Cost-Utility Analysis of a Collaborative Care Intervention for Major Depressive Disorder in an Occupational Healthcare Setting
- 646 Downloads
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.
KeywordsCosts and cost analysis Occupational health Depressive disorder Mental health services Randomized controlled trial
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.
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.
- 1.De Graaf R, Tuithof M, Van Dorsselaer S, Ten Have M. Verzuim door psychische en somatische aandoeningen bij werkenden: Resultaten van de ‘Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2). Utrecht: Trimbos Instituut; 2011.Google Scholar
- 2.van ‘t Land H, Schoemaker C. Trimbos zakboek psychische stoornissen. Utrecht: Uitgeverij de Tijdstroom; 2008.Google Scholar
- 3.Krol M, Papenburg J, Koopmanschap M, Brouwer W. Do productivity costs matter?: the impact of including productivity costs on the incremental costs of interventions targeted at depressive disorders. Pharmecon. 2011;29(7):601–19.Google Scholar
- 5.Anema JR, Jettinghoff K, Houtman I, Schoemaker CG, Buijs PC, van den Berg R. Medical care of employees long-term sick listed due to mental health problems: a cohort study to describe and compare the care of the occupational physician and the general practitioner. J Occup Rehabil. 2006;16(1):41–52.PubMedCrossRefGoogle Scholar
- 8.van Steenbergen-Weijenburg KM, van der Feltz-Cornelis CM, Horn EK, van Marwijk HW, Beekman AT, Rutten FF, Hakkaart-van Roijen L. Cost-effectiveness of collaborative care for the treatment of major depressive disorder in primary care. A systematic review. BMC Health Serv Res. 2010;10:19.PubMedCentralPubMedCrossRefGoogle Scholar
- 9.van der Feltz-Cornelis CM, Hoedeman R, de Jong FJ, Meeuwissen JA, Drewes HW, van der Laan NC, Adèr HJ. Faster return to work after psychiatric consultation for sicklisted employees with common mental disorders compared to care as usual. A randomized clinical trial. Neuropsychiatr Dis Treat. 2010;6:375–85.PubMedCentralPubMedCrossRefGoogle Scholar
- 10.Vlasveld MC, van der Feltz-Cornelis CM, Adèr HJ, Anema JR, Hoedeman R, van Mechelen W, et al. Collaborative care for sick-listed workers with major depressive disorder: a randomised controlled trial from the Netherlands Depression Initiative aimed at return to work and depressive symptoms. Occup Evniron Med. 2013;70(4):223–30.CrossRefGoogle Scholar
- 14.van Vliet IM, Leroy H, van Megen HJM. De MINI-Internationaal neuropsychiatrisch interview: een kort gestructureerd diagnostisch interview voor DSM-IV en ICD-10 psychiatrische stoornissen. Tijdschrift voor psychiatrie 2007;49.Google Scholar
- 15.Vlasveld MC, Anema JR, Beekman AT, van Mechelen W, Hoedeman R, van Marwijk HW, et al. Multidisciplinary collaborative care for depressive disorder in the occupational health setting: design of a randomised controlled trial and cost-effectiveness study. BMC Health Serv Res. 2008;8:99.PubMedCentralPubMedCrossRefGoogle Scholar
- 17.Van der Feltz-Cornelis CM. The Depression Initiative. Description of a collaborative care model for depression in the primary care setting in the Netherlands. Clinical Neuropsychiatry. 2011;8:260–7.Google Scholar
- 18.Mynors-Wallis L. Problem-solving treatment for anxiety and depression. A practicalguide. Oxford: Oxford University Press; 2005.Google Scholar
- 19.Doppegieter RMS, Willems JHBM. Code gegevensverkeer en samenwerking bij arbeidsverzuim en reïntegratie. Utrecht: KNMG; 2006.Google Scholar
- 20.van de Klink JJL, Ausems CMM, Beijderwellen BD, Blonk R, Bruinvels DJ, Dogger J, et al. NVAB. Handelen van de bedrijfsarts bij werkenden met psychische problemen. Utrecht: NVAB; 2007.Google Scholar
- 21.Hakkaart-van Roijen L. Manual Trimbos/iMTA questionnaire for costs associated with psychiatric illness (in Dutch). Rotterdam: Institute for Medical Technology Assessment; 2002.Google Scholar
- 22.Cheung K, Oemar M, Oppe M, Rabin R. Eq-5D user guide. basic information on how to use EQ-5D. Rotterdam: EuroQol Group; 2009.Google Scholar
- 24.Hakkaart-van Roijen L, Tan SS, Bouwmans CAM. Handleiding voor kostenonderzoek : Methoden en standaard kostprijzen voor economische evaluaties in de gezondheidszorg. Rotterdam: Erasmus university; 2010.Google Scholar
- 27.IBM Corp. Released 2010. IBM SPSS Statistics for Windows, Version 19.0. Armonk, NY: IBM Corp.Microsoft. Microsoft Excel. Redmond, Washington: Microsoft, 2003. Computer Software.Google Scholar
- 28.Box GEP, Cox DR. An analysis of transformations. J R Stat Soc. 1964;26:211–34.Google Scholar
- 33.World Health Organization. Towards a common language for functioning, disability and health:ICF. Geneva: WHO; 2002.Google Scholar
- 37.Organisation for Economic Cooperation and Development (OECD). Sick on the Job? Myths and Realities about Mental Health and Work. Paris: OECD publishing; 2012.Google Scholar