Cost-effectiveness analysis of collaborative treatment of late-life depression in primary care (GermanIMPACT)

Thomas Grochtdreis; Christian Brettschneider; Frederike Bjerregaard; Christiane Bleich; Sigrid Boczor; Martin Härter; Lars P Hölzel; Michael Hüll; Thomas Kloppe; Wilhelm Niebling; Martin Scherer; Iris Tinsel; Hans-Helmut König

doi:10.1016/j.eurpsy.2018.12.007

Cost-effectiveness analysis of collaborative treatment of late-life depression in primary care (GermanIMPACT)

Eur Psychiatry. 2019 Apr:57:10-18. doi: 10.1016/j.eurpsy.2018.12.007. Epub 2019 Jan 15.

Authors

Affiliations

¹ Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address: t.grochtdreis@uke.de.
² Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
³ Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
⁴ Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
⁵ Department of General Practice / Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
⁶ Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Parkklinik Wiesbaden Schlangenbad, Schlangenbad, Germany.
⁷ Center for Psychiatry Emmendingen, Emmendingen, Germany; Center for Geriatric Medicine and Gerontology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany.
⁸ Division of General Practice, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany.

PMID: 30658275
DOI: 10.1016/j.eurpsy.2018.12.007

Abstract

Background: Late-life depression is a highly prevalent disorder that causes a large economic burden. A stepped collaborative care program was set up in order to improve care for patients with late-life depression in primary care in Germany: GermanIMPACT is the adaption of the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) program that has already been established in primary care in the USA. The aim of this study was to determine the cost-effectiveness of GermanIMPACT compared with treatment as usual from a societal perspective.

Methods: This study is part of a 12-month bi-centric cluster-randomized controlled trial aiming to assess the effectiveness of GermanIMPACT compared with treatment as usual among patients with late-life depression. A cost-effectiveness analysis using depression-free days (DFDs) was performed. Net-monetary benefit (NMB) regressions adjusted for baseline differences for different willingness-to-pay (WTP) thresholds were conducted and cost-effectiveness acceptability curves were constructed.

Results: In total, n = 246 patients (intervention group: n = 139; control group: n = 107) with a mean age of 71 from 71 primary care practices were included in the analysis. After 12 months, adjusted mean differences in costs and DFDs between intervention group and control group were +€354 and +21.4, respectively. Only the difference in DFDs was significant (p = 0.022). According to the unadjusted incremental cost-effectiveness ratio, GermanIMPACT was dominant compared with treatment as usual. The probability of GermanIMPACT being cost-effective was 80%, 90% or 95% if societal WTP per DFD was ≥€70, ≥€110 or ≥€180, respectively.

Conclusion: Evidence for cost-effectiveness of GermanIMPACT relative to treatment as usual is not clear. Only if societal WTP was ≥€180 for an additional DFD, GermanIMPACT could be considered cost-effective with certainty.

Keywords: Aged; Collaborative care; Cost-effectiveness analysis; Depression-free days; Depressive disorders; Late-life depression; Primary care.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Cost-Benefit Analysis
Depression / economics*
Depression / therapy*
Depressive Disorder / economics
Depressive Disorder / therapy
Female
Germany
Health Care Costs / statistics & numerical data
Humans
Male
Middle Aged
Patient Education as Topic / economics*
Primary Health Care / economics*
Primary Health Care / organization & administration
Treatment Outcome