Skip to main content Accessibility help

Cost-effectiveness of combining systematic identification and treatment of co-morbid major depression for people with chronic diseases: the example of cancer

  • S. Walker (a1), J. Walker (a2), G. Richardson (a1), S. Palmer (a1), Q. Wu (a3), S. Gilbody (a3), P. Martin (a4), C. Holm Hansen (a4), A. Sawhney (a4), G. Murray (a5), M. Sculpher (a1) and M. Sharpe (a2)...



Co-morbid major depression occurs in approximately 10% of people suffering from a chronic medical condition such as cancer. Systematic integrated management that includes both identification and treatment has been advocated. However, we lack information on the cost-effectiveness of this combined approach, as published evaluations have focused solely on the systematic (collaborative care) treatment stage. We therefore aimed to use the best available evidence to estimate the cost-effectiveness of systematic integrated management (both identification and treatment) compared with usual practice, for patients attending specialist cancer clinics.


We conducted a cost-effectiveness analysis using a decision analytic model structured to reflect both the identification and treatment processes. Evidence was taken from reviews of relevant clinical trials and from observational studies, together with data from a large depression screening service. Sensitivity and scenario analyses were undertaken to determine the effects of variations in depression incidence rates, time horizons and patient characteristics.


Systematic integrated depression management generated more costs than usual practice, but also more quality-adjusted life years (QALYs). The incremental cost-effectiveness ratio (ICER) was £11 765 per QALY. This finding was robust to tests of uncertainty and variation in key model parameters.


Systematic integrated management of co-morbid major depression in cancer patients is likely to be cost-effective at widely accepted threshold values and may be a better way of generating QALYs for cancer patients than some existing medical and surgical treatments. It could usefully be applied to other chronic medical conditions.


Corresponding author

* Address for correspondence: S. Walker, M.Sc., Centre for Health Economics, University of York, Heslington, York YO10 5DD, UK. (Email:


