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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.



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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