Cost-effectiveness of problem-solving treatment in comparison with usual care for primary care patients with mental health problems: a randomized trial.
BACKGROUND
Mental health problems are common and are associated with increased disability and health care costs. Problem-Solving Treatment (PST) delivered to these patients by nurses in primary care might be efficient. The aim of this study was to evaluate the cost-effectiveness of PST by mental health nurses compared with usual care (UC) by the general practitioner for primary care patients with mental health problems.


METHODS
An economic evaluation from a societal perspective was performed alongside a randomized clinical trial. Patients with a positive General Health Questionnaire score (score ≥ 4) and who visited their general practitioner at least three times during the past 6 months were eligible. Outcome measures were improvement on the Hospital Anxiety and Depression Scale and QALYs based on the EQ-5D. Resource use was measured using a validated questionnaire. Missing cost and effect data were imputed using multiple imputation techniques. Bootstrapping was used to analyze costs and cost-effectiveness of PST compared with UC.


RESULTS
There were no statistically significant differences in clinical outcomes at 9 months. Mean total costs were €4795 in the PST group and €6857 in the UC group. Costs were not statistically significantly different between the two groups (95% CI -4698;359). The cost-effectiveness analysis showed that PST was cost-effective in comparison with UC. Sensitivity analyses confirmed these findings.


CONCLUSIONS
PST delivered by nurses seems cost-effective in comparison with UC. However, these results should be interpreted with caution, since the difference in total costs was mainly caused by 3 outliers with extremely high indirect costs in the UC group.


BACKGROUND
Nederlands Trial Register ISRCTN51021015.
Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, The Netherlands. j.e.bosmans@vu.nl
Judith E
JE
Bosmans
Bettine
B
Schreuders
Harm W J
HW
van Marwijk
Jan H
JH
Smit
Patricia
P
van Oppen
Maurits W
MW
van Tulder
D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D003863:Depression / Q000191:economics / Q000451:nursing*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D057184:Practice Patterns, Nurses' / Q000191:economics; D011320:Primary Health Care / Q000191:economics* / Q000379:methods; D011340:Problem Solving; D011614:Psychotherapy, Brief / Q000191:economics* / Q000379:methods; D019057:Quality-Adjusted Life Years