Cost-effectiveness of a stepped care programme to prevent depression and anxiety in residents in homes for the older people: a randomised controlled trial

被引:23
作者
Bosmans, J. E. [1 ,2 ]
Dozeman, E. [3 ,4 ,5 ]
van Marwijk, Harm W. J. [3 ,4 ]
van Schaik, Digna J. F. [3 ,4 ,5 ]
Stek, Max L. [5 ]
Beekman, Aartjan T. F. [3 ,4 ,5 ]
van der Horst, Henriette E. [3 ,4 ]
机构
[1] Vrije Univ Amsterdam, Dept Hlth Sci, Fac Earth & Life Sci, Amsterdam, Netherlands
[2] Vrije Univ Amsterdam, EMGO Inst Hlth & Care Res, Fac Earth & Life Sci, Amsterdam, Netherlands
[3] Vrije Univ Amsterdam Med Ctr, Dept Gen Practice, Amsterdam, Netherlands
[4] Vrije Univ Amsterdam Med Ctr, EMGO Inst Hlth & Care Res, Amsterdam, Netherlands
[5] Vrije Univ Amsterdam Med Ctr, Dept Psychiat, Amsterdam, Netherlands
关键词
depression; anxiety; stepped-care; cost-effectiveness; older people; LATE-LIFE DEPRESSION; MULTIPLE IMPUTATION; ADULTS; CONSEQUENCES; DISABILITY; DISORDERS; COMMUNITY; MINI;
D O I
10.1002/gps.3987
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
BackgroundDepression and anxiety are common in residents of elderly homes. Both disorders have negative effects on functioning, well-being and health-care utilisation. Besides treatment, prevention can be an option to reduce the burden of mental disorders. The objective of this study was to evaluate the cost-effectiveness of a stepped care programme to prevent the onset of depression and anxiety disorders in residents of elderly homes compared with usual care from a societal perspective. MethodsOutcomes were incidence of depression and/or anxiety, severity of depressive and anxiety symptoms and quality-adjusted life years. Health-care utilisation was measured during interviews. Multiple imputation was used to impute missing cost and effect data. Uncertainty around cost differences and incremental cost-effectiveness ratios was estimated using bootstrapping. Cost-effectiveness planes and acceptability curves were created. ResultsThe incidence of depression and anxiety combined in the intervention group was not reduced in comparison with the usual care group. There was also no effect on the other outcomes. Mean total costs in the intervention group were Euro838 higher than in the usual care group, but this difference was not statistically significant (95% confidence interval, -593 to 2420). Cost-effectiveness planes showed that there was considerable uncertainty. Cost-effectiveness acceptability curves showed that the maximum probability of the intervention being cost-effective in comparison with usual care was 0.46 for reducing the incidence of depression and anxiety combined. ConclusionA stepped care programme to prevent depression and anxiety in older people living in elderly homes was not considered cost-effective in comparison with usual care. Copyright (c) 2013 John Wiley & Sons, Ltd.
引用
收藏
页码:182 / 190
页数:9
相关论文
共 40 条
[1]   Depression in the elderly [J].
Alexapoulos, GS .
LANCET, 2005, 365 (9475) :1961-1970
[2]   Utilising survey data to inform public policy: Comparison of the cost-effectiveness of treatment of ten mental disorders [J].
Andrews, G ;
Issakidis, C ;
Sanderson, K ;
Corry, J ;
Lapsley, H .
BRITISH JOURNAL OF PSYCHIATRY, 2004, 184 :526-533
[3]  
[Anonymous], 2011, HANDLEIDING KOSTENON
[4]   Preventing late-life depression: a clinical update [J].
Baldwin, Robert C. .
INTERNATIONAL PSYCHOGERIATRICS, 2010, 22 (08) :1216-1224
[5]   The natural history of late-life depression - A 6-year prospective study in the community [J].
Beekman, ATF ;
Geerlings, SW ;
Deeg, DJH ;
Smit, JH ;
Schoevers, RS ;
de Beurs, E ;
Braam, AW ;
Penninx, BWJH ;
van Tilburg, W .
ARCHIVES OF GENERAL PSYCHIATRY, 2002, 59 (07) :605-611
[6]   Consequences of major and minor depression in later life: a study of disability, well-being and service utilization [J].
Beekman, ATF ;
Deeg, DJH ;
Braam, AW ;
Smit, JH ;
VanTilburg, W .
PSYCHOLOGICAL MEDICINE, 1997, 27 (06) :1397-1409
[7]   The longitudinal relation between chronic diseases and depression in older persons in the community: the Longitudinal Aging Study Amsterdam [J].
Bisschop, MI ;
Kriegsman, DMW ;
Deeg, DJH ;
Beekman, ATF ;
van Tilburg, W .
JOURNAL OF CLINICAL EPIDEMIOLOGY, 2004, 57 (02) :187-194
[8]  
Blazer DG, 2003, J GERONTOL A-BIOL, V58, P249
[9]   Effects of reminiscence and life review on late-life depression: a meta-analysis [J].
Bohlmeijer, E ;
Smit, F ;
Cuijpers, P .
INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, 2003, 18 (12) :1088-1094
[10]   Effects of multidisciplinary integrated care on quality of care in residential care facilities for elderly people: a cluster randomized trial [J].
Boorsma, Marijke ;
Frijters, Dinnus H. M. ;
Knol, Dirk L. ;
Ribbe, Miel E. ;
Nijpels, Giel ;
van Hout, Hein P. J. .
CANADIAN MEDICAL ASSOCIATION JOURNAL, 2011, 183 (11) :E724-E732