title: Cost-effectiveness of opportunistic screening and minimal contact psychotherapy to prevent depression in primary care patients.
abstract: BACKGROUND
  Depression causes a large burden of disease worldwide. Effective prevention has the potential to reduce that burden considerably. This study aimed to investigate the cost-effectiveness of minimal contact psychotherapy, based on Lewinsohn's 'Coping with depression' course, targeted at opportunistically screened individuals with sub-threshold depression.
  
  
  RESULTS
  Using a Markov model, future health effects and costs of an intervention scenario and a current practice scenario were estimated. The time horizon was five years. Incremental cost-effectiveness ratios were expressed in euro per Disability Adjusted Life Year (DALY) averted. Probabilistic sensitivity analysis was employed to study the effect of uncertainty in the model parameters. From the health care perspective the incremental cost-effectiveness ratio was € 1,400 per DALY, and from the societal perspective the intervention was cost-saving. Although the estimated incremental costs and effects were surrounded with large uncertainty, given a willingness to pay of € 20,000 per DALY, the probability that the intervention is cost-effective was around 80%.
  
  
  CONCLUSIONS
  This modelling study showed that opportunistic screening in primary care for sub-threshold depression in combination with minimal contact psychotherapy may be cost-effective in the prevention of major depression.
authors.affiliation: Centre for Public Health Forecasting, National Institute of Public Health and the Environment, Bilthoven, The Netherlands. matthijs.van.den.berg@rivm.nl
authors.forename: Matthijs
authors.initials: M
authors.lastname: van den Berg
authors.forename: Filip
authors.initials: F
authors.lastname: Smit
authors.forename: Theo
authors.initials: T
authors.lastname: Vos
authors.forename: Pieter H M
authors.initials: PH
authors.lastname: van Baal
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics; D003863:Depression / Q000191:economics* / Q000517:prevention & control*; D006801:Humans; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D015233:Models, Statistical; D011320:Primary Health Care / Q000191:economics*; D011336:Probability; D011613:Psychotherapy / Q000191:economics*; D019057:Quality-Adjusted Life Years; D055815:Young Adult