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PLoS One. 2015 May 19;10(5):e0123078. doi: 10.1371/journal.pone.0123078. eCollection 2015.

Cost-effectiveness of collaborative care for the treatment of depressive disorders in primary care: a systematic review.

Author information

1
Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
2
Clinical Psychology and Psychotherapy Research, Institute of Psychology, University of Zurich, Zurich, Switzerland.
3
Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany.
4
Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Abstract

BACKGROUND:

For the treatment of depressive disorders, the framework of collaborative care has been recommended, which showed improved outcomes in the primary care sector. Yet, an earlier literature review did not find sufficient evidence to draw robust conclusions on the cost-effectiveness of collaborative care.

PURPOSE:

To systematically review studies on the cost-effectiveness of collaborative care, compared with usual care for the treatment of patients with depressive disorders in primary care.

METHODS:

A systematic literature search in major databases was conducted. Risk of bias was assessed using the Cochrane Collaboration's tool. Methodological quality of the articles was assessed using the Consensus on Health Economic Criteria (CHEC) list. To ensure comparability across studies, cost data were inflated to the year 2012 using country-specific gross domestic product inflation rates, and were adjusted to international dollars using purchasing power parities (PPP).

RESULTS:

In total, 19 cost-effectiveness analyses were reviewed. The included studies had sample sizes between n = 65 to n = 1,801, and time horizons between six to 24 months. Between 42% and 89% of the CHEC quality criteria were fulfilled, and in only one study no risk of bias was identified. A societal perspective was used by five studies. Incremental costs per depression-free day ranged from dominance to US$PPP 64.89, and incremental costs per QALY from dominance to US$PPP 874,562.

CONCLUSION:

Despite our review improved the comparability of study results, cost-effectiveness of collaborative care compared with usual care for the treatment of patients with depressive disorders in primary care is ambiguous depending on willingness to pay. A still considerable uncertainty, due to inconsistent methodological quality and results among included studies, suggests further cost-effectiveness analyses using QALYs as effect measures and a time horizon of at least 1 year.

PMID:
25993034
PMCID:
PMC4437997
DOI:
10.1371/journal.pone.0123078
[Indexed for MEDLINE]
Free PMC Article

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