salsas i Roig Award – Mental Health and Community (Rubí Town Council). Germán López-Cortacans is grateful to the IDIAP Jordi Gol for a predoctoral grant (2011). The funding sources had no role in the study design, data collection, analysis, interpretation, preparation or review of the manuscript, or the decision to submit the article.
PY - 2014/4/20
Y1 - 2014/4/20
N2 - Background Collaborative care programmes lead to better outcomes in the management of depression. A programme of this nature has demonstrated its effectiveness in primary care in Spain. Our objective was to evaluate the cost-effectiveness of this programme compared to usual care. Methods A bottom-up cost-effectiveness analysis was conducted within a randomized controlled trial (2007-2010). The intervention consisted of a collaborative care programme with clinical, educational and organizational procedures. Outcomes were monitored over a 12 months period. Primary outcomes were incremental cost-effectiveness ratios (ICER): mean differences in costs divided by quality-adjusted life years (QALY) and mean differences in costs divided by depression-free days (DFD). Analyses were performed from a healthcare system perspective (considering healthcare costs) and from a society perspective (including healthcare costs plus loss of productivity costs). Results Three hundred and thirty-eight adult patients with major depression were assessed at baseline. Only patients with complete data were included in the primary analysis (166 in the intervention group and 126 in the control group). From a healthcare perspective, the average incremental cost of the programme compared to usual care was €182.53 (p<0.001). Incremental effectiveness was 0.045 QALY (p=0.017) and 40.09 DFD (p=0.011). ICERs were €4,056/QALY and €4.55/DFD. These estimates and their uncertainty are graphically represented in the cost-effectiveness plane. Limitations The amount of 13.6% of patients with incomplete data may have introduced a bias. Available data about non-healthcare costs were limited, although they may represent most of the total cost of depression. Conclusions The intervention yields better outcomes than usual care with a modest increase in costs, resulting in favourable ICERs. This supports the recommendation for its implementation.
AB - Background Collaborative care programmes lead to better outcomes in the management of depression. A programme of this nature has demonstrated its effectiveness in primary care in Spain. Our objective was to evaluate the cost-effectiveness of this programme compared to usual care. Methods A bottom-up cost-effectiveness analysis was conducted within a randomized controlled trial (2007-2010). The intervention consisted of a collaborative care programme with clinical, educational and organizational procedures. Outcomes were monitored over a 12 months period. Primary outcomes were incremental cost-effectiveness ratios (ICER): mean differences in costs divided by quality-adjusted life years (QALY) and mean differences in costs divided by depression-free days (DFD). Analyses were performed from a healthcare system perspective (considering healthcare costs) and from a society perspective (including healthcare costs plus loss of productivity costs). Results Three hundred and thirty-eight adult patients with major depression were assessed at baseline. Only patients with complete data were included in the primary analysis (166 in the intervention group and 126 in the control group). From a healthcare perspective, the average incremental cost of the programme compared to usual care was €182.53 (p<0.001). Incremental effectiveness was 0.045 QALY (p=0.017) and 40.09 DFD (p=0.011). ICERs were €4,056/QALY and €4.55/DFD. These estimates and their uncertainty are graphically represented in the cost-effectiveness plane. Limitations The amount of 13.6% of patients with incomplete data may have introduced a bias. Available data about non-healthcare costs were limited, although they may represent most of the total cost of depression. Conclusions The intervention yields better outcomes than usual care with a modest increase in costs, resulting in favourable ICERs. This supports the recommendation for its implementation.
KW - Controlled clinical trial
KW - Cost-effectiveness
KW - Depression
KW - Disease management
KW - Primary health care
UR - http://www.scopus.com/inward/record.url?scp=84896527153&partnerID=8YFLogxK
U2 - 10.1016/j.jad.2014.01.021
DO - 10.1016/j.jad.2014.01.021
M3 - Article
C2 - 24679395
AN - SCOPUS:84896527153
SN - 0165-0327
VL - 159
SP - 85
EP - 93
JO - Journal of Affective Disorders
JF - Journal of Affective Disorders
ER -