Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Home
  • Home
Article
  • Cited by 14

  • Access

Cost-effectiveness of depression case management in small practices

  • Jochen Gensichen (a1), Juliana J. Petersen (a2), Michael Von Korff (a3), Dirk Heider (a4), Steffen Baron (a2), Jochem König (a5), Antje Freytag (a6), Christian Krauth (a7), Ferdinand M. Gerlach (a2) and Hans-Helmut König (a8)...

Abstract

Background

Case management undertaken by healthcare assistants in small primary care practices is effective in improving depression symptoms and adherence in patients with major depression.

Aims

To evaluate the cost-effectiveness of depression case management by healthcare assistants in small primary care practices.

Method

Cost-effectiveness analysis on the basis of a pragmatic randomised controlled trial (2005-2008): practice-based healthcare assistants in 74 practices provided case management to 562 patients with major depression over 1 year. Our primary outcome was the incremental costeffectiveness ratio (ICER) calculated as the ratio of differences in mean costs and mean number of qualityadjusted life-years (QALYs). Our secondary outcome was the mean depression-free days (DFDs) between the intervention and control group at 24-month follow-up. The study was registered at the International Standard Randomised Controlled Trial Number Registry: ISRCTN66386086.

Results

Intervention v. control group: no significant difference in QALYs; significantly more DFDs (mean: 373 v. 311, P<0.01); no significant difference in mean direct healthcare costs (€4495 v. €3506, P = 0.16); considerably lower mean indirect costs (€5228 v. €7539, P = 0.06), resulting in lower total costs (€9723 v. €11 045, P = 0.41). The point estimate for the cost-utility ratio was €38 429 per QALY gained if only direct costs were considered, and ‘dominance’ of the intervention if total costs were considered. Yet, regardless of decision makers' willingness to pay per QALY, the probability of the intervention being cost-effective was never above 90%.

Conclusions

In small primary care practices, 1 year of case management did not increase the number of QALYs but it did increase the number of DFDs. The intervention was likely to be cost-effective.

  • 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. 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.

      Cost-effectiveness of depression case management in small practices
      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 <service> account. Find out more about sending content to Dropbox.

      Cost-effectiveness of depression case management in small practices
      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 <service> account. Find out more about sending content to Google Drive.

      Cost-effectiveness of depression case management in small practices
      Available formats
      ×

Copyright

COPYRIGHT: © Royal College of Psychiatrists, 2013 

Corresponding author

Jochen Gensichen, MD, MA, MPH, Institute of General Practice and FamilyMedicine, Friedrich-Schiller-University/Jena University Hospital, Bachstr. 18, D-07743 Jena, Germany. Email: jochen.gensichen@med.uni-jena.de

Footnotes

Hide All
∗

This paper was presented in an oral presentation at the 46th Congress of the German College of General Practitioners and Family Physicians in Salzburg, Austria, on 22-24 September 2011 and by poster at the European Conference on Health Economics (ECHE) in Zurich, Switzerland, on 18-21 July 2012.

∗∗

These authors contributed equally to the work.

Declaration of interest

None.

