The cost-utility of stepped-care algorithms according to depression guideline recommendations – Results of a state-transition model analysis

Jolanda A. C. Meeuwissen, Talitha L. Feenstra, Filip Smit, Matthijs Blankers, Jan Spijker, Claudi L. H. Bockting, Anton J. L. M. van Balkom, Erik Buskens

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: Evidence-based clinical guidelines for major depressive disorder (MDD) recommend stepped-care strategies for sequencing evidence-based treatments conditional on treatment outcomes. This study aims to evaluate the cost-effectiveness of stepped care as recommended by the multidisciplinary clinical guideline vis-à-vis usual care in the Netherlands. Methods: Guideline-congruent care as described in stepped-care algorithms for either mild MDD or moderate and severe MDD was compared with usual care in a health-economic state-transition simulation model. Incremental costs per QALY gained were estimated over five years from a healthcare perspective. Results: For mild MDD, the cost-utility analysis showed a 67% likelihood of better health outcomes against lower costs, and 33% likelihood of better outcomes against higher costs, implying dominance of guideline-congruent stepped care. For moderate and severe MDD, the cost-utility analysis indicated a 67% likelihood of health gains at higher costs following the stepped-care approach and 33% likelihood of health gains at lower costs, with a mean ICER of about €3,200 per QALY gained. At a willingness to pay threshold of €20,000 per QALY, the stepped-care algorithms for both mild MDD and moderate or severe MDD is deemed cost-effective compared to usual care with a greater than 95% probability. Limitations: The findings of our decision-analytic modelling are limited by the accuracy and availability of the underlying evidence. This hampers taking into account all individual differences relevant to optimise treatment to individual needs. Conclusions: It is highly likely that guideline-congruent stepped care for MDD is cost-effective compared to usual care. Our findings support current guideline recommendations.
LanguageEnglish
Pages244-254
JournalJournal of Affective Disorders
Volume242
DOIs
StatePublished - 2019

Cite this

Meeuwissen, Jolanda A. C. ; Feenstra, Talitha L. ; Smit, Filip ; Blankers, Matthijs ; Spijker, Jan ; Bockting, Claudi L. H. ; van Balkom, Anton J. L. M. ; Buskens, Erik. / The cost-utility of stepped-care algorithms according to depression guideline recommendations – Results of a state-transition model analysis. In: Journal of Affective Disorders. 2019 ; Vol. 242. pp. 244-254
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title = "The cost-utility of stepped-care algorithms according to depression guideline recommendations – Results of a state-transition model analysis",
abstract = "Background: Evidence-based clinical guidelines for major depressive disorder (MDD) recommend stepped-care strategies for sequencing evidence-based treatments conditional on treatment outcomes. This study aims to evaluate the cost-effectiveness of stepped care as recommended by the multidisciplinary clinical guideline vis-{\`a}-vis usual care in the Netherlands. Methods: Guideline-congruent care as described in stepped-care algorithms for either mild MDD or moderate and severe MDD was compared with usual care in a health-economic state-transition simulation model. Incremental costs per QALY gained were estimated over five years from a healthcare perspective. Results: For mild MDD, the cost-utility analysis showed a 67{\%} likelihood of better health outcomes against lower costs, and 33{\%} likelihood of better outcomes against higher costs, implying dominance of guideline-congruent stepped care. For moderate and severe MDD, the cost-utility analysis indicated a 67{\%} likelihood of health gains at higher costs following the stepped-care approach and 33{\%} likelihood of health gains at lower costs, with a mean ICER of about €3,200 per QALY gained. At a willingness to pay threshold of €20,000 per QALY, the stepped-care algorithms for both mild MDD and moderate or severe MDD is deemed cost-effective compared to usual care with a greater than 95{\%} probability. Limitations: The findings of our decision-analytic modelling are limited by the accuracy and availability of the underlying evidence. This hampers taking into account all individual differences relevant to optimise treatment to individual needs. Conclusions: It is highly likely that guideline-congruent stepped care for MDD is cost-effective compared to usual care. Our findings support current guideline recommendations.",
author = "Meeuwissen, {Jolanda A. C.} and Feenstra, {Talitha L.} and Filip Smit and Matthijs Blankers and Jan Spijker and Bockting, {Claudi L. H.} and {van Balkom}, {Anton J. L. M.} and Erik Buskens",
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The cost-utility of stepped-care algorithms according to depression guideline recommendations – Results of a state-transition model analysis. / Meeuwissen, Jolanda A. C.; Feenstra, Talitha L.; Smit, Filip; Blankers, Matthijs; Spijker, Jan; Bockting, Claudi L. H.; van Balkom, Anton J. L. M.; Buskens, Erik.

