Cost-effectiveness analysis of collaborative treatment of late-life depression in primary care (GermanIMPACT)

Abstract

Background:Late-life depression is a highly prevalent disorder that causes a large economic burden. A stepped collaborative care program was set up in order to improve care for patients with late-life depression in primary care in Germany: GermanIMPACT is the adaption of the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) program that has already been established in primary care in the USA. The aim of this study was to determine the cost-effectiveness of GermanIMPACT compared with treatment as usual from a societal perspective.Methods:This study is part of a 12-month bi-centric cluster-randomized controlled trial aiming to assess the effectiveness of GermanIMPACT compared with treatment as usual among patients with late-life depression. A cost-effectiveness analysis using depression-free days (DFDs) was performed. Net-monetary benefit (NMB) regressions adjusted for baseline differences for different willingness-to-pay (WTP) thresholds were conducted and cost-effectiveness acceptability curves were constructed.Results:In total, n = 246 patients (intervention group: n = 139; control group: n = 107) with a mean age of 71 from 71 primary care practices were included in the analysis. After 12 months, adjusted mean differences in costs and DFDs between intervention group and control group were +€354 and +21.4, respectively. Only the difference in DFDs was significant (p = 0.022). According to the unadjusted incremental cost-effectiveness ratio, GermanIMPACT was dominant compared with treatment as usual. The probability of GermanIMPACT being cost-effective was 80%, 90% or 95% if societal WTP per DFD was ≥€70, ≥€110 or ≥€180, respectively.Conclusion:Evidence for cost-effectiveness of GermanIMPACT relative to treatment as usual is not clear. Only if societal WTP was ≥€180 for an additional DFD, GermanIMPACT could be considered cost-effective with certainty.

The Effectiveness of Patient-Centred Medical Home-Based Models of Care versus Standard Primary Care in Chronic Disease Management: A Systematic Review and Meta-Analysis of Randomised and Non-Randomised Controlled Trials

“…The characteristics of included studies are presented in the Appendix A Table A3 and Table A4 . Of the 85 studies included in the review, 78 studies were RCTs [ 13 , 14 , 16 , 18 , 19 , 20 , 22 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80...…”

“…A total of 18 studies [ 13 , 22 , 37 , 44 , 46 , 52 , 58 , 59 , 60 , 65 , 66 , 69 , 73 , 79 , 80 , 92 , 98 , 108 ] reported cost-effectiveness of PCMH-based models of care compared to standard care. To avoid bias in analysis, all currencies were converted to US Dollars at the time of the respective trials and cost effectiveness was measured in terms of incremental cost of intervention.…”

Prevalência de sintomas depressivos em idosos atendidos em unidades de saúde da família e fatores associados

“…3 Esta condição promove graves consequências na vida do idoso, como, sofrimento psíquico, prejuízos nas atividades de vida diárias (AVD), aumento nos gastos em saúde, prejuízo nos relacionamentos interpessoais, além da própria incapacidade provocada pela doença. [4][5][6][7] Também é considerada um transtorno mental, o qual vem apresentando alto índice na população idosa, 3,8 com maior prevalência em mulheres, [9][10][11][12][13] pessoas com outras comorbidades ou institucionalizadas, demonstrando a necessidade da identificação e tratamento precoce desta patologia, devido as desordens médicas e neurológicas que comprometem também a qualidade de vida dos idosos. 12 Pesquisas desenvolvidas no Brasil revelam que a prevalência de sintomas depressivos em idosos pode variar.…”

Cost-effectiveness of guideline-based stepped and collaborative care versus treatment as usual for patients with depression – a cluster-randomized trial

“…Considering the cost-effectiveness, there is evidence from several studies. However, most of these studies took a rather specific focus on stepped care approaches by evaluating the inclusion of digital measures into stepped care models [ 15 – 18 ] or by investigating stepped care in populations with specific underlying diseases [ 19 – 21 ] or in combination with other interventions [ 22 , 23 ] or in specific populations [ 24 – 30 ]. There are three studies that show a certain degree of comparability to our study by evaluating stepped care exclusively for depression in a primary care sample.…”