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Case management undertaken by healthcare assistants in small primary care practices is effective in improving depression symptoms and adherence in patients with major depression.
To evaluate the cost-effectiveness of depression case management by healthcare assistants in small primary care practices.
Cost-effectiveness analysis on the basis of a pragmatic randomised controlled trial (2005-2008): practice-based healthcare assistants in 74 practices provided case management to 562 patients with major depression over 1 year. Our primary outcome was the incremental costeffectiveness ratio (ICER) calculated as the ratio of differences in mean costs and mean number of qualityadjusted life-years (QALYs). Our secondary outcome was the mean depression-free days (DFDs) between the intervention and control group at 24-month follow-up. The study was registered at the International Standard Randomised Controlled Trial Number Registry: ISRCTN66386086.
Intervention v. control group: no significant difference in QALYs; significantly more DFDs (mean: 373 v. 311, P<0.01); no significant difference in mean direct healthcare costs (€4495 v. €3506, P = 0.16); considerably lower mean indirect costs (€5228 v. €7539, P = 0.06), resulting in lower total costs (€9723 v. €11 045, P = 0.41). The point estimate for the cost-utility ratio was €38 429 per QALY gained if only direct costs were considered, and ‘dominance’ of the intervention if total costs were considered. Yet, regardless of decision makers' willingness to pay per QALY, the probability of the intervention being cost-effective was never above 90%.
In small primary care practices, 1 year of case management did not increase the number of QALYs but it did increase the number of DFDs. The intervention was likely to be cost-effective.
The World Mental Health Surveys were established by the World Health Organization in 2000 to provide valuable information for physicians and health policy planners. These surveys have shed light on the prevalence, correlates, burden, and treatment of mental disorders in countries throughout the world. This volume focuses on the epidemiology of coexisting physical and mental illness around the world. This book includes surveys from 17 discrete countries on six continents, covering epidemiology, risk factors, consequences, and implications for research, clinical work, and policy. Many physical and mental illnesses share a relationship with one another and often occur simultaneously. Clinicians from the disciplines of both psychiatry and medicine are increasingly faced with both challenges on a daily basis, making this an ideal book for a wide range of health professionals. This is the first book devoted to this topic on such a wide-ranging scale.