Cost-effectiveness of integrated collaborative care for comorbid major depression in patients with cancer

https://doi.org/10.1016/j.jpsychores.2015.10.012Get rights and content
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Highlights

  • DCPC intervention is clinically effective for the management of depression in cancer patients.

  • DCPC vs. usual care in cancer patients is likely cost-effective.

  • Findings may impact on decisions on budget allocation in specialist care settings.

Abstract

Objectives

Comorbid major depression is associated with reduced quality of life and greater use of healthcare resources. A recent randomised trial (SMaRT, Symptom Management Research Trials, Oncology-2) found that a collaborative care treatment programme (Depression Care for People with Cancer, DCPC) was highly effective in treating depression in patients with cancer. This study aims to estimate the cost-effectiveness of DCPC compared with usual care from a health service perspective.

Methods

Costs were estimated using UK national unit cost estimates and health outcomes measured using quality-adjusted life-years (QALYs). Incremental cost-effectiveness of DCPC compared with usual care was calculated and scenario analyses performed to test alternative assumptions on costs and missing data. Uncertainty was characterised using cost-effectiveness acceptability curves. The probability of DCPC being cost-effective was determined using the UK National Institute for Health and Care Excellence's (NICE) cost-effectiveness threshold range of £20,000 to £30,000 per QALY gained.

Results

DCPC cost on average £631 more than usual care per patient, and resulted in a mean gain of 0.066 QALYs, yielding an incremental cost-effectiveness ratio of £9549 per QALY. The probability of DCPC being cost-effective was 0.9 or greater at cost-effectiveness thresholds above £20,000 per QALY for the base case and scenario analyses.

Conclusions

Compared with usual care, DCPC is likely to be cost-effective at the current thresholds used by NICE. This study adds to the weight of evidence that collaborative care treatment models are cost-effective for depression, and provides new evidence regarding their use in specialist medical settings.

Keywords

Collaborative care
Cost-effectiveness
Comorbidity
Depression

Cited by (0)

Funding: Cancer Research UK (Grant no. C5547/A7375).

Registration: The trial is registered with Current Controlled Trials, number ISRCTN40568538.