Cost-effectiveness of a stepped care intervention to prevent depression and anxiety in late life: randomised trial

Abstract

BackgroundThere is an urgent need for the development of cost-effective preventive strategies to reduce the onset of mental disorders.AimsTo establish the cost-effectiveness of a stepped care preventive intervention for depression and anxiety disorders in older people at high risk of these conditions, compared with routine primary care.MethodAn economic evaluation was conducted alongside a pragmatic randomised controlled trial (ISRCTN26474556). Consenting individuals presenting with subthreshold levels of depressive or anxiety symptoms were randomly assigned to a preventive stepped care programme (n = 86) or to routine primary care (n = 84).ResultsThe intervention was successful in halving the incidence rate of depression and anxiety at €563 (£412) per recipient and €4367 (£3196) per disorder-free year gained, compared with routine primary care. The latter would represent good value for money if the willingness to pay for a disorder-free year is at least €5000.ConclusionsThe prevention programme generated depression- and anxiety-free survival years in the older population at affordable cost.

A randomized controlled trial of the efficacy and cost-effectiveness of a brief intensified cognitive behavioral therapy and/or pharmacotherapy for mood and anxiety disorders: Design and methods

“…Little information is available about how stepped care should be effectively implemented [22] and only a few randomized trials present convincing evidence and evaluations of both the cost and clinical effectiveness of this stepped-care model. Most studies investigated either the cost effectiveness [47,48] or the clinical effectiveness [49][50][51][52] of stepped care. When simultaneously investigated, the studies examined the effectiveness of a stepped-care model for patients with either a mood disorder [53] or an anxiety disorder [54], and only in primary care.…”

Cost-effectiveness of life-review for older adults with moderate depressive symptomatology: A pragmatic randomized controlled trial

“…For this reason, we have to compare our results with other cost-effectiveness studies on early interventions to prevent depression in older adults-which are also rather scarce. A recent study found that a stepped-care approach might be cost-effective in preventing depression and anxiety in later life (van't Veer-Tazelaar et al, 2010). So it might be worth investigating if life-review is more cost-effective when offered as a second or third step in a stepped-care framework.…”

Effect of stepped care on health outcomes in patients with osteoarthritis: an observational study in Dutch general practice

“…However, the added value of a stepped care approach has been demonstrated in other fields, such as in the prevention of depression and anxiety. 3,4 Also, a stepped care intervention programme showed positive effects on the outcome of care in depressed older people, which were better physical function and enhanced quality of life, 5 and the cost-effectiveness of a stepped care programme has been established in people with a depressive disorder in primary care. 6,7 In line with those findings, it was assumed that implementation of the SCS in primary care would improve adequate healthcare use and, ultimately, health outcomes.…”