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Long-term clinical and cost-effectiveness of collaborative care (versus usual care) for people with mental–physical multimorbidity: cluster-randomised trial

  • Elizabeth M. Camacho (a1), Linda M. Davies (a1), Mark Hann (a1), Nicola Small (a1), Peter Bower (a2), Carolyn Chew-Graham (a3), Clare Baguely (a4), Linda Gask (a5), Chris M. Dickens (a6), Karina Lovell (a7), Waquas Waheed (a1), Chris J. Gibbons (a8) and Peter Coventry (a9)...
Abstract
Background

Collaborative care can support the treatment of depression in people with long-term conditions, but long-term benefits and costs are unknown.

Aims

To explore the long-term (24-month) effectiveness and cost-effectiveness of collaborative care in people with mental-physical multimorbidity.

Method

A cluster randomised trial compared collaborative care (integrated physical and mental healthcare) with usual care for depression alongside diabetes and/or coronary heart disease. Depression symptoms were measured by the symptom checklist-depression scale (SCL-D13). The economic evaluation was from the perspective of the English National Health Service.

Results

191 participants were allocated to collaborative care and 196 to usual care. At 24 months, the mean SCL-D13 score was 0.27 (95% CI, −0.48 to −0.06) lower in the collaborative care group alongside a gain of 0.14 (95% CI, 0.06-0.21) quality-adjusted life-years (QALYs). The cost per QALY gained was £13 069.

Conclusions

In the long term, collaborative care reduces depression and is potentially cost-effective at internationally accepted willingness-to-pay thresholds.

