title: Cost-effectiveness analysis of a collaborative care programme for depression in primary care.
abstract: BACKGROUND
  Collaborative care programmes lead to better outcomes in the management of depression. A programme of this nature has demonstrated its effectiveness in primary care in Spain. Our objective was to evaluate the cost-effectiveness of this programme compared to usual care.
  
  
  METHODS
  A bottom-up cost-effectiveness analysis was conducted within a randomized controlled trial (2007-2010). The intervention consisted of a collaborative care programme with clinical, educational and organizational procedures. Outcomes were monitored over a 12 months period. Primary outcomes were incremental cost-effectiveness ratios (ICER): mean differences in costs divided by quality-adjusted life years (QALY) and mean differences in costs divided by depression-free days (DFD). Analyses were performed from a healthcare system perspective (considering healthcare costs) and from a society perspective (including healthcare costs plus loss of productivity costs).
  
  
  RESULTS
  Three hundred and thirty-eight adult patients with major depression were assessed at baseline. Only patients with complete data were included in the primary analysis (166 in the intervention group and 126 in the control group). From a healthcare perspective, the average incremental cost of the programme compared to usual care was €182.53 (p<0.001). Incremental effectiveness was 0.045 QALY (p=0.017) and 40.09 DFD (p=0.011). ICERs were €4,056/QALY and €4.55/DFD. These estimates and their uncertainty are graphically represented in the cost-effectiveness plane.
  
  
  CONCLUSIONS
  The amount of 13.6% of patients with incomplete data may have introduced a bias. Available data about non-healthcare costs were limited, although they may represent most of the total cost of depression.
  
  
  CONCLUSIONS
  The intervention yields better outcomes than usual care with a modest increase in costs, resulting in favourable ICERs. This supports the recommendation for its implementation.
authors.affiliation: Tarragona-Reus Primary Care Area, Catalan Health Institute, Spain; IDIAP (Primary Care Research Institute) Jordi Gol, Barcelona, Spain. Electronic address: earagones.tarte.ics@gencat.cat.
authors.forename: Enric
authors.initials: E
authors.lastname: Aragonès
authors.affiliation: Tarragona-Reus Primary Care Area, Catalan Health Institute, Spain; IDIAP (Primary Care Research Institute) Jordi Gol, Barcelona, Spain.
authors.forename: Germán
authors.initials: G
authors.lastname: López-Cortacans
authors.affiliation: Department of Economics, Public University of Navarra, Pamplona, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Sánchez-Iriso
authors.affiliation: Tarragona-Reus Primary Care Area, Catalan Health Institute, Spain; IDIAP (Primary Care Research Institute) Jordi Gol, Barcelona, Spain.
authors.forename: Josep-Lluís
authors.initials: JL
authors.lastname: Piñol
authors.affiliation: Tarragona-Reus Primary Care Area, Catalan Health Institute, Spain; IDIAP (Primary Care Research Institute) Jordi Gol, Barcelona, Spain.
authors.forename: Antonia
authors.initials: A
authors.lastname: Caballero
authors.affiliation: Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Australia.
authors.forename: Luis
authors.initials: L
authors.lastname: Salvador-Carulla
authors.affiliation: Department of Economics, Public University of Navarra, Pamplona, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Cabasés
mesh_terms: D000328:Adult; D003299:Cooperative Behavior; D003362:Cost-Benefit Analysis; D003863:Depression / Q000191:economics* / Q000628:therapy*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000191:economics* / Q000379:methods*; D015397:Program Evaluation; D019057:Quality-Adjusted Life Years; D013030:Spain; D016896:Treatment Outcome
keywords: Controlled clinical trial; Cost-effectiveness; Depression; Disease management; Primary health care