Cost-effectiveness of a care manager collaborative care programme for patients with depression in primary care: economic evaluation of a pragmatic randomised controlled study. Issue 11 (12th November 2018)

• Record Type: Journal Article
• Authors: Holst, Anna; Ginter, Annika; Björkelund, Cecilia; Hange, Dominique; Petersson, Eva-Lisa; Svenningsson, Irene; Westman, Jeanette; André, Malin; Wikberg, Carl; Wallin, Lars; Möller, Christina; Svensson, Mikael
• Is Part Of: BMJ open. Volume 8:Issue 11(2018)
• Publication Date: 2018-11-12
• Subjects: depression -- primary care -- care manager -- collaborative care -- health economic analysis -- intervention; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2018-024741
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Objective: To evaluate the cost-effectiveness of a care manager (CM) programme compared with care as usual (CAU) for treatment of depression at primary care centres (PCCs) from a healthcare as well as societal perspective. Design: Cost-effectiveness analysis. Setting: 23 PCCs in two Swedish regions. Participants: Patients with depression (n=342). Main outcome measures: A cost-effectiveness analysis was applied on a cluster randomised trial at PCC level where patients with depression had 3 months of contact with a CM (11 intervention PCCs, n=163) or CAU (12 control PCCs, n=179), with follow-up 3 and 6 months. Effectiveness measures were based on the number of depression-free days (DFDs) calculated from the Montgomery-Åsberg Depression Rating Scale-Self and quality-adjusted life years (QALYs). Results were expressed as the incremental cost-effectiveness ratio: ∆Cost/∆QALY and ∆Cost/∆DFD. Sampling uncertainty was assessed based on non-parametric bootstrapping. Results: Health benefits were higher in intervention group compared with CAU group: QALYs (0.357 vs 0.333, p<0.001) and DFD reduction of depressive symptom score (79.43 vs 60.14, p<0.001). The mean costs per patient for the 6-month period were €368 (healthcare perspective) and €6217 (societal perspective) for the intervention patients and €246 (healthcare perspective) and €7371 (societal perspective) for the control patients (n.s.). The cost per QALY gained was €6773 (healthcare perspective) and from a societal perspective the CM programme was dominant. Discussion: The CM programme was associated with a gain in QALYs as well as in DFD, while also being cost saving compared with CAU from a societal perspective. This result is of high relevance for decision-makers on a national level, but it must be observed that a CM programme for depression implies increased costs at the primary care level. Trial registration number: NCT02378272 ; Results.