Objective
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.
DesignCost-effectiveness analysis.
Setting23 PCCs in two Swedish regions.
ParticipantsPatients with depression (n=342).
Main outcome measuresA 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.
ResultsHealth 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.
DiscussionThe 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.
Trial registration numberNCT02378272; Results.
https://ift.tt/2z7aLsO
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