Journal of Occupational Rehabilitation

, Volume 24, Issue 3, pp 555–562 | Cite as

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

  • Maartje Goorden
  • Moniek C. Vlasveld
  • Johannes R. Anema
  • Willem van Mechelen
  • Aartjan T. F. Beekman
  • Rob Hoedeman
  • Christina M. van der Feltz-Cornelis
  • Leona Hakkaart-van Roijen


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.


Costs 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. ( WvM is director-shareholder of a VU University Medical Center spin-off company, Evalua Nederland B.V. ( 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.


  1. 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. 2.
    van ‘t Land H, Schoemaker C. Trimbos zakboek psychische stoornissen. Utrecht: Uitgeverij de Tijdstroom; 2008.Google Scholar
  3. 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
  4. 4.
    Smit F, Cuijpers P, Oostenbrink J, Batelaan N, de Graaf R, Beekman A. Costs of nine common mental disorders: implications for curative and preventive psychiatry. J Ment Health Policy Econ. 2006;9(4):193–200.PubMedGoogle Scholar
  5. 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
  6. 6.
    Bodenheimer T. Helping patients improve their health-related behaviors: what system changes do we need? Dis Manag. 2005;8(5):319–30.PubMedCrossRefGoogle Scholar
  7. 7.
    Gilbody S, Bower P, Torgerson D, Richards D. Cluster randomized trials produced similar results to individually randomized trials in a meta-analysis of enhanced care for depression. J Clin Epidemiol. 2008;61(2):160–8.PubMedCrossRefGoogle Scholar
  8. 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. 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. 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
  11. 11.
    Bower P, Gilbody S. Stepped care in psychological therapies: access, effectiveness and efficiency. Narrative literature review. Br J Psychiatry. 2005;186:11–7.CrossRefGoogle Scholar
  12. 12.
    Vlasveld MC, van der Feltz-Cornelis CM, Ader HJ, Anema JR, Hoedeman R, van Mechelen W, Beekman AT. Collaborative care for major depressive disorder in an occupational healthcare setting. Br J Psychiatry. 2012;200:510–1.PubMedCrossRefGoogle Scholar
  13. 13.
    Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–13.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 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. 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
  16. 16.
    van der Feltz-Cornelis CM. Towards integrated primary health care for depressive disorder in the Netherlands. The depression initiative. Int J Integr Care. 2009;9:e83.PubMedCentralPubMedGoogle Scholar
  17. 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. 18.
    Mynors-Wallis L. Problem-solving treatment for anxiety and depression. A practicalguide. Oxford: Oxford University Press; 2005.Google Scholar
  19. 19.
    Doppegieter RMS, Willems JHBM. Code gegevensverkeer en samenwerking bij arbeidsverzuim en reïntegratie. Utrecht: KNMG; 2006.Google Scholar
  20. 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. 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. 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
  23. 23.
    Matthews JNS, Altman DG, Campbell MJ, Royston P. Analysis of serial measurements in medical research. BMJ. 1990;300:230–5.PubMedCentralPubMedCrossRefGoogle Scholar
  24. 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
  25. 25.
    van Roijen L, Essink-Bot ML, Koopmanschap MA, Bonsel G, Rutten FF. Labor and health status in economic evaluation of health care.The Health and Labor Questionnaire. Int J Technol Assess Health Care. 1996;12:405–15.PubMedCrossRefGoogle Scholar
  26. 26.
    Koopmanschap MA, Rutten FF, van Ineveld BM, van Roijen L. The friction cost method for measuring indirect costs of disease. J Health Econ. 1995;14(2):171–89.PubMedCrossRefGoogle Scholar
  27. 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. 28.
    Box GEP, Cox DR. An analysis of transformations. J R Stat Soc. 1964;26:211–34.Google Scholar
  29. 29.
    Blonk RWB, Brenninkmeijer V, Lagerveld SE, Houtman ILD. Return to work: a comparison of two cognitive behavioural interventions in cases of work-related psychological complaints among the self-employed. Work Stress. 2006;20(2):129–44.CrossRefGoogle Scholar
  30. 30.
    Adler DA, McLaughlin TJ, Rogers WH, Chang H, Lapitsky L, Lerner D. Job performance deficits due to depression. Am J Psychiatry. 2006;163(9):1569–76.PubMedCrossRefGoogle Scholar
  31. 31.
    van der Klink JJ, Blonk RW, Schene AH, van Dijk FJ. Reducing long term sickness absence by an activating intervention in adjustment disorders: a cluster randomised controlled design. Occup Environ Med. 2003;60(6):429–37.PubMedCentralPubMedCrossRefGoogle Scholar
  32. 32.
    Schene AH, Koeter MW, Kikkert MJ, Swinkels JA, McCrone P. Adjuvant occupational therapy for work-related major depression works: randomized trial including economic evaluation. Psychol Med. 2007;37(3):351–62.PubMedCrossRefGoogle Scholar
  33. 33.
    World Health Organization. Towards a common language for functioning, disability and health:ICF. Geneva: WHO; 2002.Google Scholar
  34. 34.
    Loisel P, Durand M, Berhelette D, Vezina N, Baril R, Gagnon D, et al. Disability prevention - New paradigm for the management of occupational back pain. Dis Manage Health Outcomes. 2001;9(7):351–60.CrossRefGoogle Scholar
  35. 35.
    Lagerveld SE, Bultmann U, Franche RL, van Dijk FJ, Vlasveld MC, van der Feltz-Cornelis CM, et al. Factors associated with work participation and work functioning in depressed workers: a systematic review. J Occup Rehabil. 2010;20(3):275–92.PubMedCentralPubMedCrossRefGoogle Scholar
  36. 36.
    Dekkers-Sanchez PM, Hoving JL, Sluiter JK, Frings-Dresen MH. Factors associated with long-term sick leave in sick-listed employees: a systematic review. Occup Environ Med. 2008;65(3):153–7.PubMedCrossRefGoogle Scholar
  37. 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

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Maartje Goorden
    • 1
  • Moniek C. Vlasveld
    • 2
    • 3
  • Johannes R. Anema
    • 3
    • 4
  • Willem van Mechelen
    • 3
    • 4
  • Aartjan T. F. Beekman
    • 5
  • Rob Hoedeman
    • 6
    • 7
  • Christina M. van der Feltz-Cornelis
    • 2
    • 8
    • 9
  • Leona Hakkaart-van Roijen
    • 1
  1. 1.Institute for Medical Technology Assessment, Institute of Health Policy and ManagementRotterdamThe Netherlands
  2. 2.Netherlands Institute of Mental Health and Addiction (Trimbos Institute)UtrechtThe Netherlands
  3. 3.Department of Public and Occupational HealthEMGO Institute for Health and Care Research (EMGO+)AmsterdamThe Netherlands
  4. 4.Research Center for Insurance Medicine AMC-UMCG-UWV-VUmcAmsterdamThe Netherlands
  5. 5.GGZinGeest and Department of PsychiatryEMGO Institute for Health and Care Research (EMGO+)AmsterdamThe Netherlands
  6. 6.365/ArboNed Occupational Health ServicesUtrechtThe Netherlands
  7. 7.Department of Health Sciences, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
  8. 8.Tranzo DepartmentTilburg UniversityTilburgThe Netherlands
  9. 9.GGZ BreburgTilburgThe Netherlands

Personalised recommendations