Depression screening with patient-targeted feedback in cardiology: The cost-effectiveness of DEPSCREEN-INFO

• Published in: PloS one 2017-08, Vol.12 (8), p.e0181021-e0181021
• Main Authors: Brettschneider, Christian, Kohlmann, Sebastian, Gierk, Benjamin, Löwe, Bernd, König, Hans-Helmut
• Format: Article
• Language: English
• Subjects: Acute coronary syndromes; Adult; Aged; Analysis; Angina pectoris; Cardiology; Cardiovascular disease; Cardiovascular diseases; Clinical trials; Collaboration; Construction costs; Construction standards; Coronary artery disease; Coronary heart disease; Cost analysis; Cost-Benefit Analysis; Data collection; Depression (Mood disorder); Depression - diagnosis; Depression - economics; Drug therapy; Economic aspects; Feedback; Female; Follow-Up Studies; Group dynamics; Health aspects; Health economics; Health services; Heart; Heart diseases; Humans; Hypertension; Intervention; Male; Mass Screening - methods; Mathematical models; Medical screening; Medicine and Health Sciences; Mental depression; Middle Aged; Patient Acceptance of Health Care; Patients; People and Places; Psychosomatic medicine; Psychotherapy; Quality of Life; Quality-Adjusted Life Years; Regression analysis; Resource utilization; Sensitivity analysis; Social Sciences; Statistical analysis; Studies
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0181021

Although depression is common in patients with heart disease, screening for depression is much debated. DEPSCREEN-INFO showed that a patient-targeted feedback in addition to screening results in lower depression level six months after screening. The purpose of this analysis was to perform a cost-effectiveness analysis of DEPSCREEN-INFO. Patients with coronary heart disease or arterial hypertension were included. Participants in both groups were screened for depression. Participants in the intervention group additionally received a patient-targeted feedback of their result and recommended treatment options. A cost-utility analysis using quality-adjusted life years (QALY) based on the EQ-5D was performed. The time horizon was 6 months. Resource utilization was assessed by a telephone interview. Multiple imputation using chained equations was used. Net-benefit regressions controlled for prognostic variables at baseline were performed to construct cost-effectiveness acceptability curves. Different sensitivity analyses were performed. 375 participants (intervention group: 155; control group: 220) were included at baseline. After 6 months, in the intervention group adjusted total costs were lower (-€2,098; SE: €1,717) and more QALY were gained (0.0067; SD: 0.0133); yet differences were not statistically significant. The probability of cost-effectiveness was around 80% independent of the willingness-to-pay (range: €0/QALY-€130,000/QALY). The results were robust. A patient-targeted feedback in addition to depression screening in cardiology is cost-effective with a high probability. This underpins the use of the patient-targeted feedbacks and the PHQ-9 that are both freely available and easy to implement in routine care.