Cost-effectiveness of collaborative care for the treatment of major depressive disorder in primary care. A systematic review.
BACKGROUND
The effectiveness of collaborative care for patients with major depressive disorder in primary care has been established. Assessing its cost-effectiveness is important for deciding on implementation. This review therefore evaluates the cost-effectiveness of collaborative care for major depressive disorder in primary care.


METHODS
A systematic search on economic evaluations of collaborative care was conducted in Pubmed and PsychInfo. Quality of the studies was measured with the Cochrane checklist and the CHEC-list for economic evaluations. Cost-effectiveness and costs per depression-free days were reported.


RESULTS
8 studies were found, involving 4868 patients. The quality of the cost effectiveness studies, according to the CHEC-list, could be improved. Generally, the studies did not include all relevant costs and did not perform sensitivity analysis. Only 4 out of 8 studies reported cost per QALY, 6 out of 8 reported costs per depression-free days. The highest costs per QALY reported were $49,500, the highest costs per depression-free day were $24.


CONCLUSIONS
Although studies did not fulfil all criteria of the CHEC-list, collaborative care is a promising intervention and it may be cost-effective. However, to conclude on the cost-effectiveness, depression research should follow economic guidelines to improve the quality of the economic evaluations.
van Steenbergen-Weijenburg
Kirsten M
KM
Netherlands Institute for Mental Health and Addiction (Trimbos-Institute), Utrecht, The Netherlands. Ksteenbergen@trimbos.nl
van der Feltz-Cornelis
Christina M
CM
Horn
Eva K
EK
van Marwijk
Harm W J
HW
Beekman
Aartjan T F
AT
Rutten
Frans F H
FF
Hakkaart-van Roijen
Leona
L
D000328:Adult; D000368:Aged; D003299:Cooperative Behavior; D003362:Cost-Benefit Analysis; D003865:Major Depressive Disorder / Q000628:therapy*; D017048:Health Care Costs; D006801:Humans; D008875:Middle Aged; D011320:Primary Health Care / Q000191:economics* / Q000458:organization & administration; D019057:Quality-Adjusted Life Years