title: Cost-effectiveness of collaborative care for depression in UK primary care: economic evaluation of a randomised controlled trial (CADET).
abstract: BACKGROUND
  Collaborative care is an effective treatment for the management of depression but evidence on its cost-effectiveness in the UK is lacking.
  
  
  OBJECTIVE
  To assess the cost-effectiveness of collaborative care in a UK primary care setting.
  
  
  METHODS
  An economic evaluation alongside a multi-centre cluster randomised controlled trial comparing collaborative care with usual primary care for adults with depression (n = 581). Costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICER) were calculated over a 12-month follow-up, from the perspective of the UK National Health Service and Personal Social Services (i.e. Third Party Payer). Sensitivity analyses are reported, and uncertainty is presented using the cost-effectiveness acceptability curve (CEAC) and the cost-effectiveness plane.
  
  
  RESULTS
  The collaborative care intervention had a mean cost of £272.50 per participant. Health and social care service use, excluding collaborative care, indicated a similar profile of resource use between collaborative care and usual care participants. Collaborative care offered a mean incremental gain of 0.02 (95% CI: -0.02, 0.06) quality-adjusted life-years over 12 months, at a mean incremental cost of £270.72 (95% CI: -202.98, 886.04), and resulted in an estimated mean cost per QALY of £14,248. Where costs associated with informal care are considered in sensitivity analyses collaborative care is expected to be less costly and more effective, thereby dominating treatment as usual.
  
  
  CONCLUSIONS
  Collaborative care offers health gains at a relatively low cost, and is cost-effective compared with usual care against a decision-maker willingness to pay threshold of £20,000 per QALY gained. Results here support the commissioning of collaborative care in a UK primary care setting.
authors.affiliation: University of Exeter Medical School, University of Exeter, Exeter, United Kingdom.
authors.forename: Colin
authors.initials: C
authors.lastname: Green
authors.affiliation: University of Exeter Medical School, University of Exeter, Exeter, United Kingdom.
authors.forename: David A
authors.initials: DA
authors.lastname: Richards
authors.affiliation: Mood Disorders Centre, University of Exeter, Exeter, United Kingdom.
authors.forename: Jacqueline J
authors.initials: JJ
authors.lastname: Hill
authors.affiliation: Centre for Primary Care at the Institute of Population Health, University of Manchester, Manchester, United Kingdom.
authors.forename: Linda
authors.initials: L
authors.lastname: Gask
authors.affiliation: School of Nursing, Midwifery, and Social Work, University of Manchester, Manchester, United Kingdom.
authors.forename: Karina
authors.initials: K
authors.lastname: Lovell
authors.affiliation: Primary Care and Health Sciences, Keele University, Keele, United Kingdom.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Chew-Graham
authors.affiliation: Centre for Primary Care at the Institute of Population Health, University of Manchester, Manchester, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Bower
authors.affiliation: Research Department of Clinical, Educational, and Health Psychology, University College London, London, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: Cape
authors.affiliation: Research Department of Clinical, Educational, and Health Psychology, University College London, London, United Kingdom.
authors.forename: Stephen
authors.initials: S
authors.lastname: Pilling
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Araya
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Kessler
authors.affiliation: Department of Health Sciences, University of York, York, United Kingdom.
authors.forename: J Martin
authors.initials: JM
authors.lastname: Bland
authors.affiliation: Department of Health Sciences at Hull York Medical School, University of York, York, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Gilbody
authors.affiliation: Mental Health Sciences Unit, University College London, London, United Kingdom.
authors.forename: Glyn
authors.initials: G
authors.lastname: Lewis
authors.affiliation: Upstream Healthcare, Teddington, United Kingdom.
authors.forename: Chris
authors.initials: C
authors.lastname: Manning
authors.affiliation: Centre for Primary Care at the Institute of Population Health, University of Manchester, Manchester, United Kingdom.
authors.forename: Adwoa
authors.initials: A
authors.lastname: Hughes-Morley
authors.affiliation: Department of Psychology, University of Sheffield, Sheffield, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Barkham
mesh_terms: D000328:Adult; D003299:Cooperative Behavior; D003362:Cost-Benefit Analysis / Q000379:methods; D003863:Depression / Q000191:economics*; D005260:Female; D006801:Humans; D008297:Male; D011320:Primary Health Care / Q000191:economics*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome; D006113:United Kingdom