Cost-effectiveness of a care manager collaborative care programme for patients with depression in primary care: economic evaluation of a pragmatic randomised controlled study

被引：16

作者：

Holst, Anna ^{[1
]}

Ginter, Annika ^{[2
]}

Bjorkelund, Cecilia ^{[1
]}

Hange, Dominique ^{[1
]}

Petersson, Eva-Lisa ^{[1
,3
]}

Svenningsson, Irene ^{[1
,3
]}

Westman, Jeanette ^{[4
]}

Andre, Malin ^{[5
]}

Wikberg, Carl ^{[1
]}

Wallin, Lars ^{[6
,7
]}

Moller, Christina ^{[8
]}

Svensson, Mikael ^{[2
]}

机构：

[1] Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Publ Hlth & Community Med Primary Hlth Care, Gothenburg, Sweden

[2] Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Publ Hlth & Community Med Hlth Metr, Gothenburg, Sweden

[3] Reg Vastra Gotaland, Narhalsan Res & Dev Primary Hlth Care, Gothenburg, Sweden

[4] Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med, Stockholm, Sweden

[5] Uppsala Univ, Dept Publ Hlth & Caring Sci Family Med & Prevent, Uppsala, Sweden

[6] Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Nursing, Stockholm, Sweden

[7] Univ Gothenburg, Sahlgrenska Acad, Dept Hlth & Care Sci, Gothenburg, Sweden

[8] Reg Vastra Gotaland, Narhalsan, Primary Hlth Care Head Off, Hisings Backa, Sweden

来源：

BMJ OPEN | 2018年 / 8卷 / 11期

关键词：

depression; primary care; care manager; collaborative care; health economic analysis; intervention; CLINICAL EFFECTIVENESS;

D O I：

10.1136/bmjopen-2018-024741

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objective To evaluate the cost-effectiveness of a care manager (CM) programme compared with care as usual (CAU) for treatment of depression at primary care centres (PCCs) from a healthcare as well as societal perspective. Design Cost-effectiveness analysis. Setting 23 PCCs in two Swedish regions. Participants Patients with depression (n=342). Main outcome measures A cost-effectiveness analysis was applied on a cluster randomised trial at PCC level where patients with depression had 3 months of contact with a CM (11 intervention PCCs, n=163) or CAU (12 control PCCs, n=179), with follow-up 3 and 6 months. Effectiveness measures were based on the number of depression-free days (DFDs) calculated from the Montgomery-angstrom sberg Depression Rating Scale-Self and quality-adjusted life years (QALYs). Results were expressed as the incremental cost-effectiveness ratio: Cost/QALY and Cost/DFD. Sampling uncertainty was assessed based on non-parametric bootstrapping. Results Health benefits were higher in intervention group compared with CAU group: QALYs (0.357 vs 0.333, p<0.001) and DFD reduction of depressive symptom score (79.43 vs 60.14, p<0.001). The mean costs per patient for the 6-month period were Euro368 (healthcare perspective) and Euro6217 (societal perspective) for the intervention patients and Euro246 (healthcare perspective) and Euro7371 (societal perspective) for the control patients (n.s.). The cost per QALY gained was Euro6773 (healthcare perspective) and from a societal perspective the CM programme was dominant. Discussion The CM programme was associated with a gain in QALYs as well as in DFD, while also being cost saving compared with CAU from a societal perspective. This result is of high relevance for decision-makers on a national level, but it must be observed that a CM programme for depression implies increased costs at the primary care level. Trial registration number NCT02378272; Results.

引用

页数：9

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