Cost-effectiveness of problem-solving treatment in comparison with usual care for primary care patients with mental health problems: a randomized trial

Judith E Bosmans, Bettine Schreuders, Harm W J van Marwijk, Jan H Smit, Patricia van Oppen, Maurits W van Tulder

Research output: Contribution to JournalArticleAcademicpeer-review

130 Downloads (Pure)


BACKGROUND: Mental health problems are common and are associated with increased disability and health care costs. Problem-Solving Treatment (PST) delivered to these patients by nurses in primary care might be efficient. The aim of this study was to evaluate the cost-effectiveness of PST by mental health nurses compared with usual care (UC) by the general practitioner for primary care patients with mental health problems.

METHODS: An economic evaluation from a societal perspective was performed alongside a randomized clinical trial. Patients with a positive General Health Questionnaire score (score ≥ 4) and who visited their general practitioner at least three times during the past 6 months were eligible. Outcome measures were improvement on the Hospital Anxiety and Depression Scale and QALYs based on the EQ-5D. Resource use was measured using a validated questionnaire. Missing cost and effect data were imputed using multiple imputation techniques. Bootstrapping was used to analyze costs and cost-effectiveness of PST compared with UC.

RESULTS: There were no statistically significant differences in clinical outcomes at 9 months. Mean total costs were €4795 in the PST group and €6857 in the UC group. Costs were not statistically significantly different between the two groups (95% CI -4698;359). The cost-effectiveness analysis showed that PST was cost-effective in comparison with UC. Sensitivity analyses confirmed these findings.

CONCLUSIONS: PST delivered by nurses seems cost-effective in comparison with UC. However, these results should be interpreted with caution, since the difference in total costs was mainly caused by 3 outliers with extremely high indirect costs in the UC group.

TRIAL REGISTRATION: Nederlands Trial Register ISRCTN51021015.

Original languageEnglish
Article number98
JournalBMC Family Practice
Issue number1
Publication statusPublished - 2012


  • Adult
  • Aged
  • Cost-Benefit Analysis
  • Depression
  • Female
  • Health Care Costs
  • Humans
  • Male
  • Middle Aged
  • Practice Patterns, Nurses'
  • Primary Health Care
  • Problem Solving
  • Psychotherapy, Brief
  • Quality-Adjusted Life Years
  • Journal Article
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't


Dive into the research topics of 'Cost-effectiveness of problem-solving treatment in comparison with usual care for primary care patients with mental health problems: a randomized trial'. Together they form a unique fingerprint.

Cite this