Cost-effectiveness of depression case management in small practices
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Cost-effectiveness of depression case management in small practices. / Gensichen, Jochen; Petersen, Juliana J; Von Korff, Michael; Heider, Dirk; Baron, Steffen; König, Jochem; Freytag, Antje; Krauth, Christian; Gerlach, Ferdinand M; König, Hans-Helmut.
In: BRIT J PSYCHIAT, Vol. 202, 01.06.2013, p. 441-6.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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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 -