Footnotes

References

Hide All
1 Üstü, TB Ayuso-Mateos, JL Chatterji, S Mathers, C Murray, CJL Global burden of depressive disorders in the year 2000. Br J Psychiatry 2004; 184: 386–92.
2 Sobocki, P Jonsson, B Angst, J Rehnberg, C Cost of depression in Europe. J Ment Health Policy Econ 2006; 9: 87–98.
3 Thielke, S Vannoy, S Unutzer, J Integrating mental health and primary care. Prim Care 2007; 34: 571–92.
4 Gilbody, S Bower, P Fletcher, J Richards, D Sutton, AJ Collaborative care for depression: a cumulative meta-analysis and review of longer-term outcomes. Arch Intern Med 2006; 166: 2314–21.
5 van Steenbergen-Weijenburg, KM van der Feltz-Cornelis, CM Horn, EK van Marwijk, HW Beekman, AT Rutten, FF et al Cost-effectiveness of collaborative care for the treatment of major depressive disorder in primary care. A systematic review. BMC Health Serv Res 2010; 10: 19.
6 Kassenärztliche Bundesvereinigung (KBV). [National Association of Statutory Health Insurance Physicians]. Basic data 2010/2011 on SHI-authorised physician care in Germany [in German]. KBV, 2012 (http://www.kbv.de/publikationen/125.html).
7 Bodenheimer, T Laing, BY. The teamlet model of primary care. Ann Fam Med 2007; 5: 457–61.
8 Rost, K Nutting, P Smith, J Werner, J Duan, N Improving depression outcomes in community primary care practice: a randomized trial of the quEST intervention. Quality enhancement by strategic teaming. J Gen Intern Med 2001; 16: 143–9.
9 Hunkeler, EM Meresman, JF Hargreaves, WA Fireman, B Berman, WH Kirsch, AJ et al Efficacy of nurse telehealth care and peer support in augmenting treatment of depression in primary care. Arch Fam Med 2000; 9: 700–8.
10 Klinkman, MS Bauroth, S Fedewa, S Kerber, K Kuebler, J Adman, T et al Long-term clinical outcomes of care management for chronically depressed primary care patients: a report from the depression in primary care project. Ann Fam Med 2010; 8: 387–96.
11 Bosley, S Dale, J. Healthcare assistants in general practice: practical and conceptual issues of skill-mix change. Br J Gen Pract 2008; 58: 118–24.
12 German Medical Association. Collective Agreements, Collective Bargaining Agreement, Collective Bargaining for Occupational Retirement Provision and Fee Agreement for Health Care Assistants/Medical Assistents [in German]. German Medical Association, 2011 (http://www.bundesaerztekammer.de/page.asp?his = 1.99.3478. 3860.3869).
13 Gensichen, J von Korff, M Muth, C Peitz, V Beyer, M Guethlin, C et al Case management for depression by health care assistants in small primary care practices – a cluster randomized trial. Ann Intern Med 2009; 151: 369–80.
14 Wagner, EH Austin, BT Davis, C Hindmarsh, M Schaefer, J Bonomi, A Improving chronic illness care: translating evidence into action. Health Aff (Millwood) 2001; 20: 64–78.
15 The EuroQol Group. Euro-Qol – a new facility for the measurement of health-related quality of live. Health Policy 1990; 16: 199–208.
16 Dolan, P. Modeling valuations for EuroQol health states. Med Care 1997; 35: 1095–108.
17 Drummond, MF Sculpher, MJ Torrance, GW O'Brien, BJ Stoddart, GL Methods for the Economic Evaluation of Health Care Programmes. Oxford University Press, 2005.
18 Lave, JR Frank, RG Schulberg, HC Kamlet, MS Cost-effectiveness of treatments for major depression in primary care practice. Arch Gen Psychiatry 1998; 55: 645–51.
19 Krauth, C Hessel, F Hansmeier, T Wasem, J Seitz, R Schweikert, B Empirical standard costs for health economic evaluation in Germany – a proposal by the working group methods in health economic evaluation [in German]. Gesundheitsw 2005; 67: 736–46.
20 Wissenschaftliches Institut der AOK [AOK Research Institute]. ATC-classification with daily doses. Official version of the ATC-index with DDD information for Germany in the year 2006 [in German]. DIMDI, 2006 (http://www.wido.de/fileadmin/wido/downloads/pdf_arzneimittel/wido_arz_amtl_atc-index_0106.pdf).
