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

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, 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

Abstract

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.

Design: Cost-effectiveness analysis.

Setting: 23 PCCs in two Swedish regions.

Participants: Patients with depression (n=342).

Main outcome measures: 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.

Results: 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.

Discussion: 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.

Trial registration number: NCT02378272; Results.

Keywords: care manager; collaborative care; depression; health economic analysis; intervention; primary care.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Cost-effectiveness planes with confidence ellipses. The horizontal axis represents the difference in QALYs between the care manager programme and CAU. The vertical axis represents the difference in costs between the two alternatives (left graph: societal perspective, right graph: healthcare perspective). CAU, care as usual; QALYs, quality-adjusted life years.
Figure 2
Figure 2
Cost-effectiveness acceptability curves for various willingness-to-pay thresholds for one quality-adjusted life year gained based on a healthcare and societal perspective.

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