TY - JOUR
T1 - Cost-effectiveness of a stepped care program to prevent depression among primary care patients with diabetes mellitus type 2 and/or coronary heart disease and subthreshold depression in comparison with usual care
AU - van Dijk, S. E. M.
AU - Pols, A. D.
AU - Adriaanse, M. C.
AU - van Marwijk, H. W. J.
AU - van Tulder, M. W.
AU - Bosmans, J. E.
N1 - Funding Information: This study was funded by ZonMw, the Netherlands Organization for Health Research and Development (project number 80–82310-97- 12110). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Funding Information: The authors would like to thank Anna Jansen, Lennart van der Zwaan, Timo Velzeboer, Marleen Reuser, Wendy Kerstens, Jet Bessem, and Walter van Raaij for their contribution in the data collection for this study. We also would like to thank all the participating general practices and the research networks of general practitioners (ANH, THOON and LEON) for their participation and collaboration in the implementation and execution of the study. Furthermore, this study has been possible thanks to all Step-Dep participants; Michiel de Boer, our independent statistician who performed the randomization; Petra Elders who contributed in the design of the study and the recruitment of general practices in the Amsterdam region; and Hanna Joosten, who helped us design the search strategy in the electronic patient record system of the general practices. This research was supported by the National Institute for Health Research (NIHR) Applied Research Collaboration Kent, Surrey, Sussex. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Funding Information: The authors would like to thank Anna Jansen, Lennart van der Zwaan, Timo Velzeboer, Marleen Reuser, Wendy Kerstens, Jet Bessem, and Walter van Raaij for their contribution in the data collection for this study. We also would like to thank all the participating general practices and the research networks of general practitioners (ANH, THOON and LEON) for their participation and collaboration in the implementation and execution of the study. Furthermore, this study has been possible thanks to all Step-Dep participants; Michiel de Boer, our independent statistician who performed the randomization; Petra Elders who contributed in the design of the study and the recruitment of general practices in the Amsterdam region; and Hanna Joosten, who helped us design the search strategy in the electronic patient record system of the general practices. This research was supported by the National Institute for Health Research (NIHR) Applied Research Collaboration Kent, Surrey, Sussex. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Publisher Copyright: © 2021, The Author(s).
PY - 2021/12/1
Y1 - 2021/12/1
N2 - Background: Patients with diabetes mellitus type 2 (DM2) and/or coronary heart disease (CHD) are at high risk to develop major depression. Preventing incident major depression may be an important tool in reducing the personal and societal burden of depression. The aim of the current study was to assess the cost-effectiveness of a stepped care program to prevent major depression (Step-Dep) in diabetes mellitus type 2 and/or coronary heart disease patients with subthreshold depression in comparison with usual care. Methods: An economic evaluation with 12 months follow-up was conducted alongside a pragmatic cluster-randomized controlled trial from a societal perspective. Participants received care as usual (n = 140) or Step-Dep (n = 96) which consisted of four sequential treatment steps: watchful waiting, guided self-help, problem solving treatment and referral to a general practitioner. Primary outcomes were quality-adjusted life years (QALYs) and cumulative incidence of major depression. Costs were measured every 3 months. Missing data was imputed using multiple imputation. Uncertainty around cost-effectiveness outcomes was estimated using bootstrapping and presented in cost-effectiveness planes and acceptability curves. Results: There were no significant differences in QALYs or depression incidence between treatment groups. Secondary care costs (mean difference €1644, 95% CI €344; €3370) and informal care costs (mean difference €1930, 95% CI €528; €4089) were significantly higher in the Step-Dep group than in the usual care group. The difference in total societal costs (€1001, 95% CI €-3975; €6409) was not statistically significant. The probability of the Step-Dep intervention being cost-effective was low, with a maximum of 0.41 at a ceiling ratio of €30,000 per QALY gained and 0.32 at a ceiling ratio of €0 per prevented case of major depression. Conclusions: The Step-Dep intervention is not cost-effective compared to usual care in a population of patients with DM2/CHD and subthreshold depression. Therefore, widespread implementation cannot be recommended. Trial registration: The trial was registered in the Netherlands Trial Register (NTR3715).
AB - Background: Patients with diabetes mellitus type 2 (DM2) and/or coronary heart disease (CHD) are at high risk to develop major depression. Preventing incident major depression may be an important tool in reducing the personal and societal burden of depression. The aim of the current study was to assess the cost-effectiveness of a stepped care program to prevent major depression (Step-Dep) in diabetes mellitus type 2 and/or coronary heart disease patients with subthreshold depression in comparison with usual care. Methods: An economic evaluation with 12 months follow-up was conducted alongside a pragmatic cluster-randomized controlled trial from a societal perspective. Participants received care as usual (n = 140) or Step-Dep (n = 96) which consisted of four sequential treatment steps: watchful waiting, guided self-help, problem solving treatment and referral to a general practitioner. Primary outcomes were quality-adjusted life years (QALYs) and cumulative incidence of major depression. Costs were measured every 3 months. Missing data was imputed using multiple imputation. Uncertainty around cost-effectiveness outcomes was estimated using bootstrapping and presented in cost-effectiveness planes and acceptability curves. Results: There were no significant differences in QALYs or depression incidence between treatment groups. Secondary care costs (mean difference €1644, 95% CI €344; €3370) and informal care costs (mean difference €1930, 95% CI €528; €4089) were significantly higher in the Step-Dep group than in the usual care group. The difference in total societal costs (€1001, 95% CI €-3975; €6409) was not statistically significant. The probability of the Step-Dep intervention being cost-effective was low, with a maximum of 0.41 at a ceiling ratio of €30,000 per QALY gained and 0.32 at a ceiling ratio of €0 per prevented case of major depression. Conclusions: The Step-Dep intervention is not cost-effective compared to usual care in a population of patients with DM2/CHD and subthreshold depression. Therefore, widespread implementation cannot be recommended. Trial registration: The trial was registered in the Netherlands Trial Register (NTR3715).
KW - Cardiovascular disease
KW - Coronary Disease/complications
KW - Cost-Benefit Analysis
KW - Cost-effectiveness analysis
KW - Depression
KW - Depression/prevention & control
KW - Depressive Disorder, Major
KW - Diabetes Mellitus, Type 2/complications
KW - Diabetes mellitus type 2
KW - Humans
KW - Prevention
KW - Primary Health Care
KW - Quality-Adjusted Life Years
KW - Randomized controlled trial
UR - http://www.scopus.com/inward/record.url?scp=85112457514&partnerID=8YFLogxK
U2 - https://doi.org/10.1186/s12888-021-03367-z
DO - https://doi.org/10.1186/s12888-021-03367-z
M3 - Article
C2 - 34389017
SN - 1471-244X
VL - 21
SP - 402
JO - BMC Psychiatry
JF - BMC Psychiatry
IS - 1
M1 - 402
ER -
