Cost-effectiveness of a preventive counseling and support package for postnatal depression

2006 ◽  
Vol 22 (4) ◽  
pp. 443-453 ◽  
Author(s):  
Stavros Petrou ◽  
Peter Cooper ◽  
Lynne Murray ◽  
Leslie L. Davidson
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
High Risk ◽  
Willingness To Pay ◽  
Postnatal Depression ◽  
Preventive Intervention ◽  
Intervention Group ◽  
Care Group ◽  
Net Benefit ◽  
Health And Social Care

Objectives: This study reports the cost-effectiveness of a preventive intervention, consisting of counseling and specific support for the mother–infant relationship, targeted at women at high risk of developing postnatal depression.Methods: A prospective economic evaluation was conducted alongside a pragmatic randomized controlled trial in which women considered at high risk of developing postnatal depression were allocated randomly to the preventive intervention (n = 74) or to routine primary care (n = 77). The primary outcome measure was the duration of postnatal depression experienced during the first 18 months postpartum. Data on health and social care use by women and their infants up to 18 months postpartum were collected, using a combination of prospective diaries and face-to-face interviews, and then were combined with unit costs (£, year 2000 prices) to obtain a net cost per mother–infant dyad. The nonparametric bootstrap method was used to present cost-effectiveness acceptability curves and net benefit statistics at alternative willingness to pay thresholds held by decision makers for preventing 1 month of postnatal depression.Results: Women in the preventive intervention group were depressed for an average of 2.21 months (9.57 weeks) during the study period, whereas women in the routine primary care group were depressed for an average of 2.70 months (11.71 weeks). The mean health and social care costs were estimated at £2,396.9 per mother–infant dyad in the preventive intervention group and £2,277.5 per mother–infant dyad in the routine primary care group, providing a mean cost difference of £119.5 (bootstrap 95 percent confidence interval [CI], −535.4, 784.9). At a willingness to pay threshold of £1,000 per month of postnatal depression avoided, the probability that the preventive intervention is cost-effective is .71 and the mean net benefit is £383.4 (bootstrap 95 percent CI, −£863.3–£1,581.5).Conclusions: The preventive intervention is likely to be cost-effective even at relatively low willingness to pay thresholds for preventing 1 month of postnatal depression during the first 18 months postpartum. Given the negative impact of postnatal depression on later child development, further research is required that investigates the longer-term cost-effectiveness of the preventive intervention in high risk women.

scholarly journals COST-EFFECTIVENESS ANALYSIS OF THE COLLABORATIVE STEPPED CARE INTERVENTION FOR LATE-LIFE DEPRESSION

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S876-S877
Author(s):  
Shiyu Lu ◽  
Gloria H Y Wong ◽  
Terry Lum ◽  
Tianyin Liu
Keyword(s):  
Cost Effectiveness ◽  
Intervention Group ◽  
Late Life ◽  
Community Dwelling ◽  
Stepped Care ◽  
Care Group ◽  
Care Utilization ◽  
Late Life Depression ◽  
Care Intervention ◽  
The Cost

Abstract Late-life depression is a burden on society because it is costly and have a significant adverse effect on the quality of life. The aim of this study is to evaluate the cost-effectiveness of the collaborative stepped care intervention for depression among community-dwelling older adults compared to care as usual from a societal perspective. The intervention was piloted from 2016-2019 in Hong Kong. The study used a two-armed quasi-experimental design. Eventually, 412 older people were included (314 collaborative stepped care, 98 care as usual). Baseline measures and 12-month follow-up measures were assessed using questionnaires. We applied the 5-level EQ-5D version (EQ-5D-5L) and the Client Service Receipt Inventory (CSRI) respectively measuring quality-adjusted life-year (QALY) and health care utilization. The average annual direct medical cost in the intervention group was USD 6,589 (95% C.I., 4,979 to 8,199) compared to US$ 6,167 (95% C.I., 3,702 to 8,631) in the care as usual group. The average QALYs gained was 0.036 higher in the collaborative stepped care group, leading to an incremental cost-effectiveness ratio (ICER) of US$ 11,722 per QALY, lower than the cost-effectiveness threshold suggested by The National Institute for Health and Clinical Excellence. The study showed that collaborative stepped care was a cost-effective intervention for late-life depression over service as usual.

scholarly journals Screening for postnatal depression in primary care: cost effectiveness analysis

BMJ ◽  
2009 ◽  
Vol 339 (dec22 1) ◽  
pp. b5203-b5203 ◽  
Author(s):  
M. Paulden ◽  
S. Palmer ◽  
C. Hewitt ◽  
S. Gilbody
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Postnatal Depression ◽  
Cost Effectiveness Analysis ◽  
Effectiveness Analysis

scholarly journals Cost-effectiveness of computerised cognitive-behavioural therapy for anxiety and depression in primary care: Randomised controlled trial

