Cost-effectiveness of a stepped care intervention to prevent depression and anxiety in late life: randomised trial

P.J. van 't Veer-Tazelaar, H.F.E. Smit, H.P.J. van Hout, P.C. van Oppen, H.E. van der Horst, A.T.F. Beekman, H.W.J. van Marwijk

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There is an urgent need for the development of cost-effective preventive strategies to reduce the onset of mental disorders.


To establish the cost-effectiveness of a stepped care preventive intervention for depression and anxiety disorders in older people at high risk of these conditions, compared with routine primary care.


An economic evaluation was conducted alongside a pragmatic randomised controlled trial (ISRCTN26474556). Consenting individuals presenting with subthreshold levels of depressive or anxiety symptoms were randomly assigned to a preventive stepped care programme (n = 86) or to routine primary care (n = 84).


The intervention was successful in halving the incidence rate of depression and anxiety at 563 (£412) per recipient and 4367 (£3196) per disorder-free year gained, compared with routine primary care. The latter would represent good value for money if the willingness to pay for a disorder-free year is at least 5000.


The prevention programme generated depression- and anxiety-free survival years in the older population at affordable cost.
Original languageUndefined/Unknown
Pages (from-to)319-325
JournalBritish Journal of Psychiatry
Issue number4
Publication statusPublished - 2010

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