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Economic evaluation of a minimal psychological intervention in chronically ill elderly patients with minor or mild to moderate depression: A randomized trial (the DELTA-study)

Published online by Cambridge University Press:  22 October 2009

Catharina C. M. Jonkers ,
Femke Lamers ,
Silvia M. A. A. Evers ,
Hans Bosma ,
Job F. Metsemakers  and
Jacques Th. M. Van Eijk
Catharina C. M. Jonkers
Affiliation:
Maastricht University
Femke Lamers
Affiliation:
Maastricht University
Silvia M. A. A. Evers
Affiliation:
Maastricht University
Hans Bosma
Affiliation:
Maastricht University
Job F. Metsemakers
Affiliation:
Maastricht University
Jacques Th. M. Van Eijk
Affiliation:
Maastricht University
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Abstract

Objectives: Depression is associated with high healthcare utilization and related costs. Effective treatments might reduce the economic burden. The objective of this study was to establish the cost-utility of a minimal psychological intervention (MPI) aimed at reducing depression and improving quality of life in elderly persons with diabetes or chronic obstructive pulmonary disease and co-occurring minor, mild, or moderate depression.

Methods: Trial-based cost-utility analysis was used to compare the MPI with usual care. Annual costs and quality-adjusted life-years (QALYs) based on the Euroqol (EQ5D) and on depression-free days were calculated.

Results: Annual costs and effects were not significantly different for the MPI group and care as usual. Bootstrap analysis indicated a dominant intervention, with a probability of 63 percent that the MPI is less costly and more effective than usual care.

Conclusions: The cost-effectiveness analysis does not support dissemination of the MPI in its current form. The economic evaluation study showed limited probability that MPI is cost-effective over usual care. Further adjustments to the MPI are needed to make the intervention suitable for dissemination in regular care. Trial registration: isrctn.org, identifier: ISRCTN92331982.

Keywords

Cost-benefit analysisDepressive disorderAgedChronic diseaseQuality of life
Type
General Essays
Information
International Journal of Technology Assessment in Health Care , Volume 25 , Issue 4 , October 2009 , pp. 497 - 504
Copyright
Copyright © Cambridge University Press 2009

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References

REFERENCES

1. Anderson, RJ, Freedland, KE, Clouse, RE, Lustman, PJ. The prevalence of comorbid depression in adults with diabetes: A meta-analysis. Diabetes Care. 2001;24:1069–1078.Google Scholar
2. Beck, AT, Steer, RA, Garbin, MG. Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clin Psychol Rev. 1988;8:77–100.Google Scholar
3. Casparie, AF, van Hout, BA, Simoons, ML. Richtlijnen en kosten [Guidelines and costs]. Ned Tijdschr Geneeskd. 1998;142:2075–2077.Google Scholar
4. Chatfield, MD, Brayne, CE, Matthews, FE. A systematic literature review of attrition between waves in longitudinal studies in the elderly shows a consistent pattern of dropout between differing studies. J Clin Epidemiol. 2005;58:13–19.Google Scholar
5. Donohue, JM, Pincus, HA. Reducing the societal burden of depression: A review of economic costs, quality of care and effects of treatment. Pharmacoeconomics. 2007;25:7–24.CrossRefGoogle ScholarPubMed
6. Drummond, MF. Methods for the economic evaluation of health care programmes. 2nd ed. Oxford: Oxford University Press; 1997.Google Scholar
7. Engels, JM, Diehr, P. Imputation of missing longitudinal data: A comparison of methods. J Clin Epidemiol. 2003;56:968–976.Google Scholar
8EuroQol Group. EuroQol–a new facility for the measurement of health-related quality of life. The EuroQol Group. Health Policy. 1990;16:199–208.Google Scholar
9. Goossens, ME, Rutten-van Molken, MP, Vlaeyen, JW, Van Der Linden, SM. The cost diary: A method to measure direct and indirect costs in cost-effectiveness research. J Clin Epidemiol. 2000;53:688–695.CrossRefGoogle ScholarPubMed
10. Hamilton, M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56–62.Google Scholar
11. Jonkers, CCM, Lamers, F, Bosma, H, et al. Process evaluation of a minimal psychological intervention to reduce depression in chronically ill elderly persons. Patient Educ Couns. 2007;68:252–257.Google Scholar
12. Katon, W, Unutzer, J, Fan, MY, et al. Cost-effectiveness and net benefit of enhanced treatment of depression for older adults with diabetes and depression. Diabetes Care. 2006;29:265–270.CrossRefGoogle ScholarPubMed
13. Lamers, F, Jonkers, CC, Bosma, H, et al. Effectiveness and cost-effectiveness of a minimal psychological intervention to reduce non-severe depression in chronically ill elderly patients: The design of a randomised controlled trial [ISRCTN92331982]. BMC Public Health. 2006;6:161.Google Scholar
14. Lamers, LM, McDonnell, J, Stalmeier, PF, et al. The Dutch tariff: Results and arguments for an effective design for national EQ-5D valuation studies. Health Econ. 2006;15:1121–1132.Google Scholar
15. Lave, JR, Frank, RG, Schulberg, HC, Kamlet, MS. Cost-effectiveness of treatments for major depression in primary care practice. Arch Gen Psychiatry. 1998;55:645–651.Google Scholar
16. Oostenbrink, JB, Bouwmans, CAM, Koopmanschap, MA, Rutten, FFH. Handleiding voor kostenonderzoek: Methoden en standaard kostprijzen voor economische evaluaties in de gezondheidszorg [Manual for costing: Methods and Standard Costs for Economic Evaluations in Health Care]. Diemen: College voor zorgverzekeringen; 2004 updated version.Google Scholar
17. Penninx, BW, Guralnik, JM, Ferrucci, L, et al. Depressive symptoms and physical decline in community-dwelling older persons. JAMA. 1998;279:1720–1726.CrossRefGoogle ScholarPubMed
18. Pyne, JM, Tripathi, S, Williams, DK, Fortney, J. Depression-free day to utility-weighted score: Is it valid? Med Care. 2007;45:357–362.Google Scholar
19. Sheehan, DV, Lecrubier, Y, Sheehan, KH, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59 (Suppl 20):22–33.Google Scholar
20. Simon, GE, Katon, WJ, Lin, EH, et al. Cost-effectiveness of systematic depression treatment among people with diabetes mellitus. Arch Gen Psychiatry. 2007;64:65–72.Google Scholar
21. Spitzer, RL, Kroenke, K, Linzer, M, et al. Health-related quality of life in primary care patients with mental disorders. Results from the PRIME-MD 1000 Study. JAMA. 1995;274:1511–1517.Google Scholar
22. Spitzer, RL, Kroenke, K, Williams, JB. Validation and utility of a self-report version of PRIME-MD: The PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA. 1999;282:1737–1744.Google Scholar
23. Van Hout, BA, Al, MJ, Gordon, GS, Rutten, FF. Costs, effects and C/E-ratios alongside a clinical trial. Health Econ. 1994;3:309–319.Google Scholar
24. Wang, PS, Simon, G, Kessler, RC. The economic burden of depression and the cost-effectiveness of treatment. Int J Methods Psychiatr Res. 2003;12:22–33.CrossRefGoogle ScholarPubMed
25. Yohannes, AM, Baldwin, RC, Connolly, MJ. Prevalence of sub-threshold depression in elderly patients with chronic obstructive pulmonary disease. Int J Geriatr Psychiatry. 2003;18:412–416.Google Scholar
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