title: The costs of guideline-concordant care and of care according to patients' needs in anxiety and depression.
abstract: OBJECTIVE
  To describe the direct and indirect costs for people with anxiety and depressive disorders where guidelines are adhered to and patients' perceived needs are fully met.
  
  
  METHODS
  Data were derived from the Netherlands Study of Depression and Anxiety. At baseline, adult patients were interviewed and they completed questionnaires to measure DSM-IV diagnoses, socio-demographic characteristics and perceived need for care. Actual care data were also derived from electronic medical records. Criteria for guideline adherence were based on general practice guidelines, issued by the Dutch College of General Practitioners. Direct and indirect costs were inferred from the Perceived Need for Care Questionnaire administered at baseline, and the Trimbos and iMTA questionnaire on Costs associated with Psychiatric illness administered at 1-year follow-up.
  
  
  RESULTS
  For 568 patients with a current anxiety or depressive disorder a complete dataset on health care use and absenteeism was available. Guideline adherence was significantly associated with increased care use and corresponding costs, while fully met perceived need was unrelated to costs. Socio-demographic characteristics, severity of symptoms and guideline adherence all affected the societal costs of patients with fully met perceived needs compared with patients with perceived unmet needs.
  
  
  CONCLUSIONS
  It appears that guideline-concordant care for anxiety and depression costs more than non-concordant care, while care that has fulfilled all of a patient's needs seems not to be more expensive than care that has not met all perceived needs. However, randomized controlled trials should first confirm this conclusion.
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands. m.prins@nivel.nl
authors.forename: Marijn
authors.initials: M
authors.lastname: Prins
authors.forename: Judith
authors.initials: J
authors.lastname: Bosmans
authors.forename: Peter
authors.initials: P
authors.lastname: Verhaak
authors.forename: Klaas
authors.initials: K
authors.lastname: van der Meer
authors.forename: Maurits
authors.initials: M
authors.lastname: van Tulder
authors.forename: Harm
authors.initials: H
authors.lastname: van Marwijk
authors.forename: Miranda
authors.initials: M
authors.lastname: Laurant
authors.forename: Mirrian
authors.initials: M
authors.lastname: Smolders
authors.forename: Brenda
authors.initials: B
authors.lastname: Penninx
authors.forename: Jozien
authors.initials: J
authors.lastname: Bensing
mesh_terms: D000328:Adult; D001007:Anxiety / Q000628:therapy; D003365:Costs and Cost Analysis / Q000379:methods; D003863:Depression / Q000628:therapy; D039721:Diagnostic and Statistical Manual of Mental Disorders; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence / Q000191:economics*; D006296:Health Services / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D018802:Patient-Centered Care; D017410:Practice Guidelines as Topic; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D055815:Young Adult