Skip to main content
×
Home
    • Aa
    • Aa

Modelling the cost-effectiveness of preventing major depression in general practice patients

  • R. M. Hunter (a1), I. Nazareth (a1), S. Morris (a2) and M. King (a3)
Abstract
Background

The prevention of depression is a key public health policy priority. PredictD is the first risk algorithm for the prediction of the onset of major depression. Our aim in this study was to model the cost-effectiveness of PredictD in depression prevention in general practice (GP).

Method

A decision analytical model was developed to determine the cost-effectiveness of two approaches, each of which was compared to treatment as usual (TAU) over 12 months: (1) the PredictD risk algorithm plus a low-intensity depression prevention programme; and (2) a universal prevention programme in which there was no initial identification of those at risk. The model simulates the incidence of depression and disease progression over 12 months and calculates the net monetary benefit (NMB) from the National Health Service (NHS) perspective.

Results

Providing patients with PredictD and a depression prevention programme prevented 15 (17%) cases of depression in a cohort of 1000 patients over 12 months and had the highest probability of being the optimal choice at a willingness to pay (WTP) of £20 000 for a quality-adjusted life year (QALY). Universal prevention was strongly dominated by PredictD plus a depression prevention programme in that universal prevention resulted in less QALYs than PredictD plus prevention for a greater cost.

