title: Cost-utility of collaborative care for major depressive disorder in primary care in the Netherlands.
abstract: OBJECTIVE
  Major depression is a great burden on society, as it is associated with high disability/costs. The aim of this study was to evaluate the cost-utility of Collaborative Care (CC) for major depressive disorder compared to Care As Usual (CAU) in a primary health care setting from a societal perspective.
  
  
  METHODS
  A cluster randomized controlled trial was conducted, including 93 patients that were identified by screening (45-CC, 48-CAU). Another 57 patients were identified by the GP (56-CC, 1-CAU). The outcome measures were TiC-P, SF-HQL and EQ-5D, respectively measuring health care utilization, production losses and general health related quality of life at baseline three, six, nine and twelve months. A cost-utility analysis was performed for patients included by screening and a sensitivity analysis was done by also including patients identified by the GP.
  
  
  RESULTS
  The average annual total costs was €1131 (95% C.I., €-3158 to €750) lower for CC compared to CAU. The average quality of life years (QALYs) gained was 0.02 (95% C.I., -0.004 to 0.04) higher for CC, so CC was dominant from a societal perspective. Taking a health care perspective, CC was less cost-effective due to higher costs, €1173 (95% C.I., €-216 to €2726), of CC compared to CAU which led to an ICER of 53,717 Euro/QALY. The sensitivity analysis showed dominance of CC.
  
  
  CONCLUSIONS
  The cost-utility analysis from a societal perspective showed that CC was dominant to CAU. CC may be a promising treatment for depression in the primary care setting. Further research should explore the cost-effectiveness of long-term CC.
  
  
  BACKGROUND
  Netherlands Trial Register ISRCTN15266438.
authors.affiliation: Institute for Medical Technology Assessment, Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands. Electronic address: Goorden@bmg.eur.nl.
authors.forename: Maartje
authors.initials: M
authors.lastname: Goorden
authors.affiliation: GGZinGeest, partner VU University Medical Center, Amsterdam, The Netherlands; Department of Psychiatry and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Klaas M L
authors.initials: KM
authors.lastname: Huijbregts
authors.affiliation: Department of General Practice and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Harm W J
authors.initials: HW
authors.lastname: van Marwijk
authors.affiliation: GGZinGeest, partner VU University Medical Center, Amsterdam, The Netherlands; Department of Psychiatry and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Aartjan T F
authors.initials: AT
authors.lastname: Beekman
authors.affiliation: Department of Tranzo, University of Tilburg, Tilburg, The Netherlands; Topclinical Center for Body, Mind and Health Academic Psychiatry Department, GGZBreburg, Tilburg, The Netherlands.
authors.forename: Christina M
authors.initials: CM
authors.lastname: van der Feltz-Cornelis
authors.affiliation: Institute for Medical Technology Assessment, Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
authors.forename: Leona
authors.initials: L
authors.lastname: Hakkaart-van Roijen
mesh_terms: D003362:Cost-Benefit Analysis / Q000379:methods*; D003865:Major Depressive Disorder / Q000191:economics* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011320:Primary Health Care / Q000191:economics*; D011788:Quality of Life
keywords: Collaborative care; Cost utility; Depressive disorder; Primary health care; Randomized controlled trial