Hide All
Archer, J, Bower, F, Gilbody, S, Lovell, K, Richards, D, Gask, L, Dickens, C, Coventry, P (2012). Collaborative care for depression and anxiety problems. Cochrane Database of Systematic Reviews. Issue 10, Art. No. CD006525.
Arroll, B, Elley, CR, Fishman, T, Goodyear-Smith, FA, Kenealy, T, Blashki, G, Kerse, N, MacGillivray, S (2009). Antidepressants versus placebo for depression in primary care. Cochrane Database of Systematic Reviews. Issue 3, Art No. CD007954.
BMA/RPS (2010). British National Formulary. British Medical Association the Royal Pharmaceutical Society. Pharmaceutical Press: London.
Cape, J, McCulloch, Y (1999). Patients' reasons for not presenting emotional problems in general practice consultations. British Journal of General Practice 49, 875879.
Cepoiu, M, McCusker, J, Cole, MG, Sewitch, M, Belzile, E, Ciampi, A (2008). Recognition of depression by non-psychiatric physicians: a systematic literature review and meta-analysis. Journal of General Internal Medicine 23, 2536.
Coventry, P, Hays, R, Dickens, C, Bundy, C, Garret, C, Cherrington, A, Chew-Graham, CA (2011). Talking about depression: a qualitative study of barriers to managing depression in people with long term conditions in primary care. BMC Family Practice 12, 10.
Curtis, L (2011). Unit Costs of Health and Social Care 2011. Personal Social Services Research Unit (PSSRU), University of Kent: Canterbury.
Department of Health (2011 a). NHS Reference Costs 2009–2010. Department of Health: London.
Department of Health (2011 b). Ten things you need to know about long term conditions ( Accessed 12 December 2011.
Drummond, M, Sculpher, MJ, Torrance, GW, O'Brien, BJ, Stoddart, GL (2005). Methods for the Economic Evaluation of Health Care Programmes. Oxford University Press: Oxford.
Fann, J, Ell, K, Sharpe, M (2012). Integrating psychosocial care into cancer services. Journal of Clinical Oncology 30, 11601177.
First, M, Gibbon, M, Spitzer, R, Williams, J (1996). User's Guide for the SCID-I, Structured Clinical Interview for DSM-IV Axis I Disorders, Research Version. Biometrics Research Department, New York State Psychiatric Institute: New York.
Geddes, J, Carney, S, Davies, C, Furukawa, T, Knupfer, D, Frank, E, Goodwin, G (2003). Relapse prevention with antidepressant drug treatment in depressive disorders: a systematic review Lancet 361, 653661.
Gilbody, S, Sheldon, T, Wessely, S (2006). Should we screen for depression? British Medical Journal 332, 10271030.
Gilbody, SM, House, AO, Sheldon, TA (2001). Routinely administered questionnaires for depression and anxiety: systematic review. British Medical Journal 322, 406409.
Greenberg, DB (2004). Barriers to the treatment of depression in cancer patients. Journal of the National Cancer Institute. Monographs 32, 127135.
Gunn, J, Diggens, J, Hegarty, K, Blashki, G (2006). A systematic review of complex system interventions designed to increase recovery from depression in primary care. BMC Health Services Research 6, 88.
Hopko, DR, Lejuez, CW, Ruggiero, KJ, Eifert, GH (2003). Contemporary behavioral activation treatments for depression: procedures, principles, and progress. Clinical Psychology Review 23, 699717.
Katon, W (2012). Collaborative depression care models: from development to dissemination. American Journal of Preventive Medicine 42, 550552.
Katon, W, Ciechanowski, P (2002). Impact of major depression on chronic medical illness. Journal of Psychosomatic Research 53, 859863.
Katon, W, Russo, J, Lin, EH, Schmittdiel, J, Ciechanowski, P, Ludman, E, Peterson, D, Young, B, Von Korff, M (2012). Cost-effectiveness of a multicondition collaborative care intervention: a randomized controlled trial. Archives of General Psychiatry 69, 506514.
Kroenke, K, Spitzer, RL, Williams, JB (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine 16, 606613.
Ladapo, J, Shaffer, J, Fang, X, Ye, S, Davidson, K (2012). Cost-effectiveness of enhanced depression care after acute coronary syndrome: results from the coronary psychosocial evaluation studies randomized controlled trial. Archives of Internal Medicine 172, 16821684.
Mitchell, A, Vaze, A, Rao, S (2009). Clinical diagnosis of depression in primary care: a meta-analysis. Lancet 374, 609619.
Moussavi, S, Chatterji, S, Verdes, E, Tandon, A, Patel, V, Ustun, B (2007). Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet 370, 851858.
Mynor-Wallis, L (2005). Problem-solving Treatment for Anxiety and Depression: A Practical Guide. Oxford University Press: Oxford.
NCCMH (2010). Depression: The Treatment and Management of Depression in Adults. National Collaborating Centre for Mental Health. British Psychological Society: Leicester, UK.
NICE (2008). Guide to the methods of technology appraisal. ( National Institute for Health and Care Excellence: London.
NICE (2009 a). NICE Guideline Depression: the treatment and management of depression in adults (updated edition) Clinical Guideline 90. ( National Institute for Health and Care Excellence: London.
NICE (2009 b). Depression in adults with a chronic physical health problem. Clinical Guideline 91. ( National Institute for Health and Care Excellence: London.
Nutting, PA, Rost, K, Smith, J, Werner, JJ, Elliot, C (2000). Competing demands from physical problems: effect on initiating and completing depression care over 6 months. Archives of Family Medicine 9, 10591064.
Parkin, DM, Bray, F, Ferlay, J, Pisani, P (2001). Estimating the world cancer burden: Globocan 2000. International Journal of Cancer 94, 153156.
Paulden, M, Palmer, S, Hewitt, C, Gilbody, S (2009). Screening for postnatal depression in primary care: cost effectiveness analysis. British Medical Journal 339, b5203.
Pignone, M, Gaynes, B, Rushton, J, Mills Burchell, C, Orleans, C, Mulrow, C, Lohr, K (2002). Screening for depression in adults: a summary of the evidence for the US Preventive Services Task Force. Annals of Internal Medicine 136, 765776.
Pinquart, M, Duberstein, PR (2010). Depression and cancer mortality: a meta-analysis. Psychological Medicine 40, 17971810.
Revicki, DA, Wood, M (1998). Patient-assigned health state utilities for depression-related outcomes: differences by depression severity and antidepressant medications. Journal of Affective Disorders 48, 2536.
Sharpe, M, Strong, V, Allen, K, Rush, R, Postma, K, Tulloh, A, Maguire, P, House, A, Ramirez, A, Cull, A (2004). Major depression in outpatients attending a regional cancer centre: screening and unmet treatment needs. British Journal of Cancer 90, 314320.
Simon, GE, Katon, WJ, Lin, EH, Rutter, C, Manning, WG, Von Korff, M, Ciechanowski, P, Ludman, EJ, Young, BA (2007). Cost-effectiveness of systematic depression treatment among people with diabetes mellitus. Archives of General Psychiatry 64, 6572.
Sobocki, P, Ekman, M, Agren, H, Jonsson, B, Rehnberg, C (2006). Model to assess the cost-effectiveness of new treatments for depression. International Journal of Technology Assessment in Health Care 22, 469477.
Strong, V, Waters, R, Hibberd, C, Murray, G, Wall, L, Walker, J, McHugh, G, Walker, A, Sharpe, M (2008). Management of depression for people with cancer (SMaRT oncology 1): a randomised trial. Lancet 372, 4048.
U.S. Preventive Services Task Force (2009). Screening for depression in adults: U.S. preventive services task force recommendation statement. Annals of Internal Medicine 151, 784792.
Valenstein, M, Vijan, S, Zeber, JE, Boehm, K, Buttar, A (2001). The cost-utility of screening for depression in primary care. Annals of Internal Medicine 134, 345360.
Walker, J, Postma, K, Mchugh, GS, Rush, R, Coyle, B, Strong, V, Sharpe, M (2007). Performance of the Hospital Anxiety and Depression Scale as a screening tool for major depressive disorder in cancer patients. Journal of Psychosomatic Research 63, 8391.
Walker, J, Sharpe, M (2009). Depression care for people with cancer: a collaborative care intervention. General Hospital Psychiatry 31, 436441.
Walters, S, Nur, U, Rachet, B, Gordon, E, Jakomis, N, Edgar, G, Coleman, M (2010). Cancer survival in England: one-year and five-year survival for 21 common cancers, by sex and age (–followed-up-to-2008/sb1.pdf). Office for National Statistics: Newport.
Zigmond, AS, Snaith, RP (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica 67, 361370.


Type Description Title
Supplementary materials

Walker Supplementary Material

 Unknown (33 KB)
33 KB
Supplementary materials

Walker Supplementary Material

 Unknown (94 KB)
94 KB
Supplementary materials

Walker Supplementary Material

 Word (24 KB)
24 KB

Cost-effectiveness of combining systematic identification and treatment of co-morbid major depression for people with chronic diseases: the example of cancer

  • S. Walker (a1), J. Walker (a2), G. Richardson (a1), S. Palmer (a1), Q. Wu (a3), S. Gilbody (a3), P. Martin (a4), C. Holm Hansen (a4), A. Sawhney (a4), G. Murray (a5), M. Sculpher (a1) and M. Sharpe (a2)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed