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

Meeuwissen, J. A. C., Feenstra, T. L., Smit, F., Blankers, M., Spijker, J., Bockting, C. L. H., van Balkom, A. J. L. M. & Buskens, E., 1-Jan-2019, In : Journal of Affective Disorders. 242, p. 244-254 11 p.

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

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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-avis 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 (sic)3,200 per QALY gained. At a willingness to pay threshold of (sic)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.

Original languageEnglish
Pages (from-to)244-254
Number of pages11
JournalJournal of Affective Disorders
Volume242
Publication statusPublished - 1-Jan-2019

    Keywords

  • Depressive disorder, Stepped care, Clinical guideline, Treatment algorithm, Clinical decision-making, State-transition model, COGNITIVE-BEHAVIORAL THERAPY, MENTAL-HEALTH-CARE, RANDOMIZED CONTROLLED-TRIAL, MAJOR DEPRESSION, ANXIETY DISORDERS, PSYCHOLOGICAL THERAPIES, GENERAL-PRACTICE, METAANALYSIS, NETHERLANDS, INTERVENTIONS

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