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Br J Psychiatry. 2010 Apr;196(4):319-25. doi: 10.1192/bjp.bp.109.069617.

Cost-effectiveness of a stepped care intervention to prevent depression and anxiety in late life: randomised trial.

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  • 1Department of General Practice, Institute for Research in Extramural Medicine, VU Medical Centre, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands. pj.vantveer@vumc.nl



There is an urgent need for the development of cost-effective preventive strategies to reduce the onset of mental disorders.


To establish the cost-effectiveness of a stepped care preventive intervention for depression and anxiety disorders in older people at high risk of these conditions, compared with routine primary care.


An economic evaluation was conducted alongside a pragmatic randomised controlled trial (ISRCTN26474556). Consenting individuals presenting with subthreshold levels of depressive or anxiety symptoms were randomly assigned to a preventive stepped care programme (n = 86) or to routine primary care (n = 84).


The intervention was successful in halving the incidence rate of depression and anxiety at euro563 ( pound412) per recipient and euro4367 ( pound3196) per disorder-free year gained, compared with routine primary care. The latter would represent good value for money if the willingness to pay for a disorder-free year is at least euro5000.


The prevention programme generated depression- and anxiety-free survival years in the older population at affordable cost.

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