In: Journal of Affective Disorders, Vol. 242, 2019, p. 244-254.

Research output: Contribution to journalArticleAcademicpeer-review

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AU - Meeuwissen,Jolanda A. C.

AU - Feenstra,Talitha L.

AU - Smit,Filip

AU - Blankers,Matthijs

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AU - Bockting,Claudi L. H.

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N2 - Background: Evidence-based clinical guidelines for major depressive disorder (MDD) recommend stepped-care strategies for sequencing evidence-based treatments conditional on treatment outcomes. This study aims to evaluate the cost-effectiveness of stepped care as recommended by the multidisciplinary clinical guideline vis-à-vis usual care in the Netherlands. Methods: Guideline-congruent care as described in stepped-care algorithms for either mild MDD or moderate and severe MDD was compared with usual care in a health-economic state-transition simulation model. Incremental costs per QALY gained were estimated over five years from a healthcare perspective. Results: For mild MDD, the cost-utility analysis showed a 67% likelihood of better health outcomes against lower costs, and 33% likelihood of better outcomes against higher costs, implying dominance of guideline-congruent stepped care. For moderate and severe MDD, the cost-utility analysis indicated a 67% likelihood of health gains at higher costs following the stepped-care approach and 33% likelihood of health gains at lower costs, with a mean ICER of about €3,200 per QALY gained. At a willingness to pay threshold of €20,000 per QALY, the stepped-care algorithms for both mild MDD and moderate or severe MDD is deemed cost-effective compared to usual care with a greater than 95% probability. Limitations: The findings of our decision-analytic modelling are limited by the accuracy and availability of the underlying evidence. This hampers taking into account all individual differences relevant to optimise treatment to individual needs. Conclusions: It is highly likely that guideline-congruent stepped care for MDD is cost-effective compared to usual care. Our findings support current guideline recommendations.

AB - Background: Evidence-based clinical guidelines for major depressive disorder (MDD) recommend stepped-care strategies for sequencing evidence-based treatments conditional on treatment outcomes. This study aims to evaluate the cost-effectiveness of stepped care as recommended by the multidisciplinary clinical guideline vis-à-vis usual care in the Netherlands. Methods: Guideline-congruent care as described in stepped-care algorithms for either mild MDD or moderate and severe MDD was compared with usual care in a health-economic state-transition simulation model. Incremental costs per QALY gained were estimated over five years from a healthcare perspective. Results: For mild MDD, the cost-utility analysis showed a 67% likelihood of better health outcomes against lower costs, and 33% likelihood of better outcomes against higher costs, implying dominance of guideline-congruent stepped care. For moderate and severe MDD, the cost-utility analysis indicated a 67% likelihood of health gains at higher costs following the stepped-care approach and 33% likelihood of health gains at lower costs, with a mean ICER of about €3,200 per QALY gained. At a willingness to pay threshold of €20,000 per QALY, the stepped-care algorithms for both mild MDD and moderate or severe MDD is deemed cost-effective compared to usual care with a greater than 95% probability. Limitations: The findings of our decision-analytic modelling are limited by the accuracy and availability of the underlying evidence. This hampers taking into account all individual differences relevant to optimise treatment to individual needs. Conclusions: It is highly likely that guideline-congruent stepped care for MDD is cost-effective compared to usual care. Our findings support current guideline recommendations.

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