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BMC Fam Pract. 2012 Oct 10;13:98. doi: 10.1186/1471-2296-13-98.

Cost-effectiveness of problem-solving treatment in comparison with usual care for primary care patients with mental health problems: a randomized trial.

Author information

1
Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, The Netherlands. j.e.bosmans@vu.nl

Abstract

BACKGROUND:

Mental health problems are common and are associated with increased disability and health care costs. Problem-Solving Treatment (PST) delivered to these patients by nurses in primary care might be efficient. The aim of this study was to evaluate the cost-effectiveness of PST by mental health nurses compared with usual care (UC) by the general practitioner for primary care patients with mental health problems.

METHODS:

An economic evaluation from a societal perspective was performed alongside a randomized clinical trial. Patients with a positive General Health Questionnaire score (score ≥ 4) and who visited their general practitioner at least three times during the past 6 months were eligible. Outcome measures were improvement on the Hospital Anxiety and Depression Scale and QALYs based on the EQ-5D. Resource use was measured using a validated questionnaire. Missing cost and effect data were imputed using multiple imputation techniques. Bootstrapping was used to analyze costs and cost-effectiveness of PST compared with UC.

RESULTS:

There were no statistically significant differences in clinical outcomes at 9 months. Mean total costs were €4795 in the PST group and €6857 in the UC group. Costs were not statistically significantly different between the two groups (95% CI -4698;359). The cost-effectiveness analysis showed that PST was cost-effective in comparison with UC. Sensitivity analyses confirmed these findings.

CONCLUSIONS:

PST delivered by nurses seems cost-effective in comparison with UC. However, these results should be interpreted with caution, since the difference in total costs was mainly caused by 3 outliers with extremely high indirect costs in the UC group.

TRIAL REGISTRATION:

Nederlands Trial Register ISRCTN51021015.

PMID:
23052105
PMCID:
PMC3515338
DOI:
10.1186/1471-2296-13-98
[Indexed for MEDLINE]
Free PMC Article

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