Declaration of interest

None.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Correspondence: Elizabeth M. Camacho, PhD, Centre for Health Economics, Division of Population Health, Health Services Research, and Primary Care, School of Health Sciences, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK. Email: elizabeth.camacho@manchester.ac.uk
References
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1.Dickens, C, Katon, W, Blakemore, A, et al. Does depression predict the use of urgent and unscheduled care by people with long term conditions? A systematic review with meta-analysis. J Psychosom Res 2012; 73: 334–42.
2.Nunes, BP, Flores, TR, Mielke, GI, Thumé, E, Facchini, LA. Multimorbidity and mortality in older adults: a systematic review and meta-analysis. Arch Gerontol Geriatr 2016; 67: 130–8.
3.Mujica-Mota, RE, Roberts, M, Abel, G, et al. Common patterns of morbidity and multi-morbidity and their impact on health-related quality of life: evidence from a national survey. Qual Life Res 2015; 24: 909–18.
4.Thorpe, KE, Ogden, LL, Galactionova, K. Chronic conditions account for rise in Medicare spending from 1987 to 2006. Health Aff (Millwood) 2010; 29: 718–24.
5.Archer, J, Bower, P, Gilbody, S, et al. Collaborative care for depression and anxiety problems. Cochrane Database Syst Rev 2012; 10: CD006525.
6.Coventry, PA, Lovell, K, Dickens, C, et al. Collaborative Interventions for Circulation and Depression (COINCIDE): study protocol for a cluster randomized controlled trial of collaborative care for depression in people with diabetes and/or coronary heart disease. Trials 2012; 13: 139.
7.Panagioti, M, Bower, P, Kontopantelis, E, et al. Association between chronic physical conditions and the effectiveness of collaborative care for depression. JAMA Psychiatry 2016; 73: 978.
8.National Institute of Health and Care Excellence (NICE). Multimorbidity: Clinical Assessment and Management [NG56]. NICE, 2016 (https://www.nice.org.uk/guidance/ng56).
9.Coventry, P, Lovell, K, Dickens, C, et al. Integrated primary care for patients with mental and physical multimorbidity: cluster randomised controlled trial of collaborative care for patients with depression comorbid with diabetes or cardiovascular disease. BMJ 2015; 350: h638.
10.Coventry, PA, Lovell, K, Dickens, C, et al. Update on the collaborative interventions for circulation and depression (COINCIDE) trial: changes to planned methodology of a cluster randomized controlled trial of collaborative care for depression in people with diabetes and/or coronary heart disease. Trials 2013; 14: 136.
11.Brown, S, Thorpe, H, Hawkins, K, Brown, J. Minimization – reducing predictability for multi-centre trials whilst retaining balance within centre. Stat Med 2005; 24: 3715–27.
12.Kroenke, K, Spitzer, RL, Williams, JBW. The PHQ-9. J Gen Intern Med 2001; 16: 606–13.
13.National Institute of Health and Care Excellence (NICE). Depression in Adults With a Chronic Physical Health Problem: Recognition and Management [CG91]. NICE, 2009 (https://www.nice.org.uk/guidance/CG91).
14.Derogatis, LR, Cleary, PA. Confirmation of the dimensional structure of the SCL-90: a study in construct validation. J Clin Psychol 1977; 33: 981–9.
15Herdman, M, Gudex, C, Lloyd, A, Janssen, MF, Kind, P, Parkin, D, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Quality of life research 2011; 20(10): 1727–36.
16.National Institute of Health and Care Excellence (NICE). Guide to the Methods of Technology Appraisal. NICE, 2013 (https://www.nice.org.uk/process/pmg9/chapter/foreword).
17.Personal and Social Services Research Unit. Unit Costs of Health and Social Care. Personal and Social Services Research Unit, 2015 (https://www.pssru.ac.uk/project-pages/unit-costs/).
18.Department of Health. National Schedule of Reference Costs. Department of Health, 2015 (https://www.gov.uk/government/collections/nhs-reference-costs).
19.Devlin, N, Shah, K, Feng, Y, Mulhern, B, Van Hout, B. Valuing Health-Related Quality of Life: An EQ-5D-5L Value Set for England. Office of Health Economics, 2016 (https://www.ohe.org/publications/valuing-health-related-quality-life-eq-5d-5l-value-set-england).
20.van Hout, B, Janssen, MF, Feng, Y-S, et al. Interim scoring for the EQ-5D-5L: mapping the EQ-5D-5L to EQ-5D-3L value sets. Value Heal 2012; 15: 708–15.
21Skevington, SM, Lotfy, M, O'Connell, KA. The World Health Organization's WHOQOLBREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group. Qual Life Res 2004; 13: 299310.
22Spitzer, RL, Kroenke, K, Williams, JW, Löwe, B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006; 166: 1092–97.
23Lorig, K, Stewart, A, Ritter, P, Gonzalez, V, Laurent, D, Lynch, J. Outcome measures for health education and other health care interventions. Sage, 1996.
24Osborne, RH, Elsworth, GR, Whitfeld, K. The health education impact questionnaire (heiQ): an outcomes and evaluation measure for patient education and self-management interventions for people with chronic conditions. Patient Educ Couns 2007; 66: 192201.
25Sheehan, DV, Harnett-Sheehan, K, Raj, BA. The measurement of disability. Int Clin Psychopharmacol 1996; 11(suppl 3): 8995.
26.Gwirtsman, H, Blehar, M, McCullough, J, Kocsis, J, Prien, R. Standardized assessment of dysthymia. Psychopharmacol Bull 1997; 33: 15.
27.Green, C, Richards, DA, Hill, JJ, et al. Cost-effectiveness of collaborative care for depression in UK primary care: economic evaluation of a randomised controlled trial (CADET). PLoS One 2014; 9: e104225.
28.Camacho, EM, Ntais, D, Coventry, P, et al. Long-term cost-effectiveness of collaborative care (v. usual care) for people with depression and comorbid diabetes or cardiovascular disease: a Markov model informed by the COINCIDE randomised controlled trial. BMJ Open 2016; 6: e012514.
29.Barnett, K, Mercer, SW, Norbury, M, Watt, G, Wyke, S, Guthrie, B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 2012; 380: 3743.
30.Petrou, S, Murray, L, Cooper, P, Davidson, LL. The accuracy of self-reported healthcare resource utilization in health economic studies. Int J Technol Assess Health Care 2002; 18: 705–10.
31.Bhandari, A, Wagner, T. Self-reported utilization of health care services: improving measurement and accuracy. Med Care Res Rev 2006; 63: 217–35.
32.Richards, DA, Hill, JJ, Gask, L, et al. Clinical effectiveness of collaborative care for depression in UK primary care (CADET): cluster randomised controlled trial. BMJ 2013; 347: f4913.
33.The King's Fund. Long-Term Conditions and Multi-Morbidity. The King's Fund, 2015 (https://www.kingsfund.org.uk/time-to-think-differently/trends/disease-and-disability/long-term-conditions-multi-morbidity).
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
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Long-term clinical and cost-effectiveness of collaborative care (versus usual care) for people with mental–physical multimorbidity: cluster-randomised trial

  • Elizabeth M. Camacho (a1), Linda M. Davies (a1), Mark Hann (a1), Nicola Small (a1), Peter Bower (a2), Carolyn Chew-Graham (a3), Clare Baguely (a4), Linda Gask (a5), Chris M. Dickens (a6), Karina Lovell (a7), Waquas Waheed (a1), Chris J. Gibbons (a8) and Peter Coventry (a9)...
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