The costs of guideline-concordant care and of care according to patients' needs in anxiety and depression

NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
Journal of Evaluation in Clinical Practice (Impact Factor: 1.08). 08/2011; 17(4):537-46. DOI: 10.1111/j.1365-2753.2010.01490.x
Source: PubMed


To describe the direct and indirect costs for people with anxiety and depressive disorders where guidelines are adhered to and patients' perceived needs are fully met.
Data were derived from the Netherlands Study of Depression and Anxiety. At baseline, adult patients were interviewed and they completed questionnaires to measure DSM-IV diagnoses, socio-demographic characteristics and perceived need for care. Actual care data were also derived from electronic medical records. Criteria for guideline adherence were based on general practice guidelines, issued by the Dutch College of General Practitioners. Direct and indirect costs were inferred from the Perceived Need for Care Questionnaire administered at baseline, and the Trimbos and iMTA questionnaire on Costs associated with Psychiatric illness administered at 1-year follow-up.
For 568 patients with a current anxiety or depressive disorder a complete dataset on health care use and absenteeism was available. Guideline adherence was significantly associated with increased care use and corresponding costs, while fully met perceived need was unrelated to costs. Socio-demographic characteristics, severity of symptoms and guideline adherence all affected the societal costs of patients with fully met perceived needs compared with patients with perceived unmet needs.
It appears that guideline-concordant care for anxiety and depression costs more than non-concordant care, while care that has fulfilled all of a patient's needs seems not to be more expensive than care that has not met all perceived needs. However, randomized controlled trials should first confirm this conclusion.

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    • "Physiotherapist costs were high for both groups showing that besides mental health care, somatic care is frequently used [47]. Medical costs of collaborative stepped care were comparable to those of guideline concordant care for patients with anxiety or depressive disorder [48]. Including the productivity costs did change our results as the costs for absence at work were higher in the care as usual group. "
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    ABSTRACT: Objective : Generalized anxiety and panic disorder are a burden on society because they are costly and have a significant adverse effect on quality of life. The aim of this study was to evaluate the cost-utility of a collaborative stepped care intervention for panic disorder and generalized anxiety disorder in primary care compared to care as usual from a societal perspective. Methods : The design of the study was a two armed cluster randomized controlled trial. In total 43 primary care practices in the Netherlands participated in the study. Eventually, 180 patients were included (114 collaborative stepped care, 66 care as usual). Baseline measures and follow up measures (3, 6, 9 and 12 months) were assessed using questionnaires. We applied the TiC-P, the SF-HQL and the EQ-5D respectively measuring health care utilization, production losses and health related quality of life. Results : The average annual direct medical costs in the collaborative stepped care group were 1,854 Euro (95% CI, 1,726 to 1,986) compared to € 1,503 (95% CI, 1,374 to 1,664) in the care as usual group. The average quality of life years (QALY's) gained was 0.05 higher in the collaborative stepped care group, leading to an incremental cost effectiveness ratio (ICER) of 6,965 Euro per QALY. Inclusion of the productivity costs, consequently reflecting the full societal costs, decreased the ratio even more. Conclusion : The study showed that collaborative stepped care was a cost effective intervention for panic disorder and generalized anxiety disorder and was even dominant when a societal perspective was taken. Trial registration :, Netherlands Trial Register NTR107
    Full-text · Article · Jul 2014 · Journal of Psychosomatic Research
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