Cost-effectiveness of a stepped care intervention to prevent depression and anxiety in late life: Randomised trial

Department of General Practice, Institute for Research in Extramural Medicine, VU Medical Centre, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
The British journal of psychiatry: the journal of mental science (Impact Factor: 7.99). 04/2010; 196(4):319-25. DOI: 10.1192/bjp.bp.109.069617
Source: PubMed


There is an urgent need for the development of cost-effective preventive strategies to reduce the onset of mental disorders.
To establish the cost-effectiveness of a stepped care preventive intervention for depression and anxiety disorders in older people at high risk of these conditions, compared with routine primary care.
An economic evaluation was conducted alongside a pragmatic randomised controlled trial (ISRCTN26474556). Consenting individuals presenting with subthreshold levels of depressive or anxiety symptoms were randomly assigned to a preventive stepped care programme (n = 86) or to routine primary care (n = 84).
The intervention was successful in halving the incidence rate of depression and anxiety at euro563 ( pound412) per recipient and euro4367 ( pound3196) per disorder-free year gained, compared with routine primary care. The latter would represent good value for money if the willingness to pay for a disorder-free year is at least euro5000.
The prevention programme generated depression- and anxiety-free survival years in the older population at affordable cost.

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Available from: Harm Van Marwijk, Jan 20, 2014
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    • "Clinical trials examining people with various types of subthreshold anxiety confirm this benefit. They found preliminary evidence for the benefits of herbal medicine (lavender) compared to placebo on self-report measures for anxiety [69] and for a self-help intervention program compared to usual care, which reduced the incidence of new full-syndrome anxiety diagnoses by 50% and therefore saved health-care costs each disorder-free year [70,71]. "
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    • "Notable exceptions exist: randomised-controlled trials have shown that improvements in depressive symptoms [58-60] and in social activity [61] are achievable in primary practice settings. A stepped care approach in primary care was also shown to be effective to prevent late life depression [62]. Bogner et al. [58] and Katon et al. [59] showed that in patients with depression and a chronic physical condition, outcomes of both can be improved by integrated and collaborative care, where physicians receive guideline-based recommendations for treatment. "
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    ABSTRACT: It is not well established how psychosocial factors like social support and depression affect health-related quality of life in multimorbid and elderly patients. We investigated whether depressive mood mediates the influence of social support on health-related quality of life. Cross-sectional data of 3,189 multimorbid patients from the baseline assessment of the German MultiCare cohort study were used. Mediation was tested using the approach described by Baron and Kenny based on multiple linear regression, and controlling for socioeconomic variables and burden of multimorbidity. Mediation analyses confirmed that depressive mood mediates the influence of social support on health-related quality of life (Sobel's p < 0.001). Multiple linear regression showed that the influence of depressive mood (beta = -0.341, p < 0.01) on health-related quality of life is greater than the influence of multimorbidity (beta = -0.234, p < 0.01). Social support influences health-related quality of life, but this association is strongly mediated by depressive mood. Depression should be taken into consideration in research on multimorbidity, and clinicians should be aware of its importance when caring for multimorbid patients.Trial register: ISRCTN89818205.
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