About this Journal


Article Abstract

Online ISSN: 1099-176X    Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 11, Issue 1, 2008. Pages: 3-15
Published Online: 25 Mar 2008

Copyright © 2008 ICMPE.


 

Are Psychological Treatments for Depression in Primary Care Cost-Effective?

Judith E. Bosmans,1* Digna J.F. van Schaik,2 Martine C. de Bruijne,3 Hein P.J. van Hout,4 Harm W.J. van Marwijk,5 Maurits W. van Tulder,1 Wim A.B. Stalman5

1Ph.D., Health Technology Assessment Unit, Institute for Research in Extramural Medicine, VU UniversityMedicalCenter, Amsterdam and Department of Health Economics and Health Technology Assessment, Institute for Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, The Netherlands
2Ph.D., M.D., Department of General Practice and Department of Psychiatry, Institute for Research in Extramural Medicine, VU UniversityMedicalCenter, Amsterdam, The Netherlands
3Ph.D., M.D., Health Technology Assessment Unit, Institute for Research in Extramural Medicine, VU UniversityMedicalCenter, Amsterdam, The Netherlands
4Ph.D., Department of General Practice, Institute for Research in Extramural Medicine, VU UniversityMedicalCenter, Amsterdam, The Netherlands
5Ph.D., M.D., Department of General Practice, Institute for Research in Extramural Medicine, VU UniversityMedicalCenter, Amsterdam, The Netherlands

* Correspondence to: Judith E. Bosmans, VU University, Faculty of Earth and Life Sciences, Institute for Health Sciences, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands.
Tel.: +31-20-598 2843
Fax: +31-20-598 3668
E-mail: judith.bosmans@falw.vu.nl

Source of Funding: None declared

Abstract

Depression is a highly prevalent condition that is associated with high levels of work absenteeism and high health care costs. Most patients are treated in primary care. A large group of patients prefers psychological treatments to antidepressants. The aim of this study was to systematically review the evidence for the cost-effectiveness of psychological treatments, psychotherapy and counselling, in comparison with usual care or antidepressant treatment in adult primary care patients with depression. Seven studies were included in the review. No conclusion can be drawn on the cost-effectiveness of psychotherapy in primary care in comparison with usual care or antidepressant treatment. The cost-effectiveness of counselling in comparison with usual care and antidepressant therapy is yet to be established. In conclusion, based on this review, no firm conclusions on the cost-effectiveness of psychotherapy and counselling in primary care can be drawn. Methodological shortcomings of the studies limit the generalisibility of the results.

 

Background: Depression is a highly prevalent condition that is associated with high levels of work absenteeism and high health care costs. Most patients are treated in primary care. A large group of patients prefers psychological treatments to antidepressants.

Aims of the Study: To systematically review the evidence for the cost-effectiveness of psychological treatments, psychotherapy and counselling, in comparison with usual care or antidepressant treatment in adult primary care patients with depression.

Methods: A computer-assisted search of MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Library was carried out. Two independent reviewers selected studies for the review, extracted data and assessed the methodological quality of the included studies.

Results: Seven studies were included in the review. Forms of psychotherapy that were evaluated were cognitive behavioural therapy, interpersonal psychotherapy and couple therapy. Usual care generally consisted of care as usually provided by the general practitioner. No conclusion can be drawn on the cost-effectiveness of the above mentioned forms of psychotherapy in comparison with usual care or antidepressant treatment. The cost-effectiveness of counselling in comparison with usual care and antidepressant therapy is yet to be established. Meta-analyses showed that psychotherapy was significantly more expensive than usual care, but not significantly more expensive than antidepressant treatment. Counselling was associated with no statistically significant differences in costs and effects in comparison with usual care in the pooled analysis.

Discussion: Based on this review, no firm conclusions on the cost-effectiveness of psychotherapy and counselling in primary care can be drawn. Most studies had methodological shortcomings, which limit the generalisibility of the results.

Implications for Health Policies: Given the reluctance of patients to use antidepressants and the large economic impact of depression, policy makers have a need for well designed and sufficiently powered economic evaluations of psychological treatments. The available evidence seems to indicate that psychotherapy has more substantial clinical effects than counselling. Therefore, the emphasis should be on economic evaluations of forms of psychotherapy that have proved to be clinically effective.

Implications for Further Research: There are indications that the cost-effectiveness of depression treatment on the whole may be improved by incorporating psychological treatments into enhanced care models, tailored to the needs of individual patients and/or by providing them by trained nurses instead of psychologists or psychotherapists. Further research should investigate these patient tailored, stepped care treatment modalities for depression treatment.


Received 21 November 2006; accepted 18 December 2007

Copyright 2008 ICMPE