2004 ◽  
Vol 185 (1) ◽  
pp. 55-62 ◽  
Author(s):  
Paul McCrone ◽  
Martin Knapp ◽  
Judith Proudfoot ◽  
Clash Ryden ◽  
Kate Cavanagh ◽  
...  
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Cognitive Behavioural Therapy ◽  
Controlled Trial ◽  
Cost Effective ◽  
Behavioural Therapy ◽  
Quality Adjusted Life Year ◽  
Anxiety And Depression ◽  
Net Benefit ◽  
Cognitive Behavioural

BackgroundCognitive-behavioural therapy (CBT) is effective for treating anxiety and depression in primary care, but there is a shortage of therapists. Computer-delivered treatment may be a viable alternative.AimsTo assess the cost-effectiveness of computer-delivered CBT.MethodA sample of people with depression or anxiety were randomised to usual care (n= 128) or computer-delivered CBT (n= 146). Costs were available for 123 and 138 participants, respectively. Costs and depression scores were combined using the net benefit approach.ResultsService costs were £40 (90% CI-£28 to £148) higher over 8 months for computer-delivered CBT. Lost-employment costs were £407 (90% CI £196 to £586) less for this group. Valuing a 1-unit improvement on the Beck Depression Inventory at £40, there is an 81% chance that computer-delivered CBT is cost-effective, and it revealed a highly competitive cost per quality-adjusted life year.ConclusionsComputer-delivered CBT has a high probability of being cost-effective, even if a modest value is placed on unit improvements in depression.

scholarly journals Cost-effectiveness of a stepwise cardiometabolic disease prevention program: results of a randomized controlled trial in primary care

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Daphne M. Stol ◽  
Eelco A. B. Over ◽  
Ilse F. Badenbroek ◽  
Monika Hollander ◽  
Mark M. J. Nielen ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Primary Care ◽  
Cost Effectiveness ◽  
Prevention Program ◽  
Healthcare Costs ◽  
Controlled Trial ◽  
Intervention Group ◽  
Control Group

Abstract Background Cardiometabolic diseases (CMD) are the major cause of death worldwide and are associated with a lower quality of life and high healthcare costs. To prevent a further rise in CMD and related healthcare costs, early detection and adequate management of individuals at risk could be an effective preventive strategy. The objective of this study was to determine long-term cost-effectiveness of stepwise CMD risk assessment followed by individualized treatment if indicated compared to care as usual. A computer-based simulation model was used to project long-term health benefits and cost-effectiveness, assuming the prevention program was implemented in Dutch primary care. Methods A randomized controlled trial in a primary care setting in which 1934 participants aged 45–70 years without recorded CMD or CMD risk factors participated. The intervention group was invited for stepwise CMD risk assessment through a risk score (step 1), additional risk assessment at the practice in case of increased risk (step 2) and individualized follow-up treatment if indicated (step 3). The control group was not invited for risk assessment, but completed a health questionnaire. Results of the effectiveness analysis on systolic blood pressure (− 2.26 mmHg; 95% CI − 4.01: − 0.51) and total cholesterol (− 0.15 mmol/l; 95% CI − 0.23: − 0.07) were used in this analysis. Outcome measures were the costs and benefits after 1-year follow-up and long-term (60 years) cost-effectiveness of stepwise CMD risk assessment compared to no assessment. A computer-based simulation model was used that included data on disability weights associated with age and disease outcomes related to CMD. Analyses were performed taking a healthcare perspective. Results After 1 year, the average costs in the intervention group were 260 Euro higher than in the control group and differences were mainly driven by healthcare costs. No meaningful change was found in EQ 5D-based quality of life between the intervention and control groups after 1-year follow-up (− 0.0154; 95% CI − 0.029: 0.004). After 60 years, cumulative costs of the intervention were 41.4 million Euro and 135 quality-adjusted life years (QALY) were gained. Despite improvements in blood pressure and cholesterol, the intervention was not cost-effective (ICER of 306,000 Euro/QALY after 60 years). Scenario analyses did not allow for a change in conclusions with regard to cost-effectiveness of the intervention. Conclusions Implementation of this primary care-based CMD prevention program is not cost-effective in the long term. Implementation of this program in primary care cannot be recommended. Trial registration Dutch Trial Register NTR4277, registered on 26 November 2013

Reducing unplanned hospital admissions in Older people with high needs: a review of local practice in a small sample of primary care patients in an inner London borough.

