Cost-effectiveness of collaborative care for depression in UK primary care: economic evaluation of a randomised controlled trial (CADET)

• Published in: PloS one 2014-08, Vol.9 (8), p.e104225-e104225
• Main Authors: Green, Colin, Richards, David A, Hill, Jacqueline J, Gask, Linda, Lovell, Karina, Chew-Graham, Carolyn, Bower, Peter, Cape, John, Pilling, Stephen, Araya, Ricardo, Kessler, David, Bland, J Martin, Gilbody, Simon, Lewis, Glyn, Manning, Chris, Hughes-Morley, Adwoa, Barkham, Michael
• Format: Article
• Language: English
• Subjects: Adult; Adults; Collaboration; Consent; Cooperative Behavior; Cost analysis; Cost-Benefit Analysis - methods; Decision making; Depression - economics; Evaluation; Female; Health care; Health care policy; Health psychology; Health sciences; Humans; Intervention; Male; Medicin och hälsovetenskap; Medicine and Health Sciences; Mental depression; Mental health; Patients; Primary care; Primary Health Care - economics; Psychiatry; Quality of Life; Quality-Adjusted Life Years; Randomization; Sensitivity; Sensitivity analysis; Social Sciences; Social services; Substance abuse treatment; Treatment Outcome; United Kingdom
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0104225

Collaborative care is an effective treatment for the management of depression but evidence on its cost-effectiveness in the UK is lacking. To assess the cost-effectiveness of collaborative care in a UK primary care setting. An economic evaluation alongside a multi-centre cluster randomised controlled trial comparing collaborative care with usual primary care for adults with depression (n = 581). Costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICER) were calculated over a 12-month follow-up, from the perspective of the UK National Health Service and Personal Social Services (i.e. Third Party Payer). Sensitivity analyses are reported, and uncertainty is presented using the cost-effectiveness acceptability curve (CEAC) and the cost-effectiveness plane. The collaborative care intervention had a mean cost of £272.50 per participant. Health and social care service use, excluding collaborative care, indicated a similar profile of resource use between collaborative care and usual care participants. Collaborative care offered a mean incremental gain of 0.02 (95% CI: -0.02, 0.06) quality-adjusted life-years over 12 months, at a mean incremental cost of £270.72 (95% CI: -202.98, 886.04), and resulted in an estimated mean cost per QALY of £14,248. Where costs associated with informal care are considered in sensitivity analyses collaborative care is expected to be less costly and more effective, thereby dominating treatment as usual. Collaborative care offers health gains at a relatively low cost, and is cost-effective compared with usual care against a decision-maker willingness to pay threshold of £20,000 per QALY gained. Results here support the commissioning of collaborative care in a UK primary care setting.