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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.

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Copyright

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

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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

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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)...
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