21 Federal Statistical Office Germany. Structure of Earnings Survey 2006 – Earnings by Professions. Earnings and Labour Cost [in German]. Federal Statistical Office Germany, 2008.
22 Hoch, JS Rockx, MA Krahn, AD Using the net benefit regression framework to construct cost-effectiveness acceptability curves: an example using data from a trial of external loop recorders versus Holter monitoring for ambulatory monitoring of “community acquired” syncope. BMC Health Serv Res 2006; 6: 68.
23 Baron, S Heider, D Gensichen, J Petersen, JJ Gerlach, FM Krauth, C et al Cost structure of a telephone-based case management in primary care depression therapy [in German]. Psychiatr Prax 2011; 38: 342–4.
24 Williams, JW Jr Gerrity, M Holsinger, T Dobscha, S Gaynes, B Dietrich, A Systematic review of multifaceted interventions to improve depression care. Gen Hosp Psychiatry 2007; 29: 91–116.
25 Katon, WJ Schoenbaum, M Fan, MY Callahan, CM Williams, Jr J Hunkeler, E et al Cost-effectiveness of improving primary care treatment of late-life depression. Arch Gen Psychiatry 2005; 62: 1313–20.
26 Liu, CF Hedrick, SC Chaney, EF Heagerty, P Felker, B Hasenberg, N et al Cost-effectiveness of collaborative care for depression in a primary care veteran population. Psychiatr Serv 2003; 54: 698–704.
27 Rost, K Pyne, JM Dickinson, LM LoSasso, AT Cost-effectiveness of enhancing primary care depression management on an ongoing basis. Ann Fam Med 2005; 3: 7–14.
28 Simon, GE Von Korff, M Ludman, EJ Katon, WJ Rutter, C Unutzer, J et al Cost-effectiveness of a program to prevent depression relapse in primary care. Med Care 2002; 40: 941–50.
29 Simon, GE Katon, WJ VonKorff, M Unutzer, J Lin, EH Walker, EA et al Cost-effectiveness of a collaborative care program for primary care patients with persistent depression. Am J Psychiatry 2001; 158: 1638–44.
30 Simon, GE Manning, WG Katzelnick, DJ Pearson, SD Henk, HJ Helstad, CS Cost-effectiveness of systematic depression treatment for high utilizers of general medical care. Arch Gen Psychiatry 2001; 58: 181–7.
31 Schoenbaum, M Unutzer, J Sherbourne, C Duan, N Rubenstein, LV Miranda, J et al Cost-effectiveness of practice-initiated quality improvement for depression: results of a randomized controlled trial. JAMA 2001; 286: 1325–30.
32 Pyne, JM Rost, KM Zhang, M Williams, DK Smith, J Fortney, J Cost-effectiveness of a primary care depression intervention. J Gen Intern Med 2003; 18: 432–41.
33 Pyne, JM Fortney, JC Tripathi, SP Maciejewski, ML Edlund, MJ Williams, DK Cost-effectiveness analysis of a rural telemedicine collaborative care intervention for depression. Arch Gen Psychiatry 2010; 67: 812–21.
34 Heinrich, S Deister, A Birker, T Hierholzer, C Weigelt, I Zeichner, D et al Accuracy of self-reports of mental health care utilization and calculated costs compared to hospital records. Psychiatry Res 2011; 185: 261–8.
35 Simon, GE Katon, WJ Lin, EH Rutter, C Manning, WG Von Korff, M et al Cost-effectiveness of systematic depression treatment among people with diabetes mellitus. Arch Gen Psychiatry 2007; 64: 65–72.
36 Ludman, E Katon, W Bush, T Rutter, C Lin, E Simon, G et al Behavioural factors associated with symptom outcomes in a primary care-based depression prevention intervention trial. Psychol Med 2003; 33: 1061–70.
37 Pyne, JM Tripathi, S Williams, DK Fortney, J. Depression-free day to utility-weighted score: is it valid? Med Care 2007; 45: 357–62.

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

  • Cited by 14

  • Access

Cost-effectiveness of depression case management in small practices

  • Jochen Gensichen (a1), Juliana J. Petersen (a2), Michael Von Korff (a3), Dirk Heider (a4), Steffen Baron (a2), Jochem König (a5), Antje Freytag (a6), Christian Krauth (a7), Ferdinand M. Gerlach (a2) and Hans-Helmut König (a8)...
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *