Economic evaluation of stepped-care versus usual care for depression and anxiety in older adults with vision impairment: randomized controlled trial

BMC Psychiatry

Research Article

Judith E. Bosmans¹  Ruth M. A. van Nispen²  Hilde P. A. van der Aa²  Ger H. M. B. van Rens³  Hannie C. Comijs⁴ 

[1] Department of Health Sciences and the Amsterdam Public Health Research Institute, Faculty of Earth and Life Sciences, VU University Amsterdam, De Boelelaan 1105, 1081, Amsterdam, HV, The Netherlands;Department of Ophthalmology and the Amsterdam Public Health Research Institute, VU University Medical Centre, De Boelelaan 1117, 1081, Amsterdam, HV, The Netherlands;Department of Ophthalmology and the Amsterdam Public Health Research Institute, VU University Medical Centre, De Boelelaan 1117, 1081, Amsterdam, HV, The Netherlands;Department of Ophthalmology, Elkerliek Hospital, Wesselmanlaan 25, 5707, Helmond, HA, The Netherlands;Department of Psychiatry VUmc/GGZinGeest, A.J.Ernststraat 1187, 1081, Amsterdam, HL, The Netherlands;

关键词: Depression;    Anxiety;    Vision impairment;    Stepped-care;    Cost-effectiveness;    Cost-utility;    Economic evaluation;   

DOI  :  10.1186/s12888-017-1437-5

 received in 2016-12-06, accepted in 2017-07-20,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundA stepped-care program was found effective in preventing depressive and anxiety disorders in older adults with vision impairment. However, before a decision can be made about implementation, the cost-effectiveness of this program should be investigated. Therefore, we aimed to compare the cost-effectiveness of stepped-care versus usual care within low vision rehabilitation.MethodsAn economic evaluation from a societal perspective was performed alongside a multicenter randomized controlled trial. Data were collected by masked assessors during 24 months. Included were 265 older adults with vision impairment and subthreshold depression and/or anxiety. They were randomly assigned to stepped-care plus usual care (n = 131) or usual care alone (n = 134). Stepped-care comprised 1) watchful waiting, 2) guided self-help based on cognitive behavioral therapy, 3) problem solving treatment, and 4) referral to a general practitioner. Costs were based on direct healthcare costs and indirect non-healthcare costs. Main outcome measures were quality-adjusted life years (QALYs) and the cumulative incidence of major depressive, dysthymic and/or anxiety disorders. Secondary outcomes were symptoms of depression and anxiety.ResultsBased on intention-to-treat, significant differences were found in the incidence of depressive/anxiety disorders (mean difference 0.17; 95% CI 0.06 to 0.29) and symptoms of anxiety (mean difference 1.43, 95% CI 0.10 to 2.77) in favor of stepped-care versus usual care; no significant difference was found for QALYs and symptoms of depression. Societal costs were non-significantly lower in the stepped-care group compared with the usual care group (mean difference: -€877; 95% confidence interval (CI): −8039 to 5489). Cost-effectiveness acceptability curves showed that the probability of cost-effectiveness was 95% or more at a willingness-to-pay of €33,000 per disorder prevented. The probability that stepped-care was cost-effective compared to usual care was 59% or more for a ceiling ratio of 0 €/QALY and increased to 65% at 20000 €/QALY.ConclusionsThis economic evaluation shows that stepped-care is dominant to usual care, with a probability of around 60%, due to its clinical superiority and its modest cost savings. However, it depends on the willingness-to-pay of decision makers whether or not stepped-care is considered cost-effective compared with usual care.Trial registrationidentifier: NTR3296,date: 13–02-2012.

【 授权许可】

CC BY   
© The Author(s). 2017