Article Abstract

Article Abstract

Online ISSN: 1099-176X Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 27, Issue 3, 2024. Pages: 129-143
Published Online: 1 December 2024

Economic Evaluation of Self-Management for Patients with Persistent Depressive Disorder and their Caregivers

Ericka C. Solis,^1* Ingrid V.E. Carlier,¹ Noelle Kamminga,² Albert M. van Hemert,¹ M. Elske van den Akker-van Marle³

¹Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.
²Department of Psychiatry and Medical Psychology, Maastricht University Medical Center, Maastricht, The Netherlands.
³Department of Biomedical Data Sciences, unit Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.

*Correpondence to: Ericka Solis, MSc, Leiden University Medical Center, Department of Psychiatry, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
Tel +31-71-526 3785
Fax: +31-71-524 8156
E-mail address: E.C.Solis@lumc.nl

Source of Funding:The PPEP4All Study was funded by the Doelmatigheidsonderzoek program of the Netherlands Organisation for Health Research and Development (ZonMw, grant number 843-002-709, Projectleader: I.V.E. Carlier) and by GGZ Rivierduinen. These sponsors have not had any role in the conducted analyses, writing the manuscript, and the decision to publish these results. Noëlle Kamminga reports financial support was provided through her Dutch company, PPEP4All Academy B.V. Noëlle Kamminga is currently CEO and owner of PPEP4All Academy B.V. She is also the founder/developer of the PPEP4All program. PPEP4All is registered at European Union Intellectual Property Office (EUIPO).

Abstract

After several unsuccessful treatments, patients with persistent depressive disorder (PDD) may benefit from self-management, such as the “Patient and Partner Education Program for All Chronic Diseases-Persistent Depressive Disorder” (PPEP4All-PDD). This pragmatic randomized controlled trial examined the cost-effectiveness of PPEP4All-PDD for adults and elderly with PDD and their caregivers compared to care-as-usual (CAU). We included 70 patients and 14 caregivers. Data were collected at 0, 3, 6, and 12 months. Health-related quality of life and cost of healthcare utilization and productivity loss were assessed. There was no statistical difference in mean costs per patient for (mental) healthcare, non-healthcare, and societal costs nor in quality-adjusted life years (QALYs) between PPEP4All-PDD and CAU. PPEP4All-PDD did not meet the threshold for cost-effectiveness compared to CAU. After the program, PPEP4All-PDD patients continued to receive mental healthcare sessions. The COVID-19 pandemic may have affected our results. Future research may examine the digital version of PPEP4All-PDD.

Background: Persistent depressive disorder (PDD; chronic depression) is associated with high personal, economic, and societal burden. Patients with PDD often fail to respond to treatment, despite long-term, intensive care, suggesting that future treatment should focus more on functional recovery. The “Patient and Partner Education Program for All Chronic Diseases-Persistent Depressive Disorder” (PPEP4All-PDD) is a brief self-management program for patients with PDD with nine weekly sessions, provided in group or individual format. Its focus on functional recovery may increase quality of life and shorten treatment duration, thus reducing healthcare and societal costs. This study examined the cost-effectiveness of PPEP4All-PDD for adults and elderly with PDD and their partners/caregivers compared to care-as-usual (CAU).

Aims of the Study: In this economic evaluation, we examined whether a favorable cost-utility of PPEP4All-PDD compared to CAU could be attained.

Method: In this multicenter pragmatic randomized controlled trial, 70 patients with PDD and 14 partners/caregivers were included. Data were collected at 0, 3, 6, and 12 months. Health-related quality of life was measured using the EuroQoL 5-Dimensions/Levels (EQ-5D-5L). Cost of healthcare utilization and productivity loss were assessed using the Trimbos questionnaire for Costs associated with Psychiatric illness (TiC-P). We examined incremental costs per quality-adjusted life years (QALYs) after one year.

Results: In relation to PPEP4All-PDD, 62% (n= 23) of patients had no participating PPEP4All-PDD partner/caregiver, and 89% (n= 33) of patients participated in group format. On average, PPEP4All-PDD cost €232 including the PPEP4All-PDD partner/caregiver, or €166 excluding the partner/caregiver. There was no statistical difference in mean costs per patient for (mental) healthcare, non-healthcare, and societal costs nor in QALYs between PPEP4All-PDD and CAU. The probability that PPEP4All-PDD is cost-effective compared to CAU remained below 50% for all acceptable values of willingness-to-pay for a QALY.

Discussion: This was the first economic evaluation of PPEP4All-PDD. Compared to CAU, PPEP4All-PDD did not lead to lower total healthcare costs nor higher quality of life in the one-year follow-up period. PPEP4All-PDD patients continued to receive additional mental healthcare sessions, showing that the process of ending treatment after a self-management intervention is not clear. The COVID-19 situation may have also affected this process after PPEP4All-PDD, due to higher levels of anxiety and loneliness. We could not confirm that involvement of the partner/caregiver was beneficial to patient treatment outcomes and requires further examination.

Implications: This economic evaluation failed to find significant differences in costs between PPEP4All-PDD and CAU over a study period of one year. Non-significant differences were in favor of CAU, leading to a low probability of PPEP4All-PDD being cost-
effective. Providing biweekly sessions and extending the follow-up period may be necessary in future studies. Patients with PDD may require more time to learn and integrate self-management practices into their daily life prior to effecting changes in personal quality of life and (mental) healthcare utilization. Digital interventions, such as digital PPEP4All-PDD, with or without the partner/caregiver may be a cost-effective option.

Received 14 December 2023; accepted 3 July 2024