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J Affect Disord. 2010 Jan;120(1-3):177-87. doi: 10.1016/j.jad.2009.04.012.

Cost-effectiveness of a minimal intervention for stress-related sick leave in general practice: results of an economic evaluation alongside a pragmatic randomised control trial.

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EMGO Institute-VU University Medical Center, Amsterdam, The Netherlands.



Stress-related mental health problems negatively impact quality of life and productivity. Worldwide, treatment is often sought in primary care. Our objective was to determine whether a general practitioner-based minimal intervention for workers with stress-related sick leave (MISS) was cost-effective compared to usual care (UC).


We conducted an economic evaluation from a societal perspective. Quality-adjusted life years (QALYs) and resource use were measured by the EuroQol and cost diaries, respectively. Uncertainty was estimated by 95% confidence intervals, cost-effectiveness planes and acceptability curves. Sensitivity analyses and ancillary analyses based on preplanned subgroups were performed.


No statistically significant differences in costs or QALYs were observed. The mean incremental cost per QALY was -euro 7356 and located in the southeast quadrant of the cost-effectiveness plane, whereby the intervention was slightly more effective and less costly. For willingness-to-pay (lambda) thresholds from euro 0 to euro 100,000, the probability of MISS being cost-effective was 0.58-0.90. For the preplanned subgroup of patients diagnosed with stress-related mental disorders, the incremental ratio was -euro 28,278, again in the southeast quadrant. Corresponding probabilities were 0.92 or greater.


Non-significant findings may be related to poor implementation of the MISS intervention and low power. Also, work-presenteeism and unpaid labor were not measured.


The minimal intervention was not cost-effective compared to usual care for a heterogeneous patient population. Therefore, we do not recommend widespread implementation. However, the intervention may be cost-effective for the subgroup stress-related mental disorders. This finding should be confirmed before implementation for this subgroup is considered.

[Indexed for MEDLINE]

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