Cost-effectiveness of a care manager collaborative care programme for patients with depression in primary care: economic evaluation of a pragmatic randomised controlled study

Anna Holst; Annika Ginter; Cecilia Björkelund; Dominique Hange; Eva-Lisa Petersson; Irene Svenningsson; Jeanette Westman; Malin André; Carl Wikberg; Lars Wallin; Christina Möller; Mikael Svensson

doi:10.1136/bmjopen-2018-024741

Cost-effectiveness of a care manager collaborative care programme for patients with depression in primary care: economic evaluation of a pragmatic randomised controlled study

BMJ Open. 2018 Nov 12;8(11):e024741. doi: 10.1136/bmjopen-2018-024741.

Authors

Anna Holst¹, Annika Ginter², Cecilia Björkelund¹, Dominique Hange¹, Eva-Lisa Petersson^{1

3}, Irene Svenningsson^{1

3}, Jeanette Westman⁴, Malin André⁵, Carl Wikberg¹, Lars Wallin^{6

7}, Christina Möller⁸, Mikael Svensson²

Affiliations

¹ Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
² Department of Public Health and Community Medicine/Health Metrics, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
³ Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden.
⁴ Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
⁵ Department of Public Health and Caring Sciences-Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
⁶ Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
⁷ Department of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁸ Primary Health Care Head Office, Närhälsan, Region Västra Götaland, Hisings Backa, Sweden.

Abstract

Objective: To evaluate the cost-effectiveness of a care manager (CM) programme compared with care as usual (CAU) for treatment of depression at primary care centres (PCCs) from a healthcare as well as societal perspective.

Design: Cost-effectiveness analysis.

Setting: 23 PCCs in two Swedish regions.

Participants: Patients with depression (n=342).

Main outcome measures: A cost-effectiveness analysis was applied on a cluster randomised trial at PCC level where patients with depression had 3 months of contact with a CM (11 intervention PCCs, n=163) or CAU (12 control PCCs, n=179), with follow-up 3 and 6 months. Effectiveness measures were based on the number of depression-free days (DFDs) calculated from the Montgomery-Åsberg Depression Rating Scale-Self and quality-adjusted life years (QALYs). Results were expressed as the incremental cost-effectiveness ratio: ∆Cost/∆QALY and ∆Cost/∆DFD. Sampling uncertainty was assessed based on non-parametric bootstrapping.

Results: Health benefits were higher in intervention group compared with CAU group: QALYs (0.357 vs 0.333, p<0.001) and DFD reduction of depressive symptom score (79.43 vs 60.14, p<0.001). The mean costs per patient for the 6-month period were €368 (healthcare perspective) and €6217 (societal perspective) for the intervention patients and €246 (healthcare perspective) and €7371 (societal perspective) for the control patients (n.s.). The cost per QALY gained was €6773 (healthcare perspective) and from a societal perspective the CM programme was dominant.

Discussion: The CM programme was associated with a gain in QALYs as well as in DFD, while also being cost saving compared with CAU from a societal perspective. This result is of high relevance for decision-makers on a national level, but it must be observed that a CM programme for depression implies increased costs at the primary care level.

Trial registration number: NCT02378272; Results.

Keywords: care manager; collaborative care; depression; health economic analysis; intervention; primary care.

Publication types

Pragmatic Clinical Trial
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cost-Benefit Analysis*
Depressive Disorder / economics*
Depressive Disorder / therapy*
Female
Humans
Intersectoral Collaboration*
Male
Middle Aged
Patient Care Management / economics*
Primary Health Care / economics*
Quality-Adjusted Life Years
Sweden

Associated data

ClinicalTrials.gov/NCT02378272