title: Cost-effectiveness of integrated collaborative care for comorbid major depression in patients with cancer.
abstract: OBJECTIVE
  Comorbid major depression is associated with reduced quality of life and greater use of healthcare resources. A recent randomised trial (SMaRT, Symptom Management Research Trials, Oncology-2) found that a collaborative care treatment programme (Depression Care for People with Cancer, DCPC) was highly effective in treating depression in patients with cancer. This study aims to estimate the cost-effectiveness of DCPC compared with usual care from a health service perspective.
  
  
  METHODS
  Costs were estimated using UK national unit cost estimates and health outcomes measured using quality-adjusted life-years (QALYs). Incremental cost-effectiveness of DCPC compared with usual care was calculated and scenario analyses performed to test alternative assumptions on costs and missing data. Uncertainty was characterised using cost-effectiveness acceptability curves. The probability of DCPC being cost-effective was determined using the UK National Institute for Health and Care Excellence's (NICE) cost-effectiveness threshold range of £ 20,000 to £ 30,000 per QALY gained.
  
  
  RESULTS
  DCPC cost on average £ 631 more than usual care per patient, and resulted in a mean gain of 0.066 QALYs, yielding an incremental cost-effectiveness ratio of £ 9549 per QALY. The probability of DCPC being cost-effective was 0.9 or greater at cost-effectiveness thresholds above £ 20,000 per QALY for the base case and scenario analyses.
  
  
  CONCLUSIONS
  Compared with usual care, DCPC is likely to be cost-effective at the current thresholds used by NICE. This study adds to the weight of evidence that collaborative care treatment models are cost-effective for depression, and provides new evidence regarding their use in specialist medical settings.
authors.affiliation: Centre for Health Economics, University of York, Heslington, York, UK. Electronic address: ana.duarte@york.ac.uk.
authors.forename: A
authors.initials: A
authors.lastname: Duarte
authors.affiliation: Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK. Electronic address: jane.walker@psych.ox.ac.uk.
authors.forename: J
authors.initials: J
authors.lastname: Walker
authors.affiliation: Centre for Health Economics, University of York, Heslington, York, UK. Electronic address: simon.walker@york.ac.uk.
authors.forename: S
authors.initials: S
authors.lastname: Walker
authors.affiliation: Centre for Health Economics, University of York, Heslington, York, UK. Electronic address: gerry.richardson@york.ac.uk.
authors.forename: G
authors.initials: G
authors.lastname: Richardson
authors.affiliation: MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK. Electronic address: christian.hansen@lshtm.ac.uk.
authors.forename: C
authors.initials: C
authors.lastname: Holm Hansen
authors.affiliation: Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK. Electronic address: Paul.Martin@glasgow.ac.uk.
authors.forename: P
authors.initials: P
authors.lastname: Martin
authors.affiliation: University of Edinburgh, Centre for Population Health Sciences, Edinburgh, UK. Electronic address: Gordon.Murray@ed.ac.uk.
authors.forename: G
authors.initials: G
authors.lastname: Murray
authors.affiliation: Centre for Health Economics, University of York, Heslington, York, UK. Electronic address: mark.sculpher@york.ac.uk.
authors.forename: M
authors.initials: M
authors.lastname: Sculpher
authors.affiliation: Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK. Electronic address: michael.sharpe@psych.ox.ac.uk.
authors.forename: M
authors.initials: M
authors.lastname: Sharpe
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D019033:Delivery of Health Care, Integrated / Q000191:economics*; D003863:Depression / Q000191:economics* / Q000628:therapy*; D003865:Major Depressive Disorder / Q000191:economics* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D010348:Patient Care Team; D011788:Quality of Life; D019057:Quality-Adjusted Life Years
keywords: Collaborative care; Comorbidity; Cost-effectiveness; Depression