Cost-effectiveness of a stepped care intervention to prevent depression and anxiety in late life: randomised trial.
BACKGROUND
There is an urgent need for the development of cost-effective preventive strategies to reduce the onset of mental disorders.


OBJECTIVE
To 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.


METHODS
An 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).


RESULTS
The intervention was successful in halving the incidence rate of depression and anxiety at euro563 ( pound412) per recipient and euro4367 ( pound3196) 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 euro5000.


CONCLUSIONS
The prevention programme generated depression- and anxiety-free survival years in the older population at affordable cost.
Van't Veer-Tazelaar
Petronella
P
Department of General Practice, Institute for Research in Extramural Medicine, VU Medical Centre, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands. pj.vantveer@vumc.nl
Smit
Filip
F
van Hout
Hein
H
van Oppen
Patricia
P
van der Horst
Henriette
H
Beekman
Aartjan
A
van Marwijk
Harm
H
D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000191:economics / Q000517:prevention & control*; D003156:Community Mental Health Services / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D003866:Depressive Disorder / Q000191:economics / Q000517:prevention & control*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009426:Netherlands; D010342:Patient Acceptance of Health Care; D011320:Primary Health Care / Q000191:economics / Q000379:methods; D011569:Psychiatric Status Rating Scales; D012680:Sensitivity and Specificity; D016896:Treatment Outcome