title: Cost-effectiveness of life-review for older adults with moderate depressive symptomatology: A pragmatic randomized controlled trial.
abstract: OBJECTIVE
  Life-review has been established as an evidence-based treatment of depression in later life. This study investigates the cost-effectiveness of life-review compared to care-as-usual.
  
  
  METHODS
  An economic evaluation alongside a randomized controlled trial was carried out, comparing life-review (n=100) to care-as-usual (n=102). Individuals of 55 years and over, with moderate depressive symptomatology, were included. Treatment response was defined as a statistically reliable reduction of depressive symptoms on the Center for Epidemiologic Studies Depression scale. Total per-participant costs encompassed intervention costs, costs of receiving other treatments, participants' out-of-pocket expenses, and costs stemming from production losses, and were expressed in (2009) euros (€).
  
  
  RESULTS
  At 6-month follow-up, treatment response was 54.0% and 27.5% in the life-review and usual-care conditions, respectively. The difference in effectiveness was statistically significant at p=.001 (2-tailed). In the respective conditions the costs were €5550 and €3162, with the higher costs in the intervention arm of the trial. The incremental cost-effectiveness was €8675 (US$10,227) per improved participant.
  
  
  CONCLUSIONS
  The findings suggest that offering life-review rather than care-as-usual almost doubles the likelihood of a favorable outcome. However, the better clinical outcomes are achieved at greater costs. The conclusion that life-review offers good value for money is sensitive to the willingness to pay for a favorable treatment response. It is recommended that life-review is delivered by a single therapist and in larger groups as this may improve the cost-effectiveness of this intervention.
authors.affiliation: University of Twente, Faculty of Behavioral Sciences, P.O. Box 217, 7500 AE Enschede, The Netherlands. Electronic address: j.korte@utwente.nl.
authors.forename: Jojanneke
authors.initials: J
authors.lastname: Korte
authors.affiliation: Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Centre of Prevention and Early Intervention, P.O. Box 725, 3500 AS Utrecht, The Netherlands. Electronic address: cmajo@trimbos.nl.
authors.forename: M
authors.initials: M
authors.lastname: Cristina Majo
authors.affiliation: University of Twente, Faculty of Behavioral Sciences, P.O. Box 217, 7500 AE Enschede, The Netherlands. Electronic address: e.t.bohlmeijer@utwente.nl.
authors.forename: Ernst T
authors.initials: ET
authors.lastname: Bohlmeijer
authors.affiliation: University of Twente, Faculty of Behavioral Sciences, P.O. Box 217, 7500 AE Enschede, The Netherlands. Electronic address: g.j.westerhof@utwente.nl.
authors.forename: Gerben J
authors.initials: GJ
authors.lastname: Westerhof
authors.affiliation: Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Centre of Prevention and Early Intervention, P.O. Box 725, 3500 AS Utrecht, The Netherlands; EMGO(+) Institute for Health and Health Care Research, VU University Medical Centre, Department of Epidemiology and Biostatistics, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands. Electronic address: fsmit@trimbos.nl.
authors.forename: Filip
authors.initials: F
authors.lastname: Smit
mesh_terms: D000368:Aged; D003863:Depression / Q000191:economics* / Q000628:therapy; D005260:Female; D006801:Humans; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D062525:Narrative Therapy / Q000191:economics* / Q000379:methods; D009426:Netherlands; D016896:Treatment Outcome
keywords: Depression; Early intervention; Economic evaluation; Life-review; Prevention