Economic evaluation of a minimal psychological intervention in chronically ill elderly patients with minor or mild to moderate depression: a randomized trial (the DELTA-study).
OBJECTIVE
Depression is associated with high healthcare utilization and related costs. Effective treatments might reduce the economic burden. The objective of this study was to establish the cost-utility of a minimal psychological intervention (MPI) aimed at reducing depression and improving quality of life in elderly persons with diabetes or chronic obstructive pulmonary disease and co-occurring minor, mild, or moderate depression.


METHODS
Trial-based cost-utility analysis was used to compare the MPI with usual care. Annual costs and quality-adjusted life-years (QALYs) based on the Euroqol (EQ5D) and on depression-free days were calculated.


RESULTS
Annual costs and effects were not significantly different for the MPI group and care as usual. Bootstrap analysis indicated a dominant intervention, with a probability of 63 percent that the MPI is less costly and more effective than usual care.


CONCLUSIONS
The cost-effectiveness analysis does not support dissemination of the MPI in its current form. The economic evaluation study showed limited probability that MPI is cost-effective over usual care. Further adjustments to the MPI are needed to make the intervention suitable for dissemination in regular care.


BACKGROUND
isrctn.org, identifier: ISRCTN92331982.
Jonkers
Catharina C M
CC
School for Public Health and Primary Care (Caphri), Department of Social Medicine, Maastricht University, Maastricht, The Netherlands. jonkers@zonmw.nl
Lamers
Femke
F
Evers
Silvia M A A
SM
Bosma
Hans
H
Metsemakers
Job F
JF
Van Eijk
Jacques Th M
JT
D000368:Aged; D001521:Behavior Therapy / Q000191:economics* / Q000379:methods*; D003362:Cost-Benefit Analysis; D003863:Depression / Q000628:therapy*; D003920:Diabetes Mellitus / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000523:psychology*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years