Economic evaluations of interventional opportunities for the management of mental–physical multimorbidity: a systematic review

Abstract

ObjectivesEconomic evaluations of interventions for people with mental–physical multimorbidity, including a depressive disorder, are sparse. This study examines whether such interventions in adults are cost-effective.DesignA systematic review.Data sourcesMEDLINE, CINAHL Plus, PsycINFO, Cochrane CENTRAL, Scopus, Web of Science and NHS EED databases were searched until 5 March 2022.Eligibility criteriaWe included studies involving people aged ≥18 with two or more chronic conditions (one being a depressive disorder). Economic evaluation studies that compared costs and outcomes of interventions were included, and those that assessed only costs or effects were excluded.Data extraction and synthesisTwo authors independently assessed risk of bias in included studies using recommended checklists. A narrative analysis of the characteristics and results by type of intervention and levels of healthcare provision was conducted.ResultsA total of 19 studies, all undertaken in high-income countries, met inclusion criteria. Four intervention types were reported: collaborative care, self-management, telephone-based and antidepressant treatment. Most (14 of 19) interventions were implemented at the organisational level and were potentially cost-effective, particularly, the collaborative care for people with depressive disorder and diabetes, comorbid major depression and cancer and depression and multiple long-term conditions. Cost-effectiveness ranged from £206 per quality-adjusted life year (QALY) for collaborative care programmes for older adults with diabetes and depression at primary care clinics (USA) to £79 723 per QALY for combining collaborative care with improved opportunistic screening for adults with depressive disorder and diabetes (England). Conclusions on cost-effectiveness were constrained by methodological aspects of the included studies: choice of perspectives, time horizon and costing methods.ConclusionsEconomic evaluations of interventions to manage multimorbidity with a depressive disorder are non-existent in low-income and middle-income countries. The design and reporting of future economic evaluations must improve to provide robust conclusions.PROSPERO registration numberCRD42022302036.

Regular source of primary care and health services utilisation among Brazilian elderly with mental-physical multimorbidity

“…Therefore, future studies are necessary to investigate the economic questions that arise in the care of these patients. A recent systematic review [ 45 ] demonstrates that there are no economic analyses of MP-MM in LMIC. To get reliable results, future economic evaluations' design and reporting must be improved.…”

The economic burden of multimorbidity: Protocol for a systematic review

“…The PRISMA-P checklist is available in S1 Checklist . The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 15 March 2023 (registration number CRD42023407338) [ 19 ]. The PRISMA 2020 checklist [ 20 ] will be used when writing the full systematic review.…”

“…The search strategy will include two concepts: 1) multimorbidity and 2) economic burden, and will be adapted from previously published systematic reviews [ 6 , 12 ]. We will use a combination of Medical Subject Headings (MeSH) and text words related to multimorbidity and costs.…”

“…The variable definitions and measurements of multimorbidity have presented a significant challenge to research, as they complicate the comparison, interpretation, and synthesis of data, thus limiting the true burden of multimorbidity [ 12 ]. The lack of consensus on the definition and measurement of multimorbidity has also hindered the prevention and treatment of multimorbidity, including policymaking [ 13 ].…”