The costs of guideline-concordant care and of care according to patients' needs in anxiety and depression.
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.
Prins
Marijn
M
NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands. m.prins@nivel.nl
Bosmans
Judith
J
Verhaak
Peter
P
van der Meer
Klaas
K
van Tulder
Maurits
M
van Marwijk
Harm
H
Laurant
Miranda
M
Smolders
Mirrian
M
Penninx
Brenda
B
Bensing
Jozien
J
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