Abstract
BackgroundCollaborative care is an effective treatment for the management of depression but evidence on its cost-effectiveness in the UK is lacking.AimsTo assess the cost-effectiveness of collaborative care in a UK primary care setting.MethodsAn economic evaluation alongside a multi-centre cluster randomised controlled trial comparing collaborative care with usual primary care for adults with depression (n = 581). Costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICER) were calculated over a 12-month follow-up, from the perspective of the UK National Health Service and Personal Social Services (i.e. Third Party Payer). Sensitivity analyses are reported, and uncertainty is presented using the cost-effectiveness acceptability curve (CEAC) and the cost-effectiveness plane.ResultsThe collaborative care intervention had a mean cost of £272.50 per participant. Health and social care service use, excluding collaborative care, indicated a similar profile of resource use between collaborative care and usual care participants. Collaborative care offered a mean incremental gain of 0.02 (95% CI: –0.02, 0.06) quality-adjusted life-years over 12 months, at a mean incremental cost of £270.72 (95% CI: –202.98, 886.04), and resulted in an estimated mean cost per QALY of £14,248. Where costs associated with informal care are considered in sensitivity analyses collaborative care is expected to be less costly and more effective, thereby dominating treatment as usual.ConclusionCollaborative care offers health gains at a relatively low cost, and is cost-effective compared with usual care against a decision-maker willingness to pay threshold of £20,000 per QALY gained. Results here support the commissioning of collaborative care in a UK primary care setting.
Highlights
Depression is a long term and disabling condition with well documented negative impacts on health status and on health care resources [1,2]
Collaborative care offers health gains at a relatively low cost, and is cost-effective compared with usual care against a decision-maker willingness to pay threshold of £20,000 per quality-adjusted life-years (QALYs) gained
Systematic reviews, of studies mostly conducted in the United States, demonstrate that collaborative care improves depression outcomes [6,8], and a recent randomised control trial, the CADET Trial of collaborative care for depression in UK primary care, has shown it to be effective in the UK healthcare system [9]
Summary
Depression is a long term and disabling condition with well documented negative impacts on health status and on health care resources [1,2]. In most cases the responsibility for treatment of people with depression falls on primary care [3], but the organisation of care in this setting can face many challenges These include barriers between generalist and specialist mental health professionals, poor patient adherence to pharmacological treatment [4], and a shortage of specialists to provide psychological therapies [5]. Collaborative care is a complex intervention, developed in the United States, incorporating a multi-professional approach to patient care; a structured management plan; scheduled patient follow-ups; and enhanced inter-professional communication [7] In practice this is achieved by the introduction of a care manager into primary care, responsible for delivering care to patients with depression under supervision from a specialist, and for liaising between primary care clinicians and mental health specialists. Collaborative care is an effective treatment for the management of depression but evidence on its costeffectiveness in the UK is lacking
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