A supported self-help for recurrent depression in primary care; An economic evaluation alongside a multi-center randomised controlled trial

Karolien E.M. Biesheuvel-Leliefeld, Judith E. Bosmans, Sandra M.A. Dijkstra-Kersten, Filip Smit, Claudi L.H. Bockting, Digna J.F. Van Schaik, Harm W.J. Van Marwijk, Henriette E. Van Der Horst

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

Background Major depression is a prevalent mental disorder with a high risk of relapse or recurrence. Only few studies have focused on the cost-effectiveness of interventions aimed at the prevention of relapse or recurrence of depression in primary care. Aim To evaluate the cost-effectiveness of a supported Self-help Preventive Cognitive Therapy (S-PCT) added to treatment-as-usual (TAU) compared with TAU alone for patients with a history of depression, currently in remission. Methods An economic evaluation alongside a multi-center randomised controlled trial was performed (n = 248) over a 12-month follow-up. Outcomes included relapse or recurrence of depression and quality-adjusted-life-years (QALYs) based on the EuroQol-5D. Analyses were performed from both a societal and healthcare perspective. Missing data were imputed using multiple imputations. Uncertainty was estimated using bootstrapping and presented using the cost-effectiveness plane and the Cost-Effectiveness Acceptability Curve (CEAC). Cost estimates were adjusted for baseline costs. Results S-PCT statistically significantly decreased relapse or recurrence by 15% (95%CI 3;28) compared to TAU. Mean total societal costs were €2,114 higher (95%CI -112;4261). From a societal perspective, the ICER for relapse or recurrence was 13,515. At a Willingness To Pay (WTP) of 22,000 €/recurrence prevented, the probability that S-PCT is cost-effective, in comparison with TAU, is 80%. The ICER for QALYs was 63,051. The CEA curve indicated that at a WTP of 30,000 €/QALY gained, the probability that S-PCT is cost-effective compared to TAU is 21%. Conclusions Though ultimately depending on the WTP of decision makers, we expect that for both relapse or recurrence and QALYs, S-PCT cannot be considered cost-effective compared to TAU.

LanguageEnglish
Article numbere0208570
Pages1-8
Number of pages18
JournalPLoS ONE
Volume13
Issue number12
DOIs
Publication statusPublished - 19 Dec 2018

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relapse
economic analysis
quality-adjusted life year
Cost-Benefit Analysis
Primary Health Care
Randomized Controlled Trials
cost effectiveness
Depression
Cost effectiveness
Recurrence
Economics
willingness to pay
therapeutics
Cognitive Therapy
Costs
Quality-Adjusted Life Years
Costs and Cost Analysis
behavior disorders
remission
health services

Cite this

Biesheuvel-Leliefeld, K. E. M., Bosmans, J. E., Dijkstra-Kersten, S. M. A., Smit, F., Bockting, C. L. H., Van Schaik, D. J. F., ... Van Der Horst, H. E. (2018). A supported self-help for recurrent depression in primary care; An economic evaluation alongside a multi-center randomised controlled trial. PLoS ONE, 13(12), 1-8. [e0208570]. https://doi.org/10.1371/journal.pone.0208570
Biesheuvel-Leliefeld, Karolien E.M. ; Bosmans, Judith E. ; Dijkstra-Kersten, Sandra M.A. ; Smit, Filip ; Bockting, Claudi L.H. ; Van Schaik, Digna J.F. ; Van Marwijk, Harm W.J. ; Van Der Horst, Henriette E. / A supported self-help for recurrent depression in primary care; An economic evaluation alongside a multi-center randomised controlled trial. In: PLoS ONE. 2018 ; Vol. 13, No. 12. pp. 1-8.
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abstract = "Background Major depression is a prevalent mental disorder with a high risk of relapse or recurrence. Only few studies have focused on the cost-effectiveness of interventions aimed at the prevention of relapse or recurrence of depression in primary care. Aim To evaluate the cost-effectiveness of a supported Self-help Preventive Cognitive Therapy (S-PCT) added to treatment-as-usual (TAU) compared with TAU alone for patients with a history of depression, currently in remission. Methods An economic evaluation alongside a multi-center randomised controlled trial was performed (n = 248) over a 12-month follow-up. Outcomes included relapse or recurrence of depression and quality-adjusted-life-years (QALYs) based on the EuroQol-5D. Analyses were performed from both a societal and healthcare perspective. Missing data were imputed using multiple imputations. Uncertainty was estimated using bootstrapping and presented using the cost-effectiveness plane and the Cost-Effectiveness Acceptability Curve (CEAC). Cost estimates were adjusted for baseline costs. Results S-PCT statistically significantly decreased relapse or recurrence by 15{\%} (95{\%}CI 3;28) compared to TAU. Mean total societal costs were €2,114 higher (95{\%}CI -112;4261). From a societal perspective, the ICER for relapse or recurrence was 13,515. At a Willingness To Pay (WTP) of 22,000 €/recurrence prevented, the probability that S-PCT is cost-effective, in comparison with TAU, is 80{\%}. The ICER for QALYs was 63,051. The CEA curve indicated that at a WTP of 30,000 €/QALY gained, the probability that S-PCT is cost-effective compared to TAU is 21{\%}. Conclusions Though ultimately depending on the WTP of decision makers, we expect that for both relapse or recurrence and QALYs, S-PCT cannot be considered cost-effective compared to TAU.",
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Biesheuvel-Leliefeld, KEM, Bosmans, JE, Dijkstra-Kersten, SMA, Smit, F, Bockting, CLH, Van Schaik, DJF, Van Marwijk, HWJ & Van Der Horst, HE 2018, 'A supported self-help for recurrent depression in primary care; An economic evaluation alongside a multi-center randomised controlled trial', PLoS ONE, vol. 13, no. 12, e0208570, pp. 1-8. https://doi.org/10.1371/journal.pone.0208570

