Cost-effectiveness of depression case management in small practices

TY - JOUR

T1 - Cost-effectiveness of depression case management in small practices

AU - Gensichen, Jochen

AU - Petersen, Juliana J

AU - Von Korff, Michael

AU - Heider, Dirk

AU - Baron, Steffen

AU - König, Jochem

AU - Freytag, Antje

AU - Krauth, Christian

AU - Gerlach, Ferdinand M

AU - König, Hans-Helmut

PY - 2013/6/1

Y1 - 2013/6/1

N2 - BACKGROUND: Case management undertaken by healthcare assistants in small primary care practices is effective in improving depression symptoms and adherence in patients with major depression.AIMS: To evaluate the cost-effectiveness of depression case management by healthcare assistants in small primary care practices.METHOD: Cost-effectiveness analysis on the basis of a pragmatic randomised controlled trial (2005-2008): practice-based healthcare assistants in 74 practices provided case management to 562 patients with major depression over 1 year. Our primary outcome was the incremental cost-effectiveness ratio (ICER) calculated as the ratio of differences in mean costs and mean number of quality-adjusted life-years (QALYs). Our secondary outcome was the mean depression-free days (DFDs) between the intervention and control group at 24-month follow-up. The study was registered at the International Standard Randomised Controlled Trial Number Registry: ISRCTN66386086.RESULTS: Intervention v. control group: no significant difference in QALYs; significantly more DFDs (mean: 373 v. 311, P<0.01); no significant difference in mean direct healthcare costs (€4495 v. €3506, P = 0.16); considerably lower mean indirect costs (€5228 v. €7539, P = 0.06), resulting in lower total costs (€9723 v. €11 045, P = 0.41). The point estimate for the cost-utility ratio was €38 429 per QALY gained if only direct costs were considered, and 'dominance' of the intervention if total costs were considered. Yet, regardless of decision makers' willingness to pay per QALY, the probability of the intervention being cost-effective was never above 90%.CONCLUSIONS: In small primary care practices, 1 year of case management did not increase the number of QALYs but it did increase the number of DFDs. The intervention was likely to be cost-effective.

AB - BACKGROUND: Case management undertaken by healthcare assistants in small primary care practices is effective in improving depression symptoms and adherence in patients with major depression.AIMS: To evaluate the cost-effectiveness of depression case management by healthcare assistants in small primary care practices.METHOD: Cost-effectiveness analysis on the basis of a pragmatic randomised controlled trial (2005-2008): practice-based healthcare assistants in 74 practices provided case management to 562 patients with major depression over 1 year. Our primary outcome was the incremental cost-effectiveness ratio (ICER) calculated as the ratio of differences in mean costs and mean number of quality-adjusted life-years (QALYs). Our secondary outcome was the mean depression-free days (DFDs) between the intervention and control group at 24-month follow-up. The study was registered at the International Standard Randomised Controlled Trial Number Registry: ISRCTN66386086.RESULTS: Intervention v. control group: no significant difference in QALYs; significantly more DFDs (mean: 373 v. 311, P<0.01); no significant difference in mean direct healthcare costs (€4495 v. €3506, P = 0.16); considerably lower mean indirect costs (€5228 v. €7539, P = 0.06), resulting in lower total costs (€9723 v. €11 045, P = 0.41). The point estimate for the cost-utility ratio was €38 429 per QALY gained if only direct costs were considered, and 'dominance' of the intervention if total costs were considered. Yet, regardless of decision makers' willingness to pay per QALY, the probability of the intervention being cost-effective was never above 90%.CONCLUSIONS: In small primary care practices, 1 year of case management did not increase the number of QALYs but it did increase the number of DFDs. The intervention was likely to be cost-effective.

KW - Adolescent

KW - Adult

KW - Aged

KW - Case Management

KW - Cost-Benefit Analysis

KW - Depressive Disorder, Major

KW - Female

KW - Follow-Up Studies

KW - Germany

KW - Health Care Costs

KW - Humans

KW - Male

KW - Mental Health Services

KW - Middle Aged

KW - Primary Health Care

KW - Quality of Life

KW - Quality-Adjusted Life Years

KW - Questionnaires

KW - Young Adult

U2 - 10.1192/bjp.bp.112.118257

DO - 10.1192/bjp.bp.112.118257

M3 - SCORING: Journal article

C2 - 23580379

VL - 202

SP - 441

EP - 446

JO - BRIT J PSYCHIAT

JF - BRIT J PSYCHIAT

SN - 0007-1250

ER -