Cost-effectiveness of problem-solving treatment in comparison with usual care for primary care patients with mental health problems: a randomized trial

• Main Authors: Bosmans Judith E, Schreuders Bettine, van Marwijk Harm WJ, Smit Jan H, van Oppen Patricia, van Tulder Maurits W
• Format: Article
• Language: English
• Published: BMC 2012-10-01
• Series: BMC Family Practice
• Subjects: Costs and cost analysis; Problem-solving treatment; Nurses; Depression; Anxiety; Primary health care
• Online Access: http://www.biomedcentral.com/1471-2296/13/98

<p>Abstract</p> <p>Background</p> <p>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.</p> <p>Methods</p> <p>An economic evaluation from a societal perspective was performed alongside a randomized clinical trial. Patients with a positive General Health Questionnaire score (score ≥ 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.</p> <p>Results</p> <p>There were no statistically significant differences in clinical outcomes at 9 months. Mean total costs were €4795 in the PST group and €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.</p> <p>Conclusions</p> <p>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.</p> <p>Trial registration</p> <p>Nederlands Trial Register ISRCTN51021015</p>