title: Cost-effectiveness of a stepped care intervention to prevent depression and anxiety in late life: randomised trial.
abstract: 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.
authors.affiliation: 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
authors.forename: Petronella
authors.initials: P
authors.lastname: Van't Veer-Tazelaar
authors.forename: Filip
authors.initials: F
authors.lastname: Smit
authors.forename: Hein
authors.initials: H
authors.lastname: van Hout
authors.forename: Patricia
authors.initials: P
authors.lastname: van Oppen
authors.forename: Henriette
authors.initials: H
authors.lastname: van der Horst
authors.forename: Aartjan
authors.initials: A
authors.lastname: Beekman
authors.forename: Harm
authors.initials: H
authors.lastname: van Marwijk
mesh_terms: 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