Collaborative care for depression in patients with comorbid diabetes or CHD yielded a net QALY gain of 0.04 at an incremental cost of £16,123 per QALY gained over 24 months.
RCT (n=387)
Yes
Is collaborative care cost-effective compared to usual care for treating depression in patients with comorbid diabetes or coronary heart disease?
Collaborative care for depression in patients with comorbid diabetes or CHD is potentially cost-effective over the long term, with an estimated cost per QALY gained below the £20,000 threshold.
Effect estimate: Cost per QALY gained £16 123
OBJECTIVES: To evaluate the long-term cost-effectiveness of collaborative care (vs usual care) for treating depression in patients with diabetes and/or coronary heart disease (CHD). SETTING: 36 primary care general practices in North West England. PARTICIPANTS: 387 participants completed baseline assessment (collaborative care: 191; usual care: 196) and full or partial 4-month follow-up data were captured for 350 (collaborative care: 170; usual care: 180). 62% of participants were male, 14% were non-white. Participants were aged ≥18 years, listed on a Quality and Outcomes Framework register for CHD and/or type 1 or 2 diabetes mellitus, with persistent depressive symptoms. Patients with psychosis or type I/II bipolar disorder, actively suicidal, in receipt of services for substance misuse, or already in receipt of psychological therapy for depression were excluded. INTERVENTION: Collaborative care consisted of evidence-based low-intensity psychological treatments, delivered over 3 months and case management by a practice nurse and a Psychological Well Being Practitioner. OUTCOME MEASURES: As planned, the primary measure of cost-effectiveness was the incremental cost-effectiveness ratio (cost per quality-adjusted life year (QALY)). A Markov model was constructed to extrapolate the trial results from short-term to long-term (24 months). RESULTS: The mean cost per participant of collaborative care was £317 (95% CI 284 to 350). Over 24 months, it was estimated that collaborative care was associated with greater healthcare usage costs (net cost £674 (95% CI -30 953 to 38 853)) and QALYs (net QALY gain 0.04 (95% CI -0.46 to 0.54)) than usual care, resulting in a cost per QALY gained of £16 123, and a likelihood of being cost-effective of 0.54 (willingness to pay threshold of £20 000). CONCLUSIONS: Collaborative care is a potentially cost-effective long-term treatment for depression in patients with comorbid physical and mental illness. The estimated cost per QALY gained was below the threshold recommended by English decision-makers. Further, long-term primary research is needed to address uncertainty associated with estimates of cost-effectiveness. TRIAL REGISTRATION NUMBER: ISRCTN80309252; Post-results.
Camacho et al. (Sat,) conducted a rct in Depression with comorbid diabetes or coronary heart disease (n=387). Collaborative care vs. Usual care was evaluated on Incremental cost-effectiveness ratio (cost per quality-adjusted life year (QALY)) (Cost per QALY gained £16 123). Collaborative care for depression in patients with comorbid diabetes or CHD yielded a net QALY gain of 0.04 at an incremental cost of £16,123 per QALY gained over 24 months.