Article Abstract

Article Abstract

Online ISSN: 1099-176X Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 18, Issue 3, 2015. Pages: 175-183
Published Online: 1 December 2015

Economic Evaluation of Concise Cognitive Behavioural Therapy and/or Pharmacotherapy for Depressive and Anxiety Disorders

Denise Meuldijk,¹ Ingrid V.E. Carlier,² Irene M. van Vliet,³ Albert M. van Hemert,⁴ Frans G. Zitman,⁵ M. Elske van den Akker- van Marle⁶

¹MSc., Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
²PhD., Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
³M.D., Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
⁴Prof., Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
⁵Prof., Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
⁶PhD., Department of Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands

* Correspondence to: Denise Meuldijk, MSc, Leiden University Medical Centre, Department of Psychiatry, P.O. Box 9600, 2300 RC, Leiden, the Netherlands.
Tel.: +31-71-526 3785
Fax: +31-71-524 8156
E-mail: d.meuldijk@lumc.nl

Source of Funding: This is a collaborative study between Rivierduinen (RD) and the department of Psychiatry of the LUMC and is funded entirely by RD. RD is a secondary Regional Mental Health Provider (RHMP) in the province of South-Holland, the Netherlands. The funding source contributed to the study design and enrollment of participants but had no role in data collection, data analysis, data interpretation or writing of the report. The corresponding author had full access to all study data and had final responsibility for the decision to submit for publication. Trial registration: Netherlands TrialRegistry NTR2590.

Abstract

Depressive and anxiety disorders contribute to a high disease burden and are associated with high health care costs. Offering treatment for these disorders in a more concise form, can yield savings in both healthcare and societal costs, while clinical effectiveness is maintained. An economic evaluation was performed alongside a pragmatic randomised controlled trial to examine the long-term cost-utility of concise formats of cognitive behavioural therapy and/or pharmacotherapy in the treatment of depressive and/or anxiety disorders in secondary care outpatient clinics. No significant differences were found in mean healthcare and societal costs, nor were there any significant differences in utility scores between the groups. From both the societal and healthcare perspective, a favorable cost-effectiveness of concise care compared to standard care, could not be demonstrated. More strictly adhering to the study protocol and an extended follow-up period are expected to produce cost savings of concise care.

Background: Depressive and anxiety disorders cause great suffering and disability and are associated with high health care costs. In a previous conducted pragmatic randomised controlled trial, we have shown that a concise format of cognitive behavioural- and/or pharmacotherapy is as effective as standard care in reducing depressive and anxiety symptoms and in improving subdomains of general health and quality of life in secondary care psychiatric outpatients.

Aims of the Study: In this economic evaluation, we examined whether a favourable cost-utility of concise care compared to standard care was attained.

Methods: The economic evaluation was performed alongside a pragmatic randomised controlled trial. Health-related quality of life was measured using the Short-Form (SF-36) questionnaire. Cost of healthcare utilization and productivity loss (absenteeism and presenteeism) were assessed using the Trimbos/iMTA questionnaire for Costs associated with Psychiatric Illness (TiC-P). A cost-utility analysis, using cost-effectiveness acceptability curves, comparing differences in societal costs and Quality-Adjusted Life Years (QALYs) at 1 year was performed.

Results: One year after study entry, the difference in mean cost per patient of the two primary treatments was not significant between both groups. No significant differences in other healthcare and non- healthcare costs could be detected between patients receiving concise care and standard care. Also, QALYs were not statistically different between the groups during the study period. From both the societal and healthcare perspective, the probability that concise care is more cost-effective compared to standard care remains below the turning point of 0.5 for all acceptable values of the willingness to pay for a QALY. The economic evaluation suggests that concise care is unlikely to be cost-effective compared to standard care in the treatment for depressive- and anxiety disorders in secondary mental health care during a one year follow up period.

Discussion: Total costs and QALYs were not significantly different between standard and concise care, with no evidence for cost-effectiveness of concise care in the first year. The longer impact of concise care for patients with mild to moderate symptoms of depressive and/or anxiety disorders compared to standard care in secondary care needs to be further studied.

Implications: This economic evaluation failed to find significant differences in cost between concise and standard care over the study period of one year. Replication of our economic evaluation might benefit from an extended follow-up period and strict adherence to the study protocol. If concise care will be found to be cost-effective in the long term, this would have major implications for recommendations how to optimize secondary mental health care in the treatment of depressive -- and anxiety disorders.

Received 14 April 2015; accepted 19 September 2015