Cost-effectiveness of a care manager collaborative care programme for patients with depression in primary care: 12-month economic evaluation of a pragmatic randomised controlled trial

Anna Holst, Frida Labori, Cecilia Björkelund, Dominique Hange, Irene Svenningsson, Eva-Lisa Petersson, Jeanette Westman, Christina Möller, Mikael Svensson, Anna Holst, Frida Labori, Cecilia Björkelund, Dominique Hange, Irene Svenningsson, Eva-Lisa Petersson, Jeanette Westman, Christina Möller, Mikael Svensson

Abstract

Objectives: To study the cost-effectiveness of a care manager organization for patients with mild to moderate depression in Swedish primary care in a 12-month perspective.

Methods: Cost-effectiveness analysis of the care manager organization compared to care as usual (CAU) in a pragmatic cluster randomised controlled trial including 192 individuals in the care manager group and 184 in the CAU group. Cost-effectiveness was assessed from a health care and societal perspectives. Costs were assessed in relation to two different health outcome measures: depression free days (DFDs) and quality adjusted life years (QALYs).

Results: At the 12-month follow-up, patients treated at the intervention Primary Care Centres (PCCs) with a care manager organization had larger health benefits than the group receiving usual care only at control PCCs. Mean QALY per patient was 0.73 (95% CI 0.7; 0.75) in the care manager group compared to 0.70 (95% CI 0.66; 0.73) in the CAU group. Mean DFDs was 203 (95% CI 178; 229) in the care manager group and 155 (95% CI 131; 179) in the CAU group. Further, from a societal perspective, care manager care was associated with a lower cost than care as usual, resulting in a dominant incremental cost-effectiveness ratio (ICER) for both QALYs and DFDs. From a health care perspective care manager care was related to a low cost per QALY (36,500 SEK / €3,379) and DFD (31 SEK/€3).

Limitations: A limitation is the fact that QALY data was impaired by insufficient EQ-5D data for some patients.

Conclusions: A care manager organization at the PCC to increase quality of care for patients with mild-moderate depression shows high health benefits, with no decay over time, and high cost-effectiveness both from a health care and a societal perspective. Trial registration details: The trial was registered in ClinicalTrials.com ( https://ichgcp.net/clinical-trials-registry/NCT02378272 ) in 02/02/2015 with the registration number NCT02378272. The first patient was enrolled in 11/20/2014.

Keywords: Care manager; Collaborative care; Cost-effectiveness; Depression; Primary care; Sweden.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Cost-effectiveness acceptability curve (CEAC): health care and societal perspective in the 12-month evaluation of cost-effectiveness in the care manager collaborative care programme for patients with depression in primary care

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