Long-term cost-effectiveness of collaborative care (vs usual care) for people with depression and comorbid diabetes or cardiovascular disease: a Markov model informed by the COINCIDE randomised controlled trial.
BMJ Open
; 6(10): e012514, 2016 10 07.
Article
em En
| MEDLINE
| ID: mdl-27855101
ABSTRACT
OBJECTIVES:
To evaluate the long-term cost-effectiveness of collaborative care (vs usual care) for treating depression in patients with diabetes and/or coronary heart disease (CHD).SETTING:
36 primary care general practices in North West England.PARTICIPANTS:
387 participants completed baseline assessment (collaborative care 191; usual care 196) and full or partial 4-month follow-up data were captured for 350 (collaborative care 170; usual care 180). 62% of participants were male, 14% were non-white. Participants were aged ≥18â years, listed on a Quality and Outcomes Framework register for CHD and/or type 1 or 2 diabetes mellitus, with persistent depressive symptoms. Patients with psychosis or type I/II bipolar disorder, actively suicidal, in receipt of services for substance misuse, or already in receipt of psychological therapy for depression were excluded. INTERVENTION Collaborative care consisted of evidence-based low-intensity psychological treatments, delivered over 3â months and case management by a practice nurse and a Psychological Well Being Practitioner. OUTCOMEMEASURES:
As planned, the primary measure of cost-effectiveness was the incremental cost-effectiveness ratio (cost per quality-adjusted life year (QALY)). A Markov model was constructed to extrapolate the trial results from short-term to long-term (24â months).RESULTS:
The mean cost per participant of collaborative care was £317 (95% CI 284 to 350). Over 24â months, it was estimated that collaborative care was associated with greater healthcare usage costs (net cost £674 (95% CI -30â 953 to 38â 853)) and QALYs (net QALY gain 0.04 (95% CI -0.46 to 0.54)) than usual care, resulting in a cost per QALY gained of £16â 123, and a likelihood of being cost-effective of 0.54 (willingness to pay threshold of £20â 000).CONCLUSIONS:
Collaborative care is a potentially cost-effective long-term treatment for depression in patients with comorbid physical and mental illness. The estimated cost per QALY gained was below the threshold recommended by English decision-makers. Further, long-term primary research is needed to address uncertainty associated with estimates of cost-effectiveness. TRIAL REGISTRATION NUMBER ISRCTN80309252; Post-results.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Equipe de Assistência ao Paciente
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Doenças Cardiovasculares
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Análise Custo-Benefício
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Comportamento Cooperativo
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Depressão
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Transtorno Depressivo
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Diabetes Mellitus
Idioma:
En
Ano de publicação:
2016
Tipo de documento:
Article