Cost-utility of collaborative care for major depressive disorder in primary care in the Netherlands

Maartje Goorden; Klaas M L Huijbregts; Harm W J van Marwijk; Aartjan T F Beekman; Christina M van der Feltz-Cornelis; Leona Hakkaart-van Roijen

doi:10.1016/j.jpsychores.2015.06.006

Cost-utility of collaborative care for major depressive disorder in primary care in the Netherlands

J Psychosom Res. 2015 Oct;79(4):316-23. doi: 10.1016/j.jpsychores.2015.06.006. Epub 2015 Jun 24.

Authors

Maartje Goorden¹, Klaas M L Huijbregts², Harm W J van Marwijk³, Aartjan T F Beekman², Christina M van der Feltz-Cornelis⁴, Leona Hakkaart-van Roijen⁵

Affiliations

¹ Institute for Medical Technology Assessment, Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands. Electronic address: Goorden@bmg.eur.nl.
² GGZinGeest, partner VU University Medical Center, Amsterdam, The Netherlands; Department of Psychiatry and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
³ Department of General Practice and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
⁴ Department of Tranzo, University of Tilburg, Tilburg, The Netherlands; Topclinical Center for Body, Mind and Health Academic Psychiatry Department, GGZBreburg, Tilburg, The Netherlands.
⁵ Institute for Medical Technology Assessment, Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.

PMID: 26255095
DOI: 10.1016/j.jpsychores.2015.06.006

Abstract

Objective: Major depression is a great burden on society, as it is associated with high disability/costs. The aim of this study was to evaluate the cost-utility of Collaborative Care (CC) for major depressive disorder compared to Care As Usual (CAU) in a primary health care setting from a societal perspective.

Methods: A cluster randomized controlled trial was conducted, including 93 patients that were identified by screening (45-CC, 48-CAU). Another 57 patients were identified by the GP (56-CC, 1-CAU). The outcome measures were TiC-P, SF-HQL and EQ-5D, respectively measuring health care utilization, production losses and general health related quality of life at baseline three, six, nine and twelve months. A cost-utility analysis was performed for patients included by screening and a sensitivity analysis was done by also including patients identified by the GP.

Results: The average annual total costs was €1131 (95% C.I., €-3158 to €750) lower for CC compared to CAU. The average quality of life years (QALYs) gained was 0.02 (95% C.I., -0.004 to 0.04) higher for CC, so CC was dominant from a societal perspective. Taking a health care perspective, CC was less cost-effective due to higher costs, €1173 (95% C.I., €-216 to €2726), of CC compared to CAU which led to an ICER of 53,717 Euro/QALY. The sensitivity analysis showed dominance of CC.

Conclusion: The cost-utility analysis from a societal perspective showed that CC was dominant to CAU. CC may be a promising treatment for depression in the primary care setting. Further research should explore the cost-effectiveness of long-term CC.

Trial registration: Netherlands Trial Register ISRCTN15266438.

Keywords: Collaborative care; Cost utility; Depressive disorder; Primary health care; Randomized controlled trial.

MeSH terms

Cost-Benefit Analysis / methods*
Depressive Disorder, Major / economics*
Depressive Disorder, Major / therapy
Female
Humans
Male
Middle Aged
Netherlands
Primary Health Care / economics*
Quality of Life