Abstract
| Language | English |
|---|---|
| Pages | 244-254 |
| Journal | Journal of Affective Disorders |
| Volume | 242 |
| DOIs | |
| Publication status | Published - 2019 |
Cite this
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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 journal › Article › Academic › peer-review
TY - JOUR
T1 - The cost-utility of stepped-care algorithms according to depression guideline recommendations – Results of a state-transition model analysis
AU - Meeuwissen, Jolanda A. C.
AU - Feenstra, Talitha L.
AU - Smit, Filip
AU - Blankers, Matthijs
AU - Spijker, Jan
AU - Bockting, Claudi L. H.
AU - van Balkom, Anton J. L. M.
AU - Buskens, Erik
PY - 2019
Y1 - 2019
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.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85053077822&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/30216769
U2 - 10.1016/j.jad.2018.08.024
DO - 10.1016/j.jad.2018.08.024
M3 - Article
VL - 242
SP - 244
EP - 254
JO - Journal of Affective Disorders
T2 - Journal of Affective Disorders
JF - Journal of Affective Disorders
SN - 0165-0327
ER -