Conclusions

Using PredictD to identify primary-care patients at high risk of depression and providing them with a low-intensity prevention programme is potentially cost-effective at a WTP of £20 000 per QALY.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Modelling the cost-effectiveness of preventing major depression in general practice patients
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      Modelling the cost-effectiveness of preventing major depression in general practice patients
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      Modelling the cost-effectiveness of preventing major depression in general practice patients
      Available formats
      ×
Copyright
The online version of this article is published within an Open Access environment subject to the conditions of the Creative Commons Attribution-NonCommercial-ShareAlike licence . The written permission of Cambridge University Press must be obtained for commercial re-use.
Corresponding author
* Address for correspondence: R. M. Hunter, M.Sc., Department of Primary Care and Population Sciences, University College London Medical School, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK. (Email: r.hunter@ucl.ac.uk)
References
Hide All
AkehurstR, AndersonP, BrazierJ, BrennanA, BriggsA, BuxtonM, CairnsJ, CalvertN, ClaxtonK, DixonS, FrybackD, GallivanS, GreenC, LloydA, McCabeC, MitchellA, NichollJ, O'BrienB, RobertsJ, SculpherM, SeverensH, SullivanS, VeenstraD; Signatories to the Consensus Statement (2000). Decision Analytic Modelling in the Economic Evaluation of Health Technologies: A Consensus Statement. Consensus Conference on Guidelines on Economic Modelling in Health Technology Assessment. PharmacoEconomics 17, 443444.
BottomleyC, NazarethI, Torres-GonzalezF, SvabI, MaaroosHI, GeerlingsMI, XavierM, SaldiviaS, KingM (2010). Comparison of risk factors for the onset and maintenance of depression. Bristish Journal of Psychiatry 196, 1317.
BriggsA, ClaxtonK, SchulperM (2006). Decision Modelling for Health Economic Evaluation. Oxford University Press: Oxford.
CassanoP, FavaM (2002). Depression and public health: an overview. Journal of Psychosomatic Research 53, 849857.
CRD (2012). Centre for Reviews and Dissemination (www.crd.york.ac.uk/crdweb/). Accessed 28 March 2012.
CuijpersP, van StratenA, SmitF, MihalopoulosC, BeekmanA (2008). Preventing the onset of depressive disorders: a meta-analytic review of psychological interventions. American Journal of Psychiatry 165, 12721280.
CurtisL (2012). Unit Costs of Health and Social Care 2011. Personal Social Services Research Unit (PSSRU), University of Kent: Canterbury.
DH PbR team (2011). National Schedule of Reference Costs 2010–11. Department of Health Payment by Results team, Department of Health (https://www.gov.uk/government/publications/2010-11-reference-costs-publication). Accessed 10 May 2012.
DunnRL, DonoghueJM, OzminkowskiRJ, StephensonD, HylanTR (1999). Longitudinal patterns of antidepressant prescribing in primary care in the UK: comparison with treatment guidelines. Journal of Psychopharmacology 13, 136143.
EMCDDA (2012). Universal Prevention. European Monitoring Centre for Drugs and Drug Addiction (www.emcdda.europa.eu/html.cfm/index1578EN.html). Accessed 1 August 2012.
FeenstraTL, van BaalPM, Jacobs-van der BruggenMO, HoogenveenRT, KommerGJ, BaanCA (2011). Targeted versus universal prevention. a resource allocation model to prioritize cardiovascular prevention. Cost Effectiveness and Resource Allocation 9, 14.
GoldbergDP, HuxleyP (1992). Common Mental Disorders: A Biosocial Model. Routledge: London.
HM Government (2010). Healthy Lives, Healthy People: Our Strategy for Public Health in England. The Stationery Office: Norwich.
HollinghurstS, PetersTJ, KaurS, WilesN, LewisG, KesslerD (2010). Cost-effectiveness of therapist-delivered online cognitive-behavioural therapy for depression: randomised controlled trial. British Journal of Psychiatry 197, 297304.
HSCIC (2011). Hospital Episode Statistics, Admitted Patient Care - England, 2010–11: Primary Diagnosis. Health and Social Care Information Centre (www.hscic.gov.uk/pubs/hesadmitted1011). Accessed 10 May 2012.
HSCIC (2012). Prescription Cost Analysis: England 2011. Health and Social Care Information Centre (www.hscic.gov.uk/pubs/prescostanalysis2011). Accessed 10 May 2012.
JenkinsonC, LayteR, JenkinsonD, LawrenceK, PetersenS, PaiceC, StradlingJ (1997). A shorter form health survey: can the SF-12 replicate results from the SF-36 in longitudinal studies? Journal of Public Health Medicine 19, 179186.
KaltenthalerE, ShackleyP, StevensK, BeverleyC, ParryG, ChilcottJ (2002). A systematic review and economic evaluation of computerised cognitive behaviour therapy for depression and anxiety. Health Technology Assessment 6, 189.
KendrickT, PevelerR, LongworthL, BaldwinD, MooreM, ChatwinJ, ThornettA, GoddardJ, CampbellM, SmithH, BuxtonM, ThompsonC (2006). Cost-effectiveness and cost-utility of tricyclic antidepressants, selective serotonin reuptake inhibitors and lofepramine: randomised controlled trial. British Journal of Psychiatry 188, 337345.
KindP, HardmanG, MacranS (1999). UK Population Norms For EQ-5D. Centre for Health Economics Discussion Paper. University of York: York, UK.
KingM, WalkerC, LevyG, BottomleyC, RoystonP, WeichS, Bellon-SaamenoJA, MorenoB, SvabI, RotarD, RifelJ, MaaroosHI, AluojaA, KaldaR, NeelemanJ, GeerlingsMI, XavierM, CarracaI, Goncalves-PereiraM, VicenteB, SaldiviaS, MelipillanR, Torres-GonzalezF, NazarethI (2008). Development and validation of an international risk prediction algorithm for episodes of major depression in general practice attendees: the PredictD study. Archives of General Psychiatry 65, 13681376.
MannR, GilbodyS, RichardsD (2009). Putting the ‘Q’ in depression QALYs: a comparison of utility using EQ-5D and SF-6D health related quality of life measures. Social Psychiatry and Psychiatric Epidemiology 44, 134136.
MihalopoulosC, VosT, PirkisJ, SmitF, CarterR (2011). Do indicated preventive interventions for depression represent good value for money? Australian and New Zealand Journal of Psychiatry 45, 3644.
MoodGYM (2010). The MoodGYM training programme: Mark III. Australian National University (www.moodgym.anu.edu.au/welcome). Accessed 12 November 2010.
NICE (2008). Guide to the Methods of Technology Appraisal (reference N0515) . National Institute for Health and Care Excellence: London, UK.
PeasgoodT, BrazierJ, PapaioannouD (2012). A Systematic Review of the Validity and Responsiveness of EQ-5D and SF-6D for Depression and Anxiety. Health Economics and Decision Science (HEDS) Discussion Paper, University of Sheffield.
PevelerR, KendrickT, BuxtonM, LongworthL, BaldwinD, MooreM, ChatwinJ, GoddardJ, ThornettA, SmithH, CampbellM, ThompsonC (2005). A randomised controlled trial to compare the cost-effectiveness of tricyclic antidepressants, selective serotonin reuptake inhibitors and lofepramine. Health Technology Assessment 9, 1134, iii.
SmitF, WillemseG, KoopmanschapM, OnrustS, CuijpersP, BeekmanA (2006). Cost-effectiveness of preventing depression in primary care patients: randomised trial. British Journal of Psychiatry 188, 330336.
SpekV, CuijpersP, NyklicekI, SmitsN, RiperH, KeyzerJ, PopV (2008). One-year follow-up results of a randomized controlled clinical trial on internet-based cognitive behavioural therapy for subthreshold depression in people over 50 years. Psychological Medicine 38, 635639.
ThomasCM, MorrisS (2003). Cost of depression among adults in England in 2000. British Journal of Psychiatry 183, 514519.
ValensteinM, VijanS, ZeberJE, BoehmK, ButtarA (2001). The cost-utility of screening for depression in primary care. Annals of Internal Medicine 134, 345360.
van den BergM, SmitF, VosT, van BaalPH (2011). Cost-effectiveness of opportunistic screening and minimal contact psychotherapy to prevent depression in primary care patients. PLoS One 6, e22884.
WeichS, NazarethI, MorganL, KingM (2007). Treatment of depression in primary care. Socio-economic status, clinical need and receipt of treatment. British Journal of Psychiatry 191, 164169.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 4
Total number of PDF views: 102 *
Loading metrics...

Abstract views

Total abstract views: 275 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 21st October 2017. This data will be updated every 24 hours.