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Cost-Utility Analysis of a Collaborative Care Intervention for Major Depressive Disorder in an Occupational Healthcare Setting

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Abstract

Purpose Major depression is associated with high levels of absence and reduced productivity. Therefore the costs to society are high. The aim of this study was to evaluate the cost-utility of collaborative care for major depressive disorder (MDD) compared to care as usual in an occupational healthcare setting. A societal perspective was taken. Methods In this randomised controlled trial, 126 sick-listed workers with MDD were included (65 collaborative care, 61 care as usual). Baseline measurements and follow up measures (3, 6, 9 and 12 months) were assessed by questionnaire. We applied the Trimbos/iMTA questionnaire for costs associated with psychiatric illness, the SF-HQL and the EQ-5D respectively measuring the health care utilization, production losses and general health related quality of life. Results The average annual healthcare costs in the collaborative care group were €3,874 (95 % CI €2,778–€5,718) compared to €4,583 (95 % CI €3,108–€6,794) in the care as usual group. The average quality of life years (QALY’s) gained were lower in the collaborative care group, 0.05 QALY. The majority of the ICERS (69 %) indicate that collaborative care is less costly but also less effective than care as usual. Including the productivity costs did not change this result. Conclusions The cost-utility analysis showed that collaborative care generated reduced costs and a reduction in effects compared to care as usual and was therefore not a cost-effective intervention.

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Acknowledgments

This study was part of the Depression Initiative, a national program aimed at supporting depression care in the Netherlands. This study was funded by the Foundation for Innovation of Health Insurers (‘InnovatiefondsZorgverzekeraars’) in the Netherlands.

Conflict of interest

JRA is shareholder of a VU University Medical Center spin-off company, Evalua Nederland B.V. (www.evalua.nl). WvM is director-shareholder of a VU University Medical Center spin-off company, Evalua Nederland B.V. (www.evalua.nl). ATFB received grants for research support from Eli Lilly, Astra Zeneca, Jansen, and Shire; and as a speaker from Eli Lilly and Lundbeck. The Trimbos-Institute received funding for the study from the Foundation for Innovation of Health Insurers (‘Innovatiefonds Zorgverzekeraars’), received an unrestricted Grant for Collaborative Care trials for anxiety (from the Netherlands organisation for health research and development, ‘ZonMw’), for return to work (from Achmea), and for depression and pain (from Eli Lilly). Trimbos-Institute also received payment for lectures on diabetes and depression from Eli Lilly. CMFC received royalties for books on psychiatry. The Erasmus University received an unrestricted Grant from the Trimbos-Institute for this study. The abovementioned competing interests are therefore indirect linked to research.

Ethical statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

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Authors and Affiliations

  1. Institute for Medical Technology Assessment, Institute of Health Policy and Management, Burgermeester Oudlaan 50, PO Box 1738, 3000 DR, Rotterdam, The Netherlands

    Maartje Goorden & Leona Hakkaart-van Roijen

  2. Netherlands Institute of Mental Health and Addiction (Trimbos Institute), PO Box 725, 3500 AS, Utrecht, The Netherlands

    Moniek C. Vlasveld & Christina M. van der Feltz-Cornelis

  3. Department of Public and Occupational Health, EMGO Institute for Health and Care Research (EMGO+), PO Box 7057, 1007 MB, Amsterdam, The Netherlands

    Moniek C. Vlasveld, Johannes R. Anema & Willem van Mechelen

  4. Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc, 1007 MB, Amsterdam, The Netherlands

    Johannes R. Anema & Willem van Mechelen

  5. GGZinGeest and Department of Psychiatry, EMGO Institute for Health and Care Research (EMGO+), PO Box 7057, 1007 MB, Amsterdam, The Netherlands

    Aartjan T. F. Beekman

  6. 365/ArboNed Occupational Health Services, 3524 SJ, Utrecht, The Netherlands

    Rob Hoedeman

  7. Department of Health Sciences, University Medical Center Groningen, University of Groningen, 9700 AD, Groningen, The Netherlands

    Rob Hoedeman

  8. Tranzo Department, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands

    Christina M. van der Feltz-Cornelis

  9. GGZ Breburg, Lage Witsiebaan 4, Tilburg, 5042 DA, The Netherlands

    Christina M. van der Feltz-Cornelis

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  1. Maartje Goorden
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Correspondence to Maartje Goorden.

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Goorden, M., Vlasveld, M.C., Anema, J.R. et al. Cost-Utility Analysis of a Collaborative Care Intervention for Major Depressive Disorder in an Occupational Healthcare Setting. J Occup Rehabil 24, 555–562 (2014). https://doi.org/10.1007/s10926-013-9483-4

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  • DOI: https://doi.org/10.1007/s10926-013-9483-4

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