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Published on: January 7, 2019
Cost-effectiveness of depression case management in small practices
Jochen Gensichen1, Juliana J Petersen, Michael Von Korff
1Institute of General Practice and Family Medicine, Friedrich-Schiller-University/Jena University Hospital, Bachstr. 18, D-07743 Jena, Germany. jochen.gensichen@med.uni-jena.de
Summary
Healthcare assistants providing case management for major depression in primary care increased depression-free days (DFDs) without significantly impacting quality-adjusted life-years (QALYs). This intervention demonstrated likely cost-effectiveness in small practices.
Area of Science:
- Primary Care Medicine
- Mental Health Services Research
- Health Economics
Background:
- Case management by healthcare assistants is effective for major depression in primary care.
- Previous studies indicate improved depression symptoms and patient adherence.
Purpose of the Study:
- To evaluate the cost-effectiveness of depression case management.
- Focus on interventions delivered by healthcare assistants in small primary care settings.
Main Methods:
- Pragmatic randomized controlled trial involving 74 practices and 562 patients over 1 year.
- Cost-effectiveness analysis using incremental cost-effectiveness ratio (ICER) based on quality-adjusted life-years (QALYs).
- Secondary outcome: depression-free days (DFDs) at 24-month follow-up.
Main Results:
- No significant difference in QALYs between intervention and control groups.
- Significantly more DFDs in the intervention group (373 vs. 311, P<0.01).
- Lower total costs in the intervention group (€9723 vs. €11 045), driven by reduced indirect costs.
Conclusions:
- One year of case management by healthcare assistants increased DFDs but not QALYs.
- The intervention was likely cost-effective, particularly when considering total costs.
- Probability of cost-effectiveness remained below 90% regardless of willingness-to-pay thresholds.
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