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A supported self-help for recurrent depression in primary care; An economic evaluation alongside a multi-center randomised controlled trial

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  • Karolien E M Biesheuvel-Leliefeld
  • Judith E Bosmans
  • Sandra M A Dijkstra-Kersten
  • Filip Smit
  • Claudi L H Bockting
  • Digna J F van Schaik
  • Harm W J van Marwijk
  • Henriette E van der Horst

Abstract

Background: Major depression is a prevalent mental disorder with a high risk of relapse or recurrence. Only few studies have focused on the cost-effectiveness of interventions aimed at the prevention of relapse or recurrence of depression in primary care. Aim: To evaluate the cost-effectiveness of a supported Self-help Preventive Cognitive Therapy (S-PCT) added to treatment-as-usual (TAU) compared with TAU alone for patients with a history of depression, currently in remission. Methods: An economic evaluation alongside a multi-center randomised controlled trial was performed (n = 248) over a 12-month follow-up. Outcomes included relapse or recurrence of depression and quality-adjusted-life-years (QALYs) based on the EuroQol-5D. Analyses were performed from both a societal and healthcare perspective. Missing data were imputed using multiple imputations. Uncertainty was estimated using bootstrapping and presented using the cost-effectiveness plane and the Cost-Effectiveness Acceptability Curve (CEAC). Cost estimates were adjusted for baseline costs. Results: S-PCT statistically significantly decreased relapse or recurrence by 15% (95%CI 3;28) compared to TAU. Mean total societal costs were €2,114 higher (95%CI -112;4261). From a societal perspective, the ICER for relapse or recurrence was 13,515. At a Willingness To Pay (WTP) of 22,000 €/recurrence prevented, the probability that S-PCT is cost-effective, in comparison with TAU, is 80%. The ICER for QALYs was 63,051. The CEA curve indicated that at a WTP of 30,000 €/QALY gained, the probability that S-PCT is cost-effective compared to TAU is 21%. Conclusions: Though ultimately depending on the WTP of decision makers, we expect that for both relapse or recurrence and QALYs, S-PCT cannot be considered cost-effective compared to TAU.

Suggested Citation

  • Karolien E M Biesheuvel-Leliefeld & Judith E Bosmans & Sandra M A Dijkstra-Kersten & Filip Smit & Claudi L H Bockting & Digna J F van Schaik & Harm W J van Marwijk & Henriette E van der Horst, 2018. "A supported self-help for recurrent depression in primary care; An economic evaluation alongside a multi-center randomised controlled trial," PLOS ONE, Public Library of Science, vol. 13(12), pages 1-18, December.
    • Handle: RePEc:plo:pone00:0208570
    DOI: 10.1371/journal.pone.0208570
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    References listed on IDEAS

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    1. Andrew R. Willan & Andrew H. Briggs & Jeffrey S. Hoch, 2004. "Regression methods for covariate adjustment and subgroup analysis for non‐censored cost‐effectiveness data," Health Economics, John Wiley & Sons, Ltd., vol. 13(5), pages 461-475, May.
    2. Matthijs van den Berg & Filip Smit & Theo Vos & Pieter H M van Baal, 2011. "Cost-Effectiveness of Opportunistic Screening and Minimal Contact Psychotherapy to Prevent Depression in Primary Care Patients," PLOS ONE, Public Library of Science, vol. 6(8), pages 1-7, August.
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    1. Juliane Andrea Duevel & Lena Hasemann & Luz María Peña-Longobardo & Beatriz Rodríguez-Sánchez & Isaac Aranda-Reneo & Juan Oliva-Moreno & Julio López-Bastida & Wolfgang Greiner, 2020. "Considering the societal perspective in economic evaluations: a systematic review in the case of depression," Health Economics Review, Springer, vol. 10(1), pages 1-19, December.

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