2016 ◽  
Vol 6 (2) ◽  
pp. 108-118
Author(s):  
Harriet Selina Anne Sinclair ◽  
Alison Furey
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Older People ◽  
Social Care ◽  
Hospital Admissions ◽  
Health Check ◽  
Care Needs ◽  
Health And Social Care ◽  
Risk Patients ◽  
Unplanned Hospital Admissions

Background: Older people with complex health and social care needs are a growing group of people with high use of NHS and social services. In particular, this group account for a large number of unplanned hospital admissions a year.Aims: To evaluate the evidence base for preventing unplanned hospital admissions in this group, to identify their characteristics and to undertake a focussed local review of their primary care management.Methods: A literature review, a review of the Southwark CCG data risk stratification tool and a review of high risk patients and their management at a Southwark GP practice.Results: High risk patients have multiple comorbidities and are frequent users of healthcare services. Although there was in general good involvement with social care services, there were certain areas that could be improved upon. For instance, the referral of frequent fallers to falls services and provision of an older person’s annual health check both offer opportunities for primary prevention.Conclusions: An older person’s annual health check would ensure holistic assessment of their health and social care needs and could then be acted upon to ensure that there is the required level of support in place, including a personalised anticipatory care plan and attention to key preventative measures such as falls prevention, exercise, smoking cessation, medicines optimisation and sensory impairment.

scholarly journals Cost-effectiveness of a primary care model for anxiety disorders

2009 ◽  
Vol 195 (4) ◽  
pp. 308-317 ◽  
Author(s):  
Hans-Helmut König ◽  
Anja Born ◽  
Dirk Heider ◽  
Herbert Matschinger ◽  
Sven Heinrich ◽  
...  
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Anxiety Disorders ◽  
Controlled Trial ◽  
Intervention Group ◽  
Control Group ◽  
Service Utilisation ◽  
Care Model ◽  
Adequate Treatment

BackgroundIndividuals with anxiety disorders often do not receive an accurate diagnosis or adequate treatment in primary care.AimsTo analyse the cost-effectiveness of an optimised care model for people with anxiety disorders in primary care.MethodIn a cluster randomised controlled trial, 46 primary care practices with 389 individuals positively screened with anxiety were randomised to intervention (23 practices, 201 participants) or usual care (23 practices, 188 participants). Physicians in the intervention group received training on diagnosis and treatment of anxiety disorders combined with the offer of a psychiatric consultation–liaison service for 6 months. Anxiety, depression, quality of life, service utilisation and costs were assessed at baseline, 6-month and 9-month follow-up.ResultsResultsNo significant differences were observed between intervention and control group on the Beck Anxiety Inventory, Beck Depression Inventory and EQ–5D during follow-up. Total costs were higher in the intervention group (€4911 v. €3453, P = 0.09). The probability of an incremental cost-effectiveness ratio <€50 000 per quality-adjusted life year was below 10%.ConclusionsThe optimised care model did not prove to be cost-effective.

scholarly journals Cost-effectiveness of an early intervention service for people with psychosis

2010 ◽  
Vol 196 (5) ◽  
pp. 377-382 ◽  
Author(s):  
Paul McCrone ◽  
Tom K. J. Craig ◽  
Paddy Power ◽  
Philippa A. Garety
Keyword(s):  
Quality Of Life ◽  
Early Intervention ◽  
Cost Effectiveness ◽  
Standard Care ◽  
Intervention Group ◽  
Cost Effective ◽  
Care Group ◽  
Early Intervention Service ◽  
Intervention Service

BackgroundThere is concern that delaying treatment for psychosis may have a negative impact on its long-term course. A number of countries have developed early intervention teams but there is limited evidence regarding their cost-effectiveness.AimsTo compare the costs and cost-effectiveness of an early intervention service in London with standard care.MethodIndividuals in their first episode of psychosis (or those who had previously discontinued treatment) were recruited to the study. Clinical variables and costs were measured at baseline and then at 6- and 18-month follow-up. Information on quality of life and vocational outcomes were combined with costs to assess cost-effectiveness.ResultsA total of 144 people were randomised. Total mean costs were £11 685 in the early intervention group and £14 062 in the standard care group, with the difference not being significant (95% CI –£8128 to £3326). When costs were combined with improved vocational and quality of life outcomes it was shown that early intervention would have a very high likelihood of being cost-effective.ConclusionsEarly intervention did not increase costs and was highly likely to be cost-effective when compared with standard care.

scholarly journals Cost-effectiveness of a stepped care intervention to prevent depression and anxiety in late life: randomised trial

2010 ◽  
Vol 196 (4) ◽  
pp. 319-325 ◽  
Author(s):  
Petronella van't Veer-Tazelaar ◽  
Filip Smit ◽  
Hein van Hout ◽  
Patricia van Oppen ◽  
Henriette van der Horst ◽  
...  
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Preventive Intervention ◽  
Controlled Trial ◽  
Randomised Trial ◽  
Cost Effective ◽  
Stepped Care ◽  
Depression And Anxiety ◽  
Care Programme ◽  
Randomised Controlled

BackgroundThere is an urgent need for the development of cost-effective preventive strategies to reduce the onset of mental disorders.AimsTo 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.MethodAn 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).ResultsThe intervention was successful in halving the incidence rate of depression and anxiety at €563 (£412) per recipient and €4367 (£3196) 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 €5000.ConclusionsThe prevention programme generated depression- and anxiety-free survival years in the older population at affordable cost.

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