Cost-utility of collaborative care for the treatment of comorbid major depressive disorder in outpatients with chronic physical conditions. A randomized controlled trial in the general hospital setting (CC-DIM)

Abstract

PurposeMajor depressive disorder (MDD) is highly prevalent in patients with a chronic physical condition, and this comorbidity has a negative influence on quality of life, health care costs, self-care, morbidity, and mortality. Research has shown that collaborative care (CC) may be a cost-effective treatment. However, its cost-effectiveness in this patient group has not yet been established. Therefore, the aim of this study was to evaluate the cost-utility of CC for the treatment of comorbid MDD in chronically ill patients in the outpatient general hospital setting. The study was conducted from a health care and societal perspective.Patients and methodsIn this randomized controlled trial, 81 patients with moderate-to-severe MDD were included; 42 were randomly assigned to the CC group and 39 to the care as usual (CAU) group. We applied the TiC-P, short-form Health-Related Quality of Life questionnaire, and EuroQol EQ-5D 3 level version, measuring the use of health care, informal care, and household work, respectively, at baseline and at 3, 6, 9, and 12 months follow-up.ResultsThe mean annual direct medical costs in the CC group were €6,718 (95% confidence interval [CI]: 3,541 to 10,680) compared to €4,582 (95% CI: 2,782 to 6,740) in the CAU group. The average quality-adjusted life years (QALYs) gained were 0.07 higher in the CC group, indicating that CC is more costly but also more effective than CAU. From a societal perspective, the incremental cost-effectiveness ratio was €24,690/QALY.ConclusionThis first cost-utility analysis in chronically ill patients with comorbid MDD shows that CC may be a cost-effective treatment depending on willingness-to-pay levels. Nevertheless, the low utility scores emphasize the need for further research to improve the cost-effectiveness of CC in this highly prevalent and costly group of patients.

Cost and effects of integrated care: a systematic literature review and meta-analysis

“…the meta-analyses [24,[36][37][38]. The adapted PRISMA flowchart of the review update is presented in Fig.…”

“…This contrast in the findings by study design highlights a well-documented trade-off between attributability and practicability [88]. In our review, several observational economic evaluations barely took any measures to mitigate for treatment contamination or selection bias, thereby jeopardizing causal inference [36,52,55,64,68,69,71,74]. Although experimental designs are the gold standard for robust causal inference, their adoption in evaluating integrated care has been criticized due to their rigidness and low generalizability [89,90].…”

“…Three studies [52,55,64], however, reported the costs of the control and intervention groups after both a baseline period of 3 months and after implementation of the intervention programme. Similar baseline reporting practice was also undertaken in six studies with regards to the measuring of effectiveness [36,64,68,69,71,74]. In these cases, the final mean costs or outcomes of each group were adjusted (using Eq.…”

Illness burden and physical outcomes associated with collaborative care in patients with comorbid depressive disorder in chronic medical conditions: A systematic review and meta-analysis

“…Although more procedures make CC more costly, several studies have shown that CC improves quality of life for acceptable additional costs [38,75]. This has been shown to be the case for depression comorbid with various chronic medical conditions [76][77][78][79][80][81].…”

“…Although more procedures make CC more costly, several studies have shown that CC improves quality of life for 14 acceptable additional costs [38,75]. This has been shown to be the case for depression comorbid with various chronic medical conditions [76][77][78][79][80][81].In patients with ACS, comorbid depression is associated with poorer quality of life [82]. Therefore, given that CC has a better effect than CAU on depression, the fact that depression treatment in ACS has a known favourable prognostic effect on cardiac outcomes [83], and the fact that CC has a positive effect on physical outcomes, CC should be considered a good treatment option in ACS.…”