A supported self-help for recurrent depression in primary care; An economic evaluation alongside a multi-center randomised controlled trial. / Biesheuvel-Leliefeld, Karolien E.M.; Bosmans, Judith E.; Dijkstra-Kersten, Sandra M.A.; Smit, Filip; Bockting, Claudi L.H.; Van Schaik, Digna J.F.; Van Marwijk, Harm W.J.; Van Der Horst, Henriette E.

In: PLoS ONE, Vol. 13, No. 12, e0208570, 19.12.2018, p. 1-8.

Research output: Contribution to JournalArticleAcademicpeer-review

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T1 - A supported self-help for recurrent depression in primary care; An economic evaluation alongside a multi-center randomised controlled trial

AU - Biesheuvel-Leliefeld, Karolien E.M.

AU - Bosmans, Judith E.

AU - Dijkstra-Kersten, Sandra M.A.

AU - Smit, Filip

AU - Bockting, Claudi L.H.

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AU - Van Marwijk, Harm W.J.

AU - Van Der Horst, Henriette E.

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N2 - Background Major depression is a prevalent mental disorder with a high risk of relapse or recurrence. Only few studies have focused on the cost-effectiveness of interventions aimed at the prevention of relapse or recurrence of depression in primary care. Aim To evaluate the cost-effectiveness of a supported Self-help Preventive Cognitive Therapy (S-PCT) added to treatment-as-usual (TAU) compared with TAU alone for patients with a history of depression, currently in remission. Methods An economic evaluation alongside a multi-center randomised controlled trial was performed (n = 248) over a 12-month follow-up. Outcomes included relapse or recurrence of depression and quality-adjusted-life-years (QALYs) based on the EuroQol-5D. Analyses were performed from both a societal and healthcare perspective. Missing data were imputed using multiple imputations. Uncertainty was estimated using bootstrapping and presented using the cost-effectiveness plane and the Cost-Effectiveness Acceptability Curve (CEAC). Cost estimates were adjusted for baseline costs. Results S-PCT statistically significantly decreased relapse or recurrence by 15% (95%CI 3;28) compared to TAU. Mean total societal costs were €2,114 higher (95%CI -112;4261). From a societal perspective, the ICER for relapse or recurrence was 13,515. At a Willingness To Pay (WTP) of 22,000 €/recurrence prevented, the probability that S-PCT is cost-effective, in comparison with TAU, is 80%. The ICER for QALYs was 63,051. The CEA curve indicated that at a WTP of 30,000 €/QALY gained, the probability that S-PCT is cost-effective compared to TAU is 21%. Conclusions Though ultimately depending on the WTP of decision makers, we expect that for both relapse or recurrence and QALYs, S-PCT cannot be considered cost-effective compared to TAU.

AB - Background Major depression is a prevalent mental disorder with a high risk of relapse or recurrence. Only few studies have focused on the cost-effectiveness of interventions aimed at the prevention of relapse or recurrence of depression in primary care. Aim To evaluate the cost-effectiveness of a supported Self-help Preventive Cognitive Therapy (S-PCT) added to treatment-as-usual (TAU) compared with TAU alone for patients with a history of depression, currently in remission. Methods An economic evaluation alongside a multi-center randomised controlled trial was performed (n = 248) over a 12-month follow-up. Outcomes included relapse or recurrence of depression and quality-adjusted-life-years (QALYs) based on the EuroQol-5D. Analyses were performed from both a societal and healthcare perspective. Missing data were imputed using multiple imputations. Uncertainty was estimated using bootstrapping and presented using the cost-effectiveness plane and the Cost-Effectiveness Acceptability Curve (CEAC). Cost estimates were adjusted for baseline costs. Results S-PCT statistically significantly decreased relapse or recurrence by 15% (95%CI 3;28) compared to TAU. Mean total societal costs were €2,114 higher (95%CI -112;4261). From a societal perspective, the ICER for relapse or recurrence was 13,515. At a Willingness To Pay (WTP) of 22,000 €/recurrence prevented, the probability that S-PCT is cost-effective, in comparison with TAU, is 80%. The ICER for QALYs was 63,051. The CEA curve indicated that at a WTP of 30,000 €/QALY gained, the probability that S-PCT is cost-effective compared to TAU is 21%. Conclusions Though ultimately depending on the WTP of decision makers, we expect that for both relapse or recurrence and QALYs, S-PCT cannot be considered cost-effective compared to TAU.

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