학술논문
Cost-effectiveness of problem-solving treatment in comparison with usual care for primary care patients with mental health problems: a randomized trial
Document Type
Report
Author
Source
BMC Family Practice. October 10, 2012, Vol. 13 Issue 1
Subject
Language
English
ISSN
1471-2296
Abstract
Author(s): Judith E Bosmans[sup.1] , Bettine Schreuders[sup.2] , Harm WJ van Marwijk[sup.2] , Jan H Smit[sup.3] , Patricia van Oppen[sup.2,3] and Maurits W van Tulder[sup.1,4] Background Mental health problems are [...]
Background Mental health problems are common and are associated with increased disability and health care costs. Problem-Solving Treatment (PST) delivered to these patients by nurses in primary care might be efficient. The aim of this study was to evaluate the cost-effectiveness of PST by mental health nurses compared with usual care (UC) by the general practitioner for primary care patients with mental health problems. Methods An economic evaluation from a societal perspective was performed alongside a randomized clinical trial. Patients with a positive General Health Questionnaire score (score [greater than or equai to] 4) and who visited their general practitioner at least three times during the past 6 months were eligible. Outcome measures were improvement on the Hospital Anxiety and Depression Scale and QALYs based on the EQ-5D. Resource use was measured using a validated questionnaire. Missing cost and effect data were imputed using multiple imputation techniques. Bootstrapping was used to analyze costs and cost-effectiveness of PST compared with UC. Results There were no statistically significant differences in clinical outcomes at 9 months. Mean total costs were [euro]4795 in the PST group and [euro]6857 in the UC group. Costs were not statistically significantly different between the two groups (95% CI -4698;359). The cost-effectiveness analysis showed that PST was cost-effective in comparison with UC. Sensitivity analyses confirmed these findings. Conclusions PST delivered by nurses seems cost-effective in comparison with UC. However, these results should be interpreted with caution, since the difference in total costs was mainly caused by 3 outliers with extremely high indirect costs in the UC group. Trial registration Nederlands Trial Register ISRCTN51021015 Keywords: Costs and cost analysis, Problem-solving treatment, Nurses, Depression, Anxiety, Primary health care
Background Mental health problems are common and are associated with increased disability and health care costs. Problem-Solving Treatment (PST) delivered to these patients by nurses in primary care might be efficient. The aim of this study was to evaluate the cost-effectiveness of PST by mental health nurses compared with usual care (UC) by the general practitioner for primary care patients with mental health problems. Methods An economic evaluation from a societal perspective was performed alongside a randomized clinical trial. Patients with a positive General Health Questionnaire score (score [greater than or equai to] 4) and who visited their general practitioner at least three times during the past 6 months were eligible. Outcome measures were improvement on the Hospital Anxiety and Depression Scale and QALYs based on the EQ-5D. Resource use was measured using a validated questionnaire. Missing cost and effect data were imputed using multiple imputation techniques. Bootstrapping was used to analyze costs and cost-effectiveness of PST compared with UC. Results There were no statistically significant differences in clinical outcomes at 9 months. Mean total costs were [euro]4795 in the PST group and [euro]6857 in the UC group. Costs were not statistically significantly different between the two groups (95% CI -4698;359). The cost-effectiveness analysis showed that PST was cost-effective in comparison with UC. Sensitivity analyses confirmed these findings. Conclusions PST delivered by nurses seems cost-effective in comparison with UC. However, these results should be interpreted with caution, since the difference in total costs was mainly caused by 3 outliers with extremely high indirect costs in the UC group. Trial registration Nederlands Trial Register ISRCTN51021015 Keywords: Costs and cost analysis, Problem-solving treatment, Nurses, Depression, Anxiety, Primary health care