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Cost-effectiveness of a care manager collaborative care programme for patients with depression in primary care: economic evaluation of a pragmatic randomised controlled study.

Journal article
Authors Anna Holst
Annika Ginter
Cecilia Björkelund
Dominique Hange
Eva-Lisa Petersson
Irene Svenningsson
Jeanette Westman
Malin André
Carl Wikberg
Lars Wallin
Christina Möller
Mikael Svensson
Published in BMJ open
Volume 8
Issue 11
Pages e024741
ISSN 2044-6055
Publication year 2018
Published at Institute of Medicine, Department of Public Health and Community Medicine
Institute of Health and Care Sciences
Institute of Medicine, Department of Public Health and Community Medicine, Health Metrics
Pages e024741
Language en
Links dx.doi.org/10.1136/bmjopen-2018-024...
www.ncbi.nlm.nih.gov/entrez/query.f...
Subject categories Family Medicine

Abstract

To evaluate the cost-effectiveness of a care manager (CM) programme compared with care as usual (CAU) for treatment of depression at primary care centres (PCCs) from a healthcare as well as societal perspective.Cost-effectiveness analysis.23 PCCs in two Swedish regions.Patients with depression (n=342).A cost-effectiveness analysis was applied on a cluster randomised trial at PCC level where patients with depression had 3 months of contact with a CM (11 intervention PCCs, n=163) or CAU (12 control PCCs, n=179), with follow-up 3 and 6 months. Effectiveness measures were based on the number of depression-free days (DFDs) calculated from the Montgomery-Åsberg Depression Rating Scale-Self and quality-adjusted life years (QALYs). Results were expressed as the incremental cost-effectiveness ratio: ∆Cost/∆QALY and ∆Cost/∆DFD. Sampling uncertainty was assessed based on non-parametric bootstrapping.Health benefits were higher in intervention group compared with CAU group: QALYs (0.357 vs 0.333, p<0.001) and DFD reduction of depressive symptom score (79.43 vs 60.14, p<0.001). The mean costs per patient for the 6-month period were €368 (healthcare perspective) and €6217 (societal perspective) for the intervention patients and €246 (healthcare perspective) and €7371 (societal perspective) for the control patients (n.s.). The cost per QALY gained was €6773 (healthcare perspective) and from a societal perspective the CM programme was dominant.The CM programme was associated with a gain in QALYs as well as in DFD, while also being cost saving compared with CAU from a societal perspective. This result is of high relevance for decision-makers on a national level, but it must be observed that a CM programme for depression implies increased costs at the primary care level.NCT02378272; Results.

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