Abstract
ObjectivesTo study the cost-effectiveness of a care manager organization for patients with mild to moderate depression in Swedish primary care in a 12-month perspective.MethodsCost-effectiveness analysis of the care manager organization compared to care as usual (CAU) in a pragmatic cluster randomised controlled trial including 192 individuals in the care manager group and 184 in the CAU group. Cost-effectiveness was assessed from a health care and societal perspectives. Costs were assessed in relation to two different health outcome measures: depression free days (DFDs) and quality adjusted life years (QALYs).ResultsAt the 12-month follow-up, patients treated at the intervention Primary Care Centres (PCCs) with a care manager organization had larger health benefits than the group receiving usual care only at control PCCs. Mean QALY per patient was 0.73 (95% CI 0.7; 0.75) in the care manager group compared to 0.70 (95% CI 0.66; 0.73) in the CAU group. Mean DFDs was 203 (95% CI 178; 229) in the care manager group and 155 (95% CI 131; 179) in the CAU group. Further, from a societal perspective, care manager care was associated with a lower cost than care as usual, resulting in a dominant incremental cost-effectiveness ratio (ICER) for both QALYs and DFDs. From a health care perspective care manager care was related to a low cost per QALY (36,500 SEK / €3,379) and DFD (31 SEK/€3).LimitationsA limitation is the fact that QALY data was impaired by insufficient EQ-5D data for some patients.ConclusionsA care manager organization at the PCC to increase quality of care for patients with mild-moderate depression shows high health benefits, with no decay over time, and high cost-effectiveness both from a health care and a societal perspective.Trial registration details: The trial was registered in ClinicalTrials.com (https://clinicaltrials.gov/ct2/show/NCT02378272) in 02/02/2015 with the registration number NCT02378272. The first patient was enrolled in 11/20/2014.
Highlights
Depression is one of the most common health disorders [38]
We present the results from the complete case analysis (CCA) and multiple imputations in terms of an incremental cost-effectiveness ratio (ICER), which is the difference in costs divided by the difference in health outcome of implementing the care manager program compared to care as usual (CAU): ICER = (Costcare manager – CostCAU)/(Health outcomecare manager – Health outcomeCAU)
The mean cost of production loss added to healthcare cost resulted in a total cost of 111,974 Swedish krona (SEK) (€10,368) per patient in the care manager group during the 12-month follow-up
Summary
Depression is one of the most common health disorders [38]. The economic burden of depression disorder is substantial both for the affected individual and for society at large [16]. Sick leave and early retirement account for the largest expenditures [15]. Depression causes 6% of the burden of all diseases in Europe in terms of disability adjusted life years (DALYs) [25]. During the Covid-19 outbreak in 2020, depressive symptoms have vastly increased in the populations [23]. In health care, where the needs increase faster than the human and financial resources, new evidence-based organizational methods and new treatments are required to provide the best possible care to as many people as possible
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