A personalized intervention to prevent depression in primary care: cost-effectiveness study nested into a clustered randomized trial

Abstract

Background: Depression is viewed as a major and increasing public health issue, as it causes high distress in the people experiencing it and considerable financial costs to society. Efforts are being made to reduce this burden by preventing depression. A critical component of this strategy is the ability to assess the individual level and profile of risk for the development of major depression. This paper presents the cost-effectiveness of a personalized intervention based on the risk of developing depression carried out in primary care, compared with usual care.

Methods: Cost-effectiveness analyses are nested within a multicentre, clustered, randomized controlled trial of a personalized intervention to prevent depression. The study was carried out in 70 primary care centres from seven cities in Spain. Two general practitioners (GPs) were randomly sampled from those prepared to participate in each centre (i.e. 140 GPs), and 3326 participants consented and were eligible to participate. The intervention included the GP communicating to the patient his/her individual risk for depression and personal risk factors and the construction by both GPs and patients of a psychosocial programme tailored to prevent depression. In addition, GPs carried out measures to activate and empower the patients, who also received a leaflet about preventing depression. GPs were trained in a 10- to 15-h workshop. Costs were measured from a societal and National Health care perspective. Qualityadjustedlife years were assessed using the EuroQOL five dimensions questionnaire. The time horizon was 18 months.

Results: With a willingness-to-pay threshold of €10,000 (£8568) the probability of cost-effectiveness oscillated from 83% (societal perspective) to 89% (health perspective). If the threshold was increased to €30,000 (£25,704), the probability of being considered cost-effective was 94% (societal perspective) and 96%, respectively (health perspective). The sensitivity analysis confirmed these results.

Conclusions: Compared with usual care, an intervention based on personal predictors of risk of depression implemented by GPs is a cost-effective strategy to prevent depression. This type of personalized intervention in primary care should be further developed and evaluated.

Trial registration: ClinicalTrials.gov, NCT01151982. Registered on June 29, 2010.

Keywords: Cost-effectiveness; Depression; Risk assessment.

Conflict of interest statement

Ethics approval and consent to participate

The PredictD-CCRT study has been approved by the relevant ethics committees in each participating Spanish city: Ethics Committee on Human Research of the University of Granada, Ethics and Research Committee of Primary Health District of Malaga, Ethics Committee for Clinical Research of Sant Joan de Deu Foundation (Barcelona) (PIC CEIC-62-09), Ethics Committee for Clinical Research of Aragon (CEICA) (CP06/05/2009), Ethics Committee for Health Research of the Jaen Hospital, Ethics Committee for Clinical Research of Euskadi (CEIC-E) (03/2009) and Ethics Committee for Clinical Research of the Rio Hortega Hospital of Valladolid (04/2009).

Consent for publication

Not applicable.

Competing interests

This work was only supported by public grants. The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript. No conflict of interests was reported by the authors of this paper. Dr. Antoni Serrano-Blanco reports grants from Ferrer International outside the submitted work, but none of the other authors have financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years.There are no other relationships or activities that could appear to have influenced the submitted work.

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Figures

Fig. 1

Cost-effectiveness planes

Fig. 2

Cost-effectiveness acceptability curves (CEACs): societal perspective

Fig. 3

Cost-effectiveness acceptability curves (CEACs): National Health System perspective